The EAST Gavel Case

The following speech was given at the 2007 Scientific Assembly of east
by Col. Donald Jenkins, MD

I was asked by President Rotondo to make a brief presentation of a significance which will become apparent shortly. Yesterday, I was surprised to discover that 5% of Active EAST members have been deployed to war in Iraq/Afghanistan in the past year alone. But, let me share with you a story of a 22 y.o. Lance Corporal in the USMC who was injured on the October 2006 during operations near Al Taqqadam, Iraq, about 30 miles west of Baghdad in Al Anbar Province, between Fallujah and Ramadi. During a firefight, he sustained both upper and lower extremity gunshot wounds. A Navy Corpsman applied a SOF-T tourniquet on his leg due to massive hemorrhage and he was taken to the US Navy Forward Resuscitative Surgical site in Al Taqqadam, aka, TQ Surgical. There, CDR Tracy Bilski, US Navy and EAST Member, performed life and limb salvage surgery, to include vascular shunt of his femoral artery. The patient was then evacuated to the Air Force Theater Hospital in Balad, Iraq where further resuscitation and salvage surgery were performed and definitive vascular repair was accomplished. Upon entry at Balad, Maj Michelle Park, USAF and a prospective EAST member, oversaw his surgical and critical care.

His presenting blood pressure was 100/62, BD 7, INR 1.6 and Hgb 7; all independent risk factors for massive transfusion and associated with a 40% mortality. Overall, he received 11 units PRBC, 8 units cryo, 1 6-pack of platelets, 5 units of plasma and 5 units of whole blood in addition to 4 doses of recombinant fVIIa.

After this stabilizing surgery, he remained critically ill and ventilator dependent, but was flown by Air Force Critical Care Air Transport Team (trained before their deployment by Col Jay Johannigman, USAF and EAST member and Maj Stephen Barnes, USAF and prospective EAST member) to Landstuhl Regional Medical Center in Germany, where Col Warren Dorlac, USAF and EAST member assumed his care. This Military Trauma Center is run by Col Stephen Flaherty, USA and EAST member; and the Trauma Program Manager is Ms. Kathie Martin, EAST Associate Member. After several days of critical care and serial wound washouts, during which visiting Senior Surgeon Dr Donald Trunkey, former USA surgeon and Honorary EAST member, participated in his care, thanks to a program spearheaded by Bill Schwab, formerly US Navy and past president of EAST, this Marine was extubated and transferred to Bethesda National Naval Medical Center, to the care of CDR Jim Dunne and CAPT Phil Perdue, US Navy and EAST members. He is now recovering as an outpatient at Camp Pendleton, California.

The care of this Lance Corporal is perhaps the quintessential case of modern combat casualty care and highlights the participation of EAST members in the military: casualty care in echelons; use of tourniquets by field medics; far forward damage control surgery, including the use of vascular shunts; definitive vascular repair in-theater; use of ‘damage control resuscitation’ (to include ultra-fresh whole blood, PRBC:plasma in 1:1 ratio, use of platelet pheresis platelets collected in combat zone and use of rVIIa), then; CCATT transport out of theater; and rapid transition to care in the continental United States across the continuum of care with multiple surgeries along the way. These protocols, procedures and guidelines have been drafted, published, implemented and refined over the last several years with significant input and oversight from EAST members to include, CAPT Peter Rhee, USN, COL John Holcomb, USA, COL David Burris, USA, COL Brian Eastridge, USA, COL Stephen Flaherty, USA and COL Donald Jenkins, USAF. At every stop, EAST members had a vital role in his care. The SOF-T tourniquet ‘built in’ to the Presidential Gavel box was used on this Marine. Thank you.