# SOST



## Muppet (May 26, 2018)

Air Force elite surgical team's "outside-the-wire medicine"

Found this for those interested....


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## ITherneau (Sep 9, 2018)

Awesome


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## Gunz (Sep 9, 2018)

Love it, bro. 90% survival rate for WIAs. That's crazy good.


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## FIGSTER (Mar 4, 2019)

New article on SOST. Enjoy

special operations


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## Devildoc (Mar 4, 2019)

It is interesting that the article mentions the golden hour, when most current trauma doctrine has gotten away from that because there's no literature to support, and the concept is based old doctrine.

That said, great article.


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## Kaldak (Mar 4, 2019)

Devildoc said:


> It is interesting that the article mentions the golden hour, when most current trauma doctrine has gotten away from that because there's no literature to support, and the concept is based old doctrine.
> 
> That said, great article.



When did it change? And by no literature, do you mean no published studies or studies that haven't proven it true?


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## Devildoc (Mar 4, 2019)

Kaldak said:


> When did it change? And by no literature, do you mean no published studies or studies that haven't proven it true?



I'll see if I can find the sources. Golden hour is based on Cowley's research from the 60s and did baked-in averages based on outcomes from time of injury to survival rates with definitive care.

As care got pushed forward and resus techniques improved, outcomes improved.  So today you have a much higher likelihood of surviving 4 limb amputations, even if you do not get to surgery inside of an hour, when in the 1960s the same injury you would die inside 30 minutes.


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## policemedic (Mar 4, 2019)

Crowley scribbled the term Golden Hour on a cocktail napkin. My understanding is he created the concept based on his intuitive understanding that trauma patients would have better outcomes if they were seen by a surgeon sooner rather than later. But there was no real science to it. He was right, by the way. Sooner is better, but the hour was picked out of thin air and martini fumes. 

As my brother from another mother mentioned, this was the ‘60s. Paramedicine and trauma care were not what they are today. A civilian paramedic of that era would not believe what we can do if they were sent through a wormhole to today. Military field trauma care is typically much more aggressive than the civilian side, and today’s SOF medics would make that guy from the ‘60s think he was in a Twilight Zone episode. 

So, short version—the sooner you get care the better your outcome will be. Many life threatening injuries can be adequately managed in the field by a well-trained medic until evacuation is available/possible.  That doesn’t obviate the need for physicians and surgeons but I do believe it can extend the time frame within which good outcomes can be achieved.


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## FIGSTER (Mar 4, 2019)

Devildoc said:


> I'll see if I can find the sources. Golden hour is based on Cowley's research from the 60s and did baked-in averages based on outcomes from time of injury to survival rates with definitive care.
> 
> As care got pushed forward and resus techniques improved, outcomes improved.  So today you have a much higher likelihood of surviving 4 limb amputations, even if you do not get to surgery inside of an hour, when in the 1960s the same injury you would die inside 30 minutes.



Elaborating on that, in Vietnam they were resuscitating guys with massive volumes of crystalloid until they were extremely coagulopathic. I'm giving as little as I can get away with these day in hemorrhagic shock


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## policemedic (Mar 4, 2019)

FIGSTER said:


> Elaborating on that, in Vietnam they were resuscitating guys with massive volumes of crystalloid until they were extremely coagulopathic. I'm giving as little as I can get away with these day in hemorrhagic shock



With any luck, you’ll move to blood products like Houston ESD and some other places. That’s where we need to be.


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## FIGSTER (Mar 4, 2019)

policemedic said:


> With any luck, you’ll move to blood products like Houston ESD and some other places. That’s where we need to be.


Yes. I should have been more specific. That's what we try to use exclusively. I'm in the OR. We've been using whole blood for a while with good success


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## ctree (Mar 4, 2019)

Great article. Thanks!


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## ctree (Mar 4, 2019)

Great article. Thanks


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## Dvr55119 (Mar 5, 2019)

policemedic said:


> Crowley scribbled the term Golden Hour on a cocktail napkin. My understanding is he created the concept based on his intuitive understanding that trauma patients would have better outcomes if they were seen by a surgeon sooner rather than later. But there was no real science to it. He was right, by the way. Sooner is better, but the hour was picked out of thin air and martini fumes.
> 
> As my brother from another mother mentioned, this was the ‘60s. Paramedicine and trauma care were not what they are today. A civilian paramedic of that era would not believe what we can do if they were sent through a wormhole to today. Military field trauma care is typically much more aggressive than the civilian side, and today’s SOF medics would make that guy from the ‘60s think he was in a Twilight Zone episode.
> 
> So, short version—the sooner you get care the better your outcome will be. Many life threatening injuries can be adequately managed in the field by a well-trained medic until evacuation is available/possible.  That doesn’t obviate the need for physicians and surgeons but I do believe it can extend the time frame within which good outcomes can be achieved.



This doesn’t just relate to trauma. Getting someone to the appropriate level of care, and on the appropriate life saving measures ASAP is the standard. In Europe the are experimenting and having success with enroute ECLS. ECLS can and I think will be implemented in the prehospital environment moving forward. I wasnt involved too much with the hospital environment downrange, but I know the capability exists, and wonder if they are implementing ECLS protocols in our SOF medical circles today(obviously not in a TCCC environment). I work heavily with ECMO currently and in my patient population it can be a blessing or a curse, but in the healthy traumatic environment I think it can and will be used moving forward.


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## Devildoc (Mar 5, 2019)

policemedic said:


> Crowley scribbled the term Golden Hour on a cocktail napkin. My understanding is he created the concept based on his intuitive understanding that trauma patients would have better outcomes if they were seen by a surgeon sooner rather than later. But there was no real science to it. He was right, by the way. Sooner is better, but the hour was picked out of thin air and martini fumes.
> 
> As my brother from another mother mentioned, this was the ‘60s. Paramedicine and trauma care were not what they are today. A civilian paramedic of that era would not believe what we can do if they were sent through a wormhole to today. Military field trauma care is typically much more aggressive than the civilian side, and today’s SOF medics would make that guy from the ‘60s think he was in a Twilight Zone episode.
> 
> So, short version—the sooner you get care the better your outcome will be. Many life threatening injuries can be adequately managed in the field by a well-trained medic until evacuation is available/possible.  That doesn’t obviate the need for physicians and surgeons but I do believe it can extend the time frame within which good outcomes can be achieved.



Have you read Cowley's book?  I had it, lent it, never saw it again.  Talked about how much his theories on traumatology were SWAGs and geschtalt.  He was definitely a pioneer, but like everything in medicine, ideas become dated as research and best practices evolve.


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## SOSTCRNA (Mar 5, 2019)

Our SRT team leads spent a lot of time convincing mission commanders that he should consider putting us on the mission (based on risk assessment etc) even though transport time was "with in the golden hour".    Sometimes we got on the aircraft, sometimes we waited at the FOB.


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