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CSTARS: EDUCATION VALIDATION 23 June 2011 CSTARS Col William Pond, IN SAS 2

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C-STARS CCATT Cincinnati is located at the Cincinnati University Hospital Trauma Center, Cincinnati Ohio. The Trauma Center is part of the University of Cincinnati Medical Center Department of Surgery and serves the tri-state region of Southwest Ohio. It is also a verified regional Burn Center and is the only Level One Adult Trauma Center in the area.

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• Course Description This 14 -day course is composed of 12 days clinical/didactic/simulator/flight exercise plus travel days and is designed specifically for personnel assigned to the CCATT UTC. 26 June 2011 CSTARS Col William Pond, IN SAS 7

• The emphasis is on critical care and there will be didactics on the airevacuation system culminating in a field exercise involving a flight on an AC-130 aircraft. Personnel will rotate in the intensive care units of the University Hospital a multidisciplinary 18 bed unit with over 3000 patient encounters each year. 26 June 2011 CSTARS Col William Pond, IN SAS 8

• They will function as the primary providers for critically ill and injured patient under the tutelage of both civilian and military faculty. The physicians will complete approximately 80 hours of clinical duties including nighttime call responsibilities in the Surgical Intensive Care Unit. The nurse and technicians will complete approximately 56 hours of clinical duties primarily in the Surgical Intensive Care Unit. In addition there will be approximately 20 hours of AFSC/UTC specific lessons. This course enables the rotator to complete the AFSC specific RSV's and the CCATT sustainment training items. The course is designed to meet 100% of the RSV's for the individuals assigned to the CCATT UTC. 26 June 2011 CSTARS Col William Pond, IN SAS 9

Continuing Education Physicians: The Office of the Surgeon General, United States Air Force (USAF), designates this educational activity for a maximum of 60. 0 hours in AMA PRA Category 1 Credit(s) ™. Physicians should claim credit commensurate with the extent of their participation in the activity. 26 June 2011 CSTARS Col William Pond, IN SAS 10

• Prerequisites Course participants must be assigned to a CCATT UTC and must have completed the CCATT basic course at Brooks AFB, TX (B 3 OZYCCATT-000 • ALL Personnel must bring a copy of their CURRENT 1042 & Central Validation Committee (CVC) approval letter with them. 26 June 2011 CSTARS Col William Pond, IN SAS 11

• Applications will be handled by the CSTARS Home Office, AFEMSI at Wright. Patterson Air Force Base (WPAFB), OH. Once you have been identified to attend C-STARS Cincinnati training an AFEMSI credentialing specialist will contact you via email to assist with completing and submitting required paperwork. Please pay particular attention to drop dead dates as the civilian Universities will NOT provide extensions. If they do not do so, contact them and be persistent until a position is granted. 26 June 2011 CSTARS Col William Pond, IN SAS 12

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• C-STARS is a centrally funded AFMS course for ANG members. For ANG Personnel, your UTM MUST contact HQ AFRC/SGS Formal Training Manager at Commercial 478 -327 -1903 or DSN 497 -1903; For GUARD Personnel, your UTM MUST contact USAF ANG NGB Formal Training Manager at Commercial 301 -836 -8325 or DSN 278 -8325; PRIOR TO scheduling with Air Force Expeditionary Medical Skills Institute (AFEMSI). Once selected for training, you will receive a training RIP. Typically, the training RIP flows from your Formal Training Office. 14

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CSTAR Pearls • Take CCATT reference materials on deployment. • Watch for pulmonary injuries that may blossom 24 -48 hours after injury. • Check tympanic membranes for additional evidence of blast injury. • Ask for most current labs prior to departure. • Personally view the radiographs. 26 June 2011 CSTARS Col William Pond, IN SAS 32

• The deadly triangle—Acidosis, Hypothermia, Coagulopathy • Signs of severity of trauma. • • • Systolic blood pressure less than 90 INR greater than 1. 5 Hemoglobin less than 11. 0 Temperature less than 96. 0 Base deficit in excess of -6. 0 26 June 2011 CSTARS Col William Pond, IN SAS 33

CSTAR Pearls • The deadly triangle—Acidosis, Hypothermia, Coagulopathy • Signs of severity of trauma. • • • Systolic blood pressure less than 90 INR greater than 1. 5 Hemoglobin less than 11. 0 Temperature less than 96. 0 Base deficit in excess of -6. 0 26 June 2011 CSTARS Col William Pond, IN SAS 34

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• Alaris IVAC is a “canary. ” Note the lights— if all green, pump is functioning and power supplied. Green flashing means pump is working, but no power supply. • Usually have IVAC with fluids Maintenance 100 -200, Propofol 15 -30, Fentanyl 1 -4. • Warm patient before boarding aircraft. • Maintain temperature with HPK pack. • Use the reflective foil on the outside of the patient to maintain heat. 26 June 2011 CSTARS Col William Pond, IN SAS 36

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• Try not to use a body bag to maintain heat due to the psychological negative effect of placing a patient in a body bag normally used for deceased patients. • The heating blanket requires time to activate, so open the blanket and allow to warm prior to application. • Do not switch equipment with the FOB. • Do not have a litter above the CCATT patient so that there will be extra access. • At the FOB, if there has been a blood drive, take the blood with the patient since it will probably not be utilized otherwise. 26 June 2011 CSTARS Col William Pond, IN SAS 39

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• Most patients receive feeding tubes; continue the tube feedings for nutritional purposes. • Acquire small S shaped carabiners for securing IV bags and other equipment. • Do not use Lactated Ringers during the treatment of lactic acidosis. • Ballpark formula—initial PC 02 X respiratory rate = final p. C 02 X respiratory rate. • Bring a sleeping bag and thermarest mattress. 26 June 2011 CSTARS Col William Pond, IN SAS 41

• Be cognizant of circadian rhythm disruptions and sleep if opportunity arises. • Take a bag of personal items for all deployments. • Assure that bags are labeled. • Secure bags in the plane to keep them from being placed in a pile and secured. 26 June 2011 CSTARS Col William Pond, IN SAS 42

• Look professional in the aircraft. • If sleeping on the aircraft and a family or friend is on aircraft, explain it and note who will be caring for the patient. • Prior to departure 26 June 2011 CSTARS Col William Pond, IN SAS 43