Andrew D. Fisher, first-year medical student, was part of four poster presentations at the Military Health System Research Symposium. All research projects were part of his extensive career with the United States Army as a physician assistant assigned to the 75th Ranger Regiment.
The first poster, “Blood Bag Constriction for Volumetric Control in Austere Environments,” is an observational study that was able to identify the best method for determining a full blood bag in an austere environment. This has influenced the commercial production of whole blood donation kits to modify their contents and update with the new tools.
The second poster involves a novel approach to truncal hemorrhage control in the austere environment. It is titled “Resuscitative Endovascular Balloon Occlusion of the Aorta: Pushing Care Forward.” By using an endovascular technique that is usually reserved for surgeons, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a technique that could buy the critically injured patient for up to 90-120 minutes before arriving to a surgeon.
The third poster, “Prehospital Administration of Antibiotic Prophylaxis for Open Combat Wounds in Afghanistan,” helped identify issues with antibiotic guidelines in combat environments and helped prove that new strategies must be adopted to lower the preventable death rate. Tactical Combat Casualty Care (TCCC) is the Department of Defense’s guideline or prehospital medicine in the combat environment and many claim that TCCC guidelines have been instrumental in saving lives in combat. However, a 25% preventable death rate persists from the wars in Iraq and Afghanistan, despite the 90% survival rate if a casualty can make it to a surgical hospital. This retrospective study shows that TCCC guidelines for antibiotics were not being followed and new strategies must be adapted.
The fourth poster, “Advances in the Use of Whole Blood in Combat Trauma Resuscitation”, examined the use of whole blood in the combat environment. Starting in 2015, the 75th Ranger Regiment began a project to identify and use Group O low titer blood donors for whole blood transfusions in the combat environment. From May 2015-May 2016 the 75th Ranger Regiment with the assistance of the Armed Services Blood Program (ASBP) and United States Army Institute of Surgical Research tested over 1000 Rangers for anti-A and anti-B IgM and transfusion transmitted diseases. The data available found 63% (n=984) were low titer at 1:256, one case of Hepatitis C and one case of Hepatitis B. In March 2016, the ASBP began shipping stored Group O low titer whole blood to Afghanistan for use at the point of injury. There have been five units administered without any complications.
“As students, participation in research early in our academic careers is important because it not only helps us see the value of what we’re doing, but it helps us to be better prepared for clerkships and residency,” Fisher said. “I’m very proud to be combining my past military experience with my education here at Texas A&M. I believe it is important for more students to not only actively participate in research, but research associated with the military.”