The Future of Advanced Military Medicine

The Critical Care . Resuscitation . Airway . Shock . Hemorrhage (C2RASH) lab was established as a collaborative effort between the US Army Institute of Surgical Research (USAISR), the Brooke Army Medical Center (BAMC), and the 59th Medical Wing (59MDW). C2RASH operates under the leadership of LTC Steven G Schauer, DO, MS, an esteemed emergency medicine physician and critical care fellow with the U.S. Army. Contributing to the team’s dynamic structure, Jessica Mendez, MS, serves as the lab program manager. Other key physician investigators include LTC Julie A Rizzo, MD from the BAMC Department of Surgery, Maj Brit J Long, MD, and Col Joseph K Maddry, MD, from the 59MDW, and LTC Brian Kirkwood, DDS, MS from the USAISR.

Together, along with strong team of research coordinators and research associates, they lead multicenter preclinical and clinical investigations seeking to improve how the military delivers medical care in the Role 1 (prehospital) and Role 2 (forward-staged resuscitation team) settings, with a specific focus on optimizing training and clinical practice guidelines. In pursuit of their objectives, the C2RASH lab has established collaborative ties with the University of Colorado School of Medicine, the University of Texas Health at San Antonio, the Vanderbilt University Medical Center, and the University of Stellenbosch.

Through these preclinical and clinical studies, the team has had significant impact on the practice of military medicine in the deployed setting, and the practice of emergency medicine in the civilian setting. Noteworthy achievements include the successful completion of the Strategy to Avoid Excessive Oxygen (SAVEO2) trial,1 and the DirEct versus VIdeo laryngosCopE (DEVICE) trials,2 both of which prompted revisions in the Joint Trauma System Clinical Practice Guidelines. Additionally, their development and validation of study materials for combat medic autologous blood transfusion training are now the military-wide standard.3, 4 Currently, they are actively leading the Clinical Assessment of Low CalcIUm (CALCIUM) study, aimed at defining calcium supplementation triggers in the setting of massive hemorrhage.5 Furthermore, the lab’s engagement as an enrollment center in the PRagmatic trial Examining OXygen prior to Intubation (PREOXI) trial, with LTC Schauer and Maj Long assuming primary military investigator roles, underscores their commitment to driving advancements in the field of emergency medicine.6

• Dylla L, Douin DJ, Anderson EL, Rice JD, Jackson CL, Bebarta VS, Lindsell CJ, Cheng AC, Schauer SG, Ginde AA. A multicenter cluster randomized, stepped wedge implementation trial for targeted normoxia in critically ill trauma patients: study protocol and statistical analysis plan for the Strategy to Avoid Excessive Oxygen (SAVE-O2) trial
• Trials. 2021 Nov 8;22(1):784. doi: 10.1186/s13063-021-05688-6. PMID: 34749762; PMCID: PMC8574946.
Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, Vonderhaar DJ, Whitson MR, Barnes CR, Walco JP, Douglas IS, Krishnamoorthy V, Dagan A, Bastman JJ, Lloyd BD, Gandotra S, Goranson JK, Mitchell SH, White HD, Palakshappa JA, Espinera A, Page DB, Joffe A, Hansen SJ, Hughes CG, George T, Herbert JT, Shapiro NI, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz DR, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW; DEVICE Investigators and the Pragmatic Critical Care Research Group. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023 Aug 3;389(5):418-429. doi: 10.1056/NEJMoa2301601. Epub 2023 Jun 16. PMID: 37326325.
• Schauer SG, Mancha F, Mendez J, Martinez MA, Jeschke EA, April MD, Fisher AD, Brown DJ, Weymouth WL, Corley JB, Hill R, Cap AP. A prospective assessment of the medic autologous blood transfusion skills for field transfusion preparation. Transfusion. 2023 May;63 Suppl 3:S67-S76. doi: 10.1111/trf.17325. Epub 2023 Apr 17. PMID: 36971031.
• Mancha F, Mendez J, April MD, Fisher AD, Hill R, Bynum J, Cap AP, Corley JB, Schauer SG. A prospective assessment of the time required to obtain one unit of fresh whole blood by civilian phlebotomists and Army laboratory technicians (68 K). Transfusion. 2023 May;63 Suppl 3:S77-S82. doi: 10.1111/trf.17341. Epub 2023 Apr 17. PMID: 37066994.
• Mendez J, Jonas RB, Barry L, Urban S, Cheng AC, Aden JK, Bynum J, Fisher AD, Shackelford SA, Jenkins DH, Gurney JM, Bebarta VS, Cap AP, Rizzo JA, Wright FL, Nicholson SE, Schauer SG. Clinical Assessment of Low Calcium In traUMa (CALCIUM). Med J (Ft Sam Houst Tex). 2023 Jan-Mar;(Per 23-1/2/3):74-80. PMID: 36607302.
• Gibbs KW, Ginde AA, Prekker ME, Seitz KP, Stempek SB, Taylor C, Gandotra S, White H, Resnick-Ault D, Khan A, Mohmed A, Brainard JC, Fein DG, Aggarwal NR, Whitson MR, Halliday SJ, Gaillard JP, Blinder V, Driver BE, Palakshappa JA, Lloyd BD, Wozniak JM, Exline MC, Russell DW, Ghamande S, Withers C, Hubel KA, Moskowitz A, Bastman J, Andrea L, Sottile PD, Page DB, Long MT, Goranson JK, Malhotra R, Long BJ, Schauer SG, Connor A, Anderson E, Maestas K, Rhoads JP, Womack K, Imhoff B, Janz DR, Trent SA, Self WH, Rice TW, Semler MW, Casey JD; PREOXI investigators and the Pragmatic Critical Care Research Group. Protocol and statistical analysis plan for the PREOXI trial of preoxygenation with noninvasive ventilation vs oxygen mask. medRxiv [Preprint]. 2023 Mar 24:2023.03.23.23287539. doi: 10.1101/2023.03.23.23287539. PMID: 36993496; PMCID: PMC10055579.

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