MSS007: THE TRIDENT PROTOCOL: A NOVEL, COMBAT-PROVEN ULTRASOUND APPROACH TO REDUCING MORTALITY AND DISABILITY IN TRAUMA PATIENTS.BORN IN UKRAINE, TESTED BY WAR.
Oksana Popova, MD, FACS; NGO ELLING Training Center
Objectives: Standard emergency protocols for trauma often fail to detect critical injuries in a timely manner, particularly in combat scenarios, leading to high rates of irreversible damage, preventable amputations, and mortality. This abstract introduces the TRIDENT protocol, an innovative three-pronged ultrasound methodology developed in Ukraine to address critical gaps in the emergency assessment of head, torso, and limb trauma. The objective is to demonstrate a system that enhances diagnostic accuracy in resource-limited settings to significantly reduce mortality, complications, and long-term disability among trauma patients.
Methods: The TRIDENT protocol consists of three targeted ultrasound examinations:
Brain Ultrasound for Head Trauma: This non-invasive method rapidly assesses intracranial pressure (ICP) by measuring the optic nerve sheath diameter (ONSD). The results enable immediate, critical decisions regarding the need for intensive therapy or emergency decompressive craniotomy, which is crucial for patient outcomes.
FAST-U (Ukrainian FAST) for Torso Trauma: An enhancement of the standard E-FAST protocol, FAST-U is designed to detect injuries frequently missed, such as colon wounds and retroperitoneal hematomas. The technique involves assessing the diameter of the cecum and sigmoid colon, as spasm in these areas is a highly sensitive indicator of injury.
Limb Ultrasound for Extremity Trauma: Utilizing ultrasound with Doppler mode, this method quickly evaluates vascular status and soft tissue damage in injured limbs. It provides objective, evidence-based criteria for the application, continuation, or removal of tourniquets, thereby preventing unnecessary amputations.
Results: The implementation of the TRIDENT protocol in a research group yielded significant improvements in patient outcomes compared to a control group. For head trauma, total mortality decreased from 49.48% to 26.82%, and disability was reduced from 65.46% to 29.45%. In torso trauma cases, the FAST-U protocol lowered total mortality from 14.31% to 7.80% and the total complications rate from 16.20% to 9.50%. The most dramatic results were seen in limb trauma, where the use of Doppler ultrasound reduced total mortality from 55.74% to 12.91% and cut the disability rate from 73.67% to 31.34%.
Conclusion: Born from the exigencies of conflict and validated by Ukrainian medics, the TRIDENT protocol is a combat-proven, innovative contribution to global trauma care. Its three components demonstrably and substantially reduce mortality and disability across the most critical categories of traumatic injury. As a readily applicable and highly effective system, the TRIDENT protocol represents an invaluable tool for improving patient outcomes in military and civilian emergency medicine worldwide.