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Judkins JL, Nguyen VT, Richardson MD, Roy TC. Association between availability of direct access to army occupational therapy with return to duty in active-duty soldiers. J Hand Ther 2024:S0894-1130(23)00194-1. [PMID: 38320939 DOI: 10.1016/j.jht.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Upper extremity musculoskeletal injuries are common with active-duty Army Soldiers and result in increased limited duty days. Patient satisfaction and surgery rates improve with direct access to occupational therapy in the civilian community. PURPOSE Examine the amount of time from initial evaluation following an upper extremity musculoskeletal injury (MSKI) to return to full duty plus occupational therapy (OT) utilization in Army Soldiers. STUDY DESIGN Retrospective observational. METHODS Electronic health records and profiles from 18,206 US active-duty Army soldiers with MSKI and OT evaluation between 2017-2018 were examined. Repeated measures generalized estimating equations provided the rate ratios (RRs) for OT healthcare utilization (total number of OT evaluations and treatment visits) by days to first OT evaluation and limited duty profile (total days on profile). RESULTS Soldiers were on average 32.0 (SD = 8.9) y/o, predominantly senior enlisted (45.7%), white (58.0%), male (81.4%), 10.0 (SD = 8.4) years of service, and high school or less educated (51.3%). There were 22,617 UE MSKIs with an OT evaluation and 4936 UE MSKIs with profiles. Compared with UE MSKIs with an OT evaluation on the same day, there was a significant increase in rates of OT utilization for 1-7 days (RR: 1.4, 95% CI: 1.3, 1.5), 8-14 days (RR: 1.3, 95% CI: 1.2, 1.4), 15-30 days (RR: 1.4, 95% CI: 1.3, 1.5), 31-60 days (RR: 1.5, 95% CI: 1.4, 1.6), and +60 days later (RR: 1.6, 95% CI: 1.5, 1.7). Similar differences in rates for limited duty profiles were found. CONCLUSION A greater number of days between diagnosis of UE MSKI and OT evaluation results in greater rates of OT utilization and longer temporary profile. Results suggest that earlier intervention by OT may decrease recovery and healthcare utilization of soldiers.
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Affiliation(s)
- Jason L Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Vy T Nguyen
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Melissa D Richardson
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tanja C Roy
- Occupational Health Sciences, Defense Centers for Public Health, Aberdeen, MD, USA
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Socias-Morales CM, Haas EJ, Gwilliam M, Yorio PL, Delaney NB, Falcon RG, Stallings HA, Burnham BR, Stuever DM, Stouder SM, Ewing GL, Collins JW, Chaumont Menendez CK. The association between safety climate and noncombat injury events among United States Air Force workers. JOURNAL OF SAFETY RESEARCH 2024; 88:16-23. [PMID: 38485358 DOI: 10.1016/j.jsr.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/16/2023] [Accepted: 10/16/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Work-related injuries are a common lagging safety indicator whereas safety climate assessments can help identify constructs serving as leading indicators. The National Institute for Occupational Safety and Health (NIOSH) partnered with the U.S. Department of the Air Force (DAF) Safety Center to examine the association between perceptions of safety climate survey constructs and the number of injury events within the DAF workforce. METHODS The DAF administers voluntary, anonymous, occupation-specific safety climate surveys to DAF workers using the internal Air Force Combined Mishap Reduction System (AFCMRS). Survey responses from 2014 to 2018 provided by DAF workers and injury events in maintenance, support, and operations occupations were shared with NIOSH. Exploratory Factor Analysis revealed five constructs: Leadership and Communication; Organizational Safety Priority; Error Management; Resource Adequacy; and Deployment/Official Travel Impact. Squadron-level analysis included bivariate correlations and estimated Rate Ratios (RRs). RESULTS 1,547 squadrons administered the survey, averaging 144 workers and 15.8 reportable injuries per squadron. Higher (more favorable) squadron-level construct scores were consistently correlated with fewer reported injuries (p < 0.001). Controlling for the number of workers, RRs revealed significant reductions in injury rates with each one-unit increase in responses: Leadership and Communication RR = 0.40 (95%CI: 0.32-0.48); Organizational Safety Priority RR = 0.50 (95%CI: 0.40-0.64); Error Management RR = 0.37 (95%CI: 0.30-0.47); Deployment/Official Travel Impact RR = 0.36 (95%CI: 0.29-0.45). Resource Adequacy revealed a non-significant lower injury rate RR = 0.87 (95%CI: 0.73-1.04). CONCLUSIONS This unique study quantified safety climate and the association with injuries across a multi-year period. While safety climate measurements may be limited by frequent turnover and the self-reported, voluntary, anonymous nature of AFCMRS, the strength of this study is in the census of injuries. PRACTICAL APPLICATIONS Future research should include longitudinal analyses to examine the impact on injuries when squadron leaders are provided feedback on safety climate survey results.
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Affiliation(s)
| | - Emily J Haas
- CDC National Institute for Occupational Safety and Health (NIOSH), United States
| | - Melody Gwilliam
- CDC National Institute for Occupational Safety and Health (NIOSH), United States
| | - Patrick L Yorio
- CDC National Institute for Occupational Safety and Health (NIOSH), United States
| | | | | | | | | | | | | | | | - James W Collins
- CDC National Institute for Occupational Safety and Health (NIOSH), United States
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Stern CA, Liendo JA, Graham BA, Johnson GM, Kotwal RS, Shackelford S, Gurney JM, Janak JC. Nonfatal Injuries From Falls Among U.S. Military Personnel Deployed for Combat Operations, 2001-2018. Mil Med 2023; 188:e2405-e2413. [PMID: 36576031 DOI: 10.1093/milmed/usac410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Falls are a leading mechanism of injury. Hospitalization and outpatient clinic visits due to fall injury are frequently reported among both deployed and non-deployed U.S. Military personnel. Falls have been previously identified as a leading injury second only to sports and exercise as a cause for non-battle air evacuations. MATERIALS AND METHODS This retrospective study analyzed the Department of Defense Trauma Registry fall injury data from September 11, 2001 to December 31, 2018. Deployed U.S. Military personnel with fall listed as one of their mechanisms of injury were included for analysis. RESULTS Of 31,791 injured U.S. Military personnel captured by the Department of Defense Trauma Registry within the study time frame, a total of 3,101 (9.8%) incurred injuries from falls. Those who had fall injuries were primarily 21 to 30 years old (55.4%), male (93.1%), Army (75.6%), and enlisted personnel (56.9%). The proportion of casualties sustaining injuries from falls generally increased through the years of the study. Most fall injuries were classified as non-battle injury (91.9%). Falls accounted for 24.2% of non-battle injury hospital admissions with a median hospital stay of 2 days. More non-battle-related falls were reported in Iraq-centric military operations (62.7%); whereas more battle-related falls were reported in Afghanistan-centric military operations (58.3%). CONCLUSIONS This study is the largest analysis of deployed U.S. Military personnel injured by falls to date. Highlighted are preventive strategies to mitigate fall injury, reduce workforce attrition, and preserve combat mission capability. LEVEL OF EVIDENCE Level III Epidemiologic.
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Affiliation(s)
- Caryn A Stern
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Jessica A Liendo
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Brock A Graham
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Grant M Johnson
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Russ S Kotwal
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Stacy Shackelford
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Jennifer M Gurney
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Jud C Janak
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base, San Antonio, Fort Sam Houston, Texas 78234, USA
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Ran Y, Mitchnik I, Gendler S, Avital G, Radomislensky I, Bodas M, Benady A, Benov A, Almog O, Chen J. Isolated limb fractures - the underestimated injury in the Israeli Defence Forces (IDF). Injury 2023; 54:490-496. [PMID: 36402586 DOI: 10.1016/j.injury.2022.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Musculoskeletal injuries dominate warfare-related trauma and differ from civilian settings in higher hospitalization costs, morbidity, and mortality. Partly due to introduction of personal protective equipment in the Israel Defence Force (IDF) to minimize head and torso injuries while the extremities remained unprotected. This study describes military extremity injury patterns, prehospital treatment and injury sequela regarding return-to-duty and disability compensation. METHODS This retrospective study examined cases of battle and non-battle trauma casualties treated by the IDF Medical Corps from 2013 to 2020. Data from the IDF Trauma Registry (IDF-TR) was merged with The Israeli National Trauma Registry (INTR). Cases with high morbidity discharged from military service were compared with lower morbidity patients who returned to active duty service. RESULTS Out of 1360 injured soldiers, 280 (20.6%) were found to have isolated limb fractures (ILFs). High morbidity casualties had more open fractures (63% vs. 42%) and higher involvement of lower extremities (79% vs. 58%) (p < 0.001), higher rates of tourniquets use (28% compared to 9%, p < 0.001), external fixation (34% vs. 19%, p < 0.001) and amputations (9% vs. 1%, p = 0.003), required more rehabilitation (34% vs. 7%, p < 0.001), and had 46% medical disabilities compared to 24% with low morbidity (p < 0.001). CONCLUSIONS ILFs are associated with significant morbidity and disability. High morbidity is associated with high energy, scar-producing, lower-extremity open fractured limbs treated by tourniquets. Future studies should evaluate whether junctional or extremity protective gear is combat feasible and whether introducing Clinical Practice Guidelines to manage suspected limb fractures can decrease morbidity rates and improve return to duty.
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Affiliation(s)
- Yuval Ran
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel; Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Mitchnik
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel.
| | - Sami Gendler
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel.
| | - Guy Avital
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel; Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, 6423906 Tel-Aviv, Israel.
| | - Irina Radomislensky
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Moran Bodas
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel; Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel.
| | - Amit Benady
- Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Levin Center for 3D printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Avi Benov
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Ofer Almog
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel.
| | - Jacob Chen
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel; Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Schram B, Canetti E, Orr R, Pope R. Injury rates in female and male military personnel: a systematic review and meta-analysis. BMC Womens Health 2022; 22:310. [PMID: 35879707 PMCID: PMC9310503 DOI: 10.1186/s12905-022-01899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background An effective military force is required to be agile, capable, efficient, and potent. Injuries to military personnel interrupt active-duty service and can detract from overall capability. These injuries are associated with a high individual and organizational burden, with lost work time and financial costs—all problematic for the ongoing functioning of a military force. Injury control strategies have therefore been described as force multipliers. Female personnel form an integral part of any modern defence force, but little research has examined their specific experiences of injury, to inform targeted injury control efforts. The aim of this review was to identify and synthesise findings from studies of injury rates and patterns in female military personnel, comparing them to those of male personnel. Methods A systematic search was conducted for studies which compared injury rates between the sexes at any stage of military service, from basic training through to deployment. Databases searched included PUBMED, CINAHL and Medline through OVID. Methodological quality of eligible articles was assessed using the Critical Appraisal Skills Program (CASP), and AXIS tools and data were extracted, synthesized, and, where possible, underwent meta-analysis. Results Of 2287 identified studies, a total of 25 studies were eligible and included. Methodological quality ranged from 60% up to a perfect score of 100%, with an average of 82% across all studies. Relative risks for injuries (reported as RR [95%CI]) to females when compared to males were 2.10 [1.89–2.33] during basic training, 1.70 [1.33–2.17] during officer training, and 1.23 [1.05–1.43] post initial training. After adjustment for differences between the sexes in average fitness levels (2-mile run time), there was no longer a significant difference in injury rates (adjusted RR: 0.95 [0.86–1.05]). Female personnel tended to make bigger improvements in their fitness during basic training than males and tended to report their injuries more frequently and sooner than males. Conclusion While this review found a higher rate of reported injuries in female military personnel when compared to male personnel, differences between the sexes in average fitness levels and injury reporting behaviours may largely explain this rate difference. The difference in rates of reported injuries was greatest during basic training, and reduced thereafter, possibly due in part to a reduced difference in fitness between the sexes or increased opportunity to self-determine workloads relative to fitness levels.
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Yang Z, Simovic MO, Liu B, Burgess MB, Cap AP, DalleLucca JJ, Li Y. Indices of complement activation and coagulation changes in trauma patients. Trauma Surg Acute Care Open 2022; 7:e000927. [PMID: 36117727 PMCID: PMC9476135 DOI: 10.1136/tsaco-2022-000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Early complementopathy and coagulopathy are shown often after trauma. However, the prevalence of any interplay between complement cascade (ComC) and coagulation cascade (CoaC) after trauma remains unclear. This study intended to explore whether complement-coagulation crosstalk exists, which may provide a reliable guide to clinical implications in trauma patients. Methods This single-center cohort study of trauma patients enrolled 100 patients along with 20 healthy volunteers. Blood samples from patients were collected at admission, 45, 90, 135 minutes, and 18 hours after admission. Demographic characteristics were recorded, blood levels of ComC and CoaC factors, and inflammatory cytokines were measured by ELISA, clot-based assays, or luminex multiplex assay, and partial thromboplastin (PT) and partial thromboplastin time (PTT) were assessed using a Behring blood coagulation system. Results Compared with the healthy controls, plasma levels of complement factors (C5b-9 and Bb) and 11 tested inflammatory cytokines increased in moderately and severely injured patients as early as 45 minutes after admission and sustained higher levels up to 18 hours after admission. C5b-9 correlated positively to patients’ hospital stay. In parallel, the consumption of coagulation factors I, II, X, and XIII was shown throughout the first 18 hours after admission in moderately and severely injured patients, whereas PT, PTT, D-dimer, factor VII, and factor VIII values significantly increased from the admission to 135 minutes in moderately and severely injured patients. Along with an inverse correlation between plasma Bb, factors I and II, a positive correlation between C5b-9, Bb, D-dimer, PT, and PTT was evident. Conclusions This study demonstrates trauma-induced early activation of plasma cascades including ComC, CoaC, and fibrinolytic cascade, and their correlation between plasma cascades in severe trauma patients. Our study suggests that the simultaneous modulation of plasma cascades might benefit clinical outcomes for trauma patients. Level of evidence Prospective study, level III.
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Affiliation(s)
- Zhangsheng Yang
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Milomir O Simovic
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Bin Liu
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Matthew B Burgess
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | | | - Yansong Li
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.,Trauma Research, UTHSCSA, San Antonio, Texas, USA.,Geneva Foundation, Tacoma, Washington, USA
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Burn Injuries from a military perspective. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schram B, Orr R, Pope R. A profile of injuries suffered by female soldiers serving in the Australian Army. BMC Public Health 2022; 22:813. [PMID: 35461272 PMCID: PMC9034641 DOI: 10.1186/s12889-022-13225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Female soldiers comprise an important component of any modern army, yet little research has been performed to investigate differences in the profiles of injuries reported by qualified female and male army personnel. Aim The aim of this study was to compare injury rates and patterns between female and male soldiers of the Australian Regular Army (ARA). Methods Data pertaining to all injuries reported by ARA members over a two-year period were accessed from the SENTINEL database and analysed descriptively. Findings regarding injury patterns were reported by most common location, nature, mechanism, and activity being performed at the time of injury. Injury incidence rates (IR) were calculated based on population size, and injury incidence rate ratios (IRR) comparing female and male injury rates were determined. Results A total of 8750 injuries were recorded across the two-year time period (2018–2020) of the study (minor injuries: n = 1766 female, n = 6870 male; serious injuries: n = 19 female, n = 95 male). Higher incidence rates of minor injuries were reported for female soldiers (IR = 20.75 injuries/100 soldiers/year) when compared to male soldiers (IR = 13.60 injuries/100 soldiers/year), with an IRR of 1.53 [95% CI = 1.46–1.60]. More serious injuries were reported at a similar rate between female (IR = 0.22/100 soldiers/year) and male soldiers (IR = 0.21/100 soldiers/year), with an IRR of 1.05 [95% CI = 0.65–1.72]. Female soldiers tended to report more ankle injuries than male soldiers who reported more knee injuries. Physical training and combat training were the most common causes of injury for both sexes. Discussion There were subtle differences in body locations of minor injuries within female and male soldiers. Both minor and more serious injury profiles were otherwise similar between sexes. Therefore, strategies required to minimise injuries in female soldiers may be similar in many respects to strategies required for male soldiers but require some differences to account for the subtle differences in body locations of injury, and so to ensure effectiveness across all personnel.
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A Market Review of Available Airway Suction Technology. Prehosp Disaster Med 2022; 37:390-396. [PMID: 35354510 DOI: 10.1017/s1049023x22000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Airway injuries are the second leading cause of potentially survivable battlefield death and often require airway management strategies. Airway suction, the act of using negative pressure in a patient's upper airway, removes debris that can prevent respiration, decreases possible aspiration risks, and allows clearer viewing of the airway for intubation. The most important characteristics for a portable airway suction device for prehospital combat care are portability, strong suction, and ease of use. METHODS This market review searched academic papers, military publications, Google searches, and Amazon to identify devices. The search included specific characteristics that would increase the likelihood that the devices would be suitable for battlefield use including weight, size, battery life, noise emission, canister size, tubing, and suction power. RESULTS Sixty portable airway suction devices were resulted, 31 of which met inclusion criteria - 11 manually powered devices and 20 battery-operated devices. One type of manual suction pump was a bag-like design with a squeezable suction pump that was extremely lightweight but had limited suction capabilities (vacuum pressure of 100mmHg). Another type of manual suction pump had a trigger-like design which is pulled back to create suction with a firm collection canister that had increased suction capabilities (vacuum pressures of 188-600mmHg), though still less than the battery operated, and was slightly heavier (0.23-0.458kg). Battery-operated devices had increased suction capabilities and were easier to use, but they were larger and weighed more (1.18-11.0kg). CONCLUSION Future research should work to lighten and debulk battery-operated suction devices with high suction performance.
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Risk factors for injuries in female soldiers: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:54. [PMID: 35351209 PMCID: PMC8966186 DOI: 10.1186/s13102-022-00443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
Abstract
Background Female soldiers form an integral part of any modern defence force. Previous reports have highlighted that female soldiers report injuries at higher rates than male personnel. One possible reason for this is an actual difference in underlying injury rates, purported to be due to several factors, including levels of fitness. The aim of this review was to determine risk factors for injuries in female soldiers. Methods A systematic search was conducted for studies which reported on risk factors for injuries in female soldiers. Databases searched included PUBMED, CINAHL and Medline through OVID. Eligible studies were rated for their methodological quality using the Critical Appraisal Skills Program (CASP) tools and data were extracted and synthesized using a critical narrative approach. Results A total of 18 articles were included in this review which reported on 18 risk factors for injury. Smoking, previous injury, no history of deployment, heavy occupational tasks, lower levels of aerobic fitness and lower number of push-up repetitions appear to be risk factors for injuries in female soldiers. Age, height, body fat, high or low BMI and body mass do not appear to be consistent risk factors for injury in female soldiers and there appears to be minimal evidence for current levels of activity, sit-up ability, and other assessments of strength, power, speed, or movement being associated with injury risk. Additionally, neither flexibility nor previous levels of activity appear to be associated with injury risk in female soldiers. Conclusion Strategies to improve aerobic fitness and upper limb endurance, reduce smoking, and optimise rehabilitation from injuries and risk management for heavy occupational tasks need to be developed for female soldiers. Such strategies are also likely to reduce risks for male soldiers.
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Le TD, Gurney JM, Akers KS, Chung KK, Singh KP, Wang HC, Stackle ME, Pusateri AE. Analysis of Nonbattle Deaths Among U.S. Service Members in the Deployed Environment. Ann Surg 2021; 274:e445-e451. [PMID: 34238813 DOI: 10.1097/sla.0000000000005047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention. BACKGROUND Injuries in combat are categorized as battle (result of hostile action) or nonbattle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had nonbattle injuries and emphasized prevention. NBD have not yet been characterized. METHODS U.S. military casualty data for Iraq and Afghanistan from 2001 to 2014 were obtained from the Defense Casualty Analysis System (DCAS) and the Department of Defense Trauma Registry (DoDTR). Two databases were used because DoDTR does not capture prehospital deaths, while DCAS does not contain clinical details. Nonbattle injuries and NBD were identified, etiologies classified, and NBD trends were assessed using a weighted moving average and time-series analysis with autoregressive integrated moving average. Future NBD rates were forecast. RESULTS DCAS recorded 59,799 casualties; 21.0% (n = 1431) of all deaths (n = 6745) were NBD. DoDTR recorded 29,958 casualties; 11.5% (n = 206) of all deaths (n = 1788) were NBD. After early fluctuations, NBD rates for both Iraq and Afghanistan stabilized at approximately 21%. Leading causes of NBD were gunshot wounds and vehicle accidents, accounting for 66%. Approximately 25% was self-inflicted. A 24% NBD rate was forecasted from 2015 through 2025. CONCLUSIONS Approximately 1 in 5 deaths were NBD. The majority were potentially preventable, including a significant proportion of self-inflicted injuries. A single comprehensive data repository would facilitate future mortality monitoring and performance improvement. These data may assist military leaders with implementing targeted safety strategies.
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Affiliation(s)
- Tuan D Le
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
- Department of Epidemiology and Biostatistics, School of Community and Rural Health, University of Texas Health Science Center at Tyler, Tyler, Texas
| | - Jennifer M Gurney
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
- Joint Trauma System, JBSA - Fort Sam Houston, Texas
| | - Kevin S Akers
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, School of Community and Rural Health, University of Texas Health Science Center at Tyler, Tyler, Texas
| | - Heuy-Ching Wang
- Naval Medical Research Center, JBSA - Fort Sam Houston, Texas
| | - Mark E Stackle
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
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Runge CE, Moss KM, Dean JA, Waller MJ. Self-reported pain or injury from equipment used on military deployment. Occup Med (Lond) 2021; 71:79-85. [PMID: 33599260 DOI: 10.1093/occmed/kqab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Information about pain and injury from equipment on a particular deployment is not disaggregated in the literature; thus, the nature of the issue is unclear. AIMS To determine the prevalence of pain or injury during a particular deployment that military personnel attributed to equipment they used on this deployment; and to document the types of equipment they identified, the type of pain or injury and how they thought the pain or injury occurred. METHODS This paper analyses data from a deployment and health survey of Australian Defence Force personnel. The participants are 8932 personnel who deployed to Iraq and 6534 who deployed to Afghanistan. Participants indicated whether they experienced pain or injury from equipment they used on deployment and detailed their experiences in response to an open-ended question (n = 563). RESULTS Sixteen per cent of Iraq-deployed and 21% of Afghanistan-deployed participants reported pain or injury from equipment they used on deployment. Body armour was the most common equipment identified; however, a wide range of equipment was related to pain or injury. A new finding is that pain or injury related to armour was attributed to its wear in vehicles and during vehicle ingress or egress. CONCLUSIONS Knowledge of the nature of pain or injury related to equipment used on deployment may help inform improved designs and practices to reduce or prevent avoidable harm to serving personnel.
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Affiliation(s)
- C E Runge
- School of Public Health, The University of Queensland, Queensland, Australia
| | - K M Moss
- School of Public Health, The University of Queensland, Queensland, Australia
| | - J A Dean
- School of Public Health, The University of Queensland, Queensland, Australia
| | - M J Waller
- School of Public Health, The University of Queensland, Queensland, Australia
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13
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Aranda M, Poloni D, Coffin E, Hendren B. Profiles After Acute Traumatic Injury: The Non-battle Injury Impact on Readiness at a Single Military Treatment Facility. Mil Med 2021; 186:565-570. [PMID: 33372671 DOI: 10.1093/milmed/usaa566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Physical profiling is critical to the individual medical readiness of all military service members. This classification system provides detailed information about an individual's functional abilities. Profile information is used in determining whether a service member is medically deployable or non-deployable. Limited research has been conducted on the impact of acute traumatic injuries on duty status and profiles in the non-deployed setting. The purpose of this study was to characterize injured service members presenting to a CONUS MTF emergency department whose acute traumatic injury resulted in a profile. MATERIALS AND METHODS A retrospective review of patients who presented to the Dwight D. Eisenhower Army Medical Center emergency department with traumatic injuries from January 1, 2019, to December 31, 2019, was performed. Patients were identified by searching electronic encounter records for trauma-specific ICD-10 codes. Returned patient records were then reviewed for active duty status, branch, age, gender, rank, mechanism, protective equipment, substance use, procedures, and disposition. Profiles of soldiers were reviewed for indication and duration. Patients with profiles were compared to those without profiles. Correlation with age was determined by t-test, correlation with profile length was determined by ANOVA, and correlation with the remaining categorical variables was determined with chi-squared analysis. RESULTS Eight hundred and thirty-two service members were reviewed. One hundred and eight (13%) soldiers had a profile. Patients were 23.2% female with no difference between the two groups. Patients were an average of 28.7 years old. The most common mechanisms were physical training (PT) (33.1%) and falls (12.9%). Physical training and motor vehicle collisions were more common in the profile group. Combatives and crush injuries of the hand were less common in the profile group. Major procedures were more common in the profile group, and minor procedures were less common. Admissions, quarters, immediate referrals, and release without limitations were more common in the profile group. The mean duration of profiles was 48.9 days, and 7.4% were permanent. CONCLUSIONS Non-battle injuries in the garrison setting are a significant threat to readiness. This analysis of acute traumatic injuries suggests that mechanism of injury was similar to previous reports with PT and falls being most common. Interventions should be targeted at PT and motor vehicle collisions as these were more common in the profile group. This series is also similar to previous reports that extremity injuries are the most common cause of profiles. However, TBIs were more common in our analysis. Further research that encompasses all garrison MTF acute traumatic injuries is needed to define the true impact on readiness and guide development of injury prevention strategies.
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Affiliation(s)
- Marcos Aranda
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA
| | - Dana Poloni
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA
| | - Elisabeth Coffin
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA
| | - Bryan Hendren
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA
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14
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Ahmed S, Gorman GH, Susi A, Robertson BD, Collen JF, Hisle-Gorman EJ. Impact of parental injury on adolescent sleep. J Clin Sleep Med 2021; 16:1437-1444. [PMID: 32336323 DOI: 10.5664/jcsm.8514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to determine the impact of serious parental injury on adolescent sleep disorder diagnoses, outpatient care, and medication use. METHODS U.S. military personnel who sustained a serious injury and were parents of adolescents aged 10-18 years were identified. Included adolescents were enrolled in the Military Health System for 2 years before their parent's injury and 2 years after the injury. We used logistic regression clustered by adolescents to compare the odds of having a sleep diagnosis and negative binomial regression analysis clustered by adolescents to compare outpatient sleep disorder visits and sleep medication days before and after parental injury. RESULTS There were 96,318 parents seriously injured during 2004-2014 who had 117,577 children aged 10-18 years in 2002-2016. Approximately 2% of adolescents had a sleep disorder diagnosis, both before and after their parent's injury or illness. Outpatient sleep disorder visits increased 36% after a parent's injury (incidence rate ratio 1.36 [1.24-1.50]), with a twofold increase in insomnia visits (incidence rate ratio 2.35 [2.08-2.64]). Increases in sleep visits were most pronounced in adolescents of parents with traumatic brain injury, comorbid traumatic brain injury and posttraumatic stress disorder, battle injury, and those who were medically discharged from the military. The number of adolescents using sleep medications increased, but sleep medication days did not increase. CONCLUSIONS Adolescents in our study used more outpatient medical care for sleep disorders; sleep medication use increased after parental injury. Sleep disorders should be considered in the care of adolescents with injured parents.
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Affiliation(s)
- Saira Ahmed
- Division of Adolescent Medicine, Department of Pediatrics, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | | | - Apryl Susi
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
| | - Brian D Robertson
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jacob F Collen
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Medicine, Uniformed Services University, Bethesda, Maryland
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15
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Jaeger JM, Rice DC, Albright-Trainer B. Battlefield Medicine: Anesthesia and Critical Care in the Combat Zone. Anesthesiol Clin 2021; 39:321-336. [PMID: 34024434 DOI: 10.1016/j.anclin.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The US Military Joint Trauma System has been developed to mitigate the harsh conditions under which medical providers care for combat casualties and provide continuity of care from the battlefield to US medical centers. We review the components of this system with emphasis on combat trauma care under fire and the role of the anesthesiologist and intensivist in this continuum of care. An important link in the chain of survival is the Air Force Critical Care Aeromedical Transport Team, which provides critical care while transporting casualties from the theater to higher levels of care outside the war zone and home.
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Affiliation(s)
- J Michael Jaeger
- Departments of Anesthesiology and Surgery, Division of Critical Care Medicine, University of Virginia Health System, Box 800710, Charlottesville, VA 22908, USA.
| | - Darian C Rice
- Department of Anesthesiology, Division of Critical Care Medicine, University of Virginia Health System, Box 800710, Charlottesville, VA 22908, USA
| | - Brooke Albright-Trainer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Virginia Health System, Box 800710, Charlottesville, VA 22908, USA; Department of Anesthesiology, Central Virginia VA HCS, Richmond, VA 23249, USA
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16
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Sussman MS, Ryon EL, Urrechaga EM, Cioci AC, Herrington TJ, Pizano LR, Garcia GD, Namias N, Wetstein PJ, Buzzelli MD, Gross KR, Proctor KG. The Key to Combat Readiness Is a Strong Military-Civilian Partnership. Mil Med 2021; 186:571-576. [PMID: 33394041 DOI: 10.1093/milmed/usaa565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST. We test the hypothesis that the clinical experience of non-physician FRST members varies between active duty (AD) and Army reservists (AR). METHODS Over a 3-year period, all FRSTs were surveyed at one civilian center. RESULTS Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P < .001). These differences persisted across all specialties, including perioperative nurses, certified registered nurse anesthetists, operating room (OR) techs, critical-care nurses, emergency room (ER) nurses, licensed practical nurse (LPN), and combat medics. CONCLUSIONS This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers.
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Affiliation(s)
- Matthew S Sussman
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Emily L Ryon
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Eva M Urrechaga
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Alessia C Cioci
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Tyler J Herrington
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Louis R Pizano
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - George D Garcia
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Nicholas Namias
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Paul J Wetstein
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Mark D Buzzelli
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Kirby R Gross
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
| | - Kenneth G Proctor
- Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA
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Inscoe CR, Lee Y, Billingsley AJ, Puett C, Nissman D, Lu J, Zhou O. Point-of-Care Tomosynthesis Imaging of the Wrist. Mil Med 2021; 186:745-750. [PMID: 33499472 DOI: 10.1093/milmed/usaa337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Musculoskeletal injury to extremities is a common issue for both stateside and deployed military personnel, as well as the general public. Superposition of anatomy can make diagnosis difficult using standard clinical techniques. There is a need for increased diagnostic accuracy at the point-of-care for military personnel in both training and operational environments, as well as assessment during follow-up treatment to optimize care and expedite return to service. Orthopedic tomosynthesis is rapidly emerging as an alternative to digital radiography (DR), exhibiting an increase in sensitivity for some clinical tasks, including diagnosis and follow-up of fracture and arthritis. Commercially available digital tomosynthesis systems are large complex devices. A compact device for extremity tomosynthesis (TomoE) was previously demonstrated using carbon nanotube X-ray source array technology. The purpose of this study was to prepare and evaluate the prototype device for an Institutional Review Board-approved patient wrist imaging study and provide initial patient imaging results. MATERIALS AND METHODS A benchtop device was constructed using a carbon nanotube X-ray source array and a flat panel digital detector. Twenty-one X-ray projection images of cadaveric specimens and human subjects were acquired at incident angles from -20 to +20 degrees in various clinical orientations, with entrance dose calibrated to commercial digital tomosynthesis wrist scans. The projection images were processed with an iterative reconstruction algorithm in 1 mm slices. Reconstruction slice images were evaluated by a radiologist for feature conspicuity and diagnostic accuracy. RESULTS The TomoE image quality was found to provide more diagnostic information than DR, with reconstruction slices exhibiting delineation of joint space, visual conspicuity of trabecular bone, bone erosions, fractures, and clear depiction of normal anatomical features. The scan time was 15 seconds and the skin entrance dose was verified to be 0.2 mGy. CONCLUSIONS The TomoE device image quality has been evaluated using cadaveric specimens. Dose was calibrated for a patient imaging study. Initial patient images depict a high level of anatomical detail and an increase in diagnostic value compared to DR.
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Affiliation(s)
- Christina R Inscoe
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yueh Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Alex J Billingsley
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27607, USA
| | - Connor Puett
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27607, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jianping Lu
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Otto Zhou
- Department of Physics & Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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18
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Altman AHH, Carius BM, Justin GA, Schauer SG, Escandon MA, Maddry JK, Mazzoli RA, Legault GL. A Sub-Analysis of U.S. Africa Command Area of Operations Transportations for Ophthalmic Concerns, 2008-2018. Mil Med 2021; 187:e1148-e1152. [PMID: 33825888 DOI: 10.1093/milmed/usab134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION American military personnel in U.S. Africa Command (AFRICOM) operate in a continent triple the size of the USA without mature medical facilities, requiring a substantial transportation network for medical evacuation. We describe medical transportation based on ophthalmic complaints analyzed from the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) database from 2008 to 2018. METHODS We conducted a retrospective review of all TRAC2ES records for medical evacuations for ophthalmic complaints from the AFRICOM theater of operations conducted between January 1, 2008 and December 31, 2018. We analyzed free-text data in TRAC2ES for ophthalmic diagnostic and therapeutic interventions performed before established patient movement requests. An expert panel analyzed evacuations for their indications and interventions. RESULTS Nine hundred and sixty-one total records originating within AFRICOM were identified in TRAC2ES. Forty-three cases (4%) had ophthalmic complaints. The majority of transports were routine (72%) and originated in Djibouti (83%), and all were transported to Landstuhl Regional Medical Center. The majority of patients were evacuated without a definitive diagnosis (60%). Leading ophthalmic diagnoses were chalazion (14%), corneal abrasion/ulcer (14%), and posterior vitreous detachment (12%). More than one-quarter of patients were transported without recorded evaluation and approximately half (51%) did not receive any intervention before evacuation. Consultation with an ophthalmologist occurred in only 16 (37%) cases. By majority, the expert panel deemed 12 evacuations (28%) potentially unnecessary. CONCLUSION Evacuations were primarily routine often for disease etiology and further diagnostic evaluation. These findings support opportunities for telemedicine consultation to avoid potentially unnecessary transportation. Increased ophthalmic care and enhanced data collection on transports would support process improvement, optimize ophthalmic care by ensuring proper disposition of patients thus limiting unnecessary evacuations, and ultimately strengthen the entire fighting force.
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Affiliation(s)
- Adam H H Altman
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Brandon M Carius
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.,121 Field Hospital, Camp Humphreys, APO, AP 96205, Republic of Korea
| | - Grant A Justin
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steven G Schauer
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Mireya A Escandon
- 59th Medical Detachment Wing, Joint Base San Antonio-Lackland, San Antonio, TX 78236, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,59th Medical Detachment Wing, Joint Base San Antonio-Lackland, San Antonio, TX 78236, USA
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Gary L Legault
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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Kauvar DS, Gurney J. Exploring Nonbattle Injury in the Deployed Military Environment Using the Department of Defense Trauma Registry. Mil Med 2021; 185:e1073-e1076. [PMID: 32147699 DOI: 10.1093/milmed/usz481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The impact of disease and nonbattle injury (DNBI) on casualty burden of military operations has historically been greater than that of battle-related injuries. The ratio of battle to DNBI casualties has changed as advances in equipment, hygiene, and infectious diseases have been made; however, during military operations in Iraq and Afghanistan, 30% of serious injuries treated or evacuated from the area of operations were secondary to NBI. Most DoD research and intervention efforts focus on battle injuries; NBI has received much less practical attention. We aimed to explore the potential utility of the largest Department of Defense casualty database in identifying potential intervention targets for preventing NBI events. MATERIALS AND METHODS Phase I was a comprehensive NBI literature review from historical and current military operations. Phase II was an IRB exempt initial examination of relevant data contained in the Department of Defense Trauma Registry (DoDTR). Phase I: A MEDLINE search using the terms "military", "injury", and "nonbattle/non battle" was performed, and articles containing useful data points to characterize the unique risks of the modern deployed military environment and identify potentially preventable NBI hazards in the modern deployed military environment were retrieved and reviewed in full-text. Phase II: This information was used to explore data within the DoDTR's and its ability to provide data to inform NBI prevention efforts in the following areas: most prevalent NBI causes, NBI location and timing related to operational tempo, characteristics of the population at risk for NBI. RESULTS Phase I: Falls and motor vehicle crashes (MVCs) accounted for most of the serious NBI in Iraq and Afghanistan. No specific epidemiologic data was readily available to guide NBI prevention efforts. Phase II was limited to NBI and falls from Iraq and Afghanistan in the DoDTR. Only aggregate data were available with a total of 1829 falls and 1899 MVCs. Case fatality for falls was 1.1% and for MVCs 6.5%. The greatest frequency of NBI was in Iraq among U.S. Army personnel, but comparison of rates is not possible without reliable denominators for individual variables. Annual NBI incidence seems proportional to overall level of personnel deployed to each theater, but without knowledge of the true denominator of total deployed personnel, it is impossible to conclude definitively. The annual number of falls was stable throughout the period of highest operational tempo in Iraq (2003-2011), although MVCs were more common earlier in the operation (2003-2005), likely corresponding to greater operational maneuver. CONCLUSIONS The deployed military environment is dangerous and NBI presents a primary prevention target for expeditionary operations. The DoDTR is a database of detailed injury and medical care information and lacks much of the data required to perform a comprehensive epidemiologic NBI analysis. Specific prevention recommendations cannot be made based solely on DoDTR data and integration with other DoD databases that assess operational and tactical data should be considered.
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Affiliation(s)
- David S Kauvar
- Vascular Surgery Service, Brooke Army Medical Center, JBSA Ft. Sam Houston, San Antonio, TX.,Department of Surgery, Uniformed Services University, Bethesda, MD
| | - Jennifer Gurney
- Department of Surgery, Uniformed Services University, Bethesda, MD.,Joint Trauma System, JBSA Ft. Sam Houston, San Antonio, TX
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20
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Luft A, Corcostegui SP, Millet M, Gillard J, Boissier J, Rondy P, Bancarel J, Carfantan C. Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients. Mil Med 2021; 185:468-476. [PMID: 31642486 DOI: 10.1093/milmed/usz268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. METHODS We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. RESULTS We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16 hours but longer for priority patients (26 hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. CONCLUSION This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.
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Affiliation(s)
- Antoine Luft
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Simon-Pierre Corcostegui
- Special Medical Unit of Satory, French Military Medical Service, Camp des matelots, CS 10702, Versailles Cedex 78013, France
| | - Marianne Millet
- Paris Fire Brigade, French Military Medical Service, 47 rue Saint Fargeau, Paris 75020, France
| | - Jonathan Gillard
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jerome Boissier
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Patrick Rondy
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jérôme Bancarel
- Medical Center of Rochefort, French Military Medical Service, BA 721 r Bois Bernard, Rochefort Air 17133, France
| | - Cyril Carfantan
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
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21
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Cañas RG, Suay RN, Moro CR, Martín DA, Bariaín RT, Jiménez JA. Strategic Orthopedic Evacuations to the Spanish Role 4 During a Decade (2009-2018). Mil Med 2021; 185:e734-e741. [PMID: 33527111 DOI: 10.1093/milmed/usz354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Casualty evacuation is a key point in medical support to military operations, sometimes being necessary to transfer them to National Territory for a definitive diagnosis and treatment. The aim of this work is to analyze the patients evacuated from Areas of Operations to the Orthopedic Surgery and Traumatology Unit of the Spanish Role 4 Medical Treatment Facility in the last 10 years. MATERIAL AND METHODS A cross-sectional, descriptive, and retrospective study carried out in the period between January 1, 2009 and December 31, 2018. The study population was all personnel evacuated from the Area of Operations to Spanish Role 4. For categorical variables, absolute and relative percent frequencies were used. Spanish military authorization was obtained to perform this study. This study has been approved by the Ethics and Clinical Research Committee of the Defense Central Hospital "Gómez Ulla" (code 12/17). RESULTS A total of 520 medical evacuations have been performed on Role 4, of which 227 were on the Orthopedic Surgery and Traumatology Unit. Seven percent of the evacuees were categorized as "combat" casualties. The areas of operations from which more patients have been evacuated were Afghanistan and Lebanon, 30.39% and 19.38%, respectively. The most frequent lesion pattern was the fracture affecting the extremities. Accidents (n = 98, 43.17%) and sport (n = 57; 25.3%) were the main causes of injury. Sixty-seven (29.51%) patients were treated surgically in Role 4. No deaths were recorded among patients in this series. CONCLUSION Evacuations because of trauma cause more than half of the medical repatriations carried out on the National Territory, of which the majority are due to fractures affecting the limbs, especially the bones of the hand. Sport was the first preventable cause of injury among evacuated patients. Our results are similar to the experience obtained by other allied armed forces. It is a moral imperative and a fundamental necessity for the Spanish military medical services to promote and maintain the Spanish Role 4 Medical Treatment Facility as an indispensable element in medical support for international missions.
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Affiliation(s)
- Rafael García Cañas
- Orthopedic Surgery and Traumatology Unit, Defense Central Hospital "Gómez Ulla", Glorieta del Ejército 1. 28047, Madrid, Spain
| | - Ricardo Navarro Suay
- Anesthesiology, Reanimation and Pain Treatment Unit, Defense Central Hospital "Gómez Ulla", Glorieta del Ejército 1. 28047, Madrid, Spain
| | - Carlos Rodríguez Moro
- Orthopedic Surgery and Traumatology Unit, Defense Central Hospital "Gómez Ulla", Glorieta del Ejército 1. 28047, Madrid, Spain
| | - Daniel Aedo Martín
- Orthopedic Surgery and Traumatology Unit, University Hospital del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Rafael Tamburri Bariaín
- Medical Services of the Spanish Royal Guard, Guardia Real española. Paseo del Pardo, 43, 28048 El Pardo, Madrid, Spain
| | - Javier Areta Jiménez
- Orthopedic Surgery and Traumatology Unit, Defense Central Hospital "Gómez Ulla", Glorieta del Ejército 1. 28047, Madrid, Spain
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Pawlukiewicz AJ, Bridwell RE, Carius BM, Schauer SG, Maddry JK, Davis WT. Analysis of U.S. Pacific Command Area of Operations Military Medical Transportations of Adult Patients, 2008 to 2018. Mil Med 2020; 187:e6-e10. [PMID: 33219660 DOI: 10.1093/milmed/usaa289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 11/13/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION With more than 370,000 military and civilian personnel stationed across Pacific Command (PACOM), medical evacuation in this largest command presents unique challenges. The authors describe medical evacuations analyzed from the U.S. Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES) in PACOM. MATERIALS AND METHODS We performed a retrospective review of all TRAC2ES medical records for medical evacuations of adult patients from the PACOM theater of operations conducted between January 1, 2008 and December 31, 2018. We abstracted free text data entry in TRAC2ES to characterize the diagnoses requiring patient movement. Data are presented using descriptive statistics. RESULTS During this 11-year period, 3,328 PACOM TRAC2ES encounters met inclusion criteria. Of these evacuations, 65.8% were male and were comprised mostly of active duty military (1,600, 48.1%) and U.S. civilians (1,706, 51.3%). Most transports originated in Japan (1,210 transports, 36.4%) or Guam (924 transports, 27.8%) with Hawaii (1,278 transports, 38.4%) as the most frequent destination. The majority of evacuations were routine (72.5%) with only 4.9% urgent evacuations. Medical conditions (2,905 transports, 87%) accounted for the largest proportion of transports, surpassing injuries (442 transports, 13%). The most common reasons for medical transports were behavioral health (671 transports, 20.2%) and cardiovascular disease (505 transports, 15.1%). CONCLUSIONS The majority of medical evacuations in PACOM were because of medical illness with routine precedence category, mirroring the largely noncombat operations occurring across this large area.
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Affiliation(s)
- Alec J Pawlukiewicz
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA
| | - Brandon M Carius
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA
| | - Steven G Schauer
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA.,U.S. Army Institute for Surgical Research, Fort Sam Houston, Texas, 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,59th Medical Wing, Joint Base San Antonio, Texas, USA
| | - Joseph K Maddry
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,59th Medical Wing, Joint Base San Antonio, Texas, USA
| | - William T Davis
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Suresh MR, Valdez-Delgado KK, Staudt AM, Trevino JD, Mann-Salinas EA, VanFosson CA. An Assessment of Pre-deployment Training for Army Nurses and Medics. Mil Med 2020; 186:203-211. [PMID: 33007065 DOI: 10.1093/milmed/usaa291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although military nurses and medics have important roles in caring for combat casualties, no standardized pre-deployment training curriculum exists for those in the Army. A large-scale, survey-based evaluation of pre-deployment training would help to understand its current state and identify areas for improvement. The purpose of this study was to survey Army nurses and medics to describe their pre-deployment training. MATERIALS AND METHODS Using the Intelink.gov platform, a web-based survey was sent by e-mail to Army nurses and medics from the active and reserve components who deployed since 2001. The survey consisted of questions asking about pre-deployment training from their most recent deployment experience. Descriptive statistics were used to analyze the results, and free text comments were also captured. RESULTS There were 682 respondents: 246 (36.1%) nurses and 436 (63.9%) medics. Most of the nurses (n = 132, 53.7%) and medics (n = 298, 68.3%) reported that they were evaluated for clinical competency before deployment. Common courses and topics included Tactical Combat Casualty Care, Advanced Cardiac Life Support, cultural awareness, and trauma care. When asked about the quality of their pre-deployment training, most nurses (n = 186; 75.6%) and medics (n = 359; 82.3%) indicated that their training was adequate or better. Nearly all nurses and medics reported being moderately confident or better (nurses n = 225; 91.5% and medics n = 399; 91.5%) and moderately prepared or better (nurses n = 223; 90.7% and medics n = 404; 92.7%) in their ability to provide combat casualty care. When asked if they participated in a team-based evaluation of clinical competence, many nurses (n = 121, 49.2%) and medics (n = 180, 41.3%) reported not attending a team training program. CONCLUSIONS Most nurse and medic respondents were evaluated for clinical competency before deployment, and they attended a variety of courses that covered many topics. Importantly, most nurses and medics were satisfied with the quality of their training, and they felt confident and prepared to provide care. Although these are encouraging findings, they must be interpreted within the context of self-report, survey-based assessments, and the low response rate. Although these limitations and weaknesses of our study limit the generalizability of our results, this study attempts to address a critical knowledge gap regarding pre-deployment training of military nurses and medics. Our results may be used as a basis for conducting additional studies to gather more information on the state of pre-deployment training for nurses and medics. These studies will hopefully have a higher response rate and better quantify how many individuals received any form of pre-deployment training. Additionally, our recommendations regarding pre-deployment training that we derived from the study results may be helpful to military leadership.
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Affiliation(s)
- Mithun R Suresh
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | | | - Amanda M Staudt
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Jennifer D Trevino
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Krajewski KT, Bansbach HM, McLean L, McKenzie C, Rawcliffe A, Graham SM, Flanagan SD, Pourmoghaddam A, Dettmer M, Connaboy C. Effects of Short-Term Unilateral Strength Training on Measures of Postural Control When Wearing "Operationally Relevant" Backpack Loads. J Strength Cond Res 2020; 34:2743-2750. [PMID: 32956262 DOI: 10.1519/jsc.0000000000003794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Krajewski, KT, Bansbach, HM, McLean, L, McKenzie, C, Rawcliffe, A, Graham, SM, Flanagan, SD, Pourmoghaddam, A, Dettmer, M, and Connaboy, C. Effects of short-term unilateral strength training on measures of postural control when wearing "operationally relevant" backpack loads. J Strength Cond Res 34(10): 2743-2750, 2020-To examine the effects of "operationally relevant" loads on postural stability and to determine the effects of unilateral and bilateral strength training programs on postural stability in healthy, recruit-aged men. Fifteen subjects were randomly assigned to either a unilateral (UL; n = 7) or bilateral (BL; n = 8) strength training group, which performed strength training 3 times a week for 4 weeks. Subjects completed the following pretest and post-test assessments: 1 repetition maximum in bilateral (1RM-BL) and unilateral (1RM-UL) stance positions and bilateral and unilateral balance tasks with eyes open and eyes closed. Balance tasks were performed over 3 loading conditions: body mass (BM), 50% BM, and 70% BM. Sample entropy (SE) and root mean square (RMS) were calculated from the center of pressures collected during each balance assessment. The UL strength training group showed significant improvement after training in both 1RM-UL (p < 0.01) and 1RM-BL (p < 0.01). The BL strength training group only showed significant improvement in 1RM-BL (p = 0.01). There was a significant main effect of load on RMS (p < 0.05) across all balance tasks with RMS increasing with increasing load. Sample entropy was found to decrease with increasing load in the unilateral eyes open and bilateral stance tasks. Significant increases in strength (∼10 to -29%) were observed; however, increased strength alone is not enough to mitigate the effects of load carriage on the postural control, even when training is performed in stance positions that are posturally challenging. Therefore, "operationally relevant" loads negatively impact postural stability in novice load carriers when assessing nonlinear measures.
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Affiliation(s)
- Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather M Bansbach
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Virginia, School of Engineering and Applied Science, Virginia
| | - Lucy McLean
- Edinburgh Napier University, Edinburgh, Scotland, United Kingdom
| | - Clive McKenzie
- Edinburgh Napier University, Edinburgh, Scotland, United Kingdom
| | - Alex Rawcliffe
- Department of Occupational Medicine, HQ ARITC, UK Ministry of Defence, United Kingdom; and
| | - Scott M Graham
- Edinburgh Napier University, Edinburgh, Scotland, United Kingdom
| | - Shawn D Flanagan
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Marius Dettmer
- Memorial Bone & Joint Research Foundation, Houston, Texas
| | - Chris Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Staudt AM, Suresh MR, Gurney JM, Trevino JD, Valdez-Delgado KK, VanFosson CA, Butler FK, Mann-Salinas EA, Kotwal RS. Forward Surgical Team Procedural Burden and Non-operative Interventions by the U.S. Military Trauma System in Afghanistan, 2008-2014. Mil Med 2020; 185:e759-e767. [PMID: 31863088 DOI: 10.1093/milmed/usz402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION No published study has reported non-surgical interventions performed by forward surgical teams, and there are no current surgical benchmarks for forward surgical teams. The objective of the study was to describe operative procedures and non-operative interventions received by battlefield casualties and determine the operative procedural burden on the trauma system. METHODS This was a retrospective analysis of data from the Joint Trauma System Forward Surgical Team Database using battle and non-battle injured casualties treated in Afghanistan from 2008-2014. Overall procedure frequency, mortality outcome, and survivor morbidity outcome were calculated using operating room procedure codes grouped by the Healthcare Cost and Utilization Project classification. Cumulative attributable burden of procedures was calculated by frequency, mortality, and morbidity. Morbidity and mortality burden were used to rank procedures. RESULTS The study population was comprised of 10,992 casualties, primarily male (97.8%), with a median age interquartile range of 25.0 (22.0-30.0). Affiliations were non-U.S. military (40.0%), U.S. military (35.1%), and others (25.0%). Injuries were penetrating (65.2%), blunt (32.8), and burns (2.0%). Casualties included 4.4% who died and 14.9% who lived but had notable morbidity findings. After ranking by contribution to trauma system morbidity and mortality burden, the top 10 of 32 procedure groups accounted for 74.4% of operative care, 77.9% of mortality, and 73.1% of unexpected morbidity findings. These procedure groups included laparotomy, vascular procedures, thoracotomy, debridement, lower and upper gastrointestinal procedures, amputation, and therapeutic procedures on muscles and upper and lower extremity bones. Most common non-operative interventions included X-ray, ultrasound, wound care, catheterization, and intubation. CONCLUSIONS Forward surgical team training and performance improvement metrics should focus on optimizing commonly performed operative procedures and non-operative interventions. Operative procedures that were commonly performed, and those associated with higher rates of morbidity and mortality, can set surgical benchmarks and outline training and skillsets needed by forward surgical teams.
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Affiliation(s)
- Amanda M Staudt
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234
| | - Mithun R Suresh
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234
| | - Jennifer M Gurney
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234.,Joint Trauma System, DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, TX 78234
| | - Jennifer D Trevino
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234
| | - Krystal K Valdez-Delgado
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234
| | - Christopher A VanFosson
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234
| | - Frank K Butler
- Joint Trauma System, DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, TX 78234
| | - Elizabeth A Mann-Salinas
- Joint Trauma System, DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, TX 78234
| | - Russ S Kotwal
- Joint Base San Antonio-Fort Sam Houston, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, TX 78234.,Joint Trauma System, DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, TX 78234
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26
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Johnson ON, Nelson M, Estabrooke I, Sopko N, Swanson EW. Successful Treatment of War Zone Traumatic Lower Extremity Wound With Exposed Tendons Using an Autologous Homologous Skin Construct. Cureus 2020; 12:e7952. [PMID: 32399374 PMCID: PMC7212742 DOI: 10.7759/cureus.7952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Extremity injuries are common in contemporary combat and have become more prevalent as fatality rates have dropped to historic lows. Traumatic extremity wounds, especially those sustained in theater, often present with exposed structures such as tendon, bone, and joint, preventing the use of split-thickness skin grafts (STSG) for coverage. Traditional reconstructive options for these complex wounds include skin substitute with delayed STSG, local flaps, debridement of tendons, pedicled distant flaps (such as cross-leg flap), free tissue transfer, and amputation. STSG, whether on top of skin substitutes or after tendon debridement, can result in contracture and functional limitations in the extremities. Flap reconstructions require prolonged procedures, hospital stays, and periods of immobility. As an alternative to traditional reconstructive options, an autologous homologous skin construct (AHSC) uses a small full-thickness elliptical skin harvest from the patient, which is sent to a biomedical manufacturing facility, processed into AHSC, and can be returned and applied to a wound bed as soon as 48 hours after harvest and used up to 14 days after harvest. We present in this case report the treatment of a 42 cm2 complex dorsolateral ankle wound with exposed tendons in an active duty soldier following a rollover motor vehicle accident sustained in theater. After application of AHSC, the soldier’s wound closed in nine weeks with pliable, sensate skin. The patient retained function without contractures limiting ankle motion or adhesions limiting tendon gliding. The successful treatment of this complex war zone injury with AHSC has allowed the soldier to quickly participate in unrestricted physical therapy and is on a trajectory for near-term return to active duty.
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Affiliation(s)
- Owen N Johnson
- Plastic Surgery, Evans Army Community Hospital, Colorado Springs, USA.,Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Michael Nelson
- Surgery Wound Care Clinic, Evans Army Community Hospital, Colorado Springs, USA
| | - Ivy Estabrooke
- Government Affairs, PolarityTE, Inc., Salt Lake City, USA
| | - Nikolai Sopko
- Research and Development, PolarityTE, Inc., Salt Lake City, USA
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27
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Military-Type Workload and Footwear Alter Lower Extremity Muscle Activity During Unilateral Static Balance: Implications for Tactical Athletic Footwear Design. Sports (Basel) 2020; 8:sports8050058. [PMID: 32354166 PMCID: PMC7281152 DOI: 10.3390/sports8050058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
Maintaining upright standing balance is critical for military personal. The impact of military footwear and occupation-related fatigue on muscle activity during balance performance has been previously documented. However, the current literature has not provided a muscle activation profile of the lower extremity during challenging conditions such as unilateral balance trials. Twenty-two recreationally active male participants (age: 22.2 ± 2.7 years; height: 177 ± 6.8 cm; mass: 79.8 ± 9.7 kg) donned two styles of military footwear (minimalist and standard) and performed a military style workload. Unilateral static balance was accessed before (PRE) and after (POST) the workload as surface electromyography was recorded on the right lower extremity. This study found that the minimalist footwear increased muscle activation prior to the workload compared to the standard footwear (co-contraction index mean difference: 0.149), whereas the standard footwear increased muscle activity after the workload (co-contraction index mean difference: 0.097). These findings suggest that footwear design characteristics affect lower extremity muscle activity differently depending on the workload condition. These findings intend to aid in the design of military footwear to maximize balance performance in a military population.
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28
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Carius B, Davis WT, Linscomb CD, Escandon MA, Rodriguez D, Uhaa N, Maddry JK, Chung KK, Schauer S. An analysis of US Africa command area of operations military medical transportations, 2008-2018. Afr J Emerg Med 2020; 10:13-16. [PMID: 32161706 PMCID: PMC7058873 DOI: 10.1016/j.afjem.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION With personnel scattered throughout a continent 3 times larger than the United States, a lack of mature medical facilities necessitates a significant transportation network for medical evacuation in US Africa Command (AFRICOM). We describe medical evacuations analyzed from the US Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES). METHODS We performed a retrospective review of all TRAC2ES medical records for medical evacuations from the AFRICOM theater of operations conducted between January 1, 2008 and December 31, 2018. We abstracted free text data entry in TRAC2ES for diagnostic and therapeutic interventions performed prior to the patient movement request. RESULTS During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM. 961 records were complete for analysis. Most patients were male (82%) and military personnel (92%). Most transports originated in Djibouti (72%), and Germany (93%) was the most common destination. Medical evacuations were largely routine (66%), and routine evacuations were proportionally highest amongst US military personnel compared to all other groups. A small portion of patients were evacuated for battle injuries (4%), compared to non-battle injury (33%) and disease (63%). Within disease, the largest proportion of patient complaints centered on gastrointestinal symptoms (13%), behavioral health (11%) and chest pain (8%). Prior to evacuation, only 55% of patients were document as receiving any medication. Pain control was documented in 21% of cases, most commonly being NSAIDs (7%). DISCUSSION Extremely low numbers of battle injuries highlight the unique nature of AFRICOM operations compared to areas with more intense combat operations. Limitations of the dataset highlight the need for a data collection mandate within AFRICOM as within other areas for optimization and performance improvement.
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Affiliation(s)
- Brandon Carius
- Emergency Medicine Department, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, TX, USA
- Corresponding author at: 3551 Roger Brooke Drive, Joint Base San Antonio – Fort Sam Houston, TX 78234, USA.
| | - William T. Davis
- Emergency Medicine Department, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, TX, USA
- 59th Medical Detachment Wing, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Carlissa D. Linscomb
- 59th Medical Detachment Wing, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Mireya A. Escandon
- 59th Medical Detachment Wing, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Dylan Rodriguez
- 59th Medical Detachment Wing, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Nguvan Uhaa
- US Army Institute of Surgical Research, Joint Base San Antonio – Fort Sam Houston, TX, USA
| | - Joseph K. Maddry
- Emergency Medicine Department, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, TX, USA
- 59th Medical Detachment Wing, Joint Base San Antonio – Lackland, San Antonio, TX, USA
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Kevin K. Chung
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Steve Schauer
- Emergency Medicine Department, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, TX, USA
- US Army Institute of Surgical Research, Joint Base San Antonio – Fort Sam Houston, TX, USA
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Rodriguez RM, Ernat JJ. Ultrasonography for Dorsal-Sided Wrist Pain in a Combat Environment: Technique, Pearls, and a Case Report of Dynamic Evaluation of the Scapholunate Ligament. Mil Med 2020; 185:e306-e311. [PMID: 31247089 DOI: 10.1093/milmed/usz157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/18/2019] [Indexed: 11/12/2022] Open
Abstract
Ultrasonography is a commonly utilized tool in orthopedic surgery for the diagnosis and treatment of a variety of musculoskeletal conditions, including pathology about the wrist. Its value should not be underestimated when other diagnostic resources are unavailable - such as in a combat setting where ultrasounds, but not X-ray, are a standard equipment item. An active duty soldier presented to an orthopedic provider in an austere environment with chronic dorsal wrist pain due to a previous fall. Physical examination and dynamic ultrasound examination allowed the deployed provider to diagnose a scapholunate ligament injury. The patient was appropriately evacuated to a higher level of care without the need for X-ray or other advanced imaging modalities. Making this readily available resource a standard tool for providers deployed to a forward location could be beneficial for efficient and appropriate patient evacuation for musculoskeletal injuries. It can also rule out injuries that would otherwise have required unnecessary soldier movement through hostile territory for diagnostic tests such as X-rays. In addition, a simple technique and pearls for ultrasonography of the wrist are provided.
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Affiliation(s)
- Ryan M Rodriguez
- Madigan Army Medical Center, 9040 Jackson Ave., Joint Base Lewis-McChord, WA 98433
| | - Justin J Ernat
- Blanchfield Army Community Hospital, 650 Joel Dr., Fort Campbell, KY 42223
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A Profile of Injuries Sustained by Firefighters: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203931. [PMID: 31623104 PMCID: PMC6843477 DOI: 10.3390/ijerph16203931] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 01/09/2023]
Abstract
Firefighters, along with other tactical personnel, are at a high risk of work-related physical injury above that of the private sector. The aim of this critical narrative review was to identify, critically appraise and synthesise key findings from recent literature investigating firefighting musculoskeletal injuries to inform injury reduction programs. The methodological approach (search terms, databases, etc.) was registered with PROSPERO and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using the Downs and Black checklist with scores graded according to the Kennelly grading system. Levels of evidence were ranked according to the Australian National Health and Medical Research Council. Of the 8231 studies identified, 17 met the criteria for inclusion. The methodological quality of the studies was ‘fair’ with a level of evidence of III-2. Reported injury rates ranged from 9% to 74% with the lower extremities and back the leading aggregated bodily sites of injury. Sprains and strains were the leading nature of musculoskeletal injury, often caused by slips, trips and falls, although muscle bending, lifting and squatting or muscle stressing were also prevalent. This review may inform injury reduction strategies and given that injuries reported in firefighters are similar to those of other tactical populations, safety processes to mitigate injuries may be of benefit across the tactical spectrum.
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31
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Mathais Q, Montcriol A, Cotte J, Gil C, Contargyris C, Lacroix G, Prunet B, Bordes J, Meaudre E. Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases. PLoS One 2019; 14:e0223497. [PMID: 31584991 PMCID: PMC6777794 DOI: 10.1371/journal.pone.0223497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations. OBJECTIVE This study aimed to describe and analyze French anesthetic activity in a deployed military setting. METHODS Between October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital. RESULTS During the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations. CONCLUSION In the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.
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Affiliation(s)
- Quentin Mathais
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
- * E-mail:
| | - Ambroise Montcriol
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
| | - Jean Cotte
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
| | - Céline Gil
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
| | - Claire Contargyris
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
| | - Guillaume Lacroix
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
| | - Bertrand Prunet
- Service Médical de la Brigade des Sapeurs Pompiers de Paris, Paris, France
- French Military Health Service Academy Unit, Ecole du Val-De-Grâce, Paris, France
| | - Julien Bordes
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
- French Military Health Service Academy Unit, Ecole du Val-De-Grâce, Paris, France
| | - Eric Meaudre
- Department of Anesthesiology and Intensive care, Military Hospital Sainte-Anne, Toulon, France
- French Military Health Service Academy Unit, Ecole du Val-De-Grâce, Paris, France
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Huizinga E, Idenburg FJ, van Dongen TTCF, Hoencamp R. Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life. BMJ Mil Health 2019; 166:e13-e16. [PMID: 31005884 DOI: 10.1136/jramc-2019-001194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Throughout history, diseases and non-battle injuries (DNBI) have threatened deployed forces more than battlefield injuries. During the Dutch involvement in Afghanistan, the amount of DNBI that needed medical evacuation out of theatre (60%) exceeded the number of battle injuries (40%). The aim of this study is to explore the long-term quality of life (QoL) of Dutch service members that acquired a DNBI, warranting repatriation during their deployment to Afghanistan between 2003 and 2014. METHODS Observational cross-sectional cohort study in a selected group of Dutch service members who deployed to Afghanistan 2003-2014 and were repatriated due to DNBI. Using the 36-item Short Form, EuroQol-6D, Symptom Checklist 90 and Post Deployment Reintegration Scale questionnaires, their outcomes were compared with a control group of deployed service members who did not sustain injuries or illnesses. RESULTS Groups were comparable in age, rank, number of deployments and social status. There were significant differences found in terms of physical functioning, pain and health perspective. No differences were seen in emotional or psychological outcomes. CONCLUSION The amount of military service members who contract a DNBI is significant and imposes a burden on the capacity of the medical support, readiness of deployed units and sustainability of ongoing operations. However, regarding QoL, being forced to leave their units and to be repatriated to their home country due to a DNBI seems to have no significant impact on reported psychological symptoms of distress and reintegration experiences. Future research should focus on more in-depth registration of illnesses and not combat related diseases and injuries and even longer-term outcomes.
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Affiliation(s)
- Eelco Huizinga
- Department of Surgery, Central Military Hospital, Utrecht, the Netherlands .,Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands
| | - F J Idenburg
- Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands
| | - T T C F van Dongen
- Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands.,Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
| | - R Hoencamp
- Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands.,Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Schauer SG, Naylor JF, Long AN, Mora AG, Le TD, Maddry JK, April MD. Analysis of Injuries and Prehospital Interventions Sustained by Females in the Iraq and Afghanistan Combat Zones. PREHOSP EMERG CARE 2019; 23:700-707. [DOI: 10.1080/10903127.2018.1560849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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