Management of Rib Fractures in the Combat Environment

Rib fractures in combat casualties are an under-appreciated injury, and their treatment may become more common as more patients survive because of modern body armor and point-ofinjury care. The combat environment has challenges such as equipment availability and sterility. A simple and thoughtful rib fracture treatment algorithm may be useful to reduce the morbidity and mortality of rib fractures in the combat environment. Intravenous lidocaine infusions for patients with traumatic rib fractures may have important combat applications. We propose an algorithm for the management of combat casualties with traumatic rib fractures.

Revisiting Desmond Doss (1919-2006): Merging Combat Medicine and Benevolence on the Battlefield

Conscientious objectors are typically defined only by their unwillingness to serve in the armed forces. Desmond Doss participated in World War II as a combat medic and a conscientious objector by providing emergency medicine on active battlefields while refusing to handle a weapon or harm another human being. Born and raised with humility, Doss developed spiritually as a Seventh Day Adventist. Although fixated on the Ten Commandments and "Thou shall not kill," Doss felt a call to serve and voluntarily enlisted in the U.S. Army with aspirations of becoming a combat medic. Throughout his training he was met with physical, spiritual, and political obstacles as his superiors unsuccessfully tried to convince him and eventually to force him out of the military or to take up arms and fight. Doss was granted his request as a combat medic, was not required to handle a weapon or fight, and was deployed with the 307th Infantry Regiment overseas. His heroism on the battlefield saved hundreds of lives and earned him the Medal of Honor. A thorough yet concise examination of Doss' formative years, the obstacles presented by the country he aimed to serve, how he evolved from a conscientious objector to a combat medic worthy of emulation, and his lasting legacy is a necessary reminder of what we risk when courageous people are limited by outdated and potentially unconstitutional policies and perceptions.

Novel approach to the diagnosis of fractures in an austere environment using a stethoscope and a cellular phone

BACKGROUND

Fracture diagnosis in the austere environment where radiographic tests are not available can be a challenge. In the past, a diagnostic technique has been described using a tuning fork and stethoscope to assess decreased sound conduction in the fractured extremity. In this study, we evaluate the use of a cellular phone's vibrate function and a stethoscope to limit equipment carried by expeditionary practitioners.

OBJECTIVE

The purpose of this study was to evaluate the accuracy of fracture diagnosis using a cellular phone and stethoscope.

METHODS

This is a pilot study to assess the usefulness of the above technique before clinical implementation. In 3 cadavers, we created fractures of the humerus and femur. Twenty-seven emergency medicine residents and an attending physician performed the diagnostic technique.

RESULTS

Overall, the use of the cellular phone and stethoscope resulted in a sensitivity of 73% (95% confidence interval [CI]: 0.64 to 0.81) and a specificity of 83% (95% CI: 0.77 to 0.88), with a positive predicted value of 68% (95% CI: 0.59 to 0.77) and a negative predicted value of 86% (95% CI: 0.81 to 0.90). Positive likelihood ratio was 4.3, and negative likelihood ratio was 0.32.

CONCLUSIONS

The use of a cellular phone and stethoscope may be a useful tool for the diagnosis of fractures in the austere environment. However, further study is needed to validate these findings in the clinical environment.

Syrian field hospitals: A creative solution in urban military conflict combat in Syria

Since the war started in Syria nearly two years ago several independent organizations reported the use of medicine as a weapon by the Syrian authorities, killing of doctors and arresting patients who were admitted to the hospitals for treatment. In year 2012 the World Health Organization (WHO) found nearly 50% of hospitals are not functioning due to lack of staff, equipment and medicine. This report highlights how the doctors in Syria are creative and courageous to risk their own lives to save thousands of innocent lives.