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Karp MC, April MD, Newberry RK, Schauer SG. Associations with Prehospital Antibiotic Receipt among Combat Casualties with Open Wounds: A Department of Defense Trauma Registry Study. Mil Med 2024; 189:e606-e611. [PMID: 37647617 DOI: 10.1093/milmed/usad323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Current Tactical Combat Casualty Care (TCCC) guidelines recommend antibiotic administration for all open wounds to prevent infection. We identified associations between demographics, procedures, and medicines with the receipt of prehospital antibiotics among combat casualties. MATERIALS AND METHODS We used a series of emergency department procedure codes to identify adult subjects within the Department of Defense Trauma Registry from January 2007 to August 2016 who sustained open wounds. We compared demographics, procedures, and medicines administered among casualties receiving prehospital wound prophylaxis versus casualties not receiving antibiotic prophylaxis. We controlled for confounders with multivariable logistical regression. RESULTS We identified 18,366 encounters meeting inclusion criteria. Antibiotic recipients (n = 2384) were comparable to nonrecipients (n = 15,982) with regard to age and sex. Antibiotic recipients were more likely to sustain injuries from firearms and undergo all procedures examined related to hemorrhage control, airway management, pneumothorax treatment, and volume replacement except for intraosseous access. Antibiotic recipients were less likely to sustain injuries from explosives. Antibiotic recipients had a modestly higher survival than nonrecipients (97.4% versus 96.0%). Associations with prehospital antibiotic receipt in multivariable logistic regression included non-North Atlantic Treaty Organization military force affiliation (odds ratio (OR) 4.65, 95% CI, 1.0-20.8), tachycardia (OR 3.4, 95% CI, 1.1-10.5), intubation (OR 2.0, 95% CI, 1.1-3.8), and administration of tranexamic acid (OR 5.6, 95% CI, 1.2-26.5). CONCLUSIONS The proportion of combat casualties with open wounds receiving prehospital antibiotics was low despite published recommendations for early antibiotics in patients with open wounds. These findings highlight the ongoing need for additional educational and quality assurance initiatives to continue improving adherence to TCCC guidelines with regard to prehospital antibiotic administration. Future studies are necessary to determine reasons for suboptimal TCCC guideline compliance.
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Affiliation(s)
- Marissa C Karp
- Adjutant General Captains Career Course, Fort Jackson, SC 29207, USA
| | - Michael D April
- 14th Field Hospital, Fort Stewart, GA, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ryan K Newberry
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Departments of Anesthesiology and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
- Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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Sellier A, Beucler N, Joubert C, Julien C, Tannyeres P, Anger F, Bernard C, Desse N, Dagain A. Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons. Mil Med 2024; 189:598-605. [PMID: 35906867 DOI: 10.1093/milmed/usac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/03/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon. MATERIALS AND METHODS A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data. RESULTS A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury. CONCLUSIONS This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
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Affiliation(s)
- Aurore Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Christophe Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Clément Julien
- Department of Visceral Surgery, Laveran Military Hospital, Marseille 13384, France
| | - Paul Tannyeres
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Florent Anger
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Cédric Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris Cedex 5 75230, France
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Melau J, Bergan-Skar P, Callender N, Rognhaug M, Bekkestad E. 3D-Printed Tourniquets Used at the Battlefront in Ukraine: A Pilot Study. J Spec Oper Med 2023; 23:87-91. [PMID: 38133635 DOI: 10.55460/7nii-vt7t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The war in Ukraine urged a need for prompt deliv- erance and resupply of tourniquets to the front. Producing tour- niquets near the battlefront was a feasible option with respect to resupply and cost. METHODS A locally produced 3D-printed tourniquet (Ukrainian model) from the "Tech Against Tanks" charity was tested against commercially available and Committee of Tactical Combat Casualty Care (CoTCCC)- recommended tourniquets (C-A-T™ and SOF™TT-W). We tested how well the tourniquets could hold pressure for up to 2 hours. RESULTS A Kruskal-Wallis test revealed significant differences between the groups (p<.05). Post-hoc testing revealed a signif- icant difference between the C-A-T and the Ukrainian tourni- quet (p=.004). A similar significance was not found between the SOF™TT-W Wide and the Ukrainian model (p=.08). Dis- cussion: The Ukrainian model can hold pressure as well as the commercially available tourniquets. There is much value if this can be produced close to the battlefield. Factors including lo- gistics, cost, and self-sufficiency are important during wartime. CONCLUSION We found that our sample of 3D-printed tourni- quets, currently used in the war in Ukraine, could maintain pressure as well as the commercially available tourniquets. In- deed, our tests demonstrated that it could maintain a signifi- cantly higher pressure.
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Chen J, Tsur AM, Nadler R, Beit Ner E, Sorkin A, Radomislensky I, Peleg K, Ben Avi R, Shushan G, Glassberg E, Benov A. Ten-year reduction in thoracic injury-related mortality among Israel Defense Forces soldiers. BMJ Mil Health 2023; 169:510-516. [PMID: 34930818 DOI: 10.1136/bmjmilitary-2021-001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation of the 2012 IDF-Military Corps 'My Brother's Keeper' plan which included the publication of clinical practice guidelines (CPGs) for thoracic injuries, emphasis on adequate torso protection, introduction of modern life-saving procedures and encouragement of rapid evacuation. METHODS The IDF prehospital trauma registry was reviewed to identify all patients who sustained thoracic injuries from January 2006 to December 2017. IDF soldiers who were injured, died of wounds or killed in action (KIA) were included. These were cross-referenced with the Israel National Trauma Registry. The periods before and after the plan were compared. RESULTS 458 (12.3%) of 3733 IDF soldiers wounded on the battlefield sustained combat-related thoracic injuries. The overall mortality was 44.3% before the CPG and 17.3% after (p<0.001). Most were KIA: 97% (95 of 98) died by 30 June 2012, and 83% (20 of 24) after (p<0.001). Casualties treated with needle thoracostomy before and after CPG were 6.3% and 18.3%, respectively (p=0.002). More tube thoracostomies were performed after June 2012 (16.1% vs 5.4%, p=0.001). Evacuation was faster after June 2012 (119.4 min vs 560.8 min, p<0.001), but the rates of casualties evacuated within 60 min were similar (21.1% vs 25%, p=0.617). CONCLUSIONS Among military casualties with thoracic injuries, the rate of life-saving interventions increased, evacuation time decreased and mortality dropped following the implementation of My Brother's Keeper plan.
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Affiliation(s)
- Jacob Chen
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Hospital Management, Meir Medical Center, Kefar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A M Tsur
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases Israel, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - R Nadler
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- General Surgery B, Sheba Medical Center, Ramat Gan, Israel
| | - E Beit Ner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Orthopedic, Shamir Medical Center, Zerifin, Israel
| | - A Sorkin
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - I Radomislensky
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Gertner Institute for Health Policy and Epidemiology, Tel HaShomer, Israel
| | - K Peleg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Health Policy and Epidemiology, Tel HaShomer, Israel
| | - R Ben Avi
- Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel
| | - G Shushan
- Ground Forces Technology Unit, Tel Hashomer, Israel Defense Forces, Ramat Gan, Israel
| | - E Glassberg
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - A Benov
- Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Holm E, Cook J, Porter K, Nelson A, Weishar R, Mallory T, Cantor A, Croft C, Liwag J, Harrington CJ, DesRosiers TT. A Quantitative and Qualitative Literature Analysis of the Orthopedic Surgeons' Experience: Reflecting on 20 Years in the Global War on Terror. Mil Med 2023; 188:2924-2931. [PMID: 35862000 DOI: 10.1093/milmed/usac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/18/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION After over 20 years of war in the Middle East, orthopedic injuries have been among the most prevalent combat-related injuries, accounting for 14% of all surgical procedures at Role 2/3 (R2/R3) facilities according to the DoD Trauma Registry. To further delineate the role of the deployed orthopedic surgeon on the modern battlefield, a retrospective review was performed highlighting both quantitative and qualitative analysis factors associated with orthopedic surgical care during the war in the Middle East. METHODS A retrospective review was conducted of orthopedic surgeons in the Middle East from 2001 to 2021. A comprehensive literature search was conducted using the PubMed and Embase databases using a two-reviewer strategy. Articles were compiled and reviewed using Covidence. Inclusion criteria included journal articles focusing on orthopedic injuries sustained during the Global War on Terror (GWoT) in an adult U.S. Military population. In the event of a conflict, a third author would determine the relevance of the article. For the remaining articles, a full-text review was conducted to extract relevant predetermined quantitative data, and the Delphi consensus method was then utilized to highlight relevant qualitative themes. RESULTS The initial search yielded 1,226 potentially relevant articles. In all, 40 studies ultimately met the eligibility criteria. With the consultation of previously deployed orthopedic surgeons at the Walter Reed National Military Medical Center, a retrospective thematic analysis of the 40 studies revealed five themes encompassing the orthopedic surgeons experience throughout GWoT. These themes include unique mechanisms of orthopedic injury compared to previous war injuries due to novel weaponry, differences in interventions depending on R2 versus R3 locations, differences in injuries from those seen in civilian settings, the maintained emphasis on humanitarian aspect of an orthopedic surgeon's mission, and lastly relation of pre-deployment training to perceived deployed success of the orthopedic surgeons. From this extensive review, we found that explosive mechanisms of injury were greatly increased when compared to previous conflicts and were the etiology for the majority of orthopedic injuries sustained. With the increase of complex explosive injuries in the setting of improved body armor and overall survival, R2/3 facilities showed an increased demand for orthopedic intervention including debridement, amputations, and external fixation. Combat injuries sustained during the GWoT differ in the complications, management, and complexity when compared to civilian trauma. "Humanitarian" cases made up a significant number of operative cases for the deployed orthopedic surgeon. Lastly, heterogeneous training opportunities were available prior to deployment (fellowship, combat extremity surgical courses, and dedicated pre-deployment training), and the most commonly identified useful training was learning additional soft-tissue coverage techniques. CONCLUSION These major themes indicate an emphasis on pre-deployment training and the strategic positioning of orthopedic surgeons to reflect the changing landscape of musculoskeletal trauma care. Moving forward, these authors recommend analyzing the comfort and perceived capability of orthopedic surgeons in these unique military environments to best prepare for a changing operational format and the possibility of future peer-peer conflicts that will likely lead to a lack of medical evacuation and prolonged field care.
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Affiliation(s)
- Erik Holm
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - John Cook
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Kaitlin Porter
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew Nelson
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Robert Weishar
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Taylor Mallory
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Addison Cantor
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Caitlynn Croft
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jonah Liwag
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Colin J Harrington
- Department of Orthopedics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Taylor T DesRosiers
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Combat Trauma Research Group U.S. Navy, USA
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Pickering C, Muzaffar J, Reid C, Zakaria B, Coulson C, Sharma N, Breeze J. Management and outcomes of military penetrating neck injuries: An eleven-year retrospective case note review. Injury 2023; 54:119-123. [PMID: 36400629 DOI: 10.1016/j.injury.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Penetrating Neck Injuries (PNIs) affected 3.2% of trauma patients attending US and UK deployed medical treatment facilities (MTFs) during the Iraq and Afghanistan conflicts. Injured military personnel requiring aeromedical evacuation for such injuries were managed at the Royal Centre for Defence Medicine (RCDM), Birmingham, UK. The aim of this paper was to review the management of PNI in both deployed MTFs and when evacuated back to the UK. PATIENTS AND METHODS A retrospective case note review was performed of all military patients who sustained PNI whilst on deployment overseas, and who were subsequently evacuated to RCDM between March 2003 and December 2014. RESULTS Forty casualties who sustained PNI were identified, of which 28/40 (70%) sustained injury from explosive fragmentation, and 11/40 (28%) from gunshot wounds. Hard signs of PNI were present in 3/40 (7.5%) patients, soft signs in 14/40 (35%), no signs in 12/40 (30%), and unknown signs in 11/40 (28%) patients. Computed tomography angiography (CTA) was used in 39/40 (98%) patients, and was effective at ruling out significant injury, with 100% (29/29) of casualties with a negative CTA not developing vascular or aerodigestive injury. There were 9/29 (31%) patients who had surgical neck exploration despite both a negative CTA and absence of hard signs of PNI. There were 12/40 (30%) patients who required operative intervention at RCDM. CONCLUSION UK military surgeons in Role 3 MTFs had a low threshold for surgical exploration, even in the absence of CT findings or hard signs. This was likely due to the high-energy mechanisms responsible for military PNI, in addition to the limited availability of equipment and clinical expertise in visualising the larynx.
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Affiliation(s)
- Christopher Pickering
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
| | - Jameel Muzaffar
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK; University of Cambridge School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
| | - Conor Reid
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
| | - Benjamin Zakaria
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - Christopher Coulson
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - Neil Sharma
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; University of Birmingham Medical School, College of Medical and Dental Sciences, Birmingham, B15 2TT, UK.
| | - John Breeze
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK; Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK.
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Stevens RA, Pierce B, Tilley L. Airway and Hypothermia Prevention: and Treatment via STEAM The System for Thermogenic Emergency Airway Management. J Spec Oper Med 2022; 22:72-76. [PMID: 36525016 DOI: 10.55460/v1fb-01lu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Military medicine has made significant advancements in decreasing mortality by addressing the lethal triad - metabolic acidosis, coagulopathy, and hypothermia. However, casualties are still succumbing to injury. Recent conflict zones have led to the development of remarkable life-saving innovations, including the management of compressible hemorrhage and whole blood transfusions. Nevertheless, hypothermia prevention and treatment techniques remain relatively unchanged. Hypothermia prevention is anticipated to become more critical in future operations due to a predicted increase in evacuation times and reliance on Prolonged Casualty Care (PCC). This is likely secondary to increasingly distanced battlespaces and the mobility challenges of operating in semi-/non-permissive environments. Innovation is essential to combat this threat via active airway rewarming in the vulnerable patient. Thus, we propose the development, fabrication, and efficacy testing of a device in which we estimate being able to control temperature and humidity at physiologic levels in the PCC setting and beyond.
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Daniel Y, Derkenne C, Mahe P, Travers S, Martinaud C. Where Do We Stand on "Buddy Transfusion" During Military Operations? J Spec Oper Med 2022; 22:46-49. [PMID: 36525011 DOI: 10.55460/j1x0-4x05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Warm fresh whole-blood transfusion between comrades on the battlefield, also known as "buddy transfusion," has been thrust back into the limelight for several years now. It means drawing blood on the battlefield, once a bleeding soldier needs a transfusion, from one of their uninjured companions and immediately infusing it. It is a lifesaving procedure, effective and hardy. This work aims to answer the main questions that military caregivers might have about it: interest of this procedure, donor and recipient safety, and hemostatic capacity of the blood collected this way.
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Abstract
Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose-the UK Defence Medical Services have become familiar with tools such as multiplex PCR and mass spectrometry. These have the potential to accurately identify organisms and sensitivity patterns in austere environments. Management of communicable diseases depends on accurate diagnosis and has a largely well-established evidence base but can be limited by a lack of resources and skills in an austere setting, therefore telemedicine can assist diagnosis and treatment of infections by projecting specialist skill. Systems such as EpiNATO2 are useful in monitoring diseases and identifying trends in order to establish control measures. Many of these tools and techniques are effective in austere environments and offer learning opportunities for those providing care in similar settings. Further research is ongoing into diagnostic tools as well as remote management.
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Fisher AD, DesRosiers TT, Papalski W, Remley MA, Schauer SG, April MD, Blackman V, Brown J, Butler FK, Cunningham CW, Gurney JM, Holcomb JB, Montgomery HR, Morgan MM, Motov SM, Shackelford SA, Sprunger T, Drew B. Analgesia and Sedation for Tactical Combat Casualty Care: TCCC Proposed Change 21-02. J Spec Oper Med 2022; 22:154-165. [PMID: 35639907 DOI: 10.55460/8cbi-gaod] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Analgesia in the military prehospital setting is one of the most essential elements of caring for casualties wounded in combat. The goals of casualty care is to expedite the delivery of life-saving interventions, preserve tactical conditions, and prevent morbidity and mortality. The Tactical Combat Casualty Care (TCCC) Triple Option Analgesia guideline provided a simplified approach to analgesia in the prehospital combat setting using the options of combat medication pack, oral transmucosal fentanyl, or ketamine. This review will address the following issues related to analgesia on the battlefield: 1. The development of additional pain management strategies. 2. Recommended changes to dosing strategies of medications such as ketamine. 3. Recognition of the tiers within TCCC and guidelines for higher-level providers to use a wider range of analgesia and sedation techniques. 4. An option for sedation in casualties that require procedures. This review also acknowledges the next step of care: Prolonged Casualty Care (PCC). Specific questions addressed in this update include: 1) What additional analgesic options are appropriate for combat casualties? 2) What is the optimal dose of ketamine? 3) What sedation regimen is appropriate for combat casualties?
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Kulakov AA, Grebnev GA, Brailovskaya TV, Bagnenko AS, Ilyin SV, Ishniyazova AI. [Long-term results of dental implantation in military personnel]. Stomatologiia (Mosk) 2022; 101:31-35. [PMID: 35362700 DOI: 10.17116/stomat202210102131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Currently, the use of the dental implantation method for the medical service of the Armed Forces of the Russian Federation is quite new. The method of dental implantation makes it possible to eliminate defects in the dentition of military personnel and other contingents eligible for medical care in military medical institutions of the Ministry of Defense of Russia. OBJECTIVE The aim of the study is to substantiate the medical effectiveness of the use of dental implantation in military healthcare. MATERIAL AND METHODS The study was conducted on the basis of the Department of Maxillofacial Surgery and Surgical Dentistry of the Military Medical Academy named after S.M. Kirov. The study is based on the analysis of long-term results of dental implantation according to medical histories and outpatient records. The study was conducted in 3 stages: stage 1 - study of the medical histories of patients who underwent dental implantation; stage 2 - examination of patients with dental implants and analysis of long-term results; stage 3 - a patient questionnaire was conducted to determine the effectiveness of dental implantation. RESULTS The structure of complications during dental implantation was revealed. Clinical examples of long-term results of prosthetics using dental implants are presented. It has been established that due to the peculiarity of military service and the remoteness of the locations of military units from the military medical organization, it is not always possible to conduct regular medical examinations and examinations of patients. To identify early symptoms of peri-implantitis, which is more often asymptomatic, preventive examinations of military personnel should be carried out 1-2 times a year. CONCLUSION To increase the service life of an orthopedic structure with installed dental implants, regular preventive examinations of patients to identify pathological processes are important. In favor of implantation, there is a choice for some categories of military personnel. This is especially important for flight and naval personnel, since dentures installed on dental implants are the only way to preserve their professional suitability in the military accounting specialty. The presence of teeth and the absence of removable dentures is an important requirement when performing combat missions.
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Affiliation(s)
- A A Kulakov
- National Medical Research Center «Central Research Institute of Dentistry and Maxillofacial Surgery» of Ministry of Health of the Russian Federation, Moscow, Russia
| | - G A Grebnev
- Military Medical Academy named after S.M. Kirov, St. Petersburg, Russia
| | - T V Brailovskaya
- National Medical Research Center «Central Research Institute of Dentistry and Maxillofacial Surgery» of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A S Bagnenko
- National Medical Research Center «Central Research Institute of Dentistry and Maxillofacial Surgery» of Ministry of Health of the Russian Federation, Moscow, Russia
| | - S V Ilyin
- Military Medical Academy named after S.M. Kirov, St. Petersburg, Russia
| | - A I Ishniyazova
- First Saint Petersburg State Medical University named after Academician I.P. Pavlov, St. Petersburg, Russia
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Duchesne J, Taghavi S, Houghton A, Khan M, Perreira B, Cotton B, Tatum D. Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged: A Summary of Current Civilian EMS Practices and New Military Changes. Shock 2021; 56:3-8. [PMID: 32080059 DOI: 10.1097/shk.0000000000001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Mortality secondary to trauma-related hemorrhagic shock has not improved for several decades. Underlying the stall in progress is the conundrum of effective prehospital interventions for hemorrhage control. As we know, neither pressing hard on the gas nor "stay and play" has changed mortality over the last 20 years. For this reason, when dealing with effective changes that will improve severe hemorrhage mortality outcomes, there is a need for the creation of a hybrid prehospital model. Improvements in mortality outcomes for patients with severe hemorrhage based on evidence for common civilian prehospital procedures such as in-field intubation and immediate fluid resuscitation with crystalloid solution are weak at best. The use of tourniquets, once considered too risky to use, however, has risen dramatically in large part due to success seen during their use in the military. Their use in the civilian setting shows promising results. Recently updated military Advanced Resuscitative Care guidelines propose the use of prehospital whole blood transfusion as well as in-field use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta. Several case studies from Europe suggest these strategies are feasible for use in the civilian population, but could they be implemented in the US?
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Affiliation(s)
- Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Sharven Taghavi
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - August Houghton
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defense Medicine, UK
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Bryan Cotton
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Danielle Tatum
- Trauma Specialist Program, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana
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13
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Abstract
Numerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey Fellowship in the History of Medicine, we conducted archival research to shed light on the lessons that civilian surgery has learned from the military system and vice-versa. Several historical case studies highlight the need for immersive programs where surgeons from the military and civilian sectors can gain exposure to the techniques, expertise, and institutional knowledge the other domain provides. Our findings demonstrate the benefits and promise of structured programs to promote reciprocal learning between military and civilian surgery.
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Affiliation(s)
- Divyansh Agarwal
- Medical Scientist Training Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Clyde F Barker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ali Naji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - C William Schwab
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
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Sullivan-Kwantes W, Haman F, Kingma BRM, Martini S, Gautier-Wong E, Chen KY, Friedl KE. Human performance research for military operations in extreme cold environments. J Sci Med Sport 2021; 24:954-962. [PMID: 33358087 DOI: 10.1016/j.jsams.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/06/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Soldier performance in the Arctic depends on planning and training, protective equipment, and human physiological limits. The purpose of this review was to highlight the span of current research on enhancing soldier effectiveness in extreme cold and austere environments. METHODS The practices of seasoned soldiers who train in the Arctic and cold-dwelling natives inform performance strategies. We provide examples of research and technology that build on these concepts. RESULTS Examples of current performance research include evaluation of equipment and tactics such as the bioenergetics of load carriage over snow in Norwegian exercises; Canadian field monitoring of hand temperatures and freezing cold injuries for better protection of manual dexterity; and Dutch predictive modeling of cold-wet work tolerances. Healthy young men can respond to cold with a substantial thermogenic response based on US and Canadian studies on brown adipose tissue and other mechanisms of non-shivering thermogenesis; the potential advantage of greater fat insulation is offset in obese unfit subjects by a smaller thermogenic response. Current physiological studies are addressing previously unanswered problems of cold acclimation procedures, thermogenic enhancement and regulation, and modulation of sympathetic activation, all of which may further enhance cold survival and expand the performance envelope. CONCLUSION There is an inseparable behavioral component to soldier performance in the Arctic, and even the best equipment does not benefit soldiers who have not trained in the actual environment. Training inexperienced soldiers to performance limits may be helped with personal monitoring technologies and predictive models.
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Affiliation(s)
| | | | - Boris R M Kingma
- TNO, The Netherlands Organization for Applied Sciences, Soesterberg, The Netherlands
| | - Svein Martini
- Norwegian Defence Research Establishment, Kjeller, Norway
| | - Emilie Gautier-Wong
- Les Voltigeurs de Québec, 35 Canadian Brigade Group, Quebec City, Quebec, Canada
| | - Kong Y Chen
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Karl E Friedl
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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15
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Abstract
INTRODUCTION Prehospital management of intentional mass casualty incidents is a unique challenge to Emergency Medical Services. Tactical Combat Casualty Care (TCCC) and the use of tourniquets for extremity hemorrhage have already proven to reduce mortality on the battlefield. This literature review aims to determine the place of these military concepts in a civilian high-threat prehospital setting. METHODS The PubMed database was searched for articles published between January 1, 2000, and December 1, 2019, containing descriptions, discussions, or experiences of the application of tourniquets or other TCCC-based interventions in the civilian prehospital setting. Data extraction focused on identifying important common themes in the articles. RESULTS Of the 286 identified articles, 30 were selected for inclusion. According to the Oxford Centre for Evidence-based Medicine Levels of Evidence, overall level of evidence was low. Most articles were observational, retrospective cohort studies without a nontourniquet control group. Outcome measures and variables were variably reported. Two articles specifically analyzed tourniquet use during high-threat situations, and three described their application by law enforcement personnel. Overall, tourniquets were found to be effective in stopping major limb bleeding. Reported mortality was low and related complications appeared to be infrequent. Only four articles mentioned the application of other TCCC-based maneuvers, such as airway and respiratory management. CONCLUSION This literature review shows that tourniquets appear to be safe tools associated with few complications and might be effective in controlling major bleeding in civilian limb trauma. For example, during mass casualty incidents, their use could be justified. Training and equipping ambulance and police services to deal with massive bleeding could likewise improve interoperability and victim survival in a civilian high-threat prehospital setting. More qualitative research is needed to further evaluate the effects of hemorrhage control training for first responders on patient outcomes. Literature describing the application of other TCCC-based principles is limited, which makes it difficult to draw conclusions regarding their use in a civilian setting. LEVEL OF EVIDENCE Systematic review, level III.
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Affiliation(s)
- Felix Borgers
- From the Department of Anesthesiology (F.B.), University Hospitals Leuven, Leuven, Belgium; Emergency Department (V.B.), ZOL Hospital Genk, Genk, Belgium; and Emergency Department (M.S.), University Hospitals Leuven, Leuven, Belgium
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16
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Vechetti IJ, Wen Y, Hoffman JF, Alimov AP, Vergara VB, Kalinich JF, Gaitens JM, Hines SE, McDiarmid MA, McCarthy JJ, Peterson CA. Urine miRNAs as potential biomarkers for systemic reactions induced by exposure to embedded metal. Biomark Med 2021; 15:1397-1410. [PMID: 34541869 DOI: 10.2217/bmm-2021-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Explore the potential of urine microRNAs as biomarkers that may reflect the biological responses to pure metals embedded in skeletal muscle over time. Materials & methods: We tested a panel of military-relevant metals embedded in the gastrocnemius muscles of 3-month-old, male, Sprague-Dawley rats (n = 8/group) for a duration of 1, 3, 6 and 12 months, and performed small RNA-sequencing on the urine samples. Results: Results provide potential tissue targets affected by metal exposure and a list of unique or common urine microRNA biomarkers indicative of exposure to various metals, highlighting a complex systemic response. Conclusion: We have identified a panel of miRNAs as potential urine biomarkers to reflect the complex systemic response to embedded metal exposure.
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Affiliation(s)
- Ivan J Vechetti
- Department of Nutrition & Health Sciences, College of Education & Human Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Yuan Wen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY 40536, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
| | - Jessica F Hoffman
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - Alexander P Alimov
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Vernieda B Vergara
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - John F Kalinich
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - Joanna M Gaitens
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Stella E Hines
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Melissa A McDiarmid
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John J McCarthy
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Charlotte A Peterson
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY 40536, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
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Pickle NT, Zehnbauer TP, Harrand VJ, Zientara GP, Zhou X, Roos PE. Automated medical avatar animation for warfighter mission simulation. J Trauma Acute Care Surg 2021; 91:S107-S112. [PMID: 34117168 DOI: 10.1097/ta.0000000000003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Virtual representations of human internal anatomy are important for military applications such as protective equipment design, injury severity prediction, thermal analysis, and physiological simulations. High-fidelity volumetric models based on imaging data are typically in static postures and difficult to use in simulations of realistic mission scenarios. This study aimed to investigate a hybrid approach to reposition medical avatars that preserves internal anatomy but allows rapid repositioning of full three-dimensional (3D) meshes. METHODS A software framework that accepts a medical avatar in a 3D tetrahedral mesh format representing 72 organs and tissues with an articulated skeleton was developed. The skeleton is automatically resized and associated to the avatar using rigging and skinning algorithms inspired by computer animation techniques. Military relevant motions were used for animations. A motion retargeting algorithm was implemented to apply animation to avatars of various sizes, and a motion blending algorithm was implemented to smoothly transition between movements. These algorithms were incorporated into a path generation tool that accepts initial, intermediate, and final coordinates of a multisegment action along with the specific motion for each segment to synthesize a realistic compound set of movements comprising the animation. RESULTS The developed pipeline for dynamic repositioning of medical avatars was demonstrated. Various complex motions were automatically animated. Retargeting was demonstrated on models of varying sizes. Movements along a path were animated to demonstrate smooth motion transitions. Animation of the full 3D avatar mesh ran in real time on a standard desktop personal computer. The repositioning algorithm successfully preserved the shape and volume of rigid structures such as bone. CONCLUSION The developed software leverages techniques from various disciplines to create a hybrid approach enabling real-time 3D mesh repositioning appropriate for use in simulated military missions using avatars containing a complete anatomy representation. The workflow is largely automated, enabling rapid evaluation of new mission scenarios.
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Affiliation(s)
- Nathan T Pickle
- From the CFD Research Corporation (N.T.P., T.P.Z., V.J.H., P.E.R.), Huntsville, Alabama; Biophysics and Biomedical Modeling Division (G.P.Z.), US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and Department of Biomedical Engineering, New Jersey Institute of Technology (X.Z.), Newark, New Jersey
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Treager C, Lopachin T, Mandichak S, Kinney B, Bohan M, Boboc M, Go C, Friedrich E, Stuart S. A comparison of efficacy, efficiency, and durability in novel tourniquet designs. J Trauma Acute Care Surg 2021; 91:S139-S145. [PMID: 33797479 DOI: 10.1097/ta.0000000000003216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exsanguination due to extremity hemorrhage is a major cause of preventable traumatic deaths. Extremity tourniquet use has been shown to be safe and improve survival. The purpose of this study was to compare the efficacy, efficiency, and durability of the Generation 7 Combat Application Tourniquet (CAT; North American Rescue, Greer, SC), the Tactical Mechanical Tourniquet (TMT; Combat Medical Systems, Harrisburg, NC), and the SOF Tactical Tourniquet-Wide (SOFTT-W; Tactical Medical Solutions, Anderson, SC). METHODS This study was a three-phase randomized, cross-over trial. In successive trials, subjects were timed during the application of each tourniquet to the upper and lower extremity. Following successful lower extremity application, subjects low crawled 25 ft and then were dragged 25 ft, after which effectiveness was reassessed, as defined by the cessation of distal pulses by Doppler ultrasound. RESULTS In arm application, both the CAT and TMT had significantly less failure rates than the SOFTT-W (5.56%, 19.44%, 58.33%), with the CAT being the fastest tourniquet when compared with TMT and SOFTT-W (37.8 seconds, 65.01 seconds, 63.07 seconds). In leg application, the CAT had significantly less rates of failure when compared with the SOFTT-W, but there was no other significant difference between the tourniquets (27.78%, 44.44%, 61.11%). In addition, the CAT was significantly faster than both the TMT and SOFTT-W when applied to the leg (8.33 seconds, 40.96 seconds, 34.5 seconds). There was no significant difference in tourniquet failure rates between the three tourniquets after subject maneuvers in phase 3 (34.29%, 42.86%, 45.45%). DISCUSSION The CAT is as effective as the TMT and significantly more effective than the SOFTT-W. In addition, the CAT demonstrated shorter application times than either the TMT or SOFTT-W. However, there was no significant difference between the three tourniquets in their ability to maintain pulselessness after subject maneuvers. LEVEL OF EVIDENCE Care management, level II.
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Affiliation(s)
- Christopher Treager
- From the Department of Emergency Medicine (C.T., T.L., S.M., S.S.), Naval Medical Readiness Training Command, Portsmouth; Combat Trauma Research Group (C.T., T.L., S.M., M. Bohan, M. Boboc, E.F., S.S.), Naval Medical Readiness Training Command, General Dynamics Information Technology, Fairfax, Virginia; Department of Emergency Medicine (B.K.), Naval Medical Readiness Training Command, Guam; and Eastern Virginia Medical School (C.G.), Norfolk, Virginia
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19
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Dubecq C, Dubourg O, Morand G, Montagnon R, Travers S, Mahe P. Point-of-care ultrasound for treatment and triage in austere military environments. J Trauma Acute Care Surg 2021; 91:S124-S129. [PMID: 34086660 DOI: 10.1097/ta.0000000000003308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessment and triage in an austere environment represent a major challenge in casualty care. Modern conflicts involve a significant proportion of multiple wounds, either superficial or penetrating, which complicate clinical evaluation. Furthermore, there is often poor accessibility to computed tomography scans and a limited number of surgical teams. Therefore, ultrasound (US) represents a potentially valuable tool for distinguishing superficial fragments or shrapnels from penetrating trauma requiring immediate damage-control surgery. METHODS This retrospective observational multicenter study assessed casualties treated for 8 months by five medical teams deployed in Africa and Middle East. Two experts, who were experienced in military emergency medicine but did not take part in the missions, carried out an independent analysis for each case, evaluating the contribution of US to the following five items: triage categorization, diagnosis, clinical severity, prehospital therapeutic choices, and priority to operation room. Consensus was obtained using the Delphi method with three rounds. RESULTS Of 325 casualties, 189 underwent US examination. The mean injury severity scale score was 25.6, and 76% were wounded by an improvised explosive device. Ultrasound was useful for confirming (23%) or excluding (63%) the suspected diagnosis made in the clinical assessment. It also helped obtain a diagnosis that had not been considered for 3% of casualties and was responsible for a major change in procedure or therapy in 4%. Ultrasound altered the surgical priority in 43% of cases. For 30% of cases, US permitted surgery to be temporarily delayed to prioritize another more urgent casualty. CONCLUSION Ultrasound is a valuable tool for the management of mass casualties by improving treatment and triage, especially when surgical resources are limited. In some situations, US can also correct a diagnosis or improve prehospital therapeutic choices. Field medical teams should be trained to integrate US into their prehospital protocols. LEVEL OF EVIDENCE Case series (no criterion standard), level V.
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Affiliation(s)
- Christophe Dubecq
- From the Direction Interarmées du Service de Santé Réunion-Mayotte (C.D.), Antenne Médicale de Saint Pierre, French Military Health Service, La Réunion; Service Médical de L'état-Major de Défense (O.D.), French Military Health Service, Paris; 4e Antenne Médicale Spécialisé (G.M.), 1ere Chefferie du Service de Santé, French Military Health Service, Bayonne; Emergency Department (R.M.), Sainte Anne Military Training Hospital, French Military Health Service, Toulon; French Military Health Service (S.T.), Val de Grâce Military Academy, Paris; 1ere Chefferie du Service de Santé (P.M.), French Military Health Service, Villacoublay, France
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Leuze C, Zoellner A, Schmidt AR, Cushing RE, Fischer MJ, Joltes K, Zientara GP. Augmented reality visualization tool for the future of tactical combat casualty care. J Trauma Acute Care Surg 2021; 91:S40-S45. [PMID: 33938509 DOI: 10.1097/ta.0000000000003263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.
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Affiliation(s)
- Christoph Leuze
- From the Nakamir Inc. (C.L., A.Z., M.J.F.), Palo Alto; Department of Anesthesia (A.R.S.), Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California; US Army Research Institute of Environmental Medicine (R.E.C., K.J., G.P.Z.), Natick, Massachusetts
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Chapman S, Rawcliffe AJ, Smith L, Izard R, Roberts J. Evaluation of the current methods used for assessing dietary intake in military research settings: a scoping review. BMJ Mil Health 2020; 167:126-130. [PMID: 32859652 DOI: 10.1136/bmjmilitary-2020-001436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION It is important to collate the literature that has assessed dietary intake within military settings to establish which methods are commonly used and which are valid so that accurate nutrition recommendations can be made. This scoping review aims to identify which methods are typically used to assess dietary intake in military settings and which of these have been validated. This review also aims to provide a recommendation as to which method(s) should be used in military settings. METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in PubMed, Web of Science and SPORTDiscus with the most recent search executed on 12th June 2020. Eligible studies had to report original data, assess and quantify dietary intake and have been published in peer-reviewed academic journals. The reporting bias was calculated for each study where possible. RESULTS Twenty-eight studies used a single method to assess dietary intake and seven studies used a combination of methods. The most commonly used methods were the gold standard food intake/waste method, Food Frequency Questionnaire (FFQ) or a food diary (FD). The only method to date that has been validated in military settings is weighed food records (WFR). CONCLUSIONS The food intake/waste method or WFR should be used where feasible. Where this is not practical the FFQ or FD should be considered with control measures applied. There is currently not sufficient evidence to state that using multiple methods together improves validity.
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Affiliation(s)
- Shaun Chapman
- HQ Army Recruiting and Initial Training Command, UK Ministry of Defence, Upavon, UK
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - A J Rawcliffe
- HQ Army Recruiting and Initial Training Command, UK Ministry of Defence, Upavon, UK
| | - L Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - R Izard
- Defence Science and Technology, Porton Down, UK Ministry of Defence, Salisbury, Wiltshire, UK
| | - J Roberts
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Remigio-Baker RA, Kiser S, Ferdosi H, Gregory E, Engel S, Sebesta S, Beauchamp D, Malik S, Scher AI, Hinds SR. Current patterns of primary care provider practices for the treatment of post-traumatic headache in active duty military settings. PLoS One 2020; 15:e0236762. [PMID: 32706834 PMCID: PMC7380628 DOI: 10.1371/journal.pone.0236762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To provide a preliminary assessment of the current clinical practice for the treatment of post-traumatic headache following concussion in military primary health care settings. Background Headache is one of the most common symptoms post-concussion; however, little is known of the current clinical practices of primary care providers (on the treatment of post-traumatic headache), particularly in military settings. Methods Study participants were primary care providers (n = 65) who treated active duty Service members suffering from post-traumatic headache at two military installations. Qualitative data gathered via semi-structured interviews were used to describe provider practices and experience in treating patients with post-traumatic headache. Results Some patterns of care across primary care providers treating post-traumatic headache were consistent with the Department of Defense-recommended clinical recommendation (e.g., recommendation of both pharmacological and non-pharmacological treatment [89.4%]; engaging in follow-up care [100%]). Differences existed in timing of follow-up from initial visit [16.9% reporting within 24 hours; 21.5% reporting within 48–72 hours; and 26.2% reporting more than 1 week], the factors contributing to the type of care given (e.g., symptomatology [33.0%], injury characteristic [24.2%], patient characteristic [13.2%]) and the need for referral to higher level of care (e.g., symptomatology [44.6%], treatment failure [25.0%]). These variations may be indicative of individualized treatment which would be compliant with best clinical practice. Conclusion The results of this study demonstrate the current clinical practice in military primary care settings for the treatment of post-traumatic headache which can potentially inform and improve implementation of provider training and education.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States of America
- Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States of America
- * E-mail:
| | - Seth Kiser
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States of America
- General Dynamics Information Technology, Falls Church, VA, United States of America
| | - Hamid Ferdosi
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States of America
- General Dynamics Information Technology, Falls Church, VA, United States of America
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States of America
| | - Scot Engel
- Fort Hood, Intrepid Spirit Center, Ft Hood, TX, United States of America
| | - Sean Sebesta
- Fort Bliss, Intrepid Spirit Center, Ft Bliss, TX, United States of America
| | - Daniel Beauchamp
- Fort Bliss, Intrepid Spirit Center, Ft Bliss, TX, United States of America
| | - Saafan Malik
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States of America
| | - Ann I. Scher
- Preventive Medicine & Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
| | - Sidney R. Hinds
- Neurology, Uniformed Services University, Bethesda, MD, United States of America
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Chmiel Z, Żal M, Więch P, Bazaliński D, Sałacińska I, Bartusik-Aebisher D, Binkowska-Bury M. Hypertension and selected indicators of health assessment in a population of 19-year-old men subject to military qualifications. Medicine (Baltimore) 2020; 99:e20398. [PMID: 32481430 DOI: 10.1097/md.0000000000020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Małopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.
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Affiliation(s)
- Zdzisława Chmiel
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Marcin Żal
- Head of the Provincial Military Staff in Krakow, Rydla 19, 30-901 Krakow
| | - Paweł Więch
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dariusz Bazaliński
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Izabela Sałacińska
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dorota Bartusik-Aebisher
- Institute of Medical Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow, Poland
| | - Monika Binkowska-Bury
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
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Tsai YD, Tsai SH, Chen SJ, Chen YC, Wang JC, Hsu CC, Chen YH, Yang TC, Li CW, Cheng CY. Pilot study of a longitudinal integrated disaster and military medicine education program for undergraduate medical students. Medicine (Baltimore) 2020; 99:e20230. [PMID: 32443354 PMCID: PMC7461121 DOI: 10.1097/md.0000000000020230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Disaster medicine education in medical curricula is scarce and frequently nonexistent. It is reasonable to initiate educational approaches for physicians in this field at the medical school level. An understanding of disaster medicine and the health care system during massive casualty incidents has been recommended as an integral part of the medical curriculum in the United States and Germany.The goal of the reformed curriculum was to develop a longitudinal integrated disaster and military medicine education program extending from the first year to the sixth year based on previously separated clinical and military medicine topics. Emergency medicine physicians, military emergency medical technicians, and Tactical Combat Casualty Care instructors formed an interprofessional faculty group and designed a learning curriculum.A total of 230 medical students participated in the revised disaster preparedness curriculum. Satisfaction survey response rates were high (201/230, 87.4%). Most of the free-text comments on the program were highly appreciative. The students considered the number of teaching hours for the whole program to be adequate. The students showed significant improvements in knowledge and judgment regarding disaster medicine after the program.We found that medical students were highly interested, were appreciative of, and actively participated in this longitudinal integrated disaster and military medicine education program, but gaps existed between the students' scores and the educators' expectations. The educators believed that the students needed more disaster preparedness knowledge and skills.
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Affiliation(s)
- Yi-Da Tsai
- Department of Emergency Medicine, Tri-Service General Hospital
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital
- Department of Physiology and Biophysics, Graduate Institute of Physiology
- Combat and Disaster Casualty Care Training Center, National Defense Medical Center, Taipei
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital
- Combat and Disaster Casualty Care Training Center, National Defense Medical Center, Taipei
| | - Yin-Chung Chen
- Department of Emergency Medicine, Tri-Service General Hospital
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital
| | - Chia-Ching Hsu
- Department of Emergency Medicine, Tri-Service General Hospital
| | - Ying-Hsin Chen
- Department of Emergency Medicine, Hualien Armed Forces General Hospital, Hualien
| | | | | | - Cheng-Yi Cheng
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Lewis C, Nilan M, Srivilasa C, Knight RM, Shevchik J, Bowen B, Able T, Kreishman P. Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA: Extreme Measures Led to Survival in a Severely Injured Soldier-A Case Report. J Spec Oper Med 2020; 20:123-126. [PMID: 32573748 DOI: 10.55460/03ef-6lu6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
We present the case of a severely injured Special Operations Servicemember whose care was remarkable for three unique interventions: the first use of a walking blood bank performed at the point of injury, prolonged permissive hypotension, and intermittent resuscitative endovascular balloon occlusion of the aorta (REBOA).
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Rapp J, Keenan S, Taylor D, Rapp A, Turconi M, Maves R, Kavanaugh M, Makati D, Powell D, Loos PE, Sarkisian S, Sakhuja A, Mosely DS, Shackelford SA. Sepsis Management in Prolonged Field Care: 28 October 2020. J Spec Oper Med 2020; 20:27-39. [PMID: 33320310 DOI: 10.55460/i18b-1zqm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
This Role 1 prolonged field care (PFC) guideline is intended for use in the austere environment when evacuation to higher level of care is not immediately possible. A provider must first be an expert in Tactical Combat Casualty Care (TCCC). The intent of this guideline is to provide a functional, evidence-based and experience-based solution to those individuals who must manage patients suspected of having or diagnosed with sepsis in an austere environment. Emphasis is placed on the basics of diagnosis and treatment using the tools most familiar to a Role 1 provider. Ideal hospital techniques are adapted to meet the limitations of austere environments while still maintaining the highest standards of care possible. Sepsis and septic shock are medical emergencies. Patients suspected of having either of these conditions should be immediately evacuated out of the austere environment to higher echelons of care. These patients are often complex, requiring 24-hour monitoring, critical care skills, and a great deal of resources to treat. Obtaining evacuation is the highest treatment priority for these patients. This Clinical Practice Guideline (CPG) uses the minimum, better, best paradigm familiar to PFC and gives medics of varying capabilities and resources options for treatment.
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Qi X, Tian J, Sun R, Zhang H, Han J, Jin H, Lu H. Focused Assessment with Sonography in Trauma for Assessment of Injury in Military Settings: A Meta-analysis. Balkan Med J 2019; 37:3-8. [PMID: 31594286 PMCID: PMC6934008 DOI: 10.4274/balkanmedj.galenos.2019.2019.8.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-invasive, rapid, and precise assessment of injury in the military settings is extremely important, yet difficult. Focused assessment with sonography in trauma (FAST) is being increasingly employed for assessing the location and severity of injury and guiding further treatment strategy. However, the evidence regarding the utility of FAST in the military settings is scattered. AIMS To evaluate the diagnostic performance of FAST in the assessment of injury in the military settings. STUDY DESIGN Meta-analysis. METHODS We identified all relevant papers via the PubMed, EMBASE, and Cochrane Library databases. We evaluated the quality of included studies by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We pooled the area under the curve (AUC), sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio as the effect sizes, followed by evaluating the heterogeneity among the studies by p value and I2. RESULTS Among the 39 papers, a total of six papers were included. The sample size ranged from 15 to 396. The AUC of FAST for assessing the injury was 0.85. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.66, 0.98, 33.1, 0.34, and 97, respectively. The heterogeneity among the studies was statistically significant (p=0.006, I2=78%). CONCLUSION FAST is potentially valuable for assessing injury in the military settings. Due to its high specificity, FAST may be appropriate to rule in significant injury. However, because of its poor sensitivity, the ability of FAST to rule out injury cannot be relied upon.
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Affiliation(s)
- Xingshun Qi
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
- Co-first authors
- Co-corresponding authors
- * Address for Correspondence: Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China E-mail:,
| | - Jing Tian
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Co-first authors
| | - Rui Sun
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - He Zhang
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Jinsong Han
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Hai Jin
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
| | - Hui Lu
- Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China
- Co-corresponding authors
- * Address for Correspondence: Military Medical Research Group, General Hospital of Northern Theater Command Shenyang, Liaoning Province, China E-mail:,
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Breeze J, Bowley DM, Combes JG, Baden J, Rickard RF, DuBose J, Powers DB. Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study. BMJ Open 2019; 9:e033557. [PMID: 31772107 PMCID: PMC6887033 DOI: 10.1136/bmjopen-2019-033557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To perform the first direct comparison of the facial injuries sustained and treatment performed at USA and UK deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. SETTING The US and UK Joint Theatre Trauma Registries were scrutinised for all patients with facial injuries presenting alive to a UK or US deployed MTF between 1 March 2003 and 31 October 2011. PARTICIPANTS US and UK military personnel, local police, local military and civilians. PRIMARY AND SECONDARY OUTCOME MEASURES An adjusted multiple logistic regression model was performed using tracheostomy as the primary dependent outcome variable and treatment in a US MTF, US or UK military, mandible fracture and treatment of mandible fracture as independent secondary variables. RESULTS Facial injuries were identified in 16 944 casualties, with the most common being those to skin/muscle (64%), bone fractures (36%), inner/middle ear (28%) and intraoral damage (11%). Facial injuries were equally likely to undergo surgery in US MTF as UK MTF (OR: 1.06, 95% CI 0.4603 to 1.142, p=0.6656); however, variations were seen in injury type treated. In US MTF, 692/1452 (48%) of mandible fractures were treated by either open or closed reduction compared with 0/167 (0%) in UK MTF (χ2: 113.6; p≤0.0001). US military casualties who had treatment of their mandible fracture (open reduction and internal fixation or mandibulo-maxillary fixation) were less likely to have had a tracheostomy than those who did not undergo stabilisation of the fractured mandible (OR: 0.61, 95% CI 0.44 to 0.86; p=0.0066). CONCLUSIONS The capability to surgically treat mandible fractures by open or closed reduction should be considered as an integral component of deployed coalition surgical care in the future.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Douglas M Bowley
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James G Combes
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - James Baden
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - David B Powers
- Duke University Medical Center, Durham, North Carolina, USA
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Abstract
BACKGROUND In the decades following the discovery of the bacillus causing typhoid, in 1880, understanding of the disease formerly known as enteric fever was transformed, offering new possibilities for prevention. Gradually, measures that aimed to prevent infection from human carriers were developed, as were inoculations designed to confer immunity against typhoid and paratyphoid fevers. These were initially introduced in European armies that were regularly ravaged by typhoid, especially garrisons stationed in the colonies. This article reviews the research undertaken in the armed forces and the measures that they implemented in the years up to and during the First World War. METHODS The article is based on an analytical review of scientific literature from the early 19th century, focusing on the United Kingdom, Germany, and France. RESULTS The armies of the United Kingdom, Germany, and France undertook important work on the transmission of typhoid in the years between 1890 and 1918. Many preventive measures were introduced to deal with the spread of typhoid but these varied between the 3 countries, depending largely on their political traditions. Inoculation was particularly successful in preventing typhoid and greatly reduced the number of casualties from this disease during the First World War. Despite this, it proved difficult to prevent paratyphoid infection, and debates continued over which vaccines to use and whether or not immunization should be voluntary. CONCLUSIONS By the end of the First World War, the value of inoculation in preventing the spread of typhoid had been proven. Its successful implementation demonstrates the importance of vaccination as a public health intervention during times of conflict and social upheaval.
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Affiliation(s)
- Christoph Gradmann
- Department of Community Medicine and Global Health, University of Oslo, Norway
| | | | - Anne Rasmussen
- Centre Alexandre-Koyré, Ecole des hautes études en sciences sociales, Centre national de la recherche scientifique, Muséum national d’Histoire naturelle de Paris, France
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Derickson MJ, Kuckelman JP, Phillips CJ, Barron MR, Marko ST, Eckert MJ, Martin MJ, Cuadrado DG. Lifesaving interventions in blackout conditions using night vision technology: Come to the dark side. J Trauma Acute Care Surg 2019; 87:S191-S196. [PMID: 31246926 DOI: 10.1097/ta.0000000000002190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During military combat operations and civilian night-time aeromedical transport, medical providers are frequently required to perform lifesaving interventions (LSIs) in low-light environments. Because definitive surgical care is often delayed until a white light environment is permissible, we sought to determine if night optical device (NOD) technology could enable surgical capabilities in blackout conditions. METHODS Using a crossover design, six surgeons performed 11 different procedures on six swine, three in normal light conditions (LC) and 3 in blackout conditions (BC) using two-chamber NODs after familiarization with the procedures in both conditions on manikins. Successful completion and procedural times were compared between groups. RESULTS Blackout conditions were confirmed with ambient light reading of 0.2 lux during BC versus 3962.9 lux for LC (p < 0.001). There were no significant differences in success rates for any procedure. There were no differences in operative times between BC and LC for extremity tourniquet placement, femoral artery cut-down and clamping, resuscitative thoracotomy, or percutaneous resuscitative endovascular balloon occlusion of the aorta placement. The following procedures took significantly longer in BC vs. LC: Focused Assessment with Sonography for Trauma examination (98 seconds vs. 62 seconds), peripheral IV placement (140 seconds vs. 35 seconds), intraosseous access (51 seconds vs. 26 seconds), jugular vein cut-down and access (237 seconds vs. 104 seconds), laparotomy and packing (71 seconds vs. 51 seconds), stapled splenectomy (137 seconds vs. 74 seconds), resuscitative endovascular balloon occlusion of the aorta placement via cutdown (1,008 seconds vs. 338 seconds), and cricothyroidotomy (177 seconds vs. 109 seconds) (all p < 0.05). CONCLUSION Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed. LEVEL OF EVIDENCE Basic science.
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Affiliation(s)
- Michael J Derickson
- From the Madigan Army Medical Center (M.J.D., J.P.K., C.J.P., M.R.B., S.T.M., M.J.E., M.J.M., D.G.C.), Tacoma, Washington
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Martín-Ibáñez L, Pérez-Martínez J, Zamora-Mínguez D, Alcón-Rubio F, González-Alonso V, Aroca García-Rubio S, Hernández-Hernández JM, Díaz F, Román-López P. A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report. Emergencias 2019; 31:195-201. [PMID: 31210453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.
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Affiliation(s)
- Luis Martín-Ibáñez
- Grupo de Artillería de Campaña, Brigada de Infantería Ligera "Rey Alfonso XIII" II de La Legión, Almería, España
| | | | | | - Francisco Alcón-Rubio
- Batallón de Zapadores, Brigada de Infantería Ligera "Rey Alfonso XIII" II de La Legión, Almería, España
| | | | | | | | - Feliciano Díaz
- Cuerpo Nacional de Policía, Seguridad Ciudadana, Almería, España
| | - Pablo Román-López
- Departamento Enfermería, Universitat Jaume I, Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, España
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Xu Y, Xu W, Wang A, Meng H, Wang Y, Liu S, Li R, Lu S, Peng J. Diagnosis and treatment of traumatic vascular injury of limbs in military and emergency medicine: A systematic review. Medicine (Baltimore) 2019; 98:e15406. [PMID: 31045795 PMCID: PMC6504268 DOI: 10.1097/md.0000000000015406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. METHODS To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes. RESULTS Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc). CONCLUSION We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.
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Aggarwal NK. Forensic mental health evaluations in the Guantánamo military commissions system: An analysis of all detainee cases from inception to 2018. Int J Law Psychiatry 2019; 64:34-39. [PMID: 31122638 DOI: 10.1016/j.ijlp.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
Even though the Bush Administration opened the Guantánamo Bay detention facility in 2002 in response to the September 11, 2001 attacks in the United States, little remains known about how forensic mental health evaluations relate to the process of detainees who are charged before military commissions. This article discusses the laws governing Guantánamo's military commissions system and mental health evaluations. Notably, the US government initially treated detainees as "unlawful enemy combatants" who were not protected under the US Constitution and the United Nations Convention Against Torture and Other Forms of Cruel, Inhuman or Degrading Treatment, allowing for the use of "enhanced interrogation techniques." In subsequent legal documents, however, the US government has excluded evidence obtained through torture, as defined by the US Constitution and the United Nations Convention Against Torture. Using open-source document analysis, this article describes the reasons and outcomes of all forensic mental health evaluations from Guantánamo's opening to 2018. Only thirty of 779 detainees (~3.85%) have ever had charges referred against them to the military commissions, and only nine detainees (~1.16%) have ever received forensic mental health evaluations pertaining to their case. Of these nine detainees, six have alleged mental torture while in US custody. This paper shows that leaders in the United States and Europe should consider whether counterterrorism policies that supersede traditional health and human rights complicate the ability of future governments to prosecute cases when successive leaders change laws, a pertinent consideration as North American and European states grapple with the return of foreign fighters.
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Affiliation(s)
- Neil Krishan Aggarwal
- Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, Committee on Global Thought, Columbia University, New York State Psychiatric Institute, United States.
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Research on Health Effects of Low-Level Ionizing Radiation Exposure: Opportunities for the Armed Forces Radiobiology Research Institute. Mil Med 2017; 182:1675-6. [PMID: 28885924 DOI: 10.7205/MILMED-D-17-00314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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D'Angelo M, Welder M, Chauhan R, Kearns MJ. Future Trends in Trauma Care: Through the Lens of the Wounded How Lessons from the Battlefield May Be Used at Home. Anesthesiol Clin 2019; 37:183-193. [PMID: 30711231 DOI: 10.1016/j.anclin.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The coordinated terrorist attacks of 2001 thrust the United States and its allies to war. Through an evolving battlefield, the paradigm of large fixed medical facilities advanced to become nimble surgical and resuscitative platforms, able to provide care far forward. Innovations like tactical combat casualty care, evacuation, fresh whole-blood administration, freeze-dried plasma, and forward surgical care military medicine helped reduce combat mortality to its lowest levels in history. Through the account of a young wounded marine wounded in Iraq, this article examines how innovations on the battlefield saved casualties and explores how these techniques may be applied at home.
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Affiliation(s)
- Matthew D'Angelo
- Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Matthew Welder
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Ravi Chauhan
- Royal Centre of Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - Michel J Kearns
- Department of Anesthesiology, Medical Corps, U.S. Navy, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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Caubere A, Demoures T, Choufani C, Huynh V, Barbier O. Use of intramedullary nailing in poor sanitary conditions: French Military Medical Service experience. Orthop Traumatol Surg Res 2019; 105:173-177. [PMID: 30639030 DOI: 10.1016/j.otsr.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/17/2018] [Accepted: 10/10/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary (IM) nailing is the gold standard for treating long bone fractures in developed countries because of its minimally-invasive application and good biomechanical properties. In precarious conditions, external fixation or open plate fixation are often performed because surgeons do not have the means to carry out IM nailing. However, these procedures can lead to infection-related complications and mechanical failures. The aim of our study was to describe the outcomes and postoperative complications of IM nailing of closed, long bone fractures in patients operated in a French front-line combat surgical unit (role 2+). Our hypothesis was that IM nailing is a reliable technique with low morbidity for the initial treatment of long bone fractures, even in precarious situations. MATERIAL AND METHODS This was a prospective, single-center, descriptive study of patients operated on between April 2016 and November 2017. All the patients with a closed femur or tibia fracture who were treated by IM nailing were eligible, no matter their time to surgery. The minimum follow-up was 6 months. The primary endpoint was the absence of infection-related complications and the secondary endpoint was fracture union. RESULTS Fifty-eight patients were reviewed after an average follow-up of 4.7 months (range, 3-15 months). The mean patient age was 35.2 years (15-85 years) and the majority of patients were men (52 of 58). The fracture was in the femur in 74.1% (n=43) of cases and in the tibia in 25.9% (n=15) of cases. The time to surgery averaged 122.3 days (7-720 days) with a median of 60 days. In 74% of cases (n=43), fracture realignment required an open surgical approach. The postoperative course was considered normal in 96.6% of cases (n=51). No infections were reported as of the last follow-up visit. Union occurred in an average of 4 months in 70.7% of cases (n=41). There were three cases of nonunion after 6 months. DISCUSSION Even in precarious situations, IM nailing is an effective, reliable method with a low complication risk and high union rate for the treatment of neglected long bone fractures. This surgical treatment is well suited to the poor sanitary conditions on the African continent. LEVEL OF EVIDENCE II, low-powered prospective study.
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Affiliation(s)
- Alexandre Caubere
- Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Thomas Demoures
- Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Camille Choufani
- Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Victor Huynh
- Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Olivier Barbier
- Service de chirurgie orthopédique et traumatologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Jones A. We shall remember them! J Perioper Pract 2018; 28:287. [PMID: 30375275 DOI: 10.1177/1750458918809315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cogan A, Cervelli L, Dillahunt-Aspillaga T, Rossiter AG. Treating Military Service Members and Veterans in the Private Sector: Information and Resources for Clinicians. Arch Phys Med Rehabil 2018; 99:2659-2661. [PMID: 30473021 DOI: 10.1016/j.apmr.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 11/28/2022]
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Pierce E, Rapada R, Herder PA, LaPorta AJ, Hoang TN, Pena M, Blankenship J, Kiser J, Catlin SA. Surgery at Sea: The Effect of Simulated High Sea States on Surgical Performance. J Spec Oper Med 2018; 18:64-70. [PMID: 29889958 DOI: 10.55460/emq7-rozp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The US Navy initiated design concepts for a Medical Mission Module Support Container (M3SC), a mobile operating room capable of rapid installation aboard maneuverable ships within proximity of active combat units. The M3SC provides an alternative echelon of care in the current trauma system by decreasing the time between point of injury, arrival, and surgical intervention. The mobile ships used as M3SC platforms, however, are more susceptible to oceanic conditions that can induce detrimental physiologic motion sickness in medical personnel and patients aboard the vessels. This study investigated the effects of different sea-state motion conditions on the performance of surgical teams. METHODS Six four-person surgical teams performed 144 procedures in an M3SC aboard a Stewart motion table that simulated motion profiles of sea states 0, 3, and 4. A modified human-worn partial- task surgical simulator was used as a surgical surrogate to simulate the four most common, wartime, improvised explosive device injuries in the past 10 years. Electroencephalographs and heart rate variability (HRV) data were collected from surgeons and surgical technologists during each procedure to assess real-time physiologic responses to motion. Two postprocedure surveys, a Surgical Task Load Index and a Motion Sickness Assessment Questionnaire, were given to assess subjective responses of workload stress and motion-induced kinetosis. Surgical subject matter experts quantified surgical performance after each procedure by measuring blood loss and orthopedic pin placement to evaluate each intervention. RESULTS Motion did not significantly influence overall performance (ρ = .002). Surgical procedure was the strongest predictor of performance. HRV was used to measure stress and was increased in surgical technologists; however, HRV was decreased for surgeons and technologists in motion. There was a significant interaction between role and motion (ρ = .002): Surgeons had higher workloads than did surgical technologists and neither demonstrated differences between motion and no motion. Surgeons demonstrated significantly decreased workloads under motion conditions (ρ = 0.002); however, surgeons perceived their workload to be higher. We attribute this to their increased critical thinking and physical execution of procedures. Surgeons and surgical technologists showed a trend toward HRV suppression within the motion conditions. This may indicate a coping response to the increased stress of the motion setting. Procedure and team dynamic were the strongest predictors of overall performance, suggesting a learning curve exists and that added focus on training should be enforced. CONCLUSION Based on data collected in this study, similar surgical procedures should be implemented aboard these classes of ships. By doing so, injured military personnel would have more timely access to care. Surgical team members were aware of craft motion, used compensatory measures, and exhibited some physiological response.
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Kim J, Polk T. Calculated Decisions: Bastion Classification of Lower Limb Blast Injuries. Emerg Med Pract 2018; 19:1-2. [PMID: 30183238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Bastion Classification criteria stratify explosionrelated lower limb injuries into 5 categories to guide treatment.
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Affiliation(s)
- Jennie Kim
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Travis Polk
- Commander, Medical Corps, U.S. Navy; Los Angeles County+USC Medical Center, Los Angeles, CA
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Usero-Pérez C, González Alonso V, Orbañanos Peiro L, Gómez Crespo JM, Hossain López S. [Implementation of the Hartford Consensus and Tactical Combat Casualty Care recommendations in emergency services: a review of the literature]. Emergencias 2018; 29:416-421. [PMID: 29188917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent terrorist attacks involving active shooters or improvised explosive devices have shown that traditionally sequenced emergency management leads to delays in attending victims and suboptimal outcomes. Tactical medicine, a new concept in prehospital care, emerged from experience attending the wounded in combat zones, where the Tactical Combat Casualty Care (TCCC) recommendations are applied. TCCC targets 3 main causes of preventable death in combat: bleeding from extremities, tension pneumothorax, and airway obstruction. A change in the delivery of emergency care during terrorist attacks is now required if we are to improve survival rates. To that end, strategies based on the TCCC and Hartford Consensus recommendations have been developed. Both these approaches describe procedures for both first responders and medical professionals to apply in areas under threat.
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Corey S, Mueller T, Bojescul J, Cameron C. Application of High Energy Extracorporeal Shockwave Therapy on Musculoskeletal Conditions in US Military Medical Facilities. US Army Med Dep J 2018:76-83. [PMID: 30623403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Outcomes of extracorporeal shockwave therapy (ESWT) vary due to the heterogeneity of application protocols and patient characteristics. United States military medical facilities offer a unique environment to study the effects of ESWT due to the large use, consistent protocol, and ability to care for young active individuals. A retrospective review was conducted from November 2008 to March 2015 to assess types of musculoskeletal conditions treated by ESWT in US military medical treatment facilities, the demographics of patients treated with ESWT (age and gender), the trend throughout the time in question, and the protocols implemented. A literature review was performed to compare the use in US military facilities to reported data. In this study we report how US military medical facilities are using ESWT to treat musculoskeletal conditions and outcomes reported in literature. The purpose of our research is to raise awareness of this treatment modality and areas for further research within the US military medical facilities.
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Affiliation(s)
- Salley Corey
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA
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Abstract
Introduction Precepting is when a medical educator listens to a learner's presentation and must teach and assess the learner while rendering safe patient care. A popular framework for this type of educational encounter is the one-minute preceptor model, which can work for learners at all skill levels. This workshop was created to develop skills of all teaching faculty, regardless of medical specialty, in precepting. Methods The workshop is based on Kolb's experiential learning theory. A PowerPoint presentation delivers the core abstract concepts. The PowerPoint allows for discussion of participants' prior precepting experiences, including both challenges and successes. The workshop ends with role-plays for participants to practice their skills and a facilitated debrief to aid individual reflection. Twelve role-plays were created for use in the workshop; these were then reviewed by someone in the matching specialty to enhance authenticity. Participants completed a survey after the workshop to evaluate the session. Results This presentation was delivered 26 times to 392 participants at 16 different teaching hospitals. Twenty-one different medical specialties and subspecialties were represented. Ninety-seven percent of participants stated they would use the information presented in the workshop often or daily. There were conflicting comments about the role-plays. The negative comments centered around (a) personal difficulty participating in the role-plays and (b) the role-plays not being related to the learning. Discussion Discussion and role-play can be an effective way to instruct educators in use of the one-minute preceptor as a framework for teaching.
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Affiliation(s)
- Jessica Servey
- Associate Professor, Department of Family Medicine, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
- Associate Dean for Faculty Development, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Kristen Wyrick
- Assistant Professor, Department of Family Medicine, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
- Family Medicine Physician, Everett Clinic
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VanderWeele TJ. Religious Communities, Health, and Well-Being - Address to the US Air Force Chaplain. Mil Med 2018; 183:105-109. [PMID: 29584871 PMCID: PMC6487985 DOI: 10.1093/milmed/usx206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
The text is adapted from a written transcript of the address to the US Air Force Chaplain Corps Summit, delivered by Tyler J. VanderWeele, on March 28, 2017 in San Antonio, Texas. The address discussed rigorous empirical research on how religious participation and religious community are related to a number of health and well-being outcomes, along with the mechanisms behind these associations, and the implications of such religion health research to military chaplains, and to society more broadly.
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Affiliation(s)
- Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
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Abstract
Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.
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Affiliation(s)
- Carla L Fisher
- a College of Journalism & Communications, STEM Translational Communication Center, UF Health Cancer Center; UF Health Center for Arts in Medicine , University of Florida , Gainesville , FL , USA
| | - Christy J W Ledford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - David A Moss
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
| | - Paul Crawford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
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Hanlin ER, Zelenak J, Barakat M, Anderson KL. Airway ultrasound for the confirmation of endotracheal tube placement in cadavers by military flight medic trainees - A pilot study. Am J Emerg Med 2018; 36:1711-1714. [PMID: 29478724 DOI: 10.1016/j.ajem.2018.01.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model. METHODS We conducted a prospective, randomized trial in a human cadaver model. Participants received a brief didactic and hands-on presentation on airway US techniques. Each participant then performed transtracheal US on cadaver models which were randomly assigned to tracheal or esophageal intubation; time to verbalize ETT location was also recorded. Participants were then asked whether they felt airway US would be a useful adjunctive skill in their practice. RESULTS Thirty-two military flight medic trainees were enrolled. US had a sensitivity of 66.7% and a specificity of 76.4% for identification of esophageal intubations. The positive predictive value was 71.4% and the negative predictive value was 72.2%. Mean time to report ETT placement was 47.3s. Time did not vary between medics with accurate identification versus inaccurate identification (p=0.176). 83% of participants felt airway US would be a useful adjunctive skill for the confirmation of ETT placement. CONCLUSIONS Military flight medic trainees can rapidly use airway US to identify ETT placement after a short educational session with moderate sensitivity and specificity. These advanced military medics are interested in learning and implementing this skill into their practice.
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Affiliation(s)
- Erin R Hanlin
- San Antonio Military Medical Center, Department of Emergency Medicine, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Jeffrey Zelenak
- Bulverde-Spring Branch Fire, EMS- Center for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, United States; New Braunfels Fire Department, 550 Landa St, New Braunfels, TX 78130, United States
| | - Michael Barakat
- Emergency Medicine Consultants, Ltd., 6451 Brentwood Stair Rd #200, Fort Worth, TX 76112, United States
| | - Kenton L Anderson
- Stanford University School of Medicine, Department of Emergency Medicine, 900 Welch Road, Ste 350, Palo Alto, CA 94304, United States
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Anonymous A. Tactical Combat Casualty Care for Medical Personnel (TCCC-MP): Recommended Post-Course Metrics (24 July 2018). J Spec Oper Med 2018; 18:136-146. [PMID: 30222852 DOI: 10.55460/pnjd-0be0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 06/08/2023]
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Satterly S, McGrane OL, Frawley T, Bynum W, Martin J, Clegg C, Pearsall N, Reilly S, Verwiebe E, Eckert M. Special Operations Force Risk Reduction: Integration of Expeditionary Surgical and Resuscitation Teams. J Spec Oper Med 2018; 18:49-52. [PMID: 29889955 DOI: 10.55460/5um7-kbem] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
Hemorrhage in the presurgical setting has been the most significant cause of death on the battlefield. Damage control surgery (DCS) near the point of injury (POI) is not a new concept, but having conventional medical teams supporting Special Operations Forces (SOF) beyond robust military medical infrastructure is unique for the US military. The Expeditionary Resuscitative Surgical Team (ERST) was formed by the US Army Medical Command as a pilot team to fulfill a request for forces to provide DCS and personnel recovery near POI.
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Schauer SG, April MD, Fisher AD, Cunningham CW, Gurney JM. Junctional Tourniquet Use During Combat Operations in Afghanistan: The Prehospital Trauma Registry Experience. J Spec Oper Med 2018; 18:71-74. [PMID: 29889959 DOI: 10.55460/sxcy-5scx] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Hemorrhage is the leading cause of potentially preventable death on the battlefield. Although the resurgence of limb tourniquets revolutionized hemorrhage control in combat casualties in the recent conflicts, the mortality rate for patients with junctional hemorrhage is still high. Junctional tourniquets (JTQs) offer a mechanism to address the high mortality rate. The success of these devices in the combat setting is unclear given a dearth of existing data. METHODS From the Prehospital Trauma Registry (PHTR) and the Department of Defense Trauma Registry, we extracted cases of JTQ use in Afghanistan. RESULTS We identified 13 uses of a JTQ. We excluded one case in which an improvised pelvic binder was used. Of the remaining 12 cases of JTQ use, seven had documented success of hemorrhage control, three failed to control hemorrhage, and two were missing documentation regarding success or failure. CONCLUSION We report 12 cases of prehospital use of JTQ in Afghanistan. The findings from this case series suggest these devices may have some utility in achieving hemorrhage control strictly at junctional sites (e.g., inguinal creases). However, they also highlight device limitations. This analysis demonstrates the need for continued improvements in technologies for junctional hemorrhage control, prehospital documentation, data fidelity and collection, as well as training and sustainment of the training for utilization of prehospital hemorrhage control techniques.
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