Military Medicine最新文献

Introduction: Psychiatric conditions are one of the leading non-battle injury diseases resulting in medical evacuation (MEDEVAC) from combat environments. The challenge of limited MEDEVAC capability necessitating prolonged field care in future large-scale combat operations must be addressed. Therefore, a robust program is needed to address frontline care of behavioral health (BH), maximizing service members returning to duty and minimizing MEDEVAC. This review summarizes the literature on the impacts of the Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) Unit program as a solution to the challenges of treating behavioral health in future wars.

Materials and methods: We conducted a systematic literature search and review, and a non-systematic literature critique. We then used the Johns Hopkins evidence appraisal tool to appraise the strength and quality of the evidence. The following electronic databases were utilized for the search: Google Scholar, Embase, CINAHL, and PubMed. Search terms included: included "EmPATH," "prolonged field care," and "operational," alone and combined.

Results: The literature review found that the EmPATH unit, a recently developed civilian hospital-based program, can work with higher acuity psychiatric crisis patients who would otherwise be admitted to an inpatient unit, showing promising results in avoiding the need for inpatient hospitalization. EmPATH units help decrease hospitalization rates, reduce restraints and violence, and shorten the patients' boarding time in a holding area. Such findings support the use of the EmPATH unit as a tactic for prolonged field care of psychiatric patients in a combat operational environment.

Conclusions: This is the first literature review to consider EmPATH units for psychiatric prolonged field care based on its advantages demonstrated in the civilian sector. Studies have yet to be done on EmPATH units' usefulness in the military, showing a knowledge gap in current evidence supporting its suitability. Thus, this review recommends further studies of EmPATH units in military settings, especially prolonged field care environments.

Introduction: Traumatic brain injury often requires neurologic care and specialized equipment, not often found downrange. Nonconvulsive seizures (NCSs) and nonconvulsive status epilepticus (NCSE) occur in up to 30% of patients with moderate or severe traumatic brain injury and is associated with a 39% morbidity and an 18% mortality. It remains difficult to identify at bedside because of the heterogeneous clinical manifestations. The primary diagnostic tool is an electroencephalogram (EEG) which is large, requires an external power source, and requires a specialized technician and neurologist to collect and interpret the data. Rapid response EEG (rr-EEG) is an FDA-approved device that is pocket sized and battery powered and uses a disposable 10-electrode headset. Prior studies have demonstrated the noninferiority of rr-EEG in the identification of NCSE and NCS as compared to conventional EEG in hospitals. An unanswered question is whether rr-EEG could be used in the identification of NCSE and NCS by medics.

Materials and methods: In conjunction with the Critical Care Air Transport (CCAT) team, a simulation was created and implemented on a CCAT training mission. The simulation team included a neurology resident, who oversaw the simulation, a pulmonary critical care fellow, an intensive care unit nurse, and a respiratory therapy. A survey was provided before and after the simulation. The team was expected to review the rr-EEG to make clinical decisions during ground transport, takeoff, and landing. The neurology resident monitored and recorded the team's ability to distinguish between NCS and a normal EEG. In between, the neurology resident monitored the quality of the EEG for potential interference and loss of quality.

Results: The CCAT team was able to efficiently set up the rr-EEG on a patient manikin, correctly identify visual EEG wave forms of a patient in NCS, and utilize the proprietary audio program of a simulated patient in NCS. The team reported that the device was easily set up in the environment, and the data were interpretable despite vibration, aircraft auditory and electrical noise, and the ergonomics of the aircraft medical section.

Conclusions: This pilot study has validated a potentially revolutionary technology in medical transport. The rr-EEG technology is measurably user-friendly and will improve patient outcomes. This device and simulation can reduce time to an EEG by hours to days allowing for immediate treatment and intervention, which can significantly reduce morbidity and mortality.

This work explores the challenges of delivering medical care in the geographically dispersed and resource-constrained environment of Distributed Maritime Operations (DMO) and Expeditionary Advanced Base Operations (EABO). Traditional medical planning approaches may struggle to adapt to the vast operational space, extended evacuation times, and limited medical force present in these scenarios. The concept of a Medical Common Operating Picture (COP) emerges as a potential solution. By providing a shared view of the medical situation across the theater, encompassing logistics, personnel, and patient data, a medical COP has the potential to facilitate medical command and control (MED C2) in DMO/EABO. The implementation of a medical COP has the potential to optimize resource allocation, enhance situational awareness, streamline medical evacuation, and reduce healthcare provider moral injury in large-scale combat operations. A medical COP will allow medical planners to make informed decisions on triage, resupply, and evacuation, ensuring the best use of limited medical resources. This is done by leveraging a comprehensive understanding of the medical landscape, enabling informed clinical and operational decision-making by humanitarian and combat personnel respectively. A fully realized medical COP system will enable a dynamic theater evacuation policy, balancing the conflicting needs of patient care at higher echelons with the operational expediency of returning servicemembers to their operational units, thereby maximizing evacuation effectiveness. It will further enable medical personnel to perform dynamic casualty triage based on operational realities, mitigating potential ethical dilemmas. Implementing such a medical COP system will require overcoming communication limitations to facilitate data exchange and potentially integrating clinical decision support tools for real-time data analysis and recommendations. It will also require the rapid adoption of modernized operational medicine documentation solutions by medical assets within the operational forces. Ultimately, this work suggests that a medical COP has the potential to bridge the gap between traditional medical planning and the unique demands of DMO/EABO, ultimately optimizing casualty care, maximizing resource efficiency, and preserving the fighting force.

Introduction: The emergence of coronavirus disease 2019 (COVID-19) pandemic, driven by severe acute respiratory syndrome coronavirus 2, precipitated an unprecedented public health crisis, necessitating comprehensive response worldwide. The Ile-De-France region has been particularly affected, leading to rapid health care system strain and hospital saturation. Within this context, the 1st Armed Forces Medical Centre swiftly adapted its primary care services to cater to the unique needs of military personnel, leveraging telemedicine technologies for efficient health care delivery.

Materials and methods: This study undertook an observational retrospective analysis to characterize the epidemiological profile of soldiers seeking outpatient care for non-severe COVID-19 symptoms at the 1st Armed Forces Medical Centre's sub-centers between March and December 2020. Electronic medical records of patients were scrutinized to discern patterns in symptom presentation and evolution over time.

Results: The cross-section sample consisted of 519 patients, predominantly males (71%), with an average age of 38 years. Predominant symptoms reported were asthenia (43%), cephalalgia (41%), myalgia (40%), pyrexia (38%), and tussis (33%). A significant proportion of patients (33%) were asymptomatic at the follow-up consultations, marking a notable increase from initial assessments (14%). Although symptoms indicative of flu-like syndrome and sore throat exhibited regression between consultations, certain manifestations, such as anosmia, ageusia, and dyspnea, persisted without significant variance. Our analysis delineated five distinct symptom profiles within the cohort.

Conclusions: This study provides valuable insights into the clinical course of non-severe COVID-19 cases among military personnel receiving outpatient care, delineating five distinct symptom profiles. This complexity underscores the challenges in predicting and managing symptomatology effectively. Our findings align with existing literature but offer a unique perspective on military cohorts. Notably, in confined military settings with predominantly young and healthy individuals, symptomatic presentations tend to be milder. Robust public health interventions, including quarantine and contact tracing, are crucial to maintaining operational readiness amidst the pandemic's challenges.

Military physicians serve as staff officers where both leading and following are important competencies. Navigating between the two roles is a necessary skill to avoid undermining one's boss and to support the mission. This case describes a deployed junior officer reconciling his role as the lead medical expert while supporting a Commander's decision, highlighting the challenges of followership in situations of disagreement.

Background: Recent statistics released by the Department of Defense have revealed increasing numbers of military spouse suicide. Although past qualitative research has suggested possible reasons for this phenomenon, there is a lack of wide-scale quantitative research regarding suicide within the military spouse population. To fill this gap, we aimed to examine military spouses' perceptions of suicide and their ability to access mental health care. We also aimed to explore the perceptions of sucide within various subgroups of military spouses.

Materials and methods: We recruited military spouse participants (officer and enlisted) through social media to complete a 12-item Likert survey focusing on their perception of suicide in the military spouse community, including the threat level of suicide, their own mental health status, barriers and stigmas to accessing mental health care, the view from the spouse's leadership, and the leading causes for military spouse suicide. A total of 141 military spouses participated in our study.

Results: Spouses' perception of the main threats to their mental health and suicides in their community were an ongoing sense of loss of control (27.7%), loss of identity (25.5%), difficulty accessing mental health services (19.1%), and fear of seeking mental health services (10.6%). Additionally, 28.3% of participants were moderately concerned, quite concerned, or extremely concerned about their mental health. The participants also believed that the threat of suicides in their community was moderately prevalent (35.5%), quite prevalent (17.7%), and extremely prevalent (5%). There was no difference between spouses of officers or enlisted service members, spouses of service members in the Army, Navy, or Air Force on perceptions of suicide risk prevalence, stigma, participants' concern for themselves, confidence in their ability to access resources, confidence in their ability to help another spouse, or the perceived importance military leaders place on preventing suicide. Spousal tenure was similarly not significantly related to any of the variables of interest.

Conclusions: Our military spouse particpants reported elevated perceptions about the prevalence of suicide threats, concern for themselves, and stigma toward accessing mental health resources, as well as low perceived importance placed on spouse suicide prevention by military leadership. The spouses reported moderate confidence in their ability to help another spouse or access suicide prevention resources. Our participants also reported challenges in accessing mental health services and perceived a stigma associated with receiving counseling services. Continued focus and advocacy is needed to ensure military spouses receive the mental health support needed to prevent suicide within this population.

Introduction: Military medical students participate in a separate residency match program, distinct from their civilian counterparts. There is limited information regarding factors that applicants find important when selecting a residency program in Gynecologic Surgery and Obstetrics (GSO). We aimed to identify factors that influence applicant program selection.

Materials and methods: A voluntary, anonymous, 45-question survey was distributed to military candidates pursuing GSO residency training in the fall of 2023. Participants were asked to rate the factors they considered most important when ranking residency programs.

Results: Thirty-seven of the sixty (61.7%) applicants completed the survey. The culture of the residency program was deemed "important" by most participants (94.6%), followed by surgical volume (70.3%) and obstetric volume (70.3%). When asked to rank selection factors, the culture of the residency program, geographic location, and surgical volume were among the top 5 influential factors for the majority of applicants. Participants considered the following factors "not important": Salary (military pay versus civilian salary) (43.2%), research opportunities (32.4%), and availability of abortion training (21.6%). Most military applicants (62.2%) stated that abortion restrictions would not affect program selection, while 37.8% reported that this would affect their rankings.

Conclusions: Gynecologic Surgery and Obstetrics military applicants deemed the residency program's culture, surgical volume, and obstetrical volume to be the most important factors impacting residency program selection. Residency programs can use these findings to promote program strengths, improve program shortfalls, and guide applicant recruitment.