Military Medicine最新文献

The breakage of an intravenous (IV) cannula represents a rare complication associated with peripheral IV cannulation, a prevalent procedure in the civilian and military prehospital setting. Intravenous cannula breakage can lead to further complications including infection, migration, and subsequent embolization. Although fast identification and extraction are essential management components, there are no consensual guidelines for the proper management of this complication. In this report, we present a case involving a 19-year-old soldier who presented to the emergency department following the rupture of an IV cannula during military training. Subsequently, embolization of the cannula fragment occurred because of the patient's discomfort and noncompliance with venous tourniquet usage. This case report delineates the actions taken both on-site and upon the patient's arrival in the emergency room, including the utilization of point-of-care ultrasound as an expedient diagnostic tool for identifying the fragmented cannula swiftly. Additionally, we provide a review of the management approaches detailed in existing literature, with a specific emphasis on the use of venous tourniquet placement as a potential measure for avoiding complications.

Introduction: Blast exposure is responsible for the great majority of Traumatic Brain Injury (TBI) in deployed military service members (SMs). More rapid and reliable methods of diagnosis of blast TBI are needed. The Brain Gauge has been touted as an option, but published reports have had mixed results.

Materials and methods: A review of a case series of 15 U.S. SMs (2 females) with TBI from incoming missiles fired at Al Asad Air Force Base, Iraq, on January 8, 2020. All had medical evacuation to Landstuhl Regional Medical Center (LRMC), Germany where the Brain Gauge was administered; 10 of 15 also repeat the Brain Gauge 4-5 days later. Performance on the Brain Gauge was compared with other assessments conducted at LRMC. In addition, Brain Gauge results from this cohort were compared with those from pertinent controls: 30 active duty U.S. Navy male SMs and 28 female Explosive Ordnance Disposal (EOD) specialists from the US Air Force, Army, Navy and Marine Corps.

Results: Brain Gauge testing revealed significant impairment in performance in SMs with recent concussion. The Al Asad cohort exhibited significantly reduced accuracy (P = .012, Cohen's D 1.0), focus (P = .003, Cohen's D 1.37) and composite Corticalmetric Score (P = .004, Cohen's D 0.96). Readministration of the Brain Gauge several days later revealed improvement in both concussed and control SMs, indicating a practice effect. However, the Al Asad cohort showed greater improvement, likely representing evidence of some degree of recovery from concussion, and narrowing the gap versus controls, though there were still significant differences in focus and Corticalmetric scores. Despite small numbers, the two females with TBI at Al Asad also had significantly worse focus (P < .001, Cohen's D 3.4) and composite Corticalmetric scores (P < .05, Cohen's D 2.7) than female controls on the Brain Gauge.

Conclusion: Brain Gauge performance is significantly impaired upon initial administration weeks after blast TBI in SMs but shows improvement upon readministration 4-5 days later. Findings in this small sample require replication in larger populations.

Introduction: Radiofrequency (RF) exposure has been extensively studied for potential health risks. Unlike ionizing radiation, RF fields primarily cause thermal health effects, the only established mechanism of biological harm. Regulatory bodies, including the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and the Institute of Electrical and Electronics Engineers (IEEE), set limits to prevent excessive heating. This review examines the relationship between RF exposure, heat generation, and physiological responses, with relevance to civilian and military safety.

Methods: A narrative review of peer-reviewed literature, regulatory reports, and experimental studies was conducted using PubMed, IEEE Xplore, Google Scholar and Scopus. Emphasis was placed on Specific Absorption Rate (SAR) and Cumulative Equivalent Minutes at 43 °C (CEM43). Studies on thermal effects and exposure scenarios were prioritized; speculative non-thermal mechanisms were excluded.

Results: Thermal effects depend on frequency, tissue composition, and environmental conditions. Whole-body SAR limits (≤4 W/kg) generally prevent core temperature increases, but localized heating remains a concern. CEM43 provides a temperature-based metric but is difficult to apply in transient exposures. Penetration depth across NATO frequency bands shows variability because of differences in tissue models and measurement methods. This variability is clinically relevant, as localized heating of the skin, eye, or superficial nerves may occur even when whole-body exposure is within limits.

Conclusion: Current guidelines prevent systemic overheating but may not fully address localized risks. Combining SAR and CEM43 with refined penetration depth data could improve risk assessment. Future work should refine dose-response thresholds and methods for detecting and modeling localized heating, especially under military conditions where thermoregulation may be impaired.

Introduction: Heavy load carriage has negative health and performance implications for military personnel, such as links to musculoskeletal injuries and longer completion times of military tasks. There is a need to understand performance-related factors as they interact with equipment in a simulated military task, completed in teams and in an outdoor environment. The purpose of this study was to determine the effect of load condition on the performance of a simulated high-intensity military task completed in an outdoor environment in a 2-person team.

Materials and methods: A total of 14 male participants (average ± standard deviation 27.7 ± 7.5 years, 180.2 ± 7.1 cm, and 79.2 ± 7.4 kg) were recruited from the Canadian Army reserve force population. In pairs, participants completed eight simulated bounding rush tasks over 30 m in an outdoor field environment while wearing four randomized equipment conditions, including, (i) Slick (5 kg); (ii) Medium (23 kg); (iii) Heavy Pockets (37 kg), Medium with additional load concentrated anterior and posteriorly close to the torso; and (iv) Heavy Backpack (37 kg), Medium with additional load distributed posteriorly in a day pack. Each participant began one of the bounding rush trials (e.g., moved first) for each equipment condition (two trials per condition) and self-selected the distance travelled in each individual bound and speed during each task. Inertial measurement units (Movella, Henderson, NV, United States) captured the movements of both participants continuously, and surveys assessed the acceptability of aspects of the equipment conditions and performance of each task.

Results: There was a main effect of equipment condition on the total team completion time of the bounding rush task (P = .0006) and the individual prone-to-run transition (P = .0343), where the Heavy Pocket and Heavy Backpack conditions took significantly longer to complete compared to the Slick condition. Subjective ratings of speed performance demonstrated a significant difference between equipment conditions (P = .0008), where significant differences were detected between the Slick, Medium, and Heavy Backpack conditions, while there was no significant difference between the Heavy Pockets, Medium, and Heavy Backpack conditions.

Conclusions: Equivalent weight carried in a posterior location (e.g., a backpack) compared to closer to the midline of the body does not improve subjective, survey-based perceived ratings of overall performance, agility speed, or mobility during the tasks evaluated in the current investigation. Future investigations examining team dynamics would improve external validity by including the full team in the scenario.

Introduction: The U.S. military launched various combat operations following the September 11, 2001 terrorist attack on America. This included Operation Enduring Freedom (OEF) in and around Afghanistan and Operation Iraqi Freedom (OIF) in and around Iraq. These operations occurred in different locations and timeframes and had a significantly different number of casualties. Little is known about the psychological impact of these operations among service members. This study evaluated differences in mental health diagnoses and suicide risk among individuals evacuated for psychiatric conditions from these 2 theaters of combat.

Materials and methods: Data was retrieved from U.S. Transportation Command Regulating and Command and Control Evacuation System and Defense Manpower Data Center records of services members who were aeromedically evacuated for psychiatric conditions during OEF (n = 2,920) and OIF (n = 4,832) between 2001 and 2013 (N = 7,752). We computed Pearson chi-squares to identify differences between service members who had a psychiatric aeromedical evacuation from OEF versus OIF. We evaluated differences in (1) demographic and military characteristics, (2) the prevalence of psychiatric conditions, (3) the 5 most common primary diagnoses, (4) indicators of suicide risk, and (5) the relationship of suicide risk with separation from military service.

Results: There were significant differences in those who had a psychiatric aeromedical evacuation from OEF and OIF related to marital status (χ2(2) = 10.99, P = .004) and education (χ2(3) = 21.29, P < .001). The prevalence of diagnosed psychiatric conditions also differed between OEF and OIF (χ2(10) = 263.49, P < .001). There were no differences in the distribution of suicide attempts, but there was a significant difference in the number of aeromedical evacuations attributed to suicidal ideation (χ2(1) = 182.705, P < .001).

Conclusion: Significant differences were identified in service members who had a psychiatric aeromedical evacuations from OEF and OIF regarding demographic factors and military characteristics. Even though fewer services members were evacuated for suicidal ideations during OIF, a higher number of services members were evacuated for suicide attempts. This inverse trend may be attributable to deployment stressors or healthcare services differences delivered in theater. Similarly, this may explain the difference in the prevalence of diagnosed conditions.

Introduction: The physical fitness and body composition of soldiers are critical for operational readiness and overall health. Military service demands optimal levels of muscle strength, endurance, and cardiorespiratory fitness, alongside a healthy body fat percentage (%BF). However, unlike in the U.S. Armed Forces, Czech Soldiers are not required to meet specific %BF standards, and the prevalence of excessive fat remains unknown. Dual-energy X-ray absorptiometry (DXA) offers a precise and reliable assessment of body composition, yet its use in European military research remains limited. This study evaluates the body composition of Czech Artillery Soldiers using DXA, focusing on %BF, fat-free mass, visceral adipose tissue (VAT), and bone mineral density (BMD), compares %BF values with U.S. Army and civilian norms, and evaluates the practical implications of these findings for military health policy.

Materials and methods: A randomized cross-sectional study was conducted on 209 healthy adult active-duty Czech Artillery Soldiers (189 men, 20 women). Participants underwent a DXA scan to assess body composition using a Hologic Horizon system. Statistical analyses included the Mann-Whitney and Kruskal-Wallis tests, 1-way ANOVA, and generalized linear models (GLM) with age as a covariate. Health classifications were derived using BMI, %BF, and VAT thresholds for cardiometabolic risk and BMD T-scores for osteopenia and osteoporosis. The protocol adhered to the approval granted by the relevant institutional ethics committee (No. 246/2021).

Results: Czech Artillery Soldiers and U.S. Soldiers had nearly identical %BF, 24.3% in Czech men vs. 24.3% in U.S. men; 33.8% vs. 33.3% in women, respectively. Overall, excessive %BF (≥25%) was observed in 41.2% of participants. Age group was a significant predictor of VAT (ω2 = 0.20, df = 6, H = 42.51, P < .001) and %BF (ω2 = 0.07, df = 6, H = 18.73, P < .005), with older participants exhibiting higher levels. High prevalence of osteopenia was found, reaching 20% in both sexes. Contrary to expectations, the GLM revealed that there are no significant differences among units of the Czech Artillery Brigade in any measured variable when age is considered.

Conclusions: DXA-measured body composition in Czech Artillery Soldiers closely matches contemporary U.S. Army values. The high prevalence of overweight and osteopenia underscores the need for preventive and educational strategies addressing both metabolic and skeletal health risks. Future research should determine the prevalence of osteopenia and osteoporosis across the Czech Armed Forces to inform appropriate screening practices and targeted interventions.