Military Medicine最新文献

Introduction: Military families face unique stressors, including prolonged separations due to deployments, frequent relocations, and parental injury that can contribute to increased rates of mental, emotional, behavioral, and developmental (MEBD) health concerns among military-connected youth. Although military children have access to universal health insurance coverage through TRICARE and access to primary care at military treatment facilities (MTFs) or through civilian network providers, military-connected children and adolescents face challenges accessing behavioral and developmental health care services. This study examines the experiences of military-connected parents navigating health care for their children with MEDB health care needs.

Materials and methods: This study utilized a qualitative research design with focus groups. Recruitment occurred via partners from the DOD Child Collaboratory, through email, flyers, and social media. Virtual focus groups were audio recorded and transcribed. Data analysis followed an inductive coding approach. The Institutional Review Board at the Uniformed Services University approved this study.

Results: Six, 1-hour virtual focus groups were completed with 18 participants. Four themes emerged as relevant to the experiences of participants (1) Military Life Circumstances: shape every step of military-connected children's MEDB health care journeys, (2) Barriers to Accessing MEDB Health Care: structural/systemic barriers and relational/perceptual barriers present challenges to accessing quality care, (3) The Diagnostic Journey: logistical pressures of military life and health care availability can delay diagnosis, (4) Facilitators to MEDB Care: the utility of formal military supports and providers with military cultural competence can improve MEDB health care access and quality.

Conclusions: Our data underscores the multifaceted journey of military families navigating MEDB health care and highlights the coexistence of dual concepts of readiness in military culture, ideal and real. These findings highlight opportunities to improve care coordination, streamline transitions, and enhance collaboration among support systems for military families managing MEDB health care needs. Addressing access to care challenges is critical to upholding the health of military children and families and achieving ideal readiness of the U.S. Military.

Introduction: Chest pain is a frequent reason for evaluation at military treatment facilities in the deployed setting. Deployed persons are generally at low risk of coronary disease as the underlying cause for these symptoms; however, morbidity and mortality from acute coronary syndrome in an austere environment can be catastrophic. For theaters with access to computed tomography (CT), Coronary CT Angiography (CCTA) offers a diagnostic modality to effectively rule out this high-risk diagnosis in low to intermediate risk patients. The researchers present a descriptive analysis of CCTA use at a deployed Role 3 over a deployment rotation spanning 8 months.

Materials and methods: The researchers devised a CCTA protocol and delivered this diagnostic modality at a deployed Role 3 MTF. They included patients presenting with chest pain and stratified by the treating cleinician as intermediate risk given a history, electrocardiogram, age, cardiac risk factors, Troponin T, HEART score, and bedside echo when available. The CT scanner used by the researchers was a Siemens SOMATOM go, Top 128 slice, 70 cm bore, equipped with hardware to perform electrocardiography (ECG) gated studies and postprocessing. The researchers beta blocked patients to a target heart rate of 50-60 prior to each study, and administered a single 0.4 mg tab of sublingual nitroglycerin 4-7 minutes prior to starting angiography. They performed pre-angiography unenhanced CCTA to determine calcium score. Later, they performed ECG gated CCTA following intravenous (IV) contrast administration.

Results: The researchers performed four CCTA studies on symptomatic patients, each of whom also received a pre-angiogram CT calcium score. All four patients successfully completed the protocol. All four patients had a calcium score of 0. CCTA was low risk without any visible coronary disease for two patients and non-diagnostic for the remaining two patients. There was no major adverse event. One patient experienced a small volume IV access site infiltration at the end of the contrast bolus injection which did not limit that respective exam. The remaining patients did not experience any minor or major adverse events.

Conclusion: The initial data of this study is proof of concept that CCTA is feasible for assessing intermediate risk patients presenting with acute chest pain in the deployed setting, to rule our coronary pathology. The researchers' initial evaluation shows promise and suggests that this is a useful modality to continue to utilize and study in this environment.

Introduction: In 2020, the U.S. Army began implementation of the Holistic Health and Fitness (H2F) system to reduce musculoskeletal injury (MSKI) rates and expedite rehabilitation after injury. The purpose of this study was to describe the rates and characteristics of incident MSKIs evaluated by H2F physical therapists (PTs) and athletic trainers (ATs) in a U.S. Army Stryker brigade combat team from October 2021 to September 2022.

Materials and methods: In this retrospective observational study, we used negative binomial models and the H2F injury tracker and Army administrative data to estimate MSKI incidence rates for the overall brigade and within strata of battalion, age, sex, rank, race, and ethnicity. We repeated these estimates when standardized to the overall brigade population by battalion, age, sex, and rank. We characterized distributions of time from injury to evaluation, limited duty days (i.e., time-loss), and activity at time of injury. This research was determined exempt by academic and military Institutional Review Boards.

Results: The embedded H2F PTs and ATs evaluated 2,140 incident MSKIs in the brigade (4,780 person-years) for an overall rate of 39.1 MSKIs per 1,000 person-months. Battalion rates ranged from 31.8 (field artillery) to 50.0 (infantry) and did not change substantially after standardization. Embedded H2F PTs and ATs evaluated 63% of MSKIs within 1 week of onset, managed 59% without assigning time-loss, and found 51% of MSKIs occurred during unit physical fitness training.

Conclusions: These findings are consistent with the a priori expectation that embedded providers and the H2F system expedited access to MSKI evaluation and treatment. A strength of this study was our ability to estimate MSKI incidence rates and characterize MSKI evaluated in the H2F environment using a novel injury tracker coupled with administrative data. A limitation is that because of data deidentification, we could not measure cumulative time-loss. This descriptive observational study will help inform the findings of subsequent research on the effect of H2F implementation on MSKI outcomes.

Introduction: Airway compromise is an urgent and life-threatening challenge that commonly occurs on the battlefield. Effective airway management on the battlefield is critical for reducing preventable deaths. This review summarizes the existing literature on airway management in the deployed combat setting.

Materials and methods: We conducted a scoping review using the PRISMA-ScR checklist. We used PubMed and Google Scholar to identify relevant literature from 2001 to 2025 which reflects the years for the Global War On Terrorism. Studies were eligible if they reported on airway interventions in the combat setting.

Results: There were 30 airway studies that met inclusion for this review. Of the studies included in this review, 3 were focused on endotracheal intubation (ETI), 3 were focused on cricothyrotomy, 1 was focused on supraglottic airways, and 23 evaluated more than 1 airway method. The studies included 4 prospective observational studies, and 25 retrospective observational studies. Overall, ETI was the most commonly reported airway procedure with the majority performed by medical officers in both the fixed and prehospital settings. Cricothyrotomy was the second most commonly reported with a relatively low incidence and high complication. Multiple studies highlighted gaps in skills training as well as technology as a complicating factors.

Conclusions: Effective airway management is critical for reducing preventable deaths on the battlefield. Endotracheal intubation is the most common advanced airway intervention, while cricothyrotomy and supraglottic airways are less common and show variable success. Ongoing gaps in training, documentation, and equipment access highlight the need for standardized airway protocols and improved training programs to improve battlefield survival among casualties requiring an advanced airway.

Hereditary spherocytosis and sickle cell disease are two distinct hematologic diseases that affect the morphology of the red blood cell, causing implications related to splenic sequestration. Concurrent disease is very rare, with even fewer reported instances requiring surgical intervention. Furthermore, an individual with a third concomitant hematologic abnormality such as Factor VII deficiency, which degrades the normal clotting cascade, has not previously been reported. We describe an active-duty servicemember with known hereditary spherocytosis, sickle cell trait, and Factor VII deficiency who had recurrent worsening pain crises post-flight. The resulting hepatobiliary and splenic damage that ensued ultimately required splenectomy. These diseases in combination further enhance risks associated with splenic damage and intra-operative bleeding, with special consideration for intra-operative risk management and long-term sequala from end-organ damage. The military population exacerbates these conditions where physical exertion, high-altitude travel, and rapid geographic reassignment are considered the norm. This case of a servicemember with a unique disease triad managed successfully with surgical correction underscores the importance of individualized care planning and consideration of duty readiness.