Military Medicine最新文献

Introduction: Military standards favor clean shaven faces in soldiers to reinforce daily disciplinary habits and uniformity and ensure a proper seal of gas masks. In recent years, military beard policies have provided medical and religious exceptions. It has been anecdotally observed that Arctic warriors grow out their beards for added advantage in the extreme cold, but this has not been previously investigated from a thermoregulatory or frostbite injury protection perspective.

Materials and methods: Validated mathematical models and principles of biophysics were used to predict thermal responses for a standard man with varied levels of facial hair during rest (116W) and moderately active (350W) in 3 environmental conditions, mild heat stress (24 °C; 60% relative humidity (%, RH)), cold stress (-24 °C; 70% RH), and in extreme cold (-45 °C; 75% RH). Modeling was used to compare predicted times to reach core body temperatures and skin temperatures although clean shaven (B0), and in 3 progressively increased levels of facial hair (B1, B2, and B3). Core body temperature was assessed during heat stress conditions, while skin temperatures were assessed in cold and extreme cold conditions.

Results: Using existing thermoregulatory models, we determined that full beards compared to smooth shaven skin did not provide a significant advantage to protection of core temperature. However, finite elements modeling of thermographic changes in skin temperature predicted significant protection against frostbite injury to the face, and this was additional to protection provided by standard military balaclava wear in the Arctic.

Conclusions: We conclude that beards provide a lethality advantage to male soldiers operating in the cold, enhancing military exploitation of extreme cold environments.

Introduction: Military medical providers must rapidly assess and treat casualties while managing prolonged care in resource-limited environments. Tactical Combat Casualty Care and Prolonged Casualty Care (PCC) provide structured frameworks for battlefield medicine, but training often separates technical and leadership development. To address this gap, Operation Gunpowder at the Uniformed Services University was adapted to integrate leadership and clinical skills. This study examines the relationships between student leadership performance, self-reported training experiences, and faculty and peer evaluations.

Materials and methods: This study analyzed data from 203 third-year medical and graduate nursing students participating in the 36-hour Operation Gunpowder field practicum. Leadership performance was assessed using the Leader-Follower Framework, which evaluates Character, Context, Competence, Communication, and Leadership Transcendent Skills. Students completed post-practicum surveys and reflections, and Pearson correlations were conducted between survey responses and leadership performance ratings. Qualitative responses were reviewed for themes related to quantitative findings.

Results: In each squad, students who rated Primary Survey, Wound Care, or Evacuation Skills as useful had lower leadership performance scores, particularly in Character (r = -0.46 to -0.52, P < .05) and Communication (r = -0.46, P < .05). Confidence in PCC knowledge was positively correlated with adaptability (Context, r = 0.44, P < .05), suggesting that early PCC training may improve situational responsiveness. Squads that found hands-on practice most beneficial had lower Communication scores (r = -0.48, P < .05), indicating potential gaps in team coordination. Students who prepared for less than 1 hour before the practicum performed better in leadership dimensions, including Communication (r = 0.56, P < .01).

Conclusions: These findings highlight challenges in integrating leadership into technical skills training. Enhancing PCC exposure, embedding communication exercises in hands-on training, and optimizing pre-practicum preparation may improve leadership development. Insights from this study can inform refinements to military medical training, including Operation Bushmaster, to better prepare future military medical officers for battlefield decision-making and leadership.

Birt-Hogg-Dubé Syndrome (BHD) is a rare autosomal dominant disorder caused by mutations in the FLCN gene, leading to tumor formation in the skin and kidneys, as well as cystic lung disease predisposing to spontaneous pneumothoraces. These pneumothoraces often recur despite surgical intervention. We present a case of a 20-year-old male of East Asian descent with no significant medical history who developed recurrent spontaneous pneumothoraces despite undergoing video-assisted thoracoscopic surgery with pleurodesis. After undergoing the procedure, he was noted to have a recurrent pneumothorax at his postoperative visit. This required the placement of a surgical chest tube and further evaluation at a specialized lung center. This case underscores the importance of considering BHD in young, otherwise healthy patients with recurrent pneumothoraces, particularly in those of East Asian descent, who may initially lack cutaneous manifestations. Given the high recurrence rate of pneumothorax in BHD, early suspicion and genetic confirmation are critical to ensuring appropriate long-term surveillance, especially for renal malignancies. Additionally, this case highlights the challenges in military medicine, where conditions like BHD may impact fitness for duty. Increased awareness and early diagnosis can improve management strategies and patient outcomes.

Introduction: U.S. Active duty Service members (ADSMs) experience barriers to sexual and reproductive healthcare (SRH). Enhancing patient-centered SRH services is essential to empowering ADSMs to achieve their health goals, which may, in turn, contribute to improved military readiness. This study aimed to assess the feasibility and acceptability of a clinician-led group educational intervention developed to improve ADSMs' awareness of availability of SRH services and self-efficacy to access this care, in order to guide future refinement and implementation of this program.

Materials and methods: A series of standardized 20-minute, interactive group educational sessions on SRH topics was delivered over a 12 month period to groups of ADSMs at a large military installation. This pretest-posttest study was conducted without a control group to assess feasibility. The primary outcomes were changes in perceived SRH knowledge and intention to seek future SRH, and were evaluated with McNemar's tests. Logistic regression evaluated the influence of demographic characteristics on these changes.

Results: Participants included 1,077 ADSMs (72% male, 89% junior enlisted). Exposure to the intervention was associated with increased awareness of contraceptive options (pre = 81%/post = 96%), available SRH services (pre = 60%/post = 96%), how to obtain emergency contraception (pre = 57%/post = 96%), human immunodeficiency virus (HIV) pre-exposure prevention (pre = 40%/post = 92%), and how to request sexually transmitted infection (STI) screening (pre = 51%/post = 96%), (ps < 0.001). Participants indicated increased intent to schedule an appointment for STI screening (pre = 8%/post = 17%, P < .001) and contraception (female participants pre = 18%/post = 26%, P = .008). Of those who did not agree that they were comfortable discussing SRH with a military clinician on the pre-intervention questionnaire, 77% reported that they were more encouraged to use SRH services on a military base, and 76% reported that they were more comfortable seeking SRH services in a military clinic after the intervention. Logistic regression showed no statistically significant effects of demographic characteristics on responses to the intervention. One-third of participants requested an appointment after the intervention using an appointment request card. Almost all participants (i.e., 87%) reported plans to share the content.

Conclusions: This patient-centered initiative is feasible and acceptable to ADSMs, may be scalable, and has the potential to reduce barriers and empower ADSMs in optimizing their SRH goals.

Introduction: Military-Civilian Partnerships are a growing solution to both sustain military medical skills and share crisis response lessons learned. These partnerships often receive support from the Administration for Strategic Preparedness and Response (ASPR), which also oversees the National Disaster Medical System (NDMS). Given the unique austere medical training and geographic dispersion of military personnel across the country, these military-civilian partnerships hold potential untapped utility for the NDMS. The United States Army Special Operations Command (USASOC) and Advocate Health maintain a military civilian partnership (MCP) for the sustainment of mission critical wartime medical readiness skills.

Materials and methods: The military civilian partnership utilized a developmental "crawl, walk, and run" approach through didactics, clinical integration, and joint training exercises in order to integrate military personnel into a real-world NDMS response.

Results: The United States Army Special Operations Command-Advocate Health military-civilian partnership demonstrated the inaugural utilization of an MCP during a domestic disaster response to Hurricane Helene in October 2024. The mobilized team included emergency medicine, nursing, anesthesia, and surgery while providing resuscitative and surgical support over 6 days.

Conclusions: Military personnel are uniquely trained in mass casualties, austere medicine, and medical operations planning that hold the potential to support the NDMS in a federal response to a homeland disaster. This pilot program suggests that there are robust future opportunities to improve resilience of the domestic disaster system. Ongoing efforts should be directed towards formalizing the processes to incorporate military-civilian partnerships in disaster response, scaling MCP disaster training nationally, and exercising the movement of combat casualties en masse to civilian trauma centers.

Introduction: Leadership skills are critical for success in both medicine and the military. Formal leadership training and early leadership experience are inherent in the career of military physicians. The aim of this study was to evaluate and compare the demographic characteristics of orthopedic surgery department chairs and residency program directors of military and civilian programs. We hypothesized that compared to civilian programs, military programs fill these roles with surgeons earlier in their careers and with proportionally more women.

Materials and methods: A cross-sectional observational study was performed using publicly available demographic data for all civilian orthopedic surgery residency programs registered in the Association of American Medical Colleges Electronic Residency Application Service (AAMC ERAS) database and those military programs listed on the Society of Military Orthopaedic Surgeons (SOMOS) website. Institutional and professional websites (U.S. News and LinkedIn) were utilized to gather the year of residency graduation and sex of the orthopedic surgery department chairs and residency program directors for each program. The demographic information was compared between civilian and military orthopedic programs.

Results: A total of 162 civilian and 8 military orthopedic residency programs were included. For department chairs, the mean time since residency completion was longer for those at civilian programs compared to military programs (27.03 ± 7.72 vs. 10.57 ± 3.25) (P < .05). Similarly, for residency program directors, the mean time since residency completion was longer for those at civilian programs compared to military programs (19.01 ± 9.31 vs. 9.42 ± 1.81) (P < .05). Among civilian programs, 4.7% and 13% of chairs and programs directors were women. Among military programs, 14.3% and 28.6% of chairs and program directors were women.

Conclusions: Military orthopedic surgeons assume the leadership roles of department chair and residency program director significantly earlier in their careers than their civilian peers and exhibit modestly higher sex diversity. Structural and cultural aspects of military medicine likely contribute to these differences, offering a model for early leadership cultivation and highlighting the opportunity for early leadership experience in military orthopedics.

Gluteal compartment syndrome (GCS) is a rare diagnosis that is difficult to diagnose and can lead to significant morbidity. Common etiologies of GCS include direct trauma or prolonged immobilization as a result of surgical anesthesia, alcohol, or drug use. If not diagnosed and treated promptly, significant soft tissue, neurologic, and renal damage can occur. Mortality occurs in up to 7% of individuals. Conservative management is associated with poorer outcomes, with definitive management requiring surgical intervention. The occurrence of GCS in austere environments is particularly challenging because of a paucity of diagnostic and surgical resources. Herein, we describe a case of GCS that occurred in an active duty navy sailor after a shipboard fall. Diagnostic and treatment modalities of GCS are discussed, as are the implications of GCS within the operational maritime environment.