Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

Emerging technologies for monitoring vital signs are increas-ingly being adapted for surveillance purposes. As these tools grow more sophisticated, traditional countermeasures em-ployed by Special Operations Forces (SOF) may no longer be sufficient. This brief highlights examples of biological surveil-lance technologies and proposes a holistic response by con-ceptualizing the management of biological signatures during operations as biological Operational Security (bio-OPSEC). SOF medics-by virtue of their tactical perceptiveness and med-ical acumen-can play a vital role in bio-OPSEC, enhancing awareness and mitigating their team's vulnerabilities. Drawing on insights from bio-sensing technologies and security studies this in brief article introduces actionable approaches for im-plementing bio-OPSEC.

Background: Needle decompression (NDC) is the primary treatment of tension pneumothorax (tPTX) in prehospital settings. This study compared 10-gauge (10ga) and 14-gauge (14ga) fenestrated needle/catheter units for NDC. We hypoth-esized 10ga needle/catheter units would demonstrate higher tPTX decompression rates compared to 14ga needle/catheter units.

Methods: A non-randomized, non-blinded study was conducted using human cadavers with artificially induced tPTX (pleural pressure of 15mmHg). A 10ga or 14ga unit was in-serted into the 5th intercostal space, anterior axillary line, or the 2nd intercostal space, midclavicular line. Successful NDC was defined as a pressure decrease to less than 4mmHg.

Results: In 116 NDC attempts, there was no difference in the success rate of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, P=1.0). The median time to decompression of tPTX was faster using 10ga at 22.0s (IQR 14.5-42.0) vs. 14ga at 39.8 seconds (IQR 30.3-57.6, P<.001). No difference was found in time to successful decompression between AAL and MCL sites (36.0s [IQR 21.7-51.7] vs. 30.4s [IQR 18.7-49.5], P=.46). The 10ga needle/catheter units achieved an audible release of air with the needle still in place during successful NDC more frequently compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con-clusion: NDC with 10ga fenestrated needle/catheter units was similarly effective, but significantly faster than 14ga units for tPTX in a cadaveric model. A safe, depth-limiting technique was over 90% effective across all NDC sites.

The U.S. Army's current casualty evacuation (CASEVAC) strategy is inadequate for managing large-scale conflicts, particularly when mass casualties can overwhelm evacuation capabilities. The Army must rethink CASEVAC to meet the demands of future conflicts, where the U.S. may face peer adversaries capable of causing a significant number of casualties. The authors advocate that the Army should adopt a "whole of force" approach, prioritizing the requirements of the maneuver commander and enhancing operational flexibility and simplicity. To achieve this, the Army should revise its current CASEVAC doctrine, expand the integration of CASEVAC in training, and evaluate its current force structure to ensure it supports effective CASEVAC and MEDEVAC operations. Additionally, the authors present three concepts: creating asymmetric outcomes, thinking differently, and adopting a bias for action, which can all further improve the Army's CASEVAC capabilities and capacity. By embracing these concepts and recommendations, the Army can effectively support maneuver commanders and maximize the number of casualties it can replace in theater, thereby gaining a competitive edge in a great power conflict.

The evacuation timelines of Ukrainian casualties through the Operational Patient Care Pathway (OPCP) vary widely, ranging from minutes to days. Western Military reliance on air evacuation models has proven inefficient in the current conflict, dominated by sophisticated air defense and electronic warfare. This paper explores the adaptation of medical support in static warfare, focusing on the development of Subterranean Casualty Stabilization Points (ST CSP) by the Armed Forces of Ukraine (AFU). These facilities provide damage control resuscitation and damage control surgery close to the front lines, significantly reducing the time from injury to surgery. The ST CSPs, built with enhanced protection, represent a paradigm shift in military medical doctrine, offering a gold standard solution for casualty care in a contested environment. This study highlights the need for Western militaries to consider similar adaptations to ensure the survivability of medical force elements in future conflicts. 1) The Russia-Ukraine conflict has demonstrated the difficulty an air-denied environment poses for medical evacuation (MEDEVAC) and the requirement this will drive for placing surgical stabilization facilities close to the front line of troops (FLoT). 2) Artillery and drone munitions would preclude tented and other traditional forward solutions. 3) This paper presents ST CSP as an option that enables damage control resuscitation and surgery to be provided in otherwise prohibitive tactical environments.

Maritime operations conducted by military Special Operations Forces and civilian special weapons and tactics (SWAT) units present unique medical challenges. These missions often occur in unpredictable environments, far from immediate medical resources and with exposure to waterborne threats. This article examines the medical aspects critical to maritime operations, including hypothermia management, trauma care in confined and moving spaces, management of drowning and respiratory issues, and specialized training for maritime-specific injuries. A narrative review of literature from 2005-2024 was conducted across major databases and grey sources, with studies included by author consensus. The review identified core maritime medical challenges, hypothermia, drowning, confined-space trauma, respiratory hazards, motion sickness, and impact injuries. Medical support tailored to these environments is essential for maintaining operational effectiveness and responder safety. By examining both preventive and responsive medical approaches, this article highlights the need for maritimespecific medical protocols and training.

Bandages have been used in hemorrhage control since at least ancient Egyptian, Greek, and Roman times. The design remained unchanged until the fifth century BCE, when gauze was introduced. Modern bandages are relatively expensive and heavy and are not widely available in low-resource environments. Packaging wrap, sometimes called Saran wrap, cling film, cling wrap, or Glad wrap, is widely available in many countries. It is used commercially with handheld dispensers to bind goods to pallets for secure transport. In austere settings, packaging wrap has a large number of improvised medical uses. It can be used as a dressing to apply pressure to wounds, as covering for burns, to splint limb fractures, to occlude bowel evisceration, and to ensure the security of casualty cards. It can also be used to create an endotracheal tube tie, an improvised intravenous fluid pressure infuser, an improvised pneumatic limb tourniquet, or a head immobilizer for spinal immobilization. Large numbers of dressings can be created from a single dispenser, making this a cheap and light alternative to conventional dressings. Packaging wrap is not intended as a replacement for commercially available, approved products but rather to assist in packaging and for use in austere, remote and tactical environments, where space and weight are limited.

Objectives: Intraosseous (IO) access is a medical procedure primarily used in emergencies when peripheral venous access is unobtainable or delayed. The IO procedure is commonly performed using the EZ-IO, a battery-powered intraosseous driver. In contrast, the newer SAM IO is a less costly and manually powered driver. Our objective was to compare the EZ-IO and SAM IO by examining insertion times and EMS clinicians' preferences.

Methods: This randomized prospective trial was performed with EMS clinicians after watching in-structional videos. Participants practiced insertions with both drivers on plastic task trainers and porcine bones until they self-reported proficiency. Participants were randomized to one of the drivers, and insertion times into a porcine humeral bone were analyzed. All participants completed a post-study survey.

Results: Study participants (n=106) using the EZ-IO had faster insertion times, mean 1.1 seconds (s) (95% CI 0.8-1.4), versus the SAM IO, mean 2.8s (95% CI 2.5-3.1), P<.001. The mean difference was less than 2s and unlikely to be clinically signif-icant. All attempts were deemed successful. Most considered the SAM IO easy to use 68.6% (74/106), and 80.0% (85/106) reported confidence in patient use. Despite this, participants expressed some reservations.

Conclusions: In the largest ran-domized controlled trial to date, we found that the EZ-IO had a faster insertion time compared to the SAM IO, but the time difference was unlikely to be clinically meaningful. Although participant responses indicated a preference for the EZ-IO, most felt confident using the SAM IO in an EMS setting.