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

Tattooing is an ancient art form widely practiced among Special Operations Forces (SOF) personnel. The ink injected into skin tissue during tattooing often contains various compounds, including impurities and contaminants, which can pose health risks. This article provides an overview of recent research to inform SOF medical personnel about the potential health implications of both new and older tattoos.

Background: The Military Health System is a unique subsector within the nation's Graduate Medical Education (GME), with a different incentive structure for specialty selection for military medical students compared with their civilian counterparts. Changes by the Defense Health Agency (DHA) in 2017 emphasized a shift in military GME to training "operational" medical specialties. This study sought to gain insight into military medical students' reactions to the 2017 DHA transition by examining whether students continued to select "operational" specialties at similar rates as well as whether students remained satisfied with attending medical school.

Methods: We performed a retrospective analysis of Uniformed Services University (USU) post-match students from 2015 to 2020 using anonymized data from the Association of American Medical Colleges (AAMC) Graduation Questionnaire, separated into pre-DHA (2015-2017) and post-DHA (2018-2020) transition groups.

Results: Regarding both intent to practice an operational specialty and satisfaction with choosing medical school, there was no statistically significant difference between the preand post-DHA transition groups.

Conclusions: Whether preor post-DHA transition, USU medical students demonstrated similar preferences for operational specialties as well as similar levels of satisfaction with medical school attendance, suggesting that this transition may not significantly influence medical students' career preferences nor blunt their desire to enter military medicine.

Introduction: Mass casualty events (MASCALs) in the combat environment, which involve large numbers of casualties that overwhelm immediately available resources, are fundamentally chaotic and dynamic and inherently dangerous. Formal triage systems use diagnostic algorithms, colored markers, and four or more named categories. We hypothesized that formal triage systems are inadequately trained and practiced and too complex to successfully implement in true MASCAL events. This retrospective analysis evaluates the real-world application of triage systems in prehospital military MASCALs and other aspects of MASCAL management.

Methods: We surveyed Special Operations Forces (SOF) medics known to us who have participated in military prehospital MASCALs and analyzed them. Aggregated data describing the scope of the incidents, the use of formal triage algorithms and colored markers, the number of categories, and the interventions on scene were analyzed using descriptive statistics, and lessons learned were consolidated.

Results: From 1996 to 2022 we identified 29 MASCALs that were managed by military medics in the prehospital setting. There was a median of three providers (range 1-85) and 15 casualties (range 6-519) per event. Four or more formal triage categories were used in only one event. Colored markers and formal algorithms were not used. Life-saving interventions were performed in 27 of 29 (93%) missions and blood transfusions were performed in four (17%) MASCALs. The top lessons learned were: 1) security and accountability are cornerstones of MASCAL management; 2) casualty movement is a priority; 3) intuitive triage categories are the default; 4)life-saving interventions are performed as time and tacticspermit.

Conclusion: Formal triage systems requiring the use ofdiagnostic algorithms, colored tags, and four or five categories are seldom implemented in real-world military prehospitalMASCAL management. The training of field triage should besimplified and pragmatic, as exemplified by these instances.

Introduction: A systematic radiological examination is needed for military airborne troops in order to detect subclinical medical contraindications for airborne training. Many potential recruits are excluded because of scoliosis, kyphosis, or spondylolisthesis. This study aimed to determine whether complementary radiological assessment excludes too many recruits and whether medical standards might be lowered without increasing medical risk to appointees.

Methods: This retrospective, epidemiological, cross-sectional single-center study spanned 5 years at the French paratroopers' initial training center. We analyzed all medical files and full-spine X-ray results of all enlisted troops during this period. Secondary evaluation by an orthopedic surgeon enabled 23 enlisted personnel, deemed medically unacceptable because of X-ray findings, to be given waivers for airborne training. A follow-up review of their 23 files was conducted to determine whether static-line parachute jumps were hazardous to those who were initially declared medically unacceptable.

Results: Of the 3,993 full-spine X-rays, 67.5% (2,695) were described as having normal alignment and structure; 21.8% (871) had lateral spinal deviation; and 10.7% (427) had scoliosis. Sixty-six recruits (1.6%) were deemed unfit because of findings that did not meet the standard on the fullspine X-ray: 53 enlisted personnel had scoliosis greater than 15°, and 13 had spondylolisthesis (grade II or III). Of the 23 patients granted waivers, 82.3% with scoliosis (14) and all patients with kyphosis had not declared any back pain after 5 years.

Conclusion: The findings, supported by a literature review of foreign military data, suggest that spondylolisthesis above grade I and low back pain are more significant than scoliosis and kyphosis for establishing airborne standards.

In the third installment of the "Lest We Forget" series, the authors discuss a critical advance-vascular repair, pioneered by Dr. Carl Hughes-in the care of the war-wounded during the Korean War. This article reviews the management of large vessel injuries in wartime, the challenges and advances in military medicine during the Korean War, and the application of these lessons to current practices.

Separate evidence-based, best practice guidelines and recommendations exist for the prehospital management of traumatic injuries sustained in combat settings and those encountered during high-threat civilian operational incidents. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) Tactical Medic Program is a mature operational medicine asset supporting high-threat federal law enforcement operations. The ATF conducted an audit of its agency-issued tactical medic bags with regards to completeness, as defined by authorized medical protocols, which are aligned with current Tactical Combat Casualty Care and Tactical Emergency Casualty Care guidelines.

Lumbar paraspinal muscle compartment syndrome is an uncommon, rapidly progressive, and potentially devastating injury with fewer than 40 cases reported in the literature. It initially mimics nonemergent causes of low back pain, disproportionately affects young men, and is most often secondary to acute physical exertion. The disease process is commonly associated with rhabdomyolysis. Diagnostic tools include physical examination, measurement of lactate and creatine kinase levels, MRI, and direct compartment pressure measurement. While medical and nonoperative management strategies have been explored, the gold standard for treatment is emergent lumbar fasciotomy. Opioid and non-steroidal pain management, as well as physical therapy, are the mainstays of post-treatment recovery, with many surgical patients reporting complete symptom resolution at long-term follow-up. This article discusses the case of a 27-year-old, male, active-duty, Special Operations Aviation Soldier who presented to the emergency department and was found to have lumbar paraspinal muscle compartment syndrome.

Introduction: Maximizing the capabilities of available lowflow oxygen is key to providing adequate oxygen to prevent/treat hypoxemia and conserve oxygen. We designed a closed-circuit system that allows rebreathing of gases while scrubbing carbon dioxide (CO2) in conjunction with portable mechanical ventilators in a bench model.

Methods: We evaluated the system using two portable mechanical ventilators currently deployed by the Department of Defense-Zoll 731 and AutoMedx SAVe II-over a range of ventilator settings and lung models, using 1 and 3L/min low-flow oxygen into a reservoir bag. We measured peak inspired oxygen concentration (FiO2), CO2-absorbent life, gas temperature and humidity, and the effect of airway suctioning and ventilator disconnection on FiO2 on ground and at altitude.

Results: FiO2 was =0.9 across all ventilator settings and altitudes using both oxygen flows. CO2-absorbent life was >7 hours. Airway humidity range was 87%-97%. Mean airway temperature was 25.4°C (SD 0.5°C). Ten-second suctioning reduced FiO2 22%-48%. Thirtysecond ventilator disconnect reduced FiO2 29%-63% depending on oxygen flow used.

Conclusion: Use of a rebreathing system with mechanical ventilation has the potential for oxygen conservation but requires diligent monitoring of inspired FiO2 and CO2 to avoid negative consequences.

Background: Traumatic brain injury (TBI) is often underreported or undetected in prehospital civilian and military settings. This study evaluated the incidence of TBI within the Prehospital Trauma Registry (PHTR) system.

Methods: We reviewed PHTR and the linked Department of Defense Trauma Registry (DoDTR) records of casualties from January 2003 through May 2019 for diagnostic data and surgical reports.

Results: A total of 709 casualties met inclusion criteria. The most common mechanism was blast, including 328 (51%) in the non-TBI and 45 (63%) in the TBI cohorts. The median injury severity scores in the non-TBI and TBI cohorts were 5 and 14, respectively. The survival scores in the non-TBI and TBI cohorts were 98% and 92%, respectively. Subdural hematomas, followed by subarachnoid hemorrhages were the most common classifiable brain injuries. Other nonspecific TBIs occurred in 85% of the TBI cohort casualties. Seventy-two cases (10%) were documented by the Role 1 clinician. Based on coding or operative data, 15 of the 72 (21%) were identified as TBIs. Of the 637 cases, which could not be decided based on coding or operative data, TBI was suspected in 42 (7%) cases based on Role 1 records.

Conclusions: Over 1 in 10 casualties presenting to a Role 1 facility had a TBI requiring transfer to a higher level of care. Our findings suggest the need for improved diagnostic technologies and documentation systems at Role 1 facilities for accurate TBI diagnosis and reporting.