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

The Russo-Ukrainian war's prolonged warfare, resource constraints, and extended evacuation times have forced significant adaptations in Ukraine's medical system - including technological advancements and strategic resource placement. This study examined if the Abdominal Aortic and Junctional Tourniquet - Stabilized (AAJT-S) could manage traumatic cardiac arrest (TCA) at forward surgical stabilization sites (FSSS) as an adjunct to damage control surgery. Six patients in severe hypovolemic shock presented at an FSSS during fighting in Bakhmut (July 2022) and Slovyansk (May 2023). Following TCA due to exsanguination, the AAJT-S was applied 2cm below the umbilicus. Cardiopulmonary resuscitation (CPR) and transfusion (blood and/or plasma) were initiated. All six patients were resuscitated. None required vasopressor support post-resuscitation. Five survived to the next level of care. One died awaiting evacuation, and another of wounds after 10 days. Four survived to discharge. Three were followed and neurologically intact, and no death records matched the fourth's name and date of birth at 18 months. Follow-up was limited, but one patient was neurologically intact at one year. The AAJT-S effectively resuscitated TCA patients. It increased mean arterial pressure, focused resuscitative efforts on the upper torso, simplified care, and preserved crucial field resources. An alternative to traditional emergency thoracotomy, AAJT-S could replace or complement resuscitative endovascular balloon occlusion of the aorta in pre-hospital settings, given its ease of application by combat medics. AAJT-S, alongside blood transfusion and CPR, achieved 100% success in return of spontaneous circulation and effectively managed TCA in a wartime FSSS.

Introduction: Under normal conditions, the use of a supraglottic airway device (SAD) is safe and effective. There are situations in military environments in which such devices must be used in the dark (e.g., to conceal the team's position). The aim of our study was to evaluate the use of different SADs using night vision goggles (NVG) on a manikin.

Methods: A group of 53 medically trained soldiers (paramedics, emergency medical technicians [EMTs] and Combat First Responders Bravo) was given a brief demonstration of how to place three different types of SAD in a manikin's airway. This was followed by randomized use in ambient light and then, after the room was darkened, with NVG. Differences in terms of placement success, placement time, and observed usage problems were compared.

Results: Attempt success rates were >91% for all SADs used both in ambient light and with NVG. Median placement times differed significantly between ambient light and NVG (ambient light/NVG: i-gel, 7.2/15.1s; standard laryngeal mask airway [LMA], 15.4/21.5s; laryngeal tube [LT], 13.4/24.3s). In the direct comparison of the various SADs, the i-gel laryngeal mask airway was placed significantly faster than a standard LMA (P<.0001) and the LT (P<.0001).

Conclusions: Our study proves that the use of NVG has a measurable impact on the speed of placement but does not prolong placement to a clinically significant extent on a manikin. In addition, there was no significant difference in the placement success for each SAD in ambient light or with NVG. Furthermore, all participants were able to read the size information on the various SADs when wearing NVG and were thus able to make a proper size selection. It would, however, make use easier if additional size markings were added. SADs can be applied quickly and safely on the manikin even when NVG are worn. Differences in the use of the various types of SAD are not relevant from a clinical perspective. Using NVG while placing a SAD seems to be safe for the patient and might increase safety for the care provider in tactical situations by maintaining concealment in dark environments.

Background: Fresh whole blood has been the standard of care for the treatment of hypovolemia secondary to blood loss in the Tactical Combat Casualty Care guidelines since 2014. Current recommendations from the Prolonged Field Care Working Group state that the impact on mission performance is not degraded with 1 unit (450mL) of donation. Because there is limited information on combat performance after donation, the purpose of this investigation was to examine the effects of blood donation on simulated battlefield tasks in U.S. Special Forces Soldiers.

Methods: A total of 17 U.S. Special Forces Soldiers participated in this study. Soldiers served as their own controls and were subject to blinded blood draw and a sham draw, which were ordered randomly and separated by 6 days. Outcome measures consisted of performance, capillary blood lactate, salivary osmolality, heart rate, and estimated core temperature. These measures were taken at baseline, then immediately following a 1,200-m shuttle run, 3-event stress shoot, and 5-mile run, all while wearing a typical combat load.

Results: There was a moderate-to-large, statistically significant (p<0.05) increase in shuttle run time due to blood donation (δ=12.5s, Hedges' g=1.0). We also detected moderate, statistically significant increases in shooting scores (δ=29.2s, Hedges' g=0.5) and 8-km run times (δ=3.9m, Hedges' g=0.7) due to blood donation. There was no interaction between event and blood draw condition for heart rate, estimated core temperature, blood lactate, or salivary osmolality. Blinding was only 26% effective, as Soldiers were able to correctly identify the procedure that they were subjected to 74% of the time.

Conclusion: The moderate-to-large performance decrements found in this study are somewhat greater than those of previous studies. We believe that our results may be different due to the more demanding tasks that were performed after the blood draw in our investigation.

Background: Military medical officers (MMOs) and noncommissioned officers (NCOs) serve critical roles within military healthcare teams, and a successful working relationship between them is essential for mission success. The purpose of this study is to explore our participant NCOs' insights into how MMOs and NCOs can foster positive working relationships.

Methods: Utilizing a qualitative existential-phenomenological design, the research team interviewed eight medical NCOs twice through a focus group and individual interviews. Each interaction was transcribed and coded. Phenomenological analysis methods were applied to identify emergent themes.

Results: Three interdependent themes were identified: (1) open communication, (2) trust in training, and (3) mutual mentorship. The MMO should establish and maintain open lines of communication. The MMO should understand NCO roles and abilities, and work to build trust through respect for their skills and contributions. Reciprocal learning is essential for professional development between MMOs and NCOs.

Conclusion: Potential methods to integrate training into existing medical school curricula include interprofessional mentorship training and high-fidelity military medical simulations with opportunities for structured feedback.

Due to the inherent nature of service in both military and medical careers, some veterans are drawn to medicine after completing military service. However, there are significant financial and academic barriers for veterans applying into medical fields. Average grade point average (GPA) and Medical College Admission Test (MCAT) score are two heavily weighted metrics in the medical school application process. Veterans often have less rigorous academic backgrounds and more limited preparation for the MCAT in comparison to traditional medical school applicants. As a result, veterans may be less competitive than traditional applicants through direct comparisons of GPAs and MCAT scor s. The authors' analysis focuses on whether this limitation affected veterans' success in applying to medical school. Using aggregated data from the American Association of Medical Colleges (AAMC), the authors analyzed the average GPAs and MCAT scores of applicants with any military experience (defined as "military applicants") compared to the pool of all applicants from 2018 to 2024. During this period, military applicants to U.S. MD programs had an average GPA that was 0.16 points lower and average MCAT score 3.4 points below the average of all applicants. Despite lower academic metrics, the military applicant acceptance rate to MD programs was 41.7% compared to 40.7% for all applicants. Veterans should not be deterred from seeking a path of service in medicine by below average GPAs or MCAT scores. Medical school admissions over the past 6 years show that medical school admission committees value the perspective, life experience, and skills military veterans bring to medicine despite their lower GPAs and MCAT scores.

This article highlights key topic areas related to dietary supplements (DSs) and performance-enhancing substances. It also discusses evidence-based resources the medical community can use when discussing high-quality DSs with Servicemembers interested in taking DSs. We briefly overview how DSs are regulated in the United States, discuss problematic categories and issues related to quality, expand upon what are often considered performance-enhancing substances yet sometimes sold as DSs, and then offer solutions to counter the consequences of the dark side of the DS industry. Solutions include third-party certification and intentional education and resources, as military health care providers and medics need to know where to go for evidence-based information, per the Department of Defense Instruction 6130.06 - Use of Dietary Supplements in the DoD (DoDI 6130.06), which set policy and guidelines for Servicemembers in 2022. Finally, Operation Supplement Safety (OPSS) resources and tools are discussed.

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.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world. A review of published studies on prehospital MASCAL management and a recent series of military prehospital MASCAL responses highlight the need for an intuitive MASCAL management system that accounts for expected resource limitations and tactical constraints. "Move, Treat, and Transport" is a simple and pragmatic approach that emphasizes speed and efficiency of response; considers time, tactics, and scale of the event; and focuses on interventions and evacuation to definitive care if needed.

Biting sandflies are known for transmitting leishmaniasis, but sandflies also transmit sandfly fever viruses that may disrupt military operations. Sandfly fever is caused by serotypes of the Phlebovirus genus (primarily the Naples, Sicilian, or Toscana serotypes). The illness is known colloquially as "three-day fever" and "papataci fever." The clinical course of the disease normally spans about 3 days, with patients exhibiting a prodromal phase consisting of fatigue, chills, abdominal pain, and possibly facial flushing and tachycardia. Disease onset is marked by hyperpyrexia, myalgia, and arthralgia. The incubation period is typically 3-5 days, with viremia in humans lasting typically less than 1 week. This manuscript describes sandfly appearance, behavior, and geographic distribution. It then lists comparable diseases for differential diagnosis. Finally, as no vaccine exists for the sandfly virus, it concludes with steps for preparation and prevention to prevent outbreaks from disrupting military operations.

Despite advancements in military medical treatment and evacuation, soldiers in austere environments remain vulnerable to disease and non-battle injury and may face prolonged evacuation before receiving definitive care. In particular, arranging care for a soldier presenting with a conditions that has a wide differential diagnosis, such as acute altered mental status (AMS), can be especially challenging. We highlight the case of an otherwise young, healthy U.S. Soldier serving in Indonesia, who presented with acute AMS concerning for undifferentiated infection. Subsequent workup at the receiving hospital following evacuation revealed Salmonella enterica infection, more commonly known as typhoid. However, even with clinical findings of typhoid encephalitis and initiation of empiric treatment, medical care proved challenging in the resource-limited local facilities, despite multiple escalations of care. Ultimately, the patient was evacuated to a tertiary facility in Singapore, where his condition improved, and 4 days after initial presentation the patient had no definitive findings of infections on lumbar puncture. This case not only highlights the threat of typhoid and other infectious diseases in modern operations but also the challenges of suboptimal medical care in both the prehospital and hospital settings when utilizing host nation facilities.