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

Background: Detection of retained foreign bodies (FB) is a difficult task in both austere environments and emergency departments, particularly when they are radiolucent and not detectable by plain radiographs. Failure to identify and remove them can lead to increased morbidity.

Objective: To determine the accuracy of Special Forces (SF) medics in detecting wooden FBs in tissue models, using point-of-care ultrasound.

Methods: A prospective, single-blinded, observational study using chicken thigh models was performed. Medics with no prior soft-tissue ultrasound experience received a 1-hour lecture on ultrasound, then scanned 10 tissue models for up to 3 minutes each. Participants were blinded to the models: five were free of FBs and five contained a single wooden FB of varying lengths (1, 2.5, 5, 7.5, or 10mm) at a depth of 5mm.

Results: Twenty SF medics performed 200 total scans. For the detection of wooden FBs, sensitivity was 71.8% (95% CI 50.7-85.7) and specificity 82.0% (95% CI 61.1-92.6). The 10-mm FB was identified with 95% accuracy and had an overall sensitivity of 95% (95% CI 76.4-99).

Conclusions: SF medics with minimal ultrasound training are capable of accurately identifying soft-tissue wooden FBs with ultrasound. The FB size, orientation, and proximity to fibrous tissues were important factors in accurate identification. SF medics use of ultrasound to aid in the detection of superficial, soft-tissue FBs is an obtainable and valuable skill.

Background: Tension pneumothorax is a leading cause of preventable death in combat scenarios. When treating a chest wound with the potential for open hemopneumothorax using a chest seal, it is important that it efficiently drain fluid from the chest cavity. We tested the ability of commercial and novel chest seal designs to drain fluid from a simulated chest wound.

Methods: Eight novel laminar chest seal designs were created and compared to six commercially available chest seals. Closed-cell foam with a hole was used to simulate a chest wound. Fluid pressures of 10, 30, and 100cmH2O were tested. Mean flow rate through the chest seals was calculated. The percentage of the laminar channels completely saturated with fluid was also measured. The effect of laminar channel width and quantity on the dependent variables was determined.

Results: Novel chest seals with the highest flow rates were comparable to commercial chest seals with the highest flow rates at all pressures. Channel saturations were also similar between novel and commercial chest seals. As the width of the laminar channels increased so too did flow rate (p=.048), while the percentage of channel saturation decreased (p=.006). As the quantity of channels increased, the flow rate tended to increase (p=.02), and percentage of channel saturation decreased (p=.03).

Conclusions: Laminar vented chest seals with wider channel widths and more channels had higher flow rates and lower percentages of channel saturation. Certain novel chest seal designs used in this study were comparable to commercial designs in flow rate and percentage of channel saturation.

Good communication on a medical team is essential to optimize patient care and reduce human error risk. While this is well documented for civilian medicine, there is a paucity of research in the military prehospital environment (MPE). We analyzed four cases of miscommunication in the MPE: during a casualty handoff, within a team during a tactical medical operation, between a medic and a doctor during a mass casualty event, and in a helicopter while caring for a casualty. One mission had an adverse outcome, another had a rescue team disruption during operations, and two cases had errors without adverse outcomes. In each case, closed-loop communication with readbacks may have reduced or prevented actual or potential patient harm and optimized timely patient care. All branches of military prehospital medicine should employ efforts and techniques that ensure standard, reliable communications during medical operations to prevent adverse patient outcomes.

Exertional heat illness (EHI) describes a spectrum of acute medical disorders, frequently encountered in Servicemembers throughout the Armed Forces, that poses a pervasive threat to individual and unit military readiness. In June 2024, the Consortium for Health and Military Performance Warrior Heat and Exertion Related Event Collaborative published a Joint Clinical Practice Guideline for the prevention, diagnosis, and management of exertional heat illness, which outlines best practices in the diagnosis and management of EHI, including prevention, prehospital care, emergency department care, inpatient hospital care, and return to duty guidelines. In the Special Operations community, recognition and early treatment via rapid cooling to a body core temperature of 39.0-39.2°C (102.0-102.5°F) within 30 minutes from the time of injury recognition are the most crucial concepts to follow to reduce the morbidity and mortality of EHI. This article introduces the recommended best practices from the Clinical Practice Guideline, which are most relevant to the Special Operations community.

Purpose: This study evaluated the feasibility of performing a surgical cricothyrotomy (CTT) in lieu of a tube tracheostomy (TT) as the first-line emergent surgical airway access technique in military working dogs (MWDs).

Methods: In a crossover, randomized trial, five emergency medicine physician residents (MD group), trained in performing CTT in people but not canines, and five early career veterinarians (DVM group), trained in performing TT in canines but not trained in performing CTT in canines, performed a CTT and TT on 10 canine cadavers.

Results: The time to complete CTT within the MD group was statistically shorter than the time to complete TT (P<.05). In the DVM group, the time to complete TT was shorter than that of CTT, but the time difference was not statistically significant (CTT: 239.6 [SD 251.7] s vs. TT: 133.4 [SD 88.0] s). In the MD group, the TT damage score was statistically higher than the CTT damage score (CTT: 0 vs. TT: 1.6 [SD 0.9], P<.01). There was no statistically significant difference between the damage scores of CTT and TT in the DVM group (CTT: 1.4 [SD 1.1] vs. TT: 1.6 [SD 0.9]). Overall, the participants reported a positive response with CTT compared to TT.

Conclusion: CTT is a viable first-line emergent surgical airway access technique when used by veterinarians and human healthcare clinicians with limited surgical experience or no proficiency in performing TT.

In 2024 and early 2025, several successful surgeries involving brain-computer interfaces (BCIs) gained media attention, including those conducted by Elon Musk's company Neuralink, which implanted BCIs in three paralyzed volunteers, allowing them to control computers through thought alone. While the concept of merging humans with machines dates back to the 1960s, BCI technology has now entered the clinical trial stage, with a focus on restoring communication, mobility, and sensation in individuals with severe disabilities and neurodegenerative disorders. For over two decades, BCIs have also been explored as tools to enhance the cognitive and physical abilities of military personnel. However, before Special Operations Forces (SOF) medical staff encounter BCIs in an enhancement capacity, they are likely to first come across them in medical settings. This article provides an overview of BCI technology, focusing on 1) how it works, 2) its potential significance for injured SOF servicemembers, 3) current challenges, and 4) its potential to enhance SOF in the future.

Building off our operational model, we will discuss findings from our ethnographic study titled, "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOST)," to establish that optimal family formations compose and coordinate momentum. We will use qualitative quotes to explore the constellation of various family formations. To achieve our goals, we will: 1) define the social determinant of family formations and provide background on how we merge family systems theory with military formations; 2) thematize various types of family formations that optimize or degrade unconventional resilience; and 3) relate tactical engagement with family formations to our metaphor of bag sets. We conclude by gesturing to how family formations encourage hospitality, which allows them to dispassionately organize social relationships that support Special Operations Forces mission success.

Background: The impact of single-unit blood donation (BD) on donor physical performance at sea level is well-studied. However, no studies have evaluated the impacts of BD on warfighter performance at higher elevations. This study evaluated the effects of BD on high-altitude combat-load carry performance in acclimatized military personnel following BD.

Methods: Thirteen acclimatized military personnel (age: mean 28 [SD 6] years; height mean 175 [SD 7] cm; weight: mean 78.4 [SD 9.1] kg; residence elevation 2,100m) completed two 3.2-km rucksack carries (mean 24.2 [SD 2.1] kg from 2800 to 3,050m, one without BD (control) and one after BD. Total ruck march time, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), minute ventilation (VE), rating of perceived exertion (RPE), thermal sensation (TS), and acute mountain sickness (AMS) symptoms were analyzed.

Results: There were no differences between control and BD for ruck march time (F(1,11)=2.13, P>.1, η2G=.03), HR (P>.1), RR (P>.1), VE (P>.1), RPE (P>.1), and TS (P>.07). AMS symptoms were not impacted by either condition. SpO2 was lower in the control scenario than after BD (b=-4.23 [SE 2.4], P=.007).

Conclusions: A single-unit whole blood donation does not impact donor physical performance in acclimatized participants during combat-load carries at elevations up to 3,050m except with respect to SpO2.

Background: Special Operations Forces (SOF) personnel are at a high risk of musculoskeletal (MSK) injury. The aims of this systematic review were to a) profile MSK injuries sustained by SOF personnel and b) identify evidence-based injury prevention strategies.

Methods: Registered with the Open Science Framework, the protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 3,773 studies identified, 14 met the eligibility criteria, with 6 additional studies identified following screening of the reference lists of the included studies. Extracted data were summated in five naturally occurring MSK injury themes: 1) incidence in SOF populations; 2) anatomical location; 3) nature; 4) mechanism; and 5) risk factors.

Results: Injury incidence ranged from 8 to 846 injuries per 1,000 personnel per year with the lower extremities as the most reported site of injury. The leading nature of MSK injuries were strains and sprains, while the most common mechanism of injury was physical training. Smoking, physical performance, movement limitations, muscular asymmetries, and imbalances were reported as factors that can increase MSK injury risk.

Conclusion: This review informs injury prevention strategies within SOF populations, notably, reducing run mileage and alternating running with weight load walking, educating Operators on proper lifting technique, and analyzing force plate testing data to guide program design and implementation.