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

Tick-borne encephalitis (TBE) is a severe disease caused by the tick-borne encephalitis virus (TBEV). TBEV is endemic throughout Eurasia and can cause persistent neurologic deficits and death. Special Operations Forces (SOF) participating in field exercises or operations in TBE-endemic countries are at significantly increased risk of infection. Unlike Lyme disease and other tick-borne illnesses, transmission of TBEV can be immediate, and early tick removal does not reduce the risk of infection. While there are no virus-specific treatments available, the US Food and Drug Administration (FDA) recently approved a TBE vaccine that has yet to be incorporated into formal Department of Defense (DoD) recommendations. SOF medical providers should be aware of this disease entity and consider the TBE vaccine when planning exercises and operations in areas of responsibility (AORs) with TBE-endemic countries. This review serves as a refresher and update on the epidemiology, transmission, and management of TBE for the SOF provider.

Introduction: Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site.

Methods: Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests.

Results: The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79).

Conclusion: The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.

Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method of gaining proximal control of noncompressible torso hemorrhage (NCTH). Catheter placement is traditionally confirmed with fluoroscopy, but few studies have evaluated whether ultrasound (US) can be used.

Methods: Using a pressurized human cadaver model, a certified REBOA placer was shown one of four randomized cards that instructed them to place the REBOA either correctly or incorrectly in Zone 1 (the distal thoracic aorta extending from the celiac artery to the left subclavian artery) or Zone 3 (in the distal abdominal aorta, from the aortic bifurcation to the lowest renal artery). Once the REBOA was placed, 10 US-trained locators were asked to confirm balloon placement via US. The participants were given 3 minutes to determine whether the catheter had been correctly placed, repeating this 20 times on two cadavers.

Results: Overall, US exhibited an average sensitivity of 83%, specificity of 76%, and accuracy of 80%. For Zone 1, US showed a sensitivity of 78% and specificity of 83%, and for Zone 3, a sensitivity of 88% and specificity of 76%. In addition, US exhibited a likelihood positive ratio (LR+) of 3.73 and a likelihood negative ratio (LR-) of 0.22 for either position, with similar numbers for Zone 1 (+4.57, -0.26) and Zone 3 (+3.16, -0.16).

Conclusion: Ultrasound could prove to be a useful tool for confirming placement of a REBOA catheter, especially in austere environments.

SARS-CoV-2 is the virus responsible for the disease that is known as COVID-19. While there have been numerous studies detailing the survival rates of SARS-CoV-2 on various materials, there are currently no published data regarding whether this virus is stable on standard military uniforms. Consequently, there are no standard operating procedures for washing uniforms once exposed to the virus. This study aimed to determine whether SARS-CoV-2 could be removed from Army combat uniform material by washing with a commercially available detergent and tap water. Washing the fabric with detergent followed by a rinse step with tap water effectively removes detectable viral particles. Importantly, it was found that washing with hot water alone was not effective. Therefore, it is recommended that military personnel wash their uniforms with detergent and water as soon as possible after exposure to SARS-CoV-2; hot water should not be used as a substitute for detergent.

Introduction: To prepare military doctors to face mass casualty incidents (MCIs), the French Army Health Service contributed to the development of TRAUMASIMS, a serious game (SG) for training medical responders to MCIs.

Methods: French military doctors participated in a three-phase training study. The initial war trauma training was a combination of didactic lectures (Phase 1), laboratory exercises (Phase 2), and situational training exercises (STX) (Phase 3). Phase 1 lectures reviewed French Forward Combat Casualty Care (FFCCC) practices based on the acronym MARCHE (Massive bleeding, Airway, Respiration, Circulation, Head, hypothermia, Evacuation) for the detection of care priorities and implementation of life-saving interventions, triage, and medical evacuation (MEDEVAC) requests. Phase 2 was a case-control study that consisted of a traditional text-based simulation of MCIs (control group) or SG training (study group). Phase 3 was clinical: military students had to simultaneously manage five combat casualties in a prehospital setting. MCI management was evaluated using a standard 20-item scale of FFCCC benchmarks, 9-line MEDEVAC request, and time to evacuate the casualty collection point (CCP). Emotional responses of study participants were secondarily analyzed.

Results: Among the 81 postgraduate military students included, 38 took SG training, and 35 trained with a text-based simulation in Phase 2. Regarding the error rates made during STX (Phase 3), SG improved FFCCC compliance (11.9% vs. 23.4%; p < .001). Additionally, triage was more accurate in the SG group (93.4% vs. 88.0%; p = .09). SG training mainly benefited priority and routine casualties, allowing faster clearance of the CCP (p = .001). Stress evaluations did not demonstrate any effect of immersive simulation.

Conclusion: A brief SG-based curriculum (2 hours) improved FFCCC performance and categorization of casualties in MCI STX.

Crimean-Congo Hemorrhagic Fever (CCHF) is the most widespread tickborne virus causing human disease. CCHF wields a mortality rate up to 30% and was responsible for the death of a US Soldier in 2009. The virus is spread by the Hyalomma species of hard tick found across Central Europe, the Middle East, Africa, and Asia south of the 50° parallel. Infection typically consists of a 1-7-day non-specific viral prodrome, followed by onset of hemorrhagic disease on days 7-10. Severe disease may cause thrombocytopenia, transaminitis, petechial hemorrhage, hematemesis, and death typically by day 10 of illness. Education and insect control are paramount to disease prevention. Treatment is predominantly supportive care, though evidence suggests a benefit of early ribavirin administration. CCHF has caused multiple nosocomial outbreaks, and therefore consideration should be given to safe transport and evacuation of infected and exposed patients. Given the wide area of distribution, transmissibility, innocuous arthropod vectors, and high mortality rate, it is imperative that Special Operations Forces (SOF) providers be aware of CCHF and the existing countermeasures.

Obesity is a worldwide health problem that has reached pandemic proportions. In the military, obesity and overweight are associated with health problems, attrition from military service, and reduced job performance. National and international organizations suggest body mass index (BMI) as a population screening tool to define overweight and obesity. BMI is calculated as weight/height2 (kg/m2). Four categories of adult BMI are underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (=30.0 kg/m2). This article reports on a systematic review and meta-analysis examining the association between BMI and injury risk among military service members (SMs). Studies were selected for review if they involved military personnel, were prospective or retrospective observational studies, and contained original quantitative data on injury risk at all four BMI levels. Nine studies met the review criteria. Pooled data from these investigations indicated that underweight, overweight, and obese individuals were at 1.17 (95% confidence interval [95%CI]=1.07-1.28), 1.03 (95%CI=1.01-1.06), and 1.15 (95%CI=1.11-1.20) times higher risk of injury than healthy weight individuals, respectively. Compared with healthy weight SMs, military personnel with both low and high BMI are at higher injury risk.

Background: Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students.

Methods: In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests.

Results: Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students.

Conclusion: MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs.