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

Background: "Non-compressible" torso hemorrhage (NCTH) is the leading cause of preventable battlefield death, requiring rapid surgical or radiological intervention, which is essentially precluded close to the point of injury. UK Joint Theatre Trauma Registry (JTTR) analysis 2002-2012 showed 85.5% NCTH mortality. JTTR vascular injury data 2003-2008 revealed 100% mortality in named truncal vessel injuries. Gas insufflation and hyper-pressure intraperitoneal fluid animal studies have demonstrated significant reductions in blood loss in splanchnic injuries. We hypothesized that the noninvasive Abdominal Aortic Junctional Tourniquet - Stabilized ( AAJT-S) would be a forward combat medic-delivered intervention to tamponade bleeding from vessels of the celiac trunk in descending aorta zone 1 by generating clinically significant proximal epigastric compartment pressure.

Methods: Four cadaveric donors each had two manometric water-filled balloons placed intra-peritoneally (1 epigastric, 1 retropubic), con- nected to manometer tubing. Baseline pressures of 8cmH2O were set (equating mean intra-abdominal pressure (IAP). AAJT-S was applied and inflated to 250mmHg. Pressures were contemporaneously recorded. AAJT-S was removed, along with the epigastric manometer. We added 500mL of water to simulate blood through the epigastric aperture. The manometer was replaced and reset to 8cmH2O. AAJT-S was reapplied to 250mmHg, and IAP steady pressures were again recorded.

Results: Proximal compartment pressures reached a mean of 54.6cmH2O (40.2mmHg); distal compartment pressures achieved a mean of 46cmH2O (34mmHg.) With 500mL intra peritoneal fluid, proximal compartment achieved a mean of 52.25cmH2O (38.4mmHg); distal compartment achieved a mean of 35cmH2O (25.7mmHg.) BMI had a statistically significant inverse effect on epigastric pressure, in this study range (BMIs, 16.7-22.9kg/m2). This proved clinically insignificant, with sufficient pressure still achieved in all tests.

Conclusion: The AAJT-S at 250mmHg achieves proximal epigastric compartment pressures of 40mmHg, with or without 500mL simulated free blood in the abdomen. This represents a highly significant and titratable reduction in blood flow within the celiac trunk branches. BMI does not have a clinically significant effect. AAJT-S application also produces zone 3 aortic and inferior vena cava occlusion. AAJT-S may be a point-of-injury intervention for forward medics that contributes to non-surgical hemorrhage control and likely clot stabilization for zone 1 vascular and solid organ injuries.

Background: The present study examined the effect of a training program with or without equipment on 1000-m surface combat swimming and shooting ability.

Methods: The study included 45 officer cadets who were randomly assigned to one of three groups: a control group (CG), a swimsuit and fins group (SF), and a combat uniform and equipment group (UE). SF and UE followed a 60-min surface combat swimming (sCS) training program for 4 weeks. Before and after the training program, all groups performed a 1000-m sCS trial and shooting in a simulator.

Results: SF and UE improved similarly in 1000-m sCS (134 [SD 115] s, for the SF group and 111 [SD 57] s for the UE group, P<.01). Shooting ability was reduced after the 1000-m sCS, before and after training.

Conclusion: The sCS training had a positive effect on the 1000-m sCS, while did not affect participants shooting ability.

Background: This study assessed patient-reported outcomes (PRO) of active-duty U.S. Military Servicemembers following refractive surgery.

Methods: We retrospectively reviewed the medical records of 375 U.S. Servicemembers who underwent LASIK (118 eyes), photorefractive keratectomy (PRK, 550 eyes), or small incision lenticule extraction (SMILE, 82 eyes). Surgeries occurred at the former Walter Reed Army Medical Centers Center for Refractive Surgery or the current FBCHs Warfighter Refractive Eye Surgery Program and Research Center (WRESP-RC) from 2004 to 2019. Preoperative and 6-month postoperative data included "Quality of Vision and Patient Satisfaction Before and After Refractive Surgery" questionnaire. Outcome measures included uncorrected distance visual acuity (UDVA).

Results: In this study, 95% LASIK, 94% PRK, and 94% SMILE achieved UDVA 20/20 or better with no between-group differences (P=.308). There were no differences between groups in efficacy (P=.204) or the safety index (P=.066). Postoperative QOV was comparable between groups for far vision (P=.292) and night vision (P=.505). From before to after the operation, far vision significantly improved in LASIK (P=.009) and PRK (P<.001) but not SMILE (P=.384). Postoperative glare was comparable (P=.258). Driving difficulty was significantly different between treatments (P=.025), with significant improvements in PRK and LASIK. There were no significant differences between groups for activity limitations (P=.093) or being bothered by glare, halos, or lack of sharpness of vision (P=.131).

Conclusion: This study found comparable or improved PRO six months after LASIK, PRK, and SMILE. All three yielded excellent visual outcomes with minimal visual symptoms, allowing the performance of daily activities with less difficulty and limitation.

Background: Research indicates that number of nurse practitioners (NPs) is growing. Additional training is necessary to increase self-efficacy in tactical settings. Evidence shows the Tactical Combat Casualty Care (TC3) course is the national standard for tactical medical training.

Purpose: This pilot study aimed to demonstrate that the TC3 course increases the tactical self-efficacy of flight nurse practitioners (FNPs) in preparation for the role of the law enforcement tactical nurse practitioner.

Methodology: Selected FNPs completed a TC3 course to increase tactical self-efficacy through a combination of formal (didactic), informal (vicarious), and physiological conditioning (scenario-based) positive verbal or written reinforcement, as theorized by Bandura. A general self-efficacy scale (GSES) was administered, and data were compared and analyzed us- ing two-tailed paired t tests.

Results: Clinical relevance was identified in the fact that tactical self-efficacy increased in all participants, and a statistically significant increase in tactical self-efficacy was seen in 50% of the FNPs.

Conclusions: Increasing the tactical self-efficacy of FNPs helped prepare them for the role of the law enforcement tactical nurse practitioner in support of a metropolitan Special Weapons and Tactics team. This project is not generalizable but brings the current body of knowledge together regarding NPs working in tactical environments. Future studies are still needed.

Background: Junctional hemorrhage is a leading cause of battlefield death. Multiple FDA-approved junctional tourniquet (JTQ) models demonstrate effective hemorrhage control in laboratory settings. However, there are few real-world use cases within the literature.

Methods: We analyzed the Department of Defense Trauma Registry (DoDTR) for casualties with documented JTQ application (2007-2023).

Results: Of 48,301 encounters, 39 included JTQ placement. The most common injury mechanisms were explosives (23), followed by firearms (15). The most common (AIS >3) serious injury sites were the extremities (21), followed by the abdomen (4) and skin (4). Only one patient died. Of nine prehospital interventions, the most common were warming (21), limb tourniquet application (16), and intravenous fluid administration (11). The most common associated diagnoses were lower-extremity amputation (24), testis avulsion or amputation (11), pelvic fracture (9), and tympanic membrane rupture (9). The most common hospital procedures were a focused assessment with sonography in trauma (32), laparotomy (20), chest tube placement (13), fasciotomy (13), and arterial line placement (13).

Conclusion: JTQ application in the combat setting was rare. When it was performed, it was frequently in the polytrauma setting. Survival was high but DoDTR enrollment survival biases likely confounded this.

Timely implementation to contain infectious diseases (e.g., quarantine, contact tracing, isolation) is critical to curb transmission and safeguard the health and readiness of U.S. Servicemembers. This proactive approach ensures that mission-critical operations remain unaffected. We focus on the collaborative efforts of Servicemembers from the 351st Civil Affairs Command during the Salaknib 2023 exercise in the Philippines. These SMs harnessed readily available cell phone applications to deliver rapid and effective public health messaging, reducing the risk of waterborne diseases. Targeted infographics were created and disseminated through mobile apps widely used by the population. The infographics were powerful tools for conveying critical, visually engaging information, facilitating rapid understanding and compliance with recommended health measures.

Building on 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," to establish that optimal grief-processing allows Special Operation Forces (SOF) medics to alchemize the intense pain of loss into a pliant palliative posture that shows conscientious concern for others across the deployment cycle. To achieve our goals, we will: 1) provide a brief background on contemporary bereavement studies, death-stacking, and historical grief-processing; 2) define the social determinant of grief-processing as extrapolated from qualitative data; and 3) use qualitative data to thematize various grief processes. We conclude by gesturing to how grief-processing galvanizes SOF medic equanimity amid death discernment, which emphasizes the human fragility inherent in all SOF missions.

Background: Blood transfusion is critical in modern trauma care. However, unreliable access to robust blood banking in austere military and disaster medicine settings remains challenging. Stored whole blood and components have strict refrigeration guidelines; any cold-chain storage liability that results in blood products deviating from their target temperatures affects patient safety. Refrigeration in a typical blood bank requires large, specialized devices. Transportable, battery-operated devices are available, but they have limited battery life. This study evaluated the possibility of using passively cooled devices (commercially available food coolers) to store blood components.

Methods: A commercially available 45-liter capacity cooler was used. Saline bags (500mL) were precooled to 1-6°C and placed in the cooler. A thermometer placed in the cooler adjacent to each saline bag measured the cooler temperature throughout each trial. The primary outcome was the hours of adequate refrigeration (between 1 and 6°C).

Results: There were four trials, each lasting 168 hours. Trials 1-3 maintained the goal temperature range for >142 hours, while trial 4 maintained temperature range for 78 hours.

Conclusion: Passive refrigeration using commercially available coolers and ice is a viable alternative to traditional blood storage solutions in austere, disaster, and military operational environments. Further studies should investigate prolonged blood storage using this technique with the periodic addition of ice.