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

Introduction: The Department of Defense has continually refined body armor to mitigate battlefield injuries over the last 20 years. Penetrating axilla injuries remain challenging despite adoption of a four-plate ceramic armor system. This study investigates the efficacy of current armor configurations in reducing mortality and morbidity associated with axilla injuries.

Methods: This was a retrospective case series using afteraction reports from a single Special Operations unit. Records (786) from 2001-2018 were screened, yielding 11 meeting inclusion criteria. Data included injuries, body armor type, clinical interventions, and outcomes.

Results: Analysis revealed significant mortality (45%) among casualties sustaining axilla injuries, with 100% mortality for those struck in uncovered side-plate regions under a two-plate system. In contrast, no fatalities occurred when injuries were within protected side-plate regions of a four-plate system. Injury patterns showed consistent thoracic cavity violations, emphasizing the need for robust protection strategies. This study underscores the efficacy of four-plate systems in reducing mortality compared to older configurations, particularly in protecting vital structures like great vessels and the heart. However, limitations in current side-plate coverage suggest potential gaps in protection, especially superiorly. Balancing protection with mobility remains crucial, as highlighted by operational challenges and weight concerns.

Conclusion: Findings support the role of side plates in mitigating axilla injuries but highlight the need for expanded coverage using improved material technologies. Fu-ture research should focus on enhancing ballistic protection without compromising operational agility and refining trauma management protocols for optimal casualty outcomes.

This case study evaluates a simple, reliable technique for preserving a unit of blood in the field. During a search and rescue exercise in mountainous terrain, a unit of blood was drawn and stored in the rescuer's chest pocket for 13 hours while engaging in rigorous training. Despite temperatures as low as 4°C (40°F), the blood remained liquid and appeared visually viable, suggesting that body heat may help maintain adequate storage temperature. This method offers a low-resource alter-native to expensive or logistically complex storage solutions. A review of historical and modern literature supports the potential effectiveness of this approach, though the absence of laboratory analysis limits definitive conclusions. Given its practicality and historical precedent, this approach warrants further research on biochemical integrity and long-term feasibility to assess its viability for emergency transfusions in combat and wilderness rescue settings.

Introduction: The French Air and Space Force conducts search and rescue (SAR) missions across France. Given the large network of prehospital helicopter services, questions have been raised regarding their national-level efficiency. This study determined how many lives were saved through SAR missions at seven French bases over 5 years.

Methods: We analyzed completed mission reports from seven metropolitan bases between 2015 and 2019. The primary endpoint was the proportion of patients considered to be in imminent danger when the SAR team arrived. Missing person missions were excluded if patients were not located (n=4). We created a composite criterion based on the patient's clinical state or their clinical classification in mobile emergency and resuscitation structures (CCMS). Secondary endpoints included response time and the most frequent mission triggers and medical procedures performed.

Results: Of 175 mission reports, 61 patients (34.9%) were considered to be in imminent danger, and imminent danger could not be determined for 21 (12%). Trauma, secondary transport, neurological distress, and cardiac distress combined accounted for 62% of all cases. The leading causes for mission deployment were traumatic pathologies (18.9%), secondary transfers (16%), and neurological distress (14.3%). The most common procedures were volume expansion (77 times), morphine administration (33), and oxygen therapy (30).

Conclusion: SAR missions primarily assist seriously ill or injured patients in isolated areas where traditional emergency services are limited. They are often deployed as a last resort. They regularly fill a capacity deficit where conventional rescuers cannot operate and contribute to improving the prognosis of rescued patients.

The Joint Trauma System Clinical Practice Guideline on Traumatic Brain Injury Management in Prolonged Field Care recommends the use of ultrasound measurement of optic nerve sheath diameter (ONSD) in the neurologic assessment of unconscious patients without ocular injury. This recommendation is well-founded in the literature, and support is growing for use of ONSD measurement for monitoring of neurocritical patients, especially in resource-limited and austere environments, including military theaters of operation. Our patient presented as a level 1 trauma patient with a penetrating traumatic brain injury (TBI). ONSD measurements taken before, during, and after administration of a 250mL bolus of 3% hypertonic saline showed a downward trend in ONSD measurement, from 5.4 to 4.8mm in the right eye, and 7.6 to 6.3mm in the left eye, within 20 minutes. Our review of the literature identified studies in which ONSD decreased following treatment of symptomatic hyponatremia with 3% hypertonic saline, as well as cases in which ONSD decreased in real time following lumbar puncture and external ventricular drain placement. Many studies also demonstrate the usefulness of ONSD for screening and monitoring of patients with TBI. Ours is the first reported instance of which we are aware showing real-time reduction in ONSD following treatment with 3% hypertonic saline in a patient with a penetrating TBI. ONSD measurement has potential for neurocritical monitoring in austere, resource-limited environments, including prolonged field care. Further study is needed to interrogate the accuracy and reliability of ONSD measurement as a tool for assessing treatment efficacy in patients with TBI, both blunt and penetrating.

Hydatid disease is a zoonosis in which humans become the accidental host to the larval stage of Echinococcus granulosus, also known as the dog tapeworm. Occurring worldwide, the natural lifecycle of E. granulosus tapeworms consists of a canid definitive host for the adult tapeworm stage, and an herbivorous animal (sheep, in most cases) intermediate host for the tissueinvasive and cyst-forming larval stage. Dogs and other canids harboring gut-resident tapeworms readily transmit the tapeworm eggs (and subsequent formation of larval cysts) to humans in close contact with them. It is this author's experience that adoption of indigenous dogs as "camp mascots" is a common tradition in the military deployed setting. This practice puts troops in danger of acquiring hydatid disease. The U.S. Veterans Health Ad-ministration 2025 report on echinococcosis in Veterans states there were 1,059 diagnoses of the disease in their system from 2000 to 2024. In addition, deployed healthcare practitioners should include hydatid disease in the differential diagnosis of host-country nationals presenting with spaceoccupying lesions and/or anaphylaxis of uncertain etiology.

Definitive Field Care (DFC) is a medical strategy required when evacuation is impossible due to tactical, environmental, or political constraints. Unlike Prolonged Field Care (PFC) or Prolonged Casualty Care (PCC), which assume eventual evacuation, DFC places full responsibility for definitive treatment on the initial provider. Historical examples, such as the Yugoslavian Partisans in World War II and Afghan resistance fighters during the Soviet invasion, highlight the necessity of DFC in austere, high-risk environments. Key considerations include operational constraints, risk tolerance, and provider mindset. Without evacuation, medical priorities shift, requiring difficult decisions. Providers must adapt to scarce resources, hostile conditions, and the absence of Geneva Convention protections. The mindset required demands resilience, adaptability, and acceptance of non-Western medical standards. As irregular warfare becomes more prevalent, formally recognizing, studying, and integrating DFC into military and humanitarian medical planning is essential. Training personnel for DFC will enhance operational effectiveness and improve survival rates in extreme conditions.

Enhancing unit-mission effectiveness is a priority and challenge in the U.S. military, especially in a landscape of wide-ranging mission capabilities and diverse career-field health and performance needs. The first step to addressing mission-relevant health and performance needs is identifying those needs within context. Capability-based blueprinting (CBB) is designed to address mission-relevant health and performance needs by using a "bottom up" approach, beginning with career-field and unit perspectives at an installation level. Despite the value of a capability-based blueprint to a specific installation, it is unclear if a CBB with a career field at a specific installation provides actionable insight for health and performance personnel and career-field leadership that is transferable to members of the same career field at other installations with different mission requirements. CBB was conducted in collaboration with Weapons Armament System communities at three installations to address this question. Findings across three capability-based blueprints articulate the link between career-field requirements, working environments, and career-field-specific health and performance considerations. Gaining an understanding of career-field-critical tasks and the associated health and performance priorities at one installation can provide some transferable knowledge for health and performance assets at other installations, such as physical, ergonomic, and nutritional demands. Continual learning is still necessary, however, since considerations, such as team dynamics and organizational climate, are likely siteand time-specific and should be explored at each site. Finally, it is important to understand that health and performance domains (e.g., physical, psychological) interact with and impact each other, ultimately shaping health and performance demands and, therefore, readiness.

Esophageal perforations, though rare, are critical injuries because of the risk of rapid progression to mediastinitis and sepsis. Traumatic perforations, especially those following blunt trauma, carry high mortality, and explosive injuries may cause such damage. Here, we describe the case of a 38-year-old male with a history of opioid use disorder and hepatitis C who suffered a mid-esophageal perforation after a pressurized diesel fuel cap exploded, hitting his face. He presented with intraoral burns, chest pain, subcutaneous emphysema, and pneumomediastinum. Endoscopic evaluation confirmed the perforation, and he was successfully treated with esophageal stenting and IV antibiotics. Follow-up imaging showed no persistent leak, and he was discharged with plans for stent removal. This case highlights the importance of considering esophageal injury in explosive trauma and suggests that while endoscopic management is effective, operative readiness is crucial in resource-Xlimited and military settings, where explosive trauma is more common.

Ntroduction: Two-dimensional venous ultrasound may be a viable substitute for standard Doppler ultrasonography in monitoring and evaluating decompression stress. Preliminary data possibly show that ultrasound recordings of the inferior vena cava (IVC) and popliteal vein (PV) can indicate elevated decompression stress. This study aims to evaluate the feasi-bility of a microteaching program for training combat med-ics to conduct ultrasound measurements on the IVC and PV for self-monitoring of decompression stress on the waterside.

Methods: A vascular surgeon provided a microteaching course to combat medics of the Netherlands Armed Forces. Two Lumify® (Philips Medical Systems International B.V., Best, The Netherlands) handheld ultrasound devices were used, connected to a Samsung Galaxy Tab A® (generation 10.5, Samsung, Suwon, South-Korea) or a Panasonic FZ-A2® tablet (Panasonic, Kadoma, Japan). The IVC was examined using the C5-2 abdominal probe, and the PV was assessed using the L12-4 linear probe. Combat medics performed and recorded measurements observed by a vascular surgeon on their randomly assigned partners after 2 minutes of practice. Three outcomes were measured in this study: (1) observer assessment of the performance, (2) self-perceived procedure experience, and (3) video recording quality scored by a vascular surgeon and researcher.

Results: A total of 25 Special Operations Forces combat medics took part in this study. All but one participant recorded the correct vessels. Recordings of the IVC and PV were achieved in a mean time of 50 (SD 26) seconds and 1 minute and 26 seconds (SD 55s), respectively. The participants didn't report a difference in difficulty of obtaining a clear image of either vessel. Both assessors assigned median and modal scores of at least 4 out of 5 for all image quality categories.

Conclusion: This microteaching program is an effective training technique for military medical personnel with little to no ultrasound experience to obtain ultrasound images of the IVC and PV. Our findings suggest that combat medics could perform vascular ultrasound measurements, which could be used to screen for high decompression stress in the future.