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

There is a noted bidirectional relationship between sleep and posttraumatic stress disorder (PTSD), often associated with nocturnal behavior disorders contributing to sleep disturbances and impaired daytime functioning. Furthermore, disruptive nocturnal behavior (DNB) significantly impairs quality sleep among servicemembers and their sleep partners. Psychotherapy, pharmacotherapy, and alternative, integrative health interventions, such as meditation, are not particularly useful in achieving significant and durable remission of DNB. The use of oral dental appliances has demonstrated clinical success in the role of adjunctive management of sleep disorders. However, the use of these devices in managing the symptoms of mental health issues most often seen in this patient cohort has not been elucidated. This case series describes the attenuation of DNB while using a highly modified intraoral mandibular splint for the treatment of nightmares, sleep disruptions, and other sleep parasomnias associated with PTSD and PTSD / traumatic brain injury. Four Special Forces Veterans and Operators previously diagnosed with PTSD and experiencing disruptive nocturnal behaviors, including night terrors, and having failed first-line, traditional intervention, were included in this case series. A custom-designed, intraoral neuroprosthesis was used as the intervention. All four patients demonstrated a notable and significant reduction in DNB. Subjective assessments and observations indicated enhanced sleep quality and reduced PTSD-related nocturnal disturbances. Patients reported overall improvement in daytime functioning and reduction in PTSD symptom severity. These first-of-their-kind findings support the intraoral neuroprosthesis as a novel, innovative therapeutic approach for managing two pathologies simultaneously: sleep disturbances and DNB with PTSD. This device shows promise as a non-pharmacological intervention to enhance mission readiness and improve treatment compliance.

Introduction: Airway obstruction is a leading cause of potentially survivable death on the battlefield. Intubation remains the most frequently performed prehospital airway intervention. Unfortunately, survival is lower after prehospital intubation compared to the emergency department. After-action review data suggest that forward-staged technology is lacking. Additionally, video laryngoscopy (VL) is superior to direct laryngoscopy, especially in the hands of novice intubators. The i-view is a novel, inexpensive, handheld VL device that showed promise in far-forward areas. However, our clinical study demonstrated inferior clinical performance of the i-view compared to our current standard devices in first-pass success. This study used feedback from intubating operators to identify potential causes of this substandard performance.

Methods: We conducted a prospective survey of intubating operators using the novel video device as part of a clinical trial. We sought their feedback using a Likert scale survey and free text feedback. The study team reviewed the free text feedback using a thematic analysis method.

Results: We surveyed 31 emergency physicians who had used the device (30 fully completed surveys and one partially completed). The lowest-scoring areas were screen brightness, with a median score of 2 (IQR 2-4), and screen resolution, with a median score of 2 (1-4), indicating that these were the major performance challenges. Thematic analysis suggested that the i-view's primary challenges were screen brightness, resolution, visibility through bodily fluids, and fogging.

Conclusions: Our survey highlighted multiple issues with i-view's use. Our findings will inform device development and modification for prehospital deployed use.

Transfusion of blood products at the point of injury is among the most critical interventions for trauma patients. Since WWI, the U.S. Military has been attempting to perfect the methods of transfusion to limit preventable deaths on the battlefield. While whole blood is now universally recognized as the premier blood product and a myriad of guidelines/protocols exist advocating for its use by SOF medics and providers far forward in the deployed setting, there is no cohesive guidance for blood product administration within the Continental United States (CONUS). This is despite recent data demonstrating that accidents are among the leading causes of death in non-deployed Servicemembers. Under current doctrine, only FDA-approved cold-stored whole blood should be used while in the U.S. With this in mind, our unit developed this feasibility study to determine whether a Special Forces Battalion would be able to maintain, store, and transport FDA-approved coldstored whole blood within appropriate temperature ranges in order to support blood transfusion at the point of injury and treat hemorrhagic shock in the CONUS training environment. This was a very small and simple study. However, it did demonstrate that maintaining appropriate temperature ranges is feasible, even as blood is transported to and from multiple sites of training. This is a critical first step in ensuring that appropriate blood products can be staged with and transported by our well-trained medics and providers supporting SOF training objectives within the U.S.

As the U.S. Navy further develops the concept of distributed maritime operations (DMOs), where individual components of the Naval Force will be more geographically dispersed, smaller vessels may be operating at significant time and distance away from more advanced medical capabilities. Therefore, Role 1 maritime caregivers will need to manage injured and disease non-battle injury patients for prolonged periods during current and future contested DMOs. We developed hypothetical drowning and hypothermia patient scenarios to present an innovative approach to teaching complex operational medicine concepts, including the management of hypothermia and acute respiratory distress syndrome, as well as Prolonged Casualty Care (PCC) to austere Role 1 maritime caregivers using the Joint Trauma System PCC Clinical Practice Guidelines (CPGs) and other standard references. The format includes basic epidemiology of drowning and hypothermia in the operational maritime environment. The scenario includes a stem clinical vignette, followed by expected clinical changes for the affected patient at specific time points (e.g., time 0, 1 hour, 2 hours, and 48 hours) with expected interventions based on the PCC CPGs, appropriate guidelines, and available shipboard equipment. Through this process, opportunities to improve both training and clinical skills sustainment, as well as standard shipboard medical supplies, are identified.

Intra-articular metallic foreign bodies can cause both shortand long-term outcome complications, from range of motion limitations to plumbism. Locating retained metallic foreign bodies can be challenging on physical exam alone due to unexpected trajectory of the object, though ultrasound can significantly aid in identification, especially in resource-limited environments. During a deployment to AFRICOM, a Special Operations Forces Operator had an intra-articular round retained during marksmanship, requiring consultation with both medical directors and specialists and eventual removal of the foreign body; strong advocation for removal allowed for both preserved range of motion as well as return to duty in the deployed location.

Building off our findings discussed at the strategic, operational, and tactical levels of unconventional resilience, we conclude this series by developing a holistic, humanistic infrastructure of integrated performance in Special Operation Forces (SOF) medicine. This infrastructure will explicitly acknowledge the human motivational context of practical performance and provide credibility to the medical-martial profession by acknowledging cultural values, norms, skills, and standards entailed in an emerging professional code of the Warrior Medic.

Background: Within Law Enforcement Organizations, specialist police officers perform dangerous tasks beyond those of general duties police officers. These tasks are often performed in complex austere environments while officers wear or carry heavy loads and place officers at a high risk of injury. The aims of this scoping review were to identify, collect, and synthesize the available evidence on injuries sustained by specialist police, and to compare these injuries with those of other law enforcement officers and wider Special Forces populations.

Methods: Four academic databases were searched using key search terms. Duplicates of identified records were removed, with those remaining screened against eligibility criteria. A rearward and forward snowballing approach of citations was used to identify other relevant records. Key findings were then summarized in table format.

Results: From an initial 3,266 identified records, 2 studies (1 cross-sectional, 1 retrospective cohort) met the eligibility criteria. The most common injury sites varied between the studies and only one study reported injury incidence, that being 1,347 per 1,000 person-years.

Conclusion: Musculoskeletal injuries occur frequently in the specialist police population and may bear some similarities to those among general duties police officers and Military Special Forces. However, there is a limited amount of evidence elucidating the injury profile of this population.

There is a dearth of studies in undersea and hyperbaric medicine (UHM), likely due to the limited number of clinicians currently specializing in UHM. Due to the high-consequence nature of diving and the effects of pressure on the human body, medical clearance is of the utmost importance. Despite all efforts to mitigate the possibilities of dive maladies, divers occasionally succumb to the effects of prolonged submersion. This article provides an in-depth look at three individuals who suffered from separate dive-related medical events. In each example, UHM was applied and successfully mitigated short and long-term medical consequences. The manuscript then reviews common and life-threatening dive maladies, with an in-depth examination of decompression strategies and diving clearance.

The Department of the Army's 2021 strategy to "Regain Arctic Dominance" highlights the operational necessity of sustaining combat readiness in Arctic or extreme cold environments (AoECE). Presented are five scenarios inspired by casualties that illustrate capability gaps and best practices as the Army Health System applies tactical combat casualty care (TCCC) in austere, frigid climates: (1) adapting TCCC to the AoECE as a unique environment; (2) technological limitations in the prevention and treatment of hypothermia; (3) freezing cold injury (FCI) and non-freezing cold injury (NFCI) treatment and the institutional need for a cold injury center; (4) a proposal for a FCI rule-out pathway to preserve the fighting force; (5) carbon monoxide poisoning and logistical constraints. These scenarios emphasize the need for research, procurement, and doctrine tailored specifically to the AoECE, as environmental exposure and equipment capability will be a decisive factor in casualty survivability and force regeneration.