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

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.

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.

Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is used in trauma patients with pulmonary injury in the acute setting. The United States Military has an advanced ECMO transport and management capability; however, future conflicts may require forward prolonged casualty care (PCC). Special Operations Surgical Teams (SOSTs) provide damage control surgery, resuscitation, and PCC in forward, unregulated, multidomain environments. We hypothesize that SOSTs can be trained to cannulate and manage patients requiring VV ECMO.

Methods: We developed a 2.5-day course using knowledge assessments (25 questions), self-assessments (5-point Likert scale, moderate confidence=3), and instruction checklists. The instruction checklists were used to assess performance during final evaluation with Yorkshire swine (Sus scrofa) models. Data were tested for normality, and statistical significance was defined as P<.05.

Results: Twelve qualified SOST personnel completed the training. Four participants reported previous ECMO clinical exposure, and none reported formal ECMO training. When comparing pre- and post-course knowledge assessment scores, there was a significant improvement in overall scores (12.5 vs. 20.6, P<.001). The number of participants who self-reported at least moderate confidence in cognitive (2.8 vs. 11.3, P<.001), technical (1.2 vs. 11.6, P<.001), and behavioral (2 vs. 12, P<.001) aspects of VV ECMO set-up, cannulation, and management increased. Each team successfully set up, cannulated, and managed models with lights on and in darkness.

Conclusions: In a cohort of United States Air Force SOST personnel, using a modified training curriculum with 2-hour, hands-on validation testing improved self-assessment and knowledge assessment scores in performing VV ECMO. Given the rise of extracorporeal support use in the care of medical and trauma patients and the possibility of PCC in the military population, forward VV ECMO training and sustainment should be studied further.

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.