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

Purpose: This study evaluated the feasibility of performing a surgical cricothyrotomy (CTT) in lieu of a tube tracheostomy (TT) as the first-line emergent surgical airway access technique in military working dogs (MWDs).

Methods: In a crossover, randomized trial, five emergency medicine physician residents (MD group), trained in performing CTT in people but not canines, and five early career veterinarians (DVM group), trained in performing TT in canines but not trained in performing CTT in canines, performed a CTT and TT on 10 canine cadavers.

Results: The time to complete CTT within the MD group was statistically shorter than the time to complete TT (P<.05). In the DVM group, the time to complete TT was shorter than that of CTT, but the time difference was not statistically significant (CTT: 239.6 [SD 251.7] s vs. TT: 133.4 [SD 88.0] s). In the MD group, the TT damage score was statistically higher than the CTT damage score (CTT: 0 vs. TT: 1.6 [SD 0.9], P<.01). There was no statistically significant difference between the damage scores of CTT and TT in the DVM group (CTT: 1.4 [SD 1.1] vs. TT: 1.6 [SD 0.9]). Overall, the participants reported a positive response with CTT compared to TT.

Conclusion: CTT is a viable first-line emergent surgical airway access technique when used by veterinarians and human healthcare clinicians with limited surgical experience or no proficiency in performing TT.

Building off 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 (SOST)," to establish that optimal family formations compose and coordinate momentum. We will use qualitative quotes to explore the constellation of various family formations. To achieve our goals, we will: 1) define the social determinant of family formations and provide background on how we merge family systems theory with military formations; 2) thematize various types of family formations that optimize or degrade unconventional resilience; and 3) relate tactical engagement with family formations to our metaphor of bag sets. We conclude by gesturing to how family formations encourage hospitality, which allows them to dispassionately organize social relationships that support Special Operations Forces mission success.

Background: The impact of single-unit blood donation (BD) on donor physical performance at sea level is well-studied. However, no studies have evaluated the impacts of BD on warfighter performance at higher elevations. This study evaluated the effects of BD on high-altitude combat-load carry performance in acclimatized military personnel following BD.

Methods: Thirteen acclimatized military personnel (age: mean 28 [SD 6] years; height mean 175 [SD 7] cm; weight: mean 78.4 [SD 9.1] kg; residence elevation 2,100m) completed two 3.2-km rucksack carries (mean 24.2 [SD 2.1] kg from 2800 to 3,050m, one without BD (control) and one after BD. Total ruck march time, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), minute ventilation (VE), rating of perceived exertion (RPE), thermal sensation (TS), and acute mountain sickness (AMS) symptoms were analyzed.

Results: There were no differences between control and BD for ruck march time (F(1,11)=2.13, P>.1, η2G=.03), HR (P>.1), RR (P>.1), VE (P>.1), RPE (P>.1), and TS (P>.07). AMS symptoms were not impacted by either condition. SpO2 was lower in the control scenario than after BD (b=-4.23 [SE 2.4], P=.007).

Conclusions: A single-unit whole blood donation does not impact donor physical performance in acclimatized participants during combat-load carries at elevations up to 3,050m except with respect to SpO2.

In 2024 and early 2025, several successful surgeries involving brain-computer interfaces (BCIs) gained media attention, including those conducted by Elon Musk's company Neuralink, which implanted BCIs in three paralyzed volunteers, allowing them to control computers through thought alone. While the concept of merging humans with machines dates back to the 1960s, BCI technology has now entered the clinical trial stage, with a focus on restoring communication, mobility, and sensation in individuals with severe disabilities and neurodegenerative disorders. For over two decades, BCIs have also been explored as tools to enhance the cognitive and physical abilities of military personnel. However, before Special Operations Forces (SOF) medical staff encounter BCIs in an enhancement capacity, they are likely to first come across them in medical settings. This article provides an overview of BCI technology, focusing on 1) how it works, 2) its potential significance for injured SOF servicemembers, 3) current challenges, and 4) its potential to enhance SOF in the future.

Background: Special Operations Forces (SOF) personnel are at a high risk of musculoskeletal (MSK) injury. The aims of this systematic review were to a) profile MSK injuries sustained by SOF personnel and b) identify evidence-based injury prevention strategies.

Methods: Registered with the Open Science Framework, the protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 3,773 studies identified, 14 met the eligibility criteria, with 6 additional studies identified following screening of the reference lists of the included studies. Extracted data were summated in five naturally occurring MSK injury themes: 1) incidence in SOF populations; 2) anatomical location; 3) nature; 4) mechanism; and 5) risk factors.

Results: Injury incidence ranged from 8 to 846 injuries per 1,000 personnel per year with the lower extremities as the most reported site of injury. The leading nature of MSK injuries were strains and sprains, while the most common mechanism of injury was physical training. Smoking, physical performance, movement limitations, muscular asymmetries, and imbalances were reported as factors that can increase MSK injury risk.

Conclusion: This review informs injury prevention strategies within SOF populations, notably, reducing run mileage and alternating running with weight load walking, educating Operators on proper lifting technique, and analyzing force plate testing data to guide program design and implementation.

The 2015 Bataclan Concert Hall attack in Paris highlights the role of the tactical emergency medical physicians embedded within France's Research, Assistance, Intervention, Deterrence (RAID) Police Tactical Group (PTG). France's use of high-level physicians in hot zones contrasts with Australia's reliance on paramedics. This study evaluates the skillsets, effectiveness, and efficiency of Australia's paramedic response to intentional mass violence incidents (IMVI) compared to France's Service d'aide médicale urgente (SAMU), which deploys physicians and integrates seamlessly with hospital care. Findings reveal that trained Australian paramedics can deliver the minimal lifesaving interventions (LSIs) required at the point of injury; meanwhile, physicians can manage complicated cases in cold zones. Deploying highly trained clinicians into threat areas, as with the Queensland Ambulance Services (QAS) High Acuity Response Unit (HARU), may waste resources better allo- cated to the cold zone. Embedding clinicians within tactical groups may enhance survival rates, operational success, and cost-effectiveness.

The Beirut Port Explosion of 4 August 2020 posed significant medical challenges for relief teams and caused diverse blast injuries to individuals in the area. Several days after the explosion occurred, a Special Operations Forces (SOF) medic provided care for a Servicemember who developed neurologic symptoms that led to his medical evacuation out of Lebanon. These relief efforts underscore the need for vigilant post-blast monitoring and consideration of long-term consequences.

The Russo-Ukrainian war's prolonged warfare, resource constraints, and extended evacuation times have forced significant adaptations in Ukraine's medical system - including technological advancements and strategic resource placement. This study examined if the Abdominal Aortic and Junctional Tourniquet - Stabilized (AAJT-S) could manage traumatic cardiac arrest (TCA) at forward surgical stabilization sites (FSSS) as an adjunct to damage control surgery. Six patients in severe hypovolemic shock presented at an FSSS during fighting in Bakhmut (July 2022) and Slovyansk (May 2023). Following TCA due to exsanguination, the AAJT-S was applied 2cm below the umbilicus. Cardiopulmonary resuscitation (CPR) and transfusion (blood and/or plasma) were initiated. All six patients were resuscitated. None required vasopressor support post-resuscitation. Five survived to the next level of care. One died awaiting evacuation, and another of wounds after 10 days. Four survived to discharge. Three were followed and neurologically intact, and no death records matched the fourth's name and date of birth at 18 months. Follow-up was limited, but one patient was neurologically intact at one year. The AAJT-S effectively resuscitated TCA patients. It increased mean arterial pressure, focused resuscitative efforts on the upper torso, simplified care, and preserved crucial field resources. An alternative to traditional emergency thoracotomy, AAJT-S could replace or complement resuscitative endovascular balloon occlusion of the aorta in pre-hospital settings, given its ease of application by combat medics. AAJT-S, alongside blood transfusion and CPR, achieved 100% success in return of spontaneous circulation and effectively managed TCA in a wartime FSSS.

Introduction: Under normal conditions, the use of a supraglottic airway device (SAD) is safe and effective. There are situations in military environments in which such devices must be used in the dark (e.g., to conceal the team's position). The aim of our study was to evaluate the use of different SADs using night vision goggles (NVG) on a manikin.

Methods: A group of 53 medically trained soldiers (paramedics, emergency medical technicians [EMTs] and Combat First Responders Bravo) was given a brief demonstration of how to place three different types of SAD in a manikin's airway. This was followed by randomized use in ambient light and then, after the room was darkened, with NVG. Differences in terms of placement success, placement time, and observed usage problems were compared.

Results: Attempt success rates were >91% for all SADs used both in ambient light and with NVG. Median placement times differed significantly between ambient light and NVG (ambient light/NVG: i-gel, 7.2/15.1s; standard laryngeal mask airway [LMA], 15.4/21.5s; laryngeal tube [LT], 13.4/24.3s). In the direct comparison of the various SADs, the i-gel laryngeal mask airway was placed significantly faster than a standard LMA (P<.0001) and the LT (P<.0001).

Conclusions: Our study proves that the use of NVG has a measurable impact on the speed of placement but does not prolong placement to a clinically significant extent on a manikin. In addition, there was no significant difference in the placement success for each SAD in ambient light or with NVG. Furthermore, all participants were able to read the size information on the various SADs when wearing NVG and were thus able to make a proper size selection. It would, however, make use easier if additional size markings were added. SADs can be applied quickly and safely on the manikin even when NVG are worn. Differences in the use of the various types of SAD are not relevant from a clinical perspective. Using NVG while placing a SAD seems to be safe for the patient and might increase safety for the care provider in tactical situations by maintaining concealment in dark environments.