Medical journal (Fort Sam Houston, Tex.)最新文献

Background: Over the course of the US' Global War on Terrorism, its military has utilized both conventional and special operations forces (SOF). These entities have sustained and treated battlefield casualties in the prehospital, Role 1 setting, while also making efforts to mitigate risks to the force and pursuing improved interventions. The goal of this study is to compare outcomes and prehospital medical interventions between SOF and conventional military combat casualties.

Methods: This is a secondary analysis of previously published data from the Department of Defense Trauma Registry. The casualties were categorized as special operations if they were 18-series, Navy SEAL, Pararescue Jumper, Tactical Air Control Party, Combat Controller, and Marine Corps Force Reconnaissance. The remainder with a documented military occupational specialty (MOS) were classified as conventional forces.

Results: Within our dataset, a MOS was categorizable for 1806 conventional and 130 special operations. Conventional forces were younger age (24 versus 30, p is less than 0.001). Conventional forces had a higher proportion of explosive injuries (61% versus 44%) but a lower proportion of firearm injuries (22% versus 42%, p is less than 0.001). The median injury severity scores were similar between the groups. Conventional forces had lower rates of documentation for all metrics: pulse, respiratory rate, blood pressure, oxygen saturation, Glasgow Coma Scale, and pain score. On adjusted analyses, SOF had higher odds of receiving an extremity splint, packed red blood cells, whole blood, tranexamic acid, ketamine, and fentanyl.

Conclusion: SOF had consistently better medical documentation rates, more use of ketamine and fentanyl, less morphine administration, and lower threshold for use of blood products in both unadjusted and adjusted analyses. Our findings suggest lessons learned from the SOF medics should be extrapolated to the conventional forces for improved medical care.

Major trauma frequently occurs in the deployed, combat setting and is especially applicable in the recent conflicts with explosives dominating the combat wounded. In future near-peer conflicts, we will likely face even more profound weapons including mortars and artillery. As such, the number of severely wounded will likely increase. Hypocalcemia frequently occurs after blood transfusions, secondary to the preservatives in the blood products; however, recent data suggests major trauma in and of itself is a risk factor for hypocalcemia. Calcium is a major ion involved in heart contractility; thus, hypocalcemia can lead to poor contractility. Smaller studies have linked hypocalcemia to worse outcomes, but it remains unclear what causes hypocalcemia and if intervening could potentially save lives. The objective of this study is to determine the incidence of hypocalcemia on hospital arrival and the association with survival. We are seeking to address the following scientific questions, (1) Is hypocalcemia present following traumatic injury prior to transfusion during resuscitation? (2) Does hypocalcemia influence the amount of blood products transfused? (3) To what extent is hypocalcemia further exacerbated by transfusion? (4) What is the relationship between hypocalcemia following traumatic injury and mortality? We will conduct a multicenter, prospective, observational study. We will gather ionized calcium levels at 0, 3, 6, 12, 18, and 24 hours as part of scheduled calcium measurements. This will ensure we have accurate data to assess the early and late effects of hypocalcemia throughout the course of resuscitation and hemorrhage control. These data will be captured by a trained study team at every site. Our findings will inform clinical practice guidelines and optimize the care delivered in the combat and civilian trauma setting. We are seeking 391 patients with complete data to meet our a priori inclusion criteria. Our study will have major immediate short-term findings including risk prediction modeling to assess who is at risk for hypocalcemia, data assessing interventions associated with the incidence of hypocalcemia, and outcome data including mortality and its link to early hypocalcemia.

Brigadier General Douglas Kendrick warned in his seminal work on the blood program of the Second World War, "It was only by the strictest attention to such matters that blood was able to achieve its miracles, and, equally important, was prevented from becoming a deadly agent. It must never be forgotten that without proper care, blood can be lethal." His point lay in the details offered. It was only by adherence to attention to detail in procurement, storage, and delivery the miraculous powers of blood can be achieved. Throughout his historical documentation, the requirement for special training of personnel handling blood was emphasized and documented. Deviating from prescribed storage temperatures, rough handling, exceeding shelf life, improperly matching blood types, and contaminating the blood are some of the various improper care that produce a negative patient outcome. Bacterial infection, toxicity, hypoxemia, and antibodies in the blood are just a few examples and could ultimately lead to death. This article focuses on the means of this miracle in briefly telling the story of whole blood on the battlefield by the US Army.

Background: The Borden Institute, an agency of the US Army Training and Doctrine Command (TRADOC), Medical Center of Excellence (MEDCOE), is marking 35 years of excellence in publishing academic military medical textbooks in the year 2022.

In his travelogue of the 1876 Philadelphia Centennial, What Ben Beverly Saw at the Great Exposition, James L. Dale described an exhibit that impressed him with both wonder and horror: a set of photographs documenting the outcomes of surgical operations that suggested procedures "of the most fearful character, which would seem impossible to perform, and the poor patient survive." What Dale described was the US Army Medical pavilion, where the displays were designed to convince domestic and international visitors of the professionalism and innovation of American medicine and in particular to highlight the contributions of military medicine. The medical building included a full-size model of an army field hospital and multiple exhibits constituting a representative sampling of collections from the US Army Medical Museum: photographic portraits of famous surgeons; enlarged microphotographs of blood, bone, and tissue samples; images of Civil War wounds and their treatments; artifacts and supplies for surgical procedures; and a painting, Thomas Eakins's The Gross Clinic. Together, this collection of artifacts presented viewers with a narrative of the current American medical field, with special focus on the Civil War as a catalyst for new medical discoveries. While Eakins's painting became the most famous image from the pavilion, it was not part of the original display, which was explicitly designed to demonstrate how surgeons and medical researchers used healing knowledge to transcend the devastation of the Civil War. This essay examines the exhibit's roots in wartime medicine and research and studies how Dr. Joseph Janvier Woodward planned and developed the exhibit to communicate with the public about current medical and surgical practice.

We compared the COVID-19 experience in the first year of the current pandemic in the US with the smallpox experience of the 18th century, focusing on the US military but recognizing civilian and military populations are not separate and distinct. Despite the epidemics being separated by 21/2 centuries and with great advancements in technology having occurred over that time, we observed similarities which led us to several conclusions: • Infectious disease outbreaks will continue to occur and novel agents, naturally occurring or manipulated by humans, will threaten military and civilian populations nationally and globally. • Infectious disease outbreaks can affect both military and civilian populations, persist for long periods, and be catastrophic to military peacetime and wartime operations. • Effective surveillance is a prerequisite for early identification and subsequent meaningful responses to novel and reemerging threat agents and diseases. • Socio-cultural, religious, or political factors may limit the implementation of effective interventions in military or civilian populations. Public health officials must assess impediments to implementation of interventions and develop plans to overcome them.

You have probably heard the story. On the afternoon of 3 August 1943, while his 7th US Army battled the Germans across northern Sicily, Lieutenant General George S. Patton Jr. stopped outside Nicosia to visit the 15th Evacuation Hospital. The hard-pressed 1st Infantry Division's commander, Brigadier General Clarence R. Huebner had only recently warned him that "the front lines were getting thinner" because numerous soldiers malingered in the field hospitals to avoid combat.

In 1950, Congress changed the name of the Army Medical Department (AMEDD) to the Army Medical Service (AMEDS) as part of the Army Organization Act of 1950. In March 1968, at the urging of Army Surgeon General Leonard D. Heaton, then in his ninth year of service as the Surgeon General, Secretary of the Army Stanley R. Resor petitioned Congress to restore the name of the Army Medical Service to the Army Medical Department, and Congress approved the restoration of the department's name in June 1969.

June of 1950 found the US forces poorly prepared to stop North Korean forces rolling into South Korea. First encounters scattered American soldiers and presented unique challenges for care of the casualties; battalion doctors and medics hustled the wounded along, sometimes themselves trapped, captured, or killed. Finally, within the Pusan perimeter American and South Korean resistance stiffened. It was in this defensive position the first Mobile Army Surgical Hospitals (MASH) were deployed far forward-heretofore simply a paper concept. MASH units performed magnificently, resuscitating and evacuating gravely wounded American and South Korean casualties, ushering in a new dimension to combat casualty care.

Objective: Introduction: In September 2020, the 2nd Stryker Brigade Combat Team of the 4th Infantry Division at Fort Carson, CO, executed an Expert Field Medical Badge (EFMB) event, unique in its implementation of Coronavirus Disease 2019 (COVID-19) mitigation measures. We conducted a descriptive analysis of our experience to inform future EFMB events.

Methods: We planned and resourced the EFMB competition in accordance with the Army Medical Department Center and School Pamphlet 350-10. We additionally defined adjustments to each event based upon the installation's COVID-19 Health Protection Condition (B, B+, or C) to set conditions for us to execute training regardless of shifts in the public health posture. We further implemented mitigation measures to include a 72-hour restriction of movement for all candidates and cadre prior to competition start, strict use of face coverings, and two daily temperature and symptom screenings. We recorded numbers of candidates and cadre withdrawing from the competition each day and the reasons for withdrawal.

Results: Of the 66 evaluators, 179 support personnel, and 113 candidates, 2 personnel withdrew for reasons related to COVID-19 mitigation measures. A single cadre member entered a quarantine for the development of a sore throat during the competition. One candidate withdrew after disclosing failure to comply with the 72-hour restriction of movement prior to competition start. Another candidate withdrew prior to start due to an injury sustained during land navigation. Of the remaining 111 candidates, 22 (20%) earned the EFMB. Most failures occurred due to the Army Physical Fitness Test (APFT, 33) and land navigation (44).

Discussion: Our competition provides proof in principle that large-scale events to train individual skills such as EFMB are feasible in conjunction with COVID-19 public health measures. Our experience highlights the imperative of prior preparation of candidates in particular for the APFT and land navigation.