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Journal of Special Operations Medicine

Summer 2020

Summer 2020 Cover

Coming Soon!

The Summer 2020 Journal is currently at the printers and will ship soon.

The Digital version is now available for our digital subscribers. If you already have a digital subscription, log into your account and read the journal here; otherwise, you can subscribe now and have immediate access to this and all our electronic resources.

This quarter's publication continues the 20-year then-and-now retrospective of where we were, where we are, and how we got here look at the improvements in combat and tactical medicine. This edition focuses on the advancements in tourniquet use in field care, led be our own world-renowned trouniquet expert Dr. John Kragh.

Not only is Dr. Kragh the lead author on several of the key articles in this issue, he will be featured as the subject of our 20th Anniversary Special Talk Interview Podcast this month, so be sure to check that out once it is published later this month.

Journal of Special Operations Medicine

Spring 2020

Spring 2020

The Spring 2020 edition kicks off an exciting year. This is our 20th anniversary of publication, and we have many features planned including several retrospectives showing how far we've come in the tactical medical profession.

The Digital Journal is posted; digital subscribers can read the digital version now. The print edition is at the printers now and will be in the mail shortly.

Standard Medical Operating Guidelines (SMOG)

CY 20

SMOG Cover

The SMOG is used by U.S. Army MEDEVAC Critical Care Flight Paramedics. The 2020 SMOG has recently been revised and will be currently available for purchase. The digital version is also available to our digital subscribers, as well as PDF download for tablet devices.

Advanced Tactical Paramedic Protocols (ATP-P)

10th Edition

ATP-P 10th Edition

ATP-P Digital subscribers may access the 10th Edition NOW on either their desktop, laptop, or mobile device. Not a subscriber? Sign up now for immediate access to the ATP-P, all published issues of the JSOM, access to our fully searchable compendium of articles, and more!

The print version 10th Edition of the ATP-P is available at the online store. Preview the Table of Contents now.

Pararescue Medical Operations Handbook (PJ MED)

7th Ed

PJ MED Cover

The Pararescue Medical Operations Handbook is designed to form the basis of medical practice during both Rescue Operations and training mishaps for USAF Pararescuemen (PJs).

Hardcopies are available for $35.
Digital subscriptions are $25. As with the ATP-P handbook, the PJ MED will be downloadable as a PDF to your tablet device so it is available without the need of a wi-fi connection.

Independent Duty Medical Technician (IDMT) Protocols Handbook

v 2.1

IDMT Cover

The IDMT Protocols handbook is used by USAF IDMTs worldwide. It is now available for purchase on our storefront, as well as electronically by subscription.

Shared Science

The Journal of Special Operations Medicine (JSOM) and the Wilderness & Environmental Medicine (WEM) journal continue a long-standing shared science program. This opportunity is made possible through a reciprocal partnership between the journals. Select past articles appearing in WEM which may be of interest to JSOM readers can be accessed at no cost. Simply click on the WMS logo below or visit https://www.wemjournal.org/content/sharedscience to access articles for free.

Tactical Combat Casualty Care: Transitioning Lessons Learned from the Battlefield to other Austere Environments

Wilderness Medical Society
Special Operations Medical Association

The OFFICIAL Journal of the Special Operations Medical Association.

Click the logo for more information.

First Blood: Fixing American Trauma Care

October 2017

Overhauling how citizens and medical providers respond to trauma, as well as how they collect and store blood, could save thousands of lives annually.

July 2020 Feature Article

Step Duration Effects on Blood Loss in Simulated Designs of Tourniquet Use Procedure

Summer 2020

Kragh JF, Aden JK, Dubick MA. 20(2). 76 - 82. (Journal Article)


Background: We sought new knowledge by further developing a model of using calculations in the simulation of a first-aid task. The purpose of this study was to develop the model to investigate the performance of tourniquet use in its component steps. Methods: We aimed to design an experiment on a desktop computer by mathematically manipulating simulated data in tourniquet use. A time factor of tourniquet use was ranged widely through time challenges in five degrees from ideal to worst performances. Redesigning the task was assessed by time costs and blood losses. Results: The step of tourniquet application took 17% of the trial time and securing the tourniquet after bleeding control took the longest amount of the trial time, 31%. A minority of the time (48% [17% + 31%] to apply tourniquet plus secure it) was spent after the tourniquet touched the patient, whereas most of the time (52%) was spent before the tourniquet touched the patient. The step of tourniquet application lost 14% of the total blood lost, whereas no blood was lost during securing the tourniquet, because that was the moment of bleeding control despite securing the tourniquet taking much time (31%). Most (86%) of blood lost occurred before the tourniquet touched the patient. But blood losses differed 10-fold, with a maximum of 2,434mL, which, when added to a pretask indication blood loss of 177mL, summed to 2,611mL. Before redesigning the task, costs of donning gloves and calling 9-1-1 included uncontrolled bleeding, but gloving mitigated risk of spreading pathogens among people. By step and person, redesigns of the task altered the risk-benefit profile. Conclusions: The model was useful because it simulated where most of the bleeding occurred before the tourniquet touched the patient. Modeling simulated redesigns of the task, which showed changes in the task's risk-benefit profile by step and among persons. The model generated hypotheses for future research, including the capability to screen candidate ideas among task designs.

Keywords: tourniquet; first aid; bleeding control and prevention; emergency; task deconstruction, simulation, modeling

Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury

Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States Servicemembers injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events.

This report documents the remarkable decrease in casualties killed in action during the wars in Iraq and Afghanistan and the role of the Joint Trauma System, the CoTCCC, and the TCCC Working Group in helping to make that happen. It also outlines a clear and comprehensive vision for a National Trauma System that will enable the civilian and the military sectors to work in concert to help prevent ALL potentially preventable deaths in trauma victims.

Download a free PDF copy of the IOM Report

What Our Readers are Saying

I just finished reading the fall edition of the JSOM and I am completely blown away!!!! It is absolutely packed with exceptional and relevant information that without a doubt, will assist SOF Tactical Health Care professionals in providing relevant and evidence based patient care. Thank you for providing what I consider a "World Class Medical Journal". The journal itself and the website have become my primary resource for knowledge in tactical medicine."

Robert M. Miller
North American Rescue
Chief Innovation Officer

"There is no peer-reviewed academic resource that equals the Journal of Special Operations Medicine for support of the medical and veterinary lead in Stabilization, Security, Transition and Reconstruction (SSTR) operations, combat and field medicine, and adaptation of Tactical Combat Casualty Care into Tactical Emergency Casualty Care for the law enforcement and emergency management community in 195 UN member countries. JSOM is a valuable resource as we continue the Millennium Medicine Project, targeting the global population that lacks access to basic surgical services and providing crisis management, security, and defense support in this demographic."

Stephen M. Apatow
President, Humanitarian Resource Institute
(UN:NGO:DESA) and H-II OPSEC: Defense Support:
Humanitarian and Security Operations

"Military units that have trained all of their members in Tactical Combat Casualty Care have documented the lowest incidence of preventable deaths among their casualties in the history of modern warfare - and JSOM is the first journal to publish every new change in TCCC."

Frank K. Butler, MD
Chairman, Committee on Tactical
Combat Casualty Care (CoTCCC)

"The past 30 years has brought an amazing professionalization of the specialty of Tactical Emergency Medical Support (TEMS). As new standards are set and the world faces increasingly complex security challenges, it is critical that the front line medical providers supporting military, intelligence, and law enforcement operations have a mechanism to expand their knowledge and share best practices. The Journal of Special Operations Medicine offers civilian readers access to the most cutting edge developments in the field including updates on Tactical Emergency Casualty Care (TECC), the National TEMS Imitative and Council (NTIC), and combat lessons learned. JSOM is the one-stop shop for best practice and future advancements in civilian TEMS. One of the unifying principles across humanitarian, expedition and disaster response medical operations is the ability to make complex decisions in uncertain environments. The Journal of Special Operations Medicine is one of the most unique platforms for experts to convey lessons learned and relevant scientific advances across specialties that historically have little interaction. Whether you work for Doctors Without Borders, a DMAT, or provide medical support for expeditions in austere environments, Journal of Special Operations Medicine is your journal."

David W. Callaway, MD
Director, Division of Operational and Disaster Medicine
Operational Medical Director, Carolinas MED-1
Co-Chairman, The Committee for Tactical Emergency Casualty Care (C-TECC)
Civilian Vice President, Special Operations Medical Association (SOMA)