JSOM Header

Editorial on the Approach to Prolonged Field Care for the Special Forces Medical Sergeant: Balancing the Opportunity Cost

Top

Nicholson JA, Searor JN, Lane AD. 20(3). 117 - 119. (Editorial)

America's adversaries will contest US military superiority in the domains of land, sea, air, space, and cyberspace. Fundamentally, these foes seek to disrupt the dominance of American fighting forces through anti-access and area denial (A2AD) systems, such as cyber exploitation, electromagnetic jamming, air defense networks, and hypersonic capabilities. According to Training and Doctrine Command (TRADOC) Pamphlet 525- 3-1, these A2AD capabilities create multiple layers of stand-off that inhibit the US ability to focus combat power and achieve strategic objectives in a contested, increasingly lethal, inherently complex, and challenging operational environment.1 The Department of Defense (DoD) plans to mitigate this shift in enemy strategy through the adoption of multidomain operations (MDO).1 MDO is defined as operations that converge capabilities to overcome an adversary's strengths across various domains by imposing simultaneous dilemmas that achieve operational and tactical objectives.1 Within this MDO construct, medical treatment expectations must shift accordingly as the ability to rapidly treat and evacuate patients may be constrained by enemy action. Thus, the notion of prolonged field care (PFC) may be a necessity on the future battlefield. As Special Operations Forces (SOF) continue to refine what PFC entails, it is imperative that an understanding of the incidence and type of diseases that require medical evacuation to higher levels of care be thoughtfully estimated. Armed with an understanding of the anticipated epidemiology, effective prioritization of training requirements and equipment acquisition is possible in a manner that is complementary to the overall success of the assigned mission. Furthermore, this prior planning mitigates risk, as the limitations of money and time impose significant opportunity costs in the short run should the disproportionate mix of disease states be pursued, which in turn, avoids jeopardizing Soldiers' lives over the long term.

Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock

Top

Thompson P, Hudson AJ, Convertino VA, Bjerkvig C, Eliassen HS, Eastridge BJ, Irvine-Smith T, Braverman MA, Hellander S, Jenkins DH, Rappold JF, Gurney JM, Glassberg E, Cap AP, Aussett S, Apelseth TO, Williams S, Ward KR, Shackelford SA, Stroberg P, Vikeness BH, Pepe PE, Winckler CJ, Woolley T, Enbuske S, De Pasquale M, Boffard KD, Austlid I, Fosse TK, Asbjornsen H, Spinella PC, Strandenes G. 20(3). 97 - 102. (Editorial)

Based on limited published evidence, physiological principles, clinical experience, and expertise, the author group has developed a consensus statement on the potential for iatrogenic harm with rapid sequence induction (RSI) intubation and positive-pressure ventilation (PPV) on patients in hemorrhagic shock. "In hemorrhagic shock, or any low flow (central hypovolemic) state, it should be noted that RSI and PPV are likely to cause iatrogenic harm by decreasing cardiac output." The use of RSI and PPV leads to an increased burden of shock due to a decreased cardiac output (CO)2 which is one of the primary determinants of oxygen delivery (DO2). The diminishing DO2 creates a state of systemic hypoxia, the severity of which will determine the magnitude of the shock (shock dose) and a growing deficit of oxygen, referred to as oxygen debt. Rapid accumulation of critical levels of oxygen debt results in coagulopathy and organ dysfunction and failure. Spontaneous respiration induced negative intrathoracic pressure (ITP) provides the pressure differential driving venous return. PPV subsequently increases ITP and thus right atrial pressure. The loss in pressure differential directly decreases CO and DO2 with a resultant increase in systemic hypoxia. If RSI and PPV are deemed necessary, prior or parallel resuscitation with blood products is required to mitigate post intervention reduction of DO2 and the potential for inducing cardiac arrest in the critically shocked patient.

Developing TCCC Guidelines for Unmanned Aerial Vehicle Casualty Evacuation

Top

Parker PJ. 20(1). 40 - 42. (Editorial)

Editorial Response

Top

Keenan S. 18(1). 139 - 140. (Editorial)

Pretrauma Interventions in Force Health Protection: Introducing the "Left of Bang" Paradigm

Top

Eisenstein NM, Naumann DN, Bowley DM, Midwinter MJ. 16(4). 59 - 63. (Editorial)

TCCC Standardization: The Time Is Now

Top

Goforth C, Antico D. 16(3). 53 - 56. (Editorial)

SOLCUS After-Action Report: From Good Idea to the Largest Ultrasound Training Program in the Department of Defense

Top

Vasios WN. 16(1). 62 - 65. (Editorial)

USASOC Division Of Science & Technology: What It Means For Special Operations Medicine

Top

Calvano CJ, Forman S, Osborn T, Gothard W. 16(1). 65 - 66. (Editorial)

Power To The People

Top

Schauer SG, Cunningham CW, DeLorenzo RA. 16(1). 69 - 71. (Editorial)

Needle Decompression

Top

Studer NM, Horn GT. 16(1). 72 - 73. (Editorial)

Traumatic Brain Injury: Its Outcomes On High Altitude

Top

Ismailov RM, Lytle JM. 16(1). 67 - 69. (Editorial)

Providers Face Challenges Maintaining Deployment-Ready Skills at Garrison Hospitals

Top

Schauer SG, Varney SM. 15(4). 79 - 80. (Editorial)

Hot, Warm, and Cold Zones: Applying Existing National Incident Management System Terminology to Enhance Tactical Emergency Medical Support Interoperability

Top

Pennardt A, Schwartz RB. 14(3). 78 - 79. (Editorial)

Certified Tactical Paramedic: A Benchmark for Competency in Austere and Hostile Environments

Top

Clark JR. 13(3). 99 - 100. (Editorial)

The Time To Field Freeze Dried Plasma Is Now

Top

Pennardt A. 10(3). 49 - 49. (Editorial)

Psychological Resilience And Postdeployment Social Support Protect Against Traumatic Stress And Depressive Symptoms In Soldiers Returning From Operations Enduring Freedom And Iraqi Freedom

Top

Myatt CA, Johnson DC. 09(4). 63 - 64. (Editorial)

Editorial Comment On "psychsocial Buffers Of Traumatic Stress, Depressive Symptoms, And Psychosocial Difficulties In Veterans Of Operations Enduring Freedom And Iraqi Freedom: The Role Of Resilience, Unit Support, And Post-Deployment Social Support"

Top

Myatt CA, Johnson DC. 09(3). 80 - 80. (Editorial)

Editorial Comment on "Psychological Resilience and Postdeployment Social Support Protect Against Traumatic Stress and Depressive Symptoms in Soldiers Returning from Operations Enduring Freedom and Iraqi Freedom"

Top

Myatt CA, Johnson DC. 09(3). 79 - 79. (Editorial)

A Dangerous Waste Of Time: Teaching Every Soldier Intravenous Line Placement

Top

Mabry RL, Cuenca PJ. 08(4). 55 - 57. (Editorial)

Acute Mountain Sickness Prophylaxis In The SOF Operator

Top

Pennardt A, Talbot T. 08(3). 65 - 66. (Editorial)