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Featured Articles

Winter 2009

Planning And Operational Consideration For Units Utilizing Military Working Dogs

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Royal J, Taylor JF. 09(1). 5 - 9. (Journal Article)

Abstract

Military working dogs are rapidly becoming integral to military operations. While they bring many valuable capabilities to the battlefield, it is important that Special Operations leaders consider canine team capabilities and requirements when planning missions. Careful logistical and operational planning can optimize the health, performance, and readiness of the working dog while protecting the safety and well-being of the team members working with them. We also offer recommendations for medical treatment of dog bites.

Hiv Postexposure Prophylaxis For Special Forces Soldiers

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Lutz RH, Carlton D, Taylor SF. 09(1). 10 - 15. (Journal Article)

Abstract

Exposure to human immunodeficiency virus (HIV) is a recognized occupational hazard to healthcare personnel. The virus also presents an operational hazard to deployed Special Operations Forces (SOF) personnel. Management guidelines for work related exposure to HIV mainly deal with healthcare workers in a first world hospital environment. Formal guidelines for postexposure prophylaxis (PEP) regarding potential HIV exposure in third world environments have not been established. SOF personnel deploy to regions such as sub-Saharan Africa with a reported HIV prevalence of 35% or higher. This article examines the case of a SOF servicemember exposed to HIV in a confrontation with host nation personnel, the problems with trying to utilize current CDC guidelines and host-nation healthcare capabilities, and a proposed solution devised to ensure appropriate PEP in future cases.

Differential Diagnosis Of Shoulder Pain Followed By Progressive Weakness: A Case Report

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Rosenthal MD. 09(1). 16 - 19. (Case Reports)

Abstract

Upper extremity weakness can be the result of a myriad of conditions ranging from contractile tissue injury, joint injury, or injury to central or peripheral nervous system components. Accurate diagnosis is important in establishing an optimal treatment regimen and sound prognosis. This report provides an overview of the diagnosis and treatment of Parsonage-Turner Syndrome, a relatively rare cause of upper extremity weakness and dysfunction. OBJECTIVES 1. Distinguish between Parsonage-Turner Syndrome and other causes of neurological upper extremity weakness. 2. Recognize key subjective findings of Parsonage-Turner Syndrome. 3. Recognize appropriate ancillary tests to aide in the differential diagnosis of Parsonage-Turner Syndrome

Clinical Red Flags From The Ussocom Tmeps - Recognize, Act Fast, And Evacuate

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Gilpatrick S. 09(1). 20 - 26. (Journal Article)

Abstract

Military medical practitioners working in active duty clinics are known for seeing lots of people in a short amount of time. If you've ever seen what goes on every morning at a troop medical clinic on a training post or base you know what I mean. The goal of morning sick call is to find that one really sick person among the many not so sick standing in line for your services. What you learn from working in that setting is how to recognize the red flag - the sign or symptom that clues you in to a potentially dangerous condition. When at war, the ability to recognize the red flag is extremely important. In the austere or unsecure environment, the SOF Medic needs to be the one who knows what the red flags are and what to do about them once spotted.

The Special Operations Rescuscitation Team: Robust Role Ii Medical Support For Today's SOF Envrionment

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Riesberg JC. 09(1). 27 - 32. (Journal Article)

Abstract

Special Operation Forces (SOF) have historically relied upon conventional medical assets for Role II and higher medical support. Over the last five years, the need for SOF-specific medical teams and surgical support was identified and addressed. Several Special Operations based Role II assets are now available to support operations, each with unique personnel and capabilities. The Special Operations Resuscitation Teams (SORT) have been engaged in several joint deployments in the last year, demonstrating the mission readiness and lifesaving trauma support for which the teams were designed. The future of SOF Role II has many unique challenges, including personnel resourcing, training, and joint operational planning. OBJECTIVES Provide a historical perspective on the evolution of SOF-specific Role II medical support. Review current SOF-specific Role II capabilities and employment. Discuss unresolved issues related to SOF-specific Role II capabilities and employment.

Field Evaluation And Management Of Non-battle Related Knee And Ankle Injuries By The Advanced Tactical Practitioner In An Austere Environment: Part One

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Hammesfahr R. 09(1). 33 - 42. (Journal Article)

Ultrasound Detection Of Pneumothorax With Minimally Trained Sonographers: A Preliminary Study

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Monti JD, Younggren B, Blankenship R. 09(1). 43 - 46. (Journal Article)

Abstract

Background: Prompt recognition and treatment of a tension pneumothorax is critical to reducing mortality in both military and civilian settings. Physician assistants, Special Operations Forces (SOF) and conventional force Medics are often the first medical providers to care for combat trauma patients with penetrating chest trauma and frequently have limited diagnostic capabilities available to them due to mission constraints. The purpose of this study is to examine the potential for non-physician providers to determine the absence or presence of a pneumothorax in a porcine model, with the use of a portable ultrasound machine, after receiving minimal training. Methods: Physician assistants, SOF and conventional force Medics, veterinary technicians, and food service inspectors, all naïve to ultrasound, were recruited for this study. Participants underwent a brief presentation on detection of a pneumothorax by ultrasound and were then asked to perform a thoracic ultrasound examination on euthanized, ventilated swine. Some of the swine were induced with a pneumothorax prior to these examinations, and all participants were blinded to the absence or presence of a pneumothorax. Results: Twenty-two participants examined a total of 44 hemithoraces. A total of 21 out of 22 pneumothoraces were correctly identified with one false-negative. All 22 normal hemithoraces were correctly identified for a sensitivity of 95.4% (95 % CI 0.75-0.99), and a specificity of 100% (95% CI 0.81-1.00), with PPV of 100%, NPV of 95.6%. Conclusions: Non-physician healthcare providers can accurately detect a pneumothorax with portable ultrasound after receiving minimal focused training.

Keywords: ultrasound; pneumothorax; military

Tourniquets For The Control Of Traumatic Hemorrhage: A Review Of The Literature

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Richey SL. 09(1). 56 - 64. (Previously Published)

Previously published in the 24 October 2007 World Journal of Emergency Surgery 2007, 2:28. This article is available from: http://www.wjes.org/content/2/1/28. Republished in JSOM with permission.

An Evaluation Of Tactical Combat Casualty Care Interventinos In A Combat Environment

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Tien HC, Jung V, Rizoli SB, Acharya SV, MacDonald JC. 09(1). 65 - 68. (Previously Published)

Previously published in the Journal of the American College of Surgeons, Vol. 207, No. 2, August 2008. Republished in JSOM with permission of Elsevier.

Abstract

Background: Tactical combat casualty care (TCCC) is a system of prehospital trauma care designed for the combat environment. Although widely adopted, very few studies have reported on how TCCC interventions are actually delivered on the battlefield, from a quality of care perspective. Study Design: This was a prospective study of all trauma patients treated at the Role 3 multinational medical unit (MMU) at Kandahar Airfield Base from February 7, 2006 to May 30, 2006. Primary outcomes were whether or not two TCCC interventions were underused, overused, or misused. Interventions studied were needle decompression of tension pneumothoraces and tourniquet application for exsanguinating extremity injuries. Results: One hundred thirty-four trauma patients were treated at the Role 3 MMU during the study period. Six patients had eight tourniquets applied. Five tourniquets were applied to four patients appropriately and saved their lives. There was one case of misuse where a venous tourniquet was applied. There was one case of overuse where one patient had two tourniquets placed for 4 hours on extremities with no vascular injury. There were seven cases where needle decompression was underused: Seven patients presented with vital signs absent with no needle decompression. There was one case of overuse of needle decompression. There were seven cases of misuse where the patients were decompressed too medially. Conclusions: Tourniquets save lives. Needle decompression can save lives, but is usually performed in patients with multiple critical injuries. TCCC instructors must reinforce proper techniques and indications for each procedure to ensure that the quality of care provided to injured soldiers on the battlefield remains high.

The Command Of Biotechnology And Merciful Conquest In Military Oppositions

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Guo J. 09(1). 69 - 73. (Previously Published)

Previously published in Military Medicine, 171, 11:1150, 2006. Permission was granted to republish in JSOM by AMSUS.

Abstract

Biotechnology has an increasingly extensive use for military purposes. With the upcoming age of biotechnology, military operations are depending more on biotechnical methods. Judging from the evolving law of the theory of command, the command of biotechnology is feasible and inevitable. The report discusses some basic characteristics of modern theories of command, as well as the mature possibility of the command theory of military biotechnology. The evolution of the command theory is closely associated with the development of military medicine. This theory is expected to achieve successes in wars in an ultramicro, nonlethal, reversible, and merciful way and will play an important role in biotechnological identification and orientation, defense and attack, and the maintenance of fighting powers and biological monitoring. The command of military biotechnology has not become a part of the virtual military power yet, but it is an exigent strategic task to construct and perfect this theory.

Tourniquet Use In Combat Trauma: Uk Military Experience

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Brodie S, Hodgetts TJ, Ollerton J, McLeod J, Lambert P, Mahoney P. 09(1). 74 - 77. (Previously Published)

Previously published in J R Army Med Corps 2007; 153(4): 310-313. Reprinted in the JSOM with kind permission of the editor of the Journal of the Royal Army Medical Corpsí.

Abstract

Aim: To determine the prevalence of tourniquet use in combat trauma, the contribution to lives saved and the complications of their use in this environment. Population: All casualties treated at UK field hospital facilities in Iraq and Afghanistan and meeting criteria for entry into UK Joint Theatre Trauma Registry (JTTR) from 04 Feb 03 to 30 Sep 07. Methods: Cases were identified from UK JTTR. Casualties from Permanent Joint Overseas Bases (PJOBs) were excluded. ISS, NISS, TRISS and ASCOT were calculated automatically within JTTR from AIS 2005 (Military) codes. Results: 1375 patients met UK JTTR entry criteria for the period specified (excluding PJOBs). 70/1375 patients (5.1%) were treated with one or more tourniquets (total 107 tourniquet applications). 61/70 (87%) survived their injuries. 17/70 (24%) patients had 2 or more tourniquets applied. 64/70 patients received a tourniquet after April 2006, when tourniquets were introduced as an individual first aid item. 43/70 (61%) patients were UK military. Conclusions: ISS and TRISS are poorly representative of injury severity and outcome for combat trauma involving isolated multiple limb injuries and cannot be used to discriminate whether a tourniquet is life-saving. The presence of severe isolated limb injuries, profound hypovolaemic shock and the requirement for massive transfusion reasonably identifies a cohort where the use of one or more tourniquets pre-hospital to control external bleeding can be said to be life-saving.