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Featured Articles

Spring 2009

Field Evaluation And Management Of Non-Battle Related Knee And Ankle Injuries By The Advanced Tactical Practitioner (ATP) In The Austere Environment - Part Two

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Hammesfahr R. 09(2). 2 - 12. (Journal Article)

Canine Tactical Field Care Part Two - Massive Hemorrhage Control And Physiologic Stabilization Of The Volume Depleted, Shock-affected, Or Heatstroke-affective Canine

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Taylor WM. 09(2). 13 - 21. (Journal Article)

Abstract

Military and law enforcement agencies have seen a dramatic increase in the utilization of military working dogs (MWDs) and working canine officers, respectively both at home and in foreign deployments. Due to the fact that professional veterinary care is often distant from internal disaster or foreign deployment sites, the military medic, police tactical medic, or other first-response medical care providers may be charged with providing emergency or even basic, non-emergency veterinary care to working canines. The medical principles involved in treating canines are essentially the same as those for treating humans; however, the human healthcare provider needs basic information on canine anatomy and physiology, and common emergency conditions, in order to provide good basic veterinary care until a higher level of veterinary care can be obtained. This article represents the second in a series designed to provide condensed, basic veterinary information on the medical care of working canines, including police canines, federal agency employed working canines, and search-and-rescue dogs, in addition to the MWD, to those who are normally charged with tactical or first responder medical care of human patients. This article focuses on diagnosing and treating some of the more common high-mortality conditions affecting canines in the field including massive hemorrhage, volume-depletion, shock, and heatstroke.

A Case Of Reactive Arthritis In A Ranger Indoctrination Program (RIP) Student

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Hart RS, Detro JF. 09(2). 22 - 28. (Journal Article)

Abstract

Musculoskeletal complaints comprise the majority of cases encountered by military physicians when evaluating young active duty Soldier-athletes. This is a case of reactive arthritis in a 19-year-old active duty Soldier-athlete whose failure to improve with conservative therapy initiated further investigation. When evaluating what appear to be routine overuse injuries, it is important to actively include other potential causes of musculoskeletal complaints in the differential diagnosis. Further investigation of disease in patients whose symptoms and complaints do not improve with routine conservative care is paramount. Reactive arthritis, though self-limiting in two-thirds of those affected, can become a chronic disabling disease affecting as many as 40 out of 100 patients. Current theories suggest the persistent presence of non-culturable bacteria and bacterial antigens residing in the joint synovia as the etiology of the disease state. There is no curative therapy for reactive arthritis and management is focused on the treatment of symptoms with non-steroidal anti-inflammatory drugs (NSAIDs), immunomodulator therapy, and antibiotics if an infectious source is suspected.

Functional Training Program Bridges Rehabilitation And Return To Duty

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Gross DL, Christopher GE, Faulk RT. 09(2). 29 - 48. (Journal Article)

Abstract

Traditional clinic-based rehabilitation programs often fall short of returning Soldiers to peak condition prior to releasing them for duty. With the higher physical demands placed on the Special Operations Soldier, a bridge program offers rehabilitation professionals a way to maximize recovery, enhance performance, and hopefully prevent injuries (or re-injury). A six week functional training program is outlined and data collection from over two years is presented. Statistically and operationally significant differences were noted in nearly every category tested. Functional Movement Screen™ scores improved an average of 2.5 points. T-test improvement was 0.5 seconds. Single leg hop time improved 10%. Hop for distance improved approximately 10%. Body fat improvement was statistically significant. Kip-ups improved 32%. Vertical jump height improvement was statistically significant. All subjective fitness category self-evaluations demonstrated statistically significant improvements, except for pain. Data suggests that a program like this may be beneficial to patients and non-patients seeking a safe, effective alternative training regimen.

The Impedance Threshold Device (ITD-7) A New Device For Combat Casualty Care To Augment Circulation And Blood Pressure In Hypotensive Spontaneously Breathing Warfighters

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Parsons DL, Convertino VA, Idris A, Smith S, Lindstrom D, Parquette B, Aufderheide T. 09(2). 49 - 53. (Journal Article)

Abstract

Inspiration through -7cm H2O resistance results in an increase in venous blood flow back to the heart and a subsequent increase in cardiac output and blood pressure in hypotensive animals and patients. Breathing through the impedance threshold device with 7cm H2O resistance (ITD-7) also reduces intracranial pressure with each inspiration, thereby providing greater blood flow to the brain. A new device called an ITD-7 was developed to exploit these physiological mechanisms to buy time in hypotensive War Fighters when other therapies are not readily available. Animal and clinical data with the ITD-7 demonstrate the potential value and limitations of this new non-invasive approach to enhancing circulation

The United States Army Special Forces - Walter Reed Army Institute Of Research Field Epidemiologic Survey Team (Airborne)

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Dorogi LT. 09(2). 54 - 71. (Journal Article)

Abstract

The U.S. Army Special Forces - Walter Reed Army Institute of Research Field Epidemiological Survey Team (Airborne) was formed in late 1965 and later deployed to Vietnam in 1966. Funded by Walter Reed Army Institute of Research and staffed by highly trained Special Forces qualified medical personnel from Fort Bragg, North Carolina, the team was attached to the 5thSpecial Forces Group (Airborne) while in Vietnam. During its short existence, the team conducted extensive and important field studies on diseases of military medical importance, often under combat conditions.

SORT(ing) Out The Casualties: The Special Operations Resuscitation Team In Afghanistan

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Finlayson K. 09(2). 77 - 86. (Previously Published)

Previously published in Veritas Vol 5 No. 1 2009. Permission granted to republish in JSOM. in the JSOM.

Baseline Dissociation And Prospective Success In Special Forces Assessment And Selection

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Morgan CA, Hazlett G, Dial-Ward M, Southwick SM. 09(2). 87 - 92. (Previously Published)

Previously Published in Psychiatry (Edgemont) 2008;5(7):52-57. Permission granted by Psychiatry 2008 to reproduce in the JSOM.

Abstract

Introduction: Although dissociation at the time of trauma (peritraumatic dissociation) has been shown to predict the development of posttraumatic stress disorder (PTSD), it is not yet known whether the tendency to dissociate under nonstressful circumstances (i.e., at baseline) can also serve as a predictor of vulnerability to stress in healthy individuals. Method: Baseline symptoms of dissociation (CADSS) were assessed in 774 active duty male Soldiers enrolled in Special Forces Assessment and Selection (SFAS). Results: Soldiers who endorsed experiencing any symptoms of dissociation at baseline were significantly less likely to be successful in SFAS. The greater the number of symptoms of dissociation endorsed at baseline, the greater the likelihood of failure. Discussion: These data explain our earlier findings of fewer symptoms of dissociation in elite troops and may have relevance for the selection and hiring of personnel for nonmilitary, at-risk professions. Better screening may lead to improved primary intervention strategies, better job placement, and lowered risk of PTSD.

Prehospital Advances In The Management Of Severe Penetrating Trauma

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Mabry RL, McManus JG. 09(2). 93 - 101. (Previously Published)

Previously published in Critical Care Medicine 2008; 36[Suppl.]:S258 S266. Republished in JSOM with permission of LippincottWilliams &Wilkins

Abstract

Background: Historic advances in combat prehospital care have been made in the last decade. Unlike other areas of critical care, most of these innovations are not the result of significant improvements in technology, but by conceptual changes in how care is delivered in a tactical setting. The new concept of Tactical Combat Casualty Care has revolutionized the management of combat casualties in the prehospital tactical setting. Discussion: The Tactical Combat Casualty Care concept recognizes the unique epidemiologic and tactical considerations of combat care and that simply extrapolating civilian care concepts to the battlefield are insufficient. Summary: This article examines the most recent and salient advances that have occurred in battlefield prehospital care driven by our ongoing combat experience in the Iraq and Afghanistan and the evolution around the Tactical Combat Casualty Care concept.

Results Of Vietnamese Acupuncture Seen At The Second Surgical Hospital

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Rich NM, Dimond FC. 09(2). 102 - 104. (Previously Published)

Previously published in Military Medicine-October, 1967

Abstract

One of the rewards in the medical service in a foreign land is the exposure to exotic diseases and methods of therapy which are virtually unknown to many physicians in the western world. With the treatment of Vietnamese patients by medical personnel from the United States and other countries with a similar system of medical education, new experiences and challenges are presented daily. The use of acupuncture as a form of therapy is undoubtedly as unfamiliar to many physicians as it was to us. In addition to our treatment of American casualties at the Second Surgical Hospital in the Republic of Vietnam, we had the opportunity of treating some interesting problems in Vietnamese patients who had previously been treated with acupuncture. The majority of our own staff questioned, "What is acupuncture?"

Overview Of Combat Trauma In Military Working Dogs In Iraq And Afghanistan

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Baker JL, Truesdale CA, Schlanser JR. 09(2). 105 - 108. (Previously Published)

Previously published in The United States Army Medical Department Journal / The Unites States Army Veterinary Corps January - March 2009.