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Featured Articles

Winter 2010

Special Operations Individual Medical Equipment Part 2 - The In-use And Survival Medical Kits

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Geers D. 10(1). 3 - 15. (Journal Article)

Abstract

Special Operations Forces (SOF) Operators need a variety of individual medical items that can generally be broken down into three types of medical kits: a major trauma kit, to treat major traumatic wounds; an in-use medical kit, to prevent or treat anticipated common medical conditions during operations; and a survival medical kit, to treat minor injuries and ailments when in a survival/evasion situation.

Medical Seminars: A New Paradigm For SOF Counterinsurgency Medical Programs

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Alderman SM, Christensen JB, Crawford I. 10(1). 16 - 22. (Journal Article)

Abstract

Medical programs are valuable tools when they properly align with operational objectives. In counterinsurgency operations, the medical program should promote the capacity of the host nation government and lead to greater self-sufficiency. The Medical Civic Action Program (MEDCAP) often fails to fully integrate host nation providers and officials which may undermine local medical infrastructure and rarely provides sustainable improvement. The Medical Seminar (MEDSEM) was developed during Operation Enduring Freedom- Philippines to address the shortcomings of the traditional MEDCAP. The MEDSEM greatly enhanced the MEDCAP by adding education to the venue, thereby promoting self reliance and improving the sustainability of medical interventions. Furthermore, the MEDSEM forged relationships and promoted interoperability through collaboration between local medical providers, governmental leaders, host nation forces, and U.S. Special Operations Forces.

Evidence-based Diagnosis And Management Of Mtbi In Forward Deployed Settings: The Genesis Of The Usasoc Neurocognitive Testing And Post-injury Evaluation And Treatment Program

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Lutz RH, Kane S, Lay J. 10(1). 23 - 38. (Case Reports)

Abstract

A 28 year old 18-series Soldier was the driver in a vehicle which struck an improvised explosive device (IED). The vehicle was destroyed and the other occupant in the vehicle was killed instantly. The Soldier recalled hitting the roof of the vehicle a least once; however, he suffered no life-threatening injuries and was not initially evacuated to higher medical care. Immediately following the event the Soldier noticed a headache, mild dizziness, nausea, and short-term memory loss. Upon return to the forward operating base (FOB), he was evaluated by the forward surgical team physician who performed a military acute concussion exam (MACE). His score was 24 out of 30 and he was diagnosed with a mild concussion, his symptoms were treated with acetaminophen, and he was released. On day three, he participated in another combat patrol. During the operation he suffered from dizziness and headaches. He self-medicated with acetaminophen and meclizine transdermal for his symptoms. On this patrol, he was exposed to overpressure from explosions on two separate events. Each explosion was the equivalent of approximately 27 pounds of TNT (trinitrotoluene). Following this mission, he returned to his FOB and noticed increased dizziness, nausea, and memory loss. No other members of his team who were exposed to those two explosions reported any symptoms. He continued to self medicate with acetaminophen and meclizine transdermal. He did not seek follow-up medical care. Later that same day, he participated in a third mission as part of a quick reaction force which included a high altitude helicopter assault. He was not exposed to any additional blast or injuries. After returning from the third mission, the patient experienced significant fatigue. He went to sleep and later the same night experienced loss of consciousness after quickly standing from a lying position. Upon recovering consciousness, he experienced increased dizziness, nausea, and emesis. He was evaluated by the unit medical provider and evacuated to a Level III Theater Hospital. Over the next three days, his nausea and dizziness improved; however, he continued to have significant issues with short term memory loss, difficulty concentrating, short-term memory recall, and headaches. His MACE scores slowly improved to 27 out of 30 over several days. He was evacuated through Landstuhl Regional Medical Center to the United States for additional evaluation and treatment.

Evaluation And Treatment Of Persistent Cognitive Dysfunction Following Mild Traumatic Brain Injury

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Cozzarelli TA. 10(1). 39 - 42. (Journal Article)

Abstract

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and the Defense and Veterans Brain Injury Center (DVBIC) hosted a consensus conference to address persistent cognitive impairments following mild traumatic brain injury (mTBI) and the role of cognitive rehabilitation in this population. Fifty military and civilian subject matter experts developed clinical guidance for cognitive rehabilitation of Service members with cognitive symptoms persisting three or more months following injury. This article highlights the initial evaluation, comprehensive assessment and treatment recommendations contained within the guidance "Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and Defense and Veterans Brain Injury Center Consensus Conference on Cognitive Rehabilitation for Mild Traumatic Brain Injury." The full clinical guidance is available at: (http://www.dcoe.health.mil/Resources.aspx).

Dislocation Of The Knee: Imaging Findings

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Shearer D, Lomasney L, Pierce K. 10(1). 43 - 47. (Journal Article)

Abstract

Dislocations of the knee are relatively uncommon injuries. However, the incidence of this injury appears to be increasing. Knee dislocations are most often high velocity blunt injuries, with motor vehicle accidents being a frequent etiology. Other causes include falls from height, athletic injuries, farming and industrial accidents, and even low velocity mechanisms such as a misstep into a hole. Likewise, minor trauma in the morbidly obese is increasingly recognized as a mechanism of knee dislocation. Multiple forms of dislocation exist, with the common factor being disruption of the tibiofemoral articulation. Dislocation can occur in a variety of directions depending on the mechanism of injury. The most common dislocation is anterior, which may be seen in hyperextension injuries such as martial arts kicking. The "dashboard injury" of motor vehicle accidents can result in a posterior dislocation of the knee. Lateral and rotary dislocations are less common. Knee dislocation is more commonly diagnosed in men, with a mean age of 23 to 31 years old. This is the very patient population encountered by Special Operations Forces (SOF) healthcare providers. Given the mechanisms of injury noted above, it is reasonable to conclude that knee dislocations may be seen in a young, active SOF patient population, particularly those engaged in parachuting, fast-roping/rappelling, driving at high speeds during military operations, and mixed martial arts.

Monkey Bite Exposure Treatment Protocol

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Newton F. 10(1). 48 - 49. (Journal Article)

Canine Tactical Field Care Part Three - Thoracic and Abdominal Trauma

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Taylor WM. 10(1). 50 - 58. (Journal Article)

Abstract

Military and law enforcement agencies have seen a dramatic increase in the utilization of working canines both at home and in foreign deployments. Due to the fact that professional veterinary care is sometimes distant from internal disaster or foreign deployment sites, the military medic, police tactical medic, or other first-response medical care provider may be charged with providing emergency or even basic, non-emergency veterinary care to working canines. (Editor's Note: Military veterinary detachments are collocated next to the major human treatment facilities in a deployment environment. In a deployed environment veterinary care is located in areas where they are most needed or where most of the animals are located.) The medical principles involved in treating canines are essentially the same as those for treating humans, but 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 third in a series of articles designed to provide condensed, basic veterinary information on the medical care of working canines, to include military working dogs (MWDs), police canines, federal agency employed working canines, and search and rescue dogs, to those who are normally charged with tactical or first responder medical care of human patients. This article provides and overview of the diagnosis and treatment of common traumatic injuries to the thorax and abdomen.

Portable Ultrasound Empowers Special Forces Medics

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Crisp JD. 10(1). 59 - 62. (Journal Article)

Medical Humanitarian Missions

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Mulvaney SW, Mcbeth MJ. 10(1). 73 - 74. (Previously Published)

Previously Published as an Editorial in the American Family Physician. Permission to republish granted by American Academy of Family Physicians.

Pain Management In Current Combat Operations

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Black IH, McManus JG. 10(1). 75 - 79. (Previously Published)

Permission granted to republish. Reproduced from Prehospital Emergency Care 2009, Vol. 13, No. 2, Pages 223-227

Abstract

Pain management in the U.S. military, particularly in combat, shares many of the same principles found in civilian heathcare organizations and institutions. Pain is one of the most common reasons for which Soldiers seek medical attention in the combat environment, which mirrors the civilian experience. However, the combat environment exacerbates the typical challenges found in treating acute pain and has the additional obstacles of a lack of supplies and equipment, delayed or prolonged evacuation times and distances, devastating injuries, provider inexperience, and dangerous tactical situations. These factors contribute to the difficulty in controlling a Soldier's pain in combat. Furthermore, civilian healthcare providers have also learned the importance of practicing pain management principles in austere and tactical environments because of recent natural and man-made domestic disasters. Pain management research, education, and treatment strategies have been created to try to achieve adequate battlefield analgesia, and these lessons learned may aid civilian healthcare providers if the circumstances arise. This article presents a brief history and current overview of pain management for combat casualties on today's battlefield. Recent natural disasters and increased threats for terrorist acts have proven the need for civilian healthcare providers to be properly trained in pain management principles in an austere or tactical environment.