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Featured Articles

Spring 2011

Public Health Operations In The JSOTF-P


Rufolo D, Facciolla C. 11(2). 4 - 7. (Journal Article)


Medical personnel have a proven operational and strategic role as part of Counterinsurgency (COIN) and Foreign Internal Defense (FID) operations. In addition to the traditional employment of medical assets in Medical Civic Action Programs, commanders can utilize their medical resources in a teaching and educational capacity to effectively target an entire village (men, women, and children), with minimal logistical support. In the Joint Special Operations Task Force- Philippines, Environmental Science Engineer Officers and veterinarians added additional capabilities and facilitated educational programs that stimulate the coordination of local, military, and government resources to improve public health infrastructure and make a sustainable, lasting impact.

PMID: 21455902


Counterinsurgency, Healthcare, And Human Nature: Tapping Into The Hierarchy Of Needs


Caci JB. 11(2). 8 - 11. (Journal Article)

PMID: 21455903


Optimizing Nutrition For Performance At Altitude: A Literature Review


Kechijian D. 11(2). 12 - 17. (Journal Article)


Human beings are unique for their capacity to maximize their physical potential through various means. High altitude mountaineering is one such way that people challenge generally accepted notions about what is biologically and evolutionarily possible. While a 20,000+ ft summit may be uninhabitable for extended periods of time, enterprising individuals have demonstrated that even the most remote locations are accessible with sufficient physical effort and proper strategy. High altitude athletes, and the scientists who study them, generally focus their research and preparation on physiological parameters, with a particular emphasis on the cardiopulmonary system. While careful scrutiny in this area is certainly justified, the relationship between physiological output at altitude and nutrition is somewhat neglected in the literature. Many athletes, alpinists included, consider eating to be instinctive and mundane. However, very few activities at 30,000ft or even 15,000ft are intuitive. Furthermore, nutrition is one of the few variables mountain athletes can control in an otherwise unpredictable environment. Despite the intrinsic limitations and seemingly contradictory findings often associated with performance nutrition studies at high altitude, mountain athletes should adhere to certain dietary guidelines related to macronutrient composition, micronutrient supplementation, and hydration status.

PMID: 21455904


Soldiers Can Take It - A Conceptual Analysis Of Trauma


Froede K. 11(2). 18 - 22. (Journal Article)


Purpose: This article will analyze the concept of trauma, and illustrate distinctions between accepted definitions and actual meaning. For populations at high risk for exposure to traumatic situations, such as Special Operations Forces (SOF) and deployed military personnel, delineating the beliefs and environment-specific comprehension of trauma and its consequences is imperative. Background: Trauma is a common term in health sciences literature and in the social vernacular, but is often misunderstood and lacks specificity. Differences in perception of what trauma is and is not may exist even between civilian and military populations. Therefore, the concept of trauma warrants clarification, to define the terminology and to use it appropriately with full understanding. Data sources: EbscoHost, PubMed, CINAHL, MedLine, and Google Scholar. Only English-language results were accepted, and were limited to publications from the dates of 1975- 2010.

PMID: 21455905


Feedback To The Field: An Assessment Of Sternal Intraosseous (io) Infusion


Harcke HT, Crawley G, Ritter BA, Mazuchowski EL. 11(2). 23 - 26. (Journal Article)


Intraosseous vascular infusion (IO) is a recognized alternative to peripheral intravenous infusion when access is inadequate. The sternum and proximal tibia are the preferred sites. A review of 98 cases at autopsy revealed successful sternal IO placement in 78 cases (80%). Assuming a worst case scenario for placement (pin mark and no tip in bone [17 cases] and tip present and not in the sternum [3 cases]), attempts were unsuccessful in 20 cases (20%). We draw no specific conclusions regarding sternal IO use, but hope that personnel placing these devices and those providing medical training can use the information.

PMID: 21455906


Altered Mental Status In A U.s. Army Special Forces Soldier


Brandon JW, Hill GJ. 11(2). 27 - 29. (Journal Article)


Special Operations medical provider must be familiar with the differential diagnosis for a patient with altered mental status since it includes multiple life-threatening illnesses. Potential diagnoses include meningitis, encephalitis, malaria and many others. While preparing to evacuate to definitive care from an austere location, they must also be prepared to initiate empiric therapy that is specific to the patient and the area of operations. We present a case of a U.S. Army Special Forces Soldier that developed limbic encephalitis of presumed Herpes Simplex Virus (HSV) origin. We will review the key differential diagnoses for this presentation with a focus on infectious etiologies. We will also summarize current diagnostic and therapeutic strategies. Our recommendation is to initiate oral acyclovir when IV acyclovir is not available and this diagnosis cannot be excluded.

PMID: 21455907


Survey Of The Indications For Use Of Emergency Tourniquets


Kragh JF, O'Neill ML, Beebe DF, Fox CJ, Beekley AC, Cain JS, Parsons DL, Mabry RL, Blackbourne LH. 11(2). 30 - 34. (Journal Article)


Indications and evidence are limited, multiple and complex for emergency tourniquet use. Good recent outcomes challenge historically poor outcomes. Optimal tourniquet use in trauma care appears to depend on adequate devices, modern doctrine, refined training, speedy evacuation, and performance improvement. Challenges remain in estimation of blood loss volumes, lesion lethality, and casualty propensity to survive hemorrhage. Summary Background Data: Evidence gaps persist regarding emergency tourniquet use indications in prehospital and emergency department settings as indication data are rarely reported. Methods: Data on emergency tourniquet use was analyzed from a large clinical study (NCT00517166 at ClinicalTrials.gov). The study included 728 casualties with 953 limbs with tourniquets. The median casualty age was 26 years (range, 4-70). We compared all other known datasets to this clinical study. Results: Tourniquet use was prehospital in 671 limbs (70%), hospital only in 104 limbs (11%), and both prehospital and hospital in 169 limbs (18%).Major hemorrhage was observed at or before the hospital in 487 (51%) limbs and minor hemorrhage was observed at the hospital in 463 limbs (49%). Anatomic lesions indicating tourniquets included open fractures (27%), amputations (26%), soft tissue wounds (20%), and vascular wounds (17%). Situations, as opposed to anatomic lesions, indicating tourniquets included bleeding from multiple sites other than limbs (24%), hospital mass casualty situations (1%), one multiple injury casualty needed an airway procedure, and one casualty had an impaled object. Conclusions: The current indication for emergency tourniquet use is any compressible limb wound that the applier assesses as having possibly lethal hemorrhage. This indication has demonstrated good outcomes only when devices, training, doctrine, evacuation, and research have been optimal. Analysis of emergency tourniquet indications is complex and inadequately evidenced, and further study is prudent. Prehospital data reporting may fill knowledge gaps. Objective: The purpose of this study is to report and analyze emergency tourniquet use indications to stop limb bleeding.

PMID: 21455908


Physiological And Psychological Characteristics Of Successful Combat Controller Trainees


Walker TB, Lennemann LM, McGregor JN, Mauzy C, Zupan MF. 11(2). 37 - 47. (Journal Article)


Objectives: The United States Air Force (USAF) Combat Controller (CCT) training pipeline is extremely arduous and historically has an attrition rate of 70-80%. The primary objective of this study was to identify the physiological, psychological, or demographical characteristics associated with successful progression through the CCT pipeline program. Methods: A battery of physiological measurements, biographical information, and psychological tests were used to determine the profile of a successful CCT trainee. These measures were chosen on the basis of being standard physical fitness parameters, CCT-specific physical attribute indicators or validated psychological surveys. A multiple of physical tests served as measurements for cardiovascular endurance (VO2max and running economy), "anaerobic" capacity (Wingate power and loaded anaerobic endurance treadmill tests), body composition skinfolds measurements, power (Wingate and vertical jump), and reaction time (Makoto eye-hand test.) Each test was conducted using a standardized protocol. Psychological characteristics were explored through use of the International Personality Item Pool (IPIP-NEO) and the Mental Toughness Questionnaire 48 (MTQ 48). Results: Our findings revealed the following mean characteristics of 109 CCTs who completed Phase I of the pipeline and achieved their 3-level rating: 23 years old, 1.8m tall, 81kg, 12% body fat, VO2max of 59ml/kg/min, vertical jump of 62cm, able to generate 11.4W/kg peak power and 9.3W/Kg mean power during Wingate tests, overall mental toughness rating of 8 (out of 10) with high levels of extraversion and conscientiousness and low levels of neuroticism. The most popular competitive sport played in high school was football, followed by track, wrestling, and baseball. Conclusions: The results of the investigation confirm that CCT trainees who have achieved a 3-level rating possess much higher than average levels of aerobic and anaerobic fitness, power, mental toughness, extraversion and conscientiousness. They possess lower than average levels of neuroticism and openness to experience. These results may prove useful in refining the selection criteria and in designing training for CCT trainees.

PMID: 21455909