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Featured Articles

Fall 2011

Fresh Whole Blood Transfusions In The Austere Environment

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Bowling F, Kerr W. 11(4). 3 - 37. (Journal Article)

Abstract

The use of Fresh Whole Blood (FWB) transfusions can be a powerful tool for the Special Operations Forces (SOF) medic to treat uncontrolled hemorrhage. In fact, it may be the only tool currently available for hemostatic resuscitation, which along with hypotensive resuscitation, forms the basis for Damage Control Resuscitation (DCR). Until now, no comprehensive protocol has existed for conducting FWB transfusions in austere environments. The United States Special Operations Command (USSOCOM) sponsored Curriculum Evaluation Board (CEB), which is responsible for authoring the Tactical Emergency Medical Protocols (TMEPs) has produced a protocol. This article serves as its introduction.

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Mild Traumatic Brain Injury Literature Review and Proposed Changes To Classification

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Krainin BM, Forsten RD, Kotwal RS, Lutz RH, Guskiewicz KM. 11(4). 38 - 47. (Journal Article)

Abstract

Mild traumatic brain injury (mTBI) reportedly occurs in 8-22% of U.S. servicemembers who conduct combat operations in Afghanistan and Iraq. The current definition for mTBI found in the medical literature, to include the Department of Defense (DoD) and Veterans Administration (VA) clinical practice guidelines is limited by the parameters of loss of consciousness, altered consciousness, or post-traumatic amnesia, and does not account for other constellations of potential symptoms. Although mTBI symptoms typically resolve within seven days, some servicemembers experience symptoms that continue for weeks, months, or years following an injury. Mild TBI is one of few disorders in medicine where a benign and misleading diagnostic classification is bestowed on patients at the time of injury, yet still can be associated with lifelong complications. This article comprehensively reviews the clin ical literature over the past 20 years and proposes a new classification for TBI that addresses acute, sub-acute, and chronic phases, and includes neurocognitive, somatic, and psychological symptom presentation.

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Parasitology Results From A Medcap In Africa

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Franklin B, Swierczewski B. 11(4). 48 - 51. (Journal Article)

Abstract

The Medical Civil Action Program (MEDCAP) is an important tool that is utilized to support the larger missions in all areas of current operations. In Ethiopia, MEDCAPs are one of many tools commanders use to earn the trust and confidence of the local population. There are many ways to implement a MEDCAP and this paper will highlight one such successful engagement. This mission was intended in increase the medical capacity of host nation (HN) medical personnel and increase HN confidence in their government to provide for essential services. The mission was broken into four phases similar to traditional MEDCAPs, but with a significant difference.

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A New Plan For The 800-pound Guerrilla: Perinatal Mortality. A 21st Century Medical Counterinsurgency Model For Afghanistan

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Johnson TC. 11(4). 52 - 55. (Journal Article)

Abstract

Afghanistan has the highest perinatal mortality rate in the entire world. One Afghani woman dies every 30 minutes from perinatal- related event. One of eight Afghani women will die from perinatal events. Maternal mortality is (use percentage, not fractions) 1600/100,000 vs 13 /100,000 in the United States. Afghanistan is one of the only countries in the world in which the average woman's life expectancy is shorter than a males- despite the active, nationwide combat fought primarily by Afghani males. Meaning, women in Afghanistan are not routinely involved in combat, yet are more likely to die than a man of the same age. This article presents an alternative model Medical Seminar (MEDSEM) for a successful Special Forces (SF) medical counterinsurgency (COIN) plan that can obtain real results by addressing the mission of the Afghan Ministry of Health versus clinging to old notions. This model forms around the medical capabilities of the SF Operational Detachment (ODA)- Alpha (A) and preventinmaternal- infant complications.

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Underneath The Unconventional: Philosophies And Paradigms Of Special Operations Forces Clinical Science

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Froede K. 11(4). 56 - 60. (Journal Article)

Abstract

Special Operations Forces (SOF) medical personnel (clinicians) directly impact their patients' outcomes, regardless if the patient is a Soldier, civilian, or indigenous person. Any health practitioner who specializes in trauma, Soldiers' healthcare, or tactical and/or operational healthcare must have a working knowledge of SOF medicine and its philosophical, political, and contextual origins. SOF clinical evidence and knowledge base is extensive and inextricably linked to SOF clinicians' underlying warrior philosophy and worldview. This submission will argue the point that SOF healthcare is a discipline and mature science in its own right, as evidenced by SOF's utilization and/or rejection of other disciplines' (nursing, medicine, conventional military) paradigms, community-wide adoption of its own specific paradigms, disciplinary matrix, and language. Peer-reviewed articles relevant to SOF and military healthcare from 2009-2011 are reviewed to determine possible philosophical frameworks, identify extant methodologies, and demonstrate underlying philosophical constructs.

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Zoonotic And Infectious Disease Surveillance In Ecuador: Ehrlichia Canis, Anaplasma Phagocytophilum, Borrelia Burgdorferi, And Dirofilaria Immitis Prevalence Rates In Canines

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McCown ME, Monterroso VH, Grzeszak B. 11(4). 61 - 65. (Journal Article)

Abstract

Vector-borne diseases (VBD) make up a large number of emerging infectious and zoonotic diseases. Ticks, fleas, and mosquitoes are effective vectors parasitizing canines, making dogs adequate reservoirs for zoonoses. The U.S. military deploys personnel and government- owned animals around the world with possible risk of exposure to VBD. Canine VBD have veterinary and public health significance for the host nations as well as for the U.S. troops and its working animals deployed in the theater of operations. These factors make disease surveillance a great importance. The objective of this work was to survey canines from the cities of Manta and Guayaquil in Ecuador to determine prevalence of heartworm disease (D. immitis), ehrlichi os is (E. canis), Lyme disease (B. burgdorf eri), and anapl asmosis (A. phagocytophilum). Canine blood samples (1-3ml) collected from the cities of Manta (n=50) and Guayaquil (n=50) were tested on site using a SNAP® 4Dx® Test Kit. Prevalence for single or multiple disease status was calculated for each city. In the city of Manta the overall prevalence of diseases was 78%; 52% for E. canis alone, and 26% for co-infection with E. canis and A. phagocytophilum. The overall prevalence for the city of Guayaquil was 88%; 40% for E. canis alone, 22% for A. phagocytophilum alone, and 26% for co-infection with E. canis and A. phagocytophilum. Neither heartworm disease nor Lyme disease was detected in any samp le. In conclusion, this study showed the extensive presence of E. canis and A. phagocytophilum in both cities in Ecuador, emphasizing the value of surveillance for zoonotic diseases to determine disease prevalence and risk assessments, as well as to implement control measures.

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Hot Dogs: Not Just Backyard Fun A K-9 Heat Injury Case Study

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LeClair TG. 11(4). 66 - 68. (Journal Article)

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Nasal Foreign Body: Case Review For The Advanced Tactical Practitioner

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Paul J. 11(4). 69 - 71. (Journal Article)

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Broken Bodies/Shattered Minds: A Medical Odyssey from Vietnam to Afghanistan

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Hester RA. 11(4). 79 - 80. (Book Review)

Abstract

Ronald J. Glasser, MD
History Publishing Co LLC, August 2011. ISBN: 9781933909479. 280 pages.

Tactical Emergency Casualty Care (TECC): Guidelines For The Provision Of Prehospital Trauma Care In High Threat Environments

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Callaway DW, Smith ER, Cain JS, Shapiro G, Burnett WT, McKay SD, Mabry RL. 11(4). 104 - 122. (Journal Article)

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A Prehospital Trauma Registry for Tactical Combat Casualty Care

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Kotwal RS, Montgomery HR, Mechler KK. 11(4). 127 - 128. (Previously Published)

Previously published in AMEDD Journal, Prehospital Combat Casualty Care - The Starting Point of Battlefield Survival. April June 2011

Abstract

Many combat-related deaths occur in the prehospital environment before the casualty reaches a medical treatment facility. The tenets of Tactical Combat Casualty Care (TCCC) were published in 1996 and integrated throughout the 75th Ranger Regiment in 1999. In order to validate and refine TCCC protocols and procedures, a prehospital trauma registry was developed and maintained. The application of TCCC, in conjunction with validation and refinement of TCCC through feedback from a prehospital trauma registry, has translated to an increase in survivability on the battlefield.

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