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This week's featured articles

12/1/2018

The Combat Application Tourniquet Versus the Tactical Mechanical Tourniquet

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Beaven A, Ballard M, Sellon E, Briard R, Parker PJ. 18(3). 75 - 78. (Journal Article)

Abstract

Background: Exsanguination from limb injury is an important battlefield consideration that is mitigated with the use of emergency tourniquets. The Combat Application Tourniquet (C-A-T®) is the current British military standard tourniquet. Methods: We tested the self-application of a newer tourniquet system, the Tactical Mechanical Tourniquet (TMT), against self-application of the C-A-T. A total of 24 healthy British military volunteers self-applied the C-A-T and the TMT to their mid thigh in a randomized, sequential manner. Popliteal artery flow was monitored with a portable ultrasound machine, and time until arterial occlusion was measured. Pain scores were also recorded. Results The volunteers allowed testing on their lower limbs (n = 48 legs). The C-A-T was applied successfully to 22 volunteers (92%), and the TMT was successfully applied to 17 (71%). Median time to reach complete arterial occlusion was 37.5 (interquartile range [IQR], 27-52) seconds with the C-A-T, and 35 (IQR, 29-42) seconds with the TMT. The 2.5-second difference in median times was not significant (ρ = .589). The 1-in-10 difference in median pain score was also not significant (ρ = .656). The success or failure of self-application between the two tourniquet models as assessed by contingency table was not significant (p= .137). Conclusion: The TMT is effective when self-applied at the mid thigh. It does not offer an efficacy advantage over the C-A-T.

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Cognitive Agility as a Factor in Human Performance Optimization

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Ross J, Miller L, Deuster PA. 18(3). 86 - 91. (Journal Article)

Abstract

Cognitive agility reflects the capacity of an individual to easily move back and forth between openness and focus. The concept is being translated into a tool to help train leaders to perform well in the "dynamic decision-making context." Cognitive agility training (CAT) has the potential to increase emotional intelligence by improving an individual's ability to toggle between highly focused states to levels of broad, outward awareness, which should enable dynamic decision-making and enhance personal communication skills. Special Operations Forces (SOF) Operators must work in rapidly evolving, complex environments embedded with multiple high-risk factors. Generally, success in these operational environments requires the ability to maintain highly focused states. However, SOF Operators must also be able to transition rapidly back to their roles within their families, where a more outwardly aware state is needed to allow flexibility in emotional responses. CAT addresses these seemingly conflicting requirements. Successful CAT must reflect the methodologies and culture already familiar within the SOF community (i.e., "live" scenario-based activities) to replicate challenges they may encounter when operationally deployed and when at home. This article provides an overview of cognitive agility, the potential benefits, applications that could be used for training SOF Operators to improve their cognitive agility to optimize performance, and sample training scenarios. The issue of what metrics to use is also discussed.

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