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ATP-P Handbook 10th Edition (978-0-9966297-6-8)

The Advanced Tactical Protocols-Paramedic (ATP-P) Handbook is an essential reference tool for the tactical and combat medics, SWAT team members, and medical professionals operating in austere environments.

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*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

Customers living in Europe can purchase the ATP-P 10th Edition through WERO GmbH and save a significant amount of money on shipping and processing. The ATP-P 10th can be purchased at this link.

Before you buy, you will receive an offer with your total price, including shipping and VAT.


Kunden mit Wohnsitz in Europa können die ATP-P 10th Edition über die WERO GmbH erwerben und dabei erheblich an Versand- und Bearbeitungskosten sparen. Das ATP-P 10th kann unter diesem Link erworben werden.

Vor dem Kauf erhalten Sie ein Angebot mit Ihrem Gesamtpreis, inklusive Versand und Mehrwertsteuer.

$49.00
Pararescue Medical Operations (PJ MED) Handbook 8th ed (978-1-7332239-4-2)
The Pararescue Medical Operations Handbook is designed to form the basis of medical practice during both Rescue Operations and training mishaps for USAF Pararescuemen (PJs).

This revised handbook includes an outline of the principles of PJ medicine and the patient assessment checklist. This approach to patients is slightly modified from traditional primary and secondary surveys to reflect both a more efficient and a comprehensive approach to combat trauma based on PJ experience and data from Overseas Contingency Operations.

Portions of the Tactical Combat Casualty Care (TCCC) guidelines and the ATP Tactical Medical Emergency Protocols (TMEPS) that pertain to the Pararescue are included and have been modified to suit the PJ mission. The goal remains to have all PJs work to a single standard. The section on prolonged care has been modified and expanded based on PJ experiences.

*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

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This version of the PJ Handbook is printed on waterproof, tearproof paper and is spiral bound with a 1/2" ring.
$60.00
Advanced Ranger First Responder Handbook
Advanced Ranger First Responder Handbook (978-1-7332239-8-0)
The Advanced Ranger First Responders are entrusted with an advanced skillset of procedures, medications, and training. They are trained on specific first responder medical skills to provide a higher level of trauma response during Ranger operations. The ARFR is expected to provide limited scope trauma and emergency care in a tactical or austere setting; they may work independently or in support of a medical provider. They are proficient at advanced medical procedures and basic medication administration. The skills in this handbook enhance the basics of Tactical Combat Casualty Care (TCCC)

*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

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Customers living in Europe can purchase the Advanced Ranger First Responder Handbook 2021 Updates through WERO GmbH and save a significant amount of money on shipping and processing. The ARFR can be purchased at this link.

Before you buy, you will receive an offer with your total price, including shipping and VAT.

Kunden mit Wohnsitz in Europa können die Advanced Ranger First Responder Handbook 2021 Updates über die WERO GmbH erwerben und dabei erheblich an Versand- und Bearbeitungskosten sparen. Die ARFR kann unter diesem Link erworben werden.

Vor dem Kauf erhalten Sie ein Angebot mit Ihrem Gesamtpreis, inklusive Versand und Mehrwertsteuer.
$35.00
Independent Duty Medical Technician (IDMT) Protocols Handbook (978-1-7332239-0-4)

US Air Force Independent Duty Medical Technician (IDMT), Medical and Dental Treatment Protocols, Ed 2.1 Handbook is a resource for Air Force IDMT medical personnel with advanced skills and knowledge. These protocols are the product of a concerted effort by representatives from all major command surgeons offices with the express goal to standardize  the  care  IDMTs  are  permitted  to  provide regardless of location and command affiliation. These protocols clearly define the scope of care parameters that the IDMT is expected and trained to work within. These treatment protocols are designed as a guide to accepted step-by-step treatments for medical disorders that may be encountered by IDMTs in the field

*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

Table of Contents

$54.00
Standard Medical Operations Guide (SMOG) CY 2020 (978-1-7332239-2-8)

This current set of medical guidelines were developed through a collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the development of these guidelines by the Joint Trauma System, Committee of En Route Combat Casualty Care and the Committee of Tactical Combat Casualty Care. The shared goal is to ensure excellent en route care that is standard across all evacuation and emergency medical pre-hospital units. All these enhancements and improvements will advance en route care across the services and the Department of Defense.

*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

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$47.00
Ranger Medic Handbook 2020 Updates (978-1-7332239-6-6)
The Ranger Medic Handbook is the medical instruction handbook provided to Ranger Medics by the 75th Ranger Regiment. It is the premier resource for all Ranger Medics and is now available exclusively for purchase by Breakaway Media and by digital subscription on the Journal of Special Operations Medicine website. This handbook is offered on Water/Tear Proof Paper. The 2020 Updates is the official and current edition of the Ranger Medic Handbook.

*** For orders of 10 or more, please contact us at subscriptions@jsomonline.org for pricing ***

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Print: 978-1-7332239-6-6

Customers living in Europe can purchase the Ranger Medic Handbook 2020 Updates through WERO GmbH and save a significant amount of money on shipping and processing. The RMH can be purchased at this link.

Before you buy, you will receive an offer with your total price, including shipping and VAT.

Kunden, die in Europa leben, können die Ranger Medic Handbook 2020 Updates über die WERO GmbH erwerben und dabei erheblich an Versand- und Bearbeitungskosten sparen. Das RMH kann unter diesem Link erworben werden.

Vor dem Kauf erhalten Sie ein Angebot mit Ihrem Gesamtpreis, inklusive Versand und Mehrwertsteuer.
$60.00
20th Anniversary Collector's Edition

The 20th Anniversary Collector's Edition features all 4 editions of the 2020 Journal of Special Operations Medicine. Each edition features a retrospective look at the evolution of SOF Medicine and TCCC protocols.

The Spring edition focuses on the use of whole blood, Summer deals with Hemorrhage Control, Fall looks at Prolonged Field Care, and Winter dives into the changes to TCCC.

Regular price for all 4 journals is $160 - buy the set for $128 - a 20% savings!

$128.00
Spring 2021 Journal (Vol 21 Ed 1)

Vol 21 Ed 1
Spring 2021 Journal of Special Operations Medicine
ISSN: 1553-9768

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Available for preorder. Estimated ship date is March 31st 2021

$40.00
Summer 2021 Journal (Vol 21 Ed 2)

Vol 21 Ed 2
Summer 2021 Journal of Special Operations Medicine
ISSN: 1553-9768

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Available for preorder. Estimated ship date is June 30th 2021

$40.00
Autopsy-Determined Atherosclerosis in Elite US Military Special Operations Forces

Kotwal RS, Mazuchowski EL, Howard JT, Hanak JC, Harcke HT, Gurney JM, Shackelford SA 21(2). 19 - 24 (Journal Article)

Background: Autopsy studies of trauma fatalities have provided evidence for the pervasiveness of atherosclerosis in young and middle-aged adults. The objective of this study was to determine the prevalence of atherosclerosis in elite US military forces. Methods: We conducted a retrospective study of all US Special Operations Command (USSOCOM) fatalities from 2001 to 2020 who died from battle injuries. Autopsies were evaluated from Afghanistan- and Iraq-centric combat operations for evidence of coronary and/or aortic atherosclerosis and categorized as minimal (fatty streaking only), moderate (10-49% narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Prevalence of atherosclerosis was determined for the total population and by subgroup characteristics of age, sex, race/ethnicity, combat operation, service command, occupation, rank, cause of death, manner of death, and body mass index (BMI). Results: From the total of 388 USSOCOM battle injury fatalities, 356 were included in the analysis. The mean age was 31 years (range, 19-57 years), and 98.6% were male. The overall prevalence of coronary and/or aortic atherosclerosis was 17.4%. The prevalence of coronary atherosclerosis alone was 13.8%. Coronary atherosclerosis was categorized as minimal in 1.1%, moderate in 7.6%, and severe in 5.1%. Of those with atherosclerosis, 24.2% were <30 years old, 88.7% were from enlisted ranks, and 95.2% had combatant occupations. When BMI could be calculated, 73.5% of fatalities with atherosclerosis had a BMI ≥25. Conclusions: Autopsy-determined atherosclerosis is prevalent in elite US military Special Operations Forces despite young age and positive lifestyle benefits of service in an elite military unit.

$37.00
23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation

DeSoucy ES, Cacic K, Staak BP, Petersen CD, van Wyck D, Rajajee V, Dorsch J, Rush SC 21(2). 25 - 28 (Journal Article)

There are limited options available to the combat medic for management of traumatic brain injury (TBI) with impending or ongoing herniation. Current pararescue and Tactical Combat Casualty Care (TCCC) guidelines prescribe a bolus of 3% or 5% hypertonic saline. However, this fluid bears a tactical burden of weight (~570g) and pack volume (~500cm3). Thus, 23.4% hypertonic saline is an attractive option, because it has a lighter weight (80g) and pack volume (55cm3), and it provides a similar osmotic load per dose. Current literature supports the use of 23.4% hypertonic saline in the management of acute TBI, and evidence indicates that it is safe to administer via peripheral and intraosseous cannulas. Current combat medic TBI treatment algorithms should be updated to include the use of 23.4% hypertonic saline as an alternative to 3% and 5% solutions, given its effectiveness and tactical advantages.

$37.00
Operation Blood Rain: The Effect of Airdrop on Fresh Whole Blood

Tong RL, Bohlke CW, Clemente Fuentes RW, Moncada M, Schloe AD, Ashley RL 21(2). 29 - 33 (Journal Article)

Background: Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient FWB to treat critically wounded patients or multiple-hemorrhaging casualties. This study describes the effect of airdrop on FWB and explores the possibility of using airdrop to deliver FWB to combat medics treating casualties in the prehospital setting when FDA-approved, cold-stored blood products are not readily available and timely casualty evacuation (CASEVAC) is not feasible. Methods: Four units of FWB were collected from volunteer donors and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a standard airdrop training bundle (SATB) parachute. A control group of 4 units of FWB was stored in a blood cooler that was not dropped. Baseline and postintervention laboratory samples were measured in both airdropped and control units, including full blood counts, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), pH, lactate, potassium, indirect bilirubin, glucose, fibrinogen, lactate dehydrogenase, and peripheral blood smears. Results: The blood cooler, cooling bags, and all 4 FWB units did not sustain any damage from the airdrop. There was no evidence of hemolysis. All airdropped blood met parameters for transfusion per the Whole Blood Transfusion Clinical Practice Guideline of the Joint Trauma System (JTS). Conclusions: Airdrop of FWB in a blood cooler with a SATB parachute may be a viable way of delivering blood products to combat medics treating hemorrhaging patients in the prehospital setting, although further research is needed to fully validate the safety of this method of FWB delivery.

$37.00
Unconventionally Acquired Brain Injury: Guidance and Instruction About an Emerging Challenge to Warfighter Brain Health

Biggs AT, Henry SM, Johnston SL, Whittaker DR, Littlejohn LF 21(2). 43 - 48 (Journal Article)

Special Operations Forces have made brain health a medical priority in recent years, and new guidance identified a new challenge-unconventionally acquired brain injury (UBI). Although this emerging condition is described as a cluster of neurosensory and cognitive symptoms with unknown etiology/ origin, there remain critical questions about how this diagnosis differs from other brain injuries. More importantly, there are limited recommendations about how medical personnel should approach the problem. The current discussion will provide context and information about UBI based on higher guidance and will also review the scant literature to provide context. Foremost, UBI can be distinguished from traumatic brain injury (TBI) largely due to an unknown point of injury. The described symptoms otherwise appear to be largely the same as TBI. Likewise, the recommended course of treatment is to follow the Clinical Practice Guidelines for mild TBI/TBI even if the injury is an actual or suspected UBI. Personnel must be careful to avoid entering sensitive information into the medical record, which may be particularly challenging if identifying the cause involves classified information about an unconventional weapon. Finally, we briefly discuss the literature about several suspected incidents fitting UBI diagnostic criteria, and we conclude with five primary takeaways for medical personnel to follow.

$37.00
An Analysis of Prehospital Trauma Registry After-Action Reviews in Afghanistan

Carius BM, Dodge PM, Fisher AD, Loos PE, Thompson D, Schauer SG 21(2). 49 - 53 (Journal Article)

Background: After-action reviews (AARs) in the Prehospital Trauma Registry (PHTR) enable performance improvements and provide commanders feedback on care delivered at Role 1. No published data exist exploring overall trends of end-user performance-improvement feedback. Methods: We performed an expert panel review of AARs within the PHTR in Afghanistan from January 2013 to September 2014. When possible, we categorized our findings and selected relevant medical provider comments. Results: Of 737 registered patient encounters found, 592 (80%) had AAR documentation. Most AAR patients were male (98%, n = 578), injured by explosion (48%, n = 283), and categorized for urgent evacuation (64%, n = 377). Nearly two thirds of AARs stated areas needing improvement (64%, n = 376), while the remainder left the improvement section blank (23%, n = 139) or specified no improvements (13%, n = 76). The most frequently cited areas for improvement were medical knowledge (23%, n = 136), evacuation coordination (19%, n = 115), and first responder training (16%, n = 95). Conclusions: Our expert panel reviewed AARs within the PHTR and found substantial numbers of AARs without improvements recommended, which limits quality improvement capabilities. Our analysis supports previous calls for better documentation of medical care in the prehospital combat setting.

$37.00
Project Reach: A Pilot Cross-Sectional Study of the Telemedical Capabilities of Special Operations Medical Personnel

Carlton DM, Lowery D, Woodard C, Lugo-Robles R, Charny G 21(2). 54 - 60 (Journal Article)

Background: While the US military has relied on the "Golden Hour" for casualty evacuation in Iraq and Afghanistan during most of the last two decades, Special Operations Forces (SOF) personnel have found themselves operating further outside of this established medical infrastructure. This has required prolonged casualty care beyond doctrinal timelines. Telemedicine is increasingly used by medical personnel to bridge this gap, augmenting the local staff with the expertise of a distant consultant. This pilot study was launched to establish a baseline of current SOF telemedical capabilities. Methods: This is a cross-sectional study of a 292 Department of Defense (DoD) SOF medical personnel via an online questionnaire during the period of October 2018-May 2019. Results: Approximately 16.1% of the 292 respondents stated they received telemedicine equipment, 51.1% of respondents who received telemedicine equipment reported also receiving training on their equipment. Overall, 40.6% of respondents were "actively looking to add telemedicine to their practice," with prolonged field care as the primary intended use. Ideal characteristics of telemedicine equipment were described as a device weighing 6 lb or less, with real-time video and ultrasound transmission capabilities. Discussion: The data demonstrated a gap between provider demand for telemedicine capabilities and their comfort to employ these capabilities downrange. Conclusions: This study suggests a need to increase the self-reported telemedicine competency of deployed local providers. Authors believe that this is best accomplished through incorporation of early integration of teleconsulting systems into mission rehearsals and unit exercises. Further study should be considered to investigate the efficacy of ongoing acquisition and training programs, along with how telemedicine is being incorporated in the unit during the predeployment training period.

$37.00
Targeted Intervention Improves Symptoms and Impairments in Patients With Mild Traumatic Brain Injury With Chronic Symptom: A Prospective, Multiple Interventional Research Trial

Eagle SR, Kontos AP, Collins MW, Mucha A, Holland CL, Edelman K, Benso S, Schneider W, Soose R, Okonkwo DO 21(2). 61 - 66 (Journal Article)

Background: Mild traumatic brain injury (mTBI) and its potential long-term consequences is a primary concern for the US military. The purpose of the study is to evaluate if participants improved in anxiety/mood symptoms, sleep quality, and vestibular/ocular symptoms following a 6-month active intervention, and to explore the effect of targeted treatment for those with specific symptoms/impairments (e.g., psychological, sleep, ocular, vestibular). Materials and Methods: A multidisciplinary clinical team adjudicated participants (n=72, 35.8±8.6 years old, 19% female) to have one of the following primary clinical trajectories: psychological (PSYCH; n=34), sleep (SLEEP; n=25) and vestibular/ocular (VESTIB/OCULAR; n=18). Participants returned for follow-up assessment 6 months later. Assessments included the Post-Concussion Symptom Scale [PCSS], Generalized Anxiety Disorder-7 [GAD-7], Pittsburgh Sleep Quality Index [PSQI], and Dizziness Handicap Inventory [DHI]. Change in concussion symptoms and primary outcome for the given trajectory (i.e., PSYCH=GAD-7, SLEEP=PSQI, VESTIB/OCULAR=DHI) was assessed. Results: Following the 6-month intervention, participants reduced PCSS Score (-14.5±2.4; p<.001; η2=0.34), GAD-7 (-3.1±0.5; p<.001; η2=0.34), PSQI (-2.7±0.5; p<.001; η2=0.34) and DHI (-9.2±2.0; p<.001; η2=0.23). PSYCH (n=34) reduced PCSS score (-17.9±3.6; p<.001; η2=0.45) and GAD-7 (-3.1±0.7; p<.001; η2=0.38). SLEEP (n=25) reduced PCSS score (-8.8±4.4; p=.06; η2=0.15) and PSQI (-3.6±0.9; p<.001; η2=0.45) scores. VESTIB/OCULAR (n=18) reduced PCSS score (-16.7±4.8; p=.03; η2=0.45), and DHI (-15.7±5.5; p=.012; η2=0.35). Conclusions: Large effects were observed for concussion, anxiety, sleep, and dizziness symptom reduction over 6-month treatment. Each primary outcome demonstrated a larger treatment effect for the given trajectory than the overall sample, indicating that targeted treatment can reduce symptom burden in patients with mTBI with chronic symptoms.

$37.00
Prevalence of Low Back and Cervical Back Pain in Military Helicopter Crews: An Underestimated Italian Problem

Marchesini M, Ippolito C, Ambrosini L, Bignami EG, Fasani M, Abbenante D 21(2). 67 - 71 (Journal Article)

Background: Studies have highlighted the incidence and prevalence of chronic pain, which is an epidemic problem in all career sectors, as well as estimated the economic loss that follows its pathology. Several studies have indicated a high incidence of chronic osteoarticular pain in military service members, particularly in flight personnel. To date, no studies have estimated the incidence of pain pathology in the Italian military population, despite the implications related to flight qualification. Methods: A survey was conducted on helicopter flight personnel undergoing periodic annual evaluation. Results: A statistically significantly higher incidence of pain pathology than that reported in the global civilian population was demonstrated. More than 80% of the interviewed population reported moderate-to-severe back pain (45% in the lumbar tract and 38% in the cervical tract). Further, it was found that most staff with chronic pain do not use drugs or other treatments for severe pain because of concerns that such treatment approaches may compromise flight qualifications. Discussion: The present study observed a high incidence of pain in Italian military flight personnel and examined the degree to which this problem is undertreated in these individuals. To address this problem, further in-depth and larger investigations that include therapeutic protocols to resolve such pain pathologies should be conducted. Such investigations could help to reduce pain experienced by flight personnel and enhance the productivity of the Italian military forces while considering the pharmacologic limitations related to the task. Conclusion: Chronic lumbar and neck pain is more common in military helicopter crews than in the civilian population. The true figure is frequently underestimated because of staff concerns regarding the potential influence of therapies on work activity.

$37.00
A Survey of Tranexamic Acid Use by US Tactical Emergency Medical Support Providers

McGuire SS, Klassen AB, Mullan AF, Sztajnkrycer MD 21(2). 72 - 76 (Journal Article)

Background: Tactical Emergency Medical Support (TEMS) providers may encounter severe traumatic injuries, with associated hemorrhagic shock, coagulopathy, and hyperfibrinolysis. Tranexamic acid (TXA) administration represents a potential intervention in this operational environment. This study evaluated TXA availability and use among US tactical medical personnel supporting law enforcement tactical teams. Methods: An anonymous on-line survey of the American College of Emergency Physicians (ACEP) Tactical Emergency Medicine (TEM) section was administered. Results: Fifty respondents were included in the final study. Fifty-four percent reported TXA availability, with 14% reporting its use at least once in the past year. Additional available resuscitative products included crystalloids (88%) and packed red blood cells (6%). Twenty-five respondents reported managing ≥ 1 patient(s) with hemorrhagic shock in the past year. Resuscitative measures included crystalloids (96%), TXA (68%), and blood products (16%). Overall, 88% of respondents were supportive of TXA use. Full-time teams, those with ≥ 3 monthly callouts, and teams that carried blood products were more likely to have TXA. Conclusions: Half of respondents reported managing a patient with hemorrhagic shock in the past year. Although 88% were supportive of TXA use, only 54% reported availability. Tactical teams with higher call volume and more resources were more likely to carry TXA. Further studies evaluating TEMS patient wounding patterns and barriers to TXA utilization are required.

$37.00
A Case Study of Long-Range Rotary Wing Critical Care Transport in the Battlefield Environment

Eastman J, Dumont J, Green K 21(2). 77 - 79 (Journal Article)

Military medical evacuation continues to grow both in distance and transport times. With the need for long-range transport of greater than 2 hours, crews are having to manage critical care patients for longer trips. This case study evaluates one specific event in which long-range transport of a sick noncombat patient required an enroute critical care team. Medical electronics and other equipment require special attention. Oxygen bottles and batteries for medical devices become the limiting factor in transport from point to point. Having to juggle multiple data streams requires prioritization and reassessment of interventions. Using the mnemonic "bottles, bags, batteries, battlefield environment" keeps the transport paramedic and enroute care nurse on track to effectively deliver the patient to the next level of care. Consideration should be given to such mnemonics for long critical care transports.

$37.00
Case Report of Infectious Myositis in the Austere Setting

Sarkisian S, Sletten ZJ, Roberts P, Powell T 21(2). 80 - 84 (Journal Article)

Although skin and soft tissue infections are common in the deployed setting, infectious myositis is relatively uncommon. Bacterial infection of the muscle is the most common infectious etiology and can result in a spectrum of disease, to include abscess formation to necrotizing myositis, toxic shock syndrome, and death. Diagnosis can be elusive, particularly in the early stages. Recognition and proper management are crucial to prevent complications. The authors present a case report of infectious myositis diagnosed and managed in an austere deployed environment, as well as a discussion regarding current recommendations on diagnosis and treatment.

$37.00
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