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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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Customers living in Europe can purchase the ATP-P 10th Edition through Medical Sales Consultants and save a significant amount of money on shipping and processing.

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

Kunden, die in Europa leben, können die ATP-P 10th Edition über Medical Sales Consultants kaufen und eine erhebliche Menge Geld für Versand und Bearbeitung sparen.

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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

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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.

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Print: 978-1-7332239-6-6
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.

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Fall 2020 Journal (Vol 20 Ed 3)

Vol 20 Ed 3
Fall 2020 Journal of Special Operations Medicine
ISSN: 1553-9768

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Available for preorder. Estimated ship date is October 15th 2020

Pararescue Medical Operations (PJ MED) Handbook 7th Ed (978-0-9966297-8-2)
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.

We are currently out of stock and will not print any more until we receive the 2020 updates from the PJ Program Manager. The pandemic has caused a significant delay in the update and we now anticipate the 8th edition to be available early January 2021. We will announce republication and updates via Social Media and here once they are available. Thank you for your patience.

Airway Management in Prolonged Field Care

Dye C, Keenan S, Carius BM, Loos PE, Remley MA, Mendes B, Arnold JL, May I, Powell D, Tobin JM, Riesberg JC, Shackelford SA 20(3). 141 - 156 (Journal Article)

This Role 1, prolonged field care (PFC) clinical practice guideline (CPG) is intended to be used after Tactical Combat Casualty Care (TCCC) Guidelines, when evacuation to higher level of care is not immediately possible. A provider must first and foremost be an expert in TCCC, the Department of Defense standard of care for first responders. The intent of this PFC CPG is to provide evidence and experience-based solutions to those who manage airways in an austere environment. An emphasis is placed on utilizing the tools and adjuncts most familiar to a Role 1 provider. The PFC capability of airway is addressed to reflect the reality of managing an airway in a Role 1 resource-constrained environment. A separate Joint Trauma System CPG will address mechanical ventilation. This PFC CPG also introduces an acronym to assist providers and their teams in preparing for advanced procedures, to include airway management.

Far Forward Gaps in Hemorrhagic Shock and Prolonged Field Care: An Update of ALM Fluid Therapy for Field Use

Dobson GP, Letson HL 20(3). 128 - 134 (Journal Article)

Future expeditionary missions are expected to occur in more remote austere environments where combat medics and casualties may have to wait up to 7 days before resupply or safe evacuation. Currently, there is no effective fluid therapy for hemorrhagic shock (HS) at the point-of-injury and continuum-of-care over this extended period. We have been developing a small-volume IV or IO ALM therapy for noncompressible HS and have shown in preclinical models that it extends survival to 3 days, reduces abdominal bleeding by 60%, blunts inflammation, corrects coagulopathy, preserves platelet function, and prevents immunodeficiency. The ALM-survival phenotype is associated with an upregulation of the master genes of metabolism and mitochrondrial biogenesis in heart and brain and a downregulation in the periphery. Future translational studies will investigate the timing and nature of the "switch" and extend survival to 7 days. We will also discuss some of the controversies of ALM resuscitation in pigs, present our Systems Hypothesis of Trauma (SHOT), and discuss future clinical safety trials before field use.

Management of Critically Injured Burn Patients During an Open Ocean Parachute Rescue Mission

Staak BP, Petersen CD, Smith J, Hartman M, Rush SC 20(3). 135 - 140 (Journal Article)

Best practices and training for prolonged field care (PFC) are evolving. The New York Pararescue Team has used part task training, cadaver labs, clinical rotations, and a complicated sim lab to prepare for PFC missions including critical care. This report details an Atlantic Ocean nighttime parachute insertion to provide advanced burn care to two sailors with 50% and 60% body surface area burns. Medical mission planning included pack-out of ventilators, video laryngoscopes, medications, and 50 L of lactated Ringer's (LR). Over the course of 37 hours, the patients required high-volume resuscitation, analgesia, wound care, escharotomies, advanced airway and ventilator management, continuous sedation, telemedicine consultation, and complicated patient movement during evacuation. A debrief survey was obtained from the Operators highlighting recommendation for more clinical rotations and labs, missionspecific pack-outs, and tactical adjustments. This historic mission represents the most sophisticated PFC ever performed by PJs and serves to validate and share our approach to PFC.

Ketamine Use for Prolonged Field Care Reduces Supply Use

Hall AB, Morrow L, Dixon M 20(3). 120 - 121 (Journal Article)

This case describes the prolonged treatment of a 38-year-old man with a transpelvic gunshot wound requiring a diverting ostomy and cystostomy for damage control procedures with a comminuted acetabular and femoral head fracture. The team used a ketamine drip for prolonged field care over 48 hours. The benefit of using a ketamine drip included low supply requirement, excellent analgesia, and ease of administration, but side-effects included somnolence and atelectasis necessitating oxygen supplementation before evacuation.

A Case Series of Air Force Pararescue Long-Range Ocean Rescues

Mix JW, DeSoucy ES, Hilser A, Houser DJ, Mhayamaguru KM, Dorsch J, Gaither JB, Rush SC 20(3). 122 - 127 (Journal Article)

Background: US Air Force (USAF) pararescuemen (PJs) perform long-range ocean rescue missions for ill or injured civilians when advanced care and transport are not available. The purpose of this case series is to examine the details of these missions, review patient treatments and outcomes, and describe common tactics, techniques, and procedures for these missions. Methods: Cases in which the USAF PJs preformed long-range ocean rescue for critically ill or injured civilians between 2011 and 2018 were identified. Case information was obtained, including patient demographics, location, infiltration/exfiltration methods, diagnoses, treatments, duration of patient care, patient outcome, and lessons learned. Results: A total of 14 pararescue missions involving 22 civilians were identified for analysis. Of the 22 patients, 10 (45%) suffered burns, six (27%) had abdominal issues, four (18%) had musculoskeletal injuries, one had a traumatic brain injury, and one had a necrotizing soft-tissue infection. Medical care of these patients included intravenous fluid and blood product resuscitation, antibiotics, analgesics, airway management, and escharotomy. The median duration of patient care was 51 hours. Conclusion: This case series illustrates the complex transportation requirements, patient and gear logistical challenges, austere medicine, and prolonged field care (PFC) unique to USAF PJ open-water response.

Applications of the SOCOM Spiritual Fitness Scale: Program Development and Tailored Coaching for Optimized Performance

Alexander DW 20(3). 109 - 112 (Journal Article)

The SOCOM Spiritual Fitness Scale (SSFS) enables religious support teams and other spiritual fitness/performance (SF/SP) stakeholders in the Special Operations Forces community to reliably measure both "horizontal" and "vertical" dimensions of spirituality, as defined by the chairman of the Joint Chiefs of Staff Instruction on SF. The SSFS's three subscales relate to core attributes of SF/SP, which were identified through factor analysis during the iterations of the tool's development. The SSFS is capable of generating baseline assessments for research related to SF/SP. It is also capable of generating unique SF/SP profiles for individuals and groups, which can shape programs and inform tailored coaching for optimized performance.

Mouthguards for the Prevention of Orofacial Injuries in Military and Sports Activities: Part 2, Effectiveness of Mouthguard for Protection From Orofacial Injuries

Knapik JJ, Hoedebecke BL, Mitchener TA 20(3). 114 - 116 (Journal Article)

This is second of a two-part series on the history and effectiveness of mouthguards (MGs) for protection from orofacial injuries. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue which helps prevent lacerations and bruises. The single study on MG use in military training found that when boil-and-bite MGs were required for four training activities, orofacial injury rates were reduced 56% compared with when MGs were required for just one training activity. A recent systematic review on the effectiveness of MGs for prevention of orofacial injuries included 23 studies involving MG users and nonusers and a wide variety of sports. For cohort studies that directly collected injury data, the risk of an orofacial injury was 2.33 times higher among MG nonusers (95% confidence interval, 1.59-3.44). More well-designed studies are needed on the effectiveness of MGs during military training. Despite some methodological limitations, the current data suggest that MGs can substantially reduce the risk of orofacial injuries in sport activities. MGs should be used in activities where there is a significant risk of orofacial injuries.

Improving Concussion Education: Consensus From the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge

Kroshus E, Cameron KL, Coatsworth JD, D'Lauro C, Kim NJ, Lee KM, Register-Mihalik J, Milroy JJ, Roetert EP, Schmidt JD, Silvermann RD, Warmath D, Wayment HA, Hainline B 20(3). 88 - 95 (Journal Article)

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and MSA settings with a priori thresholds for retaining, discarding, and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and MSA cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes, and (5) organizational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioral health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Operational K9s in the COVID-19 World

Gray BO, St. George D, Cativo M, Tagore A, Ariyaprakai N, Palmer LE 20(3). 103 - 108 (Journal Article)

Severe acute respiratory syndrome coronavirus 2 (SARSCov- 2) is hypothesized to have originated from a spillover event from an animal reservoir. This has raised many questions, with an important one being whether the widely disseminated coronavirus disease 2019 (COVID-19) is transmissible to other animal species. SARS-CoV-2 is primarily transmitted person to person. K9-to-human transmission, although theoretically possible via fomites, is considered minimal, if at all, and there have been no reported cases of K9-to-human transmission. Human-to-K9 transmission, although rare, seems more likely; however, in only one case has a K9 been suspected to have displayed symptoms of COVID-19. Preparation, decontamination, hand hygiene, and distancing remain the key factors in reducing transmission of the virus. The information presented is applicable to personnel operating within the military conventional and Special Operation Forces as well as civilian Tactical Emergency Medical Services communities who may have the responsibility of supporting an operational K9.

Prehospital Combat Wound Medication Pack Administration in Iraq and Afghanistan: A Department of Defense Trauma Registry Analysis

Schauer SG, Naylor JF, Ahmed YM, Maddry JK, April MD 20(3). 76 - 80 (Journal Article)

Background: The United States (US) military utilizes combat wound medication packs (CWMP) to provide analgesia and wound prophylaxis in casualties who are still able to fight. We compared characteristics of combat casualties receiving CWMP to those not receiving CWMP. We also describe the proportions of casualties with injury patterns consistent with Tactical Combat Casualty Care (TCCC) guideline indications for CWMP use who received this intervention. Methods: This is a secondary analysis of Department of a Defense Trauma Registry (DODTR) dataset of US military personnel from January 2007 to August 2016. We searched for all subjects with documented use of at least one medication from the CWMP (acetaminophen, meloxicam, moxifloxacin). Results: Within our dataset, 11,665 casualties were US military Servicemembers. Overall, <1% (84) of our study population received the CWMP. The median age and mechanism of injuries were similar between CWMP nonrecipients versus recipients. Median composite injury scores were higher for nonrecipients than recipients (6 versus 4, P < .001). Proportions of casualties with injury patterns meeting TCCC guideline CWMP indications who received this intervention were low: gunshot wound, <1% (14 of 1805), tourniquet applied, <1% (11 of 1912), major amputation, <1% (5 of 803), and open fracture, <1% (10 of 2425). Based on serious injuries by body region, we had similar findings for the thorax (<1%; 3 of 1122), abdomen (<1%; 1 of 736), and extremities (<1%; 11 of 2699). Conclusions: Subjects receiving the CWMP were less severely injured compared to those who did not receive this intervention. The CWMP had very infrequent use among those casualties with injury patterns meeting indications specified in the TCCC Guidelines for use of this intervention.

Ketamine Administration by Special Operations Medical Personnel During Training Mishaps

Fisher AD, Schwartz DS, Petersen CD, Meyer SE, Thielemann JN, Redman TT, Rush SC 20(3). 81 - 86 (Journal Article)

Background: Opioids can have adverse effects on casualties in hemorrhagic shock. In 2014, the Committee on Tactical Combat Casualty Care (CoTCCC) recommended the use of ketamine at the point of injury (POI). Despite these recommendations the adherence is moderate at best. Poor use may stem from a lack of access to use ketamine during training. The United States Special Operations Command (USSOCOM) is often in a unique position, they maintain narcotics for use during all training events and operations. The goal of this work is to demonstrate that ketamine is safe and effective in both training and operational environments. Methods: This was a retrospective, observational performance improvement project within United States Special Operations Command and Air Combat Command that included the US Army's 75th Ranger Regiment, 160th Special Operations Aviation Regiment, and US Air Force Pararescue. Descriptive statistics were used to calculate the doses per administration to include the interquartile range (IQR), standard deviation (SD) and the range of likely doses using a 95% confidence interval (CI). A Wilcoxon signed-rank test was used to compare the mean pre-ketamine pain scores to the mean post-ketamine on a 0-to-10 pain scale. Results: From July 2010 to October 2017, there was a total of 34 patients; all were male. A total of 22 (64.7%) received intravenous ketamine and 12 (35.3%) received intramuscular ketamine and 8 (23.5%) received intranasal ketamine. The mean number of ketamine doses via all routes administered to patients was 1.88 (SD 1.094) and the mean total dose of all ketamine administration was 90.29mg (95% CI, 70.09-110.49). The mean initial dose of all ketamine administration was 47.35mg (95% CI, 38.52-56.18). The median preketamine pain scale for casualties was noted to be 8.0 (IQR 3) and the median post-ketamine pain scale was 0.0 (IQR 3). Conclusion: Ketamine appears to be safe and effective for use during military training accidents. Military units should consider allowing their medics to carry and use as needed.

Tactical Combat Casualty Care in Operation Freedom's Sentinel

Shukal A, Perez C, Hoemann B, Keasal M 20(3). 67 - 70 (Journal Article)

Over the course of nearly 19 years of conflict, Tactical Combat Casualty Care (TCCC) guidelines and their implementation have evolved to incorporate the latest advances in trauma research, casualty care, and transport, playing a large role in generating the lowest incidence of preventable deaths in the history of modern warfare. During the conflicts in Afghanistan and Iraq, the adoption and implementation of TCCC principles by conventional forces have been extrapolated to have been responsible for saving the lives of more than 1,000 US Servicemembers. As the intensity and nature of the military conflicts in Afghanistan and Iraq change, and a growing potential for a near peer conflict rises, it remains important that the lessons of TCCC continue to be instilled in our formations in garrison, before deployment, and while in theater. This article reviews the use of TCCC principles by an assault helicopter battalion, in combination with a variety of other factors, in the successful management of a mass casualty event during Operation Freedom's Sentinel 2019 in Afghanistan.

US Army Combat Medic Performance With Portable Ultrasound to Detect Sonographic Findings of Pneumothorax in a Cadaveric Model

Meadows RM, Monti JD, Umar MA, Van Arnem KA, Chin EJ, Mitchell CA, Love S 20(3). 71 - 75 (Journal Article)

Background: Ultrasound, due to recent advances in portability and versatility, has become a valuable clinical adjunct in austere, resource-limited settings and is well demonstrated to be an accurate/efficient means to detect pneumothorax. The purpose of this study was to evaluate the impact of hands-on ultrasound training on ultrasound-naive US Army combat medics' ability to detect sonographic findings of pneumothorax with portable ultrasound in a cadaver model. Methods: Ultrasound-naive US Army combat medics assigned to conventional military units were recruited from a single US Army installation and randomized to receive either didactic training only, or "blended" (didactic and hands-on) training on ultrasound detection of pneumothorax. Blinded participants were asked to perform a thoracic ultrasound exam on ventilated human cadaver models. Primary outcome measured was sensitivity and specificity of detecting sonographic findings of pneumothorax between cohorts. Results: Forty-three participants examined a total of 258 hemithoraces. The didactic-only cohort (n = 24) detected sonographic findings of pneumothorax with a sensitivity of 68% and specificity of 57%. The blended cohort (n = 19) detected sonographic findings of pneumothorax with an overall sensitivity of 91% and specificity of 80%. Detection sensitivities were similar between B-mode versus M-mode use. Conclusion: US Army combat medics can use portable U/S to detect sonographic findings of pneumothorax in a human cadaver model with high sensitivity after a brief, blended (didactic and hands-on) training intervention.

OMNA Marine Tourniquet Self-Application

Hingtgen E, Wall PL, Buising CM 20(3). 52 - 61 (Journal Article)

Background: The OMNA Marine Tourniquet is a 5.1cm-wide, simple redirect buckle, hoop-and-loop secured, ratcheting tourniquet designed for storage and use in marine environments. This study evaluated self-application effectiveness and pressures. Methods: Triplicate secured, occlusion, and completion pressures were measured during 60 subjects pulling down or up thigh applications and nondominant, single-handed arm applications. Arm pressure measurements required circumferences ≥30cm. Results: Thirty-one subjects had arm circumferences ≥30cm. All 540 applications were effective; 376 of 453 applications had known secured pressures >150mmHg (89 of 93 arm). Thigh down versus up pulling directions were not different (secured, occlusion, and completion pressures and ladder tooth advances). Occlusion pressures were 348mmHg (275-521mmHg) for combined thighs and 285mmHg (211-372mmHg) for arms. Completion pressures were 414mmHg (320-588mmHg) for combined thighs and 344mmHg (261-404mmHg) for arms. Correlations between secured pressures and occlusion ladder tooth advances (clicks) were r2 = 0.44 for combined thighs and 0.68 for arms. Correlations between occlusion pressures and occlusion clicks were poor (r2 = 0.24, P < .0001 for combined thighs and r2 = 0.027, P = .38 for arms). Conclusions: The OMNA Marine Tourniquet can be self-applied effectively, including one-handed applications. Occlusion and completion pressures are similar to reported 3.8cm-wide Ratcheting Medical Tourniquet pressures.

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