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Could He Stay or Should He Go Now?

Hampton K, Van Humbeeck L 19(4). 118 (Journal Article)

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Applying Swiss Armed Forces Training Didactics and Methodology for Tactical Combat Casualty Care Training

Anonymous A 19(4). 114 - 117 (Journal Article)

Some of the current methods of instruction used within international armed forces courses are not always goal oriented and satisfactory for both the teaching staff and the student. The Swiss Armed Forces approach presented here has been historically effective in preparing and sustaining national conscription with large numbers of recruits and new cadres every year.

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United States Military Parachute Injuries: Part 2: Interventions Reducing Military Parachute Injuries in Training and Operations

Knapik JJ 19(4). 109 - 113 (Journal Article)

This is part 2 of an article detailing the reduction in airbornerelated injuries over time. Part 1 examined the early history of airborne operations and provided evidence for the reduction in injuries over time; part 2 discusses interventions associated with the decline in injury rates. In 1943 at the United States (US) Army Airborne School, data showed that injuries were substantially reduced from 120 to 18 injuries/1000 trainees. Credit for the reduction was given to development of the parachute landing fall (PLF), better supervision of students while in initial airborne training, intensive ground training prior to actual jumping, and elimination of dangerous and unnecessary training procedures (like practice jumps from 11-foot heights). Compared to the older T-10 parachute introduced in the 1950s, the newer T-11 parachute introduced in 2010 reduced injuries by 43% in operational training (9.1 vs 5.2 injuries/1000 jumps). In aircraft with jump doors on both sides, alternating jumps between the doors so that the jumpers exit at slightly different times reduced high-altitude and mid-altitude entanglement injuries by 85% (0.13 to 0.02 injury/ 1000 jumps). Data from six scientific studies involving more than 1,300,000 jumps and two systematic reviews indicated that the parachute ankle brace (PAB) reduced ankle injuries and ankle fractures by about half with an estimated return on investment of at least $7 in medical and personnel costs for every $1 spent on the PAB. However, the PAB is not currently used or even well-known within the airborne community because of a lack of acceptance and promotion. While some airborne injury-reducing innovations are discussed here it is likely that there have been others that have not been documented. It is important to detail these interventions so future paratroopers and leaders can better understanding their rationale and effectiveness.

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Severe Lower Body Swelling and Bacteremia Secondary to Shewanella algae Bacteremia During Basic Underwater Demolition SEAL Training

Bridwell RE, Carius BM, Oliver JJ 19(4). 19 - 21 (Case Reports)

Shewanella algae is a unique bacterium largely documented in skin and soft tissue infections (SSTIs) with a wide range of presentations from gas-producing necrotizing fasciitis to osteomyelitis. Seawater exposure to lower extremity ulcers and wounds is most often correlated with infection, which has been documented in causing complications of bacteremia, sepsis, and infective endocarditis. Further complicating treatment is poor response to most empiric regimens prior to definitive diagnosis and an uneven response to antibiotics, including documented resistance to carbapenem. This case documents the presentation of a Basic Underwater Demolition SEAL (BUD/S) training candidate who presented acutely for complaints of severe lower body swelling and abrasions during "Hell Week" and was found to have polymicrobial bacteremia with Staphylococcus aureus, Enterococcus, and S algae.

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Medical Screening of a Repatriated Afghan National Army Special Operations Command Prisoner of War

Florance JM, Hicks M 19(4). 16 - 18 (Case Reports)

The Combined Joint Special Operations Task Force-Afghanistan (CJSOTF-A) Surgeon partnered with the Afghan National Army Special Operations Command (ANASOC) Surgeon to complete medical screening of a repatriated ANASOC soldier following a 2019 combined raid on a Taliban prison that freed 35 prisoners of war (POWs). This article discusses the presentation and management of the ANASOC POW while also providing a literature review of common pathologies within the POW population. The purpose of this document is to address a unique aspect of military medicine in the expectation that future military providers are prepared to receive repatriated soldiers and prepared to care for fellow prisoners should they themselves become captured.

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Fall 2016 Journal (Vol 16 Ed 3)

Vol 16 Ed 3
Fall 2016 Journal of Special Operations Medicine
ISSN: 1553-9768

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$36.75
Summer 2016 Journal (Vol 16 Ed 2)

Vol 16 Ed 2
Summer 2016 Journal of Special Operations Medicine
ISSN: 1553-9768

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$36.75
Winter 2015 Journal (Vol 15 Ed 4)
Vol 15 Ed 4
Winter 2015 Journal of Special Operations Medicine
ISSN: 1553-9768
$30.00
Summer 2019 Journal (Vol 19 Ed 2)

Vol 19 Ed 2
Summer 2019 Journal of Special Operations Medicine
ISSN: 1553-9768

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$38.00
Spring 2019 Journal (Vol 19 Ed 1)

Vol 19 Ed 1
Spring 2019 Journal of Special Operations Medicine
ISSN: 1553-9768

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$38.00
Fall 2019 Journal (Vol 19 Ed 3)

Vol 19 Ed 3
Fall 2019 Journal of Special Operations Medicine
ISSN: 1553-9768

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$38.00
Winter 2011 Journal (Vol 11 Ed 4)

Vol 11 Ed 4
Winter 2011 Journal of Special Operations Medicine
ISSN: 1553-9768

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Winter 2018 Journal (Vol 18 Ed 4)

Vol 18 Ed 4
Winter 2018 Journal of Special Operations Medicine
ISSN: 1553-9768

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Proficiency in Improvised Tourniquets for Extremities: A Review

Rohrich C, Plackett TP, Scholz BM, Hetzler MR 19(3). 123 - 127 (Journal Article)

Tourniquets have become ubiquitous tools for controlling hemorrhage in the modern prehospital environment, and while commercial products are preferable, improvised tourniquets play an important role when commercial options are not available. A properly constructed improvised tourniquet can be highly effective provided the user adheres to certain principles. This review article identifies key skills in the construction and application of improvised tourniquets on an extremity. An improvised tourniquet design for an extremity should include three components: a strap, a rod, and a securing mechanism. The strap can be made from a variety of materials, but cravat- like fabric has been shown to work well. Optimal strap dimensions should be at least 2cm in width and a continuous segment long enough to extend around the extremity while still offering ends to accommodate and secure the rod. The rod should be constructed from a material that is hard, strong, and capable of withstanding the torque placed on it without bending or breaking. After torque is applied, the rod must be secured into position to maintain the constricting force and survive patient transport. Finally, the need for an improvised tourniquet is a contingency that all first responders should anticipate. Hands-on training should be conducted routinely in conjunction with other first responder tasks.

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ReSTRAiN Yourself Before Diagnosing Strain

Hampton K, Van Humbeeck L 19(3). 122 (Journal Article)

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A SORT Plus a GHOST Equals: Experience of Two Forward Medical Teams Supporting Special Operations in Afghanistan 2019

Nam JJ, Milia DJ, Diamond SR, Gourlay DM 19(3). 117 - 121 (Journal Article)

Theater Special Operations Force (SOF) medical planners have been using Army forward surgical teams (FSTs) to maintain a golden hour for US SOF during Operation Freedom's Sentinel in the form of Golden Hour Offset Surgical Treatment Teams (GHOST-Ts) in Afghanistan. Recently, the Special Operations Resuscitation Team (SORT) was designed to decompress and augment a GHOST-T to help extend a golden hour ring in key strategic locations. This article describes both teams working together in Operation Freedom's Sentinel while deployed in support of SOF in central Afghanistan during the summer fighting season.

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United States Military Parachute Injuries. Part 1: Early Airborne History and Secular Trends in Injury Incidence

Knapik JJ 19(3). 110 - 115 (Journal Article)

This article traces the early history of military airborne operations and examines studies that have provided overall incidences of parachute-related injuries over time. The first US combat parachute assault was proposed during World War I, but the war ended before the operation could be conducted. Experimental jumps were conducted near San Antonio, Texas, in 1928 and 1929, but it was not until 1939, spurred by the developments in Germany, that the US Army Chief of Infantry proposed the development of an "air infantry." An Airborne Test Platoon was instituted with 48 men at Fort Benning, Georgia, and mass training of paratroopers began in 1940. The US entered World War II in December 1941 with the attack on Pearl Harbor and declaration of war by Germany. In January 1942, US War Department directed that four parachute regiments be formed. The 509th Parachute Infantry Battalion made the first US Army combat jumps into Morocco and Algeria in November 1942. At the US Army Airborne School in the 1940-1941 period, the parachute-related injury incidence was 27 injuries/1000 jumps; by 1993 it was 10 injuries/1000 jumps and in 2005-2006, 6 injuries/1000 jumps. Analysis of time-loss injuries in operational units showed a decline in injuries from 6 injuries/1000 jumps to 3 injuries/1000 jumps to 1 injury/1000 jumps in the periods 1946-1949, 1956-1962, and 1962-1963, respectively. When all injuries (not just time-loss) experienced in operational units are considered, the overall injury incidence was about 8 injuries/1000 jumps in the 1993- 2013 period. In jump operations involving a larger number of risk factors (e.g., high winds, combat loads, rough drop zones) injury incidences was considerably higher. The few studies that have reported on parachute-related injuries in combat operations suggest injury incidence ranged from 19 to 401 injuries/ 1000 jumps, likely because of the number of known injury risk factors present during these jumps. Despite the limitations of this analysis stemming from different injury definitions and variable risk factors, the data strongly suggest that military parachute injuries have sharply declined over time. Part 2 of this series will discuss techniques and equipment that have likely improved the safety of parachute operations.

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Scabies

Crecelius EM, Burnett MW 19(3). 107 - 108 (Journal Article)

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Human Performance Optimization: An Operational and Operator-Centric Approach

Lunasco T, Chamberlin RA, Deuster PA 19(3). 101 - 106 (Journal Article)

USSOCOM invests millions of dollars in the assessment, selection, and training of its Operators. Handpicked and forged to defend their nation, each Operator emerges from initial and career field training with unique skills and honed talents integral to their unit's effectiveness, sustainability, and mission success. The need for SOF unit commanders to optimize and preserve the talents of their Operators was highlighted as a top priority in the 2018 National Defense Strategy. Human performance optimization (HPO) offers a paradigm shift to support that priority by grounding health and performance services in the unique needs, cultures, skills, and missions of SOF Operators at the career field and unit level. Currently, HPO efforts continue to inform Military Health System (MHS) realignment efforts towards this paradigm shift; however, significant gaps still exist due to a lack of definitional clarity around HPO as a conceptual framework and to the unequal operationalization of HPO across the Department of Defense (DoD). To synergize health and performance efforts through HPO and provide SOF unit commanders with the tools they need to sustain the optimal performance of their operational forces over a career lifespan, this review builds upon previous work in HPO and highlights the operationalization of HPO on a tactical level to support units' Mission Essential Task List (METL) and Operator's Core Tasks (CT). Through returning to HPO's tenets, this review discusses how performance and health priorities of an Operational community can be identified in order to enhance the targeting of performance and health efforts. Last, we present a community-based model for mapping these priorities.

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