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Derivation of a Procedural Performance Checklist for Bifemoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Placement in Operational Environments

Powell E, Betzold R, Kundi R, Anderson D, Haase D, Keville M, Galvagno S 99(5). 0 (Journal Article)

Background: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a low-frequency, high-intensity procedure used for severe lung illness or injury to facilitate rapid correction of hypoxemia and respiratory acidosis. This technology is more portable and extracorporeal support is more frequently performed outside of the hospital. Future conflicts may require prolonged causality care and more specialized critical care capabilities including VV ECMO to improve patient outcomes. We used an expert consensus survey based on a developed bifemoral VV ECMO cannulation checklist with an operational focus to establish a standard for training, validation testing, and sustainment. Methods: A 36-item procedural checklist was provided to 14 experts from multiple specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed, resulting in a final 32-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for bifemoral VV ECMO using the modified Delphi method. This is an objective tool to assist procedural training and validation for medical providers performing VV ECMO in austere environments.

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Life Over Limb: Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine

Patterson J, Bryan RT, Turconi M, Leiner A, Plackett TP, Rhodes LL, Sciulli L, Donnelly S, Reynolds CW, Leanza J, Fisher AD, Kushnir T, Artemenko V, Ward KR, Holcomb JB, Schmitzberger FF 99(5). 0 (Journal Article)

The use of tourniquets for life-threatening limb hemorrhage is standard of care in military and civilian medicine. The United States (U.S.) Department of Defense (DoD) Committee on Tactical Combat Casualty Care (CoTCCC) guidelines, as part of the Joint Trauma System, support the application of tourniquets within a structured system reliant on highly trained medics and expeditious evacuation. Current practices by entities such as the DoD and North Atlantic Treaty Organization (NATO) are supported by evidence collected in counter-insurgency operations and other conflicts in which transport times to care rarely went beyond one hour, and casualty rates and tactical situations rarely exceeded capabilities. Tourniquets cause complications when misused or utilized for prolonged durations, and in near-peer or peer-peer conflicts, contested airspace and the impact of high-attrition warfare may increase time to definitive care and limit training resources. We present a series of cases from the war in Ukraine that suggest tourniquet practices are contributing to complications such as limb amputation, overall morbidity and mortality, and increased burden on the medical system. We discuss factors that contribute to this phenomenon and propose interventions for use in current and future similar contexts, with the ultimate goal of reducing morbidity and mortality.

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Occlusion Pressures of Tactical Pneumatic Tourniquet 2"

Wall P, Buising CM, Eernisse D, Rentschler T, Winters C, Renner CH 99(5). 0 (Journal Article)

Background: The Tactical Pneumatic Tournqiuet 2" (TPT2, 5.1cm-wide deflated) allows total average applied pressure measurement, which should be useful toward development of emergency-use limb tourniquet certification devices. Methods: The TPT2 hand bulb was replaced with stopcocks and syringes, allowing filling with continuous pressure measurement. Forearm and mid-thigh applications involved two sets of five Doppler-based pulse gone/return pairs. Second set pulse gones were chosen a priori for occlusion pressures (preliminary work indicated greater consistency in second sets). Results: All 68 forearms occluded (30 female, 38 male, median circumference 17.8cm, range 14.6-23.5cm; median second set of pulse gone tourniquet pressures 176mmHg, range 128-282mmHg). Fifty-five thighs occluded (median circumference 54.3cm, range 41.6-62.4cm; median systolic pressure 126mmHg, range 102-142mmHg; median second set of pulse gone pressures 574mmHg, range 274-1158mmHg). Thirteen thigh applications were stopped without occlusion because of concerning pressures combined with no indication of imminent occlusion and difficulties forcing more air into the TPT2 (3 female, 10 male, peak pressures from 958-1377mmHg, median 1220mmHg, p<.0001 versus occluded thighs; median circumference 63.3cm, range 55.0-72.9cm, p<.0001 versus occluded thighs; median systolic pressure 126mmHg, range 120-173mmHg, p<.019 versus occluded thighs). Thigh TPT2 impression widths on five subjects after occlusion were as follows: 3.5cm, occlusion 274mmHg; 2.8cm, occlusion 348mmHg; 2.9cm, occlusion 500mmHg; 2.8cm, occlusion 782mmHg; 2.7cm, occlusion 1114mmHg. Conclusions: Though probably useful to tourniquet certification, the required pressures for thigh occlusion make the TPT2 undesirable for any clinical use, emergency or otherwise.

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Social Determinant of Unconventional Resilience Tactical Engagement with Bonding Patterns

Jeschke EA, Wyma-Bradley J, Baker JB, Dorsch J, Huffman SL 99(5). 0 (Journal Article)

Building upon our strategic framework and operational model, we will discuss findings from our ethnographic study, entitled: "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams (SOSTs)," to explain the tactical nature and importance of social determinants within our new characterization of unconventional resilience. Our fourth paper in this series, will explain how bonding patterns establish the quality of intra- and interpersonal connections that create a tensive conduit for the pressure of performance within our operational model, allowing for dynamic freedom of maneuver to take place in ambiguity. We will use qualita- tive quotes to illustrate various ways SOST medics relate to themselves, other people, and the Special Operations Forces (SOF) culture. To achieve our goals, we will: 1) provide an in- troduction to social determinants as tactical engagement with unconventional resilience; 2) define the social determinant of bonding patterns as extrapolated from qualitative data as well as use qualitative data to thematize various types of bonding patterns; and 3) relate tactical engagement with bonding pat- terns to our metaphor of bag sets. We conclude by gesturing to the importance of bonding patterns in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.

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Winter 2022 Journal (Vol 22 Ed 4) ( Copy ) ( Copy ) ( Copy ) ( Copy )

Vol 22 Ed 4
Winter 2022 Journal of Special Operations Medicine
ISSN: 1553-9768

View the Table of Contents

Available for preorder. Estimated ship date is December 31st 2022

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Effects of Tourniquet Features on Application Processes Times

Wall P, Buising CM, White A, Jensen J, Davis J, Renner CH 99(5). 0 (Journal Article)

Background: We investigated emergency-use limb tourniquet design features effects on application processes (companion paper) and times to complete those processes (this paper). Methods: Sixty-four appliers watched training videos then each applied all eight tourniquets: Combat Application Tour- niquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T-Tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop Tourniquet (RST). Application processes times were captured from videos. Results: From "Go" to "touch tightening system" was fastest with clips and self-securing redirect buckles and without strap/redirect application process problems (n, median seconds: CAT7 n=23, 26.89; SOFTTW3 n=11, 20.95; SOFTTW5 n=16, 20.53; TMT n=5, 26.61; OMT n=12, 25.94; X8T n=3, 18.44; Tac RMT n=15, 30.59; RST n=7, 22.80). From "touch tightening system" to "last occlusion" was fastest with windlass rod systems when there were no tightening system understanding or mechanical problems (seconds: CAT7 n=48, 4.21; SOFTTW3 n=47, 5.99; SOFTTW5 n=44, 4.65; TMT n=38, 6.21; OMT n=51, 6.22; X8T n=48, 7.59; Tac RMT n=52, 8.44; RST n=40, 8.02). For occluded, tightening system secure applications, from "touch tightening system" to "Done" was fastest with self-securing tightening systems tightening from a tight strap (occluded, secure time in seconds from a tight strap: CAT7 n=17, 14.47; SOFTTW3 n=22, 10.91; SOFTTW5 n=38, 9.19; TMT n=14, 11.42; OMT n=44, 7.01; X8T n=12 9.82; Tac RMT n=20, 6.45; RST n=23, 8.64). Conclusions: Suboptimal processes in- crease application times. Optimal design features for fast, occlusive, secure tourniquet applications are self-securing strap/ redirect systems with an easily identified and easily used clip and self-securing tightening systems.

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3D-Printed Tourniquets Used at the Battlefront in Ukraine: A Pilot Study

Melau J, Bergan-Skar P, Callender N, Rognhaug M, Bekkestad E 99(5). 0 (Journal Article)

Background: The war in Ukraine urged a need for prompt deliv- erance and resupply of tourniquets to the front. Producing tour- niquets near the battlefront was a feasible option with respect to resupply and cost. Methods: A locally produced 3D-printed tourniquet (Ukrainian model) from the "Tech Against Tanks" charity was tested against commercially available and Committee of Tactical Combat Casualty Care (CoTCCC)- recommended tourniquets (C-A-T™ and SOF™TT-W). We tested how well the tourniquets could hold pressure for up to 2 hours. Results: A Kruskal-Wallis test revealed significant differences between the groups (p<.05). Post-hoc testing revealed a signif- icant difference between the C-A-T and the Ukrainian tourni- quet (p=.004). A similar significance was not found between the SOF™TT-W Wide and the Ukrainian model (p=.08). Dis- cussion: The Ukrainian model can hold pressure as well as the commercially available tourniquets. There is much value if this can be produced close to the battlefield. Factors including lo- gistics, cost, and self-sufficiency are important during wartime. Conclusion: We found that our sample of 3D-printed tourni- quets, currently used in the war in Ukraine, could maintain pressure as well as the commercially available tourniquets. In- deed, our tests demonstrated that it could maintain a signifi- cantly higher pressure.

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Effects of Tourniquet Features on Application Process Times

Wall P, Buising CM, White A, Jensen J, Davis J, Renner CH 99(5). 0 (Journal Article)

Background: We investigated emergency-use limb tourniquet design features effects on application processes (companion paper) and times to complete those processes (this paper). Methods: Sixty-four appliers watched training videos then each applied all eight tourniquets: Combat Application Tour- niquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T-Tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop Tourniquet (RST). Application processes times were captured from videos. Results: From "Go" to "touch tightening system" was fastest with clips and self-securing redirect buckles and without strap/redirect application process problems (n, median seconds: CAT7 n=23, 26.89; SOFTTW3 n=11, 20.95; SOFTTW5 n=16, 20.53; TMT n=5, 26.61; OMT n=12, 25.94; X8T n=3, 18.44; Tac RMT n=15, 30.59; RST n=7, 22.80). From "touch tightening system" to "last occlusion" was fastest with windlass rod systems when there were no tightening system understanding or mechanical problems (seconds: CAT7 n=48, 4.21; SOFTTW3 n=47, 5.99; SOFTTW5 n=44, 4.65; TMT n=38, 6.21; OMT n=51, 6.22; X8T n=48, 7.59; Tac RMT n=52, 8.44; RST n=40, 8.02). For occluded, tightening system secure applications, from "touch tightening system" to "Done" was fastest with self-securing tightening systems tightening from a tight strap (occluded, secure time in seconds from a tight strap: CAT7 n=17, 14.47; SOFTTW3 n=22, 10.91; SOFTTW5 n=38, 9.19; TMT n=14, 11.42; OMT n=44, 7.01; X8T n=12 9.82; Tac RMT n=20, 6.45; RST n=23, 8.64). Conclusions: Suboptimal processes in- crease application times. Optimal design features for fast, occlusive, secure tourniquet applications are self-securing strap/ redirect systems with an easily identified and easily used clip and self-securing tightening systems.

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Effects of Tourniquet Features on Application Processes

Wall P, Buising CM, Jensen J, White A, Davis J, Renner CH 99(5). 0 (Journal Article)

Background: We investigated emergency-use limb tourniquet design features effects on application processes (this paper) and times to complete those processes (companion paper). Methods: Sixty-four appliers watched training videos and then each applied all eight tourniquets: Combat Application Tourniquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop™ Tourniquet (RST). Application processes were scored from videos. Results: Thirty-three appliers had no prior tourniquet experience. All 512 applications were placed proximal to the recipient's simulated distal thigh injury. Thirty-one appliers (13 with no experience) had 66 problem-free applications (18 by no experience appliers). Tightening-system mechanical problems were more frequent with windlass rod systems (26 losing hold of the rod, 27 redoing rod turns, and 58 struggling to secure the rod) versus ratchet systems (3 tooth skips and 16 advance failures). Thirty-five appliers (21 with no experience) had 68 applications (45 by no experience appliers) with an audible Doppler pulse when stating "Done"; causes involved premature stopping (53), inadequate strap pull (1 SOFTTW3, 1 RST), strap/redirect understanding problem (1 SOFTTW5, 1 X8T, 4 Tac RMT, 1 RST), tightening-system understanding problem (2 CAT7, 1 SOFTTW3, 1 TMT, 1 RST), and physical inability to secure (1 SOFTTW3). Fifty-three appliers (32 no experience) had 109 applications (64 by no experience appliers) not correctly secured. Six involved strap/redirect understanding problems: 4 Tac RMT, 1 X8T, 1 SOFTTW5; 103 involved improper securing of non-self-securing design features: 47 CAT7 (8 strap, 45 rod), 31 TMT (17 strap, 19 rod), 22 OMT (strap), and 3 SOFTTW3 (rod). Conclusion: Self-securing systems have process advantages. Because most emergent tourniquet recipients require transport, we believe tourniquet security is a critical design aspect. Decisions regarding tourniquet choices may become very different when both occlusion and tourniquet security are considered.

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Social Determinant of Unconventional Resilience: Tactical Engagement with Impression Management

Jeschke EA, Wyma-Bradley J, Baker JB, Dorsch J, Huffman SL 99(5). 0 (Journal Article)

Building upon our operational model, we will discuss findings from our ethnographic study titled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams" to establish that impression management allows Special Operation Forces (SOF) medics to navigate implicit social status symbols to either degrade or optimize performance. We will use qualitative quotes to explore how Special Operations Surgical Team (SOST) medics engage in impression management to establish individual, team, and/or organizational competency to deal with ambiguity. To achieve our goals, we will: 1) provide a background on impression management and perception of competency; 2) define the social determinant of impression management extrapolated from qualitative data as well as use qualitative data to thematize various types of impression management; and 3) relate tactical engagement with impression to our metaphor of bag sets. We conclude by gesturing to the importance of impression management in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.

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Association of Physical Domain Participation with POTFF Domains in Special Forces Operators

Nelson T, Youngblade L, Goldberg P, Bricker D, Werth K, Riesberg JC, Surrett GW 99(5). 0 (Journal Article)

Background: The purpose of this study was to evaluate the effectiveness of the physical domain (PD) to improve performance in all the POTFF domains (physical, psychological, social/family, and spiritual) among Special Forces (SF) Operators. Methods: This was a cross-sectional study of active SF Operators assigned to the United States Army Special Operations Command (USASOC). Recruitment began in October 2016. Testing began on 1 January 2017, and concluded on 28 February 2020. Participants completed physical testing, blood draws, and questionnaires to determine domain metrics. Means, medians, and proportions were compared by level of participation in the PD. Results: A total of 231 Soldiers participated; n=63 in the control group, n=93 in the <4 days PD/week (PD <4) group, and n=66 in the >4 days PD/week (PD ≥4) group. The average age was 31 years (range 21-47 y). The average time in the Special Operations Forces (SOF) was 4 years (range 0-19 y). The PD ≥4 group showed significantly greater overall upper (p=.01) and lower (p=0) body strength, power (p=.01), and positive affect (p=.04). The PD ≥4 group also had significantly lower anxiety (p=.03), stress (p=.04), and depression (p=.02) than the control group. Conclusion: The PD and psychological domain metrics were most associated with PD participation. This finding is consistent with the goals of the PD, which are to increase physical and mental capabilities and decrease injury recovery time.

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Effectiveness of Sternal Intraosseous Device in Patients Presenting with Circulatory Shock: A Retrospective Observational Study

Hynes A, Murali S, Bass GA, Kheirbek T, Qasim Z, George N, Yelon JA, Chreiman KC, Martin ND, Cannon JW 99(5). 0 (Journal Article)

Background: Hemorrhagic shock requires timely administration of blood products and resuscitative adjuncts through multiple access sites. Intraosseous (IO) devices offer an alternative to intravenous (IV) access as recommended by the massive hemorrhage, A-airway, R-respiratory, C-circulation, and H-hypothermia (MARCH) algorithm of Tactical Combat Casualty Care (TCCC). However, venous injuries proximal to the site of IO access may complicate resuscitative attempts. Sternal IO access represents an alternative pioneered by military personnel. However, its effectiveness in patients with shock is supported by limited evidence. We conducted a pilot study of two sternal-IO devices to investigate the efficacy of sternal-IO access in civilian trauma care. Methods: A retrospective review (October 2020 to June 2021) involving injured patients receiving either a TALON® or a FAST1® sternal-IO device was performed at a large urban quaternary academic medical center. Baseline demographics, injury characteristics, vascular access sites, blood products and medications administered, and outcomes were analyzed. The primary outcome was a successful sternal-IO attempt. Results: Nine males with gunshot wounds transported to the hospital by police were included in this study. Eight patients were pulseless on arrival, and one became pulseless shortly thereafter. Seven (78%) sternal-IO placements were successful, including six TALON devices and one of the three FAST1 devices, as FAST1 placement required attention to Operator positioning following resuscitative thoracotomy. Three patients achieved return of spontaneous circulation, two proceeded to the operating room, but none survived to discharge. Conclusions: Sternal-IO access was successful in nearly 80% of attempts. The indications for sternal-IO placement among civilians require further evaluation compared with IV and extremity IO access.

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Bluetooth Tactical Headsets Improve The Speed of Accurate Patient Handoffs

Stinner D, McEvoy C, Broussard MA, Nikolaus AD, Parker CH, Santana H, Karnopp JM, Patel JA 99(5). 0 (Journal Article)

Background: The Committee on En Route Combat Casualty Care recently ranked the patient handoff as their fourth research priority. Bluetooth technology has been introduced to the battlefield and has the potential to improve the tactical patient handoff. The purpose of this study is to compare the traditional methods of communication used in tactical medical evacuation by Special Operations medical personnel (radio push-to-talk [PTT] and Tactical Medic Intercom System [TM-ICS]) to Bluetooth communication. Methods: Twenty-four simulated tactical patient handoffs were performed to compare Bluetooth and traditional methods of communication used in tactical medical evacuation. Patient scenario order and method of communication were randomized. Accuracy and time required to complete the patient handoff were determined. The study took place using a rotary-wing aircraft kept at level 2 to simulate real-world background noise. Preferred method of communication for each study participant was determined. Results: There were no differences in accuracy of the received patient handoffs between groups or patient handoff transmission times at the ramp of the aircraft. However, when comparing patient handoff times to the medical team within the aircraft, Bluetooth communication was significantly faster than both TM-ICS and radio PTT, while Bluetooth PTT and radio PTT were also significantly faster than TM-ICS. Bluetooth communication was ranked as the preferred method of handoff by all study participants. Conclusion: The study demonstrated that utilization of Bluetooth technology for patient handover results in faster handoffs compared with traditional methods without sacrificing any accuracy in a scenario with high levels of noise.

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Time for the Department of Defense to Field Video Laryngoscopy Across the Battlespace

Schauer S, Long B, Fisher AD, Stednick PJ, Bebarta VS, Ginde AA, April MD 99(5). 0 (Editorial)

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Unconventional Resilience: An Operational Model

Jeschke EA, Baker JB, Wyma-Bradley J, Dorsch J, Huffman SL 99(5). 0 (Journal Article)

This is the third of nine planned papers drawn from the findings of our ethnographic study entitled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams." Building from our strategic framework, this paper will establish that resilience is better understood as cohesive adaptation within a Special Operation Forces (SOF) cultural ecosystem. Exploring unconventional resilience as the inter-relationship across the organization, team, and individual, we will use qualitative quotes to describe the ecosystem of dynamic freedom of maneuver in ambiguity. To achieve our goals, we will: 1) compare conventional and unconventional resilience to operationalize the components of our strategic framework; 2) use qualitative quotes to show how the ecosystem of unconventional resilience functions at each level supporting our operational model; and 3) describe how the operational model of unconventional resilience links to tactical performance through five social determinants. We conclude by gesturing to how transformational change-agency applies to practical performance of all SOF medics.

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A Brief Primer on the Concept of the Neuroweapon for U.S. Military Medical Personnel

Washington M, Dinh DT, Ibarra C, Kua SC 99(5). 0 (Journal Article)

The malevolent application of neuroscience is an emerging threat to the U.S. military. At present, U.S. military medical personnel are not capable of adequately diagnosing or treating the injuries and illnesses that may result from exposure to potential neuroweapons. This fact was illustrated in 2016 when U.S. diplomats serving in Havana, Cuba reported hearing strange noises accompanied by a constellation of unexplained health effects. Similar incidents have been reported in China and Russia. Although various hypotheses have been put forward to explain these symptoms, none of them have been verified. The reported symptoms were analogous to the physiological responses that have been produced in the laboratory by exposing volunteers to pulsed microwave energy. However, these incidents of undetermined origin demonstrate that widespread neurological illness can be disruptive to U.S. government operations and that it is currently not possible to identify the cause, determine the correct treatment, or ascribe attribution to potential neuroweapon use in an overseas setting. Since it is likely that Special Operations medical personnel will be among the first to respond to neuroweapon attacks in the deployed environment, it is essential that they be made aware of this emerging threat and that efforts be made to incorporate potential directed energy neuroweapons and other neuroweapon configurations into future Chemical, Biological, Radiological, Nuclear, and high yield Explosives (CBRN-E) training modules. The intention of this article is to introduce the concept of the neuroweapon to military medical personnel and to provide a brief review of the relevant literature.

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Effects of Airway Localization Device Use During Surgical Cricothyrotomy on Procedural Times and Confidence Levels of Pre-Hospital Personnel

Schlocker C, Grosser S, Spaulding C, Beltrech B, Brady R 99(5). 0 (Journal Article)

This study evaluated the effect of an airway localization device (ALD) on surgical cricothyrotomy (SC) success rates and prehospital provider confidence. SC is indicated in 0.62% to 1.8% of all patients with military trauma, especially those presenting with traumatic airway obstruction. The effect of ALD was evaluated in an airway mannequin model during SC with the Committee on Tactical Combat Casualty Care (CoTCCC)-recommended Control-Cric Cricothyrotomy System. Outcomes included procedural time, Likert measures of operator confidence, and qualitative data/feedback for suggested future improvements in device design and training. The average procedural times of the hospital corpsmen (HM) including 20 men and 8 women were 67 seconds (without ALD) and 87 seconds (with ALD) respectively, which were statistically significant. Provider confidence for all SC procedural steps increased significantly after SC with and without ALD. The average procedural times of the Navy Special Operations Forces (SOF) group comprising 8 males were 56 seconds (without ALD) and 64 seconds (with ALD), which was not statistically significant. Provider confidence for two SC procedural steps (adequate hook retraction and first-attempt SC tube insertion) increased significantly after SC with and without ALD. First-attempt SC success rates were 90% in each group. Both groups provided feedback on the Control-Cric and ALD, with qualitative feedback analyzed for further SC training recommendations. Procedural times were increased with ALD when compared to those without ALD, although the increase may not be clinically significant in this classroom setting.

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Optimizing Brain Health of United States Special Operations Forces

Edlow BL, Gilmore N, Tromly SL, Deary KB, McKinney IR, Hu CG, Kelemen JN, Maffei C, Tseng CJ, Llorden GR, Healy BC, Masood M, Cali RJ, Baxter T, Yao EF, Belanger HG, Benjamini D, Basser PJ, Priemer DS, Kimberly WT, Polimeni JR, Rosen BR, Fischl B, Zurcher NR, Greve DN, Hooker JM, Huang SY, Caruso A, Smith GA, Szymanski TG, Perl DP, Dams-O'Connor K, Mac Donald CL, Bodien YG 99(5). 0 (Journal Article)

United States Special Operations Forces (SOF) personnel are frequently exposed to explosive blasts in training and combat. However, the effects of repeated blast exposure on the human brain are incompletely understood. Moreover, there is currently no diagnostic test to detect repeated blast brain injury (rBBI). In this "Human Performance Optimization" article, we discuss how the development and implementation of a reliable diagnostic test for rBBI has the potential to promote SOF brain health, combat readiness, and quality of life.

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The Impact of Progressive Simulation-Based Training on Tourniquet Application

Cole R, Steffens K, Flash Z, Conley S, Givens ML 99(5). 0 (Journal Article)

The Advanced Combat Medical Experience (ACME) is a progressive simulation-based training held for second-year medical students at the Uniformed Services University (USU). This study explored the impact of participating in ACME on students' tourniquet application skills. A panel of emergency medicine physician experts developed an assessment to evaluate the participants' performance. Trained raters then scored students' tourniquet application performance before and after participating in ACME. We conducted a Wilcoxon signed-rank test to detect any significant difference in the participants' pretest and posttest ratings as well as time it took them to apply the tourniquet. Our results indicated a significant difference in the pre- and posttest ratings of students as well as the time it took them to apply the tourniquet. This study confirms the effectiveness of progressive simulation-based education for teaching TCCC skills to military medical trainees.

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Winter 2022 Journal (Vol 22 Ed 4) ( Copy ) ( Copy ) ( Copy )

Vol 22 Ed 4
Winter 2022 Journal of Special Operations Medicine
ISSN: 1553-9768

View the Table of Contents

Available for preorder. Estimated ship date is December 31st 2022

$47,00
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