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Leveraging Combat Casualty Reporting in the Afghan National Army Special Operations Command for Evidence-Based Changes in the ANASOC School of Excellence

Florance JM, Hicks M 19(4). 59 - 61 (Journal Article)

The Afghan National Army Special Operations Command (ANASOC) uses several documents for casualty reporting. By analyzing these documents from a period of March to December 2018, the authors demonstrate the predominance of gunshot fatalities within ANASOC at approximately 63% of combat deaths and a high rate of prehospital death at approximately 97% of combat deaths. The data also demonstrate relatively few cases of long-term disability from ANASOC soldiers wounded in action. The authors used these conclusions to create a Combined Joint Special Operations Task Force-Afghanistan (CJSOTF-A) working group that recommended changes to the medical curriculum at the ANASOC School of Excellence. These recommendations centered on an increased emphasis on bleeding control to prevent death from hemorrhagic shock.

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Interoperable Readiness to Use Tourniquets by One's Familiarity With Different Models

Kragh JF, Aden JK, Dubick MA 19(4). 51 - 57 (Journal Article)

Background: We investigated interoperability for a first aid provider to perform simulated use of three tourniquet models of maximal, moderate, and minimal familiarity. Methods: The experiment was focused on the tourniquets used by an expert who rendered aid on a manikin by using three models of tourniquet with different extents of familiarity: The familiarity with Combat Application Tourniquet (C-A-T) was maximal; that for Special Operations Forces Tactical Tourniquet (SOFTT) was moderate, and that for Military Emergency Tourniquet (MET) was minimal. Each model had a band-and-rod design. Interoperability changes as intermodel differences were beneficial or costly in that performances were improved or impaired in units of time, ease, blood, and pressure. Each model had 10 tests, and test order was randomized by model. The HapMed Leg Tourniquet Trainer simulated a limb amputation. Results: In comparison of interoperability burdens, sums of 10 test durations by model for C-A-T, SOFTT, and MET were 38, 77, and 64 minutes, respectively; C-A-T was fastest (p ≤ .002, both). The sums of times to stop bleeding for C-A-T, SOFTT, and MET were 334, 953, and 826 seconds, respectively; C-A-T was fastest (p ≤ .0013, both). The sums of blood losses for C-A-T, SOFTT, and MET were 2105, 3287, and 4256mL, respectively; that for C-A-T was least (p ≤ .0005, both). The mean ease of use differed, with C-A-T being easiest (p ≤ .0046, both). The mean pressure differed, with C-A-T being higher than SOFTT (p = .0073). Conclusions: Timesaving strongly favored the model with which the user had maximal familiarity. In theory and simulation, interoperability bears costs in successfully attaining it, in maintaining it, and in failing either. The user's familiarity with tourniquet model was associated with improved interoperability as seen by improved performances. If multiple models are fielded, then organizations may plan on extra spending, supplying, training, and managing.

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2019 Recommended Limb Tourniquets in Tactical Combat Casualty Care

Montgomery HR, Hammesfahr R, Fisher AD, Cain JS, Greydanus DJ, Butler FK, Goolsby AM, Eastman AL 19(4). 27 - 50 (Journal Article)

Military and civilian trauma can be distinctly different but the leading cause of preventable trauma deaths in the prehospital environment, extremity hemorrhage, does not discriminate. The current paper is the most comprehensive review of limb tourniquets employable in the tactical combat casualty care environment and provides the first update to the CoTCCC-recommended limb tourniquets since 2005. This review also highlights the lack of unbiased data, official reporting mechanisms, and official studies with established criteria for evaluating tourniquets. Upon review of the data, the CoTCCC voted to update the recommendations in April 2019.

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A Case for Improvised Medical Training

Hetzler MR 19(4). 123 - 125 (Journal Article)

The hyperresourced, uber-controlled, ultrareactive, constant environment that we have come to know in the past 20 years should not be mistaken as the norm in conflict. In truth, unrealistic expectations of both commanders and systems in resourcing is presently being reinforced almost daily. Only in the past few years of this decade have the majority of allied forces experienced challenge in resupply and support in contingency operations. When logistical lines are cut, limited, or untimely, we must know and exercise other means of providing the highest level of medical care possible-if not with indigenous ways and means, then by improvisation. History has proved that improvised medicine can be capable, professional, and ethically sound if practiced properly and to standards, the price being time, education, and investment in the requirement. Most often, these are already time-honored means of care.

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"There I Was": A Cup of Improvisation

Hubbard B, Freeman C 19(4). 120 - 122 (Journal Article)

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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

$38.00
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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