Military medicine
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Observational Study
Ultrasound Detection of Soft Tissue Abscesses Performed by Non-Physician U.S. Army Medical Providers Naïve to Diagnostic Sonography.
Patients commonly present to emergency rooms and primary care clinics with cellulitic skin infections with or without abscess formation. In military operational units, non-physician medical personnel provide most primary and initial emergency medical care. The objective of this study was to determine if, after minimal training, Army physician assistants and medics could use portable ultrasound (US) machines to detect superficial soft tissue abscesses. ⋯ Non-physician military medical providers can be trained in a very brief period to use US to detect superficial soft tissue abscesses with excellent accuracy.
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The Combat Application Tourniquet (CAT) is the tourniquet of choice in the Israeli defense forces. Applying the device loosely before windlass twisting is a main pitfall in CAT application. This study objective is to assess the effectiveness of a novel design modification of the CAT, aiming to prevent loose applications, by minimizing the slack. ⋯ The modified CAT demonstrated an upgraded pressure profile and hemorrhage control rate, potentially indicating its improved efficacy.
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Historical Article
Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20.
Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. ⋯ Now-20 years later-TCCC has been documented to produce unprecedented decreases in preventable combat death in military units that have trained all of their members in TCCC. As a result of this proven success, TCCC has become the standard for battlefield trauma care in the U.S. military and for the militaries of many of our allied nations. Committee on TCCC members and the Joint Trauma System also work closely with civilian trauma colleagues through initiatives such as the Hartford Consensus, the White House Stop the Bleed campaign, and the development of National Association of Emergency Medical Technicians TCCC-based courses to ensure that advances in prehospital trauma care pioneered by the military on the battlefield are translated into civilian practice on the streets of America. Active shooter incidents, terrorist bombings, and the day-to-day trauma that results from motor vehicle accidents and criminal violence create the potential for many additional lives to be saved in the civilian sector. Along with the other components of the Department of Defense's Joint Trauma System, the Committee on TCCC, and the TCCC Working Group have been recognized as a national resource and will continue to advocate for advances in best-practice battlefield trauma care as opportunities to improve are identified.
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The Mortality Surveillance Division (MSD) of the U.S. Armed Forces Medical Examiner System was established in 1998 to improve surveillance for all military deaths although emphasizing deaths from infectious diseases. Establishment of the MSD was part of the 1997 Department of Defense initiative to improve surveillance and response for emerging infectious diseases. Before 1998, mortality surveillance was limited to compiling information from death certificates, a system that provided limited useful information and lacked the timeliness needed to take meaningful action to address emerging infectious disease threats. ⋯ The time lag between death and notification of the MSD at the start of this surveillance program was 24 to 48 hours. The lag at the end of the reported surveillance period was 8 to 24 hours. The MSD surveillance system identified an agent in 140 of 217 (64.5%) uniformed deaths. In a similar program by the Centers for Disease Control and Prevention, in 122 cases with specimens, an agent could be identified in 34 (28%). MMR data and information provided strong support for re-establishing the military recruit adenovirus vaccination program, which ceased in 1999 and was finally re-established in 2011. MMR data and information also assisted in monitoring the military meningococcal vaccine program, helped to describe the virulence of circulating influenza viruses, and identified areas where deadly malaria infections were not being prevented.
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Observational Study
Anesthesia and Postoperative Respiratory Compromise Following Major Lower Extremity Surgery: Implications for Combat Casualties.
Care of military casualties requires not only assessment of patient, injury, and setting, but also the consequences of care decisions on other organ systems. In contemporary conflicts, pelviperineal and lower extremity trauma are common injuries, yet the optimal perioperative anesthetic and analgesic care remains unclear. Residual anesthesia and opioids can cause respiratory depression, specifically postoperative respiratory depression and opioid-induced respiratory depression. ⋯ These findings suggest that, while SA may be considered the safer alternative, it may in fact introduce confounding factors, which increase the risk of respiratory depression. Ensuring adequate respiratory status is particularly critical for the military population, as combat casualties are often monitored in understaffed environments following surgery. Using an SA strategy instead of GA may not prevent postoperative respiratory depression, and respiratory volume monitor monitoring may be useful to optimize care.