Military medicine
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Airway obstruction is the second leading cause of preventable death on the battlefield. Most airway obstruction occurs secondary to traumatic disruptions of the airway anatomical structures. However, casualties may require airway interventions for other indications (e.g., depressed mental status). We describe casualties undergoing airway intervention in the prehospital, combat setting without apparent upper airway trauma. ⋯ In this subgroup analysis of casualties without apparent upper airway trauma, survival rates were lower when compared to our previous report. Higher quality data are necessary to better understand the resuscitation needs of this critically ill subset of combat casualties.
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Any implicit and explicit biases that exist may alter our interpretation of people and events. Within the context of assessment, it is important to determine if biases exist and to decrease any existing biases, especially when rating student performance to provide meaningful, fair, and useful input. The purpose of this study was to determine if the experience and gender of faculty members contribute to their ratings of students in a military medical field practicum. This information is important for fair ratings of students. Three research questions were addressed: Were there differences between new versus experienced faculty raters? Were there differences in assessments provided by female and male faculty members? Did gender of faculty raters impact ratings of female and male students?. ⋯ The study revealed that there were no differences in ratings of student leader performance based on faculty experience. In addition, there were no differences in ratings of student leader performance based on faculty gender.
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Randomized Controlled Trial
Assessing the Current Generation of Tourniquets.
Tourniquet application is an urgent life-saving procedure. Previous studies demonstrated several drawbacks in tourniquet design and application methods that limit their efficacy; among them, loose application of the device before windlass twisting is a main pitfall. A new generation of modern combat tourniquets was developed to overcome these pitfalls. The objective of this study was to assess the effectiveness of three new tourniquet designs: the CAT Generation 7 (CAT7), the SAM Extremity Tourniquet (SAM-XT), and the SOF Tactical Tourniquet Wide (SOFTT-W) as well as its correlation to the degree of slack. ⋯ Both SAM-XT and CAT7 demonstrated a better pressure profile and hemorrhage control rate compared to SOFTT-W, with no significant difference between the two. The better outcome measures were strongly correlated to less slack.
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Recent malicious use of chemical warfare agents (CWAs) is a reminder of their severity and ongoing threat. One of the main categories of CWAs is the organophosphate (OP) nerve agents. Presently, there is an urgent need to identify and evaluate OP nerve agent biomarkers that can facilitate identification of exposed individuals post-CWA incident. While exposures to OP nerve agents may be scenario-specific, the public is commonly exposed to OP compounds through the ubiquitous use of OP pesticides, which are chemically related to nerve agents. Therefore, a systematic literature review and methodological quality assessment were conducted for OP pesticide biomarker studies to serve as a baseline to assess if these approaches may be adapted to OP nerve agent exposures. ⋯ Cholinesterase activity may have utility for identifying individuals with exposures surpassing a given threshold of OP nerve agent, but further investigation of how acetylcholinesterase and butyrylcholinesterase levels correlate with observed patient symptoms may be required to ensure accuracy of results. As CWAs and nerve agents are more readily used, more standardized reporting of biomarker measurements are needed to develop new approaches for OP nerve agent biomarkers.