Military medicine
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Operations Iraqi Freedom and Enduring Freedom saw higher rates of combat ocular trauma (COT) than any past U.S. conflict. The improvised explosive device, the signature weapon of the conflicts, as well as improved personal protective equipment and combat medical care all attributed to COT being the fourth most common injury sustained by wounded U.S. service members. This review describes the epidemiology, mechanisms, and treatment patterns and discusses the relationship of traumatic brain injuries (TBIs) to ocular injuries sustained by U.S. service members during the War on Terror. ⋯ The Global War on Terrorism saw an evolution in the types of ocular injuries sustained by U.S. service members compared to previous conflicts. The widespread use of IEDs led to injury patterns not encountered in previous conflicts. Weapons of today utilize blast and shrapnel as the mechanism for destruction. Sequelae such as TBIs and complicated head and neck trauma have pushed innovation in the field of ophthalmology. Improvements in medical technology and personal protective equipment have resulted in not only survival of previously life-threatening injuries, but also a greater chance of severe loss of vision. By analyzing ocular injury data from the trauma literature, improvements in education and training can lead to improvements in point-of-injury care and eye protection for the next generation of warfighters.
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Extensive efforts have been directed toward developing an effective vaccine to fight against the Coronavirus Disease 2019 (COVID-19); however, hesitancy to receive COVID-19 vaccinations has become detrimental to overcoming the COVID-19 pandemic. Although the U.S. Military instated a COVID-19 vaccine mandate, some members were still hesitant to receive the vaccine. To determine the efficacy of a program focused on vaccine hesitation, a program evaluation was conducted on a COVID-19 vaccine educational intervention (hereafter COVID-19 Educational Presentation) for trainees at Lackland Air Force Base, TX, in September 2021. Objectives of the educational session included (1) determining the participants' level of confidence that the COVID-19 vaccines are safe and effective, (2) understanding the concern for long-term side effects from COVID-19 vaccinations, and (3) identifying the driving forces behind hesitancy to receive a COVID-19 vaccination. ⋯ The COVID-19 Educational Presentation increased confidence and decreased hesitancy to receive the COVID-19 vaccine. Vaccine educational programs should continue in the military population to help combat misinformation and ensure that our military force is fully vaccinated and able to maintain mission readiness.
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Tranexamic acid (TXA) is a standard component of Tactical Combat Casualty Care. Recent retrospective studies have shown that TXA use is associated with a higher rate of venous thromboembolic (VTE) events in combat-injured patients. We aim to determine if selective administration should be considered in the prolonged field care environment. ⋯ There may be an increased risk of VTE in combat casualties that receive TXA; however, this risk must be considered in the context of improved survival and an absence of VTE-associated deaths. To optimize combat casualty care during prolonged field care, it will be essential to ensure the timely administration of VTE chemoprophylaxis as soon as the risk of significant hemorrhage permits.
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High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. ⋯ The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon's training.Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.
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The majority of critical care air transport (CCAT) flights are regulated, meaning that a theater-validating flight surgeon has confirmed that the patient is medically cleared for flight and that evacuation is appropriate. If the conditions on the ground do not allow for this process, the flight is unregulated. Published data are limited regarding CCAT unregulated missions to include the period of troop drawdown at the end of the Afghanistan conflict. The objective of our study was to characterize the unregulated missions within Afghanistan during troop drawdown and compare them to regulated missions during the same timeframe. ⋯ During the troop drawdown in Afghanistan, the number of unregulated missions increased geometrically because the medical footprint was decreasing. During unregulated missions, CCAT providers used ketamine more frequently, consistent with Tactical Combat Casualty Care guidelines. In addition, TBI was the only predictor of vasopressor use and may reflect an attempt to adhere to unmonitored TBI clinical guidelines. Interoperability between CCAT and AE teams is critical to meet mass casualty needs in unregulated mission environments and highlights a need for joint training. It remains imperative to evaluate changes in mission requirements to inform en route combat casualty care training.