Military medicine
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The purpose of this study was to review whether air ambulance transportation of trauma patients to the Brooke Army Medical Center (BAMC) level I trauma center contributed to maintaining national mortality standards in the trauma care of these patients. Aeromedical transportation is considered a standard-of-care component of regional trauma systems throughout the United States. Pooled trauma database information from 792 consecutive ambulance-transported trauma patients received at BAMC during the fiscal year from October 1, 1995, to September 30, 1996, were reviewed. ⋯ The mortality rates (immediate, early, and late deaths) of both ambulance groups were compared with national mortality standards using the internationally recognized Trauma and Injury Severity Score methodology, based on the Major Trauma Outcome Study in 1986 and validated in 1992. The Z test for independent populations demonstrated no statistically significant difference between BAMC trauma mortality rates for either ambulance group compared with national trauma mortality rates. The results suggest that aeromedical evacuation of the more severely injured patients farthest from the BAMC trauma center resulted in mortality rates that met national standards.
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Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. ⋯ The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.
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The purpose of the current investigation was to determine the prospective predictors of discharge in a population of individuals entering U. S. Air Force Basic Military Training (BMT). ⋯ Results suggest that women and ethnic minorities are not biased in favor of discharge and that both lifestyle and psychosocial variables are consistent predictors of discharge. Future research could potentially yield other significant predictors of success versus discharge in the U. S. military.
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Biography Historical Article
New York-Tidewater Chapters' History of Military Medicine Award. The military odyssey of Norman Bethune.
While visiting the Peoples Republic of China in 1982, I became aware of the work of the Canadian, Norman Bethune, as a military surgeon. Bethune first served as a stretcher-bearer in an ambulance unit and later as a medical officer with the Allies during the First World War. He also participated in the Spanish Civil War as a military physician. ⋯ In the annals of Chinese military history, he has been given an honored place as a military surgeon and a martyr. He is also credited in China with improving the practice of battlefield medicine, as an organizer, teacher, and innovator. Bethune's fame in China is now spreading to Canada.
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A pediatric critical care transport program was initiated and organized at Naval Medical Center San Diego in January 1994. The primary goal of the program was to formally train military pediatric residents in the early stabilization and transport of the critically ill neonatal and pediatric patient. It was also felt that such a program would generate significant cost savings to the Department of Defense. We present the statistics, training protocol, and the cost savings. In addition, we surveyed previous residents who had been involved with this program to determine its perceived benefit. ⋯ In summary, we report our experience with the development of a pediatric critical care transport program. The program was developed to provide military pediatric residents instruction and experience in the stabilization and transport of critically ill children. In addition, we were able to demonstrate a significant cost avoidance.