Explore the vast range of titles available.

Background Airway management is critical in combat casualty care, with airway compromise being the second leading cause of preventable battlefield deaths. Suction devices are essential for clearing obstructions during airway management; however, many medics choose not to carry them due to their excessive weight. Current standards for suction devices mention a minimum liquid flow rate of 1.2 L/min and a maximum device weight of 6 kg, but these standards fail to meet the practical needs of military end-users. The team conducted an I-Corps funded end-user assessment study with over 100 participants, in which a minimum flow rate of 1 L/min and a maximum weight of 4.5 kg were indicated as preferred among respondents. This gap between the standards and user preferences results in exclusion of existing devices from military kits due to weight concerns despite meeting performance criteria. Methods To address this gap, the Suction Combat Ready Advanced Multifunctional Machine (SCRAMM) was developed with input from U.S. Military clinical stakeholders to emphasize both performance and portability. SCRAMM is designed to handle diverse medical scenarios simultaneously and was characterized against the market leaders Zoll 330 and Impact 326M. Liquid flow rates and device weights were measured and analyzed according to ISO standards and end-user requirements. Results Zoll 330 and Impact 326M exceeded the ISO-required liquid flow rate by 145%, with weights of 4.8 kg and 5.1 kg, respectively. Additionally, both devices were heavier than the user-preferred weight limit of 4.5 kg. SCRAMM, with three suction lines for simultaneous diverse medical tasks, exceeded the ISO flow rate by 23%. It remained within the preferred weight range at 3.4 kg, demonstrating greater performance-to-weight balance in consideration of actual user needs. Conclusion This study demonstrates the successful development and characterization of SCRAMM. It met ISO flow rate standards and remained under the 4.5 kg weight threshold preferred by end-users—outperforming current market leaders in portability while maintaining effective suction. These results highlight the importance of incorporating a performance-to-weight metric in evaluating portable suction devices. We recommend that future standards balance performance with portability to better suit military and emergency medical needs. Clinical trial number: not applicable.

Recently the Committee on Tactical Combat Casualty Care changed the guidelines on fluid use in hemorrhagic shock. The current strategy for treating hemorrhagic shock is based on early use of components: Packed Red Blood Cells (PRBCs), Fresh Frozen Plasma (FFP) and platelets in a 1:1:1 ratio. We suggest that lack of components to mimic whole blood functionality favors the use of Fresh Whole Blood in managing hemorrhagic shock on the battlefield. We present a safe and practical approach for its use at the point of injury in the combat environment called Tactical Damage Control Resuscitation. We describe pre-deployment preparation, assessment of hemorrhagic shock, and collection and transfusion of fresh whole blood at the point of injury. By approaching shock with goal-directed therapy, it is possible to extend the period of survivability in combat casualties.

Abstract Objective Approximately 55–76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. Methods A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. The committee made evidence-informed judgments and recommendations for practice and self-care use. Results Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil’s claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. Conclusions Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.

The Tactical Combat Casualty Care (TCCC) project begun by the Naval Special Warfare Command and continued by the U.S. Special Operations Command developed a set of tactically appropriate battlefield trauma care guidelines that were initially published in 1996. Transition of these guidelines into use throughout the Department of Defense has been ongoing since that time. The need for updates to the TCCC guidelines was recognized early on and has been carried out by the Committee on Tactical Combat Casualty Care established and operated by the Naval Operational Medicine Institute. The evolution of these guidelines from the 1996 recommendations to the present is described. Numerous reports in the medical literature and collected from combat first responders have documented that TCCC is saving lives on the battlefield and improving the tactical flow of missions on which casualties have occurred. Present challenges to the optimized implementation of TCCC in U.S. combat units include the need to expedite transition of new TCCC techniques and technologies to deploying units, to provide TCCC training for all U.S. combatants, and to ensure adequate funding for the Committee on TCCC.

BackgroundGeneral Practice training in the civilian and military environments follows a common training pathway, yet the scope of practice of a military General Practitioner (GP) varies significantly. A level of care for the acutely unwell and traumatically injured patients is frequently provided in austere environments remotely located from definitive medical care. This qualitative service needs evaluation scopes current level of trauma and acute care training and requirement for further training within military GPs and GP trainees. The transition to contingency operations increases the likelihood of medical officers being deployed to remote, austere locations, and it remains important to be fully skilled to manage any acute medical or trauma situation.Aims and objectivesThe aim of this project is to identify how to maintain skills in prehospital and acute care within the military general practice. The specific objectives are (1) to assess the current level of training and experience across military GPs and military GP trainees in the domain of prehospital and acute competencies; (2) to assess satisfaction with the current level of training in these domains; (3) to assess the current deficiencies in training in this domain; and (4) to suggest possible changes or enhancements to the current military GP training pathway.MethodsQualitative data was collected using a combination of focus groups and semistructured interviews. An initial focus group gathered codes and concepts. A topic guide generated from the initial focus group informed six semistructured interviews. A final focus group was used for validation purposes. Data were analysed using the constructivist grounded theory approach. Concurrent observational data were also collected from military and civilian courses pertinent to the research topic.ResultsFocus groups (n=2, total participants=14) and semistructured interviews (n=6) suggest that military GPs and trainees feel their level of trauma and acute care training generally diminishes over time, with significant interservice variation, and is of generally a lower level than desired. Qualified GPs suggest that maintaining clinical currency in prehospital emergency care (PHEC) for short-notice deployments is difficult. Modification to the current military GP training programme and easier access to training courses are suggested as potential solutions to the perceived shortfall in training in these areas.ConclusionsPrehospital care and care of the acutely unwell patient remain an area of significant anxiety within military primary care doctors. While most military GPs may not want or choose to spend much of their time exclusively managing trauma and acute care, it is accepted that there is a professional requirement to provide this level of care on a frequent basis. The study suggests that there is an appetite for a higher level of training, both within the military GP specialist training pathway and postqualification. Suggested solutions to this challenge include (1) modification of the current military general practice specialty trainee residential course and (2) modification of military GPs’ terms of reference to include PHEC experience during the working week.

Neurocritical care is usually practiced in the comfort of an intensive care unit within a tertiary care medical center. Physicians deployed to the frontline with the US military or allied military are required to use their critical care skills and their neurocritical skills in austere environments with limited resources. Due to these factors, tactical critical care and tactical neurocritical care differ significantly from traditional critical care. Operational constraints, the tactical environment, and resource availability dictate that tactical neurocritical care be practiced within a well-defined, mission-constrained framework. Although limited interventions can be performed in austere conditions, they can significantly impact patient outcome. This review focuses on the US Army approach to the patient requiring tactical neurocritical care specifically point of injury care and care during transportation to a higher level of care.

The U.S. military medical community spends a great deal of time and resources training its personnel to provide them with the knowledge and skills necessary to perform life-saving tasks, both on the battlefield and at home. However, personnel may fail to retain specialized knowledge and skills if they are not applied during the typical periods of nonuse within the military deployment cycle, and retention of critical knowledge and skills is crucial to the successful care of warfighters. For example, we researched the skill and knowledge loss associated with specialized surgical skills such as those required to perform laparoscopic surgery (LS) procedures. These skills are subject to decay when military surgeons perform combat casualty care during their deployment instead of LS. This article describes our preliminary research identifying critical LS skills, as well as their acquisition and decay rates. It introduces models that identify critical skills related to laparoscopy, and proposes objective metrics for measuring these critical skills. This research will provide insight into best practices for (1) training skills that are durable and resistant to skill decay, (2) assessing these skills over time, and (3) introducing effective refresher training at appropriate intervals to maintain skill proficiency.

The Forward Surgical Team and Combat Support Hospital have been used extensively only during the past decade in Iraq and Afghanistan. The scope of their operational experience and historical development remain to be described. The literature was searched to obtain publications regarding the historical development of Forward Surgical Teams and Combat Support Hospitals, as well as their surgical experiences in Iraq and Afghanistan. Relevant publications were reviewed in full and their results summarized. The doctrine behind the use of modern military surgical assets was not well developed at the start of the Iraq and Afghanistan conflicts. The Forward Surgical Team and Combat Support Hospital were used in practice only over the past decade. Because of the nature of these conflicts, both types of modern military surgical assets have not been used as intended and such units have operated in various roles, including combat support elements and civilian medical treatment facilities. As more research comes to light, a better appreciation for the future of American military medicine and surgery will develop.

According to the U.S. Census Bureau, 18.2 million veterans were living in the United States in 2017, of whom 1.6 million were female. Less than one-half of all veterans receive care at a Veterans Health Administration or military treatment facility, leaving most to receive services from primary care physicians. Injuries and illnesses common among this patient population include musculoskeletal injuries and chronic pain, mental health issues such as posttraumatic stress disorder (PTSD) and moral injury, traumatic brain injury, chemical and noise exposures, and infectious disease concerns. Family physicians should ask about military service and be well informed about the range of veterans' health concerns, particularly PTSD, depression, and suicidality. Physicians should screen veterans for depression using the Patient Health Questionnaire-9 and for PTSD using the PTSD Checklist for DSM-5. Veterans with traumatic brain injury should be screened specifically for comorbid PTSD and chronic pain because the diagnosis informs treatment. Exposures to loud noise, chemicals, and infectious diseases are prevalent and can cause disability. Family physicians can use available resources and clinical practice guidelines such as those from the U.S. Department of Veterans Affairs and Department of Defense to inform care and to assist veterans. Illustration by Jonathan Dimes

IntroductionTo evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.MethodsA prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ‘clinical diagnostic probability’ (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an ‘ultrasound diagnostic probability’ (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).ResultsForty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).ConclusionPOCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.