Military medicine
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The tactical environment and the mission given the Special Operations Forces in Afghanistan during the initial phases of Operation Enduring Freedom placed the Special Operations Forces medics (18Ds) in a position of significant medical responsibility. The 18Ds became the primary care providers for the indigenous anti-Taliban fighters as well as U. ⋯ The areas of greatest interest and concern were orthopedics, field transfusions, and field-expedient anesthesia. It is hoped that the training prepared and given to the 18Ds by the personnel of the 274th FST and presented in this article not only was useful to them but also will be of benefit to 18Ds who find themselves in similar situations in the future.
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Measures of post-traumatic stress disorder (PTSD) and depression were used to predict Veterans Affairs outpatient treatment costs among Persian Gulf War veterans with medically unexplained physical symptoms. Patients (N = 206) enrolled in a Veterans Affairs primary care clinic for Persian Gulf War veterans completed study assessments at the initial appointment or at a proximal follow-up visit. Costs of care for mental health, medical, and pharmacy services for these veterans were computed for the subsequent 6-month period. ⋯ None of the mental status measures was significantly related to costs of medical care. Models using global measures of mental health status were as robust as models using disorder-specific measures of PTSD and depression in predicting mental health care and pharmacy costs. The implications of these findings for anticipating costs of care for Persian Gulf War veterans are discussed.
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Concern about respiratory diseases in soldiers increased in the late 1990s as production of the successful adenovirus vaccines stopped and the possibilities of an emergent pandemic influenza strain and use of bioweapons by terrorists were seriously considered. Current information on the causes and severity of influenza-like illness (ILI) was lacking. Viral agents and clinical presentations were described in a population of soldiers highly immunized for influenza. ⋯ Most (58.5%) patients with an adenovirus had a chest radiograph; 31.3% of these had an infiltrate. Clinical findings did not differentiate ILI caused by the various agents. Only 29 cases of influenza occurred in approximately 7,200 person-years of observation, supporting the use of influenza vaccine.
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Uncontrolled hemorrhage is the leading cause of preventable combat-related deaths. The vast majority of these deaths occur in the field before the injured can be transported to a treatment facility. ⋯ A number of hemostatic agents have recently been deployed to the warfront that can be used to arrest bleeding before surgical control of the source. The purpose of this article is to summarize the background information regarding these hemostatic agents, indications and rationale for their use, and characteristics of these products that may impact effectiveness.
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The ability to accurately triage trauma patients can be difficult in the prehospital environment. Prehospital trauma scoring systems have been developed with a goal of determining which patients should be transported immediately to a trauma center, thus benefiting from critical personnel and resource-intensive lifesaving interventions (LSIs). A resource-based endpoint, LSIs, therefore might be the optimal endpoint of prehospital triage scoring and could be used to determine where patients are transported. We hypothesized that simple physiologic data available immediately upon scene arrival would prove predictive of the need for a LSI. ⋯ The presence of hypotension or decreased motor score was correlated with the need for LSIs. However, normotensive patients with normal motor scores still frequently required LSIs. Optimal discrimination of this group of patients will require new analytic approaches.