Military medicine
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Triage of medical care, whether necessary because of routine daily limitations or forced by exceptional circumstances, such as for soldiers injured in combat or civilians in mass casualty situations, is increasingly coming under scrutiny. The decisions that limit access to fundamental and even life-or-death treatments are fraught with controversy. These decisions are difficult for the medical provider to make and are even more difficult for the patient to understand. ⋯ Both provider and patient can feel that triage is immoral. In contrast, when triage is taught proactively and reviewed relative to the situation, the ethical principles that guide triage are evident and intact. Both provider and patient must learn the considerations and consequences of triage.
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Increased central nervous system norepinephrine outflow and alpha1-adrenergic receptor responsiveness appear to be involved in the pathophysiologic processes of trauma-related nightmares in post-traumatic stress disorder. On the basis of reports that the brain-accessible alpha1-adrenergic antagonist Prazosin substantially reduced chronic combat-related nightmares among Vietnam War veterans, we evaluated Prazosin effects on combat-related nightmares among combat soldiers returning from Operation Iraqi Freedom. ⋯ Prazosin appeared highly beneficial for combat-related nightmares characteristic of post-traumatic stress disorder among troops recently returned from Operation Iraqi Freedom. These findings provide a rationale for a placebo-controlled trial to establish efficacy in this population.
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The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. ⋯ At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.
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To describe health patterns in evacuated military members during Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and postdeployment health information to understand the utility of data collected for aeromedical evacuations. ⋯ Combining data sources increases our understanding of disease patterns in deployed troops. Targeted preventive interventions can then be implemented. Changes in the U.S. Transportation Command's Regulating and Command & Control Evacuation System database can improve its utility as an epidemiological tool.
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Operation Iraqi Freedom was the first large-scale combat operation involving the U.S. Marine Corps since the Persian Gulf War in 1991. Data from a combat surgical company are presented. ⋯ The time from injury to surgical care was considered long by civilian standards; however, this did not appear to affect outcomes substantially. A small percentage (5.2%) of injuries were to the torso. Hypothermia was commonly present. Because of the nature of their wounds, all patients required additional surgery after evacuation to rear area facilities. The outcomes of individual patients are not known, although it is known that only one Marine died after reaching medical care and, to date, no Marines have subsequently died of their wounds.