Military medicine
-
While damage control surgery and resuscitation techniques have revolutionized the care of injured service members who sustain severe traumatic hemorrhage, the physiologic and inflammatory consequences of hemostatic resuscitation and staged abdominal surgery in the face of early aeromedical evacuation (AE) have not been investigated. We hypothesized that post-injury AE with an open abdomen would have significant physiologic and inflammatory consequences compared to AE with a closed abdomen. ⋯ These results demonstrate the complex interaction of AE and temporary or definitive abdominal closure after post-injury laparotomy. Contrary to our hypothesis, we found that AE in those animals with open abdomens is relatively safe with no difference in mortality compared to those with closed abdomens. However, given the physiologic and inflammatory changes observed in animals with open abdomens, further evaluation is necessary prior to definitive recommendations regarding the safety or downstream effects of exposure to AE prior to definitive abdominal closure.
-
The Indo-Asia-Pacific region has the highest incidence of natural disasters world-wide. Since 2000, approximately 1.6 billion people in this region have been affected by earthquakes, volcanos, tsunamis, typhoons, cyclones, and large-scale floods. The aftermath of disasters can quickly overwhelm available resources, resulting in loss of basic infrastructure, shelter, health care, food and water, and ultimately, loss of life.Over the last 12 years, US military forces have collaborated with countries throughout the Indo-Asia-Pacific region to enhance disaster preparedness and management during shipboard global health engagement missions. Military health care personnel are integral in this effort and have planned subject-matter expert exchanges, multidisciplinary conferences, courses, and hyper realistic simulated military-to-military training exercises related to disaster preparedness.Military health care providers are essential not only to providing international education and training, but also to ensuring optimal readiness to respond to future disasters in the Indo-Asia-Pacific region and worldwide. The ability to effectively respond to disasters and collaborate with other nations promotes international stability. Yet, few studies have examined disaster preparedness among US military health care personnel. This study aimed to assess knowledge, skills, and preparedness for disaster management among US military health care personnel preparing to deploy on a global health engagement mission. ⋯ Disaster preparedness among military healthcare personnel could be improved to function optimally for future global health engagement missions. This study expands current understandings of disaster preparedness among US military health care providers and identifies ways to improve and enhance training.
-
The purpose of the cross-sectional study was to explore the relationships between occupational and general-self efficacy, and perceived preparedness among Commissioned Corps officers in the United States Public Health Service (Commissioned Corps). Commissioned Corps officers fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. Commissioned Corps officers play a vital role in the fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. The Commissioned Corps provided healthcare services in Liberia during the 2014 Ebola crisis that underscored the challenges of emerging diseases in a globalized community. It is imperative that these health professionals maintain a high level of self-efficacy and feel confident in their overall preparedness training as they respond to public health emergencies. ⋯ This study reflects the training perceptions and self-beliefs of Commissioned Corps officers, fills an important gap in the empirical research in this population, and advances previous investigations, which suffered from an underrepresentation of female service members.
-
Longer steps with load carriage is common in shorter Soldiers when matching pace with taller Soldiers whereas shorter steps are hypothesized to reduce risk of injury with load carriage. The effects of load carriage with and without step length manipulation on loading patterns of three commonly injured structures were determined: Achilles tendon, patellofemoral joint (PFJ) and medial tibiofemoral joint (mTFJ). ⋯ A preferred step length is the safest strategy when walking with load carriage. Taking a shorter step is not an effective strategy to reduce loading on the Achilles tendon, PFJ, and mTFJ.
-
Exertional Heat Illness with associated ischemic hepatitis (IH) is a common occurrence among military trainees; however, few specific therapies exist if unresponsive to appropriate supportive measures. A 27-year-old basic combat trainee presented with altered mental status, renal insufficiency, rhabdomyolysis, and a core temp of 107.9 °F after collapsing during a run, leading to the diagnosis of heat stroke. While the patient's azotemia and creatinine kinase levels rapidly improved with aggressive intravenous hydration, transaminases continued to increase to nearly 155 times the upper limit of normal. ⋯ The mortality of IH among critically ill patients has been estimated to be as high as 60%, with those demonstrating coagulopathy especially at risk. NAC is shown to improve the transplant-free survival rate in non-acetaminophen related ALF, consistent with its proposed mechanisms of improving hepatic blood flow and conjugating toxic metabolites. NAC therapy should be considered early in the course of heat injury-mediated IH to reduce reperfusion injury, improving transplant free outcomes.