Military medicine
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in devastating consequences, with high death tolls and significant impact on global health, geopolitics, and socioeconomic aspects of society among others. Militaries around the world have been affected in many ways, in terms of force attrition and disruption to operations. ⋯ The military remains essential to every country's defense and security. However, its unique construct and nature of operations may render it susceptible to uncontained viral transmission. To minimize manpower attrition and maximize force health in the face of a devastating pandemic, well-thought and tailored management measures must be implemented.
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Little evidence of outcome is available on critically ill Coronavirus Disease 2019 (COVID-19) patients hospitalized in a field hospital. Our purpose was to report outcomes of critically ill COVID-19 patients after hospitalization in a field intensive care unit (ICU), established under military tents in a civil-military collaboration. ⋯ In this study, a military field ICU joined a regional civil hospital to manage a large cluster of COVID-19-related ARDS patients in Mulhouse, France. This report illustrates how military teams can support civil authorities in the provision of advanced critical care. Outcomes of patient suggest that this field hospital deployment was an effective adaptation during pandemic conditions.
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Cholinergic urticaria is a common disorder that has been associated with anaphylaxis. We report the events, workup, and eventual second dose vaccination of a patient at the Walter Reed National Military Medical Center, who had immediate anaphylaxis after administration of the first Pfizer-BioNTech Covid-19 (BNT162b2) vaccine dose. During the initial evaluation after anaphylaxis, the patient described a history of symptoms suspicious for cholinergic urticaria but had never had this condition confirmed with standardized testing. ⋯ These results, combined with the patient history, suggested that the episode of anaphylaxis was most likely driven by a severe flare of cholinergic urticaria. After obtaining the patient's consent, she received and tolerated her second dose without any objective findings of anaphylaxis. We conclude that patients with mast cell disorders or anaphylaxis after their first Covid-19 immunization will benefit from referral to an allergist since receipt of their second Covid-19 immunization may be possible.
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An outbreak of coronavirus disease 2019 (COVID-19) occured within a land based 2,000-member cohort stationed on a remote air base in the Middle East from June to August 2020. We retrospectively reviewed base characteristics and mitigation measures instituted during the outbreak. We also reviewed documentation on the individuals that were either quarantined or placed in isolation and provide data on demographics, real-time reverse transcriptase polymerase chain reaction (rRT-PCR) results, occupation, and workdays lost. ⋯ The data show a disproportionate impact on healthcare workers and personnel involved in aviation operations. The purpose of this study is 2-fold: to describe the characteristics of the outbreak and to highlight the effectiveness of mitigation measures implemented to control it during military operations. This study may serve to inform medical professionals and military leaders in the management of a similar outbreak in a congregate living setting.
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Upon the U. S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U. ⋯ Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.