Military medicine
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The use of tourniquets in combat medicine continues to be a key focus as they have consistently been shown to combat one of the leading causes of preventable death on the battlefield, massive hemorrhage to extremities. The present study analyzed tourniquet application among combat medics (68W) and combat lifesavers (CLSs) in a training environment to determine whether trainees' performance is consistent among one another and whether performance can be associated with participant demographics such as experience or role. ⋯ The findings suggest that high variability in CAT application methodology and performance exists among CLS and combat medics, which is largely not predictable by various demographics such as role, experience within the designated role, and self-reported confidence, skill, or experience. The observed disconnect between training or experience and CAT application performance suggests substantial variability in the consistency of training for both CLS and 68W soldiers. These inconsistencies may stem from variability in instructor knowledge, teaching styles, or training materials or may be developed through informal methods such as experiences in the field or recommendations from colleagues and experts. These findings highlight a potential need to reassess CAT application training, particularly in regard to consistency and validation. Finally, it should be noted that the study's findings may be limited or fail to capture some study effects because of the sample size and wide range of reported experience among participants.
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The fit of military clothing and equipment is essential for the health and safety of military operators. Given the aim of increasing the proportion of women and the known biological and morphological differences between male and female soldiers, an understanding of fit across different items of kit is needed. The aim of this study was to quantify subjective fit ratings of 8 items of military clothing and equipment, including combat shirt, combat pants, rucksack, small pack, tactical vest, fragmentation vest, helmet, and ballistic eyewear as a function of relative stature and occupational group among male and female Canadian Armed Forces members. ⋯ Military equipment fit has previously been shown to have implications for protection, performance, and mobility. The results of the investigation demonstrate different patterns of fit acceptability in male and female soldiers across items of clothing and equipment and may require different solutions.
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Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. ⋯ Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.
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Warfighters are exposed to life-threatening injuries daily and according to the Joint Trauma System Military Clinical Practice Guideline-Global Snake Envenomation Management snakebites are a concerning threat in all theaters of operation. Snake venom is a complex mixture of toxins including phospholipases A2 (PLA2) and snake venom metalloproteinases (SVMP) that produce myotoxic, hemotoxic, and cytotoxic injuries. Antibody-based antivenom is the standard of care but new approaches including small-molecule inhibitors have gained attention in recent years. Doxycycline is an effective inhibitor of human metalloproteinases and PLA2. The enzymatic activities of 3 phylogenetically distinct snakes: Agkistrodon piscivorus, Naja kaouthia, and Daboia russelii were tested under inhibitory conditions using doxycycline. ⋯ Doxycycline reduced PLA2- and SVMP-related lethality, particularly in A. piscivorus envenomings and in a limited capacity with D. russelii revealing its promise as a treatment for snakebites. In addition, CK activity, a common indicator of muscle damage was inhibited in mice that received doxycycline-treated venom. The doxycycline concentrations identified in the ED50 studies correspond to 1,456 to 5,061 mg dosages for a 70 kg human. Factors including venom yield and snake species would affect the actual dosage needed. Studies into high-dose doxycycline safety and its effectiveness against several snake species is needed to fully translate its use into humans. Based on this work, doxycycline could be used as a treatment en route to higher echelons of care, providing protection from muscle damage and reducing lethality in different snake species.
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Force readiness is a priority among senior leaders across all branches of the Department of Defense. Units that do not achieve readiness benchmarks are considered non-deployable until the unit achieves the requisite benchmarks. Because military units are made up of individuals, the unit cannot be ready if the individuals within the unit are not ready. For medical personnel, this refers to one's ability to competently provide patient care in a deployed setting or their individual clinical readiness (ICR). A review of the literature found no conceptual model of ICR. Other potential concepts, such as individual medical readiness, were identified but used inconsistently. Therefore, the purpose of this article is to define ICR and propose a conceptual model to inform future efforts to achieve ICR and facilitate future study of the concept. ⋯ Force readiness is a Department of Defense priority. In order for military units to be deployment ready, so too must their personnel be deployment ready. For COSMs, this includes one's ability to competently provide patient care in a deployed setting or their ICR. This article defines ICR, as well as identifies another key concept and other factors associated with ICR. The proposed model is a tool for military medical leaders to communicate with and influence non-medical military leaders in the Department of Defense. Future research is needed to further refine the proposed model, determine the strength of the proposed relationships, and identify interventions to improve ICR.