Military medicine
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Commercial off-the-shelf (COTS) intravenous fluid (IVF) containers contain residual air, introducing the risk of venous air embolism (VAE). Venous air embolism occurs when air displaces blood flow in vasculature. The danger from residual air is often negligible in terrestrial settings, where gravitational forces generate buoyancy, pushing residual air to the top of the IVF container. However, in microgravity there is no buoyancy to separate liquid and gas layers. We performed experiments to quantify the amount of air in COTS IVF containers (Experiment 1) and identify the variables that affect the stability of sterilely produced airless containers (Experiment 2). ⋯ Residual air has a wide variety of volumes in COTS IVFs. The average amount of residual air is high enough to contribute to clinically significant VAEs, although unlikely to be fatal. If airless IVF containers are produced for exploration missions, a progressive increase in the amount of residual air should be expected. Extremes of temperatures and humidity will increase the reaccumulation of residual air and decrease the shelf-life of airless IVFs.
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The critical role of emergency physicians in military settings underscores the necessity for a broad and proficient skill set, especially in life-saving procedures such as thoracostomies, endotracheal intubations, and cricothyrotomies, to maintain combat readiness. The current peacetime phase, however, presents challenges in maintaining these skills because of decreased exposure to high-acuity medical scenarios. This decrease in exposure jeopardizes skills retention among military emergency medicine physicians, highlighted by studies showing a significant decline in performance over time because of reduced practice. ⋯ The Military Health System must find avenues to maintain the clinical skills of wartime procedures in the peacetime environment. Although there is no substitute for clinical encounters, alternative modalities are needed to augment skills retention in high-acuity, low-frequency procedures. Self-directed, small-group task trainers and cadaveric labs are a lower maintenance mechanism by which faculty can improve their confidence in certain procedural skills. Further studies should evaluate if this translates to changes in clinically oriented outcomes and how to optimize such training evolutions within the skills retention paradigm.
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Blood is critical to expeditionary casualty care. Currently, low-titer O whole blood is the preferred product, because it serves as a universal blood product, but demand is higher than supply. Type-specific whole blood (TSWB) has the potential to address this shortfall and provide an identical clinical benefit to specific patient populations. This study estimates the benefit of TSWB to the expeditionary blood supply. ⋯ Incorporating TSWB is anticipated to meaningfully expand whole blood availability to meet current shortfalls and future expeditionary casualty needs.
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Improving the dietary behaviors of personnel can result in positive impact beyond the individual, creating benefits for their organization and wider society. Military personnel endure extended periods of physical and cognitive activity. Healthful dietary behaviors by military personnel support preparedness; yet poor diet behaviors remain common and persistent, and adversely impact health and physical and cognitive performance. Urgent and effective action is needed to improve diet behaviors, but this action has not been prioritized. This study aimed to estimate the value that could be realized from improved diet behaviors to support prioritization of investment in this area for policy and program change. ⋯ These estimates were constructed using the best available data and transparency within the calculations, but they remain estimates. The collection of additional data would enable the calculation of further outcomes and increase the usefulness of Social Return on Investment estimation in this area. Militaries should invest greater effort and funding in achieving, maintaining, and optimizing personnel health and performance. Promoting healthy diet behaviors should be prioritized as a cost-effective preventive action that supports productivity and performance, in comparison with the costs of remediating treatment. Conceptualizing the value of improving diet behaviors in monetary terms may refocus efforts on prevention rather than treatment.
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Transfusion of packed red blood cells (PRBC) or low-titer group O whole blood (LTOWB) has become standard practice in trauma patients with significant blood loss. As blood ages, it undergoes metabolic and structural changes. This study aimed to test the association between age of PRBC/LTOWB and mortality among adult trauma patients. ⋯ The mean age of LTOWB or PRBC units transfused during the first 24 hours after presenting to the ED for a traumatic injury was not found to be associated with in-hospital mortality.