Military medicine
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Airway compromise is a contributor to preventable mortality on the battlefield. Supraglottic airway devices are an accepted intervention for these casualties. Combat Medics, civilian prehospital care providers, and lay civilians have demonstrated proficiency with supraglottic airways. However, the Combat Lifesaver (CLS) course includes no instruction on their use. ⋯ CLS students are capable and confident in the use of a supraglottic airway device after only brief instruction.
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The Combat Lifesaver course taught to nonmedical personnel includes instruction on performing needle thoracostomy to decompress tension pneumothorax, the second leading cause of preventable combat death. Although the Tactical Combat Casualty Care curriculum is pushed to the lowest level of battlefield first responders, the instruction of this advanced procedure is routinely limited to a verbal block of instruction with a standardized presentation. ⋯ Cadaver training provided the largest single educational confidence boost for needle decompression skills, and is an effective method of enhancing confidence in needle decompression.
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Randomized Controlled Trial Multicenter Study
Identification of barriers to adaptation of battlefield technologies into civilian trauma in California.
To characterize the adoption of routine battlefield medical techniques (tourniquets, hemostatic agents, and tactical combat casualty care into civilian prehospital trauma care and to identify the barriers to their use in the state of California through anonymous electronic survey of local emergency medical services agency (LEMSA) directors. ⋯ Tourniquets, hemostatic agents, and tactical medical care are the integral components of battlefield medicine and have been lifesaving in these settings. The barriers to this transition are multifactorial. Physicians familiar with these technologies should become advocates for their integration in civilian trauma patient care.
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The study establishes the functional outcomes of service personnel injured in current conflicts by correlating data on initial injury to the findings of medical boards after trauma and reconstructive treatment. Data comprehensively include all casualties of the Royal Navy and Royal Marines and all functional outcomes. ⋯ The Defence Medical Service (DMS) provides excellent trauma and rehabilitative care. The authors contend that this is a valid proxy for other larger coalition formations. Specific injury patterns have higher impact on functional outcomes; future research efforts should focus on these areas.
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Pressures to increase the efficacy and effectiveness of medical training are causing the Department of Defense to investigate the use of simulation technologies. This article describes a comprehensive cognitive task analysis technique that can be used to simultaneously generate training requirements, performance metrics, scenario requirements, and simulator/simulation requirements for medical tasks. On the basis of a variety of existing techniques, we developed a scenario-based approach that asks experts to perform the targeted task multiple times, with each pass probing a different dimension of the training development process. ⋯ The technique was pilot tested with expert instructors from a large military medical training command. These instructors were employed to generate requirements for two selected combat casualty care tasks-cricothyroidotomy and hemorrhage control. Results indicated that the technique is feasible to use and generates usable data to inform simulation-based training system design.