Military medicine
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To combat increasing wait times and left without being seen (LWOBS) rates, our emergency department (ED) implemented an accelerated triage and treatment (TNT) protocol. A TNT team was allocated treatment rooms to begin management of urgent patients if a bed in the main ED was not available. A retrospective database study was performed using three separate 6-month periods: two control periods before the intervention (P1, P2) and one period after the intervention (P3). ⋯ The time to be seen for EC3 patients improved from P1 to P3 by an average of 12.6 minutes (18.5%, p < 0.0001) and from P2 to P3 by an average of 12.0 minutes (17.6%, p < 0.0001). The EC3 LWOBS rate decreased from 2.0% in P1 and 1.9% in P2 to 0.8% in P3 (p < 0.0001 for both). The use of an accelerated TNT protocol was associated with a significant reduction in EC3 patient LWOBS rates and time to evaluation.
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This archival study explored why military tobacco control initiatives have thus far largely failed to meet their goals. We analyzed more than 5,000 previously undisclosed internal tobacco industry documents made public via an online database and additional documents obtained from the U. S. military. ⋯ Our findings suggest that lowering military smoking rates will require health policymakers to better anticipate and counter political opponents. The findings also suggest that effective tobacco control policies may require strong, explicit implementation instructions and high-level Department of Defense support. Finally, policy designers should also consider ways to reduce or eliminate existing perverse incentives to increase tobacco consumption, such as allowing exchange store tobacco sales to fund Morale, Recreation, and Welfare Programs.
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Case Reports
A case of malignant hyperthermia in a child encountered during a humanitarian assistance mission to the Philippines.
Potentially fatal operating room events have become largely preventable with advances in anesthesia and surgical technique. Nonetheless, some lethal emergencies remain unpredictable and can occur whenever general anesthesia is given. We describe a case of malignant hyperthermia encountered and treated during surgical operations concurrent with an overseas humanitarian assistance mission. This case highlights the clinical diversity of malignant hyperthemia as well as the importance of preparation for any potential adverse event wherever trigger agents may be used from the mundane to exotic locales.
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The objective of this study was to determine the effects of inspired oxygen concentration (FIO2), positive end-expiratory pressure (PEEP), and breath type on the battery life of the LTV-1000 external lithium ion battery (LiB). ⋯ Battery life of the external LiB is significantly reduced by the use of pressure control, increasing PEEP, and increasing FIO2. This information is critical to resource planning for medical missions.
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Increasing rates of coccidioidomycosis among the general population are being described. Given the large number of military personnel stationed and training in endemic areas, data regarding infection trends among military members would be informative. ⋯ Coccidioidomycosis incidence rates have significantly increased during the last 5 years among military beneficiaries. Active duty members were more likely to develop coccidioidomycosis than dependents or retirees, perhaps related to the number and intensity of exposures in this group.