Military medicine
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To determine the critical care experience encountered by three recently graduated military pediatricians at an overseas military hospital and present one model of maximizing allowable critical care training time during residency. ⋯ Graduating military pediatric residents may be faced with caring for a wide range of critically ill neonatal and pediatric patients depending on their assignment. Residency training programs, with the recent increased emphasis on primary pediatric care, will need to streamline instruction in pediatric critical care to provide maximal benefit to the resident while maintaining compliance with Residency Review Committee guidelines.
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This descriptive, correlational study was conducted to explore factors (nurses and staff, doctors, waiting and convenience issues, and tests and treatments) and specific interpersonal behaviors affecting Department of Defense patient satisfaction in a military emergency department (ED). Data from a random sample of 534 patients using a mail-back questionnaire (N = 178) revealed that military patients who perceived the staff to have treated them courteously, taken their problems seriously, and paid attention to them during their stay were more satisfied with their military ED encounter. ⋯ Our findings suggest that a patient's perception of the ED encounter, particularly the interactions between the patient and staff, ultimately influence satisfaction. Significant improvements in patient satisfaction might be realized if quality improvement efforts focus on providing ED staff specific training in interpersonal interactions.
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The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. ⋯ We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses.
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A significant number of casualties in previous conflicts died from peripheral vascular wounds. A well-designed tourniquet could possibly have prevented these deaths. The objective of this study was the identification of such a tourniquet. ⋯ Of the several successful tourniquets, two were preferred. Tourniquets incorporating a windlass technique take longer to place and often fail when placed with only one hand. New, relatively simple tourniquet devices incorporating bladder and ratchet mechanisms can significantly improve tourniquet performance.
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To assess the influence of protective gear on intubation performance. ⋯ Protective gear causes a significant prolongation of intubation duration; however, endotracheal intubation can be performed effectively. Technical improvements are warranted for tube fixation because it is the critical step.