Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
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Battlefield tourniquet use can be lifesaving, but most reports are from hospitals with knowledge gaps remaining at the forward surgical team (FST). The quality of tourniquet applications in forward settings remain unknown. The purpose of this case series is to describe observations of tourniquet use at an FST in order to improve clinical performance. ⋯ Tourniquets are liberally applied to extremity injuries on the battlefield. 17% were arterial and 83% were venous tourniquets. When ongoing bleeding or distal pulses were appreciated, medics tightened tourniquets under surgeon supervision until distal pulses stopped. Medics were generally surprised at how tight a tourniquet must be to stop arterial flow ? convert a venous tourniquet into an arterial tourniquet. Implications for sustainment training should be considered with regard to this life-saving skill.
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Protracted use of stressors during military training courses does not necessarily enhance a Soldier?s ability to regulate stress on the battlefield. Extensive stress during training can be a contributing factor to suboptimal neurologic and overall long-term health. Prolonged high-stress military training programs, as well as extended duration combat deployments, should be comprehensively scrutinized for opportunities to preserve health and increase combat effectiveness. Contemporary research in neuroscience and psychology can provide insight into training techniques that can be used to control stress and optimize performance in combat. Physical fitness training programs can elevate the stress threshold. Extensive situational training can also inoculate Soldiers to specific combat stressors. Training methods such as these will enable Soldiers to achieve higher levels of performance while under enemy fire and are encouraged for units deploying to combat. ⋯ combat stress, military training, military deployment, physical training, post-traumatic stress disorder, sleep deprivation, stress inoculation training.
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Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. ⋯ MEDSEMs leave residual sustainable medical capabilities, in contrast to MEDCAP models. This report describes a modification of the MEDSEM concept?Medical Mentoring Event (MME)?a short term focused intervention designed to insert medical technology or techniques into an indigenous medical facility that creates sustainable, tangible benefits to patient care while fostering a SOF Commanders objectives. Follow up with embedded NATO trainers at National Military Hospital (NMH) shows that the video laryngoscope continues to be used successfully in airway management training and in difficult intubations, enhanced the teaching impact of imbedded NATO medical mentors, left a residual training capability for Afghan medical instructors and created relationships between SOF medical providers and the host institution that can facilitate healthcare for SOF partner forces.
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The objective was to determine the effects of darkness on self-application of a stretch and wrap style tourniquet. ⋯ The SWAT-T stretch and wrap style tourniquet can be self-applied properly even in darkness. When properly applied, it can stop limb arterial flow.
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Historical review of modern military conflicts suggests that airway compromise accounts for 1?2% of total combat fatalities. This study examines the specific intervention of pre-hospital cricothyrotomy (PC) in the military setting using the largest studies of civilian medics performing PC as historical controls. The goal of this paper is to help define optimal airway management strategies, tools and techniques for use in the military pre-hospital setting. ⋯ The majority of patients who underwent PC died (66%). The largest group of survivors had gunshot wounds to the face and/or neck (38%) followed by explosion related injury to the face, neck and head (33%). Military medics have a 33% failure rate when performing this procedure compared to 15% for physicians and physician assistants. Minor complications occurred in 21% of cases. The survival rate and complication rates are similar to previous civilian studies of medics performing PC. However the failure rate for military medics is three to five times higher than comparable civilian studies. Further study is required to define the optimal equipment, technique, and training required for combat medics to master this infrequently performed but lifesaving procedure.