A Word From Our Publisher

Greetings JSOM Newsletter Subscribers,

The Spring 2023 episode of the JSOM podcast is now available. Listen here as Josh, Alex, and our guest medic editor, SSG Blake Wright, discuss content from the current issue. We want to grow our listening audience and would like to encourage all of our subscribers to share the JSOM podcast with friends and colleagues. These succinct

conversations are crafted to present this important information in a way that flows and informs, and the episodes are available wherever you listen to podcasts. Please subscribe, rate, and review! For more information about this episode and a chance to win a free copy of the Ranger Medic Handbook, be sure to follow us on social media @jsomonline. We will have an announcement later in the week.

The new and updated Standard Medical Operations Guide CY 2023 (SMOG) is out and available for purchase. This current set of medical guidelines was developed by collaborating with Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in developing these guidelines by the Joint Trauma System, the Committee of En Route Combat Casualty Care, and the Committee of Tactical Combat Casualty Care. The shared goal is to ensure excellent en-route care that is standard across all evacuation and emergency medical pre-hospital units. All these enhancements and improvements will advance en-route care across the services and the Department of Defense. Purchase the handbook here.


Michelle DuGuay Landers, MBA, BSN, RN

Breakaway Media, LLC


Journal of Special Operations Medicine (JSOM)

Lt Col, USAF/NC (Ret)



Purchase our Handbooks

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Journal of Special Operations Medicine Featured Abstracts

Epidemiology of Musculoskeletal Injuries Among Naval Special Warfare Personnel

Lovalekar MKeenan KABird MCruz DEBeals KNindl BC. 23(1). 38 - 44. (Journal Article)


Background: Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students. Methods: In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests. Results: Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students. Conclusion: MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs.

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Association of Body Mass Index with Injuries: A Systematic Review and Meta-Analyses Comparing Healthy Weight Military Service Members with Underweight, Overweight, and Obese

Knapik JJHoedebecke SS. 23(1). 96 - 102. (Journal Article)


Obesity is a worldwide health problem that has reached pandemic proportions. In the military, obesity and overweight are associated with health problems, attrition from military service, and reduced job performance. National and international organizations suggest body mass index (BMI) as a population screening tool to define overweight and obesity. BMI is calculated as weight/height2 (kg/m2). Four categories of adult BMI are underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (=30.0 kg/m2). This article reports on a systematic review and meta-analysis examining the association between BMI and injury risk among military service members (SMs). Studies were selected for review if they involved military personnel, were prospective or retrospective observational studies, and contained original quantitative data on injury risk at all four BMI levels. Nine studies met the review criteria. Pooled data from these investigations indicated that underweight, overweight, and obese individuals were at 1.17 (95% confidence interval [95%CI]=1.07-1.28), 1.03 (95%CI=1.01-1.06), and 1.15 (95%CI=1.11-1.20) times higher risk of injury than healthy weight individuals, respectively. Compared with healthy weight SMs, military personnel with both low and high BMI are at higher injury risk.

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May 2023 Featured Article

The Effect of Prehospital Blood Transfusion on Patient Body Temperature from the Time of Emergency Medical Services Transfusion to Arrival at the Emergency Department 

Mannion E, Pirrallo RG, Dix A, Estes L. 23(1). 46 - 53. (Journal Article)


Background: Transfusion of blood products is life-saving and time-sensitive in the setting of acute blood-loss anemia, and is increasingly common in the emergency medical services (EMS) setting. Prehospital blood products are generally "cold-stored" at 4°C, then warmed with a portable fluid-warming system for the purpose of preventing the "lethal triad" of hypothermia, acidosis, and coagulopathy. This study aims to evaluate body temperature changes of EMS patients receiving packed red blood cells (PRBC) and/or fresh frozen plasma (FFP) when using the LifeWarmer Quantum Blood & Fluid Warming System (LifeWarmer, https://www.lifewarmer.com/). Methods: From 1 January 2020 to 31 August 2021, patients who qualified for and received PRBC and/or FFP were retrospectively reviewed. Body-temperature homeostasis pre- and post-transfusion were evaluated with attention given to those who arrived to the emergency department (ED) hypothermic (<36°C). Results: For all 69 patients analyzed, the mean initial prehospital temperature (°C) was 36.5 ± 1.0, and the mean initial ED temperature was 36.7 ± 0.6, demonstrating no statically significant change in value pre- or post-transfusion (0.2 ± 0.8, p = .09). Shock index showed a statistically significant decrease following transfusion: 1.5 ± 0.5 to 0.9 ± 0.4 (p < .001). Conclusion: Use of the Quantum prevents the previously identified risk of hypothermia with respect to unwarmed prehospital transfusions. The data is favorable in that body temperature did not decrease in critically ill patients receiving cold-stored blood warmed during administration with the Quantum.

Keywords: prehospital blood transfusion; lethal triad; damage-control resuscitation; Tactical Combat Casualty Care

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The Journal of Special Operations Medicine Podcast

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field.

Current Episode

The Spring 2023 episode of the JSOM podcast is our most recent recording and is now available on our website and wherever you listen to podcasts.

Our guest medic editor this quarter, SSG Blake Wright, enlisted in 2013 and has since served in various roles across the 173d, 82d Airborne, and USASOC. He currently serves as a Special Operations Flight Medic and has future aspirations of applying to the Inter-Service Physician Assistant Program. He will review The Effect of Prehospital Blood Transfusion on Patient Body Temperature from the Time of Emergency Medical Services Transfusion to Arrival at the Emergency Department.

Our author interview will be with Sean M. Stuart, DO, FACEP, FAAEM, FAWM Commander, Medical Corps, US Navy (Naval War College). Commander Stuart received his Doctor of Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine in 2009. CDR Stuart reported to the 3rd Battalion, 3rd Marines, where he served as the Battalion Surgeon from 2010 to 2013. During this time, CDR Stuart deployed twice to support Operation Enduring Freedom. He also served as the Director of Medical Readiness for 3d Marines. CDR Stuart also served as the Deputy Regimental Surgeon, coordinating medical support for developing Marine Rotational Force–Darwin and RIMPAC exercises. He pioneered the development of a combat training curriculum, created a training tactical simulation laboratory, and served as the Director of Operational Training. In 2014, CDR Stuart began his emergency medicine residency training. After graduating, CDR Stuart assumed the role of MEU Surgeon for the 13th Marine Expeditionary Unit. In 2019, CDR Stuart returned to Naval Medical Center Portsmouth as academic faculty. In 2022, CDR Stuart was selected to attend the Naval War College. CDR Stuart is board-certified in Emergency Medicine, holds a faculty appointment as Assistant Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, and is a Fellow of the American College of Emergency Physicians, American Academy of Emergency Medicine, and the Academy of Wilderness Medicine. He will review iTClamp-Mediated Wound Closure Speeds Control of Arterial Hemorrhage with or without Additional Hemostatic Agents on p. 87 of the Winter 2022 edition.

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The Journal of Special Operations Medicine is proud to have the support of many great sponsors and media partners. Our sponsors are leaders in the field of military medical technology. Please help support these companies by following the links below to learn more about their missions and the products they offer. This section also features peridoic promtional information for events and conferences, including the 2023 SOMA Scientific Assembly. 

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The JSOM is incredibly grateful to have the support of many institutions around the world. We would like to thank our recent institutional subscribers and re-subscribers for their support by acknowledging them in our eNewsletter and, when applicable, sharing their social media information.

Visit https://jsom.us/Library for a full list of institutions currently subscribing to the JSOM. We are beginning a campaign to expand our institutional subscriptions. If you think your company would benefit from an institutional subscription, let us know! We'll be happy to talk to you and get the ball rolling. You don't have to be a university or medical center to subscribe - we have many EMS units, government agencies, and military medical units in the United States and abroad.

Are you on the list? Great! Need to know how to access our resources? You can either contact your head librarian or shoot an email to subscriptions@JSOMonline.org.

Institutions receive a print copy of our journal, digital access, or both. Digital subscribers have unlimited access to our full compendium of articles, journals, and the ATP-P. If you are a student, researcher, doctor, or other medical professionals at one of these institutions, please contact your librarian for login details. Additionally, the digital resources are typically available 2-3 weeks ahead of print publication.

If your institution is not on the list and you want more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.

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For over 20 years, the Journal of Special Operations Medicine (JSOM) has brought important, lifesaving information to the Special Operations Forces (SOF) community. And over the years, as our audience and readership has expanded into over 80 countries, physicians, military and tactical medics, and other medical professionals working in unconventional environments rely on the JSOM for breakthrough research at the intersection of operational medicine and tactical casualty care. Our peer-reviewed research and interactive clinical content make the JSOM a must-read for:

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For these reasons, many of the world’s top medical technology companies and medical device distributors make the JSOM a cornerstone of their advertising programs. And with a strong multichannel and social media presence, the JSOM offers the most dynamic print and digital media options at cost-effective prices. For medical marketers worldwide looking to reach our niche audience, the JSOM is the gold standard. For more information, please see our attached media kit.

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Photo of the Week


Photo by Alejandro Pena  

Joint Base Elmendorf-Richardson Public Affairs 

U.S. Airmen from across the 673d Medical Group render tactical combat casualty care (TCCC) to a simulated trauma victim during the Arctic Warrior Challenge 2022 at Joint Base Elmendorf-Richardson, Alaska, April 20, 2023. The Arctic Warrior Challenge was a scenario-based field training exercise designed to hone the 673d Medical Group Airmen’s TCCC skills, improve operational readiness, and foster unit cohesion. TCCC outlines prehospital combat medicine devised to provide lifesaving care to injured combatants, to limit the risk of further casualties, and to help achieve mission success.

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