Respectfully,

Michelle DuGuay Landers, MBA, BSN, RN

Breakaway Media, LLC

Publisher

Journal of Special Operations Medicine (JSOM)

Lt Col, USAF/NC (Ret)

publisher@jsomonline.org

www.JSOMonline.org

Purchase our Handbooks

ABSTRACT

Optimal pain management is challenging in Tactical Combat Casualty Care (TCCC), particularly in remote and austere settings. In these situations, appropriate treatment for prehospital analgesia can be limited or delayed due to the lack of intravenous access. Several guidelines suggest to implement intranasal (IN) analgesia in French Armed Forces for forward combat casualty care (Sauvetage au Combat), similar to the US TCCC. Four medical teams from the French Medical Military Service were deployed to the Middle East and Sahel from August 2017 to March 2019 and used IN ketamine for analgesia in 76 trauma patients, out of a total of 259 treated casualties. IN administration of ketamine 50mg appeared to be safe and effective, alone or in addition to other opioid analgesics. It also had minimal side effects and led to a reduction in the doses of ketamine and morphine used by the intravenous (IV) route. The French Military Medical Service supports current developments for personal devices delivering individual doses of IN ketamine. However, further studies are needed to analyze its efficacy and safety in combat zones.

Admission Forced Vital Capacity Adds a Predictive Physiologic Tool to Triage Patients Suffering Rib Fractures: A Prospective Observation Trial

Johnston LR, Nam JJ, Nissen AP, Sleeter JJ, Aden JK, Mills AF, Sams VG. 23(1). 107 - 113. (Journal Article)

ABSTRACT

Background: Patients with rib fractures are at high risk for morbidity and mortality. This study prospectively examines bedside percent predicted forced vital capacity (% pFVC) in predicting complications for patients suffering multiple rib fractures. The authors hypothesize that increased % pFVC is associated with reduced pulmonary complications. Methods: Adult patients with =3 rib fractures admitted to a level I trauma center, without cervical spinal cord injury or severe traumatic brain injury, were consecutively enrolled. FVC was measured at admission and % pFVC values were calculated for each patient. Patient were grouped by % pFVC <30% (low), 30-49% (moderate), and =50% (high). Results: A total of 79 patients were enrolled. Percent pFVC groups were similar except for pneumothorax being most frequent in the low group (47.8% vs. 13.9% and 20.0%, p = .028). Pulmonary complications were infrequent and did not differ between groups (8.7% vs. 5.6% vs. 0%, p = .198). Discussion: Increased % pFVC was associated with reduced hospital and intensive care unit (ICU) length of stay (LOS) and increased time to discharge to home. Percent pFVC should be used in addition to other factors to risk stratify patients with multiple rib fractures. Bedside spirometry is a simple tool that can help guide management in resource-limited settings, especially in large-scale combat operations. Conclusion: This study prospectively demonstrates that % pFVC at admission represents an objective physiologic assessment that can be used to identify patients likely to require an increased level of hospital care.

ABSTRACT

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

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.

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. 

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.

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:

• Physicians
• Medics
• Educators
• Law Enforcement
• The military and civilian global medical community

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.

KEESLER AIR FORCE BASE, MS

Photo by Tech. Sgt. Kristen Pittman 

403rd Wing Public Affairs

DVIDS

Senior Airmen Alexis Adeleke and Matthew Devine, 36th Aeromedical Evacuation Squadron flight medics, review procedures during a local training flight out of Keesler Air Force Base, Miss., April 20, 2023. The 36th AES is part of the Air Force Reserve's 403rd Wing, and is responsible for providing medical care to patients needing aerial transport.

Do You Have a Photo to Share?  

Please send us your approved medical action images for future covers, our journal Photo Gallery, bi-weekly eNewsletters, and JSOM social media! All images must include captions in the emails in which they are sent. Images for print must be high resolution, at least 300 dpi. Images for the eNewsletter and social media must be at least 400px wide, 72 dpi.