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If you are working from an older edition of the Ranger Medic Handbook and/or the Standard Medical Operations Guide (SMOG) now is the time to update your resource. Save 10% today by using the code MemDay2022 at checkout. This code will expire on 6/4.

Michelle DuGuay Landers, MBA, BSN, RN
Breakaway Media, LLC
Journal of Special Operations Medicine (JSOM)
Lt Col, USAF/NC (Ret)
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Journal of Special Operations Medicine Featured Abstracts

Use of Knives and Multitools to Perform a Cadaveric Limb Amputation

Baker RAWorth KPourrajabi NMartin JMitchell SBaker S. 22(1). 71 - 75. (Journal Article)


Background: An austere field amputation can be a life-saving procedure for an entrapped patient when standard equipment is not available or operable. The objective of this study was to use hand tools to perform cadaveric amputations in < 2 minutes. Methods: Timed guillotine amputation of the extremities on three cadavers was attempted using four available hand tools: a multitool, a rescue tool, a hunting knife, and a fixedblade knife. The primary outcome was successful amputation of the extremity in < 2 minutes. Results: Amputation success was different among the tools. The multitool amputated 78% of attempts; the hunting knife, 67%; the rescue knife, 56%; and the fixed-blade knife, 44%. The distal tibia/fibula and radius/ ulna were amputated successfully in 100% of attempts, whereas none of the tools could amputate the femur. The multitool received the best subjective ranking - 1.4 (p = .001) - by amputators, with the fixed-blade knife receiving the worst score. Conclusions: In the rare circumstance that an emergent field amputation requires a hand tool, the multitool is a capable instrument for a distal extremity amputation.


Injuries During High-Intensity Functional Training: Systematic Review and Meta-Analysis

Knapik JJ. 22(1). 121 - 129. (Journal Article)


High-intensity functional training (HIFT) involves high-volume and high-intensity physical activities with short rest periods between movements and use of multiple joint exercises. This article reports the results of a systematic review and meta- analysis of studies involving injuries during HIFT. Individual studies were selected for review if they involved individuals =18 years of age and provided quantitative data on injury prevalence and/or injury rates during HIFT. Twenty-eight studies involving 11,089 participants met the inclusion criteria. There was considerable variability in individual studies with injury prevalences ranging from 12% to 74% and injury rates from 0.04 to 18.90 injuries/1000 h of training. Meta-analyses indicated that the overall injury prevalence was 36% (95% confidence interval [95% CI] = 32-41%) and overall injury rate 4.3 injuries/1000 h (95% CI = 3.35-5.23). Injury rates among the five available prospective cohort studies was considerably higher, 9.9 injuries/1000 h (95% CI = 3.3-16.4). The most commonly injured anatomical locations (with % of total injuries) were the shoulder (26%), back/spine (26%), knee (14%), wrist/hands/fingers (12%), arm/elbow (10%), and ankle/foot (6%). Given the higher injury rates among prospective studies that likely more effectively tracked injuries over time, more prospectively designed studies are required before the injury rate during HIFT can be appropriately quantified.


June 2022 Featured Article

Development of a Swine Polytrauma Model in the Absence of Fluid Resuscitation (Winter 2021)

Abdou H, Patel N, Edwards J, Richmond MJ, Elansary N, Du J, Poliner D, Morrison JJ. 21(4). 77 - 82. (Journal Article)


Background: In locations in which access to resuscitative therapy may be limited, treating polytraumatized patients present a challenge. There is a pressing need for adjuncts that can be delivered in these settings. To assess these adjuncts, a model representative of this clinical scenario is necessary. We aimed to develop a hemorrhage and polytrauma model in the absence of fluid resuscitation. Materials and Methods: This study consisted of two parts: pulmonary contusion dose-finding (n = 6) and polytrauma with evaluation of varying hemorrhage volumes (n = 6). We applied three, six, or nine nonpenetrating captive bolt-gun discharges to the dose-finding group and obtained computed tomography (CT) images. We segmented images to assess contusion volumes. We subjected the second group to tibial fracture, pulmonary contusion, and controlled hemorrhage of 20%, 30%, or 40% and observed for 3 hours or until death. We used Kaplan-Meier analysis to assess survival. We also assessed hemodynamic and metabolic parameters. Results: Contusion volumes for three, six, and nine nonpenetrating captive bolt-gun discharges were 24 ± 28, 50 ± 31, and 63 ± 77 cm3, respectively (p = .679). Animals receiving at least six discharges suffered concomitant parenchymal laceration, whereas one of two swine subjected to three discharges had lacerations. Mortality was 100% at 12 and 115 minutes in the 40% and 30% hemorrhage groups, respectively, and 50% at 3 hours in the 20% group. Conclusion: This study characterizes a titratable hemorrhage and polytrauma model in the absence of fluid resuscitation. This model can be useful in evaluating resuscitative adjuncts that can be delivered in areas remote to healthcare access.

Keywords: Polytrauma model; pulmonary contusion; controlled hemorrhage; tibial fracture; delayed medical care; prolonged casualty care; prolonged field 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.


In this episode of the JSOM Podcast, Alex and Josh review:

Feasibility of Obtaining Intraosseous and Intravenous Access Using Night Vision Goggle Focusing Adaptors by Alexander Iteen, MD, and colleagues (p. 56)

The Efficacy of Vancomycin Powder in Mitigating Infection of Open Penetrating Trauma Wounds on the Battlefield: An Evidence-Based Review by Brett R. TerBeek, 18B, 18F, MPAS, and colleagues (p. 76)

Development of a Swine Polytrauma Model in the Absence of Fluid Resuscitation by Hassam Abdou, MD, and colleagues (p. 77, Winter 2021 Edition)

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In this edition, we welcome back the Medical Support Unit Hereford Garrison, United Kingdom, and the 528th Sustainment Brigade, Ft. Bragg, North Car!

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Photo of the Week


Photo by Airman 1st Class Joshua Hastings 

6th Air Refueling Wing Public Affairs


U.S. Air Force Airman 1st Class Ruby Akwei Luke Anthony, 6th Medical Group lab technician, drags a manikin to a safe location during a Tactical Combat Casualty Care (TCCC) assessment at MacDill Air Force Base, Florida, May 26, 2022. During TCCC, Airmen are taught to remove wounded members from the battlefield to secure locations once enemies are suppressed and the area is no longer under effective fire. 

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