Greetings JSOM Newsletter Subscribers,
We are currently at the 2021 Special Operations Medical Association's Scientific Assembly (SOMSA) in Charlotte, North Carolina. There is a lot to see and if you're attending the conference, please stop by our booth 501. We have complimentary copies of the JSOM available (while they last), as well as copies of our handbooks for purchase. One of the titles we have on hand is the brand new PJ Med Handbook 8th Edition. If you can't make the conference, the book will be available for purchase on our Online Store early next week.
Our Summer 2021 issue is out. Digital subscribers can access the issue via our website and print copies have already started arriving. The issue is also available to purchase on our Online Store here.
ZOLL is running live and on-demand clinical summits around brain injury from now through July 13. Please see the attached information.
The 2021 CMC (Combat Medical Care) conference is happening July 13th & 14th. This virtual symposium is one of the largest meetings on TCCC principals outside of the US. For more information, please see the attached flyer.
Have a safe and happy Independence Day!
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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
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ABSTRACT
Background: Tourniquet training sometimes involves models, and a certification process is expected to use something other than human limbs; therefore, investigating model- and limb-pressure responses to force application is important. Methods: Pressure response to force was collected for a 3.8cm-wide nonelastic strap and a 10.1cm-wide elastic strap placed over 14 objects. Each object was suspended; an inflated neonatal blood pressure cuff was placed atop the object with the strap over the bladder; and strap ends were connected below with 4.54kg weights attached at 20-second intervals to 27.24kg. Results: Pressure-response curves differed by strap, thigh aspect (medial, lateral, ventral, dorsal; n = 2 subjects; p < .0001); subject (medial thigh; n = 3 subjects; p < .0001); and object (thighs; small and large pool noodles ± central metal rod, foam yoga roller, coffee can, 20% ballistic gel cylinder [Gel; Clear Ballistics; clearballistics.com] with central metal tubing, rolled pair of 5mm yoga mats ± central metal rod, hemorrhage-control training thigh [Z-Medica], sand-filled training manikin limb [Drumm Emergency Solutions]; p < .0001). Compliance, circumference, support techniques, and surface interactions, especially with the 10.1cm-wide elastic strap, affected pressure responses: smaller circumference, lower compliance, and lower surface coefficient of friction were associated with higher pressure/force applied.
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ABSTRACT
Background: Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient FWB to treat critically wounded patients or multiple-hemorrhaging casualties. This study describes the effect of airdrop on FWB and explores the possibility of using airdrop to deliver FWB to combat medics treating casualties in the prehospital setting when FDA-approved, cold-stored blood products are not readily available and timely casualty evacuation (CASEVAC) is not feasible. Methods: Four units of FWB were collected from volunteer donors and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a standard airdrop training bundle (SATB) parachute. A control group of 4 units of FWB was stored in a blood cooler that was not dropped. Baseline and postintervention laboratory samples were measured in both airdropped and control units, including full blood counts, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), pH, lactate, potassium, indirect bilirubin, glucose, fibrinogen, lactate dehydrogenase, and peripheral blood smears.
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July 2021 JSOM Feature Article |
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Autopsy-Determined Atherosclerosis in Elite US Military Special Operations Forces
Kotwal RS, Mazuchowski EL, Howard JT, Hanak JC, Harcke HT, Gurney JM, Shackelford SA. 21(2). 19 - 24. (Journal Article)
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ABSTRACT
Background: Autopsy studies of trauma fatalities have provided evidence for the pervasiveness of atherosclerosis in young and middle-aged adults. The objective of this study was to determine the prevalence of atherosclerosis in elite US military forces. Methods: We conducted a retrospective study of all US Special Operations Command (USSOCOM) fatalities from 2001 to 2020 who died from battle injuries. Autopsies were evaluated from Afghanistan- and Iraq-centric combat operations for evidence of coronary and/or aortic atherosclerosis and categorized as minimal (fatty streaking only), moderate (10-49% narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Prevalence of atherosclerosis was determined for the total population and by subgroup characteristics of age, sex, race/ethnicity, combat operation, service command, occupation, rank, cause of death, manner of death, and body mass index (BMI). Results: From the total of 388 USSOCOM battle injury fatalities, 356 were included in the analysis. The mean age was 31 years (range, 19-57 years), and 98.6% were male. The overall prevalence of coronary and/or aortic atherosclerosis was 17.4%. The prevalence of coronary atherosclerosis alone was 13.8%. Coronary atherosclerosis was categorized as minimal in 1.1%, moderate in 7.6%, and severe in 5.1%. Of those with atherosclerosis, 24.2% were <30 years old, 88.7% were from enlisted ranks, and 95.2% had combatant occupations. When BMI could be calculated, 73.5% of fatalities with atherosclerosis had a BMI =25. Conclusions: Autopsy-determined atherosclerosis is prevalent in elite US military Special Operations Forces despite young age and positive lifestyle benefits of service in an elite military unit.
Keywords: atherosclerosis; elite US military forces; coronary atherosclerosis; aortic atherosclerosis
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The Journal of Special Operations Medicine Podcast |
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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 addition, the podcast features a special, not to be missed Interview Series with leaders, doctors, and authors. |
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Spring 2021
The new JSOM podcast episode is up on our website and on Apple podcasts. For this episode, our podcast hosts Alex and Josh take a deep dive into civilian practice with the world-renowned rotor wing tactical detail from Los Angeles. Their interview with Deputy Steve Doucette of the Los Angeles County Sheriff's Dept will give you a better understanding of the original transfer of tactical skills from military to law enforcement setting after the Korean war. We then find out about the absorption of tactical medicine into special weapons and tactics (SWAT) teams and its recent drastic evolution, thanks to the hard-won lessons from the battlefield. Our interview ends with an outstanding overview of the difference between a tactical medic, tactical medicine, and TEMS. Please let us know what you think about our foray into civilian medicine.
Our Interview with Dr. Stephen Rush is now available on the JSOM podcast. One of the true pillars of our SOF medical community, Doc Rush helps us learn more about the tremendous advances in special operations en route care over the last 20 years. We also get to hear about his background and how he serendipitously become involved with pararescue in the latter part of his civilian physician career. Looking back through the retrospectoscope, he is able to describe the training and level of en route care provided at the turn of the last century.
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Highlights From the JSOM Special Talk Series:
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COL (Ret) Russ Kotwal, MD, MPH
Dr. Kotwal spent nearly 30 years in the military and more than 15 years in operational assignments with the 25th Infantry Division, 75th Ranger Regiment, and U.S Army Special Operations Command. He deployed to combat 12 times with the Rangers -- nine times to Afghanistan and three to Iraq. He conducted hundreds of combat ground and air missions as the senior medical provider and is highly decorated, including five Bronze Star medals, two Joint Service Commendation medals for Valor, and two combat jump stars, among many others. Dr. Kotwal is also a master parachutist, master flight surgeon, and Ranger qualified. He is credited with numerous novel training and technology initiatives, professional publications, and national and international presentations related primarily to prehospital medicine on the battlefield. Dr. Kotwal is an adjunct professor for both the Texas A&M Health Science Center and the Uniformed Services University of the Health Sciences. He has been an advisor for the Defense Health Agency’s Joint Trauma System and Committee on Tactical Combat Casualty Care, as well as the National Academy of Sciences, Engineering and Medicine. He is a Fellow of the American Academy of Family Physicians, a Hero of Military Medicine award recipient, a Distinguished Member of the 75th Ranger Regiment, an inductee into the US Army Ranger Hall of Fame, and the current president of the Special Operations Medical Association.
MSG (Ret.) Rick Hines I
Rick Hines has a long history in Special Operations and is currently an instructor Special Warfare Training Group. He teaches at the SF Medical Sergeant Recertification Course and focuses on anesthesia and surgical care in the austere environment. Rick discusses the benefits of recycling at the 18D course, historical basis, and current practice of surgical care and anesthesia for the far forward Special Operations medic.
Dr. Kyle Stigall
Dr. Stigall attended the United States Air Force Academy for undergrad and the University of Kentucky for medical school. He is currently a fourth-year general surgery resident at Brooke Army Medical Center. He completed a research year at the Naval Medical Research Unit in San Antonio in 2020 with a focus on trauma resuscitation and plans to apply to the Air Force Special Operations Surgical Team next year.
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FOXSEAL™ VENTED
512 REASONS IT’LL NEVER LET YOU DOWN
A Special Presentation from CeloxTM Medical / Medtrade Products Ltd.
Tension pneumothorax is a life-threatening condition that develops when air enters the chest from outside the body through a penetrating chest injury. This pressure can build up and if trapped inside, can lead to the collapse of the lung. Such build-up of pressure can compress both the affected and unaffected lung, as well as the heart and great vessels, leading to reduced cardiac output and death.
Emergency treatment is needed to allow the trapped air out and seal the wound area, preventing further tension. Combat-related thoracic trauma has been a significant contributor to the morbidity and mortality of casualties throughout multiple decades. Pneumothorax is reported as the most common injury sustained in chest trauma, occurring in 20% of patients. In the late 1980s and early 1990s, a study of 3,640 military casualties concluded that 10.7% were treated for chest injuries.
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Institutional Subscribers and Re-subscribers |
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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.
This edition, we welcome PPA International Medical of Aalborg, Denmark to the growing list of JSOM institutional Subscribers. Welcome!
Visit https://jsom.us/Library for a full list of institutions that are 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 both 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 either 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 professional 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 would like more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.
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LANDSTUHL, RP, GERMANY
DVIDS
U.S. Army Spc. Brooke Rivera (left), healthcare specialist, Landstuhl Regional Medical Center, and U.S. Army Pvt. Qu’Darius Clayton (right), orthopedic specialist, apply a tourniquet to a simulated casualty during Operation Courageous Fury, a joint training exercise designed to assess medical operations in Germany at Landstuhl Regional Medical Center. The exercise was designed to measure Service Members’ competency in combat lifesaving skills and Army Warrior Training. The three-day exercise is the third training event of its kind at LRMC, a Role 4 theater hospital responsible for the medical care of wounded, ill or injured warfighters evacuated from the U.S. European Command, U.S. Africa Command, and U.S. Central Command areas of operation.
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Journal of Special Operations Medicine
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