ABSTRACT

Rapid and effective tourniquet application is crucial in life-threatening limb hemorrhage to minimize mortality. However, the widespread availability of counterfeit tourniquets is a growing concern, as these devices may lack essential quality control measures, potentially compromising patient care. We describe one case where the delayed mechanical failure of a Combat Application Tourniquet (CAT)-like tourniquet caused the death of a Ukrainian soldier during evacuation to an urban trauma center. In April 2022, a 19-year-old male underwent a bilateral below-the-knee amputation from an antipersonnel landmine. Massive hemorrhage prompted the use of bilateral CAT-like tourniquets. During transportation, the right tourniquet's windlass broke, resulting in a brisk hemorrhage. Due to the high patient-to-healthcare-personnel ratio, the bleeding remained unaddressed for an unknown amount of time, resulting in death from hemorrhagic shock. This study underscores the need for robust quality control measures and the establishment of strict regulations against deploying counterfeit tourniquets to avoid preventable deaths.

Sandfly Fever

Jarvis J. 24(3). 70 - 73. (Journal Article)

Biting sandflies are known for transmitting leishmaniasis, but sandflies also transmit sandfly fever viruses that may disrupt military operations. Sandfly fever is caused by serotypes of the Phlebovirus genus (primarily the Naples, Sicilian, or Toscana serotypes). The illness is known colloquially as "three-day fever" and "papataci fever." The clinical course of the disease normally spans about 3 days, with patients exhibiting a prodromal phase consisting of fatigue, chills, abdominal pain, and possibly facial flushing and tachycardia. Disease onset is marked by hyperpyrexia, myalgia, and arthralgia. The incubation period is typically 3-5 days, with viremia in humans lasting typically less than 1 week. This manuscript describes sandfly appearance, behavior, and geographic distribution. It then lists comparable diseases for differential diagnosis. Finally, as no vaccine exists for the sandfly virus, it concludes with steps for preparation and prevention to prevent outbreaks from disrupting military operations.



ABSTRACT

Introduction: A systematic radiological examination is needed for military airborne troops in order to detect subclinical medical contraindications for airborne training. Many potential recruits are excluded because of scoliosis, kyphosis, or spondylolisthesis. This study aimed to determine whether complementary radiological assessment excludes too many recruits and whether medical standards might be lowered without increasing medical risk to appointees. Methods: This retrospective, epidemiological, cross-sectional single-center study spanned 5 years at the French paratroopers' initial training center. We analyzed all medical files and full-spine X-ray results of all enlisted troops during this period. Secondary evaluation by an orthopedic surgeon enabled 23 enlisted personnel, deemed medically unacceptable because of X-ray findings, to be given waivers for airborne training. A follow-up review of their 23 files was conducted to determine whether static-line parachute jumps were hazardous to those who were initially declared medically unacceptable. Results: Of the 3,993 full-spine X-rays, 67.5% (2,695) were described as having normal alignment and structure; 21.8% (871) had lateral spinal deviation; and 10.7% (427) had scoliosis. Sixty-six recruits (1.6%) were deemed unfit because of findings that did not meet the standard on the full spine X-ray: 53 enlisted personnel had scoliosis greater than 15°, and 13 had spondylolisthesis (grade II or III). Of the 23 patients granted waivers, 82.3% with scoliosis (14) and all patients with kyphosis had not declared any back pain after 5 years. Conclusion: The findings, supported by a literature review of foreign military data, suggest that spondylolisthesis above grade I and low back pain are more significant than scoliosis and kyphosis for establishing airborne standards.

Keywords: military medicine; airborne; scoliosis; kyphosis; spondylolisthesis

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. The Summer 24 episode is here! We have also uploaded a bonus episode for our listeners featuring a special interview with Jeff Butler, co-author of Tell Them Yourself: It's Not Your Day to Die."

Current Episode

Our JSOM podcast team will be reviewing the following articles for our Summer podcast: 

Advancing Combat Casualty Care Statistics and Other Battlefield Care Metrics by Jud C. Janak, Russ S. Kotwal, Jeffrey T. Howard, Jennifer M. Gurney, Brian J. Eastridge, John B. Holcomb, Stacy S. Shackelford, Robert A. De Lorenzo, Ian J. Stewart, and Edward L. Mazuchowsk (https://www.jsomonline.org/FeatureArticle/2024211Janak.pdf)

Evaluation of a Rebreathing System for use with Portable Mechanical Ventilators by Thomas Blakeman, Maia Smith, and Richard Branson (https://www.jsomonline.org/FeatureArticle/2024234Blakeman.pdf)

The Effect of Critical Task Auto-failure Criteria on Medical Evaluation Methods in the Pararescue Schoolhouse by Ian Richardson, Michael Lauria, Brian Gravano, Jeffrey Swenson, and Stephen Rush (https://www.jsomonline.org/FeatureArticle/2024267Richardson.pdf)

JSOM Guest Author

Advancing Combat Casualty Care Statistics and Other Battlefield Care Metrics author Jud C. Janak will be interviewed by our podcaster team about the article. 

Jud C. Janak, PhD, has over 10 years of experience as an epidemiologist and applied biostatistician in the private sector, public sector, and academia. He has published over 50 peer-reviewed studies on topics related to traumatic injury, accelerated aging, chronic disease, and real-world pharmacoepidemiology. He completed a post-doctoral fellowship at the U.S. Army Institute for Surgical Research where he focused on traumatic brain and genitourinary injuries. He was Director of Epidemiology and Biostatistics for the Department of Defense Joint Trauma System from 2017 to 2020. He also served as the lead epidemiologist for the Military Trauma Preventable Death Working Group. He was an Associate Director of Epidemiology at CorEvitas from 2020 to 2023. His current responsibilities focus on leveraging real-world patient and clinical registry data to study the safety and effectiveness of FDA-approved therapies as a Principal Epidemiologist in the Real-World Data Research and Analytics group at Merative. Dr. Janak received his master’s and doctoral degrees in Epidemiology from the University of Texas Health Science Center School of Public Health.

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