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Objective: There is a need to develop a training oriented to citizens so they can identify and use available resources to avoid preventable deaths that occur in this kind of incidents, especially massive hemorrhage. Methods: A 7-hour training intervention program was developed and conducted between January and May Data were collected from participants' answers on a multiple-choice test before and after undertaking the training.

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Conclusion: There was a clear improvement in the knowledge of the students after the training when pre- and post-training test scores were compared within the three groups. Keywords: tourniquet ; hemostatic ; compression bandage ; terrorism ; mass-casualty event. Buy Now. Banting J , Meriano T. In the process, core knowledge and management principles are enhanced. A clinical case will be presented. Details will be presented in such a way that the reader can follow along and identify how they would manage the case clinically depending on their experience and environment situation.

Commentary will be provided by currently serving military medical technicians. Commentary and input from active special operations medical technicians will be part of the feature. Keywords: muscle, fatigue ; muscle, soreness ; rhabdomyolysis ; workout. Ryan L. Independently published April 17, ISBN Independently published August 3, Hubbard B , Freeman C. Keywords: improvisation ; tourniquets. On 3 October , the first chalk of Night Stalkers left Campbell Army Airfield enroute to Uzbekistan in support of what would become our nation's longest war.

The vast majority of Soldiers were untested in war and would quickly have the opportunity to meet with the enemies of our nation in close combat. Due to the inherent nature of forced entry operations restrictive terrain, lack of medical infrastructure, etc. Military and civilian trauma can be distinctly different but the leading cause of preventable trauma deaths in the prehospital environment, extremity hemorrhage, does not discriminate.

The current paper is the most comprehensive review of limb tourniquets employable in the tactical combat casualty care environment and provides the first update to the CoTCCC-recommended limb tourniquets since This review also highlights the lack of unbiased data, official reporting mechanisms, and official studies with established criteria for evaluating tourniquets.

Background: Special Operations Forces SOF medics have written and published numerous practice reflections that intricately describe their practice environments, clinical dilemmas, and suggestions for teaching and practice. The lack of translation of SOF medics' experiential evidence to their curriculum has created a gap in evidence-based curriculum development.

This study analyzed SOF medics' learning and practice patterns and compared it to the evidence in the interdisciplinary clinical literature. After framing the problem, the literature was reviewed to determine appropriate tools by which perceptions and attitudes toward reflection-centered curricula could be measured. Methods: A recognizable practice reflection was extracted from the published SOF clinical literature and presented in writing to self-identified SOF medics and medic instructors via a descriptive crossover design, to ensure possible biases were mitigated.

To measure SOF medics' perceptions of reflection-based curricula, the Dundee Ready Education Environment Measure survey instrument was used, as it has validated psychometric properties and is used worldwide. Results: SOF medics' averaged scores of perceptions of their medic education indicated positive but not completely statistically significant preferences toward reflection-based curricula over traditional curriculum. Keywords: Special Operations ; medics ; reflective practice ; curricula. The hyperresourced, uber-controlled, ultrareactive, constant environment that we have come to know in the past 20 years should not be mistaken as the norm in conflict.

In truth, unrealistic expectations of both commanders and systems in resourcing is presently being reinforced almost daily. Only in the past few years of this decade have the majority of allied forces experienced challenge in resupply and support in contingency operations.


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When logistical lines are cut, limited, or untimely, we must know and exercise other means of providing the highest level of medical care possible-if not with indigenous ways and means, then by improvisation. History has proved that improvised medicine can be capable, professional, and ethically sound if practiced properly and to standards, the price being time, education, and investment in the requirement.

Most often, these are already time-honored means of care. Keywords: military medicine ; environment ; equipment design ; unconventional medicine. During an assault on an extremely remote target, a US Special Operations Soldier sustained multiple gunshot and fragmentation wounds to the thorax, resulting in a traumatic arrest and subsequent survival.

The case is used to illustrate the complex dynamics of Special Operations care on the modern battlefield and the exceptional outcomes possible when evidence-based medicine is taken to the warfighter with effective, farforward, expeditionary medical-force projection. Musculoskeletal complaints comprise the majority of cases encountered by military physicians when evaluating young active duty Soldier-athletes. This is a case of reactive arthritis in a year-old active duty Soldier-athlete whose failure to improve with conservative therapy initiated further investigation.

When evaluating what appear to be routine overuse injuries, it is important to actively include other potential causes of musculoskeletal complaints in the differential diagnosis. Further investigation of disease in patients whose symptoms and complaints do not improve with routine conservative care is paramount.

Reactive arthritis, though self-limiting in two-thirds of those affected, can become a chronic disabling disease affecting as many as 40 out of patients. Current theories suggest the persistent presence of non-culturable bacteria and bacterial antigens residing in the joint synovia as the etiology of the disease state. There is no curative therapy for reactive arthritis and management is focused on the treatment of symptoms with non-steroidal anti-inflammatory drugs NSAIDs , immunomodulator therapy, and antibiotics if an infectious source is suspected. Case Reports. Blood flow-restricted resistance BFRR training is effective as a means to improve muscle strength and size while enduring less mechanical stress.

It is generally safe but can have adverse effects.

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We present a case of an active duty Soldier who developed rhabdomyolysis as a result of a single course of BFRR training. He was presented to the emergency department with bilateral lower extremity pain, was admitted for electrolyte monitoring and rehydration, and had an uncomplicated hospital course and full recovery.


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This is an increasingly common mode of rehabilitation in the military, and practitioners and providers should be aware of it and its possible adverse effects. Keywords: rhabdomyolysis ; blood flow restricted training ; ischemic training.

Intelligence and Evolutionary Biology

Scott A , Hogan R. Medical Stability Operations has evolved into Global Health Engagement in the lexicon of planners but the goal is still the same. The case study evaluates the utility of a hypothetical framework developed by the RAND researchers relative to the actual events and outcomes of an actual mission. The principal finding is that the RAND technical report is of value to planners, Operators, and trainers as a systematic approach to successful building partner capacity in health BPC-H missions.

The article also offers several examples of metrics that aid leadership in making better decisions as to when corrective actions might be required.

Reality: A Synthesis of Thomistic Thought

Background: Studies indicate that the skills needed to use video laryngoscope systems are easily learned by healthcare providers. This study compared several video laryngoscopic VL systems and a direct laryngoscope DL view when used by medical residents practicing intubation on cadavers. The cadavers were lightly embalmed.

The study subjects were asked to perform intubations on two cadavers using both DL and VL while using the three different VL systems. Procedural data was recorded for each attempt and pre and post experience perceptions were collected. All subjects reported their varied previous intubation experience. Conclusion: Based on our data, we believe that the incorporation of VL into cadaver airway management training provided an improved learning environment for the study residents.

In conclusion, the researchers believe this cadaver model incorporated with VL is a powerful tool which may help improve the overall learning curve for orotracheal intubation. Keywords: videolaryngoscopy ; prehospital ; direct laryngoscopy ; indirect laryngoscopy ; intubation ; cadaver. Background: Airway obstruction is the second most common cause of potentially preventable death on the battlefield.

We compared survival in the combat setting among patients undergoing prehospital versus emergency department ED intubation. We compared study variables between these cohorts; survival was our primary outcome.

The Lying-in Hospital: An Attraction for Medical Students

A lower proportion of the prehospital cohort survived to hospital discharge The prehospital cohort had lower odds of survival to hospital discharge in both univariable odds ratio [OR] 0. In a subgroup analysis of patients with a head injury, the lower odds of survival persisted in the multivariable analysis OR 0. Conclusions: Patients intubated in the prehospital setting had a lower survival than those intubated in the ED.