Military Medicine最新文献

{"title":"Letter From the Chief Executive Officer Dr John Cho.","authors":"","doi":"10.1093/milmed/usag482","DOIUrl":"https://doi.org/10.1093/milmed/usag482","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Multidrug-Resistant Organisms in Combat-Related Injuries: Insights from Iraq, Afghanistan, Ukraine, and Implications for Large-Scale Combat Operations.","authors":"","doi":"10.1093/milmed/usag478","DOIUrl":"https://doi.org/10.1093/milmed/usag478","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Simulation Versus Post-Simulation Debriefing in Medical Training: A Scoping Review and Theoretical Framework for Military Application.","authors":"Ian Richardson, Brian Gravano, John Keefe","doi":"10.1093/milmed/usag470","DOIUrl":"https://doi.org/10.1093/milmed/usag470","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based medical training is important for readiness. Feedback and debriefing are important components of simulation that support learning. Debriefs for military training are traditionally conducted at the conclusion of training, but recent evidence in the civilian medical training literature suggests that in-simulation debriefing may provide benefits for skill acquisition. The purpose of this scoping review is to map the body of literature examining post-simulation and in-simulation debriefing, highlight trends in the literature, and identify research gaps.</p><p><strong>Materials and methods: </strong>A scoping review of the literature was conducted using the Joanna Briggs Institute Scoping Review Methodology, searching PubMed, the Web of Science Core Collection, and gray literature. Studies were included if they evaluated simulation-based emergency medicine or critical care medical training with an in-simulation debriefing intervention compared to post-simulation debriefing, measured at least one learning or performance outcome, and included a randomization element. Studies were excluded if they lacked a comparison group, involved non-acute care, utilized solely device-generated feedback, or did not explicitly articulate in-simulation debriefing protocols.</p><p><strong>Results: </strong>A total of 21 articles met inclusion criteria; none involved military populations. The majority of studies (90.5%) employed rapid cycle deliberate practice as the in-simulation debriefing method, and the most studied domain was cardiac arrest and resuscitation (57.1%). No studies reported performance or retention measures favoring post-simulation debriefing, and 77.8% of studies measuring time to intervention found significant improvements when in-simulation debriefing was utilized. Effect sizes were only reported in 14.3% of included studies.</p><p><strong>Conclusions: </strong>The majority of reviewed studies reported outcomes favoring in-simulation debriefing; no studies favored post-simulation debriefing for performance measures. Effective implementation of in-simulation debriefing in a military training context would require deliberate instructor development and standardized methods for aligning debriefing methods with the experience level of the target audience. Future research should examine the effects of in-simulation debriefing on tactical medical skill performance and the time to intervention in a military training context.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drone-Related Injuries Among Deployed U.S. Military Personnel, 2023-2024.","authors":"Jessamyn E Boltz, Amber L Dougherty, James D Wallace, Brian E Wilson, James M Zouris, Ryan W Smith, Andrew J MacGregor","doi":"10.1093/milmed/usag466","DOIUrl":"https://doi.org/10.1093/milmed/usag466","url":null,"abstract":"<p><strong>Introduction: </strong>The proliferation of drone warfare is a significant threat to U.S. forces. Research on drone-related injuries is critically needed to prepare military healthcare providers for combat casualty care. The study objective was to assess wounding patterns among U.S. service members injured in drone attacks during deployment in the Central Command area of operations in 2023-2024.</p><p><strong>Materials and methods: </strong>Service members with drone-related injuries were identified in the Expeditionary Medical Encounter Database. Injuries were assessed using International Classification of Diseases, 10th Revision, Clinical Modification and Abbreviated Injury Scale (AIS) codes. Service members were grouped by their maximum AIS score in any body region as minor (MAIS 1), moderate (MAIS 2), or serious injury (MAIS 3+). Differences between groups were assessed by AIS body region. This study was approved by the Naval Health Research Center Institutional Review Board.</p><p><strong>Results: </strong>A total of 367 service members were wounded in drone attacks during the study period. Approximately 48.5% had a traumatic brain injury. Of 710 injuries identified, most were minor (92.3%) and primarily involved the head and neck region (81.0%), followed by extremities (13.5%). Most injuries with moderate or higher severity (n = 53) were to the head (43.4%), thorax (18.9%), and upper extremities (15.1%). Those in the moderate (MAIS 2) compared with minor (MAIS 1) injury group had significantly higher proportions of thorax (45.8% vs. 1.5%) and spine injuries (20.8% vs. 4.2%), respectively.</p><p><strong>Conclusions: </strong>U.S. forces injured during drone attacks most frequently sustained head injuries, marking a significant shift in wounding patterns from previous conflicts characterized by lower extremity trauma. Results suggest a dual preparedness strategy is needed for combat casualty care to manage a high volume of minor head injuries while retaining advanced surgical capabilities for less frequent but serious head and upper body trauma. Further research on wounding patterns and a re-evaluation of personal protective equipment are essential as drone warfare continues to evolve.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting to the Operational Forces: Synchronizing Medical Research With the Modern Battlefield.","authors":"Gary Legault, Jeanette Little, Holly Pavliscsak, Sylvain Cardin, Kristopher Raines, Shaun Brown","doi":"10.1093/milmed/usag476","DOIUrl":"https://doi.org/10.1093/milmed/usag476","url":null,"abstract":"<p><p>The USAISR hosted a Warfighter Researcher Integration Symposium to connect clinical researchers directly with operational forces. Joint force representatives, medical research stakeholders, and scientific experts convened in San Antonio, Texas. Through presentations and 5 collaborative working groups, the symposium aligned researchers and warfighters with operational requirements.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Triage Scores and Systems in Military Settings: Advantages, Limitations, and Ethical Concerns.","authors":"Rayan Fawaz, Ulysse Comte, Fabien Armengaud, Antoine Lamblin","doi":"10.1093/milmed/usag458","DOIUrl":"https://doi.org/10.1093/milmed/usag458","url":null,"abstract":"<p><strong>Introduction: </strong>Military triage is a cornerstone of combat casualty care and aims to optimize the use of limited medical resources in hostile environments. Over time, military triage systems have evolved according to the nature of conflicts, operational constraints, and technological advances. This review aimed to analyze the military triage systems described in the literature, including their characteristics, advantages, limitations, and associated ethical concerns.</p><p><strong>Materials and methods: </strong>A scoping review was conducted according to relevant PRISMA-ScR guidelines using PubMed and Google Scholar databases. Articles published in English up to July 7, 2025, were screened using predefined keywords related to military triage. Two independent reviewers selected studies addressing military triage systems, operational doctrines, or historical perspectives. Data extraction included study characteristics, conflict settings, triage methodologies, implementation modalities, and ethical considerations.</p><p><strong>Results: </strong>Twenty-eight articles published between 1984 and 2025 were included. Most studies originated from the United States and the United Kingdom and primarily addressed asymmetric warfare. The NATO triage system remained the most widely used model, although several modified systems were identified, including the Modified Military Sieve, Modified Physiological Triage Tool, Fast Triage in Burns, and Sacco Triage Method. Recent developments focused on physiological scoring systems, wearable biosensors, computerized algorithms, and artificial intelligence-assisted triage. Ethical concerns frequently involved expectant casualty management, distributive justice, reverse triage, resource scarcity, and conflicts between military objectives and medical ethics.</p><p><strong>Conclusions: </strong>Military triage systems continue to evolve from simple clinical algorithms toward technology-assisted decision-making tools. Despite advances in physiological monitoring and artificial intelligence, triage remains highly dependent on human judgment and operational context. Ethical dilemmas remain central to military triage and require continued consideration in future doctrine and system development.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality From 1918-1919 Spanish Flu Among the American Expeditionary Forces Analyzed Through People-Powered Research.","authors":"Peter C Wever, Sonja E van Roeden, Weldon J Hoppe","doi":"10.1093/milmed/usag479","DOIUrl":"https://doi.org/10.1093/milmed/usag479","url":null,"abstract":"<p><strong>Introduction: </strong>The Card Register of Burials of Deceased American Soldiers, 1917-1922 holds the burial cards of American servicemen and women who died at sea or overseas during or after World War I (WWI). We aimed to use this online register to study mortality statistics in the American Expeditionary Forces (AEF) during the 3 waves of Spanish flu in 1918 and 1919. However, the register, which includes 104 file units, lacks database query functionality.</p><p><strong>Materials and methods: </strong>Over 6,000 volunteers attached to the Zooniverse platform for people-powered research submitted 4 million transcription tasks from individual burial cards in the online register. This information was used to create the American WWI Burial Cards Search Tool, which is a free online searchable database that also allows, among others, for study of mortality statistics.</p><p><strong>Results: </strong>The first wave of Spanish flu resulted in a relevant increase in mortality in the AEF. During the second wave, mortality increased significantly, peaking on October 9, 1918, with 474 deaths. Moreover, data show that the weekly mortality rate started to increase already in early August, in contrast to a previous report stating that the second wave of Spanish flu ran its course in the AEF roughly from September 15 onwards. In all, at least 14,494 servicepersons in the AEF died from influenza and/or pneumonia during the deadly second and third waves of Spanish flu. In contrast, mortality from COVID-19 in the U.S. military was low, with 96 deaths as of December 8, 2022.</p><p><strong>Conclusions: </strong>People-powered research provided a unique possibility to study single-day mortality figures from influenza and/or pneumonia in the AEF during the different waves of Spanish flu. In all, at least 14,494 servicepersons in the AEF died from influenza and/or pneumonia during the second and third waves of Spanish flu, while we show that the weekly mortality rate during the second wave increased already in early August 1918. In contrast, mortality from COVID-19 in the U.S. military was low. Thus, pandemics of respiratory infections have different impacts on mortality in army personnel, depending on specific pathogenic characteristics of the causative agent.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Performance Optimization in Action: Early Medical Observations and Actions From Operation Epic Fury.","authors":"Carter Kaminski, Dana Mayer, Jan-Michael Van Gent, Teresa Duquette-Frame, Jennifer M Gurney","doi":"10.1093/milmed/usag447","DOIUrl":"https://doi.org/10.1093/milmed/usag447","url":null,"abstract":"<p><p>This MPO Minute summarizes early clinical and operational lessons in Operation Epic Fury from the JTS Combat Casualty Care conferences. It highlights preventable injury patterns, system and force protection gaps, and actionable recommendations for providers and commanders to optimize trauma care, documentation, and patient outcomes in high-threat, dispersed operational environments.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Case for Dedicated Vaccine Communication Training: A Survey of Military Pediatricians.","authors":"Daley Auvil, Katherine Jones, Rebecca Ratusnik, Daniel J Adams","doi":"10.1093/milmed/usag473","DOIUrl":"https://doi.org/10.1093/milmed/usag473","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccine uncertainty is rising among families in the United States, even among military families. The ACGME mandates that pediatric residents be trained in effective communication strategies for patients and families hesitant about recommended vaccinations, yet few validated curriculum tools exist. We aimed to understand the current landscape of vaccine uncertainty experienced by military general pediatricians and see what communication strategies were routinely being implemented in clinical practice.</p><p><strong>Materials and methods: </strong>In March 2025, 45 graduates of a mid-sized military pediatrics residency program from the years 2016-2024 who were currently practicing general pediatricians were invited to participate in a survey on vaccine communication in clinical practice. The survey was a mix of quantitative questions asking for experienced trends in vaccine uncertainty as well as open-ended questions about communication strategies being implemented. Three clinical researchers performed a manual thematic analysis of free-text answers to understand and quantify common themes.</p><p><strong>Results: </strong>Thirty-seven general pediatricians (82%) responded, and 95% of those surveyed rated a curriculum during medical training on vaccine communication as \"very\" or \"extremely important.\" Only 19% of physicians were able to recall formal training in addressing vaccine hesitancy during medical school, and only 62% during residency. The 3 most commonly declined vaccines were COVID-19, influenza, and HPV. Pediatricians reported using communication strategies focused on knowledge-sharing (65%), partnership with families (62%), and normalizing vaccines (40%). Common barriers to vaccine acceptance were mistrust and disinterest, most commonly with unwillingness to engage in a conversation.</p><p><strong>Conclusions: </strong>Most practicing military pediatricians who graduated from our residency program report a rise in vaccine uncertainty in their practice and agree that a residency curriculum on vaccine communication is highly important. Such curricula should encourage evidence-based communication styles using vaccine normalization while de-emphasizing the urge to combat misinformation using knowledge-sharing and should specifically address the most commonly declined immunizations.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary-The Development of the North Atlantic Treaty Organisation Standards on Military Healthcare Ethics From Concept to Publication.","authors":"Charlie Beardmore, Martin Bricknell, Alexander Faas","doi":"10.1093/milmed/usag480","DOIUrl":"https://doi.org/10.1093/milmed/usag480","url":null,"abstract":"<p><p>Military Healthcare Professionals face ethical dilemmas, which may cause them psychological suffering. Moral Injury may potentially be prevented through training in military healthcare ethics and practical simulations of clinical situations. Law, Ethics and Morality all influence the professional conduct of Military Healthcare Professionals. A widely accepted military healthcare ethics guidance Code may assist Military Healthcare Professionals discharge their duties. This commentary describes the development of such guidance. The North Atlantic Treaty Organisation Committee of the Chiefs of Military Medical Services tasked its Military Healthcare Working Group to produce such guidance, intended to promote consistency in applying ethical principles. It may also potentially mitigate against Moral Injury, although this has not been evaluated yet. A series of workshops created the document, published as Allied Medical Publication 8.19 (Military Healthcare Ethics), in July 2025. Military healthcare ethical issues include: \"dual loyalty\" (military healthcare professionals' responsibility to ensure patients receive appropriate care, whilst concurrently looking after the best interests of their parent organization), medical rules of eligibility, special populations, prisoners of war and detainees, conduct of military medical units/personnel, use of the Red Cross/Crescent/Crystal symbol, arming of medical units/personnel and absolute prohibitions. The workshops developed the King's Military Healthcare Ethics Analytical Framework to help analyze military healthcare ethical dilemmas. This is intended to add value and consistency to decision-making and to have wide utility across Military Healthcare Practitioners. This publication has the potential to support training, improve consistency in ethical decision-making, and potentially mitigate moral distress or Moral Injury if effectively implemented.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}