Military Medicine最新文献

{"title":"Ethical Readiness: A Framework for Integrating Ethical Competence into Military Graduate Medical Education.","authors":"Sherri L Rudinsky, Anne Wildermuth, Holly Meyer","doi":"10.1093/milmed/usag462","DOIUrl":"https://doi.org/10.1093/milmed/usag462","url":null,"abstract":"<p><strong>Introduction: </strong>Military medicine in armed conflict presents unique ethical challenges, especially under the resource constraints and extended evacuation timelines anticipated in future large-scale combat operations. Currently, there is no standardized military medical ethics (MME) curriculum within U.S. military Graduate Medical Education (GME) programs, leaving a significant portion of the medical force unprepared for high-intensity conflicts and at increased risk of moral injury, thereby compromising operational readiness. The purpose of this study was to characterize the current landscape of MME training within U.S. military GME, identify critical educational gaps, and establish an expert-driven consensus framework to inform the development of standardized curricula.</p><p><strong>Materials and methods: </strong>This study utilized a sequential, multi-method design incorporating an exploratory survey and a modified Nominal Group Technique (mNGT). First, a convenience sample of military GME Program Directors across the Military Health System (MHS) completed an online survey evaluating current MME training. Second, an mNGT session was conducted virtually with a purposively selected panel of 9 current and former Program Directors representing seven medical specialties. The mNGT addressed three focus questions prioritizing core topics, teaching methods, and implementation barriers. Quantitative ranking data were analyzed using the Borda Count technique, and inter-rater agreement was assessed using Kendall's Coefficient of Concordance (W). Qualitative data from transcripts were analyzed using thematic analysis.</p><p><strong>Results: </strong>The exploratory survey (n = 41) revealed that 39% of respondents' programs lack a formal MME curriculum, and existing instruction relies heavily on passive lectures, frequently omitting military-specific topics such as dual loyalty and Medical Rules of Eligibility. For curriculum content, the mNGT panel achieved significant consensus (W = 0.63, P < .001), ranking principlism and dual loyalty as top priorities. Qualitative themes highlighted dual loyalty as the defining overarching construct of MME. For pedagogy, the strongest consensus was observed (W = 0.76, P < .001), decisively favoring active, blended strategies like small group case discussions and simulation-based learning over passive instruction. Regarding implementation obstacles (W = 0.33, P = .02), a lack of faculty expertise in MME and a scarcity of curated resources were identified as primary barriers, compounded by an apprehension surrounding sensitive operational topics.</p><p><strong>Conclusions: </strong>The operational realities of contemporary warfare demand that military healthcare professionals possess ethical readiness before deployment. This study presents a framework for integrating ethical competence as a core operational readiness capability longitudinally throughout military residency and fellowship training. Key i","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127967","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":"Developing War-Relevant Wound Care Skills for Medical Technicians Through Local Military-Civilian Partnership.","authors":"Michael Carrillo, Jessica Mickelson, Shawn Dufford, Lana Watts, Melissa Burrows, Jonathan Patrick, Courtney Rucker, Alexandra Kiekhaefer, Jennifer Bein, Andrew Hall","doi":"10.1093/milmed/usag441","DOIUrl":"https://doi.org/10.1093/milmed/usag441","url":null,"abstract":"<p><strong>Introduction: </strong>Aerospace Medical Service Technicians (Air Force Specialty Code 4N0X1) provide bedside wound care in the expeditionary environment, but military treatment facility activity does not consistently generate the volume or categorical breadth of presentations required to sustain the Comprehensive Medical Readiness Program (CMRP) wound care domains. Keesler Medical Center (KMC) established a Training Affiliation Agreement with Memorial Health System (MHS), embedding 4N0 personnel within the civilian wound care service. This study quantified available exposure at each site.</p><p><strong>Materials and methods: </strong>Retrospective analysis of wound care activity over 13 consecutive weeks (March 2 through May 31, 2025). Four CMRP-aligned metrics were extracted weekly: patient encounters (Cat II.B), debridements (Cat II.C), negative--pressure dressing changes (Cat II.J), and burn encounters (Cat II.E). Weekly volumes were compared using a paired Wilcoxon signed-rank test by calendar week; Fisher's exact test was used for sparse categories.</p><p><strong>Results: </strong>MHS exceeded KMC across all 4 categories. Patient encounters: 2,498 vs. 285 (rate ratio 8.8; P < .001); debridements: 377 vs. 41 (rate ratio 9.2; P < .001); Negative-pressure dressings: any event in 9 of 13 vs. 3 of 13 weeks (P = .047); Burn encounters: 9 of 13 vs. 0 of 13 weeks (P < .001).</p><p><strong>Conclusions: </strong>A formal civilian wound care partnership produced approximately 9-fold greater patient and debridement exposure than the military site and introduced burn exposure that was otherwise absent. Attaching 4N0 personnel to a CMRP-dense civilian functional area under a Training Affiliation Agreement is a generalizable readiness template for enlisted medical specialties.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112110","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":"Interventions to Reduce Burnout for Military Physicians: A Scoping Review.","authors":"Richard B Pace, Lydia W McBee, Walter J Sowden, John Eric M Novosel-Lingat","doi":"10.1093/milmed/usag437","DOIUrl":"https://doi.org/10.1093/milmed/usag437","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Physician burnout is an increasingly researched topic, particularly since the COVID-19 pandemic. Burnout reduction interventions, both organizational and individual, have been studied in the civilian healthcare setting. Few have been conducted in military settings. A 2022 United States (U.S.) Department of Defense (DOD) Inspector General report identified staff burnout and fatigue as a serious concern for Military Treatment Facilities. Other studies identified a significant association between burnout and suicidal ideation. From 2011 to 2022, the suicide rates in the Active component of the U.S. military have gradually increased, and per DOD Suicide Event Report forms, workplace problems were identified as a significant stressor for 26% of those who died by suicide in 2022. Since poor outcomes, staff shortages, and increased suicide risk are associated with burnout, identifying interventions that reduce burnout are vital for military physician retention and our fighting force's well-being. This scoping review aims to identify and analyze all intervention strategies since 2018 that sought to reduce physician burnout in military settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This literature search utilized PubMed, Embase, and the American Psychological Association's PsycINFO (APA) databases. Search criteria included the following keywords: \"Burnout,\" \"Physicians,\" \"Military,\" \"Interventions,\" and \"Strategies.\" Eligibility criteria included studies after 2017 with pre- and post-intervention measures via a valid, reliable burnout survey method, like the Maslach Burnout Inventory (MBI) and the Professional Quality of Life Scale-5 (ProQOL-5), among physicians in a military setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Database searches produced 84 articles for screening, but only three studies met analysis criteria. The first study evaluated an OBGYN training program's wellness component and reported no significant difference in burnout (MBI surveys) at 0-, 6-, and 12-month time periods. The second study was a 12-month randomized controlled trial (RCT) that evaluated the effectiveness of a Web-based tool at reducing burnout in behavioral health clinicians treating post-traumatic stress disorder (PTSD), using the ProQOL-5 to assess for burnout, and it also reported no significant differences between the intervention and control groups. Finally, the third study evaluated healthcare workers' self-reported stress levels pre- and post-utilization of a Mindfulness-Based Stress Reduction toolkit at two Air Force Family Care clinics. This study did report a statistically significant decrease in both self-reported stress (P = .018) and burnout (P = .045).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Only three articles met evaluation criteria, illustrating the lack of evidence-based burnout reduction interventions in the military. Three additional studies did not meet eligibility criteria but offered promising interventions for furth","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112060","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":"Cardiovascular Emergency Action Planning in the United States Military.","authors":"John-Henry L Dean, Matthew A Soderstrom, Andrea N Keithler, M Alaric Franzos, Mark Haigney, Eli M Friedman, Caroline E Murphy, Bradley J Petek","doi":"10.1093/milmed/usag460","DOIUrl":"https://doi.org/10.1093/milmed/usag460","url":null,"abstract":"<p><p>Sudden cardiac arrest/death (SCA/D) are uncommon but potentially catastrophic events in military service members, occurring most often during physically demanding training and operational activities. Compared with similarly aged athletic populations, service members experience higher rates of SCD, highlighting the unique risks inherent in military service. Although cardiovascular (CV) screening can identify many at-risk individuals, it does not prevent all acute CV events. In athletic populations, improvements in emergency preparedness including cardiopulmonary resuscitation (CPR) training, rapid automated external defibrillator (AED) use, and rehearsed emergency action plans (EAPs) have been associated with significant improvements in survival following sports-related SCA. However, despite similar exertional demands, standardized CV-specific EAPs are inconsistently established and implemented across military settings. Existing policies emphasize physical readiness and emergency response capabilities, yet substantial variability remains regarding formalized planning for CV emergencies that occur during military activities. Importantly, military environments differ substantially from traditional athletic venues. Physical training (PT) and operational missions often occur in austere locations with limited medical resources, evacuation constraints, environmental extremes, and reliance on other service members as initial responders. Additionally, service members may be required to engage in prolonged exertion, load carriage, water-based activities, or remote operations that may delay recognition and treatment of SCA. These unique factors necessitate military-specific CV EAPs that extend beyond traditional competitive athlete frameworks and incorporate adaptable emergency response strategies for diverse tactical environments. Accordingly, the broad adoption of structured but flexible CV EAPs across the U.S. military represents a practical and meaningful opportunity to improve survival after SCA.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112112","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":"Peer Comparison Improves Guideline Adherence for Urinary Tract Infection in a Military Emergency Department: A Quality Improvement Project.","authors":"Lijah Vann Gardner, David Deysher, Kelsey Wilson, Jessie E Conner, Natalie A Welch, Beau A Sauley, William N Bennett V","doi":"10.1093/milmed/usag456","DOIUrl":"https://doi.org/10.1093/milmed/usag456","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Given the threat of antimicrobial resistance, accrediting organizations require antimicrobial stewardship programs (ASPs) to create facility-specific guidelines (FSGs) for common infectious syndromes to improve patient outcomes. Personalized feedback with peer comparison (PC) can increase adherence to guidelines and reduce broad-spectrum antibiotic use. The emergency department (ED) is Wright-Patterson Medical Center's (WPMC) largest antibiotic prescriber for urinary tract and skin and soft-tissue infections (SSTI), and adherence to FSGs for management of urinary tract infection (UTI) is historically low despite accessible FSGs. We assessed the effects of monthly PC report cards on ED adherence to FSGs for UTI and SSTI, with community-acquired pneumonia (CAP) serving as a control syndrome, with the primary aim of improving UTI FSG adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A quasi-experimental stepped-wedge intervention with monthly chart review was conducted from July 2023 through June 2024 regarding UTI, SSTI, and CAP management. A poster including the FSGs for UTI, SSTI, and CAP was displayed in the ED at the end of September 2023. Monthly de-anonymized PC report cards (individual names and scores visible to all 20 ED colleagues) of UTI FSG adherence were provided to the ED starting in January 2024, and SSTI encounters were added to the report in the following month. Patient demographics, FSG adherence scores (0.25 point per encounter for each correct criterion: diagnosis, antibiotic choice, antibiotic dose, antibiotic duration), UTI antibiogram, and syndrome resolution within 2 weeks were analyzed. Descriptive statistics were performed using Microsoft Excel version 2308. Bayesian and regression analyses were performed with \"R\" version 4.5.1. This project received a non-research (quality improvement) determination from the WPMC Human Protections Office.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;568 ED encounters (295 UTI; 173 SSTI; 100 CAP) were reviewed. Median patient age was 55 years (IQR 34-70) and 68% were female (387/568). Mean FSG adherence scores changed for UTI and SSTI from 0.47 (SD 0.31) and 0.64 (SD 0.27) to 0.73 (SD 0.37) and 0.61 (SD 0.29), respectively, after PC. Before PC, cephalosporins were prescribed for 62% of UTIs (106/170); after PC, the most prescribed antibiotics were nitrofurantoin (51%, 64/125) and trimethoprim-sulfamethoxazole (18%, 22/125). In contrast to the poster display, for UTI management PC improved probability of correct medication (median 0.365, 95% highest posterior density interval [0.084, 0.648]), dosage (0.395 [0.118, 0.679]), and duration (0.473 [0.219, 0.728]). Each one-point improvement in adherence was associated with an estimated reduction in days of antibiotic therapy (DOT) for UTI (-1.4 days; 95% CrI: -2.030, -0.735) and SSTI (-4.36 days; 95% CrI: -6.063, -2.651) without reducing clinical resolution. Poster display alone did not improve adherence for any syndr","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112015","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":"How Veterans Describe Military Environmental Exposure-Informed Care: A Quality Improvement Study.","authors":"Rachel L Boska, Katharine J Bloeser, Mikayla B McAdams, Lisa M McAndrew","doi":"10.1093/milmed/usag424","DOIUrl":"https://doi.org/10.1093/milmed/usag424","url":null,"abstract":"<p><strong>Introduction: </strong>Care for environmental hazards is a particular concern for the Department of Veterans Affairs (VA), which has encouraged \"exposure-informed care\" (EIC). A recent Delphi study conceptualized 6 core components of EIC (e.g., build trust, assess and document). The current quality improvement project used qualitative interviews with Veterans to understand if and how these core components of EIC are reflected in patient perspectives of their military environmental exposure care at the VA to guide the development of future Veteran-centered tools and education to support the implementation of EIC.</p><p><strong>Materials and methods: </strong>Participants (N = 53) were Veterans who received care at the VA for military environmental exposures. Veterans were interviewed and the team iteratively developed an initial codebook using quotes and supportive statements. The codebook was then applied to the previously established EIC core components and the team identified statements that suggested the presence or absence of EIC.</p><p><strong>Results: </strong>Findings suggest that when asked broadly about their care for exposure-related conditions, EIC core components are reflected in patient perspectives. The presence and absence of all 6 EIC components were found in Veterans' perspectives of their exposure-related healthcare. Veterans described specific actions from their providers and VA that were important to EIC. Their descriptions suggest the core components work synergistically to impact perceptions of care for military exposures.</p><p><strong>Conclusions: </strong>The results of this project suggest that future tools to support the implementation of EIC should address EIC core components. Veterans described actions from providers and VA identified as EIC and may be used to design strategies to implement EIC. These strategies should consider incorporating multiple core components into implementation efforts, since Veterans' descriptions suggest the core components synergistically work together to impact care for military exposures.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112040","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":"Veterans Health Administration Pain Management Quality Improvement in a Post-Commission on Accreditation for Rehabilitation Facilities Era.","authors":"Jolie N Haun, Christopher Fowler, Rebecca S Bolinski, Jacquelyn N Heuer, Melissa Echevarria-Baez, Friedhelm Sandbrink","doi":"10.1093/milmed/usag443","DOIUrl":"https://doi.org/10.1093/milmed/usag443","url":null,"abstract":"<p><p>Tertiary interdisciplinary pain rehabilitation programs (IPRPs) provide integrated, comprehensive pain rehabilitation using an evidence-based biopsychosocial approach delivered by teams offering multi-modal care. A 2009 Veterans Health Administration (VHA) Directive mandated implementation of Commission on Accreditation for Rehabilitation Facilities (CARF) accredited IPRPs in each Department of Veterans Affairs (VA) service network. Commission on Accreditation for Rehabilitation Facilities accreditation included regular program surveys to reinforce continuous quality and improvement standards. IPRPs are integral to the VHA's capacity to provide a stepped-care model including advanced pain diagnostics and functional rehabilitation to best meet the needs of veterans with complex chronic pain. Recently, VHA ended its enterprise-wide contract with CARF International for accreditation across all programs. The absence of a formal external accreditation process created a gap in sustaining quality oversight and may put VA IPRPs at risk for closure or losing their relevance as tertiary pain care centers. As such, the VA national Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) is launching an initiative to ensure governance, sustainability, and alignment with VHA and PMOP strategic priorities. PMOP's provision of oversight, support, and strategic direction is critical as the VA continues to sustain the highest quality standard for pain management and rehabilitation in the post-CARF era. This commentary will discuss current PMOP initiatives for VA IPRPs to address gaps left by the absence of the CARF accreditation framework.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111310","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":"Running on Empty: Relative Energy Deficiency in a Military Endurance Athlete.","authors":"Malcolm Engelbrecht, Aaron Tallant","doi":"10.1093/milmed/usag459","DOIUrl":"https://doi.org/10.1093/milmed/usag459","url":null,"abstract":"<p><p>Relative Energy Deficiency in Sports (RED-S) is a clinical syndrome characterized by low caloric intake relative to energy expenditure, resulting in a cascade of endocrine, metabolic, and musculoskeletal consequences. In females, hallmark features include decreased bone mineral density and menstrual dysfunction, though the syndrome affects multiple organ systems in both sexes. We present the case of a 22-year-old active-duty military member who suffered recurrent stress fractures, irregular menstrual cycles, and chronic fatigue that impacted her duty status. She was noted to have a long history of non-intentional calorie restriction and was eventually diagnosed with RED-S. Treatment consisted of a multidisciplinary approach, resulting in objective improvement in bone density and a successful return to full duty status. This case highlights the importance of early diagnosis and appropriate treatment of RED-S among military members to decrease morbidity and prevent limitations to military readiness and career progression.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110750","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":"Letter to the Editor for \"Skin Cancer Incidence Among U.S. Navy and Marine Corps Aviators: A Retrospective Cohort Study\".","authors":"Michael N Passarelli, Paolo Boffetta","doi":"10.1093/milmed/usag450","DOIUrl":"https://doi.org/10.1093/milmed/usag450","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112066","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":"A Scoping Review of Inhaled Methoxyflurane for Acute Traumatic Pain.","authors":"Michael T Le, Joshua J Oliver, Julie A Rizzo, Michael S Patzkowski, Michael D April, Steven G Schauer","doi":"10.1093/milmed/usag446","DOIUrl":"https://doi.org/10.1093/milmed/usag446","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pain after trauma remains a major challenge in emergency department, prehospital, and operational medicine settings. Methoxyflurane, an inhaled anesthetic first developed in the 1960s but later withdrawn due to dose-related nephrotoxicity, has been repurposed internationally at substantially lower sub-anesthetic doses as an analgesic delivered via a compact, hand-held inhaler. This review aims to characterize the available evidence regarding its efficacy, safety, and operational applications for adoption in U.S. civilian and military trauma systems.</p><p><strong>Materials and methods: </strong>A scoping review was conducted using the PRISMA-ScR checklist. PubMed and Google Scholar were used to identify relevant literature from 1960 to 2025. Studies were eligible if they reported on the use of methoxyflurane for acute traumatic pain. Our initial search yielded 31 potential studies, of which 22 met inclusion for this review. Of those, there were 5 systematic reviews, 13 randomized controlled trials, 2 prospective observational studies, and 2 retrospective observational studies. There were 2 articles that focused on the pediatric population. Two trials are currently ongoing, 1 a systematic review comparing speed to onset of pain relief of methoxyflurane vs. the usual care and another study analyzing use and effectiveness in prehospital helicopter transport.</p><p><strong>Results: </strong>Across studies, methoxyflurane consistently demonstrated clinically meaningful rapid analgesia onset and greater efficacy than placebo and other standard selected analgesic strategies, particularly within the first 10-20 minutes. Available short-term safety data at contemporary analgesic dosages were reassuring, with few adverse events, primarily mild and transient side effects. Studies also confirmed effective patient self-administration of methoxyflurane with minimal occupational exposure risk.</p><p><strong>Conclusion: </strong>Current evidence suggests that methoxyflurane is an effective, well-tolerated, and rapid-acting analgesic for acute trauma. Current evidence supports short-term, episodic use within approved dosing limits, with favorable safety data in both adult and pediatric populations. The favorable safety profile, ease of self-administration, and non-opioid mechanism make it a potentially valuable therapy in emergency and prehospital settings. Future studies should assess usability, safety, and efficacy of methoxyflurane to define its operational use in the prehospital deployed combat setting.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112084","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}