Military Medicine最新文献

{"title":"Double the Trouble: Successful Cannulation and Air Transportation of Two Obese Trauma Patients Requiring Extracorporeal Membrane Oxygenation.","authors":"Steven T Stoffel, Sarah A Juhasz, Matthew E Wood, Theodor Danciu, Amanda R Wiggins, Erika R O'Neil, Erik S Manninen","doi":"10.1093/milmed/usaf045","DOIUrl":"https://doi.org/10.1093/milmed/usaf045","url":null,"abstract":"<p><p>Acute Respiratory Distress Syndrome (ARDS) is a known and severe complication of thoracic trauma. Many patients, despite appropriate ventilator and medical support, continue to worsen requiring additional cardiopulmonary support with extracorporeal membrane oxygenation (ECMO). Additionally, obesity adds a layer of complexity in the management of trauma ARDS on ECMO. We describe the first U.S. Military air transportation mission via Critical Care Air Transport (CCAT) involving the cannulation and transportation of 2 obese trauma patients requiring ECMO support. We reviewed a cohort of 2 obese patients with ARDS secondary to trauma cannulated for venovenous ECMO and simultaneously transferred via Critical Care Air Transport to a DoD ECMO Center. We describe the logistics involved in the transport and management of obese trauma patients on ECMO. Both patients were safely cannulated and transported without complications, and survived their ECMO run and hospital stay. This is the first air transport of 2 obese ECMO patients simultaneously in U.S. Military history. This transport highlights the safety of cannulation and transportation of obese trauma patients, in addition to the flexibility and logistics needed to successfully complete an ECMO military transport.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476715","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":"Characteristics of Lateral Clavicle Fractures Treated With Coracoclavicular Ligament Repair or Reconstruction in a Military Population.","authors":"Nicholas M Panarello, Matthew M O'Hara, Colin J Harrington, Scott M Feeley, Conor F McCarthy, Donald F Colantonio, Jonathan F Dickens, Kelly G Kilcoyne","doi":"10.1093/milmed/usaf050","DOIUrl":"https://doi.org/10.1093/milmed/usaf050","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral clavicle fractures comprise a minority of all clavicle fractures and are associated with high rates of nonunion when managed nonoperatively. Various fixation methods have been described, including augmentation with coracoclavicular (CC) ligament repair or reconstruction. Outcomes following the surgical treatment of lateral clavicle fractures are limited to small case series and systematic reviews, and the literature within physically demanding populations remains sparse. We sought to describe the characteristics and complications of operative lateral clavicle fractures treated with CC ligament repair or reconstruction within the Military Health System.</p><p><strong>Materials and methods: </strong>We queried the U.S. Military Health System Data Repository for patients with a lateral clavicle fracture treated with CC ligament repair or reconstruction between October 2013 and March 2020. We reviewed electronic health records, including patient demographics, radiographs, operative reports, and clinical notes, to assess injury characteristics, surgical constructs, postoperative complications, and functional outcomes.</p><p><strong>Results: </strong>A total of 40 patients underwent CC ligament repair (n = 20, 50%) or reconstruction (n = 20, 50%) for treatment of lateral clavicle fractures during the study period. Twenty-two (55%) patients underwent surgery within 6 weeks of injury, and 40% (n = 18) required concomitant open reduction and internal fixation. Complications included adhesive capsulitis (n = 3, 7.5%), unplanned return to the operating room (n = 4, 10%), and loss of CC reduction (n = 10, 25%). Twenty-six (65%) patients achieved a full, pain-free range of motion. There was a statistically significant association between postoperative complications and shoulder pain or diminished range of motion (P = .026). Seven of 32 (21.9%) active-duty service members required medical separation from military service. Female sex (P = .04) and distal clavicle plate fixation increase the risk of unplanned return to the operating room (P = .01). Nicotine use was predictive of eventual military separation (P = .004).</p><p><strong>Conclusions: </strong>In this case, a series of lateral clavicle fractures treated with CC ligament repair or reconstruction, all patients achieved fracture union and the majority of patients regained full, pain-free range of motion. Complications were common and portended a poor functional outcome. At the conclusion of their fracture care, 1 in 5 active-duty patients necessitated medical separation from military service.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476712","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":"ACE I/D and AGT Met235Thr Polymorphisms Distinctly Affect Biomarker Levels and Risk of AKI and Exertional Rhabdomyolysis After Intense Exercise.","authors":"Ayexa Cruz, Diego Gomes, Cintia Verdan, Jessica Branquinho, Michele Xavier, Gianna Kirsztajn, Caleb Guedes Miranda Dos Santos, João Bosco Pesquero, Andreia Carneiro","doi":"10.1093/milmed/usaf041","DOIUrl":"https://doi.org/10.1093/milmed/usaf041","url":null,"abstract":"<p><strong>Introduction: </strong>Exertional rhabdomyolysis (ER) is one of the severe complications attributable to prolonged and repeated muscle exercises and is most commonly seen in military personnel and elite athletes. In military personnel, ER usually results from the long and strenuous nature of military training and may sometimes result in severe outcomes, such as acute kidney injury (AKI) and cardiac arrhythmias. Besides, muscle tissue injuries impair physical function, decreasing strength and flexibility and delaying muscle soreness and inflammation. The existing literature has studied genetic polymorphisms related to the renin-angiotensin-aldosterone system, such as AGT*Met235Thr (rs699) and ACE I/D (rs1799752), and clinical chemistry-related markers about their influence on athletic performance and injury prevention from exercise-induced trauma. The present study aimed to evaluate the association between the ACE (rs1799752) and AGT (rs699) gene polymorphisms and the increased susceptibility to exertional rhabdomyolysis risk (ERR) and AKI induced by strenuous exercise in military personnel.</p><p><strong>Materials and methods: </strong>Sixty-four male volunteers from the Brazilian Marine Corps who were sent on the Sandstorm mission in 2017, 2018, 2019, and 2022 were enrolled in the study. Blood and urine samples were collected from the participants before and immediately after the mission.</p><p><strong>Results: </strong>After physical exercise, 54 of 64 individuals (84%) were positive for ER. Of these, 13 participants (24%) were positive for AKI, representing 20% of the whole group. AKI was more frequent in T allele carriers, as 13 of 14 positive findings belonged to the MT + TT group, while only one case occurred in MM (approaching significance at P = .063). A significant postexercise increase in serum creatinine (CRE) levels was observed for carriers of I (II + ID) and T (MT + TT) alleles (P = .008 and P = .028, respectively), with a significantly higher ΔCRE in the (II + ID) group compared to the DD group (P = .001).</p><p><strong>Conclusion: </strong>These findings suggest that the ACE I/D and AGT M235T polymorphisms might be related to an increased risk for AKI following intensive, mixed-type exercise in military personnel.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458586","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":"Identifying Concepts to Establish Problematic Medications in Active Duty Servicemembers (ProMADS).","authors":"Ryan C Costantino, Nicole J Brandt, Eleanor M Perfetto, Jessica R Hull, C Daniel Mullins","doi":"10.1093/milmed/usaf037","DOIUrl":"https://doi.org/10.1093/milmed/usaf037","url":null,"abstract":"<p><strong>Introduction: </strong>The military's approach to medication use often evolves in response to operational issues that have the potential to impact the medical readiness and combat effectiveness of active duty service members (ADSMs). Historically, medications have been considered problematic because they serve as surrogate markers for deployment limiting health conditions or due to factors that make sustainment challenging in military/austere environments. This study aims to identify key concepts that capture the aspects of a medication that make it problematic in ADSMs. The goal of this effort would be to inform a future policy and establish criteria for Problematic Medications in Active Duty Servicemembers (ProMADS) to enhance the readiness and deployability of ADSMs.</p><p><strong>Materials and methods: </strong>Concepts of ProMADS were elicited from 8 key informants (KIs). Key informants included care providers and care recipients from the Army, Navy, Air Force, and Defense Health Agency. Semi-structured interviews were conducted, and a phenomenological approach was used to summarize KI perspectives, and thematic analysis identified core elements and sub-elements.</p><p><strong>Results: </strong>Five core elements were identified: (1) Adverse cognitive or behavioral effects, (2) sustainment issues, (3) controlled substance compliance and risk mitigation, (4) medication-related hemostasis interference, and (5) combat-readiness inhibitors. Key sub-concepts were related to whether a medication might impact cognition, cause sedation, have complex monitoring requirements (e.g., laboratory, adverse drug reactions, etc.), is temperature sensitive, or impacts the functioning of the immune system.</p><p><strong>Conclusion: </strong>This study generated core medication-related concepts and sub-concepts that KIs believe make a medication innately problematic among ADSMs. These findings can guide consensus-driven efforts to identify ProMADS which would enable Military Departments and Combat Support Agencies to create programs that improve lethality, warfighting, and readiness by optimizing medication use.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425585","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":"Musculoskeletal Care Within the Holistic Health and Fitness Team: A 12-month Retrospective Review.","authors":"Eliza Szymanek, Megan Jones, Ryan Clark, Michael Robertson, Brian Hatler, Don Goss","doi":"10.1093/milmed/usaf042","DOIUrl":"https://doi.org/10.1093/milmed/usaf042","url":null,"abstract":"<p><strong>Introduction: </strong>People are the Army's greatest strength and most valuable asset. The Holistic Health and Fitness (H2F) performance team was designed to optimize Soldiers' individual performance potential and well-being by becoming stronger, faster, and more ready in the physical and nonphysical domains of health and wellness. The H2F team is a human performance readiness platform composed of a team of professionals to include: strength and conditioning specialists, dietitian, nutrition care technician, occupational therapist, certified occupational therapist assistant, cognitive performance specialist, certified athletic trainers (ATs), physical therapists, and physical therapy technician. In the military health care system, where resources are limited, it is important to consider the H2F musculoskeletal (MSK) team as an integral part of the military health care system.</p><p><strong>Methods: </strong>For the 12-months analyzed, we tracked AT, physical therapy, and occupational therapy initial encounters, follow-ups, and rehabilitative treatment encounters. A retrospective analysis of ankle injuries, postoperative patients, and concussions was completed.</p><p><strong>Results: </strong>During the 12-month period, a total of 946 initial AT, physical therapy, and occupational therapy evaluations were completed. Including follow-ups and rehabilitative treatments, a total of 4862 MSK medical encounters were completed during this time.</p><p><strong>Discussion: </strong>The subanalysis comparing primary care manager-based care to H2F physical therapy and AT group for ankle injuries demonstrated a reduction in imaging, days on profile, and reduction in referral to specialty care. The subanalysis of postoperative MSK care within the H2F footprint demonstrates not only a 93% return to duty rate but minimizing lost duty time due to appointment location. For all 6 acute concussions identified, they were successful in Progressive Return to Activity, with an average of 4 occupational therapy visits and return to duty within 3 weeks of injury. Utilization of the H2F MSK care platform is essential to providing timely and efficient MSK care to return Soldiers to duty.</p><p><strong>Conclusion: </strong>To optimize Soldiers lethality and maintain a high level of readiness during the challenges of multi-domain operations, the Army developed the H2F team. This description of MSK care within an H2F team describes the importance of utilizing the H2F MSK care team within the military health care system to reduce cost, health care utilization, and minimize duty time lost to MSK injuries.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425696","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":"Use, Benefits, and Barriers to Financial and Credit Counseling Among Veterans According to Financial Counselors and Other Subject Matter Experts.","authors":"Rebecca L Kinney, Dina Hooshyar, Jack Tsai","doi":"10.1093/milmed/usaf040","DOIUrl":"https://doi.org/10.1093/milmed/usaf040","url":null,"abstract":"<p><strong>Introduction: </strong>Over a million U.S. veterans report an income below the poverty line. The Veterans Affairs (VA) offers financial literacy and money management education to promote veterans' economic well-being. This study examined perceptions of the barriers and facilitators to economic resources among financial providers and experts serving veterans.</p><p><strong>Methods: </strong>This study implemented a VA Redcap survey constructed of closed-ended and open-ended questions to examine perceptions of financial programs. Descriptive statistics were used to examine the close-ended responses; qualitative analysis was performed on the open-ended responses.</p><p><strong>Results: </strong>A total of 269 subject matter experts responded to the survey. Fifty-nine percent (n = 158) of respondents reported that financial counseling and education for veterans takes place outside of their local VA. Most frequently used services included financial coaching (46%; n = 124), assistance in attaining other sources of income (44%; n = 118), establishing a bank account (25%; n = 67), group financial education (23%; n = 62), and providing representative payee or conservator (19%; n = 51). Barriers to financial counseling and education exist with a lack of program awareness (70%; n = 188) and eligibility (66%; n = 178) being most often reported.</p><p><strong>Conclusion: </strong>Financial and money management interventions produce positive outcomes but should consider more effective modes in which to extend reach, education, and build trusting relationships in effort to increase financial stability and quality of life among low-income veterans.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425699","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":"eFAST to OR: Determining the Quality of Paramedic Conduction and Interpretation of eFAST Exams in Prehospital Settings.","authors":"Emily Roberts, Alexa Carboni, Michael Miller, Aleesa Rosas, Ryan Shelton, Jodi Peterson, Jonathan Apfelbaum, Amanda Toney, Anthony LaPorta, K Dean Gubler","doi":"10.1093/milmed/usaf008","DOIUrl":"https://doi.org/10.1093/milmed/usaf008","url":null,"abstract":"<p><p>Traumatic injuries are a leading cause of morbidity and mortality, particularly among young adults. Direct transport to the operating room has been associated with reduced mortality by minimizing treatment delays. The extended Focused Assessment with Sonography for Trauma (eFAST) is a critical diagnostic tool in trauma care, identifying life-threatening conditions that may require urgent surgical intervention. This study aims to assess the diagnostic accuracy of eFAST performed by paramedics in a prehospital environment, comparing their interpretations to those of expert physicians. A retrospective observational cohort analysis was conducted on trauma cases (n = 64) attended by South Metro Fire Rescue from January to December 2022. Paramedics underwent comprehensive training in ultrasound use and interpretation before performing eFAST exams in transit to medical facilities. Exam findings were compared to interpretations by an expert ultrasonographer, with sensitivity, specificity, and predictive values calculated. The cohort consisted primarily of males (63%), with a mean age of 46 years. The most common injury mechanism was motor vehicle crash (n = 20). Paramedic-conducted eFAST exams demonstrated a sensitivity of 80.0% and specificity of 95.8%. Positive and negative predictive values were 50% and 95.8%, respectively. False positives were largely due to difficulty in interpreting normal anatomy or identifying pathologies. Paramedics can reliably perform eFAST exams with high diagnostic accuracy, suggesting that prehospital eFAST could enhance trauma care by reducing time to surgical intervention. Future research should explore the integration of eFAST into prehospital protocols across diverse settings to improve trauma outcomes.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425561","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":"Evaluating Nanopore Sequencing as a Respiratory Virus Diagnostic Tool for the Prehospital Setting.","authors":"Grace M Reed, Amanda K Strickland, Cameron T Mutchler, Anna R Ochoa, Susana N Asin, August N Blackburn","doi":"10.1093/milmed/usaf046","DOIUrl":"https://doi.org/10.1093/milmed/usaf046","url":null,"abstract":"<p><strong>Introduction: </strong>Upper respiratory tract infections are a strain on military that results in lost duty days and an overall reduced readiness of the force. Improved diagnostic testing would enable better force health protection measures and earlier treatment of illness. Lightweight portable devices are preferred for diagnostic testing in austere environments where they are sometimes needed during military deployment. Current diagnostic testing is targeted to specific pathogens despite multiple pathogens that present with similar symptoms. In practice the pathogens that cause upper respiratory tract infections often go unidentified, which could be improved using agnostic or semi-agnostic diagnostic testing. Here, we performed an evaluation of shotgun metagenomic sequencing using the Oxford Nanopore Technologies (ONT) Rapid Sequencing Kit as a method for diagnostic testing of upper respiratory tract infections. This sequencing library preparation kit was chosen because of its ease of use and compatibility with the ONT MinION, a lightweight portable sequencer.</p><p><strong>Materials and methods: </strong>Samples from patients with symptoms of upper respiratory tract infections were collected at Wilford Hall Ambulatory Surgical Center under an approved IRB protocol. Nasal rinse samples from 59 study participants were tested using the BioFire FilmArray Respiratory 2.1 Panel as well as shotgun metagenomic sequencing using ONT Rapid Sequencing Kit and ONT R9.4.1 flow cells.</p><p><strong>Results: </strong>A mixture of various viral pathogens was present among the 59 samples used in this study. We observed high specificity and modest sensitivity to detect the identified pathogens using shotgun metagenomic sequencing. Shotgun metagenomic sequencing detected additional pathogens that were missed by the BioFire FilmArray Respiratory 2.1 Panel, which are discussed. Lastly, we observe modest evidence of nonuniformity of the proportion of reads belonging to the pathogen during the duration of sequencing runs, which has implications for improving sensitivity by increasing the amount of sequencing performed.</p><p><strong>Conclusions: </strong>Overall, ONT Rapid Sequencing Kit combined with alignment to a known panel of pathogens has shown great potential utility in our hands for quickly and accurately identifying viral respiratory pathogens. This, combined with its ease of use and portability, makes it a great candidate for further research and development toward a deployable agnostic diagnostic testing platform.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425566","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 To: Vision Loss in an Infantryman With Complex Hearing Loss: Case Report and Review of Susac Syndrome.","authors":"","doi":"10.1093/milmed/usaf049","DOIUrl":"https://doi.org/10.1093/milmed/usaf049","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409080","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":"Patient Characteristics and Procedural Volume at an Overseas Military Treatment Facility Emergency Department: Effects of the COVID-19 Pandemic and Implications on Clinical Skill Sustainment.","authors":"Martin A C Manoukian, Connor E Maguire, Tyler R Lopachin, Derek A Benham, Raj C Singaraju","doi":"10.1093/milmed/usaf039","DOIUrl":"https://doi.org/10.1093/milmed/usaf039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Future conflicts against near-peer competitors require proficient physicians to mitigate operational morbidity and mortality. Recent literature suggests that current patient demographics and staffing models may not sustain the combat care skills of military physicians. However, skill sustainment at overseas military treatment facilities located within foreign countries has not been examined. This article investigates patient characteristics and procedural performance rates within the U.S. Naval Hospital Okinawa Emergency Department (USNHO-ED), providing novel insight into the skill sustainment provided to U.S. Military physicians stationed in a foreign country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;An automated retrospective chart review of patients triaged within the USNHO-ED from January 2018 to June 2022 was performed. Patient census, emergency severity index (ESI) triage scores, patient disposition, and procedures of interest were recorded. Procedures of interest included: \"endotracheal intubation,\" \"arterial line placement,\" \"central line placement,\" \"dislocation reduction,\" \"procedural sedation,\" \"cardioversion,\" \"thoracostomy,\" \"blood product transfusion,\" \"lumbar puncture,\" \"paracentesis,\" \"arthrocentesis,\" and \"joint injection.\" Monthly procedure rates and procedure rates per 1,000 patients were calculated. Procedure rates for individual physicians with greater than 500 patient encounters were calculated. Variation in patient characteristics and procedural rates during the COVID-19 pandemic was investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The USNHO-ED triaged 128,696 patients and performed 865 procedures of interest during the study period. In total, 5,020 patients were triaged as ESI 1/2, 34,179 patients were triaged as ESI 3, and 89,499 patients were triaged as ESI 4/5. A total of 122,881 patients were discharged from the emergency department. The procedures performed most often were procedural sedation (4.02 per month, 2.06 per 1,000 patients), dislocation reduction (3.41 per month, 1.75 per 1,000 patients), lumbar puncture (1.94 per month, 0.99 per 1,000 patients), and endotracheal intubation (1.21 per month, 0.62 per 1,000 patients). All other procedures were performed less than once per month and 0.5 instances per 1,000 patients. Over half of physicians with at least 500 encounters did not perform a blood product transfusion, thoracostomy, central line placement, arterial line placement, cardioversion, or paracentesis. Rates for many procedures were lower than those seen at civilian institutions. During the COVID-19 pandemic, the daily census was lower, patients were more often triaged to higher ESI 1-3, and the admission rate was higher. Procedural sedations per month, as well as procedural sedations, dislocation reductions, and blood product transfusions per 1,000 patients, increased during the COVID-19 pandemic. No other temporal procedural variation occurred. Pediatric patients were mo","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399480","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}