Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

{"title":"Tactical Venous Access: Clinical and Operational Considerations of IV and IO Access in High-Acuity Environments.","authors":"Martrin Gutierrez, Yisel Menendez","doi":"10.55460/J.Spec.Oper.Med.2026.4YLV-TX21","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.4YLV-TX21","url":null,"abstract":"<p><p>Peripheral intravenous (IV) access remains the standard route for the administration of critical medications in both hospital and military environments. However, under high-acuity and tactical conditions, its success may be affected by trauma physiology and operational constraints. Intraosseous (IO) access provides a reliable rescue pathway when IV access cannot be rapidly obtained; nevertheless, differences in pharmacokinetic performance between IO and IV routes may have clinical relevance in specific scenarios. This manuscript integrates available clinical and operational evidence to examine the challenges associated with vascular access in modern combat and other high-acuity environments. It highlights the variability in IV success rates, the physiological and operational factors that influence access, and the limitations of approaches based primarily on palpation techniques. Additionally, the analysis explores the role of visualization technologies in improving decision-making and access success, particularly in settings where time, mobility, and resource availability influence clinical practice. Rather than proposing a specific technological implementation, this work frames vascular access as a context-dependent challenge and identifies key factors that may influence its optimization in both tactical and civilian settings.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"lluminating the Shadows: The Case for Research in Unconventional Warfare Medicine.","authors":"Timothy Makrides, Adam Cantrick, Andrew Maher, Jason Pickett","doi":"10.55460/J.Spec.Oper.Med.2026.PG8H-2K1R","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.PG8H-2K1R","url":null,"abstract":"<p><p>Unconventional warfare medicine operates in contested, resource-limited, and nonpermissive environments that challenge traditional models of combat care. Characterized by irregular forces, proxy engagements, and disrupted medical evacuation pathways, it requires clinicians to deliver prolonged, adaptable care with limited command, control, and logistics. Despite its operational significance, the field remains poorly defined, with knowledge dispersed across classified reports, practitioner experience, and fragmented literature. This gap constrains doctrine development, training, interoperability, and innovation. Emerging studies highlight themes, such as distributed treatment nodes, autonomous resuscitation, and adaptive medical structures, yet evaluative research and outcome data remain scarce. As modern conflict increasingly reflects irregular and hybrid characteristics, advancing unconventional warfare medicine is essential for future readiness. A scoping review of existing evidence can provide the first structured foundation for establishing this discipline, fostering collaboration between practitioners and researchers, and guiding capability development without compromising operational security.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"78-79"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Training Method for Prolonged Care: Scenario-Based Simulation for Military Medical Practitioners.","authors":"Sean Morrison, Dan S Mosely, Sean Keenan, Russell P Wier","doi":"10.55460/J.Spec.Oper.Med.2026.7KI7-VLFF","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.7KI7-VLFF","url":null,"abstract":"<p><p>Prolonged Casualty Care (PCC) is a critical skill for all military medical practitioners responsible for managing trauma patients for extended periods in austere environments. Aligned with the Joint Trauma System (JTS) PCC Guidelines, this article introduces a novel training method developed for the Combat Casualty Care Course (C4) PCC Lane. The C4 is an 8-day course hosted by the Defense Medical Readiness Training Institute (DMRTI), a division of the Defense Health Agency (DHA), at Camp Bullis, TX, and serves to provide training to Army, Navy, Air Force, Coast Guard, and foreign national medical officers in the conduct of medical operations in a simulated combat environment. Having identified the requirement to expose students to PCC, constraints such as time, staffing, and materials, coupled with the need to ensure minimal interference with already established training objectives created challenges for integrating PCC training events. The approach described herein uses scenario-based simulations with moulaged mannequins, deliberate inaccuracies, and structured debriefs to enhance the critical thinking and hands-on skills of participants. Designed for a heterogeneous audience, from combat medics to physicians, this scalable model adapts to diverse training venues and provider expertise levels. By integrating realistic patient scenarios and go/no-go checklists, it ensures providers address key PCC tasks while identifying and correcting clinical discrepancies within time constraints.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"89-92"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Disposition: Submersion Injury.","authors":"Joseph Chilbert, Charles Swail, John Siefert, Lyubov Tmanova","doi":"10.55460/J.Spec.Oper.Med.2026.JEIJ-GSWI","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.JEIJ-GSWI","url":null,"abstract":"<p><p>Both radiographs and pulmonary ultrasonography can inform diagnosis, severity, prognosis, clinical change, management, and disposition of submersion injury patients. Radiography is not typically available at the point of injury or in austere settings. However, ultrasound can provide real-time information at the point of care, facilitating timelier disposition toward greater resources of care. A 25-year-old male presented to the emergency department with an acute submersion injury from water aspiration during snorkel training exercises as a part of U.S. Navy Search and Rescue Swimmer training. Pulmonary ultrasound was utilized as an initial diagnostic tool, to follow clinical course, and as an adjunct to radiography. This case study demonstrates the potential to provide more thorough, timely, reproducible, and repeatable assessments of a submersion-injured patient's lung parenchyma than traditional chest radiography. Pulmonary ultrasonography can be utilized at the point of injury and in austere settings, enabling real-time decision-making and prognostication.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"70-73"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Only Thing Worth Dying For: How Eleven Green Berets Forged a New Afghanistan.","authors":"Scott P Graverson","doi":"10.55460/J.Spec.Oper.Med.2026.PWSV-22UJ","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.PWSV-22UJ","url":null,"abstract":"<p><p>Blehm, Eric. The Only Thing Worth Dying For: How Eleven Green Berets Forged a New Afghanistan. New York: Harper, 2010. 448 pp. ISBN: 9780061661228.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"112"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Novel Chitosan-Based Hemostatic Spray in a Standard Swine Hemorrhage Model.","authors":"Thomas Freier, Rivelino Montenegro, Eraldo B Calado, Rosaura L Rodrigues, Mauro L S Filho, Tathiana A Marques, Arthur L Kellermann","doi":"10.55460/J.Spec.Oper.Med.2026.ODL7-80M5","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.ODL7-80M5","url":null,"abstract":"<p><strong>Background: </strong>Chitosan is widely recognized as an effective hemostatic biomaterial, and chitosan-based products are extensively deployed for topical hemorrhage control in military and civilian settings. Nevertheless, existing formulations have limited applicability in austere and challenging environmental conditions. This study compared SEAL™ Hemostatic Wound Spray (SEAL)-the only FDA-cleared chitosan aerosol spray- against CELOX®, a current chitosan-based hemostatic standard.</p><p><strong>Methods: </strong>Eight adult male pigs were randomized into two groups: SEAL (n=4) and CELOX (n=4). A 4mm femoral arteriotomy was created. Following 30 seconds of uncontrolled bleeding, SEAL or CELOX was applied, followed by three minutes of gauze compression. Fluid resuscitation with Ringer's Lactate maintained the mean arterial pressure at 60-65mmHg. The animals were monitored for 2.5 hours or until death. Efficacy endpoints included hemorrhage time, blood loss, blood pressure, survival, and a simulated walking test to assess rebleeding. Safety was evaluated by gross necroscopy and histopathology.</p><p><strong>Results: </strong>No statistically significant differences were observed between SEAL and CELOX in bleeding time, blood loss, mean arterial pressure, and overall survival. Blood hemogram and clotting parameters showed no abnormalities. Gross necropsy and histopathology by a boardcertified pathologist blinded to each animal's study group assignment revealed no tissue or organ damage attributable to either product. No thromboemboli or product residues were detected in samples treated with either product.</p><p><strong>Conclusion: </strong>SEAL demonstrated equivalent efficacy and safety to CELOX for hemorrhage control. As a sprayable formulation with unique properties, SEAL offers several advantages in challenging prehospital environments where use of conventional products is less feasible.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"44-48"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone for the Management of Traumatic Hemorrhage: A Systematic Review.","authors":"Jun Bo Wang, Joseph Russell, Benson Law, David Boersma, Alla Iansavitchene, Colin Laverty, Fran Priestap, Shane A Smith, Kelly Vogt, Ian M Ball","doi":"10.55460/J.Spec.Oper.Med.2026.YT5S-X925","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.YT5S-X925","url":null,"abstract":"<p><strong>Background: </strong>Testosterone may assist in traumatic hemostasis given its well-established role in erythropoiesis, platelet activation, and vasoconstriction; however, whether exogenous testosterone improves acute outcomes in traumatic hemorrhage is unknown.</p><p><strong>Methods: </strong>Following PRISMA 2020, we registered the protocol in PROSPERO (CRD42024617294; 12 October 2024). MEDLINE, EMBASE (both via Ovid), and PubMed were searched from inception to November 2024 for studies that investigated the acute effects of testosterone administration in adults with hemorrhage. Two reviewers independently screened citations and full texts using prespecified eligibility criteria. Independent and duplicate data extraction by two reviewers, and GRADE certainty assessments were prespecified.</p><p><strong>Results: </strong>Of the 215 records identified, 197 were excluded at title/abstract and 18 underwent full-text review. No study met the inclusion criteria. Consequently, no planned data extraction and GRADE assessments were performed.</p><p><strong>Conclusions: </strong>No eligible human studies evaluate exogenous testosterone as an acute intervention in traumatic hemorrhage. The literature gap persists despite a clear clinical rationale and predefined outcome set. High-quality translational and clinical studies using rigorous dosing/timing definitions and standard coagulation and patient-centred endpoints are needed to determine whether testosterone confers benefit or harm in this setting.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Battle Injury in Military Operations Novel Treatment for Soft Tissue Injury and Infection with Logistics Implications.","authors":"J Rick Hammesfahr","doi":"10.55460/J.Spec.Oper.Med.2026.M1XC-G0IV","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.M1XC-G0IV","url":null,"abstract":"<p><strong>Background: </strong>Non-battle injuries (NBIs) represent a substantial proportion of morbidity during military deployments, often exceeding combat-related injuries in frequency. NBIs, including superficial wounds, burns, blisters, and soft tissue infections, remain a significant source of lost duty time and operational disruption in deployed military populations. In austere environments with limited medical support, even minor injuries often progress to cellulitis or abscess, which require substantial logistical resources including irrigation fluids, medical dressings, and antibiotics, impairing operational readiness.</p><p><strong>Methods: </strong>This review synthesizes epidemiologic data, clinical outcomes, and logistical considerations from surveillance reports, peer-reviewed publications and Department of War guidelines. Rates of wound progression, hospitalization, and duty loss were analyzed alongside logistics modeling based on U.S. Army Clinical Practice Guidelines (CPGs).</p><p><strong>Results: </strong>Evidence indicates that 15%-20% of untreated superficial wounds develop infection, 3%-7% progress to cellulitis or abscess, and 1%-2% require hospitalization. Blister-related cellulitis contributes significantly to lost duty time, with up to 120-150 duty days lost per 100 infections. Standard CPG-based wound care requires multiple liters of irrigation fluid, frequent dressing changes, and systemic antibiotics. Novel products such as Field Shield™ Wound Dressing and KeriCleanz™ Antiseptic that are optimized for ease of use and multiple applications per product show potential to reduce infection rates and resupply burdens, decreasing fluid and dressing requirements while conserving antibiotics.</p><p><strong>Conclusion: </strong>Early recognition and aggressive management of superficial wounds and preventative measures for managing minor injuries such as blisters and skin infections are essential for both clinical recovery and sustaining combat effectiveness.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"93-98"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Body Composition Between Special Operations Forces and Conventional Military Units: A Cross-Sectional Study.","authors":"Patrick Mullie","doi":"10.55460/J.Spec.Oper.Med.2026.S40G-QG5R","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.S40G-QG5R","url":null,"abstract":"<p><strong>Background: </strong>Special Operations Forces (SOF) undergo significantly more rigorous selection and training than conventional military units, which can have an impact on body composition. The aim of this study was to determine whether SOF exhibit distinct body composition characteristics compared to conventional military personnel.</p><p><strong>Methods: </strong>A total of 500 Belgian male soldiers, aged 20-30 years, participated in this study. Participants were recruited from six military units: 182 noncommissioned officers (NCOs), 85 officers, 122 paratroopers, 32 SOF, 24 physical training instructors (PTIs), and 55 sailors serving on a frigate (Navy personnel). Multifrequency bioelectrical impedance analysis assessed anthropometric measurements.</p><p><strong>Results: </strong>Mean body weight ranged from a minimum of 75.4 (SD 9.4) kg in NCOs to a maximum of 83.2 (SD 12.5) kg in Navy personnel. Body fat percent was lowest in PTI (13.7% [SD 3.6%]) and highest in Navy personnel (19.7% [SD 5.8%]). Fat mass index (FMI) in SOF was comparable to other units, with 3.6 (SD 0.8) kg/m2. Fat-free mass index (FFMI) was lowest for officers, and highest for SOF, at 19.6 (SD 1.4) kg/m2 and 21.0 (SD 0.9) kg/m2, respectively. A low FMI coupled with a high FFMI was most prevalent in SOF with 53.1%.</p><p><strong>Conclusion: </strong>SOF demonstrated the highest FFMI, likely as a result of the rigorous selection process, daily physical training, and operational demands. This finding underscores the importance of body composition assessment in evaluating candidates' potential for success in SOF selection.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"30-33"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Casualty Management in Eastern Ukraine and the Application of the Eight Domains of Mass Casualty Management.","authors":"David Ferraby, Andrew Hamer, John Miles, Conor Spillsbury","doi":"10.55460/J.Spec.Oper.Med.2026.W2F1-ADL8","DOIUrl":"10.55460/J.Spec.Oper.Med.2026.W2F1-ADL8","url":null,"abstract":"<p><p>This paper explores the management of mass casualty incidents in Eastern Ukraine, focusing on the application of the Eight Domains of Mass Casualty Management by the Ukrainian Medical Service. Following the Russian invasion, Ukraine's military and civilian health services have had to adapt to unprecedented casualty rates to prevent overwhelming the healthcare system. The Eight Domains-distribution, decompress, delay, delegate, deliver faster and deliver better, dynamic levels of care, and de-escalation-serve as compensatory mechanisms to manage this chronic major medical incident. The paper highlights the innovative approaches and adaptive strategies employed by the Armed Forces of Ukraine (AFU) Medical Services to maintain effective medical care despite the high demand and constrained resources. The report underscores the importance of international support and continued research to enhance the resilience and capability of the AFU Medical Services in responding to ongoing and future conflicts and proposes future direction for all military medical services to meet the challenges of large scale conflict operations and warfighting at scale.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"20-25"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}