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

{"title":"Use of an Intraoral Neuroprosthesis for the Treatment of Posttraumatic Stress Disorder (PTSD)-Associated Nocturnal Behavior Disorder: Case Series of Four Patients.","authors":"Donald R Moeller, Karen P Davidson","doi":"10.55460/Q007-46XH","DOIUrl":"10.55460/Q007-46XH","url":null,"abstract":"<p><p>There is a noted bidirectional relationship between sleep and posttraumatic stress disorder (PTSD), often associated with nocturnal behavior disorders contributing to sleep disturbances and impaired daytime functioning. Furthermore, disruptive nocturnal behavior (DNB) significantly impairs quality sleep among servicemembers and their sleep partners. Psychotherapy, pharmacotherapy, and alternative, integrative health interventions, such as meditation, are not particularly useful in achieving significant and durable remission of DNB. The use of oral dental appliances has demonstrated clinical success in the role of adjunctive management of sleep disorders. However, the use of these devices in managing the symptoms of mental health issues most often seen in this patient cohort has not been elucidated. This case series describes the attenuation of DNB while using a highly modified intraoral mandibular splint for the treatment of nightmares, sleep disruptions, and other sleep parasomnias associated with PTSD and PTSD / traumatic brain injury. Four Special Forces Veterans and Operators previously diagnosed with PTSD and experiencing disruptive nocturnal behaviors, including night terrors, and having failed first-line, traditional intervention, were included in this case series. A custom-designed, intraoral neuroprosthesis was used as the intervention. All four patients demonstrated a notable and significant reduction in DNB. Subjective assessments and observations indicated enhanced sleep quality and reduced PTSD-related nocturnal disturbances. Patients reported overall improvement in daytime functioning and reduction in PTSD symptom severity. These first-of-their-kind findings support the intraoral neuroprosthesis as a novel, innovative therapeutic approach for managing two pathologies simultaneously: sleep disturbances and DNB with PTSD. This device shows promise as a non-pharmacological intervention to enhance mission readiness and improve treatment compliance.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025609","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":"Unconventional Resilience: A Holistic, Humanistic Infrastructure of Integrated Performance.","authors":"Erika Ann Jeschke, Jennifer Patton, Jared Wyma-Bradley, Jay B Baker, John Dorsch, Sarah Lynn Huffman","doi":"10.55460/Q4T9-JT45","DOIUrl":"10.55460/Q4T9-JT45","url":null,"abstract":"<p><p>Building off our findings discussed at the strategic, operational, and tactical levels of unconventional resilience, we conclude this series by developing a holistic, humanistic infrastructure of integrated performance in Special Operation Forces (SOF) medicine. This infrastructure will explicitly acknowledge the human motivational context of practical performance and provide credibility to the medical-martial profession by acknowledging cultural values, norms, skills, and standards entailed in an emerging professional code of the Warrior Medic.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032777","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":"Performance-Based Differences in Prefrontal Cortex Activation: Assessing Dynamic Marksmanship Performance Using Functional Near-Infrared Spectroscopy.","authors":"Owen F Salmon, Thomas X Statz, Cierra B Ugale, Matthew D Segovia, Joshua R Thompson, Hunter D Dobbs, Rachel M Rauth, Cory M Smith","doi":"10.55460/4RIR-IM31","DOIUrl":"https://doi.org/10.55460/4RIR-IM31","url":null,"abstract":"<p><strong>Introduction: </strong>Marksmanship is a fundamental skill for all servicemembers. However, the underlying neurophysiological differences in performance among marksmen remain unclear. Incorporating neurophysiological tracking such as functional near-infrared spectroscopy (fNIRS) may identify performance-based differences in prefrontal cortex (PFC) activation during dynamic marksmanship scenarios. This study examined cognitive load within the PFC during a simulated dynamic marksmanship scenario in non-proficient and proficient marksmen.</p><p><strong>Methods: </strong>Twenty-four participants (12 men, 12 women) wore an fNIRS device over their forehead during a simulated stationary pistol marksmanship task (to determine proficiency status) and a dynamic shoot/no-shoot course of fire (COF) (to assess cognitive load). Relative concentrations of oxyhemoglobin (HbO2 ), deoxygenated hemoglobin (deoxygenated Hb), and total hemoglobin (total Hb) were tracked to quantify PFC activation differences in twelve proficient (=80% hit percentage) and twelve non-proficient (<80% hit percentage) marksmen.</p><p><strong>Results: </strong>No difference in completion time was observed between groups during the dynamic COF (p=.34). However, non-proficient marksmen showed 26.3% higher HbO2 (p=.02) and 42.1% higher total Hb (p<.01) in the PFC compared to proficient marksmen.</p><p><strong>Conclusion: </strong>Tracking PFC hemodynamic activity identified proficiency-based differences in cognitive load during a dynamic COF. Applying fNIRS during marksmanship-related tasks may be useful in developing stress resilience and mission readiness for servicemembers.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136563","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":"Committee on Tactical Combat Casualty Care (CoTCCC) Update.","authors":"Harold R Montgomery","doi":"10.55460/ZVDM-AM8I","DOIUrl":"10.55460/ZVDM-AM8I","url":null,"abstract":"","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"135"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814920","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":"Traumatic Hyphema with Commotio Retinae in a Special Operations Environment.","authors":"Scott R Bird, Kaytlin Hack, John W Kircher, Rachel E Bridwell","doi":"10.55460/Q09D-3I9E","DOIUrl":"10.55460/Q09D-3I9E","url":null,"abstract":"<p><p>Traumatic ocular injuries from both combat- and noncombat-related activity remain a significant burden in active duty Ser- vicemembers and present a diagnostic and therapeutic challenge to Special Operations medics with limited resources in far forward and remote areas. Blunt ocular injury, whether from sports or battlefield engagement, can result in a variety of eyesight-threatening injuries, including hyphema, commotio retinae, iritis, uveitis, and open globe injury. The management of these conditions often requires teleconsultation with ophthalmology and potential evacuation, which is tailored to the resources available for the Special Operations Forces medic. The authors present a case of sports-related traumatic hyphema complicated by commotio retinae in a Special Operations unmanned aircraft systems (UAS) operator, requiring teleconsultation and evacuation to specialty care. The authors additionally provide tailored prehospital strategies for the management of these unique but imperative injuries.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774793","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":"On Saving - The Psychosocial Benefit of Saving Lives in War and Society.","authors":"Russ S Kotwal, Robert L Mabry, Jeffrey T Howard","doi":"10.55460/XLYN-MH81","DOIUrl":"10.55460/XLYN-MH81","url":null,"abstract":"<p><p>Posttraumatic stress can result from combat and noncombat-related experiences. Conditioning military forces to be lethal or to save lives may influence responses to stress. Training to respond to casualties and to save lives should be a universal practice among medical and non-medical personnel when preparing for combat operations and battlefield casualties. National security requires a strong military. A strong military is reliant on a strong society that is cohesive as well as economically and spiritually intact. Cohesion is vital to the overall health and development of a society. A lack of cohesion can result in excess mortality and a reduction in life expectancy. Cohesion expands social networks and increases social capital that provides support for its military and overall population. Cohesion and leadership are needed to defend our nation, preserve national security, improve societal health, and save lives.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"109-112"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774777","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":"Updated Findings on the Efficacy of Combined Subanesthetic Ketamine Infusion and Cervical Sympathetic Blockade as a Symptomatic Treatment of PTSD/TBI in a Special Forces Patient with a 2-year Follow-up: A Case Report.","authors":"Eugene Lipov, Zubin Sethi, Hunter Rolain","doi":"10.55460/2QC5-PHPF","DOIUrl":"10.55460/2QC5-PHPF","url":null,"abstract":"<p><p>Posttraumatic stress disorder (PTSD)/blast traumatic brain injury (bTBI) in a Special Operations Forces (SOF) cohort has been shown to be successfully treated using a cervical sympathetic blockade (CSB)/ketamine infusion (KI) combination, termed the SOF method. In a prior case report, the patient was followed for 1 year. This report followed the same patient for a total of 720 days and found prolonged and sustained benefits with respect to PTSD and bTBI symptoms with further application of the SOF method.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"102-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774804","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":"Airway Management in Tactical Combat Casualty Care: TCCC Change 24-1.","authors":"Travis A Shaw, Justin Grisham, Joseph Kotora, Ryan M Knight, Jared Sleeman, Kelby Durnin, Harold R Montgomery, Travis G Deaton","doi":"10.55460/C0YI-YZNK","DOIUrl":"10.55460/C0YI-YZNK","url":null,"abstract":"<p><p>Tactical Combat Casualty Care (TCCC) has been designated by the U.S. Department of Defense as the military standard for battlefield trauma care. The TCCC Guidelines are a set of evidence-based, best-practice recommendations for combat medical personnel to use in caring for casualties on the battlefield prior to their arrival at a medical treatment facility. In 2024, the Committee on TCCC approved a change to the recommended management of the airway in TCCC. This change to the TCCC Guidelines does the following: - Continues the recommendation for use of the \"Sit-Up and Lean-Forward\" positioning to keep the airway clear in casualties with direct maxillofacial trauma when the casualties are conscious and able to do so. - Recommends the removal of the extraglottic airway as an airway adjunct. - Recommends that casualties who are unconscious but do not have a traumatic airway obstruction be placed in the recovery position with the chin tilted away from the chest. There is no longer a recommendation to use the \"jaw thrust.\" - Recommends the removal of the Control-Cric as the preferred cricothyroidotomy device. - Recommends continuous capnography monitoring for casualties who have a cricothyroidotomy performed, in order to provide initial and ongoing assurance that the cricothyrotomy tube is positioned correctly. - Adds an oxygenation and ventilatory support note at the end of the respiratory/breathing section of Tactical Field Care. - Adds a recommendation in the Respirations/Breathing section that in the case of impaired ventilation and uncorrectable hypoxia with an oxygen saturation less than 90%, a properly sized nasopharyngeal airway should be considered when performing bag valve mask ventilations. - Adds a recommendation in the Respirations/Breathing section that states that in the case of impaired ventilation and uncorrectable hypoxia with an oxygen saturation less than 90%, the casualty should be ventilated with a 1,000mL resuscitator bag valve mask. - Removes recommendations for airway management in the Tactical Evacuation Care phase of care, as responsibility for that phase of care has been shifted to the Committee on Enroute Combat Casualty Care.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"45-56"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840285","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":"Does Technique Matter? A Comparison of Fresh Whole Blood Donation Venous Access Techniques for Time and Success.","authors":"David K Rodgers, Cecil J Simmons, Philip Castaneda, Brandon M Carius","doi":"10.55460/WJ7Z-QH0P","DOIUrl":"10.55460/WJ7Z-QH0P","url":null,"abstract":"<p><strong>Background: </strong>Fresh whole blood (FWB) is essential for hemorrhagic shock resuscitation, but little literature evaluates medics ability to obtain intravenous (IV) access. Options for IV access include a 16-gauge hypodermic needle attached to the FWB collection bag (straight stick technique [SST]) and an 18-gauge angiocatheter with a saline lock (saline lock technique [SLT]), which may improve access given its confirmatory flash chamber and medic familiarity.</p><p><strong>Methods: </strong>In a prospective, randomized, crossover study, a convenience sample of U.S. Army medics performing FWB transfusion training initiated IV access with SST or SLT for FWB collection to achieve the minimum transfusable volume of 527g. The primary outcome was seconds to achieve minimum transfusable volume. Secondary outcomes included first-attempt IV access success and end-user feedback.</p><p><strong>Results: </strong>Eighteen medics demonstrated a shorter median time to reach the minimum transfusable volume with SST (819.36 [IQR 594.40-952.30] sec) compared with SLT (1148.43 [IQR 890.90-1643.70] sec, P=.002). No sequence or period effects occurred. Compared with SLT, SST demonstrated higher first-attempt IV access success (18, 78% versus 11, 48%; P=.037). Accordingly, most medics reported SLT would perform worse than SST for FWB collection and IV access in tactical environments.</p><p><strong>Conclusions: </strong>Medics achieved minimum transfusable volume faster and higher first-attempt IV access success with SST than SLT. Future studies should compare a 16-gauge SLT and SST, and further evaluate IV access techniques for improved evaluation of medic skills.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824592","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":"Chronicity of Posttraumatic Stress Disorder Symptoms Following Traumatic Brain Injury: A Comparison of Special Operators and Conventional Forces.","authors":"Shannon Miles, Daniel Klyce, Amanda Garcia, Alexandra R Thelan, Xinyu Tang, Rachel Wallace, Raj G Kumar, Risa Nakase-Richardson","doi":"10.55460/VUM3-FKJO","DOIUrl":"10.55460/VUM3-FKJO","url":null,"abstract":"<p><strong>Background: </strong>Special Operations Forces (SOF) have become the solution to many of the United States military challenges due to their ability to conduct time sensitive, clandestine, and high-risk missions. Historically, SOF were assumed to be resilient to the psychological sequelae of war, including posttraumatic stress disorder (PTSD). However, the objective burden of PTSD in SOF, particularly after traumatic brain injury (TBI), remains unknown. This study compared average PTSD symptoms over time between SOF and Conventional Forces (CF) who had sustained a TBI.</p><p><strong>Methods: </strong>This prospective cohort study examined Servicemembers and Veterans admitted to one of five Veterans Affairs Polytrauma Rehabilitation Centers for TBI. Propensity score matching created matched samples of 205 SOF and 205 CF. The PTSD Checklist-Civilian version (PCL-C) measured PTSD symptoms at admission and 1, 2, 5, and 10 years post TBI.</p><p><strong>Results: </strong>In a longitudinal mixed-effects model of PTSD symptoms over time grouped by TBI severity, SOF and CF had similar severity and patterns of PTSD symptoms. SOF and CF with mild TBI had more PTSD symptoms across all time points compared to those with moderate and severe TBI.</p><p><strong>Conclusion: </strong>The evolution and severity of PTSD symptoms after TBI in SOF and CF were similar. While SOFs had higher resilience compared to CFs in previous work, SOFs are not impervious to trauma exposure and PTSD. Increasing awareness of PTSD prevalence and consequences is needed to serve SOF. Identifying those needing care and providing evidence-based PTSD treatments can have the downstream effects of reducing attrition from the service and maintaining military readiness.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":" ","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774769","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}