Medical journal (Fort Sam Houston, Tex.)最新文献

{"title":"Successful Surgical Airway Performance in the Combat Prehospital Setting: A Qualitative Study of Experienced Military Prehospital Providers.","authors":"Timothy B Pekari,&nbsp;John L Melton,&nbsp;Ronald M Cervero,&nbsp;Anita Samuel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Military first responders are in a unique category of the healthcare delivery system. They range in skill sets from combat medic and corpsman to nurses, physician assistants, and occasionally, doctors. Airway obstruction is the second leading cause of preventable battlefield death, and the decision for intervention to obtain an airway depends on the casualty's presentation, the provider's comfort level, and the available equipment, among many other variables. In the civilian prehospital setting cricothyroidotomy (cric) success rates are over 90%, but in the US military combat environment success rates range from 0-82%. This discrepancy in success rates may be due to training, environment, equipment, patient factors and/or a combination of these. Many presumed causes have been assumed to be the root of the variability, but no research has been conducted evaluating the first-person point of view. This research study is focused on interviewing military first responders with real-life combat placement of a surgical airway to identify the underlying influences which contribute to their perception of success or failure.</p><p><strong>Materials and methods: </strong>We conducted a qualitative study with in-depth semi-structured interviews to understand participants' real-life cric experiences. The interview questions were developed based on the Critical Incident Questionnaire. In total, there were 11 participants-4 retired military and 7 active-duty service members.</p><p><strong>Results: </strong>Nine themes were generated from the 11 interviews conducted. These themes can be categorized into 2 groups: factors internal to the provider, which we have called intrinsic influences, and factors external to the provider, which we call extrinsic influences. Intrinsic influences include personal well-being, confidence, experience, and decision-making. Extrinsic influences include training, equipment, assistance, environment, and patient factors.</p><p><strong>Conclusions: </strong>This study revealed practitioners in combat settings felt the need to train more frequently in a stepwise fashion while following a well-understood airway management algorithm. More focus must be on utilizing live tissue with biological feedback, but only after anatomy and geospatial orientation are well understood on models, mannequins, and cadavers. The equipment utilized in training must be the equipment available in the field. Lastly, the focus of the training should be on scenarios which stress the physical and mental capabilities of the providers. A true test of both self-efficacy and deliberate practice is forced through the intrinsic and extrinsic findings from the qualitative data. All of these steps must be overseen by expert practitioners. Another key is providing more time to focus on medical skills development, which is critical to overall confidence and overcoming hesitation in the decision-making process. This is even more specific to ","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-4/5/6","pages":"39-49"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9700881","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":"Closing the Trauma and Critical Care Gap: A Paradigm Shift through Virtual Reality and Augmented Reality.","authors":"Brian G Gomez,&nbsp;James Winstead,&nbsp;James Lopata,&nbsp;Ryan McMahon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A nationwide surgeon shortage, particularly with general surgeons and trauma surgeons, continues to plague the civilian and military systems readiness. To fill this shortcoming, we provide a narrative review describing current and potential uses of augmented reality and virtual reality (AR/VR) for synthetic training environments which could significantly improve the Army's wartime medical readiness through improved skills of surgeons and non-surgeon providers. Multiple studies demonstrate the potential benefits of AR/VR in cost, time, and critical medical skills for enhanced care delivery. While encouraging, the novelty and relative youth of AR/VR platforms requires further prospective validation as the data for its use as a training adjunct is limited. Nevertheless, state of the art simulated training platforms like AR/VR which mimic surgical trauma cases and review critical surgical skills could help enable a transformation of non-surgeon providers to quickly augment current surgeon personnel shortages.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-4/5/6","pages":"20-24"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282914","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":"Neuroprotection and Therapeutic Implications of Creatine Supplementation for Brain Injury Complications.","authors":"Jamison M Newman,&nbsp;Timothy B Pekari,&nbsp;David W Van Wyck","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Creatine supplementation has not been researched for Traumatic Brain Injury (TBI) extensively, but studies suggest potential as a neuroprotective agent and potential treatment for brain-injury complications. Patients suffering from TBI experience mitochondrial dysfunction, neuropsychological burden, and deficits in cognitive performance due to malperformance of brain creatine levels, diminished brain Adenosine Triphosphate (ATP) levels, glutamate toxicity, and oxidative stress. In this systemic review, the current available research is reviewed to examine the effects of creatine on common sequalae of TBI within children, adolescents, and mice. Past and present data still lacks the knowledge of creatine supplementation for the adult population and military members during TBI. PubMed was searched for studies which assessed the correlation between creatine supplementation of TBI complications. The search strategy yielded 40 results, of which 15 articles were included in this systemic review. The results of the review supported an apparent understanding creatine does offer an obvious benefit to patients suffering from TBI and post-injury complications under specific guidelines. Time and dose dependent metabolic alterations seem to be only exceptionally prevalent when given as a prophylaxis or if given acutely. Results are only clinically significant after a month of supplementation. Although patients may need many therapeutic treatments to recover from TBI, especially in acute resuscitation, creatine shows superior efficacy as a neuroprotective agent in battling the chronic manifestations which lead to oxidative stress and cognitive function post brain injury.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-4/5/6","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282921","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":"Combating Fentanyl: National Guard Physician Assistants on the Front Lines of America's War Against Synthetic Opioids.","authors":"Joshua K Radi,&nbsp;Robert A Dent,&nbsp;Cesar A Allen,&nbsp;Jeffrey A Anderson,&nbsp;J Brandon Atkins,&nbsp;Matthew Schneider","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There is a significant threat to global health security due to synthetic opioids, illicitly manufactured fentanyl (IMF), and nefarious uses of pharmaceutical based agents (PBA). Since 2014, increased distribution of synthetic opioids including IMF into the US through China, India, and Mexico has resulted in devastating consequences to the average street drug user. Additionally, clandestine lab operations for pill manufacturing and distribution have increased, along with unintentional drug overdoses due to drugs being laced with fentanyl or some other synthetic opioid derivative. Naloxone has been shown to be an effective and useful tool for reversing signs and symptoms of synthetic opioid overdose, though additional doses may be required depending on the analog. In addition to the risk of overdose in US civilians, other state actors have utilized fentanyl and its analogs as incapacitants resulting in significant numbers of casualties. The National Guard Weapons of Mass Destruction-Civil Support Teams (WMD-CST) have been on the front lines supporting federal law enforcement agencies with hazard identification and assessment. Physician Assistants (PA) are assigned to these units and provide the necessary skills and expertise to keep on scene personnel safe. This article aims to dispel some of the rumors and myths surrounding fentanyl in an effort to educate first receivers, first responders, and hospital providers. Lastly, this article provides a review of synthetic opioid production, overdose, hazards, treatment/countermeasures, decontamination for responders, and the potential use of synthetic opioids as WMDs.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-4/5/6","pages":"50-59"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282922","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":"MRI Predictive Model's Utility in a Recruit Training Environment for Tibia Stress Fractures.","authors":"Raymond J Carlson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the study was to assess the utility of Fredricson Magnetic Resonance Imaging Grading model in predicting return to duty in Marine recruits who sustain tibia stress fractures at Marine Corps Recruit Depot San Diego (MCRDSD).</p><p><strong>Materials and methods: </strong>A retrospective review of 106 tibia stress fractures in 82 Marine recruits was performed. A baseline Fredricson grade was assigned, based on magnetic resonance imaging (MRI) evaluation. The electronic health record was reviewed for return to full duty. Non-parametric testing and descriptive statistics were used to evaluate the study population, varying subgroups, and the utility of this model in predicting the return to full duty in the recruit population and any differences based on stress fracture location or training platoon.</p><p><strong>Results: </strong>The mean return to full duty (RTFD) was 11.8 weeks. The study participants sustained a greater percentage of middle tibia stress fractures (51.2%) and grade IV stress fractures (37.8 %) than other tibia sites and severities. There was a difference in RTFD amongst the Fredricson grades (p is equal to 0.001). The median RTFD for grade I stress fracture was 8.5 weeks, the median RTFD for grade II stress fracture was 10.00 weeks, the median RTFD for Grade III stress fracture was 10.00 weeks, and the median RTFD for grade IV stress fractures was 13.00 weeks. As Fredricson grade increased, RTFD increased (p is equal to 0.00) although no median RTFD met the Bonferroni correction for statistical significance.</p><p><strong>Conclusion: </strong>The analysis suggested the Fredricson MRI grade was associated with RTFD in the recruit population. As Fredricson grade increased, median RTFD increased; however, mid-grade stress fractures (i.e., II-III) had similar median RTFD.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-4/5/6","pages":"10-16"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282917","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":"Tranexamic Acid Improves Survival in the Setting of Severe Head Injury in Combat Casualties.","authors":"Navneet K Baidwan,&nbsp;Steven G Schauer,&nbsp;Julia M Dixon,&nbsp;Smitha Bhaumik,&nbsp;Michael D April,&nbsp;Michael D April,&nbsp;Bradley A Dengler,&nbsp;Nee-Kofi Mould-Millman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 1.7 million people sustain traumatic brain injuries (TBI) annually in the US. To reduce morbidity and mortality, management strategies aim to control progressive intracranial bleeding. This study analyzes the association between Tranexamic Acid (TXA) administration and mortality among casualties within the Department of Defense Trauma Registry, specifically focusing on subsets of patients with varying degree of head injury severities.</p><p><strong>Methods: </strong>Besides descriptive statistics, we used inverse probability weighted (for age, military service category, mechanism of injury, total units of blood units administered), and injury severity (ISS) and Abbreviated Injury Scale (AIS) head score adjusted generalized linear models to analyze the association between TXA and mortality. Specific subgroups of interest were increasing severities of head injury and further stratifying these by Glasgow Coma Score of 3-8 and severe overall bodily injuries (ISS>=15).</p><p><strong>Results: </strong>25,866 patients were included in the analysis. 2,352 (9.1%) received TXA and 23,514 (90.9%) did not receive TXA. Among those with ISS>=15 (n=6,420), 21.2% received TXA. Among those with any head injury (AIS head injury severity score>=1; n=9,153), 7.2% received TXA. The median ISS scores were greater in the TXA versus no-TXA group (17 versus 6). Weighted and adjusted models showed overall, there was 25% lower mortality risk between those who received TXA at any point and those who did not (OR:0.75, 95% CI: 0.59, 0.95). Further, as the AIS severity score increased from >=1 (1.08; 0.80, 1.47) to >=5 (0.56; 0.33, 0.97), the odds of mortality decreased.</p><p><strong>Conclusions: </strong>TXA may potentially be beneficial in patients with severe head injuries, especially those with severe overall injury profiles. There is a need of definitive studies to confirm this association.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-1/2/3","pages":"34-40"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9415829","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":"Placement of Antibiotic Powder in Open Fracture Wounds during the Emergency Room (POWDER): Design and Rationale for an Investigation of the Acute Application of Topical Antibiotic Powder in Open Fracture Wounds for Infection Prophylaxis.","authors":"Abigail R Wheeler,&nbsp;Kimberly M Burbank,&nbsp;Michael D April,&nbsp;Joseph C Wenke,&nbsp;Robert A De Lorenzo,&nbsp;Steven G Schauer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Open fractures are at high risk for complications both in the military and civilian setting. Treatments to prevent fractures are limited in the Role 1 (prehospital, battalion aid station) setting. The goal of this study is to assess the efficacy of topical vancomycin powder, administered within 24 hours of an open fracture injury, in the prevention of infection and infection-related complications.</p><p><strong>Methods: </strong>The POWDER study is a multicenter, prospective, randomized controlled clinical trial using a pragmatic open-label design. We will recruit 200 long bone open fracture patients from University Hospital at University of Texas Health at San Antonio (UTHSA) and the Brooke Army Medical Center (BAMC). We will screen and randomize patients in a 1:1 ratio to receive either usual care plus 2g topical vancomycin or usual care only. The primary objective of this study is to compare the proportion of infection and infection-related complications which occur in the 2 arms. An additional objective is to develop a risk-prediction model for open fracture wound complications.</p><p><strong>Conclusions: </strong>The infection rates seen in open fractures remain alarmingly high in both combat and civilian settings. Several orthopedic surgery studies suggest vancomycin powder is effective in reducing surgical site infections when applied topically at the time of wound closure. We expect to see a reduction in infections in open fracture injuries treated acutely with vancomycin powder. This study may provide important information regarding the use of local vancomycin powder during the acute treatment of open fractures. If shown to be efficacious, vancomycin powder could provide a simple, time- and cost-effective infection prophylaxis strategy for these injuries.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-1/2/3","pages":"103-111"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9420025","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":"Occam's Razor and Prehospital Documentation: When the Simpler Solution Resulted in Better Documentation.","authors":"Lance E Nissley,&nbsp;Ramiro Rodriguez,&nbsp;Michael D April,&nbsp;Steven G Schauer,&nbsp;Gregory J Stevens","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The Tactical Combat Casualty Care (TCCC) card has undergone several changes since its first introduction in 1996. In 2013, updates to the card included more data points to increase prehospital documentation quality and enable performance improvement. This study reviews the proportions of data collected before and after the implementation of the new TCCC card.</p><p><strong>Methods: </strong>This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR) focused on prehospital medical care. In this sub-analysis, we defined the pre-implementation period as 2009-2013 followed by a 1-year run-in with the post-implementation period as 2015-2019. Our primary outcome was documentation of a pulse rate and our secondary outcomes included documentation of other vital signs. We used multivariable logistic regression models to adjust for confounders.</p><p><strong>Results: </strong>There were 18,182 encounters that met inclusion for this analysis-14,711 before and 3,471 after the update. Across all vital signs, there was a peak around 2012-2013 with a drop noted in 2015. Comparing the preimplementation and post-implementation groups, there were higher proportions with documentation of a pulse rate (62% versus 49%), respirations (51% versus 45%), systolic pressure (53% versus 46%), diastolic pressure (49% versus 41%), oxygen saturation (55% versus 46%), and pain score (27% versus 19%, all p is less than 0.001) in the pre-implementation group. When adjusting for injury severity score (ISS), casualty category, and year of injury, the odds ratio of documentation of a pulse after implementation was 0.01 (95% CI: 0.00-0.01). When adjusting for ISS and casualty category, the odds ratio was 0.64 (95% CI: 0.60-0.70). When adjusting for ISS only, the odds ratio was 0.58 (95% CI: 0.54-0.63).</p><p><strong>Conclusions: </strong>Implementation of the new TCCC card resulted in overall lower documentation proportions which persisted after adjusting for measurable confounders.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-1/2/3","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9420021","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":"Lessons from the Fallen: An After-Action Review of Prehospital Casualty Data during the Global War on Terror.","authors":"Matthew W Paulson,&nbsp;John D Hesling,&nbsp;Steven G Schauer,&nbsp;Robert A De Lorenzo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The US military's recent involvement in long standing conflict has caused the pioneering of many lifesaving medical advances, often made possible by data-driven research. However, future advances in battlefield medicine will likely require greater data fidelity than is currently attainable. Continuing to improve survival rates will require data which establishes the relative contributions to preventable mortality and guides future interventions. Prehospital data, particularly that from Tactical Combat Casualty Care (TCCC) Cards and TCCC After Action Reports (TCCC AARs), are notoriously inconsistent in reaching searchable databases for formal evaluation. While the military has begun incorporating more modern technology in advanced data capture over the past few years like the Air Force's Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) and the Army's Medical Hands-free Unified Broadcast system (MEDHUB), more analysis weighing the advantages and disadvantages of substituting analog solutions is needed.</p><p><strong>Discussion: </strong>We propose 3 changes which may aid prehospital data capture and facilitate analysis: reexamine the current format of TCCC Cards and consider reducing the number of available datapoints to streamline completion, implement a military-wide mandate for all Role 1 providers to complete a TCCC AAR within 24 hours of a casualty event, and formalize the process of requesting de-identified data from the Armed Forces Medical Examiner System (AFMES) database.</p><p><strong>Conclusion: </strong>Reflecting on the state of US military medicine after 20 years of war, an important focus is improving the way prehospital data is gathered and analyzed by the military. There are steps we can take now to enhance our capabilities.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-1/2/3","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9420022","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":"Antarctic Evacuation: A Retrospective Epidemiological Study of Medical Evacuations on US Military Aircraft in Antarctica.","authors":"Samuel P Brown,&nbsp;Sarah M Mongold,&nbsp;Thomas L Powell,&nbsp;Sarah E Goss,&nbsp;Steven G Schauer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The international community has shown increasing interest in the Arctic and Antarctic due to the value polar regions have in terms of environmental research, natural resources, and national defense. The US Government maintains several permanent research and military facilities in polar regions. Medical evacuation (MEDEVAC) from these facilities can be limited for prolonged periods of time due to their extreme climates. Published data regarding MEDEVACs from these facilities is extremely limited.</p><p><strong>Methods: </strong>Evacuations on military aircraft registered in the Transportation Command Regulation and Command and Control Evacuation System (TRAC2ES) database in a previously de-identified dataset were queried for events from McMurdo, Antarctica. The data was analyzed to determine the number of evacuations, reasons for evacuation, and additional demographic data.</p><p><strong>Results: </strong>There were 31 evacuations from McMurdo Station and Scott Amundsen South Pole Station for 29 unique patients recorded in the available TRAC2ES dataset. Reasons for evacuation included traumatic brain/head injury, behavioral health concerns, extremity injuries, pregnancy, and various other medical/surgical concerns.</p><p><strong>Conclusions: </strong>MEDEVAC was typically required for advanced diagnostic/treatment modalities or if a patient could no longer fulfill his/her duties. Most evacuations were not directly related to environmental exposure. Given the climate in polar regions can preclude timely evacuation for large periods of time, the need for evacuation must be anticipated and mitigated whenever possible. Better data is needed to guide staffing and mission planning in this remote location.</p>","PeriodicalId":74148,"journal":{"name":"Medical journal (Fort Sam Houston, Tex.)","volume":" Per 23-1/2/3","pages":"41-46"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9415830","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}