Military surgeon最新文献

{"title":"A Hierarchy of Medical Countermeasures Against Biological Threats.","authors":"Adam T. Biggs, Lanny F. Littlejohn","doi":"10.1093/milmed/usac077","DOIUrl":"https://doi.org/10.1093/milmed/usac077","url":null,"abstract":"INTRODUCTION\u0000Emerging biological threats represent a serious challenge for force health protection (FHP). Against a novel biological threat, medical countermeasures are the first line of defense. However, as exposed by global pandemic conditions, there are significant complications when administering medical countermeasures against novel threats. One such limitation involved the lack of any guiding structure to discuss and deliberate upon the relative value of employing different countermeasures either alone or in tandem. For example, both personal protective equipment and prophylactic medication can provide some protection, but how are individual protections weighed against operational capabilities and FHP initiatives? The goal of this review is to provide a hierarchical organizing structure to the different medical countermeasures available in response to emerging biological threats.\u0000\u0000\u0000MATERIALS AND METHODS\u0000This review used no explicit inclusion or exclusion criteria for its literature review. References are provided for illustrative purposes to represent different components of the medical hierarchy.\u0000\u0000\u0000DISCUSSION\u0000The hierarchy presented here is organized around a resource-durability structure that functions as a push-pull mechanism. Specifically, lower levels of the hierarchy require more resources to sustain FHP conditions while also providing less durable protection. These countermeasures require continual reapplication, and so resources become conceived as much in time and effort to apply as in exhaustible supplies. Higher-order countermeasures require less resources investment as a single application can provide weeks, months, or years of protection. Moreover, higher-order protections are less likely to interfere with military operational capabilities, which further support their classification as superior countermeasures to sustain FHP. The five levels of the hierarchy are presented here as follows, organized from lowest to highest value as a medical countermeasure: (1) Sanitization, (2) personal protective equipment, (3) prophylaxis, (4) vaccines, and (5) optimized immune system. Rationale and descriptions identify how each higher-order countermeasure is superior to its lower-order counterparts while noting that optimizing FHP will likely require employing multiple countermeasures at different levels. The discussion concludes with an overview as to how different countermeasures were employed to various degrees during a novel global pandemic.\u0000\u0000\u0000CONCLUSIONS AND FUTURE USES\u0000Identifying medical countermeasures is important to optimizing FHP. Different countermeasures have different advantages, and the hierarchy distinguishes between inferior and superior countermeasures through the push-pull style mechanism of resource-durability assessment. Future deployment and development should focus on superior countermeasures to maximize medical protections and operational readiness while understanding the relative value and complications inherent with","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47056369","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":"Letter From the Executive Director Dr. John Cho.","authors":"John M. Cho","doi":"10.1093/milmed/usac076","DOIUrl":"https://doi.org/10.1093/milmed/usac076","url":null,"abstract":"","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41877652","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":"Cause-Specific Mortality Among Norwegian Veterans Deployed to Afghanistan Between 2001 and 2019.","authors":"Leif Åge Strand, Inger Rudvin, Einar Kristian Borud, Hans Jakob Bøe, Andreas Espetvedt Nordstrand, Elin Anita Fadum","doi":"10.1093/milmed/usac075","DOIUrl":"10.1093/milmed/usac075","url":null,"abstract":"<p><strong>Introduction: </strong>Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a \"healthy soldier effect\" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019.</p><p><strong>Materials and methods: </strong>We followed cohort members from their first day of service in Afghanistan through 2019. We computed standardized mortality ratios (SMRs) with 95% CIs by comparing the observed number of deaths in our cohort with the expected number of deaths in the general population. Standardized mortality ratios were calculated for the full follow-up period among men and women separately, and among men only for two time periods: during deployment and after discharge from service in Afghanistan.</p><p><strong>Results: </strong>We observed 77 deaths (3 women and 74 men), 10 of which occurred during deployment (war casualties, 1 woman and 9 men); all others occurred after discharge. All-cause mortality in women did not differ from that in the general population (SMR = 0.52, 95% CI 0.11-1.53). For men, the observed all-cause mortality was lower than the expected rate for the full follow-up period (SMR = 0.55, 95% CI 0.43-0.69), during deployment, and after discharge, while deaths because of transport accidents after discharge (13 cases) were more than twice as high as expected rates (SMR = 2.36, 95% CI 1.26-4.04). The 11 observed suicides gave a nonstatistically significant, lower suicide risk compared to the expected rates (SMR = 0.66, 95% CI 0.33-1.18).</p><p><strong>Conclusion: </strong>In accordance with the \"healthy soldier effect,\" military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.</p>","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48930153","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":"Response to Letter to the Editor on Concerning the Occupational Military Neuromusculoskeletal Injury Matrix.","authors":"T. Roy, Melissa D Richardson, B. Ritland, Robin E Cushing, Vy-Tuong Nguyen","doi":"10.1093/milmed/usac068","DOIUrl":"https://doi.org/10.1093/milmed/usac068","url":null,"abstract":"","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42569245","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 Hospital Ship as a Strategic Asset in21st Century Foreign Policy and Global Health Crises.","authors":"M. S. Baker, Jacob B Baker, F. Burkle","doi":"10.1093/milmed/usac061","DOIUrl":"https://doi.org/10.1093/milmed/usac061","url":null,"abstract":"INTRODUCTION\u0000Current U.S. hospital ships-USNS Mercy and Comfort-are old, slow, cumbersome, and indefensible, and due for retirement. As new challenges and new threats emerge in the 21st century, the U.S. Navy should field new afloat medical platforms to potentially deal with both mass casualty scenarios and humanitarian disaster relief in a rapid and tactical manner. New hospital ships should be able to defend themselves with more modern weapons and to be interconnected with encrypted communications. They must be fast, nimble, tactical, defensible, and forward deployed in the risky global commons of the 21st century.\u0000\u0000\u0000MATERIALS AND METHODS\u0000Systematic review of the literature on hospital ships, U.S. Navy policy, the Geneva Conventions, and current global threat conditions.\u0000\u0000\u0000RESULTS\u0000Hospital ships provide medical support for U.S. forces in conflict and promote goodwill and a positive image of the U.S. abroad. Current hospital ships do not fit the operational paradigm of the current needs for forward deployed and rapidly deliverable operational medicine. There is a need for a new and more capable platform to deliver operational health care in the forward deployed setting.\u0000\u0000\u0000CONCLUSIONS\u0000Multiple high-speed medical response vessels-whether reconfigured from an existing ship, or an entirely new platform developed for more robust medical delivery-need to be urgently fielded for future combat operations, humanitarian missions, and participation in cooperative security engagements. These medical platforms need to be able to defend themselves and be tactically interconnected with the Fleet and Fleet Forces.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46331236","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 Commentary.","authors":"Bruce J. Gillingham, Christopher Kurtz, D. Daniels, K. Marler, Amal Robertson","doi":"10.1093/milmed/usac062","DOIUrl":"https://doi.org/10.1093/milmed/usac062","url":null,"abstract":"Most people spend a large part of their lives working. It is, perhaps, inevitable that workplace environments help to shape people’s well-being and happiness. As we reflect on the past 20 years of Media & Jornalismo research we must also look forward to the future of journalism and consider how research can contribute to that future. We also should consider a possible paradigmatic shift in journalism studies and practice that de-focuses journalism and considers the humanity of journalism workers, seeing them less as commodities or commodifiable and more as complex individuals calling for and deserving of personal and professional well-being.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46926318","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 Effectiveness of a Standardized Ice-Sheet Cooling Method Following Exertional Hyperthermia.","authors":"Aaron R. Caldwell, Michelle M. Saillant, Dina M. Pitsas, Audrey Johnson, K. Bradbury, N. Charkoudian","doi":"10.1093/milmed/usac047","DOIUrl":"https://doi.org/10.1093/milmed/usac047","url":null,"abstract":"INTRODUCTION\u0000Exertional heat illnesses remain a major threat to military service members in the United States and around the world. Exertional heat stroke (EHS) is the most severe heat illness, characterized by core hyperthermia and central nervous system dysfunction. Per current Army regulations, iced-sheet cooling (ISC) is the recommended immediate treatment for heat casualties in the field, but concerns have been raised regarding the efficacy of this approach. Thus, the purpose of this study was to quantify the cooling rate of ISC following exertional hyperthermia.\u0000\u0000\u0000MATERIALS AND METHODS\u0000We utilized a randomized crossover design with 2 experimental trials. In both trials, exertional hyperthermia was induced by walking (3.5 mph at 5% grade) on a treadmill in an environmental chamber (40 °C, 30% RH) for up to 3 hours or until core body temperature reached 39.2 °C. After the walking portion, individuals either received ISC (experimental trial) or cooling and rested supine in the same environmental conditions for 30 minutes with no ISC (control trial). For ISC, bed sheets soaked in ice water were applied (per Army guidance) at the neck, chest, and groin with another sheet covering the body. Sheets were rotated and resoaked every 3 minutes until core temperature decreased to <38.0 °C.\u0000\u0000\u0000RESULTS\u0000By design, participants finished exercise with increased core temperature (38.8 ± 0.39 °C vs. 38.90 ± 0.34 °C, ISC and control trials, P = 1.00). The ISC trial provided significantly (P = .023) greater cooling rates, 0.068 °C/min 95% confidence interval [CI; 0.053, 0.086], compared to the control trial, 0.047 °C/min 95% CI [0.038, 0.056]. Additionally, the time to decrease to less than 38.0 °C was significantly (P = .018) faster in the ISC trial (median = 9.3 minutes) compared to the control trial (median = 26.6 minutes).\u0000\u0000\u0000CONCLUSION\u0000ISC increases the cooling rate of those recovering from exertional hyperthermia. With the observed cooling rate, we can extrapolate that ISC would reduce core temperature by ∼2 °C within 30 minutes during a case of EHS. We conclude that ISC provides a safe and effective alternative for the field where cold water immersion resources may not be readily available.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44908912","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":"Correction To: Femoral Nerve Blockade Does Not Lead to Subjective Functional Deficits After Anterior Cruciate Ligament Reconstruction.","authors":"","doi":"10.1093/milmed/usac070","DOIUrl":"https://doi.org/10.1093/milmed/usac070","url":null,"abstract":"","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48509483","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":"Health Conditions Among Navy Submariners at the End of Active Duty; A Retrospective Cohort Study.","authors":"Brian J Maguire, Linda M Hughes, Douglas C McAdams, Michael Gilbert, Robert Nordness","doi":"10.1093/milmed/usac063","DOIUrl":"10.1093/milmed/usac063","url":null,"abstract":"<p><strong>Introduction: </strong>Maintaining healthy, well-trained, and highly qualified armed forces is critical for ensuring military readiness. The purpose of this article is to contribute to the body of research focused on the health of U.S. Navy submariners and to identify the health conditions of U.S. Navy submariners during their final year of active duty service.</p><p><strong>Materials and methods: </strong>In this retrospective cohort study, we examined medical records and personnel files of separating U.S. Navy sailors who were: (1) active duty between 2009 and 2018; (2) separated before 2019; and (3) were assigned to a submarine for at least 30 days. Both officers and enlisted service members were included. We linked, described, and analyzed data from the Defense Health Agency, Military Health System Data Repository (MDR), and the Bureau of Naval Personnel (BUPERS). International Classification of Diseases (ICD) diagnoses codes were obtained from MDR. Data collected from BUPERS include age, sex, and rank. We determined the number of individuals who had at least one diagnosed condition (identified as a three-digit ICD code). We report the number of diagnoses and calculate prevalence rates and confidence intervals per condition, as well as prevalence rates per year, using standard formulas. The study was approved by the Naval Submarine Medical Research Laboratory Institutional Review Board.</p><p><strong>Results: </strong>During the study period, 26,014 submariners separated from the Navy. The average number of separations per year was 2,601. About a third of the separating submariners were in the 25 to 29 age group and over 50% were under 30 years of age. Of the three-digit individual ICD codes, some of the highest operationally relevant rates over the 10-year study period (2009-2018) were for joint disorders (prevalence rate [PR] = 180 per 1,000 submariners), back disorders (PR = 128), and sleep disorders (PR = 134). Three mental-health-related conditions were also among the 20 conditions with the highest rates.</p><p><strong>Conclusions: </strong>High rates of specific diagnoses such as joint disorders indicate the need for additional study to examine causal relationships, to determine which conditions may contribute to lost work time, early separations, or low rates of reenlistment and which conditions might be a result of specific military occupations or duties. Study strengths are the large number of subjects and the long period of observations. A study weakness was the inability to identify submariners who separated because of health conditions. The overall impact of the study is that it identifies urgent health risks and establishes a way to prioritize future research. Future research should include a focus on medically separated personnel; compare rates for submariners to other military groups including all-Navy and all-Department of Defense; and determine specific and relative risks as a necessary precursor to developing, imp","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47587022","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":"Learning to Lead: 10 Leadership Lessons From Operation Bushmaster.","authors":"John G Blickle, Leslie Vojta, Che-Sheu Huang, Jacob M Wyse, A. Yarnell, Joshua D. Hartzell","doi":"10.1093/milmed/usac058","DOIUrl":"https://doi.org/10.1093/milmed/usac058","url":null,"abstract":"Medical students at the Uniformed Services University of the Health Sciences participate in a leadership curriculum designed to develop leadership skills. Operation Bushmaster is a 5-day field practicum designed to test these skills. In this article, we describe 10 leadership lessons learned during Operation Bushmaster applicable to all leaders.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46131940","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}