Rationale and Implementation of a Novel Special Operations Medical Officer Course.

Background: The Air Force Special Warfare Medical Officer Course was created to address the lack of operationally focused, job-specific clinical training for medical officers (MOs). This course addresses the gap in knowledge, skill, and application of operational medicine, as well as the behavioral health, human performance, education, and medical oversight of Operators.

Methods: The course was designed around the senior author's decade of experience piecing together training for his own role as a pararescue flight surgeon and informed by 5 years of flight surgeon courses, lessons learned from case studies of ill-prepared deployed physicians, and input from prehospital medicine subject matter experts.

Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study.

Introduction: To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.

Methods: This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015.

Airway Management for Trauma Patients.

Trauma airway management is a critical skill for medical providers supporting combat casualties since it is an integral component of damage control resuscitation and surgery. This clinical practice guideline presents methods for optimizing the airway management of patients with traumatic injury in the operational medical treatment facility environment. The guidelines represent the knowledge and experience of 10 co-authors from 3 allied countries representing Emergency Medicine, Surgery and Anesthesia.

Successful Use of Ketamine as a Prehospital Analgesic by Pararescuemen During Operation Enduring Freedom.

Effective analgesia is a crucial part of the care and resuscitation of a traumatically injured patient. These secondary effects of pain may increase morbidity and mortality in the acutely injured patient. When ketamine is administered appropriately in the clinical setting, it can provide analgesia, anxiolysis, and amnesia for patients with less respiratory depression and hypotension than equivalent doses of opioid analgesics.

Stop the Bleed: The Effect of Hemorrhage Control Education on Laypersons' Willingness to Respond During a Traumatic Medical Emergency.

Background: The "Stop the Bleed" campaign advocates for non-medical personnel to be trained in basic hemorrhage control. However, it is not clear what type of education or the duration of instruction needed to meet that requirement. The objective of this study was to determine the impact of a brief hemorrhage control educational curriculum on the willingness of laypersons to respond during a traumatic emergency.

Measuring US Army medical evacuation: Metrics for performance improvement.

Background: The US Army medical evacuation (MEDEVAC) community has maintained a reputation for high levels of success in transporting casualties from the point of injury to definitive care. This work served as a demonstration project to advance a model of quality assurance surveillance and medical direction for prehospital MEDEVAC providers within the Joint Trauma System.

Methods: A retrospective interrupted time series analysis using prospectively collected data was performed as a process improvement project.

The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons.

Background: The "Stop the Bleed" campaign in the United States advocates for nonmedical personnel to be trained in basic hemorrhage control and that "bleeding control kits" be available in high-risk areas. However, it is not clear which tourniquets are most effective in the hands of laypersons.

Objectives: The objective of this pilot study was to determine which tourniquet type was the most intuitive for a layperson to apply correctly.

Awake Cricothyrotomy: A Novel Approach to the Surgical Airway in the Tactical Setting.

Airway obstruction on the battlefield is most often due to maxillofacial trauma, which may include bleeding and disrupted airway anatomy. In many of these cases, surgical cricothyrotomy (SC) is the preferred airway management procedure. SC is an emergency airway procedure performed when attempts to open an airway using nasal devices, oral devices, or tracheal intubation have failed, or when the risks from intubation are unacceptably high.

An Assessment of National EMT Certification Among Enlisted Military Medics.

Background: Navy Hospital Corpsmen (HMs) are the Navy equivalent to Emergency Medical Technicians (EMTs) both in-garrison and on the battlefield. In 2000, the Emergency Medical Services (EMS) Education Agenda for the Future highlighted the need for a single certification agency to provide consistent evaluation of entry level competence for each nationally recognized EMS provider level. Administered by the National Registry of EMTs (NREMT), National EMT Certification is currently utilized by 46 states, the District of Columbia, four territories, and six federal organizations as part of their processes for granting licensure.

Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

Introduction: As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa.

Navy En Route Care: A 3-Year Review of 428 Navy Air Evacuations.

Background: Navy medical personnel have been recording en route care (ERC) missions through Search and Rescue (SAR) reports since the 1970's. Our objective was to report clinical ERC cases treated by Navy operational assets from January 2012 to January 2015.

Methods: The Search and Rescue Model Manager office collects SAR reports for all patient transports involving Navy personnel and equipment.

Time to epinephrine in out-of-hospital cardiac arrest: A retrospective analysis of intraosseous versus intravenous access.

Introduction: The 2015 advanced cardiac life support update continues to advocate administering epinephrine during cardiac arrest. The goal of our study is to determine if prehospital intraosseous (IO) access results in shorter time to epinephrine than prehospital peripheral intravenous (PIV) access.

Methods: The out-of-hospital cardiac arrest (OHCA) database of a large, urban, fire-based emergency medical services system was searched for consecutive cases of OHCA between January 2013 and December 2015.

Assessment of Groin Application of Junctional Tourniquets in a Manikin Model.

Unlabelled: Introduction To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use. Hypothesis Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.

Methods: In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets.

A randomized control hands-on defibrillation study-Barrier use evaluation.

Introduction: Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time results in a zero blood flow state.

The long spine board does not reduce lateral motion during transport--a randomized healthy volunteer crossover trial.

Objective: For thirty years, emergency medical services agencies have emphasized limiting spinal motion during transport of the trauma patient to the emergency department. The long spine board (LSB) has been the mainstay of spinal motion restriction practices, despite the paucity of data to support its use. The purpose of this study was to determine reduction in lateral motion afforded by the LSB in comparison to the stretcher mattress alone.

Cinnarizine for Sea Sickness During a Remote Pacific Ocean Rescue Mission.

Motion sickness can be a limiting factor for sea and air missions. We report the experience of a Pararescue (PJ) team on a Pacific Ocean rescue mission in which motion sickness was prevalent. Cinnarizine, an antagonist of H1-histamine receptors, was used to treat affected PJs.

Evolution of Pararescue medicine during operation Enduring Freedom.

This article highlights recent advances made in U.S. Air Force Pararescue Medical Operations in relation to tactical evacuation procedures.

Pilot ejection, parachute, and helicopter crash injuries.

USAF Pararescuemen (PJs) respond to downed aircrew as a fundamental mission for personnel recovery (PR), one of the Air Force's core functions. In addition to responding to these in Military settings, the PJs from the 212 Rescue Squadron routinely respond to small plane crashes in remote regions of Alaska. While there is a paucity of information on the latter, there have been articles detailing injuries sustained from helicopter crashes and while ejecting or parachuting from fixed wing aircraft.