Mobility Solutions After a Lower Extremity Fracture and Applicability to Battlefield and Wilderness Medicine.

The potential for delayed evacuation of injured Service members from austere environments highlights the need to develop solutions that can stabilize a wound and enable mobility during these prolonged casualty care (PCC) scenarios. Lower extremity fractures have traditionally been treated by immobilization (splinting) followed by air evacuation - a paradigm not practical in PCC scenarios. In the civilian sector, treatment of extremity injuries sustained during remote recreational activities have similar challenges, particularly when adverse weather or terrain precludes early ground or air rescue.

The "Brookhaven Brassie" and the Response to the Three Mile Island Accident.

In the mid-1970s, American civil defense authorities became increasingly concerned with the potential threat of fission reactor accidents. Research from the Defense Civil Preparedness Agency began to be aimed not just at the ever-present threat of nuclear warfare but also peacetime emergencies as part of a "dual use" philosophy. The Brookhaven National Laboratory received funding to create a prototype radioiodine air sampling system, with multiple publications detailing the creation of the air sampler itself and a special CD V-700 survey meter that accompanied it.

Hyperbaric Oxygen Therapy for Vascular Air Embolism From Iatrogenic Intravenous Infusion of Air in a Patient With Atrial Septal Defect: A Case Report.

Vascular air embolism (VAE) is an important complication of some routine medical procedures, particularly intravenous access for the administration of fluids or medications. The capillary bed of the pulmonary circulatory system is capable of compensating for small amounts of air entrained into a vein. However, large amounts of air can overwhelm that system and lead to complications ranging from cough, chest pain, or shortness of breath to cardiopulmonary collapse.

Prehospital Battlefield Casualty Intervention Decision Cognitive Study.

Introduction: Airway compromise is the third most common cause of preventable battlefield death. Surgical cricothyroidotomy (SC) is recommended by Tactical Combat Casualty Care (TCCC) guidelines when basic airway maneuvers fail. This is a descriptive analysis of the decision-making process of prehospital emergency providers to perform certain airway interventions.

Manikin Human-Patient Simulator Training.

Background: Human-patient simulators (HPSs) may help enhance medical education. Manikin HPS devices respond to common field medical interventions, such as cricothyroidotomy, and have realistic feedback features, such as respirations and pulses. This study surveys Special Operations Medics for evaluations of HPS features.

Albumin for Prehospital Fluid Resuscitation of Hemorrhagic Shock in Tactical Combat Casualty Care.

Optimal fluid resuscitation on the battlefield in the absence of blood products remains unclear. Contemporary Combat medics are generally limited to hydroxyethyl starch or crystalloid solutions, both of which present significant drawbacks. Obtaining US Food and Drug Administration (FDA)-approved freeze-dried plasma (FDP) is a top casualty care research priority for the US Military.

Compatibility of Hydroxyethyl Starch and Tranexamic Acid for Battlefield Co-Administration.

Introduction: The current Tactical Combat Casualty Care Guidelines recommend tranexamic acid (TXA) administration for casualties in whom massive blood transfusion is anticipated. However, despite Hextend being the recommended resuscitation fluid, the guidelines recommend against using TXA with Hextend. This appears to be due to a concern about pharmaceutical compatibility, despite the absence of a direct study of compatibility in the literature.

A Herpes Zoster Outbreak on the Sinai Peninsula.

Background: Infection with the varicella zoster virus, a type of herpesvirus, causes chickenpox in children and herpes zoster (commonly known as shingles) in adults.

Case Presentation: Two 20-year-old male Soldiers returned from an outpost with a rash consistent with herpes zoster. Two other Soldiers with whom they were in close had had a similar rash 2 weeks earlier, which had since resolved at the time of initial presentation.

Care of the Burn Casualty in the Prolonged Field Care Environment.

Burns are frequently encountered on the modern battlefield, with 5% - 20% of combat casualties expected to sustain some burn injury. Addressing immediate life-threatening conditions in accordance with the MARCH protocol (massive hemorrhage, airway, respirations, circulation, hypothermia/head injury) remains the top priority for burn casualties. Stopping the burning process, total burn surface area (TBSA) calculation, fluid resuscitation, covering the wounds, and hypothermia management are the next steps.

Decompression sickness following altitude-chamber training.

Decompression sickness (DCS) is one of several dysbarisms (medical conditions resulting from a change in atmospheric pressure) that can be encountered by the Special Operations Forces (SOF) medical provider. DCS can present with several different manifestations. The authors present the case of a 23-year-old Airman who presented with vague neurologic symptoms following altitude-chamber training.

Evaluation of commercially available traction splints for battlefield use.

Background: Femoral fracture is a common battlefield injury with grave complications if not properly treated. Traction splinting has been proved to decrease morbidity and mortality in battlefield femur fractures. However, little standardization of equipment and training exists within the United States Armed Forces.

Preparedness for resuscitation at a geographically isolated army troop medical clinic: lessons from Camp Blanding, Florida.

Introduction: Many Servicemembers rely on nondeployed Role 1 facilities, such as troop medical clinics, as their primary source of healthcare. At geographically isolated military installations, these facilities are the "only game in town" for medical care. Servicemembers may present to these facilities with emergent conditions, regardless of designed intent of the facility or the wishes of staff.

Self-rated readiness for performance of needle decompression in combat lifesaver training.

Background: The Combat Lifesaver course taught to nonmedical personnel includes instruction on performing needle thoracostomy to decompress tension pneumothorax, the second leading cause of preventable combat death. Although the Tactical Combat Casualty Care curriculum is pushed to the lowest level of battlefield first responders, the instruction of this advanced procedure is routinely limited to a verbal block of instruction with a standardized presentation.

Objective: The purpose of this study was to assess the confidence of nonmedical personnel in their preparation to perform a needle thoracostomy before Combat Lifesaver training, after verbal instruction on the procedure, manikin training, and practice on a human cadaver.

Feasibility of supraglottic airway use by combat lifesavers on the modern battlefield.

Background: Airway compromise is a contributor to preventable mortality on the battlefield. Supraglottic airway devices are an accepted intervention for these casualties. Combat Medics, civilian prehospital care providers, and lay civilians have demonstrated proficiency with supraglottic airways.