Medical units designed to provide combat and operational stress control services have evolved since World War II into the current Combat and Operational Stress Control (COSC) detachments. Yet the structure of these COSC detachments differ greatly between what is authorized in the table of organization and equipment (TO&E) and what is doctrinally described in the current field manual guiding combat and operational stress control operations. We therefore explore the evolution of the COSC detachment, compare the organizations found in current doctrine with that currently authorized on the TO&E, and conclude with a proposed structure of a modern COSC detachment that is functionally modular with more clear chains of command.
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Lancet Reg Health Am
December 2024
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
Background: Over the last decade, numerous efforts have been made to combat the opioid crisis globally. The impact of these strategies has not been adequately measured and may differ across populations depending on baseline risk. We compared changes in long-term prescription opioid use following surgery within a national US cohort, between 2017 and 2022.
View Article and Find Full Text PDFBMC Emerg Med
January 2025
Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, CNY149, 13th St, Charlestown, 02129, MA, USA.
Background: The use of emergency tourniquets among military personnel has helped to dramatically reduce battlefield deaths and has recently gained popularity in the civilian sector. Yet, even well-trained individuals can find it difficult to assess proper tourniquet application. Emergency tourniquets are typically deemed sufficiently tightened through cursory visual confirmation or pulse assessment.
View Article and Find Full Text PDFJ Control Release
January 2025
Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China. Electronic address:
Keloids are pathological scars characterized by excessive fibroblast proliferation, abnormal collagen deposition, and chronic inflammation, which often result in high recurrence rates and limited treatment success. Targeting BACH1 with gene therapy has shown promise in regulating fibroblast activity and reducing inflammation. However, effective delivery systems for targeted gene therapy in keloids remain a major challenge.
View Article and Find Full Text PDFJ Trauma Acute Care Surg
January 2025
From the Department of Orthopedic Surgery (I.F., S.B., M.T., D.P., R.B., N.G.), Chaim Sheba Medical Center at Tel Hashomer, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel.
Background: Combat-related injuries have evolved in urban warfare because of close-contact engagements and high-energy blast injuries, with rapid medical evacuation improving survival rates. This study analyzes injury patterns and outcomes in the Gaza conflict, emphasizing the need to optimize trauma care protocols in modern combat environments, particularly because of the unique proximity of conflict zones to tertiary trauma centers.
Methods: A retrospective study was conducted at a single center involving 189 patients evacuated by helicopter to a Level I tertiary trauma center.
J Trauma Acute Care Surg
January 2025
From the Department of Surgery (J.-M.V., T.W.C., B.A.C.), McGovern Medical School, University of Texas Health Science Center, Houston, Texas; Department of Epidemiology (B.L.R.-R., S.R.W.) and Department of Surgery (J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Donald D. Trunkey Center for Civilian and Combat Casualty Care (M.A.S.), Oregon Health & Science University, Portland, Oregon; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health (E.E.M.), University of Colorado Health Sciences Center, Denver, Colorado; Department of Surgery (N.N.), University of Miami/Jackson Memorial Hospital, Miami, Florida; and Department of Surgery (J.L.S.), Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
Background: Blood shortages and utilization stewardship have motivated the trauma community to evaluate futility cutoffs during massive transfusions (MTs). Recent single-center studies have confirmed meaningful survival in ultra-MT (≥20 U) and super-MT (≥50 U), while others advocate for earlier futility cut points. We sought to evaluate whether transfusion volume and intensity cut points could predict 100% mortality in a multicenter analysis.
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