HOSPITAL CORPSMAN: THE HOSPITAL CORP MANUAL... THE ELITE CORPS OF THE U S NAVY

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The Navy Ceremonial Duty Ribbon is presented to members of the ceremonial guard who, receives their full honors qualification, and completes a standard tour of duty 2 years with the United States Navy Ceremonial Guard. For the Ceremonial Guard, the enlisted Full Dress uniforms are more elaborate with the wearing of a white pistol belt, ascot, and dress aiguilette the latter two are white for winter and navy blue for summer , and white canvas leggings. This uniform is due to be replaced in From Wikipedia, the free encyclopedia. Main article: Navy Ceremonial Duty Ribbon. See also: Uniforms of the United States Navy.

Navy Band". Okinawa Stripes. Retrieved Two silver stars. Three silver stars. Four silver stars. See also: Warrant officer United States. Marine Corps. Performed by the U. Marine Band in June Problems listening to the file? See media help. See also: List of active United States military aircraft. Main article: United States Navy. Main article: United States Army. Main article: United States Air Force. Main article: United States Coast Guard. Retrieved on July 15 , Department of Defense 9 February Retrieved on February 11 , Retrieved on 13 June Marine Corps Order No.

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Tactical Aviation Integration. Retrieved on April 1 , Marine Corps Decade Timeline. Shaw, Jr.. Pearl Harbor to Guadalcanal. History of U. Retrieved 2 June Strobridge Western Pacific Operations. Retrieved 3 August Saw, Jr. Victory and Occupation. Marine Corps, but it is part of United States Department of Homeland Security and does not normally operate under the DoD except during times of war or as directed by the U.

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Archived from the original on 5 February The Marine Officer's Guide, 6th Edition. Naval Institute Press. In Office of the Federal Register. Clinton, , Book 2: July 1 to December 31, Government Printing Office. Jefferson was a violin player who loved music almost as much as he loved freedom.

He named the band "The President's Own". Zenith Imprint. Citadel Press. New York: Thames and Hudson. American Spartans: The U. Ensuring 'Every Marine a Rifleman' is more than just a catch phrase. Story ID Heinl, Jr. Maneuver Warfare Handbook. Boulder, Colorado: Westview Press. Gates: Time has come to re-examine future of Marine Corps. Marines return to their amphibious roots. II Marine Expeditionary Force. New York: Main Street. Congress 11 July Retrieved on May 16 , Congress 18 March Act to provide a Naval Armament.

Annapolis, Maryland: Naval Institute Press. Congress 30 June Archived from the original on October 7 , Retrieved on August 3 , Robert Marine Corps Story. New York: McGraw-Hill. Archived from the original on October 1 , Retrieved on October 7 , Marine Corps Casualties: Frequently Requested. Archived from the original on April 26 , Retrieved on April 23 , Washington, D. Marine Corps.. Life Magazine Retrieved on 7 October Archived from the original on January 11 , Retrieved on August 11 , Pete Ellis: an amphibious warfare prophet, — Marine Corps Historical Center. Archived from the original on February 8 , Retrieved on January 17 , Turner Publishing Company.

Westport, Connecticut: Greenwood Press. New York: Simon and Schuster. Penguin Group US. Chapter 7, The Marines' Push Button pp. History Division, U. Archived from the original on August 6 , This source provides a number of 14, Military Casualties in Southeast Asia. Archived from the original on September 2 , Archived from the original on June 5 , Marines was witnessed by millions of U. United States Naval Aviation, — PDF file, see ", 9 December" on p. Retrieved 14 April The New York Times.

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Walking Point: American Narratives of Vietnam. To Lead by the Unknowing, to Do the Unthinkable. Osprey Publishing. Paul W. The meaning of 'Oorah' traced back to its roots. Marine Corps News. Archived from the original on December 24 , Clemons McGraw-Hill Professional. New York: Collins. Jamison, USMC. Black Belt 41 7. Kit Up! Retrieved on April 27 , Headquarters Marine Corps 4 April Archived from the original on January 10 , Retrieved on June 11 , Marine corps.

Archived from the original on February 25 , Archived from the original on February 11 , None of the STF-treated animals bled following the simulated walking maneuver. Three of five STF-treated animals reestablished blood flow distal to the injury as demonstrated by angiography. Further, the STF dressing formed a fibrin sealant over the injury, whereas CG achieved hemostasis by occlusive compression of the artery. The sealant property of the STF dressing allowed reestablishment of antegrade blood flow into the distal limb, demonstrating that this dressing has the potential of limb salvage in addition to control of life-threatening hemorrhage.

The Department of Defense has placed considerable emphasis on the identification of post-traumatic stress disorder PTSD in military personnel returning from Iraq and Afghanistan, and several mandatory screening tools are currently used by primary care clinicians to assist in this effort. PTSD has been shown to impair emotional and social functioning, and to affect physical health and quality of life.

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Previous research has identified that combat veterans meeting diagnostic criteria for PTSD are more likely to experience some form of sexual dysfunction. On the other hand, the barriers to care for sexual dysfunction have been reduced in recent years. Young, healthy male combat veterans who seek treatment for sexual dysfunction should be questioned about symptoms of PTSD. Within the Department of Defense over the past decade, a focus on enhancing Warfighter resilience and readiness has increased.

For Special Operation Forces SOF , who bear unique burdens for training and deployment, programs like the Preservation of the Force and Family have been created to help support SOF and their family members in sustaining capabilities and enhancing resilience in the face of prolonged warfare. In this review, we describe the shift in focus from resilience to human performance optimization HPO and the benefits of human performance initiatives that include holistic fitness. We then describe strategies for advancing the application of HPO for future initiatives through tailoring and cultural adaptation, as well as advancing methods for measurement.

By striving toward specificity and precision performance, SOF human performance programs can impact individual and team capabilities to a greater extent than in the past, as well as maintaining the well-being of SOF and their families across their careers and beyond. Keywords: human performance optimization ; Special Operations Forces. Lidwell D , Meghoo CA. Skeletal traction is a useful technique for managing proximal femur fractures in austere environments where fracture stabilization for this injury is difficult.

We present a technique and a construct appropriate for field use that facilitates patient evacuation, and we provide guidelines for the use of this technique by an advanced medical provider managing these injuries. The objectives of this article are to enable to reader to 1 recognize the role of skeletal traction in managing proximal femur fractures in an austere environment, 2 identify the key steps in placing transfemoral skeletal traction pins, and 3 identify options and requirements for building a traction construct in resource-limited environments.

Keywords: traction skeletal ; fracture proximal femur. Heat injuries are a common occurrence in the military training setting due to both the physically demanding nature of the training and the environments in which we train. Testing is often done after the diagnosis of a heat injury to screen for abnormalities. We present the case of a year-old male Soldier with an abnormal electrocardiogram ECG with a possible injury pattern and an elevated troponin level. He underwent a diagnostic cardiac angiogram, which demonstrated no abnormal findings.

He was returned to duty upon recovery from the catheterization. Ischemic-appearing ECG and troponin findings may be noted after heat injury. In this case, it was not associated with any cardiac lesions. Keywords: injury, heat ; heat-associated injuries ; electrocardiogram ; cardiac.

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This article describes both teams working together in Operation Freedom's Sentinel while deployed in support of SOF in central Afghanistan during the summer fighting season. Keywords: prolonged field care ; austere medicine ; military medicine ; damage control resuscitation ; damage control surgery.

Documentation of medical care provided is paramount for improving performance and ultimately reducing morbidity and mortality. However, documentation of prehospital trauma care on the battlefield has historically been suboptimal. Modernization of prehospital documentation tools have aligned data and information to be gathered with up-to-date treatment being rendered through Tactical Combat Casualty Care TCCC protocols and practices.

Our study was conducted to evaluate TCCC Card completion, and accuracy of card completion, by military medical providers conducting precombat training through the Tactical Combat Medical Care Course. Study results do not show a deficiency in TCCC documentation training as provided by this course which should translate to adequate ability to accurately document prehospital trauma care on the battlefield.

Leadership emphasis and community acceptance is required to increase compliance with prehospital documentation. Keywords: combat ; documentation ; prehospital ; trauma. Although the majority of potentially preventable fatalities among U. Morphine given intramuscularly has a delayed onset of action and, like all opioids, may worsen hemorrhagic shock. Additionally, on a recent assessment of prehospital care in Afghanistan, combat medical personnel noted that Tactical Combat Casualty Care TCCC battlefield analgesia recommendations need to be simplified-there are too many options and not enough clear guidance on which medication to use in specific situations.

They also reported that ketamine is presently being used as a battlefield analgesic by some medics in theater with good results. This report proposes that battlefield analgesia be achieved using one or more of three options: 1 the meloxicam and Tylenol in the TCCC Combat Pill Pack for casualties with relatively minor pain who are still able to function as effective combatants; 2 oral transmucosal fentanyl citrate OTFC for casualties who have moderate to severe pain, but who are not in hemorrhagic shock or respiratory distress and are not at significant risk for developing either condition; or 3 ketamine for casualties who have moderate to severe pain but who are in hemorrhagic shock or respiratory distress or are at significant risk for developing either condition.

Ketamine may also be used to increase analgesic effect for casualties who have previously been given opioids morphine or fentanyl. Keywords: battlefield analgesia ; fentanyl ; ketamine ; morphine. This is an important cause of potentially preventable deaths on the battlefield and a difficult condition to treat in the civilian prehospital setting. Having a solution to definitively treat the condition decreases the mortality and morbidity of these injuries.

Keywords: Abdominal Aortic and Junctional Tourniquet ; hemorrhage ; gunshot wound. Junctional hemorrhage, bleeding from the areas at the junction of the trunk and its appendages, is a difficult problem in trauma. These areas are not amenable to regular tourniquets as they cannot fit to give circumferential pressure around the extremity. Junctional arterial injuries can rapidly lead to death by exsanguination, and out-of-hospital control of junctional bleeding can be lifesaving.

To our knowledge, the present report is the first human use of a junctional tourniquet to control an upper extremity junctional hemorrhage. Keywords: AAT ; hemorrhage ; amputations. Excerpts from the medical provider's account of the tactical evacuation phase of care are provided. Keywords: pain ; abdominal pain ; appendicitis ; diagnosis ; treatment. Background: Accurate point-of-injury reports and casualty evacuation requests allow for optimal resource utilization.

However, the accuracy of these reports has not been previously studied. Methods: All trauma patients treated at one of three forward surgical elements FSE in Western Afghanistan during May-August were prospectively included. Results: There were casualty evacuation reports and patients. There was no difference between the mean vital signs at the point of injury or on arrival at the FSE. When analyzed individually, however, there was no correlation between each casualty's pulse, mean arterial pressure, or respiratory rate between the two time points.

Discussion: There was a high degree of correlation between the triage category of casualty evacuation reports and the patient's actual medical needs. There was also a highly significant association with the number of patients, mechanism of injury, and bodily injuries. However, there was discordance between the vital signs at an individual level, which may represent regression toward the resuscitation threshold. Keywords: triage ; trauma ; war ; Afghanistan ; combat ; accuracy. Pennardt A , Talbot T. Modifications to their physical training program were principally aimed at reducing overtraining and overuse injury, educating trainees and cadre on how to train smarter, and transitioning from traditional to "functional" PT.

A battery of physiological measurements and a psychological test were administered prior to and immediately after trainees undertook an 8-week modified physical fitness training program designed to reduce overtraining and injury and improve performance. We performed multiple physical tests for cardiovascular endurance VO2max and running economy , "anaerobic" capacity Wingate power and loaded running tests , body composition skinfolds , power Wingate and vertical jump , and reaction time Makoto eye-hand test. Results: We observed several significant improvements in physical and physiological performance over the eight weeks of training.

Body composition improved by VO2max, time-to-exhaustion, and ventilatory threshold were all significantly higher after implementation of the new program than before it. Other measures of lower body power did not change significantly over the training period, but did show mild trends towards improvement.

Upper body average and peak power per kilogram of body mass both improved significantly by 5. Conclusions: The modifications resulted in significant improvement in trainees' graduation rate. In the eight classes prior to implementation of these changes, average CCT graduating class size was nine trainees.

For the eight classes following the changes, average CCT graduating class rose to Due to its success, STTS leadership expanded the modifications from the eight weeks prior to CDS to include the entire second year of the pipeline. This acknowledgment will allow researchers to evaluate and delimit the medic's needs in relationship to an expanded set of roles that move beyond life-saving care.

This article comprises four sections. First, I provide background to my argument by exploring some assumptions of modern medicine and objections to exploring battlefield death care. Second, I describe how I see the medic's role expanding with the introduction of prolonged field care. Third, I address the implications of the medic's expanded role in relationship to role and function stress and strain.

Fourth, I address the moral complexity related to withdrawing or withholding care. I conclude by briefly highlighting some of the implications for future research. In explicitly engaging death as a medical reality for which the medic ought to be prepared, SOF medicine could set the foundational development for seeing death as a valuable gift to be explored, not a failure to be avoided or burden to be overcome.

Keywords: death ; ethics ; combat casualty care ; prolonged field care ; Special Operations medic ; death care ; unconventional medicine. It is difficult for Special Operations Forces SOF to provide meaningful long-term medical solutions for the indigenous population in their area of operation AO. Limited time, equipment, supplies, the inability to follow-up, and re-exposure to disease are common obstacles to effective local national patient care.


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Poor vision due to uncorrected refractive errors has a significant negative impact on quality of life in under-developed countries. New eyewear technology will give SOF Medics the ability to provide definitive care for this chronic, burdensome condition which will benefit both patient and mission.

Lang G , Lang C. All pregnant women are at risk of obstetric complications, most of which occur during labor and delivery among women with no previously identified risk factors. More than 95 percent of these deaths occur in developing countries. In sub-Saharan Africa, a region of the world currently experiencing significant humanitarian crises, the lifetime risk of maternal death is one in 30 whereas the lifetime risk in developed countries is one in 2, Emergency obstetric care is critical to reducing maternal death and disability. SOF medical personnel supporting counterinsurgency COIN operations may find themselves in situations where no legitimate agencies are available to provide maternal healthcare.

Similarly, SOF medical personnel should be prepared to assist in rebuilding infrastructure and basic services to include the provision for maternal health. This article provides an overview of maternal health in underdeveloped countries; the importance of addressing the unique healthcare needs of women during COIN operations; and how the employment of Female Treatment Teams FTT can assist in meeting these needs. A subsequent article will review the basics of prenatal care and life-saving emergency obstetric care, and discusses the essential information and skills that should be taught in a MEDSEM covering maternal healthcare.

Background: Optimal airway management protocols for the prehospital battlefield setting have not been defined. Airway management strategies in this environment must take into account the injury patterns, the environment and training requirements of military prehospital providers. This study examines only those patients who had advanced airways placed for trauma by an enlisted military medic at the point of injury.

The Glasgow Coma Scale provides a score in the range ; patients with scores of are usually said to be in a coma. Three patients in this group survived to transfer from the CSH. The third patient had a surgical cricothyroidotomy SC performed in the field for an expanding neck hematoma and recovered fully following surgery. Conclusions: Casualties that tolerate invasive airway management without sedation in the context of trauma prognosticates a very high mortality.

Airway management algorithms for military providers should reflect the casualties encountered on the battlefield not patients in cardiac arrest which predominate in the civilian EMS airway management practice. Further data are needed to understand the injuries encountered on the battlefield and to develop airway management solutions that optimize outcomes of patients with battlefield trauma.

The MEDSEM uses a Commander's military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population's health system. At the heart of the MEDSEM is the "train the trainer" concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander's objectives of increasing access and influence with the population through a medical training venue rather than direct patient care.

This model can also be used to engage host nation HN medical personnel and improve medical treatment capabilities in population centers. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders' objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. TCCC has previously recommended interventions that can effectively prevent 4 of the top 5 causes of prehospital preventable death in combat casualties-extremity hemorrhage, junctional hemorrhage, airway obstruction, and tension pneumothorax- and deaths from these causes have been markedly reduced in US combat casualties.

Noncompressible torso hemorrhage NCTH is the last remaining major cause of preventable death on the battlefield and often causes death within 30 minutes of wounding. Additionally, Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA can provide temporary control of bleeding in the abdomen and pelvis and improve hemodynamics in casualties who may be approaching traumatic cardiac arrest as a result of hemorrhagic shock.

Although Special Operations units are now using whole blood far-forward, this capability is not routinely present in other US combat units at this point in time. REBOA is not envisioned as care that could be accomplished by a unit medic working out of his or her aid bag. This intervention should be undertaken only by designated teams of advanced combat medical personnel with special training and equipment. Background: Training partner forces in battlefield first-responder medical skills is an important component of US military advise-and-assist operations.

We designed and executed a training curriculum focused on high-yield-based medical skills to prevent death on the battlefield for non-English speaking members of the Turkish, Azerbaijani, and Albanian militaries deployed to Afghanistan. Methods: We designed a 2-hour training curriculum focusing on four basic medical skills: 1 assessment of scene safety; 2 limb tourniquet application; 3 wound bandaging; and 4 patient transportation via litter. Our combat medics delivered standardized training using both didactic and practicum components.

Instructors made beforeand- after assessments of the proficiency of each participant for each skill in accordance with the Dreyfus model of skill acquisition. We also administered before-and-after, Likertscale- based surveys for training participants to report their self-assessed comfort level with each of the four skills. Results: We delivered training to participants over five classes. All 28 participants in the final teaching class completed the study. Instructors categorized each participant's skill level as novice before training for all four skills.

After the training curriculum, all participants achieved a skill level consistent with advanced beginner for all four skills. The largest reported increase in median comfort level was for tourniquet application: median pretraining comfort level, 4 interquartile range [IQR], Conclusion: Our curriculum resulted in significant improvements in instructor-assessed proficiency and self-reported comfort level for all four basic medical skills.

Although our outcome measures have important limitations, this curriculum may be useful framework for future medics and physicians designing battlefield first-responder training curricula for members of foreign militaries. Keywords: education ; wounds and injuries ; emergency medical services ; military personnel. The call for small surgical teams to provide direct support to SOF units has gained intensity over the last seven years. But even though these units are small compared to traditional Level III surgical hospitals, their size is too large to support emerging and short duration SOF missions.

In doing so, it became clear that "SOF specific" surgical units serve a unique customer, must work within unique constraints, and must be agile enough to provide unique solutions. Background: An Army Reserve Combat Medic's training is focused on knowledge attainment, skill development, and building experience and training to prepare them to perform in austere conditions with limited resources like on the battlefield. Unfortunately, the exposure to skills they may be responsible for performing is limited. The skill and decision-making of this population are prime targets to optimize outcomes in the battlefield setting.


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Methods: Army Reserve combat medics were selected to voluntarily participate in an educational intervention provided by anesthesia providers focusing on airway management. Participants completed a preintervention assessment to evaluate baseline knowledge levels as well as comfort with airway skills. Medics then participated in a simulated difficult airway scenario. Next, airway management was reviewed, and navigation of the difficult airway algorithm was discussed.

The presentation was followed by simulations at four hands-on stations, which focused on fundamental airway concepts such as bag-mask ventilation and placement of oral airways, tracheal intubation, placement of supraglottic airways, and cricothyrotomy.

Establishment of ventilation was completed faster after the intervention. More coherent and effective airway management was noted, new knowledge was gained, and implications from psychological research applied. Conclusion: Supplementing the training of Army Reserve Combat Medics with the utilization of anesthesia providers is an effective platform. This exercise imparted confidence in this population of military providers. This is critical for decision-making capabilities, performance, and the prevention of potentially survivable mortality on the battlefield.

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Keywords: airway ; mortality ; military ; nurse anesthetist ; education. 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. Interest in this agent reflects a desire to simultaneously expand intravascular volume and address coagulopathy. Callahan CL , Eisenman J. This space fills with blood, lymph, and cellular debris, giving the lesion a fluctuant appearance on examination.


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The potential space associated with larger lesions can be a source for hemorrhage in the appropriate clinical context. However, these lesions are often diagnosed late in their clinical course or are misdiagnosed, leading to long-term complications. Management of this injury typically depends upon the size of the lesion. Special Operations medical provider must be familiar with the differential diagnosis for a patient with altered mental status since it includes multiple life-threatening illnesses.

Potential diagnoses include meningitis, encephalitis, malaria and many others. While preparing to evacuate to definitive care from an austere location, they must also be prepared to initiate empiric therapy that is specific to the patient and the area of operations. We present a case of a U. We will review the key differential diagnoses for this presentation with a focus on infectious etiologies. We will also summarize current diagnostic and therapeutic strategies.

Our recommendation is to initiate oral acyclovir when IV acyclovir is not available and this diagnosis cannot be excluded. Mabry RL , Frankfurt A. This study examines the specific intervention of pre-hospital cricothyrotomy PC in the military setting using the largest studies of civilian medics performing PC as historical controls. The goal of this paper is to help define optimal airway management strategies, tools and techniques for use in the military pre-hospital setting.

Methods: This retrospective chart review examined all patients presenting to combat support hospitals following prehospital cricothyrotomy during combat operations in Iraq and Afghanistan during a month period. A PC was determined "successful" if it was documented as functional on arrival to the hospital. All PC complications that were documented in the patients' record were also noted in the review. Results: Two thirds of the patients died.

The most common injuries were caused by explosions, followed by gunshot wounds GSW and blunt trauma. Eighty-two percent of the casualties had injures to face, neck or head. Those injured by gunshot wounds to the head or thorax all died. Complications were not significantly different than those found in civilian PC studies, including incorrect anatomic placement, excessive bleeding, air leak and right main stem placement.

The survival rate and complication rates are similar to previous civilian studies of medics performing PC. However the failure rate for military medics is three to five times higher than comparable civilian studies. Further study is required to define the optimal equipment, technique, and training required for combat medics to master this infrequently performed but lifesaving procedure. Waterborne infection is an important cause of morbidity and mortality throughout the world.

Personal hydration packs have been used by military personnel since the Gulf War and are now a common issue item. Since military personnel tend to operate under austere conditions and may use a variety of water sources, preventing the acquisition of waterborne infections is extremely important.

Further, since hydration pack water reservoir replacements may not be available during combat operations, the development of a reliable cleaning protocol for use in the field is essential. Several methods for cleaning have been described. The study results suggest that the use of bleach and proprietary CAMELBAK tablets should be encouraged since they both operate by releasing bactericidal chlorine compounds into solution, which is more effective at reducing post-treatment bacterial burden. Background: Tactical combat casualty care TCCC is a system of prehospital trauma care designed for the combat environment.

Although widely adopted, very few studies have reported on how TCCC interventions are actually delivered on the battlefield, from a quality of care perspective. Primary outcomes were whether or not two TCCC interventions were underused, overused, or misused. Interventions studied were needle decompression of tension pneumothoraces and tourniquet application for exsanguinating extremity injuries. Results: One hundred thirty-four trauma patients were treated at the Role 3 MMU during the study period. Six patients had eight tourniquets applied. Five tourniquets were applied to four patients appropriately and saved their lives.

There was one case of misuse where a venous tourniquet was applied. There was one case of overuse where one patient had two tourniquets placed for 4 hours on extremities with no vascular injury. There were seven cases where needle decompression was underused: Seven patients presented with vital signs absent with no needle decompression. There was one case of overuse of needle decompression. There were seven cases of misuse where the patients were decompressed too medially. Conclusions: Tourniquets save lives.

Needle decompression can save lives, but is usually performed in patients with multiple critical injuries. TCCC instructors must reinforce proper techniques and indications for each procedure to ensure that the quality of care provided to injured soldiers on the battlefield remains high. The Department of Defense DoD faces unprecedented challenges as the Nation confronts balancing a strong military to confront threats with the realities of diminishing financial resources.

That each warfighter is a critical resource was underscored the Special Operations principal tenet "humans are more important than hardware. This article is the first in a new series relating to HPO, and we define the term and concept of HPO, describe other phrases used e. Last, we introduce an integrated model for HPO. Keywords: human performance optimization ; demands ; resource ; OODA loop. Keywords: interviews ; Viola, Steven.

SERE schools are responsible for preparing military members for these situations, but the concept of SERE medicine is not particularly well defined. To provide a comprehensive working description of SERE medicine, operational and training components were examined. Ideally, medical lessons taught in SERE training are based on actual documented events. Unfortunately, the existing body of literature is dated and does not appear to be expanding.

In this article, four distinct facets of SERE medicine are presented to establish a basis for future discussion and research. Recommendations to improve SERE medical curricula and data-gathering processes are also provided. Keywords: SERE ; survival, evasion, resistance, escape ; captivity ; isolation ; wilderness. Introduction: Prehospital care documentation is crucial to improving battlefield care outcomes.

This study documents length of time and accuracy of U. Army Combat Medic trainees in completing the minimum preestablished required fields on the TCCC card, establishing a baseline for point-of-injury cards. Design and Methods: This was a prospective observational study in which U. Army combat medic trainees were timed while recording data on the TCCC card in both the classroom and simulated combat environment. Results: We enrolled U. Conclusion: Results imply that the TCCC card is well designed to quickly and accurately record prehospital combat injury information.

Further investigation and future studies may compare other prehospital data collection methods with the TCCC card in terms of timely and accurate data collection. Background: Public health personnel from the 28th Combat Support Hospital in Baghdad, Iraq, conducted an outbreak investigation in response to many local cases of gastrointestinal GI illness presenting to U.

The investigation was conducted to identify the source of the illness, assess the extent of cases, and make recommendations to prevent similar outbreaks. Methods and Materials: For this retrospective cohort study, medical records and patient outbreak questionnaires were reviewed. A patient case, relative to the outbreak, was defined as any person who had developed a GI illness and presented for medical evaluation to either sick call or an emergency service at a diplomatic or military medical facility in Baghdad from 30 September to 12 October Results: A total of people met the case definition.

Other symptoms included abdominal cramps, fatigue, and headache. Five salad ingredients had significantly elevated levels of Escherichia coli. Conclusion: Mitigation strategies to reduce the probability of similar outbreaks include purchasing food solely from approved vendors or thoroughly cooking all foods, including fruits and vegetables.

Keywords: gastrointestinal illness ; Escherichia coli ; public health. Closed circuit underwater breathing apparatus UBA have gained popularity in recreational diving. Closed circuit UBAs carry a unique set of risks to the diver. We present the case of a diver who lost consciousness while diving and had pulmonary abnormalities. The case is illustrative of the diving related problems associated with closed circuit UBA that a physician may be faced with.

The genus Acinetobacter has long been associated with war wounds. Indeed, A baumannii was responsible for so many infected wounds during Operation Iraqi Freedom that it was given the nickname "Iraqibacter. A junii is an infrequently reported human pathogen. Here, we report a case of a slow-healing wound infection with A junii in a woman on the island of Oahu. This case highlights the pathogenic potential of this organism and the need for proper wound care when dealing with slow-healing wounds of unknown etiology.

It also underscores the need for identifying species of Acinetobacter that are not A baumannii to better understand the epidemiology of slow-healing wound infections. Keywords: Acinetobacter junii ; emerging infection ; Hawaii ; Oahu ; wound. Keywords: sedation ; analgesia ; prolonged field care ; guidelines. Androgen use outside of legitimate medical therapy is a perceived concern that is drawing attention across military and specifically Special Operations Forces SOF communities. For leadership and the medical community to properly address the issue and relate to those individuals who are using or considering use, it will be crucial to understand the scope of the problem.

Limited data suggest that the prevalence of androgen use may be increasing, and inferences made from the scientific literature suggest that SOF may be a population of concern. While risks of androgen use are well known, there are little data specific to military performance that can be applied to a rigorous risk:benefit analysis, allowing myths and poorly supported theories to perpetuate within the community.

Further efforts to define the potential benefits balanced against the short- and longterm risks should be undertaken. Providers within the SOF community should arm themselves with information to engage androgen users and leadership in meaningful discussion regarding androgen use. Keywords: androgen steroids ; protein building. Increasing data and anecdotal operational reports are supporting the early, aggressive, prehospital application of tourniquets in potentially life-threatening extremity trauma. Especially in the civilian urban setting where transport times are short, the benefit in terms of lives saved far outweighs the potential risk to the extremity.

The popular press has reported frequently on law enforcement- applied tourniquets, but to date, no group has published a scientific review of any of these cases. This case report suggests that law enforcement personnel can be trained to safely identify indications for tourniquet application, properly apply them with limited training, and function as effective first care providers.

Keywords: tourniquet ; law enforcement ; tactical medicine. Medical intelligence is an underused or sometimes misapplied tool in the protection of our Soldiers and the execution of nonkinetic operations.