ABSTRACT

Background: Irrigation is used to minimize infection of open wounds. Sterile saline is preferred, but potable water is becoming more widely accepted. However, the large volumes of water that are recommended are usually not available in austere environments. This study determined the long-term antimicrobial effectiveness of military purification powder compared with currently available civilian methods. The study also compared the physical characteristics and outcomes under the logistical constraints. Methods: Six commercially available water decontamination procedures were used to decontaminate five different sources of water (pond water, river water, inoculated saline, tap water, and sterile saline). Each product was evaluated based on six different parameters: bacterial culture, pH, turbidity, cost, flow rate, and size. Results: All methods of treatment decreased the bacterial count below the limit of detection. However, they had variable effects on pH and turbidity of the five water sources. Prices ranged from $7.95 to $350, yielding 10-10,000L of water, and weighing between 18 and 500g. Conclusion: In austere settings, where all equipment is carried manually, no single decontamination device is available to optimize all the measured parameters. Since all products effectively reduced microbial levels, their size, cost, and production capability should be evaluated for the intended application.



Sterile Instrument Storage in an Austere Environment: Are Sterile Peel Packaging and Cellulose Wrapping Equivalent?

Lanham N, Belyea CM, Marcello D, Wataka AB, Musila L. 24(1). 77 - 80. (Journal Article)

ABSTRACT

Background: Recommendations for optimal temperature and humidity for sterile instrument storage vary according to different sources. Furthermore, there are limited data comparing methods of packing smaller, lightweight, low-profile instruments. The purpose of this study was to compare sterile peel packaging and sterile cellulose wrapping for sterile instrument storage in an austere environment characterized by elevated temperature and humidity. Methods: Stainless steel screws were sterilized and stored in either sterile peel packaging, sterile cellulose wrapping, or no packaging. Four groups were evaluated. Group 1 consisted of four screws in a sterile peelpack envelope and served as a time-zero control. Group 2 consisted of two groups of five screws, each packaged with blue sterilization cellulose wrap. Group 3 consisted of two groups of five screws, each packaged in sterile peel-pack envelopes. Group 4 consisted of 10 non-sterile unpackaged screws, which served as controls. Screws from groups 2, 3, and 4 were then cultured for 6 and 12 weeks. Temperature and humidity values were recorded in the instrument storage area. Results: Average temperature was 21.3°C (SD 1.2°C; range 18.9°C-27.2°C) and average humidity was 51.7% (SD 3.9%; range 39%- 70%). Groups 1 (time-zero control) and 2 (sterile cellulose wrapping) demonstrated no growth. After 6 and 12 weeks, groups 3 (sterile peel packaging) and 4 (control) demonstrated bacterial growth. Conclusion: The most common culture isolates were gram-positive rods and two common nosocomial Staphylococcius species. Sterile peel packaging was not found to be equivalent to sterile cellulose wrapping in austere environmental conditions.

ABSTRACT

Background: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a low-frequency, high- intensity procedure used for severe lung illness or injury to facilitate rapid correction of hypoxemia and respiratory acidosis. This technology is more portable and extracorporeal support is more frequently performed outside of the hospital. Future conflicts may require prolonged causality care and more specialized critical care capabilities including VV ECMO to improve patient outcomes. We used an expert consensus survey based on a developed bifemoral VV ECMO cannulation checklist with an operational focus to establish a standard for training, validation testing, and sustainment. Methods: A 36-item procedural checklist was provided to 14 experts from multiple specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed, resulting in a final 32-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for bifemoral VV ECMO using the modified Delphi method. This is an objective tool to assist procedural training and validation for medical providers performing VV ECMO in austere environments.

Keywords: VVECMO; checklist; prolonged casualty care; ARDS



The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field. The Winter 23 episode is here!

Current Episode

Our JSOM podcast team will be reviewing the following articles for our Winter podcast: 

Optimizing Brain Health of United States Special Operations Forces by Brian L. Edlow, Natalie Gilmore, Samatha L. Tromly, et al. 

Bluetooth Tactical Headsets Improve the Speed of Accurate Patient Handoffs by Daniel J. Stinner, Cory McEvoy, Michael A. Broussard, et al.

Effectiveness of Sternal Intraosseous Device in Patients Presenting with Circulatory Shock: A Retrospective Observational Study by Allyson M. Hynes, Shyam Murali, Gary A. Bass, et al. 

JSOM Guest Medic Interview

Our guest medic for this quarter is Ricky Ditzel, who will review “Optimizing Brain Health of United States Special Operations Forces” by Edlow and colleagues. Ricky and his two siblings’ adolescent lives were defined by chaos. Inspired to make a positive change for his family, he enlisted in the Army and served as a U.S. Army Special Operations Flight Paramedic. In this role, Ricky treated U.S. and Allied forces Servicemembers who suffered from the acute and chronic effects of traumatic brain injury. These experiences propelled Ricky to become a neurodegenerative disease researcher and vocal advocate for brain and mental health. Ricky believes strongly in a life of service and consistently seeks opportunities to support underserved communities and promote health equity. He believes the current healthcare structure reduces access to care for individuals with neurologic disabilities because of limitations associated with public transportation, specialty care access, and education. Driven towards research and finding solutions to increase the quality of life for people with neurological disabilities, Ricky is pursuing a career as a physician. He plans to create a neurologic center of excellence that will provide comprehensive multidisciplinary outpatient care under one roof. Ricky is the Chairman of the Special Operations Forces to School of Medicine (SOF to SOM) (https://www.softosom.org/), a board member of Neuroacanthocytosis Advocacy USA, and the Special Operations Medical Association. He will continue to serve his country and community while doing his best to honor the legacies of those who have gone before him. “For they loved to fight, fought to win, and would rather die than quit. Night Stalkers don’t quit!”

JSOM Guest Author Interview

Our guest author interview will be with Cory McEvoy, author of “Bluetooth Tactical Headsets Improve the Speed of Accurate Patient Handoffs.” Cory is a former 18D who served with 1-1SFG(A) and USASOC. Cory has deployed to both humanitarian and combat zones as an 18D and has been involved with many research projects, with his primary interest being repetitive and low-level blast. Cory left the Army in 2023 and is in the process of applying to medical school.

The Journal of Special Operations Medicine is proud to have the support of many great sponsors and media partners. Our sponsors are leaders in the field of military medical technology. Please help support these companies by following the links below to learn more about their missions and the products they offer. This section also features peridoic promtional information for events and conferences, including the 2024 SOMA Scientific Assembly. 

The JSOM is incredibly grateful to have the support of many institutions around the world. We would like to thank our recent institutional subscribers and re-subscribers for their support by acknowledging them in our eNewsletter and, when applicable, sharing their social media information.

Visit https://jsom.us/Library for a full list of institutions currently subscribing to the JSOM. We are beginning a campaign to expand our institutional subscriptions. If you think your company would benefit from an institutional subscription, let us know! We'll be happy to talk to you and get the ball rolling. You don't have to be a university or medical center to subscribe - we have many EMS units, government agencies, and military medical units in the United States and abroad.

Are you on the list? Great! Need to know how to access our resources? You can either contact your head librarian or shoot an email to subscriptions@JSOMonline.org.

Institutions receive a print copy of our journal, digital access, or both. Digital subscribers have unlimited access to our full compendium of articles, journals, and the ATP-P. If you are a student, researcher, doctor, or other medical professionals at one of these institutions, please contact your librarian for login details. Additionally, the digital resources are typically available 2-3 weeks ahead of print publication.

If your institution is not on the list and you want more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.

For over 20 years, the Journal of Special Operations Medicine (JSOM) has brought important, lifesaving information to the Special Operations Forces (SOF) community. And over the years, as our audience and readership has expanded into over 80 countries, physicians, military and tactical medics, and other medical professionals working in unconventional environments rely on the JSOM for breakthrough research at the intersection of operational medicine and tactical casualty care. Our peer-reviewed research and interactive clinical content make the JSOM a must-read for:

• Physicians
• Medics
• Educators
• Law Enforcement
• The military and civilian global medical community

For these reasons, many of the world’s top medical technology companies and medical device distributors make the JSOM a cornerstone of their advertising programs. And with a strong multichannel and social media presence, the JSOM offers the most dynamic print and digital media options at cost-effective prices. For medical marketers worldwide looking to reach our niche audience, the JSOM is the gold standard. For more information, please see our attached media kit.

Coming Soon from the Journal of Special Operations Medicine published by Breakaway Media, LLC

We are excited to announce the upcoming publication of Tell Them Yourself: It's Not Your Day To Die*, by Frank Butler, Kevin O'Connor, and Jeff Butler.

It's an extraordinary, true account of how a small group of world-class trauma experts joined forces with America’s best combat medics to rewrite the battlefield medicine rule book and then sell these revolutionary new concepts to a disbelieving medical world.

This is the definitive record of how TCCC came to be and how these protocols forever changed the way care is provided to those wounded in combat, written by the men who fought for the change.

*This highly anticipated book will premiere at the 2024 Special Operations Medical Association symposium. Dr. Frank Butler will be at the JSOM booth #611 signing copies. The book will then be available to purchase on the JSOM website on or around May 20th.



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