ABSTRACT

Background: The U.S. Military needs fast-acting, non-opioid solutions for battlefield pain. The U.S. Military recently used morphine auto-injectors, which are now unavailable. Off-label ketamine and oral transmucosal fentanyl citrate use introduces challenges and is therefore uncommon among conventional forces. Sublingual suftentanil is the only recent pain medication acquired to fill this gap. Conversely, methoxyflurane delivered by a handheld inhaler is promising, fast-acting, and available to some partner forces. We describe methoxyflurane use reported in the Department of Defense Trauma Registry (DODTR). Methods: We requested all available DODTR encounters from 2007 to 2023 with a documented intervention or assessment within the first 72 hours of care. We analyzed casualties who received methoxyflurane in the prehospital setting using descriptive statistics. Results: There were 22 encounters with documented methoxyflurane administration. The median patient age was 23 (range 21-31) years. All were men. The largest proportion was partner force (50%), followed by U.S. Military (27%). Most (64%) sustained battle injuries. Explosives were the most common mechanism of injury (46%), followed by firearms (23%). The median injury severity score was 5 (range 1-17). The most frequent injuries were serious injuries to the extremities (27%), and 23% of patients (5) received a tourniquet. One-half of the casualties received concomitant pain medications. Only three casualties had multiple pain scores measured, with a median pain score change of -3 on a scale of 10. Conclusion: Methoxyflurane use in deployed combat shows both feasibility and usability for analgesia.

Management of Rib Fractures in the Combat Environment

Smith S, Hilsden R, Patton P, Vogt K, Beckett A, Ball IM. 24(1). 85 - 87. (Journal Article)

ABSTRACT

Rib fractures in combat casualties are an under-appreciated injury, and their treatment may become more common as more patients survive because of modern body armor and point-ofinjury care. The combat environment has challenges such as equipment availability and sterility. A simple and thoughtful rib fracture treatment algorithm may be useful to reduce the morbidity and mortality of rib fractures in the combat environment. Intravenous lidocaine infusions for patients with traumatic rib fractures may have important combat applications. We propose an algorithm for the management of combat casualties with traumatic rib fractures.

ABSTRACT

Background: Blood is a highly valuable medical resource that necessitates strict guidelines to ensure the safety and well-being of the recipient. Since the onset of the war in Ukraine there has been an increased demand for training in emergency fresh whole blood transfusion (EFWBT) to improve damage control resuscitation capabilities. To meet this demand, we developed, implemented, and evaluated a training program aimed at enhancing Ukrainian EFWBT proficiency. Methods: Eight Ukrainian healthcare professionals (UHPs), including six physicians and two medics, completed our training, derived from the Joint Trauma System Clinical Practice Guidelines, Tactical Combat Casualty Care (TCCC) Guidelines, 75th Ranger Regiment Ranger O-Low Titer (ROLO) program, and Marine Corps Valkyrie program. Participants were assessed on their confidence in the practical application and administrative oversight requirements of an EFWBT program. A cross-comparison was conducted between a larger data set of third-year medical students from the Uniformed Services University and the UHPs to determine the statistical significance of the program. Results: The difference in mean scores of UHPs during preand post-training was statistically significant (p<0.001). Additionally, the average rate of improvement was greater for the UHPs compared with the third-year medical students (p=0.000065). Conclusion: Our study revealed that the application of an EFWBT training program for UHPs can significantly increase confidence in their ability to conduct EFWBTs on the battlefield. Further larger-scale research is needed to determine the impact of this training on performance outcomes.

Keywords: Ukraine; fresh whole blood; transfusion medicine; emergency medical services; Russian-Ukrainian War



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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