THE JOURNAL FOR OPERATIONAL MEDICINE AND TACTICAL COMBAT CASUALTY CARE
For 20 years, the Journal of Special Operations Medicine (JSOM) has been the only published venue that brings together military SOF, civilian Tactical EMS, and federal Department of Justice agencies with tactical medical assets. Originally established by the Command Surgeon's Office of the United States Special Operations Command (USSOCOM-SG), we have grown into one of the world's most renowned peer-reviewed medical journals, now subscribed to in 80 countries!
Journal of Special Operations Medicine (JSOM) Newsletter
15 October 2020 - Issue 183
Greetings JSOM Newsletter Subscribers,

By now, the Fall 2020 issue should be reaching our subscribers. As always, we welcome any feedback, questions, or comments you may have. We encourage all of our subscribers to follow us on social media. Start a conversation with us on Facebook, Instagram, and/or LinkedIn. We want to hear from you!

We want to thank everyone who has pre-ordered the Ranger Medic Handbook. The book should be ready to ship later this month. Thank you for your patience.
Handbook Updates
Currently in production and available soon:
The 2020 updated and new versions to the following handbooks have been slightly delayed due to the authors' response to COVID19:

  • Pararescue Medical Operations (PJ MED) Handbook 8th Ed. If you currently own the ring-bound 7th ed, you will be able to buy the updated pages and update the handbook yourself. **The 8th Ed will be available as a spiral-bound handbook.
  • 2020 Updated Ranger Medic Handbook: This title is currently available for pre-order and SHIPPING SOON!
  • NEW 2020 Advanced Ranger First Responder Handbook

Respectfully,
Michelle DuGuay Landers, MBA, BSN, RN
Breakaway Media, LLC
Publisher
Journal of Special Operations Medicine and Advanced Tactical Paramedic Protocols Handbook
Lt Col, USAFR/NC (Ret)
A note about the newsletter design: This newsletter has been created using one cohesive font and a unified JSOM brand and color design. If multiple fonts or unusual colors are appearing in your copy, it is a result of your personal settings or the settings attached to your email. For optimal viewing of this newsletter, including the sidebar items which can sometimes disappear depending on your email settings, we suggest opening the newsletter in a browser.
ABSTRACT

This Role 1, prolonged field care (PFC) clinical practice guideline (CPG) is intended to be used after Tactical Combat Casualty Care (TCCC) Guidelines, when evacuation to higher level of care is not immediately possible. A provider must first and foremost be an expert in TCCC, the Department of Defense standard of care for first responders. The intent of this PFC CPG is to provide evidence and experience-based solutions to those who manage airways in an austere environment. An emphasis is placed on utilizing the tools and adjuncts most familiar to a Role 1 provider. The PFC capability of airway is addressed to reflect the reality of managing an airway in a Role 1 resource-constrained environment. A separate Joint Trauma System CPG will address mechanical ventilation. This PFC CPG also introduces an acronym to assist providers and their teams in preparing for advanced procedures, to include airway management.
ABSTRACT

Background: US Air Force (USAF) pararescuemen (PJs) perform long-range ocean rescue missions for ill or injured civilians when advanced care and transport are not available. The purpose of this case series is to examine the details of these missions, review patient treatments and outcomes, and describe common tactics, techniques, and procedures for these missions. Methods: Cases in which the USAF PJs preformed long-range ocean rescue for critically ill or injured civilians between 2011 and 2018 were identified. 

October 2020 JSOM Feature Article
Far Forward Gaps in Hemorrhagic Shock and Prolonged Field Care: An Update of ALM Fluid Therapy for Field Use
Dobson GP, Letson HL. 20(3). 128 - 134. (Journal Article)
ABSTRACT

Future expeditionary missions are expected to occur in more remote austere environments where combat medics and casualties may have to wait up to 7 days before resupply or safe evacuation. Currently, there is no effective fluid therapy for hemorrhagic shock (HS) at the point-of-injury and continuum-of-care over this extended period. We have been developing a small-volume IV or IO ALM therapy for noncompressible HS and have shown in preclinical models that it extends survival to 3 days, reduces abdominal bleeding by 60%, blunts inflammation, corrects coagulopathy, preserves platelet function, and prevents immunodeficiency. The ALM-survival phenotype is associated with an upregulation of the master genes of metabolism and mitochrondrial biogenesis in heart and brain and a downregulation in the periphery. Future translational studies will investigate the timing and nature of the "switch" and extend survival to 7 days. We will also discuss some of the controversies of ALM resuscitation in pigs, present our Systems Hypothesis of Trauma (SHOT), and discuss future clinical safety trials before field use.

Keywords: hemorrhage; trauma; survival; genetics; metabolism; inflammation; military medicine; resuscitation
The Journal Of Special Operations Medicine Podcast
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. In addition, the podcast features a special, not to be missed Interview Series with leaders, doctors, and authors.
Podcast News And Updates
We are working hard to get the new interviews and discussions uploaded to the website. We apologize for the delay. Our November 1st eNewsletter will be updated with information regarding brand new interviews and conversations coinciding with the release of the Fall 2020 edition of the Journal of Special Operations Medicine. For now, please be sure to review and catch up on all the highlights from Summer.

In the Summer 2020 episode of the JSOM Podcast, Alex and Josh discuss the article, "Step Duration Effects on Blood Loss in Simulated Designs of Tourniquet Use Procedure". Guest Will Price breaks down the article, "Clothing Effects on Limb Tourniquet Application", and authors Matt Douma and Peter Brindley discuss their article, "Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even 'Knee BOA'.

  1. Step Duration Effects on Blood Loss in Simulated Designs of Tourniquet Use Procedure Kragh JF, Aden JK, Dubick MA.
  2. Guest Will Price discusses: Clothing Effects on Limb Tourniquet Application. Wall PL, Buising CM, Hingtgen E, Smith H, Renner CH. Drs. Matt Dumas and Peter Brindley discuss their paper:
  3. Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even "Knee BOA" O'Dochartaigh D, Picard CT, Brindley PG, Douma MJ.

Duration: 37:10
Highlights From The 20th Anniverseary JSOM Interview Series:
MAJ Andrew Fisher, MS-4, PA-C, LP for a great review of pre-hospital whole blood in the military; where we are now and how we got there. He reminds us that, "everything old is new again." The first whole blood transfusion research was done by the military in 1940 (Armed Forces Blood Program) and was used extensively in WWII and the Korean War. But times change and lessons learned are lost to the sands of time as one generation of peacetime military surgeons hands off the reigns to the next. Listen here.

World-renowned tourniquet expert Dr. John Kragh. In this interview, Dr. Kragh takes us through his history in becoming a tourniquet expert as well as detailing the evolution of tourniquet use in combat situations as a battalion surgeon in Southwest Asia. Tourniquet use has evolved considerably even during the 20-years since the JSOM has been in publication. Be sure to read Dr. Kragh's contributions to this quarter's journal as a companion to this interview. Listen here.

CMSgt Michael Rubio, currently the commandant of the 351st Special Warfare Training Squadron of the PJ schoolhouse at Kirkland AFB. It's a great opportunity to hear from the best about how PJ training has changed during the past 20 years, and get a glimpse of where it is heading in the future. You can listen here. Look for another episode later this month.
JSOM Podcast
Wilderness Medical Society
In an effort to broaden and strengthen our ties with the Wilderness Medical Society and all who work in the wilderness medicine community, our webmaster and podcast hosts will be partnering with the organization to share more information and crossover content between our podcast platforms.

The mission of the Wilderness Medical Society is to encourage, foster, support, or conduct activities to improve the scientific knowledge of the membership and general public in human health activities in a wilderness environment.

The Journal of Special Operations Medicine has long partnered with the WMS in a shared science program as we understand the importance of sharing information with all who work in various forms of unconventional medicine.
Management of COVID-19 in Austere Operational Environments (Prehospital & Prolonged Field Care)

This practice management guide does not supersede DoD Policy. It is a guideline only and not a substitute for clinical judgment. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The practice management guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. 

Institutional Subscribers And Re-subscribers
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. We reached a milestone, surpassing 50 institutions! We currently have 53 active institutional subscriptions, reaching a potential 59,000+ readers!

This edition, we welcome back 2 subscribers

Plano Fire Rescue, Plano Texas
Service Sante des Armees (Army Health Services), Paris, France

Visit https://jsom.us/Library for a full list of institutions that are 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 both 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 either 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 professional 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 would like more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.
Photo of the Week
A student in the Special Operations Combat Medic Course at the U.S. Army John F. Kennedy Special Warfare Center and School prepares an intravenous bag during field training at Fort Bragg, North Carolina. Enlisted service members who completed the course specialize in trauma management, infectious diseases, cardiac life support and surgical procedures and qualify as highly trained combat medics with the skills necessary to provide initial medical and trauma care and to sustain a casualty for up to 72 hours.
(U.S. Army photo by K. Kassens)

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