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. Be informed. Stay Informed. Subscribe today!
Journal of Special Operations Medicine (JSOM) Newsletter
01 December 2020 - Issue 186
Greetings JSOM Newsletter Subscribers,

We hope everyone had a safe and happy Thanksgiving. The Ranger Medic Handbook is back in stock and available to order on the JSOM Online Store.
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.
  • 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

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure.
ABSTRACT

This is second of a two-part series on the history and effectiveness of mouthguards (MGs) for protection from orofacial injuries. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue which helps prevent lacerations and bruises. The single study on MG use in military training found that when boil-and-bite MGs were required for four training activities, orofacial injury rates were reduced 56% compared with when MGs were required for just one training activity. 
December 2020 JSOM Feature Article
Management of Critically Injured Burn Patients During an Open Ocean Parachute Rescue Mission
Staak BP, Petersen CD, Smith J, Hartman M, Rush SC. 20(3). 135 - 140. (Journal Article)
ABSTRACT

Best practices and training for prolonged field care (PFC) are evolving. The New York Pararescue Team has used part task training, cadaver labs, clinical rotations, and a complicated sim lab to prepare for PFC missions including critical care. This report details an Atlantic Ocean nighttime parachute insertion to provide advanced burn care to two sailors with 50% and 60% body surface area burns. Medical mission planning included pack-out of ventilators, video laryngoscopes, medications, and 50 L of lactated Ringer's (LR). Over the course of 37 hours, the patients required high-volume resuscitation, analgesia, wound care, escharotomies, advanced airway and ventilator management, continuous sedation, telemedicine consultation, and complicated patient movement during evacuation. A debrief survey was obtained from the Operators highlighting recommendation for more clinical rotations and labs, missionspecific pack-outs, and tactical adjustments. This historic mission represents the most sophisticated PFC ever performed by PJs and serves to validate and share our approach to PFC.

Keywords: prolonged field care; military medicine; austere medicine; burns; critical care
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
Fall 2020

In this episode of the JSOM Podcast, Alex and Josh discuss the articles "Ketamine Administration by Special Operations Medical Personnel During Training Mishaps". Guest Rico Pesce breaks down the article, "Far Forward Gaps in Hemorrhagic Shock and Prolonged Field Care: An Update of ALM Fluid Therapy for Field Use."
Alex and Josh also discuss, "Management of Critically Injured Burn Patients During an Open Ocean Parachute Rescue Mission."

Fisher AD, Schwartz DS, Petersen CD, Meyer SE, Thielemann JN, Redman TT, Rush SC

Staak BP, DeSoucy ES, Petersen CD, Smith J, Hartman M, Rush SC
Guest: Rico Pesce

Dobson GP, Letson HL

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.
Jobs and Fellowships

Military Medicine Education Research Fellow - One-year paid fellowship with benefits at Mayo Clinic in Phoenix, Arizona. We are looking for a candidate with a medical education background who has experience and training in study design, data analysis, statistics and medical simulation. Experience in the military Special Operations community is beneficial but not required for this position. Completion of the fellowship does not provide a degree. Contact Amy Low, M.B.A. | Program Manager | Center for Military Medicine at  low.amy@mayo.edu.

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 currently have 56 active institutional subscriptions, reaching a potential 59,000+ readers!

This edition, we welcome back 2 subscribers

Philadelphia College of Osteo Medicine, Philadelphia, Pa
Defence Library Service Canungra, Canungra, Queensland, Australia

We also have a brand new subscriber! Please help us welcome our first Finnish insitution!

Kainuun Keskussairaala (Kainuu Central Hospital), Kajaani, Finland. You can visit them on Facebook at https://www.facebook.com/kainuunuusisairaala

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
AL ASAD AIR BASE, IRAQ
U.S. Army Lt. Gen. Paul T. Calvert, far right, commanding general for Combined Joined Task Force – Operation Inherent Resolve and Command Sgt. Major Walter C. Puckett, center, command senior enlisted leader for CJTF-OIR, deplane from a C-130 Hercules at Al Asad Air Base, Iraq, Nov. 26, 2020. Calver and Puckett visited the base to spend time with U.S. service members during the Thanksgiving holiday. During the visit, Calvert, Puckett, and AAAB leadership served and ate meals with the troops. (U.S. Army National Guard photo by Staff Sgt. Armando Vasquez)


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Journal of Special Operations Medicine 

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