Greetings JSOM Newsletter Subscribers,
It's finally here. The DIGITAL version of the Pararescue Medical Operations Handbook 8th Edition is available to purchase on the JSOM website. To order the Digital Flip Book follow the link to our Subscription Page and select the 12th option on the list, Subscription to `Digital Only PJ MED` (50 USD). Print copies of the book will be available on the Online Store very soon. If you prefer a print copy, please check our social media for the announcement.
The Special Operations Medical Association (SOMA) is looking forward to its 2021 Scientific Assembly (SOMSA) in Charlotte, North Carolina. Due to continued concerns about COVID, this year we will be holding a hybrid event providing the opportunity for educational attendees to participate either in-person or virtually.
In-person Registration: Pre-registration is required for those planning to attend the assembly in-person and may be limited based on current city/state and convention center COVID safety regulations.
Virtual Registration: We kindly ask that all virtual participants pre-register before the registration deadline.
For the most current information and to register, please visit the SOMA website.
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Respectfully,
Michelle DuGuay Landers, MBA, BSN, RN
Breakaway Media, LLC
Publisher
Journal of Special Operations Medicine (JSOM)
Lt Col, USAF/NC (Ret)
publisher@jsomonline.org
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ABSTRACT
Background: Uncontrolled external hemorrhage is a common cause of preventable death. The Hartford Consensus recommendations presented the concept of a continuum of care, in which police officers should be considered an integral component of the emergency medical response to active shooter incidents. Recent publications have reported individual cases of tourniquet application by police officers. This report analyzed all documented cases of hemorrhage control using tourniquets applied by police officers in a single large metropolitan police department.
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ABSTRACT
We report the case of a civilian 27-year-old man treated in a military hospital in France who sustained multiple stab wounds, including one in the left groin, with massive external bleeding. When first responders arrived, the patient was in hemorrhagic shock. A tourniquet and two intraosseous catheters were placed to start resuscitative care. On the patient's arrival at the hospital, bleeding was not controlled, so a junctional tourniquet was put in place and massive transfusion was started. Surgical exploration revealed a laceration of the superficial femoral artery and a disruption of the femoral vein. Vascular damage control was achieved by a general surgeon and consisted of primary repair of the superficial femoral artery injury and venous ligation. The patient was discharged from the intensive care unit after 2 days and from the hospital after 8 days. This case illustrates some of the persistent challenges shared between military and civilian trauma care.
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May 2021 JSOM Feature Article |
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Conversion of the Abdominal Aortic and Junctional Tourniquet (AAJT) to Infrarenal Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Is Practical in a Swine Hemorrhage Model
Stigall K, Blough PE, Rall JM, Kauvar DS. 21(1). 30 - 36. (Journal Article)
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ABSTRACT
Background: Two methods of controlling pelvic and inguinal hemorrhage are the Abdominal Aortic and Junctional Tourniquet (AAJT; Compression Works) and resuscitative endovascular balloon occlusion of the aorta (REBOA). The AAJT can be applied quickly, but prolonged use may damage the bowel, inhibit ventilation, and obstruct surgical access. REBOA requires technical proficiency but avoids many of the complications associated with the AAJT. Conversion of the AAJT to REBOA would allow for field hemorrhage control with mitigation of the morbidity associated with prolonged AAJT use. Methods: Yorkshire male swine (n = 17; 70-90kg) underwent controlled 40% hemorrhage. Subsequently, AAJT was placed on the abdomen, midline, 2cm superior to the ilium, and inflated. After 1 hour, the animals were allocated to an additional 30 minutes of AAJT inflation (continuous AAJT occlusion [CAO]), REBOA placement with the AAJT inflated (overlapping aortic occlusion [OAO]), or REBOA placement following AAJT removal (sequential aortic occlusion [SAO]). Following removal, animals were observed for 3.5 hours. Results: No statistically significant differences in survival, blood pressure, or laboratory values were found following intervention. Conversion to REBOA was successful in all animals but one in the OAO group. REBOA placement time was 4.3 ± 2.9 minutes for OAO and 4.1 ± 1.8 minutes for SAO (p = .909). No animal had observable intestinal injury. Conclusions: Conversion of the AAJT to infrarenal REBOA is practical and effective, but access may be difficult while the AAJT is applied.
Keywords: hemorrhage; Abdominal Aortic and Junctional Tourniquet; resuscitative endovascular balloon occlusion of the aorta; swine
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The Journal of Special Operations Medicine Podcast |
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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. |
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Spring 2021
The new JSOM podcast episode is up on our website and on Apple podcasts. For this episode, our podcast hosts Alex and Josh take a deep dive into civilian practice with the world-renowned rotor wing tactical detail from Los Angeles. Their interview with Deputy Steve Doucette of the Los Angeles County Sheriff's Dept will give you a better understanding of the original transfer of tactical skills from military to law enforcement setting after the Korean war. We then find out about the absorption of tactical medicine into special weapons and tactics (SWAT) teams and its recent drastic evolution, thanks to the hard-won lessons from the battlefield. Our interview ends with an outstanding overview of the difference between a tactical medic, tactical medicine, and TEMS. Please let us know what you think about our foray into civilian medicine.
Our Interview with Dr. Stephen Rush is now available on the JSOM podcast. One of the true pillars of our SOF medical community, Doc Rush helps us learn more about the tremendous advances in special operations en route care over the last 20 years. We also get to hear about his background and how he serendipitously become involved with pararescue in the latter part of his civilian physician career. Looking back through the retrospectoscope, he is able to describe the training and level of en route care provided at the turn of the last century.
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Highlights From the JSOM Special Talk Series:
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MSG (Ret.) Rick Hines I
Rick Hines has a long history in Special Operations and is currently an instructor Special Warfare Training Group. He teaches at the SF Medical Sergeant Recertification Course and focuses on anesthesia and surgical care in the austere environment. Rick discusses the benefits of recycling at the 18D course, historical basis, and current practice of surgical care and anesthesia for the far forward Special Operations medic.
Dr. Kyle Stigall
Dr. Stigall attended the United States Air Force Academy for undergrad and the University of Kentucky for medical school. He is currently a fourth-year general surgery resident at Brooke Army Medical Center. He completed a research year at the Naval Medical Research Unit in San Antonio in 2020 with a focus on trauma resuscitation and plans to apply to the Air Force Special Operations Surgical Team next year.
COMING SOON
COL (Ret) Russ Kotwal, MD, MPH
Dr. Kotwal spent nearly 30 years in the military and more than 15 years in operational assignments with the 25th Infantry Division, 75th Ranger Regiment, and U.S Army Special Operations Command. He deployed to combat 12 times with the Rangers -- nine times to Afghanistan and three to Iraq. He conducted hundreds of combat ground and air missions as the senior medical provider and is highly decorated, including five Bronze Star medals, two Joint Service Commendation medals for Valor, and two combat jump stars, among many others. Dr. Kotwal is also a master parachutist, master flight surgeon, and Ranger qualified. He is credited with numerous novel training and technology initiatives, professional publications, and national and international presentations related primarily to prehospital medicine on the battlefield. Dr. Kotwal is an adjunct professor for both the Texas A&M Health Science Center and the Uniformed Services University of the Health Sciences. He has been an advisor for the Defense Health Agency’s Joint Trauma System and Committee on Tactical Combat Casualty Care, as well as the National Academy of Sciences, Engineering and Medicine. He is a Fellow of the American Academy of Family Physicians, a Hero of Military Medicine award recipient, a Distinguished Member of the 75th Ranger Regiment, an inductee into the US Army Ranger Hall of Fame, and the current president of the Special Operations Medical Association.
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Institutional Subscribers and Re-subscribers |
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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 did it! We now have 60 active institutional subscriptions, reaching a potential 55,000+ readers!
New this edition, we are happy to welcome the Belgian Ministry of Defense (Belgische Ministerie van Defensie, Universitaire Bibliotheek van Defensie) located in Neder-Over-Hambeek, Belgium.
Returning subscribers this edition:
Canadian Forces Medical Simulation Center, Courcelette, Quebec
Naval Medical Center - Portsmouth, Virginia
Franzello Aeromedical Library, Wright Patterson AFB, Ohio
Wilford Hall Medical Center, Joint Base San Antonio - Lackland, Texas
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.
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MIHAIL KOGALNICEANU, ROMANIA
DVIDS
Soldiers from the Dutch 11th Medical Company (Air Assault) load simulated casualties onto a HH-60M MEDEVAC Blackhawk belonging to Charlie Company, 2nd General Support Aviation Battalion, 1st Combat Aviation Brigade, during Swift Response 21, May. 7, 2021, at Mihail Kogalniceanu, Romania. Defender-Europe 21 integrates approximately 28,000 U.S., allied, and partner forces from 27 nations to build readiness and conduct simultaneous operations across more than a dozen nations.
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Journal of Special Operations Medicine
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