A Word From Our Publisher
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Greetings JSOM Newsletter Subscribers,
Welcome to 2022! We hope everyone had a safe and wonderful holiday.
Our Winter 2021 issue was released last week. Digital subscribers now have access to the issue and print subscribers will be receiving their copies shortly. Please share your thoughts with us on social media or via email. Your comments and suggestions are always considered as we strive to improve the JSOM with each passing year.
As always, we invite you to check out the valuable resources found on the JSOM website and on our Online Store. From TCCC guidelines to articles and handbooks, we have all the information you need in one convenient place. Our resources are always updated as new and improved protocols and information become available.
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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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A note about the newsletter design: This newsletter has been created using one cohesive font and a unified JSOM brand and color design. If the banner/header is missing and/or 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, we suggest opening the newsletter in a browser.
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Journal of Special Operations Medicine Featured Abstracts
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Voller J, Tobin JM, Cap AP, Cunningham CW, Denoyer M, Drew B, Johannigman J, Mann-Salinas EA, Walrath B, Gurney JM, Shackelford SA. 21(4). 11 - 21. (Journal Article)
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ABSTRACT
This Clinical Practice Guideline (CPG) provides a brief summary of the scientific literature for prehospital blood use, with an emphasis on the en route care environment. Updates include the importance of calcium administration to counteract the deleterious effects of hypocalcemia, minimal to no use of crystalloid, and stresses the importance of involved and educated en route care medical directors alongside at a competent prehospital and en route care providers (see Table 1). With the paradigm shift to use FDA-approved cold stored low titer group O whole blood (CS-LTOWB) along with the operational need for continued use of walking blood banks (WBB) and point of injury (POI) transfusion, there must be focused, deliberate training incorporating the different whole blood options. Appropriate supervision of autologous blood transfusion training is important for execution of this task in support of deployed combat operations as well as other operations in which traumatic injuries will occur. Command emphasis on the importance of this effort as well as appropriate logistical support are essential elements of a prehospital blood program as part of a prehospital/en route combat casualty care system.
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ABSTRACT
Background: Video laryngoscopy (VL) is shown to improve first-pass success rates and decrease complications in intubations, especially in novice proceduralists. However, the currently fielded VL devices are cost-prohibitive for dispersion across the battlespace. The novel i-view VL is a low-cost, disposable VL device that may serve as a potential solution. We sought to perform end-user performance testing and solicit feedback. Methods: We prospectively enrolled Special Operations flight medics with the 160th Special Operations Aviation Regiment at Hunter Army Airfield, Savannah, Georgia. We asked them to perform an intubation using a synthetic cadaver model while in a mobile helicopter simulation setting. We surveyed their feedback afterward. Results: The median age of participants was 30 and all were male. Of those, 60% reported previous combat deployments, with a median of 20 months of deployment time. Of the 10, 90% were successful with intubation, with 60% on first-pass success with an average of 83 seconds time to intubation. Most had a grade 1 view. Most agreed or strongly agreed that it was easy to use (70%), with half (50%) reporting they would use it in the deployed setting. Several made comments about the screen not being bright enough and would prefer one with a rotating display. Conclusions: We found a high proportion of success for intubation in the mobile simulator and a high satisfaction rate for this device by Special Operations Forces medics.
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January 2022 Featured Article
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Comprehensive Ultrasound Course for Special Operations Combat and Tactical Medics
Fatima H, Kuppalli S, Baribeau V, Wong VT, Chaudhary O, Sharkey A, Bordlee JW, Leibowitz A, Murugappan K, Pannu A, Rubenstein LA, Walsh DP, Kunze LJ, Stiles JK, Weinstein J, Mahmood F, Matyal R, Lodico DN, Mitchell J. 21(4). 54 - 61. (Journal Article)
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ABSTRACT
Background: Advances in ultrasound technology with enhanced portability and high-quality imaging has led to a surge in its use on the battlefield by nonphysician providers. However, there is a consistent need for comprehensive and standardized ultrasound training to improve ultrasound knowledge, manual skills, and workflow understanding of nonphysician providers. Materials and Methods: Our team designed a multimodal ultrasound course to improve ultrasound knowledge, manual skills, and workflow understanding of nine Special Operations combat medics and Special Operations tactical medics. The course was based on a flipped classroom model with a total time of 43 hours, consisting of an online component followed by live lectures and hands-on workshops. The effectiveness of the course was determined using a knowledge exam, expert ratings of manual skills using a global rating scale, and an objective structured clinical skills examination (OSCE). Results: The average knowledge exam score of the medics increased from pre-course (56% ± 6.8%) to post-course (80% ± 5.0%, p < .001). Based on expert ratings, their manual skills improved from baseline to day 4 of the course for image finding (p = .007), image optimization (p = .008), image acquisition speed (p = .008), final image quality (p = .008), and global assessment (p = .008). Their average score at every OSCE station was > 91%. Conclusion: A comprehensive multimodal training program can be used to improve military medics' ultrasound knowledge, manual skills, and workflow understanding for various applications of ultrasound. Further research is required to develop a reliable, sustainable course.
Keywords: ultraound; medics; competency; curriculum
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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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FALL 2021
In this episode of the JSOM Podcast, Alex and Josh start by reviewing, "Timeline of Psychological and Physiological Effects Occurring During Military Deployment on a Medical Team" by Hall, et. al. Guest reviewer Rico Pesce and SSG Meredith Cole review "Blood Product Administration During Transport Throughout the US Africa Command Theater of Operation," by Schauer, et. al. Josh and Alex discuss, "Impact of a 10,000m Cold-Water Swim on Norwegian Naval Special Forces Recruits" with author Jorgen Melau.
Hall AB, Qureshi I, Wilson RL, Glasser JJ
Schauer SG, Naylor JF, Fisher AD, Hyams DG, Carius BM, Escandon MA, Linscomb CD, McDonald H, Cap AP, Bynum J
Melau J, Hisdal J, Solberg PA
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Highlights from the JSOM Special Talk Series
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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.
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.
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Cognitive Behavioral Therapy (CBT) for Insomnia
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Are you a U.S. service member or veteran who finds it hard to fall or stay asleep?
Military service members and veterans sometimes struggle with insomnia after coming home. Luckily, cognitive behavioral therapy (CBT) is a common treatment that can help. But in-person sessions aren’t always feasible, especially now with COVID-19 restrictions. CNRM is testing an eCBT-I (Internet Guided CBT) app that was made
specifically for military personnel with a history of head injury. This online study is open for enrollment and needs volunteers. Interested? Contact us at cnrm-ecbti@usuhs.edu or call/text 301-456-5474.
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Please Support Our Sponsors
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Institutional 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.
Today, we welcome back several renewals:
The Defence Medical Library - Burnett Library, Lichfield, Staffs, United Kingdom
Oregon Health and Science University, Portland, Oregon
University College Cork, County Cork, Ireland
DAPING Hospital Research Center, Birmingham, Alabama
We also have the pleasure of welcoming the Hospital Central de la Defensa Gomes Ulla in Madrid, Spain into the JSOM family! WELCOME!!!
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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Support the Journal of Special Operations Medicine
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IWATE, JAPAN
DVIDS
U.S. Marines and Sailors with 2d Battalion, 8th Marines conduct bilateral tactical combat casualty care training with the 39th Infantry Regiment, Japan Ground Self-Defense Force (JGSDF), during Resolute Dragon 21 at Iwate, Japan, Dec. 11, 2021. RD21 is the largest bilateral field training exercise between the U.S. Marine Corps and the JGSDF since 2013 and the largest ever in Japan. RD21 is designed to strengthen the defensive capabilities of the U.S.-Japan Alliance by exercising integrated command and control, targeting, combined arms, and maneuver across multiple domains. 2/8 is forward deployed in the Indo-Pacific under 4th Marines, 3d Marine Division.
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Journal of Special Operations Medicine
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