scholarly journals Applying Pharmacogenomic Guidelines to Combat Medical Care

2021 ◽  
Vol 187 (Supplement_1) ◽  
pp. 18-24
Author(s):  
Jesse DeLuca ◽  
Thomas Oliver ◽  
Chad Hulsopple ◽  
Daniel Selig ◽  
Elaine Por ◽  
...  
Keyword(s):  
Medical Care ◽  
Beta Blockers ◽  
Military Medicine ◽  
Medical Settings ◽  
War Surgery ◽  
Combat Casualty ◽  
Potential Applications ◽  
Care Guidelines ◽  
Optimized Treatment ◽  
Combat Casualty Care

ABSTRACT Pharmacogenomics is a pillar of personalized medicine that has the potential to deliver optimized treatment in many medical settings. Military medicine in the deployed setting is unique and therefore warrants separate assessment pertaining to its potential capabilities and impact. Pharmacogenomics for United States Active Duty Service Members medical care in the deployed setting has not, to our knowledge, been previously reviewed. We present potential applications of pharmacogenomics to forward medical care through two comprehensive references for deployed medical care, the Tactical Combat Casualty Care Guidelines (TCCC) and Emergency War Surgery (EWS) fifth edition. All drugs within the deployment manuals, TCCC guidelines and EWS book, were identified and the list was cross-referenced to the Clinical Pharmacogenetics Implementation Consortium guidelines and genes–drugs interactions list as well as the Food and Drug Administration Table of Pharmacogenomics Biomarkers in Drug Labeling. Ten pharmacologic categories were identified, consisting of 15 drugs, along with the classes, aminogylcosides, beta-blockers, and volatile anesthetics. Drugs and pharmacogenomics liabilities were tabulated. Eight specific drugs or classes are expounded upon given the belief of the authors of their potential for impacting future treatment on the battlefield in the setting of prolonged field care. This review outlines several genes with liabilities in the prolonged field care setting and areas that may produce improved care with further study.

scholarly journals Recommended medical and non-medical factors to assess military preventable deaths: subject matter experts provide valuable insights

2019 ◽  
Vol 166 (E) ◽  
pp. e47-e52 ◽  
Author(s):  
Whitney Y Harrison ◽  
J L Wardian ◽  
J A Sosnov ◽  
R S Kotwal ◽  
F K Butler ◽  
...  
Keyword(s):  
Data Collection ◽  
Medical Care ◽  
Subject Matter ◽  
Review Process ◽  
Preventable Death ◽  
Subject Matter Experts ◽  
Medical Factors ◽  
Combat Casualty ◽  
Medical Recommendations ◽  
Combat Casualty Care

IntroductionHistorically, there has been variability in the methods for determining preventable death within the US Department of Defense. Differences in methodologies partially explain variable preventable death rates ranging from 3% to 51%. The lack of standard review process likely misses opportunities for improvement in combat casualty care. This project identified recommended medical and non-medical factors necessary to (1) establish a comprehensive preventable death review process and (2) identify opportunities for improvement throughout the entire continuum of care.MethodsThis qualitative study used a modified rapid assessment process that includes the following steps: (1) identification and recruitment of US government subject matter experts (SMEs); (2) multiple cycles of data collection via key informant interviews and focus groups; (3) consolidation of information collected in these interviews; and (4) iterative analysis of data collected from interviews into common themes. Common themes identified from SME feedback were grouped into the following subject areas: (1) prehospital, (2) in-hospital and (3) forensic pathology.ResultsMedical recommendations for military preventable death reviews included the development, training, documentation, collection, analysis and reporting of the implementation of the Tactical Combat Casualty Care Guidelines, Joint Trauma System Clinical Practice Guidelines and National Association of Medical Examiners autopsy standards. Non-medical recommendations included training, improved documentation, data collection and analysis of non-medical factors needed to understand how these factors impact optimal medical care.ConclusionsIn the operational environment, medical care must be considered in the context of non-medical factors. For a comprehensive preventable death review process to be sustainable in the military health system, the process must be based on an appropriate conceptual framework implemented consistently across all military services.

scholarly journals Evaluation of prolonged ‘Permissive Hypotension’: results from a 6-hour hemorrhage protocol in swine

2019 ◽  
Vol 4 (1) ◽  
pp. e000369
Author(s):  
Clifford G Morgan ◽  
Leslie E Neidert ◽  
Emily N Hathaway ◽  
Gerardo J Rodriguez ◽  
Leasha J Schaub ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Level Of Evidence ◽  
Permissive Hypotension ◽  
Tissue Samples ◽  
Golden Hour ◽  
Combat Casualty ◽  
Care Guidelines ◽  
Study Type ◽  
Combat Casualty Care ◽  
Experimental Group

BackgroundTactical Combat Casualty Care guidelines for hemorrhage recommend resuscitation to systolic blood pressure (SBP) of 85±5 mm Hg during prehospital care. Success depends on transport to definitive care within the ‘golden hour’. As future conflicts may demand longer prehospital/transport times, we sought to determine safety of prolonged permissive hypotension (PH).MethodsAdult male swine were randomized into three experimental groups. Non-shock (NS)/normotensive underwent anesthesia only. NS/PH was bled to SBP of 85±5 mm Hg for 6 hours of prolonged field care (PFC) with SBP maintained via crystalloid, then recovered. Experimental group underwent controlled hemorrhage to mean arterial pressure 30 mm Hg until decompensation (Decomp/PH), followed by 6 hours of PFC. Hemorrhaged animals were then resuscitated with whole blood and observed for 24 hours. Physiologic variables, blood, tissue samples, and neurologic scores were collected.ResultsSurvival of all groups was 100%. Fluid volumes to maintain targeted SBP in PFC were significantly higher in the hemorrhage group than sham groups. After 24 hours’ recovery, no significant differences were observed in neurologic scores or cerebrospinal fluid markers of brain injury. No significant changes in organ function related to treatment were observed during PFC through recovery, as assessed by serum chemistry and histological analysis.ConclusionsAfter 6 hours, a prolonged PH strategy showed no detrimental effect on survival or neurologic outcome despite the increased ischemic burden of hemorrhage. Significant fluid volume was required to maintain SBP—a potential logistic burden for prehospital care. Further work to define maximum allowable time of PH is needed.Study typeTranslational animal model.Level of evidenceN/A.

An Analysis of Adherence to Tactical Combat Casualty Care Guidelines for the Administration of Tranexamic Acid

2019 ◽  
Vol 57 (5) ◽  
pp. 646-652 ◽  
Author(s):  
Andrew D. Fisher ◽  
Brandon M. Carius ◽  
Michael D. April ◽  
Jason F. Naylor ◽  
Joseph K. Maddry ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Care Guidelines ◽  
Combat Casualty Care

The effects of QuikClot Combat Gauze and Celox Rapid on hemorrhage control

2019 ◽  
Vol 14 (1) ◽  
pp. 17-23
Author(s):  
Don Johnson, PhD ◽  
Michelle Johnson, DNP, CRNA
Keyword(s):  
Observation Time ◽  
Hemorrhage Control ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Care Guidelines ◽  
The Right ◽  
Combat Casualty Care ◽  
Pressure Dressing ◽  
Better Than ◽  
Made In

Objective: Compare QuikClot Combat Gauze (QCG) and Celox Rapid (CR) for initial hemostasis and over a 1-hour period.Design: Experimental study.Setting: Approved animal laboratory.Subjects: Twenty-one Yorkshire swine.Interventions: Subjects were randomly assigned to either the QCG (n = 11) or CR (n = 10) group. An arteriotomy was made in the right femoral artery with a 6-mm vascular punch. Bleeding was allowed for 45 seconds. QCG or CR was applied followed by firm pressure for 3 minutes according to Committee on Tactical Combat Casualty Care guidelines. A 10-pound weight simulating a pressure dressing was applied, and the wound was observed for 1 hour. Dressing failure was bleeding 2 percent of blood volume.Main outcome measures: Achievement and maintenance of hemostasis and amount of hemorrhage during observation. Odds of successful hemostasis.Results: QCG was significantly better than CR in initial hemostasis (p = 0.049) and maintaining hemostasis over 1 hour (p = 0.020). One hundred percent of QCG subjects and 70 percent of CR subjects achieved initial hemostasis. During the 1-hour observation, one additional CR subject failed to maintain hemostasis. CR had significantly more hemorrhage than QCG during the 1-hour observation (p = 0.027). QCG had no bleeding compared to CR that had a mean of 162 ± 48 mL (standard error of mean) over 2 minutes. QCG had 15.9 times greater odds of success compared to CR over a period of 1 hour. Over the 1-hour observation time, 100 percent of QCG achieved hemostasis compared to 60 percent of CR.Conclusions: QCG is more effective than CR.

An analysis of 13 years of prehospital combat casualty care – implications for maintaining a ready medical force

2021 ◽  
pp. 1-12
Author(s):  
Steven G Schauer ◽  
Jason F Naylor ◽  
Andrew D Fisher ◽  
Michael D April ◽  
Ronnie Hill ◽  
...  
Keyword(s):  
Combat Casualty ◽  
Combat Casualty Care

scholarly journals Medical Challenges in Underground Warfare

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 839-844
Author(s):  
Alex Sorkin ◽  
Roy Nadler ◽  
Adir Sommer ◽  
Avishai M Tsur ◽  
Jacob Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Trauma Registry ◽  
Smoke Inhalation ◽  
Expert Committee ◽  
Medical Support ◽  
Response Planning ◽  
Combat Casualty ◽  
Combat Casualty Care

ABSTRACT Introduction Throughout history, underground systems have served military purposes in both offensive and defensive tactical settings. With the advance of underground mining, combat tactics, and weapon systems, providing medical support in the subterranean battlefield is a constantly growing challenge. This retrospective cohort study describes the Israeli Defense Force (IDF) Medical Corps experience with treating casualties from underground warfare, as recorded in the IDF Trauma Registry. Methods A retrospective cohort study of all casualties engaged in underground warfare, between the years 2004-2018. Medical data were extracted from the IDF Trauma Registry and tactical data were obtained from operational reports. An expert committee characterized the most prevalent challenges. Recommendations were based on a literature review and the lessons learned by the IDF experience. Results During the study period, 26 casualties were injured in the underground terrain. Of casualties, 12 (46%) due to blast injuries, 9 (35%) were due to smoke inhalation, and 5 (19%) due to crushing injuries. All were males, and the average age was 21.6 years. Ten (38%) were killed in action (died before reaching a medical facility). All 16 casualties reaching the hospital survived (Table I). The expert committee divided the most common challenges into three categories—tactical, environmental, and medical. An overview of medical response planning, common injuries, and designated combat casualty care are discussed below. As in all combat casualty care, the focus should be on safety, bleeding control, and rapid evacuation. Conclusion To plan and provide medical support, a thorough understanding of operational planning is essential. This manuscript presents the evolution of underground warfare, tactical and medical implications, environmental hazards, and common casualty care challenges.

The first military hospitals in Saint Petersburg

2020 ◽  
Vol 22 (3) ◽  
pp. 258-266
Author(s):  
N. V. Milasheva ◽  
V. O. Samoilov
Keyword(s):  
Medical Care ◽  
Military Medicine ◽  
Senior Physician ◽  
Military Hospitals ◽  
Saint Petersburg ◽  
Peter The Great ◽  
Russian State ◽  
Shortage Of Doctors ◽  
History Of ◽  
Hospital Doctors

Abstract. The documentary materials from the funds of the Russian State Archive of the Navy, other archives, published letters and documents of Peter the Great, his Daily Note and other sources about the history of the first military hospitals (infirmaries) of Saint Petersburg are studied. At the same time, the history of the first military hospitals is reflected against the background of the difficult events of the Northern War of 17001721, with which the establishment of hospitals for the Russian army and the navy and the development of military medicine are inextricably linked. The organization of military medicine became aggravated immediately with the outbreak of hostilities, with the first wounded and sick. The fight against the plague epidemic and other infections during the war, the shortage of doctors, healers, infirmaries, hospitals and their own national staff greatly complicated the provision of medical care. Numerous documents and facts prove that the events before 1715 can be attributed to the first stage in the development of military medicine in Saint Petersburg. It was established that in 1704 the issue of establishing a military land hospital in the northern capital was already discussed (Peter I, A.D. Menshikov, N.L. Bidloo); hospital), and the senior physician of the Navy Yang Govi served in it with zeal In 1713, by the decree of the Great Sovereign Y. Govi, he was appointed head of the Admiralty Hospital, doctors, apprentices and medical students in it. By that time, Dr. R. Erskine actually assumed the office of archiatrist (until 1712). A detailed statement of Lieutenant General R.V. Bruce on the number of sick and wounded who received medical care in hospitals and hospitals in Saint Petersburg from 1713 to 1715. The decree of Peter I on the construction of a complex of General hospitals with anatomical theaters on the Vyborgskaya side (1715) according to Dr. Areskins drawing, and the establishment of a medical school (until 1719) are the next stage in the development of military medicine in Saint Petersburg, prepared by all previous events.

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