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 Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1271-e1276
Author(s):  
Stephen M Scott ◽  
Margaret J Carman ◽  
Michael E Zychowicz ◽  
Mark L Shapiro ◽  
Nicholas A True
Keyword(s):  
Prehospital Care ◽  
Preventable Death ◽  
Post Intervention ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Nasopharyngeal Airway ◽  
Austere Environment ◽  
Care Training ◽  
Combat Casualty Care ◽  
Paired T Test

Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p < 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = −7.31, p < 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway. Conclusion TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector.

scholarly journals Pengembangan LKPD Berbasis Problem Based Learning (PBL) dengan Penguatan Karakter Kerja Keras Subtema Indahnya Persatuan dan Kesatuan di Negeriku untuk Kelas IV SDN Banggle 02 Kabupaten Blitar

2021 ◽  
Vol 1 (4) ◽  
pp. 254-268
Author(s):  
Anggia Diah Wahyu Mastuti ◽  
Lilik Bintartik ◽  
Sumanto Sumanto
Keyword(s):  
Data Collection ◽  
Subject Matter ◽  
Research Method ◽  
Problem Based Learning ◽  
Instructional Materials ◽  
Teaching Material ◽  
Development Research ◽  
Subject Matter Experts ◽  
Student Responses ◽  
Product Trial

Abstract: The purpose of this development research is to produce a valid Problem Based Learning LKPD based on material experts, instructional materials experts, and users as well as practical and interesting according to students. This product can be used as additional teaching material on the Theme of Diversity and Unity of My Country The Subtheme of the Beautiful Unity and Unity in my Country learning 1 and 2. The development of this LKPD uses the research method of Borg & Gall modified by Sugiyono. The steps are 1) potential and problems, 2) data collection, 3) product design, 4) product validation 5) product revision, 6) product trial, 7) product revision, 8) trial use, and 9) revision product. The results of the product validation were stated to be very valid, with an average rating of 94 percent material experts, subject matter experts, and 100 percent users. Student responses about practicality and attractiveness reached 96 percent and 100 percent. Based on all of the assessment results it can be concluded that PBL-based LKPD products are very valid, very practical, very interesting, and can be used without revision. Abstrak: Tujuan penelitian  pengembangan ini menghasilkan LKPD berbasis Problem Based Learning yang valid menurut ahli materi, ahli bahan ajar dan pengguna serta  praktis dan menarik menurut peserta didik. Produk ini dapat digunakan sebagai bahan ajar tambahan pada Tema Keragaman Persatuan dan Kesatuan Negeriku Subtema Indahnya Persatuan dan Kesatuan di Negeriku pembelajaran 1 dan 2. Pengembangan LKPD ini menggunakan metode peneltitian dari Borg & Gall yang dimodifikasi oleh Sugiyono. Langkah-langkahnya yaitu 1) potensi dan masalah, 2) pengumpulan data, 3) desain produk, 4) validasi produk 5) revisi produk, 6) uji coba produk, 7) revisi produk, 8) uji coba pemakaian, dan 9) revisi produk. Hasil validasi produk dinyatakan sangat valid, dengan rata-rata penilaian ahli materi 94 persen, ahli bahan ajar dan pengguna 100 persen. Respon peserta didik tentang kepraktisan dan kemenarikan mencapai 96 persen dan 100 persen.  Berdasarkan seluruh hasil penilaian dapat disimpulkan bahwa produk LKPD berbasis PBL sangat valid, sangat praktis ,sangat  menarik, dan dapat digunakan tanpa revisi.

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.

Feasibility of Mos Job Analysis and Redesign to Reduce Physical Demands in the U.S. Army

1996 ◽  
Vol 40 (13) ◽  
pp. 678-682
Author(s):  
Rene J. de Pontbriand ◽  
Joseph J. Knapik
Keyword(s):  
Data Collection ◽  
Subject Matter ◽  
Health And Safety ◽  
Job Analysis ◽  
Subject Matter Experts ◽  
Structured Interviews ◽  
Physical Demands ◽  
Job Selection ◽  
Occupational Tasks ◽  
The U.S

Heavy physical requirements characterize a large number of military occupational specialties (MOSs). Current efforts at reducing some of these physical requirements stem from concerns with health and safety, the need to conserve soldier strength and endurance for other battlefield tasks, and the need to optimize personnel utilization. This paper describes an ongoing feasibility study aimed at identifying and attempting to reduce physical demands in five MOSs. Three data-collection phases involve (a) review of publications describing occupational tasks, (b) structured interviews with subject matter experts (SMEs), and (c) filming the most physically demanding tasks. The fourth phase involves use of SMEs and ergonomists to identify specific redesign solutions. An illustrative example is provided. This technique coupled with others (job selection and physical training) can enhance military operational capability by reducing physical requirements.

scholarly journals Pengembangan Lampu Warna terhadap Perkembangan Kognitif Anak Kelompok A di TK PGRI 1 Bancaran

2020 ◽  
Vol 7 (1) ◽  
pp. 47-51
Author(s):  
Nurul Kholidiyah ◽  
Dwi Nurhayati Adhani ◽  
Siti Fadjryana Fitroh
Keyword(s):  
Data Collection ◽  
Research And Development ◽  
Subject Matter ◽  
Field Trials ◽  
Instructional Media ◽  
Subject Matter Experts ◽  
Main Field ◽  
Initial Product ◽  
Initial Field ◽  
Group A

Researchers used a development model Borg Gall. Steps to be taken include the research and data collection, planning, early product development, initial test, revise the initial product, the main field testing and revision of the final product. Research and development is carried out through four stages of a trial that is testing subject matter experts, instructional media expert testing, field trials beginning, and major field trials. The subject of research and development that children in group A or 4-5 years in kindergarten PGRI 1 Bangcaran totaling 21 children. The data collection technique using a questionnaire (questionnaire subject matter experts, instructional media expert questionnaire, and the questionnaire responses of children) and documentation. The results showed that the values obtained from the color light matter experts for86.11% with the title of "high", 76.67% of instructional media expert with the title of "high", the initial field trials 83.9%with the title of "high", and the main field trials 86.9%with the title of "high". Based on the results of research and development has been done can be concluded that the media color lights as stimulationability to recognize the concept of color in group A at TK PGRI 1 Bancaran fit for use

Emerging technologies in Indian mining industry: an exploratory empirical investigation regarding the adoption challenges

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Som Sekhar Bhattacharyya ◽  
Yash Shah
Keyword(s):  
Technology Adoption ◽  
Data Collection ◽  
Subject Matter ◽  
Value Chain ◽  
Emerging Technologies ◽  
Mining Industry ◽  
Subject Matter Experts ◽  
Content Type ◽  
Wide Range ◽  
Blasting Excavation

Purpose Emerging technologies have been transforming most industries. A wide range of emerging technologies such as blockchain, internet of things (IoT), artificial intelligence (AI), machine learning (ML), robotics and many others have changed the way in which firm value chain activities or processes were executed traditionally. The mining industry has also witnessed the introduction of these emerging technologies in various processes from the exploration stage to the final processing of ores. The purpose of this paper is to understand the pace of adoption of emerging technologies in the Indian mining industry and identify the challenges that managers confront while adopting emerging technologies. Design/methodology/approach The authors undertook qualitative research. Data collection was done in two stages. Secondary research was conducted to arrive at a repository of use cases of the adoption of emerging technologies in the global mining industry. Primary data collection was also done. The insights on emerging technology adoption and challenges faced in the Indian mining industry were captured by in-depth interviewing of subject matter experts. The authors interviewed 21 mining subject matter experts with a semi-structured open-ended questionnaire. The responses were content analyzed by thematic content analysis. Technological-organizational-environmental (TOE) and diffusion of innovation (DOI) frameworks were applied to segregate different factors affecting the adoption of emerging technologies in the Indian mining industry. Findings Emerging technologies such as blockchain, IoT, AI, ML, robotics has been applied across various mining engineering value chain activities such as in drilling, blasting, excavation and ore hauling. However, emerging technologies adoption was hindered because of a lack of managerial awareness, cultural inertia, substantive upfront investments and the nature of intangible benefits in the short run. Research limitations/implications The research applied technology adoption frameworks in the mining industry. The authors used TOE and DOI frameworks to understand the challenges faced by Indian mining firms. The research findings, thus added to the conversation of TOE and DOI frameworks in the context of the Indian mining industry. Practical implications The research finding would help mining firm managers to anticipate the challenges with respect to technology adoption. This would allow mining executives to create a proper technology adoption plan and intervene proactively. The research would also provide information about the steps taken by competing firms with respect to emerging technologies adoption. The research would help managers to decide technology implementation steps in drilling, blasting, excavation and ore hauling to be undertaken for successful adoption of emerging technologies. Technology firms could gain insights into the issues faced by mining firms in adopting emerging technologies. This research would help managers to influence organizational technology policy and endorse the addition of pro-technology policies in mining activities. Policymakers involved in the mining sector could also incorporate industry-level policy decisions so as to facilitate the adoption of emerging technologies among mining firms and remove the barriers to the adoption of emerging technologies. This would create an opportunity for technology providers to redesign product offerings, which could be a good fit for Indian mining firms. Originality/value Indian mining industry contributed significantly to the Indian economy. Despite this, limited focus has been put regarding the adoption of emerging technologies in the mining industry. Mining managers did not have any framework to understand the challenges faced in the adoption of technologies across the mining value chain that is in drilling, blasting, excavation and ore hauling. This study focused on identifying those challenges through the use of technology adoption frameworks. This research was one of the first studies to gain insights on emerging technologies adoption in the context of the mining industry through the theoretical lens of TOE and DOI frameworks.

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.

Development of an Instrument for Assessing Trauma Team Performance

2007 ◽  
Vol 51 (11) ◽  
pp. 678-682 ◽  
Author(s):  
Barbara Kuenzle Haake ◽  
Yan Xiao ◽  
Colin Mackenzie ◽  
F. Jacob Seagull ◽  
Thomas Grissom ◽  
...  
Keyword(s):  
Team Performance ◽  
Performance Feedback ◽  
Subject Matter ◽  
Clinical Performance ◽  
Trauma Team ◽  
Ease Of Use ◽  
Initial Assessment ◽  
Subject Matter Experts ◽  
Real Patient ◽  
Widespread Application

Teamwork training is critical for patient safety and has been advocated for widespread application in many settings. A key challenge for evaluating teamwork training is measurement. Despite much effort, the team performance instruments reported thus far suffer from a variety shortcomings that prevent their wide application in assessing teams in real settings. Based on review of video recorded trauma team activities in real patient care, a multi-disciplinary research team developed an instrument based on observable behaviors (UMTOP). A set of video clips were reviewed by 6 subject matter experts who were requested to provide “descriptors” about the observed team activities. The 167 collated descriptors were combined to a reduced list, which was then sent to the subject matter experts for revision. The revised list was then categorized into 5 areas of team performance (task and clinical performance, leadership organization, teamwork organization, social environment, sterile precaution). UMTOP was developed to be a tradeoff among four criteria: ease of use, reliability, usefulness for team performance feedback, and speed of scoring. An initial assessment of reliability was conducted with surgeon and nursing reviewers.

Sign in / Sign up

Export Citation Format

Share Document