Ten-year reduction in thoracic injury-related mortality among Israel Defense Forces soldiers

IntroductionThis study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation of the 2012 IDF-Military Corps ‘My Brother’s Keeper’ plan which included the publication of clinical practice guidelines (CPGs) for thoracic injuries, emphasis on adequate torso protection, introduction of modern life-saving procedures and encouragement of rapid evacuation.MethodsThe IDF prehospital trauma registry was reviewed to identify all patients who sustained thoracic injuries from January 2006 to December 2017. IDF soldiers who were injured, died of wounds or killed in action (KIA) were included. These were cross-referenced with the Israel National Trauma Registry. The periods before and after the plan were compared.Results458 (12.3%) of 3733 IDF soldiers wounded on the battlefield sustained combat-related thoracic injuries. The overall mortality was 44.3% before the CPG and 17.3% after (p<0.001). Most were KIA: 97% (95 of 98) died by 30 June 2012, and 83% (20 of 24) after (p<0.001). Casualties treated with needle thoracostomy before and after CPG were 6.3% and 18.3%, respectively (p=0.002). More tube thoracostomies were performed after June 2012 (16.1% vs 5.4%, p=0.001). Evacuation was faster after June 2012 (119.4 min vs 560.8 min, p<0.001), but the rates of casualties evacuated within 60 min were similar (21.1% vs 25%, p=0.617).ConclusionsAmong military casualties with thoracic injuries, the rate of life-saving interventions increased, evacuation time decreased and mortality dropped following the implementation of My Brother’s Keeper plan.

High Success Rate of Prehospital and En Route Cricothyroidotomy Performed in the Israel Defense Forces: 20 Years of Experience

Introduction: Securing the airway is a crucial stage of trauma care. Cricothyroidotomy (CRIC) is often addressed as a salvage procedure in complicated cases or following a failed endotracheal intubation (ETI). Nevertheless, it is a very important skill in prehospital settings, such as on the battlefield. Hypothesis/Problem: This study aimed to review the Israel Defense Forces (IDF) experience with CRIC over the past two decades. Methods: The IDF Trauma Registry (IDF-TR) holds data on all trauma casualties (civilian and military) cared for by military medical teams since 1997. Data of all casualties treated by IDF from 1998 through 2018 were extracted and analyzed to identify all patients who underwent CRIC procedures. Variables describing the incident scenario, patient’s characteristics, injury pattern, treatment, and outcome were extracted. The success rate of the procedure was described, and selected variables were further analyzed and compared using the Fisher’s-exact test to identify their effect on the success and failure rates. Odds Ratio (OR) was further calculated for the effect of different body part involvement on success and for the mortality after failed ETI. Results: One hundred fifty-three casualties on which a CRIC attempt was made were identified from the IDF-TR records. The overall success rate of CRIC was reported at 88%. In patients who underwent one or two attempts, the success rate was 86%. No difference was found across providers (physician versus paramedic). The CRIC success rates for casualties with and without head trauma were 80% and 92%, respectively (P = .06). Overall mortality was 33%. Conclusions: This study shows that CRIC is of merit in airway management as it has shown to have consistently high success rates throughout different levels of training, injuries, and previous attempts with ETI. Care providers should be encouraged to retain and develop this skill as part of their tool box.

Contribution of mutual perceived support to the marital satisfaction of combat commander couples

LAY SUMMARY Military combat commander couples face many difficulties, and support, especially perceived support, can be an important source for coping with them. This study examined how perceived support contributes to marital satisfaction among 248 male combat commanders in the Israel Defense Forces and their female spouses. The study found that the level of perceived support among combat commanders was significantly higher than that among their spouses, whereas there was no significant difference in their marital satisfaction.

# Pillar of Defense: Using Social Media to Manage Impressions of Conflict: A Case Study of the November 2012 Israel-Hamas conflict

Threats to reputation can destroy a brand. Communicating effectively during a conflict can help to manage negative impressions that expose brands to reputation risk. This is important now more than ever as organizations—and nations—turn to Twitter to address various publics. The rigid 140-character structure of Twitter thus necessitates the creation of sound bites that act as productive texts to address multiple rhetorical objectives simultaneously. An examination of the Israel Defense Forces’ (IDF) Twitter account through sentiment and content analysis shows evidence that the Force took a significantly defensive approach to impression management of Operation Pillar of Defense in November 2012. There is evidence that Israel sought to re-frame public impression of its military involvement from aggressor to defender in the armed conflict. Codes discovered in the analysis suggest that the IDF tried to justify force, avoid responsibility and establish legitimacy of its operations.

# Pillar of Defense: Using Social Media to Manage Impressions of Conflict: A Case Study of the November 2012 Israel-Hamas conflict

Threats to reputation can destroy a brand. Communicating effectively during a conflict can help to manage negative impressions that expose brands to reputation risk. This is important now more than ever as organizations—and nations—turn to Twitter to address various publics. The rigid 140-character structure of Twitter thus necessitates the creation of sound bites that act as productive texts to address multiple rhetorical objectives simultaneously. An examination of the Israel Defense Forces’ (IDF) Twitter account through sentiment and content analysis shows evidence that the Force took a significantly defensive approach to impression management of Operation Pillar of Defense in November 2012. There is evidence that Israel sought to re-frame public impression of its military involvement from aggressor to defender in the armed conflict. Codes discovered in the analysis suggest that the IDF tried to justify force, avoid responsibility and establish legitimacy of its operations.

Consistency of Civil-Military Relations in the Israel Defense Forces: The Defensive Mode in Cyber

The Israel Defense Forces (IDF) has four battle threats, where cyber is equitable to conventional (state), subconventional (nonstate), and nonconventional. An escalation in one could lead to an overall escalation in all. In the political areas and, by extension, in civil-military relations (CMR), the IDF has a defensive mode as routine, while an offensive mode is manifest rarely in emergencies and war. The IDF is engaged in a total war in a defensive mode yet a limited war in the offensive mode as Israel’s adversaries do not share the same policies with regular cyber and terror attacks against civilian, government, and military targets. There is consistency in all four threats. Fencing, active defense, and preventive and preemptive strikes dominate.