Development of a Critical Care Air Transport Team “Go Bag”: Slimming Down ICU Capability to Augment Pararescue or Civilian Contract Medical Evacuation Personnel

ABSTRACT Introduction Critical Care Air Transport Team (CCATT) is a three-person United States Air Force (USAF) medical asset, typically providing intercontinental medical evacuation on large military aircraft. The CCATT equipment Allowance Standard (AS) weighs approximately 272 kg (600 lbs). In austere locations, CCATT teams may augment contract medical evacuation (CME) personnel or Pararescue (PJ) in small aircraft with limited space for medical equipment. It was unknown what deployed PJ and CME carry within their packouts. We sought to design a packout or “Go Bag,” weighing less than 22.7 kg (50 lbs) and sourced from the CCATT AS, that a CCATT member could use to complement CME or PJ equipment to provide a higher level of care while limiting redundancy. Materials and Methods Equipment lists were obtained from a CME and PJs from two separate USAF squadrons. The equipment lists were combined to provide a reference for development of a CCATT Go Bag. Three members of a deployed CCATT team independently generated a list of necessary equipment from the CCATT AS. The list was peer reviewed by a separate, deployed CCATT team. Results A Go Bag was developed with the supplies and equipment necessary for video laryngoscopy, ventilation, invasive pressure monitoring, basic laboratory capability, chest tube placement, ultrasound, and advanced pharmacologic interventions. The Go Bag weighed 18.3 kg (40.4 lbs). A separate respiratory bag weighing 1.1 kg (2.4 lbs) was attached directly to a ventilator. Intravenous pumps and cardiac monitoring equipment were notable ICU equipment excluded from the Go Bag. Conclusion Major components of the CCATT AS can be reduced into a Go Bag and accompanying Ventilator Accessory Bag. This may benefit CCATT teams required to augment PJs or CME in small aircraft during prolonged field care scenarios.

Phylodynamics Of A Regional, Sars-Cov-2 Rapid Spreading Event In Colorado

ABSTRACTSince the initial reported discovery of SARS-CoV-2 in late 2019, genomic surveillance has been an important tool to understand its transmission and evolution. Here, we describe a case study of genomic sequencing of Colorado SARS-CoV-2 samples collected August through November 2020 at the University of Colorado Anschutz Medical campus in Aurora and the United States Air Force Academy in Colorado Springs. We obtained nearly complete sequences for 44 genomes, inferred ancestral sequences shared among these local samples, and used NextStrain variant and clade frequency monitoring in North America to place the Colorado sequences into their continental context. Furthermore, we describe genomic monitoring of a lineage that likely originated in the local Colorado Springs community and expanded rapidly over the course of two months in an outbreak within the well-controlled environment of the United States Air Force Academy. This variant contained a number of amino acid-altering mutations that may have contributed to its spread, but it appears to have been controlled using extensive contact tracing and strict quarantine protocols. The genome sequencing allowed validation of the transmission pathways inferred by the United States Air Force Academy and provides a window into the evolutionary process and transmission dynamics of a potentially dangerous but ultimately contained variant.SIGNIFICANCESARS-CoV-2 spreads and mutates, negatively impacting containment. In this study, we use long-read sequencing to generate 44 SARS-CoV-2 genomes from COVID-19 patients associated with a rapid-spreading event on the USAFA campus, as well as a neighboring community for reference. We reconstruct the genomic and evolutionary signatures of the rapid-spreading event, and pin-point novel, protein-altering mutations that may have impacted viral fitness. These insights into viral evolutionary dynamics, in the context of contact tracing and a rigorous containment program, help to inform response efforts in the future.

Applications of Theory of Bureaucratic Caring in the United States Air Force and Defense Health Agency

The theory of bureaucratic caring, generated from lived experiences of healthcare professionals and patients, synthesized the thesis of caring with the anti-thesis of bureaucracy (hospital). This author applied the theory in settings within the United States Air Force Medical Service and the Military Health System. Using categories of caring as spheres in which to leverage caring, the author developed projects on communication, self-efficacy, healthcare readiness, evidence-based practice, spiritual health, and education. The article describes applications of the theory across settings in the military. This author encourages others to apply the theory in their organizations as part of their nursing journey.

Shaving Waivers in the United States Air Force and Their Impact on Promotions of Black/African-American Members

ABSTRACT Introduction Regulations of the United States Air Force (USAF) prohibit male members from growing beards. Shaving waivers can be issued to airmen who are not able to shave due to various medical conditions such as pseudofolliculitis barbae, a condition that predominantly affects Blacks/African-Americans. Beard growth has been anecdotally associated with a negative impact on career progression. This study sought to establish if shaving waivers are associated with delays in promotion and, if present, if this association leads to racial bias. Materials and Methods An online survey that collected information relating to shaving waivers and demographic data was emailed to all air force male members at 12 randomly selected air force bases. Generalized linear models were conducted to test the waiver group difference in promotion time controlling for rank and the covariates of race/ethnicity, level of education, professional military education completion, and disciplinary action. Results A total of 51,703 survey invitations were emailed to members, and 10,383 complete responses were received (20.08% response rate). The demographics of the study cohort closely matched that of the USAF. Shaving waivers were associated with a longer time to promotion (P = .0003). The interaction between race and waiver status was not significant, indicating that shaving waivers are associated with a similarly longer time to promotion in individuals of all races. However, 64.18% of those in the waiver group were Black/African-American despite only being 12.85% of the study cohort. Conclusions This study found an association between shaving waivers and delayed promotions. The majority of the waiver group was Black/African-American, which may lead to a racially discriminatory effect of the male grooming standards of the USAF.