Combat Deaths Research Articles

An Assessment of Clinical Accuracy of Vital Sign-based Triage Tools Among U.S. and Coalition Forces.

Early appropriate allocation of resources for critically injured combat casualties is essential. This is especially important when inundated with an overwhelming number of casualties where limited resources must be efficiently allocated, such as during mass casualty events. There are multiple scoring systems utilized in the prehospital combat setting, including the shock index (SI), modified shock index (MSI), simple triage and rapid treatment (START), revised trauma score (RTS), new trauma score (NTS), Glasgow Coma Scale + age + pressure (GAP), and the mechanism + GAP (MGAP) score. The optimal score for application to the combat trauma population remains unclear. This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry from January 1, 2007 through March 17, 2020. We constructed univariable analyses to determine the area under the receiving operator characteristic (AUROC) for the scoring systems of interest. Our primary outcomes were early death (within 24 hours) or early massive transfusion, as defined by ≥3 units. There were 12,268 casualties that met inclusion criteria. There were 168 (1%) who died within the first 24 hours and 2082 (17%) that underwent significant transfusion within the first 24 hours. When assessing the predictive capabilities for death within 24 hours, the AUROCs were 0.72 (SI), 0.69 (MSI), 0.89 (START), 0.90 (RTS), 0.83 (NTS), 0.90 (GAP), and 0.91 (MGAP). The AUROCs for massive transfusion were 0.89 (SI), 0.89 (MSI), 0.82 (START), 0.81 (RTS), 0.83 (NTS), 0.85 (MGAP), and 0.86 (GAP). This study retrospectively applied seven triage tools to a database of 12,268 cases from the Department of Defense Trauma Registry to evaluate their performance in predicting early death or massive transfusion in combat. All scoring systems performed well with an AUROC >0.8 for both outcomes. Although the SI and MSI performed best for predicting massive transfusion (both had an AUROC of 0.89), they ranked last for assessment of mortality within 24 hours, with the other tools performing well. START, RTS, NTS, MGAP and GAP reliably identified early death and need for massive transfusion, with MGAP and GAP performing the best overall. These findings highlight the importance of assessing triage tools to best manage resources and ultimately preserve lives of traumatically wounded warfighters. Further studies are needed to explain the surprising performance discrepancy of the SI and MSI in predicting early death and massive transfusion.

Mini review on Artificial Blood Substitutes: Future perspective of Perfluorocarbon based oxygen carriers

The primary cause of death in the battle field and in civilian trauma is haemorrhagic shock. Around 50% combat deaths occur due to haemorrhage, depending on the severity of bleeding medical supervision can be provided like in catastrophic haemorrhage individual death occurs before providing the medical care and it is not a prehospital combat medical management problem during warfare scenario, even to transport wounded personnel to causality centre often takes 45 minutes to one hours. The hazardous nature of the forward combat areas and hostile operational environment frequently prevents medical personnel from quickly reaching the wounded even if the transport distances are small. Moreover, injuries with penetrating battlefield trauma often have only a "platinum 5 minutes." It is very important for military medical personnel to understand their options for treating haemorrhage quickly and efficiently during combat. Early intervention and definitive treatment could save up to 30% of soldier’s who die of action or of wounds. In view of this there is a requirement for the development of synthetic blood substitutes or oxygen therapeutic agents (OTA) in order to maintain the tissue oxygenation. Blood substitutes are the substances which mimic one of the physiological functions of the blood that is transportation of oxygen and carbon dioxide throughout the body. Blood substitutes or OTAs are being clinically tested as artificial oxygen carriers to improve tissue oxygenation and also to reduce allogenic blood transfusions. Two types of blood substitutes are reported so far: 1. Haemoglobin based oxygen carriers (HBOCs) and 2. Perfluorocarbon based oxygen carriers (PFOCs). PFOCs has huge advantages like universal compatibility, no requirement of cold storage, longer shelf life and no risk of infection transmission. These products have their own limitations and they have been withdrawn from international market for clinical use because of their side effects. It is a challenging task to the scientists to develop a safe, stable and biocompatible blood substitute for combat scenarios and also for civilian applications.

Ruggedized Self-Propelling Hemostatic Gauze Delivers Low Dose of Thrombin and Systemic Tranexamic Acid and Achieves High Survival in Swine With Junctional Hemorrhage.

Hemorrhage is responsible for 91% of preventable prehospital deaths in combat. Bleeding from anatomic junctions such as the groin, neck, and axillae make up 19% of these deaths, and reports estimate that effective control of junctional hemorrhage could have prevented 5% of fatalities in Afghanistan. Hemostatic dressings are effective but are time-consuming to apply and are limited when proper packing and manual pressure are not feasible, such as during care under fire. CounterFlow-Gauze is a hemostatic dressing that is effective without compression and delivers thrombin and tranexamic acid into wounds. Here, an advanced prototype of CounterFlow-Gauze, containing a range of low thrombin doses, was tested in a lethal swine model of junctional hemorrhage. Outcomes were compared with those of Combat Gauze, the current dressing recommended by Tactical Combat Casualty Care. CounterFlow-Gauze containing thrombin doses of 0, 20, 200, and 500 IU was prepared. Swine received femoral arteriotomies, and CounterFlow-Gauze was packed into wounds without additional manual compression. In a separate study using a similar model of junctional hemorrhage without additional compression, CounterFlow-Gauze containing 500 IU thrombin was tested and compared with Combat Gauze. In both studies, the primary outcomes were survival to 3 h and volume of blood loss. CounterFlow-Gauze with 200 and 500 IU had the highest 3-h survival, achieving 70 and 75% survival, respectively. CounterFlow-Gauze resulted in mean peak plasma tranexamic acid concentrations of 9.6 ± 1.0 µg/mL (mean ± SEM) within 3 h. In a separate study with smaller injury, CounterFlow-Gauze with 500 IU achieved 100% survival to 3 h compared with 92% in Combat Gauze animals. An advanced preclinical prototype of CounterFlow-Gauze formulated with a minimized thrombin dose is highly effective at managing junctional hemorrhage without compression. These results demonstrate that CounterFlow-Gauze could be developed into a feasible alternative to Combat Gauze for hemorrhage control on the battlefield.

The staffing problem in the police during 1943–1944 and ways to resolve it

The state of police staffing during 1943-1944 is revealed, its peculiarities related to the course of the German-Soviet war are identified. The staffing problem in the police during the war was extremely acute. The mobilisation of police officers to the army, their deaths in combat, and evacuation to the east significantly worsened the staffing potential of this law enforcement body. The situation with recruitment in 1943–1944 changed somewhat compared to the first stage of the war. This process became more manageable and lost the main elements of chaos and situationalism that were characteristic of the initial period of the war. In the regions of Ukraine liberated from the Nazis, NKVD operational groups immediately began recruiting police officers. There were several sources of this formation: pensioners, women, demobilised soldiers and partisans, as well as officers seconded from other regions of the USSR. The educational level of newly recruited police officers was very low at the time. Thus, of those recruited to the state police, only 7.6 % had special training, 3.1 % had military education, and 10.6 % had a secondary education. A significant proportion of police officers had little work experience. For example, 45 % of the state police had less than 1 year of service, and almost 69 % of the departmental police had less than 1 year of service. By the end of 1944, the total percentage of police personnel reached 70.4%. The ethnic composition of the police was as follows: Ukrainians – 47.8%, Russians – 36.5 %, Jews – 15.4 %, and others – 0.3%. Due to the shortage of people, large deviations from the mandatory conditions and rules for staffing the police were allowed. People who did not meet the requirements for police personnel in terms of age, health, education and generally did not meet the requirements for police personnel were recruited. This resulted in numerous official misconducts and crimes. The qualitative shortage of staff led to a significant turnover of personnel. To overcome the difficulties, this police staff learnt the basics of police service on the job, combining service with training. In addition, police officers received the necessary knowledge at various seminars and advanced training courses.

A Review of75th Ranger Regiment Battle-Injured Fatalities Incurred During Combat Operations From 2001 to 2021.

The 75th Ranger Regiment is an elite U.S. military special operations unit that conducted over 20 years of sustained combat operations. The Regiment has a history of providing novel and cutting-edge prehospital trauma care, advancing and translating medical initiatives, and documenting and reporting casualty care performance improvement efforts. A retrospective case fatality rate (CFR) review, mortality review, and descriptive analysis of fatalities were conducted for battle-injured personnel assigned or attached to the 75th Ranger Regiment from 2001 to 2021 during combat operations primarily in Afghanistan and Iraq. Fatalities were evaluated for population characteristics, cause of death, mechanism of death, injury severity, injury survivability, and death preventability. A total of 813 battle injury casualties, including 62 fatalities, were incurred over 20 years and 1 month of continuous combat operations. The Regiment maintained a zero rate of prehospital preventable combat death. Additionally, no fatalities had a mechanism of death because of isolated extremity hemorrhage, tension pneumothorax, or airway obstruction. When comparing the CFR of the Regiment to the U.S. military population as a whole, the Regiment had a significantly greater reduction in the cumulative CFR as measured by the difference in average annual percentage change. Documentation and analysis of casualties and care, mortality and casualty reviews, and other performance improvement efforts can guide combatant commanders, medical directors, and fighting forces to reduce preventable combat deaths and the CFR. Early hemorrhage control, blood product resuscitation, and other lifesaving interventions should be established and maintained as a standard prehospital practice to mitigate fatalities with potentially survivable injuries.

Novel cross-linked polysaccharide-polyelectrolyte hemostatic foam improves survival compared to CombatGauze in swine femoral artery hemorrhage model.

Uncontrolled hemorrhage is the leading cause of preventable death in combat and civilian trauma. Efficacious hemostatic agents in junctional hemorrhage can quell blood loss and improve survival. We hypothesized that a novel hemostatic foam of starch and chitosan would improve hemostasis, and thereby increase survival in a swine femoral artery hemorrhage model when compared to CombatGauze. A novel hemostatic foam of starch and chitosan was created and modified over the study period. 30 pigs (4 excluded) were assigned to treatment using either foam version 1 (FV1, n = 9) or 2 (FV2, n = 8), or CombatGauze (CG, n = 9) in a standard swine femoral artery hemorrhage model. Animals were observed for 150 minutes. Outcomes assessed included hemostasis, survival, post-treatment blood loss, IV fluid volume, and hemodynamic and laboratory trends. Hemostasis prior to 150 minutes was similar with 44.4%, 77.8%, and 50% of swine treated with CG, FV1 and FV2, respectively (Kaplan-Meyer and log-rank test [KM-LR] p > 0.05). Survival to 150 minutes was improved in swine treated with FV1 (100%) compared to CG (55.6%) (KM-LR p = 0.02). Survival was similar between FV1 and FV2 (75%) (KM-LR p > 0.05), and between CG and FV2 (KM-LR p > 0.05). Using mixed model for longitudinal data, MAP decreased significantly in CG- and FV2-treated swine, while there was no significant change in MAP in FV1-treated swine. Trends in lactic acid, hematocrit, platelets, INR, and TEG were more favorable for FV1 compared to CG. In this preclinical study of junctional hemorrhage, survival was improved in swine treated with version 1 of a novel chitosan/starch foam compared to CombatGauze. Trends in hemodynamics and laboratory data were also more favorable in the FV1-treated swine. This novel hemostatic foam may be an effective alternative to current hemostatic agents. not applicableStudy type: Original research: animal research.

Market Analysis of Video Laryngoscopy Equipment for the Role 1 Setting.

Airway compromise is the second leading cause of potentially preventable prehospital combat death. Endotracheal intubation (ETI) remains the most common role 1 airway intervention. Video laryngoscopy (VL) is superior to direct laryngoscopy (DL) for first-attempt intubation, especially in less-experienced providers and for trauma patients. The cost has been a major challenge in pushing VL technology far-forward; however, the cost of equipment continues to become more affordable. We conducted a market analysis of VL devices under $10,000 for possible options for role 1. We searched Google, PubMed, and the Food and Drug Administration database from August 2022 to January 2023 with a combination of several keywords to identify current VL market options under $10,000. After identifying relevant manufacturers, we then reviewed individual manufacturer or distributor websites for pricing data and system specifications. We noted several characteristics regarding VL device design for comparison. These include monitor features, size, modularity, system durability, battery life, and reusability. When necessary, we requested formal price quotes from respective companies. We identified 17 VL options under $10,000 available for purchase, 14 of which were priced below $5,000 for individual units. Infium (n = 3) and Vimed Medical (n = 4) provided the largest number of unique models. VL options under $10,000 exist in both reusable and disposable modalities. These modalities included separate monitors as well as monitors attached to the VL handle. Disposable options, on a per-unit basis, cost less than reusable options. Several VL options exist within our goal price point in both reusable and disposable options. Clinical studies assessing the technology performance of ETI and deliberate downselection are needed to identify the most cost-effective solution for role 1 dispersion.

Courage, Honour, and Phlegm: A Study of Eighteenth‐Century Military Writers' Descriptions of Soldiers' Combat Emotions and Motivation

AbstractThis article will aim to cover military writers' comments upon the psychological, emotional, and motivational aspects of soldiers in the eighteenth century. In recent years, there has been a positive re‐evaluation of the Ancien Régime soldier compared with that of the later citizen soldier of the French Revolutionary and Napoleonic Wars. This article seeks to add to this re‐appraisal by introducing a literature element to the discussion, highlighting and analysing the many passages writers wrote on these psychological topics, such as the fear of death in combat, the world of honour governing the soldier, and nationalistic differences in temperament.

Combat Death in Contemporary American Culture: Popular Cultural Conceptions of War since World War II Agnieszka SoltysikMonnet. Lexington Books, 2021.

The Journal of American CultureVolume 46, Issue 1 p. 104-105 Book Review Combat Death in Contemporary American Culture: Popular Cultural Conceptions of War since World War II Agnieszka Soltysik Monnet. Lexington Books, 2021. Josh Sopiarz, Corresponding Author Josh Sopiarz jsopiarz@govst.edu Governors State UniversitySearch for more papers by this author Josh Sopiarz, Corresponding Author Josh Sopiarz jsopiarz@govst.edu Governors State UniversitySearch for more papers by this author First published: 27 March 2023 https://doi.org/10.1111/jacc.13423Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume46, Issue1Special Issue: FashionMarch 2023Pages 104-105 RelatedInformation

Marketing The Dead of Antietam: Photographs of Death as a Cultural Commodity

Marketing The Dead of AntietamPhotographs of Death as a Cultural Commodity A. Maggie Hazard (bio) In October 1862 photographer and entrepreneur Mathew Brady launched an exhibition of photographs taken by Alexander Gardner at the Battle of Antietam. The exhibition, held at Brady’s New York City gallery and titled The Dead at Antietam, was the first of its kind in America.1 Among the photographs was Gardner’s Dead of Stonewall Jackson’s Brigade by the Rail Fence on the Hagerstown Pike (Fig. 1). The powerful image presents a startling glimpse of the battle. The contorted bodies of three Confederate soldiers lie next to a rail fence. Two of the three soldiers’ faces are not visible. Their legs flail in various directions, as if barely connected to their torsos. The soldier on the left is so twisted that he appears to be headless, his legs jutting out toward the viewer as his upper body pushes against the fence. His left arm reaches up, frozen in time as if he is reaching for a weapon or raising a hand to beg for assistance. On the right side of the photograph, another soldier is even more knotted. One leg bends as if the man was interrupted while trying to rise, his arm fixed forever in a cradled position against the fence. His head is almost indistinguishable from the foliage into which he has fallen, and his lower leg blends into the figure beside him. He still wears his hat. In the center of the group lies the only soldier whose face we might recognize. The agony of death demonstrated in the soldier’s twisted expression means that any small relief the viewer might [End Page 9] experience in seeing a complete body is short lived, and that agony will remain with the viewer well after they leave the exhibition. Click for larger view View full resolution Fig. 1. Alexander Gardner, Dead of Stonewall Jackson’s Brigade by the Rail Fence on the Hagers town Pike, Battle of Antietam, 1862. (Library of Congress, Prints and Photographs Division, Civil War Photographs [LC-B811-559]) Gardner’s photograph was typical for the exhibition but was previously unknown to society. Even more, Brady’s exhibition of these photographs and the sale of them afterward is significant to the way the war was seen and known and to how it is understood even today. The Battle of Antietam resulted in the first sustained photographic rendering and display of the casualties of war, and the exhibition was the public’s first encounter with grisly photographic images of actual battlefield death. Promoted in newspapers like the New York Times, the exhibition, along with the conversion of several photographs into woodcut prints that were published in illustrated journals and photographic images that were advertised for sale to those at home, created a new kind of commodity—a marketing of the dead.2 This new way of visualizing, which captured the bodies of fallen soldiers contorted, maimed, and anything but heroic, was crucial to redefining the way people back home (in the North at least) understood [End Page 10] combat and the death that inevitably accompanied it. Although a few photographs of combat death had been created prior to this moment, they were restricted to far off wars that those in the US did not experience, such as the Second Opium War in China in the 1850s. Photographs of other conflicts, like the Crimean War and the Mexican-American War, did not include images of the dead. This meant that when the photographs from the Battle of Antietam went on view in New York City, citizens were seeing these graphic depictions of the dead for the first time. Not only that, photographs of those earlier conflicts were much more scattered in their scope and, more significantly, were not subject to an aggressive marketing campaign to distribute the photographs to the public in their place of origin (largely Europe).3 It is important to note that all the photographs of fallen combatants from the Civil War that are known to exist are of white soldiers. There are a few reasons for this. The clearest and most obvious of these with regard...

"БОСЫЕ ДВОРЯНЕ": НАЯРЫ ГЛАЗАМИ ВЕНЕЦИАНЦЕВ ВТОРОЙ ПОЛОВИНЫ XVI В.

The article deals with the imagery of the Nayar (Nair) warrior caste group in two famous 16th century Venetian travelogues. These accounts were written by the merchants Cesare Federici (traveled in the Middle East and Asia in 1563–1581) and Gasparo Balbi (traveled in 1576–1588). Their descriptive particularities are compared with the ones of some Portuguese accounts of South Asia. Federici and Babli both linked their Nayar accounts to Cochin (Kochi), an ancient city, which thrived of maritime commerce. For the merchants, the Nayars seemed analogous to the European nobility, these recklessly brave noble warriors were always loyal to their king, despised death, walked barefoot, used sword and rondache in combat and had “common women”. Federici told about his personal communication with one of them. Balbi’s Nayar account is distinguished by his particular attention to the hypergamic relations between the Nayar women and Brahmin men. Balbi tried to observe the complex Hindu society of the South through the lens of the European trifunctional model. Although these Venetian authors proved to be partly dependent on the Portuguese descriptive pattern of India, their accounts contained some unique details of everyday life of 16thcentury Kerala.

Where There's a War, There's a Way: A Brief Report on Tactical Combat Casualty Care Training in a Multinational Environment.

With most combat deaths occurring in prehospital settings, the US Armed Forces focuses on life-threatening conditions at or near the point of injury. Tactical Combat Casualty Care (TCCC) guidelines are required for all US Servicemembers. Multinational militaries lack this requirement, and international partner forces often have limited prehospital medical training. From November 2019 to March 2020, military members assigned to the Role 2E at the Hamid Kazai International Airport (HKIA) North Atlantic Treaty Organization (NATO) base conducted multinational TCCC training. The standardized Joint Trauma System (JTS) TCCC curriculum consisted of two-day classroom instruction and situational training exercises. Competency was assessed through verbalized and demonstrated knowledge. After Action Reviews (AAR) were completed. Twelve multinational TCCC training courses trained 590 military Servicemembers and civilians from 10 countries, ranging from 16 to 62 participants (avg class size = 35). Portugal and Turkey represented the two largest participating nations with 219 and 133, respectively. Student feedback determined optimal group ratios for instruction. AARs were reviewed to categorize best practices. Multinational TCCC standardization will save lives. Most nations lack TCCC training requirements. Thus, providing opportunities for standardized training for HKIA residents helped established a multinational baseline of medical interoperability. Utilizing this curriculum in multinational environments can replicate these results. International adoption of TCCC is dynamic and ongoing and should be promulgated to reduce preventable deaths.

Danish military fatalities in international operations 2002–2018

IntroductionThis study describes deaths among Danish soldiers in international operations 2002–2018. Having been part of UN and later NATO forces in ex-Yugoslavia, in 2002 the first Danish contingent took part...

The Better Angels of Our Nature: Why Violence Has Declined

Pinker’s goal to provide evidence that accounts for the falling homicide and violent combat death rates in the modern world is insufficient and, more often than not, misguided. The main issue being his failure to set up a productive analytical approach that lives up to his remarkably overarching research question: today’s level of global violence is the lowest in history. While he has attempted to present the violence levels typically in the past by coupling empirical and archeological data of the prehistory mankind, he lacks the credibility to do so for mainly two reasons: the sheer limitation of archeological evidence prior to the development of modern nation-state along with his flawed statistical analysis, and his persistence to treat war mortalities as merely an empirical variable. Similarly, though this article makes only remote attempts to examine the actual trend in civilizational and cultural conflict over a longer time period, it has brought into attention the demand to incorporate constructivist approach into the study of violence in order to better comprehend its complexities which have been largely driven by the development in the new wars. For the reasons mentioned above, Pinker has and will continue to get the violence levels wrong, and the world is as violent as ever.

Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan

In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response. To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan. In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk. The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting. Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied. In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

Effect of special operational forces surgical resuscitation teams on combat casualty survival: A narrative review.

The most common cause of preventable death on the conventional battlefield or on special operations force (SOF) missions is hemorrhage. SOF missions may take place in remote and austere locations. Many preventable deaths in combat occur within 30 min of wounding. Therefore, SOF damage control resuscitation (DCR) and damage control surgery (DCS) teams may improve combat casualty survival in the SOF environment. To determine the effect of SOF DCR and DCS teams on combat casualty survival. Also, to describe commonalities in team structure, logistics, and blood product usage. A narrative review of the English literature used a Medline and Embase search strategy. The authors were contacted for more details as required. The risk of bias was assessed using the Cochrane Collaboration's ROBINS-I tool. Pooling of data was not done to the heterogeneity of studies. Weak evidence was identified showing a clinical benefit of SOF DCR and DCS teams. Conflicting evidence from less rigorous studies was also found. The overall risk of bias using ROBINS-I was serious to critical. Several commonalities in team structure, training, and logistics were found. There is conflicting evidence regarding the effect SOF DCR and DCS teams have on combat casualty survival. There is no strong evidence that SOF DCR and DCS teams cause harm. More robust data collection is recommended to evaluate these teams.

Trauma type as a risk factor for insomnia in a military population

BackgroundThis study evaluated whether lifetime traumatic stress compared to deployment-related traumatic stress differentially affected the likelihood of insomnia in military personnel. MethodsData were obtained from the Army Study to Assess Risk and Resilience in Servicemembers (unweighted N = 21,499; weighted N = 670,335; 18–61 years; 13.5% Female). DSM-5 criteria were applied to the Brief Insomnia Questionnaire to determine past month insomnia diagnostic status. A lifetime stress survey was used to assess traumatic stress encountered outside of the military, and a deployment-related stress survey assessed for various types of deployment-related traumatic stress. ResultsAdjusting for sex and psychiatric disorders, lifetime traumatic stress increased the prevalence for insomnia among those who endorsed combat death of close friend or relative, 1.021 (95% CI, 1.02–1.02), followed by those who reported other experiences that put them at risk of death or serious injury, 1.013 (95% CI, 1.01–1.01), whereas deployment-related traumatic stress showed that the prevalence for insomnia was highest for those who reported being sexually assaulted or raped, 1.059 (95% CI, 1.04–1.08), followed by those who endorsed being hazed or bullied by one or more members of their unit 1.042 (95% CI, 1.04–1.05). LimitationsThe cross-sectional nature of the assessment limits causal inferences and there was no clinician determined diagnosis for insomnia. ConclusionFindings suggest that traumas over both one's lifetime and during deployment are associated with a higher prevalence for insomnia among Army soldiers. Results highlight the importance of considering both lifetime and deployment traumas into mental health assessment and treatment for active-duty soldiers.

Fall of a tyrant, or heroic last stand? Tipu Sultan and the moral undercurrent in historiography

ABSTRACT What does morality have to do with history? Should the past be pluralised as a heuristic category? Might we disengage common representational tropes from historical events otherwise remembered in mutually contradictory ways? This study attempts to answer these questions by narrowing in on the contested legacy of Tipu Sultan of Mysore (1750–1799). Tipu is remembered today both as a proto-anticolonial figure who died fighting the East India Company (EIC), and a Muslim tyrant who colonised a mostly Hindu southern India. This martyr/monster duality finds expression in contending portrayals of his death in combat against the British in 1799. Tipu’s ‘last stand’ becomes the pivot of this discussion where I will demonstrate how the past is used to envision moral victory from conflict by its presenters in comparable events like the Battle of Pollilur (1780) and the Battle of Alamo (1836). This means, I contend, that the past being exploited for various ends is split from itself at the moment of its enunciation; replicated and reproduced in accordance with the ideological exigencies of its presenters. I will argue that this calls for a paradigmatic shift from the Rankean ideal of what really happened to how what supposedly happened is told; who tells it; and for what purpose. Through this proposed model, I will elaborate how the historical ‘fact’ becomes ‘meaningful’, and how morals and history, history and fiction, colonial and anticolonial, are closer to each other than apart.

Association of Traumatic Brain Injury With Mortality Among Military Veterans Serving After September 11, 2001

Emerging evidence suggests that harmful exposures during military service, such as traumatic brain injury (TBI), may contribute to mental health, chronic disease, and mortality risks. To assess the mortality rates and estimate the number of all-cause and cause-specific excess deaths among veterans serving after the September 11, 2001, terrorist attacks (9/11) with and without exposure to TBI. This cohort study analyzed administrative and mortality data from January 1, 2002, through December 31, 2018, for a cohort of US military veterans who served during the Global War on Terrorism after the 9/11 terrorist attacks. Veterans who served active duty after 9/11 with 3 or more years of care in the Military Health System or had 3 or more years of care in the Military Health System and 2 or more years of care in the Veterans Health Administration were included for analysis. The study used data from the Veterans Affairs/Department of Defense Identity Repository database, matching health records data from the Military Health Service Management Analysis and Reporting tool, the Veterans Health Administration Veterans Informatics and Computing Infrastructure, and the National Death Index. For comparison with the total US population, the study used the Centers for Disease Control and Prevention WONDER database. Data analysis was performed from June 16 to September 8, 2021. Traumatic brain injury. Multivariable, negative binomial regression models were used to estimate adjusted all-cause and cause-specific mortality rates for the post-9/11 military veteran cohort, stratified by TBI severity level, and the total US population. Differences in mortality rates between post-9/11 military veterans and the total US population were used to estimate excess deaths from each cause of death. Among 2 516 189 post-9/11 military veterans (2 167 736 [86.2%] male; and 45 324 [1.8%] American Indian/Alaska Native, 160 178 [6.4%], Asian/Pacific Islander, 259 737 [10.3%] Hispanic, 387 926 [15.4%] non-Hispanic Black, 1 619 834 [64.4%] non-Hispanic White, and 43 190 [1.7%] unknown), 17.5% had mild TBI and 3.0% had moderate to severe TBI; there were 30 564 deaths. Adjusted, age-specific mortality rates were higher for post-9/11 military veterans than for the total US population and increased with TBI severity. There were an estimated 3858 (95% CI, 1225-6490) excess deaths among all post-9/11 military veterans. Of these, an estimated 275 (95% CI, -1435 to 1985) were not exposed to TBI, 2285 (95% CI, 1637 to 2933) had mild TBI, and 1298 (95% CI, 1023 to 1572) had moderate to severe TBI. Estimated excess deaths were predominantly from suicides (4218; 95% CI, 3621 to 4816) and accidents (2631; 95% CI, 1929 to 3333). Veterans with moderate to severe TBI accounted for 33.6% of total excess deaths, 11-fold higher than would otherwise be expected. This military veteran cohort experienced more excess mortality compared with the total US population than all combat deaths from 9/11/01 through 9/11/21, concentrated among individuals exposed to TBI. These results suggest that a focus on what puts veterans at risk for accelerated aging and increased mortality is warranted.

Blood Product Administration During the Role 1 Phase of Care: The Prehospital Trauma Registry Experience.

The majority of combat deaths occur in the prehospital setting. Efforts to increase survival including blood transfusions are made in the prehospital setting. The blood products available in the Role 1 setting include whole blood (WB), red blood cells (RBCs), fresh frozen plasma (FFP), and lyophilized (freeze-dried) plasma (FDP). This is a secondary analysis of a previously published dataset within the Prehospital Trauma Registry (PHTR) from 2003 through May 2019. Deterministic linking was used when possible with the DoD Trauma Registry for outcome data. Descriptive statistics were used to analyze the data. We identified 1,357 patient encounters in the PHTR. Within that group, 28 patients received a prehospital blood product, with 41 total administrations: WB (18), RBCs (12), FFP (6), FDP (3), and blood not otherwise specified (2). Outcome data were available for 17 of the 28 patients. The median injury severity score was 20, with the thorax being the most frequent seriously injured body region. Most (94%) patients survived to discharge. The median ICU days was 11 (Interquartile Range [IQR] 3-19), and the median hospital days was 19 (IQR 8-29). The average volume (units) of RBCs was 6.0 (95% CI 1.9-10.1), WB 2.8 (95% CI 0.0-5.6), platelets 0.7 (95% CI 0.0-1.4), and FFP 5.0 (95% CI 1.2-8.8). The use of prehospital blood products is uncommon in U.S. combat settings. Patients who received blood products sustained severe injuries but had a high survival rate. Given the infrequent but critical use and potentially increased need for adequate prolonged casualty care in future near-peer conflicts, optimizing logistical chain circulation is required.