Hostile Fire Research Articles

Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war.

Extremity tourniquets have proven to be lifesaving in both civilian and military settings and should continue to be used by first responders for trauma patients with life-threatening extremity bleeding. This is especially true in combat scenarios in which both the casualty and the first responder may be confronted by the imminent threat of death from hostile fire as the extremity hemorrhage is being treated. Not every extremity wound, however, needs a tourniquet. One of the most important aspects of controlling life-threatening extremity bleeding with tourniquets is to recognize what magnitude of bleeding requires this intervention and what magnitude of bleeding does not. Multiple studies, both military and civilian, have shown that tourniquets are often applied when they are not medically indicated. Overuse of extremity tourniquets has not caused excess morbidity in either the recent conflicts in Iraq and Afghanistan or in the US urban civilian setting. In the presence of prolonged evacuation, however, applying a tourniquet when it is not medically indicated changes tourniquet application from being a lifesaving intervention to one that may cause an avoidable amputation and the development of an array of metabolic derangements and acute kidney injury collectively called prolonged tourniquet application syndrome. The recent literature was reviewed for papers that documented the complications of tourniquet use resulting from the prolonged casualty evacuation times being seen in the current Russo-Ukrainian war. The literature was also reviewed for the incidence of tourniquet application that was found to not be medically indicated, in both the US civilian setting and from Ukraine. Finally, an in-person meeting of the US/Ukraine Tourniquet Working Group was held in Warsaw, Poland, in December of 2023. Unnecessary loss of extremities and life-threatening episodes of prolonged tourniquet application syndrome are currently occurring in Ukrainian combat forces because of nonindicated tourniquet use combined with the prolonged evacuation time seen in the Russo-Ukrainian war. Specific numbers of the complications experienced as a result of tourniquet use by Ukrainian forces in the current conflict are treated as classified information and are not available, but multiple sources from the Ukrainian military medical personnel and from the US advisors providing medical assistance to Ukraine have all agreed that the problem is substantial. Unnecessary tourniquet morbidity might also occur in US forces in a variety of potential future combat scenarios in which evacuation to surgical care is delayed. Prehospital trauma training programs, including but not limited to tactical combat casualty care, place insufficient emphasis on the need to avoid leaving tourniquets in place when they are not medically indicated. This aspect of training should receive emphasis in future Tactical Combat Casualty Care (TCCC) and civilian first responder curriculum development. An interim ad hoc training solution on this topic is available at the websites noted in this articles. Additional training modalities may follow in the near future. Therapeutic/Care Management; Level V.

‘Winners, Regardless’?: Racial Politics, Civil Rights Struggles, and the 1950 Track and Field Tour of South Africa

ABSTRACT In 1950 as the Civil Rights Movement gathered momentum in the US and apartheid policies hardened in South Africa, the American Amateur Athletic Union sponsored a tour by US track and field all-stars to South Africa. The controversial 1950 venture, following an original 1931 trek and a 1938 trip cancelled after objections to the exclusion of Black athletes from the team, drew hostile fire from a variety of groups in the US went it leaked to the press that only white American athletes were invited. This lily-white American touring squad was selected at a national championship meet held in the national capital region surrounding Washington, DC, created a public relations firestorm. It also inspired many commentators in the US to link racial segregation in the US to South African variants, particularly since Black American athletes were not only excluded from the international tour but from the official hotel of the championship meet, the infamous Willard Hotel open only to whites in the nation’s capital. These Cold War era sagas of race and sport sparked an early focus by Civil Rights groups on connecting the struggle against colour lines in the US to the struggle against colour lines in South Africa.

Tactical Combat Casualty Care Scenario: Management of a Gunshot Wound to the Chest in a Combat Swimmer.

Tactical Combat Casualty Care (TCCC) has always emphasized the need to consider the tactical setting in developing a plan to care for wounded unit members while still on the battlefield. The TCCC Guidelines provide an evidence-based trauma care approach to specific injuries that may occur in combat. However, they do not address what modifications might need to be made to the basic TCCC guidelines due to the specific tactical setting in which the scenario occurs. The scenario presented below depicts a combat swimmer operation in which a unit member is shot while in the water. The unit casualty response plan for a combat swimmer who sustains a gunshot wound to the chest while on a mission is complicated by the inability to perform indicated medical interventions for the casualty while he is in the water. It is also complicated by the potential for ballistic damage to his underwater breathing apparatus and the need to remain submerged after wounding for at least for a period of time to avoid further hostile fire. Additionally, there is a potential for a cerebral arterial gas embolism (CAGE) and/or a tension pneumothorax to develop while surfacing because of the decreasing ambient pressure on ascent. The tactical response may be complicated by limited communications between the mission personnel while submerged and by the vulnerability of the mission personnel to antiswimmer measures if their presence is compromised.

Opportunities and challenges in RCS measurement of 9‐mm bullet model with 77 GHz mmwave COTS radar systems

AbstractThis article indicates a thus far unexplored area of applied research and development to the application and system engineers and researchers from broad engineering backgrounds. Results of a study are presented for measurement of calibrated Radar Cross Section (RCS) of a 9‐mm bullet (projectile) model by using a commercial‐of‐the‐shelf (COTS) millimeter wave Frequency Modulated Continuous Wave (FMCW) radar system operating in 77 to 81 GHz frequency range. The calibrated RCS variation against the aspect angle is measured experimentally, analyzed, and compared with the simulation results which shows fair matching between the two. The opportunities and challenges attached with the use of such COTS systems for development of Hostile Fire Indication (HFI) systems are discussed. This bullet type and this mmwave frequency has not been thus far studied and reported in literature. This may motivate interested individuals/entities to try to measure (at acceptable accuracy before anechoic chamber measurements) RCS of similar low‐size objects by using such low‐cost COTS platforms.

Characterization of digital MEMS microphone elements for usage in a hostile fire detection system on a multi-rotor drone

Acoustic based Hostile Fire Detection Systems (HFDS) depend on multi-element arrays of microphones which are simultaneously sampled at sample rates often in the 10–50 ksps range. A driving component of the electronic hardware complexity of the system is the signal buffering, filtering, and analog to digital conversion required for each microphone channel. Digital MEMS microphones consolidate these functions to within the microphone element giving a digital output representative of the measured acoustic signal. Digital MEMS microphones allow for a completely digital hardware solution which reduces complexity and allows more flexibility in utilizing higher element number arrays if desired. The performance parameters relevant to HFDSs of current best-in-class digital MEMS microphones were measured and compared to current analog microphones commonly utilized in these systems. The purpose of these tests was to determine the viability of digital MEMS microphones as an alternate acoustic sensing element for a HFDS system being implemented on a multi-rotor drone.

Method for effective implementation of an acoustic based Hostile Fire Detection System on moving vehicles

Due to background noise issues, effective implementation of an acoustic array as part of a Hostile Fire Detection System on moving vehicles has been a significant challenge to date. A new method utilizing both software and hardware design parameters has been developed and successfully demonstrated to be very effective at high speeds on various vehicles. This method has been shown to be effective against both flow based noise sources and acoustic wave based noise sources in low signal to noise ratio conditions. The technology will be discussed and results from measurements utilizing conformally mounted acoustic sensors on moving ground vehicles will be shown.

Why a "Women in Combat Symposium"?

INTRODUCTION Women have served as combatants in the U.S. Armed Forces since the Revolutionary War, when they avoided being detected as females by disguising their appearance and changing their names. Likewise, hundreds of women presented themselves as men to fight in the Civil War. More than 12,000 women enlisted in the U.S. Navy and Marine Corps during World War I, and some 400 died. Approximately 350,000 women served in the U.S. Armed Forces in World War II, assigned to every theater of combat, many in positions that had been newly created to meet emerging military scientific and technological needs. Some women were taken prisoners of war, some earned the highest honors, and many died in service to their country. However, women (other than nurses) were only permitted to serve in temporary, emergency capacities; they were then discharged without benefits. The military changed after World War II, when General Dwight Eisenhower and other military leaders supported integration of women as regular service members. General Eisenhower told Congress that although he had originally opposed women’s military service (“I was violently against it.”), “Every phase of the record they compiled during the war convinced me of the error of my first reaction.” Interestingly, Eisenhower also believed that few women would remain members long enough to earn retirement benefits. He believed that “after an enlistment or 2 enlistments they will ordinarily – and thank God – they will get married.” Today, women comprise more than 200,000 members (about 15%) of the U.S. active duty military. As of 2014, 2 million of the nation’s military veterans were women, approximately one-third of whom were enrolled in Veterans Health Administration health care. In 1948, President Harry S. Truman signed the Women’s Armed Services Integration Act, officially allowing women to serve as full and permanent members of the Army, Navy, Marine Corps, and Air Force. However, the law capped women’s total military membership at 2%. It also limited promotions, prohibited service in combat positions, and allowed for involuntary discharge because of pregnancy or parenthood. Despite marked sociocultural changes and legal efforts to expand women’s access to military service opportunities, these conditions applied to female members of the U.S. military until 1991, when Congress modified exclusions of women from Navy and Marine Corps assignments and repealed prohibitions that had prevented women being assigned to combat aircraft. In 1994, the Department of Defense (DoD) adopted the Direct Ground Combat Definition and Assignment Rule, which specifically excluded women from assignments to or co-location with units or organizations whose primary mission was to engage in direct combat on the ground. This policy prevented women from serving in infantry, artillery, armor, combat engineer, and special operation units below the level of brigade. However, this was difficult to apply in the Afghanistan and Iraq wars, where enemy tactics obscured the traditional distinction between combat and noncombat environments and where, to achieve mission critical objectives, female military members were instead “attached” (not assigned) to combat units. Whereas among post-1990 female veterans 24% report having been exposed to combat, a 2009 study by the Defense Advisory Committee on Women in the Services found that most military women deployed to Afghanistan and Iraq were involved in combat functions and/or exposed to hostile fire. In January 2013, in response to recommendations of the Joint Chiefs of Staff (JCS), the Secretary of Defense rescinded the ground combat exclusion rule. This action opened the door for women to serve in more than 14,000 additional occupations and assignments involving exposure to direct ground combat. The JCS directed the Services to develop integration plans—with full implementation to occur no later than January 1, 2016 (unless SECDEF approved an exception to keep certain positions closed)—in keeping with JCS guidelines and objectives as follows:

Hostile fire detection using a bio-inspired mobile acoustic sensor network

Hostile Fire Detection (HFD) sensors play an increasing role in combating asymmetric threats in both military and civilian operations. Bio-inspired advances in acoustic sensor technology have enabled small aperture arrays to localize and identify target sounds on baselines as small as 7.5 cm, making them practical for body worn and mobile applications such as UAVs. The unique approach to acoustic processing reduces acoustic information through a neural transform to key features that allow segregation of multiple targets using spectro-temporal cues creating auditory objects. The sparse representation of targets as auditory objects enables fast computationally efficient localization, identification, and tracking of several acoustic targets nearly simultaneously. The sparse representation is also ideal for information fusion among sensors over limited bandwidth networks for enhanced performance in challenging environments. Through a collaborative effort between Army research groups, the University of California Santa Barbara, and BioMimetic Systems, a prototype acoustic sensor network using biologically inspired sensors and network synchronization for a mobile HFD application has been developed. The network employs body worn PinPoint™ HFD sensors interfaced with smartphones (Android) running net-centric fusion algorithms. The network will be discussed in terms of the biologically inspired components, information fusion, as well as results from preliminary field tests.

Military sexual assault, gender, and PTSD treatment outcomes of U.S. Veterans.

This study examined whether gender and military sexual assault (MSA) were associated with psychiatric severity differences at initiation of treatment for posttraumatic stress disorder (PTSD) and whether MSA and gender predicted psychiatric treatment outcomes. Male (n = 726) and female (n = 111) patients were recruited from 7 U.S. Department of Veterans Affairs (VA) PTSD specialty intensive treatment programs and completed an intake survey; 69% (n = 574) of the participants completed a 4-month postdischarge follow-up survey. Measures included current PTSD and depressive symptoms, aggressive/violent behaviors, alcohol and drug use severity, and quality of life. Multilevel multivariate regression analyses were conducted to examine the main and interaction effects of gender and MSA on psychiatric treatment outcomes at 4-month follow-up, including demographics, baseline severity, hostile fire, and treatment length of stay. Baseline PTSD severity did not differ by gender or MSA status, but women had more severe depressive symptoms (d = 0.40) and less aggressive/violent symptoms (d = -0.46) than men. Gender, MSA status, and the interaction between gender and MSA did not predict treatment outcomes as hypothesized. Male and female veterans with and without MSA responded equally well to treatment in VA PTSD intensive treatment programs.

Death does not become her: An examination of the public construction of female American soldiers as liminal figures

AbstractSince the invasions of Afghanistan and Iraq, over 150 female American military personnel have been killed, over 70 following hostile fire. Given Western society’s long-standing practice of reserving the conduct of collective violence to men, these very public deaths are difficult to encompass within the normative and ideological structures of the contemporary American political system. This study examines the ways in which the public duty to commemorate the heroism of soldiers – and the private desire to accurately remember daughters and wives – poses a significant challenge to coherent discursive representation. In doing so, the study employs hermeneutical interpretation to analyse public representations of female soldiers and their relation to death in US popular culture. These representations are examined via Judith Butler’s concept of grievability – the possibility of receiving recognition as a worthy life within the existing social imaginary. It is argued that female soldiers are grievable as both ‘good soldiers’ and ‘good women’, but not as ‘good female soldiers’. The unified subject position of ‘good female soldier’ is liminal, and thus rendered socially and politically unintelligible. The article concludes with an analysis of the implications of this liminality for collective mourning and the possibility of closure after trauma.

Wise Latinas

Wise Latinas José Esteban Muñoz1 (bio) US Supreme Court Justice Sonia Sotomayor’s nomination to the court in May of 2009 was met with great skepticism by the North American Right. When Republicans went through her public record, they came across a speech she had given at a few universities. Sotomayor’s and President Barack Obama’s enemies had attached themselves to the quote “I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn’t lived that life.”2 Republicans decried this quotation as an example of reverse racism. Their objection, it would seem, had much to do with the idea that a jurist who did not claim universality in the fashion in which white men could was an invalid adjudicator. I contend the sensationalist ire that the quote generated was in no small part due to her use of the term “wise Latina.” It would seem that the term “Latina” and its linkage to a word like “wise,” which is usually associated with more so-called universal subjects, was precisely the site of provocation for her conservative enemies. We are left to conclude that “wise” is a word reserved for subjects who claim a more objectivist mode of knowledge production and knowing. This essay focuses on what I would like to describe as the “otherwiseness” of Brownness. By otherwiseness, I mean to render the production and performance of knowledge that does not conform to the mimetic coordinates assigned to both the designations wise and other. I want to sketch another, more subterranean route to the production of knowledge. To do this, I cast an odd Puerto Rican predecessor to Justice Sotomayor: underground screen legend Mario Montez. This essay mediates upon Montez’s embodied production and performance of knowledge during select moments during his work with Andy Warhol and Jack Smith. I turn to Montez as an important and indexical moment that allows us to imagine a brown otherwise. The cinematic/performance moments I [End Page 249] consider display Montez’s performance of an affective particularity that displaces much of the coercive mimesis that structures North American understandings of Latino particularity. This essay draws a zigzagging line between Montez and Sotomayor and contemporary performance artist Nao Bustamante for the purpose of a brown mode of knowledge production and knowing-beyond-knowing, otherwiseness, which gives us a richer account of feeling and being brown in America. I will narrate the parallel tales of Montez and Sotomayor’s star-turn performances, especially the staging of both of their big auditions for careermaking cameras, as well as the way in which Bustamante, like Montez and Sotomayor, found affective and other immaterial resources so as to stand tall in the face of hostile fire. The linkage between feeling brown and being brown is crucial to the larger sequence of writings that this essay belongs to. No simple idea of Latino ontology makes any sense unless it is linked to a phenomenological field. We often know latinidad, or what I will alternatively call brownness, through its affective contours, which is to say the set of collective and often contagious responses to one’s historical and emotional situation. This relay of responses is once again knowable to us as a kind of affective performativity, which is to say a kind of feeling which is a mode of doing. Certain collectivities, like those that provisionally cohere under the sign brownness, share historical trajectories of negotiating particular sets of material obstacles within the social, which include, but are not limited to, uneven distribution of resources; systematic race-, nation-, and language-based bias; unjust and phobic immigration policies; and a general tendency to be scapegoated during a nation-state’s moments of economic or cultural instability. Thus, I am interested in a mode of affective particularity that I am describing as brownness, and this focus leads me to the project of describing particular performances of brown feelings that produce knowledge about singularities and pluralities that do not conform to anticipatable notions of reason. But these alternative and often-subterranean paths to knowledge production and reception are, I want...

Projectile detection using quasi-electrostatic field sensor array

Abstract Detection, localization, and ranging of the hostile fire source are very important for military and law enforcement operations. In this work authors explore use of quasi-electrostatic field created by a moving, charged projectile for the projectile detection. This paper describes development of a novel and inexpensive sensor network for detecting the quasi-electrostatic field of a charged bullet. The principle method used to sense the quasi-electrostatic field was based on a novel sensor utilizing voltage-controlled variable capacitance. A wired network was used to propagate the measurements to a central data acquisition unit. Several missile localization algorithms were explored to process the data from the sensor array making sure that all variables, including signal latency, would not affect the accuracy of the results. The results received and processed by the system report the passing objects coordinated in relation to the designated central location.

Disability among US Army Veterans vaccinated against anthrax

ContextTo protect troops against the use of anthrax as a biological weapon, the US Department of Defense began an anthrax vaccination program in 1998. 14 years after the inception of the vaccination program, there is no evidence suggesting vaccination against anthrax carries long-term health risks for Active Duty Soldiers. ObjectiveTo investigate the association between Anthrax Vaccine Adsorbed (AVA) received while on Active Duty and subsequent disability determined by the Veterans Benefits Administration. Design, setting and participantsCase–control study nested in the cohort of all Active Duty personnel known to have separated from the US Army between December 1, 1997 and December 31, 2005. Cases were ≥10% disabled, determined either by the Army prior to separation (N=5846) or by the Veterans Benefits Administration (VBA) after separation (N=148,934). Controls (N=937,705) separated from the Army without disability, and were not receiving pensions from the VBA as of April 2007. Data were from the Total Army Injury and Health Outcomes Database and the VBA Compensation and Pension and Benefits database. Main outcomesDisability status (yes/no); for primary disability, percent disabled (≥10%, 20%, >20%) and type of disability. ResultsVaccination against anthrax was four times more likely among disabled Veterans with hostile fire pay records (HFP, a surrogate for deployment). Vaccinated Soldiers with HFP had lower odds of disability separation from the Army 0.89 (0.80, 0.98); there was no association between vaccine and receiving Army disability benefits among those without HFP (OR=1.05, CI: 0.96, 1.14). Vaccination was negatively associated with receiving VA disability benefits for those with HFP (OR=0.66, CI: 0.65, 0.67), but there was little or no association between vaccine and receipt of VA disability benefits for those without HFP (OR=0.95, CI: 0.93, 0.97). ConclusionsRisk of disability separation from the Army and receipt of disability compensation from the VA were not increased in association with prior exposure to AVA. This study provides evidence that vaccination against anthrax is not associated with long term disability.

Did the Panamanian Defense Forces conduct infiltration operations at the Arraijan Tank Farm in 1988?

This article reviews the circumstances surrounding a relatively obscure and almost forgotten US Marine Corps and Army security enhancement operation undertaken in Panama that commenced in early April of 1988. Marines were sent to Panama to protect oil and ammunition storage facilities from potential saboteurs. By April 1989 they had reported sighting armed, uniformed intruders on at least 43 occasions and receiving gunfire or discharging their own weapons during 16 incidents. Yet despite the repeated barrages of small arms fire over the course of a year, they failed to recover enemy ammunition, bodies or body parts and their own equipment and positions displayed no signs of suffering from hostile fire. This article analyzes the events from the point of view of a veteran of the operation and highlights the role that psychological operations may have played in generating the situation.

Review

140 The Michigan Historical Review Richard Paul Liblong. Answering the Call to Duty: Saving Custer, Heroism at Gettysburg, POWs and other Stories of Michigan’s Small Town Soldiers in the Civil War. Traverse City, Mich.: Arbutus Press, 2011. Pp. 192. Illustrations. Index. Photographs. Sources. Paper, $17.95. Though today’s Michigan is quite different from the predominantly rural society that confronted the Civil War in 1861, the notion of community remains relevant. Sending 90,000 of Michigan’s sons (and a few daughters) off to fight for Union and liberty required a multitude of small towns, villages, and farms all across both peninsulas to endure steep sacrifices. Soldiers from these communities volunteered to risk their lives and forsake the security of home; while those who were left behind coped with major disruptions to the everyday social fabric and an uncertain future. Rick Liblong’s paean to his Michigan hometown seeks to preserve rural stories of those who answered the call to duty on behalf of their country. Their service deserves the remembrance. Of the book’s eight chapters, the first five set the stage by discussing Lapeer County, the town of Almont, and the broader context of the Civil War, the bloodiest conflict in the nation’s history. The final two chapters center on the war memorial erected at the town’s main intersection in 1865—one of the earliest in Michigan, if not the nation— and life in Almont once the victors came home. Sandwiched between is the great substance of the work, a lengthy chapter in which Liblong recounts some two dozen memorable stories of individual soldiers. The book, then, is largely anecdotal. We learn of the five Austin brothers from St. Clair, including ten-year-old George, who served in an artillery unit as a drummer boy. Levi Clark was a 38-year-old farmer from Almont who enlisted late (1864) and participated in both the siege of Atlanta and Sherman’s renowned March to the Sea. In recounting a long-forgotten act of heroism by his own great-grandfather, Norvell Churchill, Liblong proves how one individual’s actions can change the course of history. Near the raging battle of Gettysburg, Churchill’s cavalry unit went into action under its new general, George Armstrong Custer, at the Pennsylvania hamlet of Hunterstown. Custer faced capture or death when his mount went down in front of enemy lines. The Almont lad bravely rode into hostile fire, hoisted his commander aboard his horse, and raced back to safety. William Hamilton, who was a teacher, was less fortunate. He spent 17 months in Confederate prisons, surviving despite the odds and returning home, where he later became a physician and one of Almont’s leading citizens. Book Reviews 141 This eminently readable effort by first-time author Liblong contributes to our knowledge of Michigan’s participation in America’s largest crisis. The key role played by Michiganders in preserving the Union deserves a fuller telling and a larger audience. Answering the Call to Duty shows how history is frequently comprised of inspiring accounts from small-town America that enrich understanding and increase appreciation for our rural heritage. Jack Dempsey, President Michigan Historical Commission Joseph M. Lubig. Maltese in Michigan. “Discovering the Peoples of Michigan” series. Lansing: Michigan State University Press, 2011. Pp. 100. Appendices. For further reference. Illustrations. Index. Notes. Paper, $12.95. This booklet is the latest disappointing publication in the “Discovering the Peoples of Michigan” series. At its core is an illustrated 28-page essay (32 pages minus the blank pages numbered 18, 28, 34, and 38), which can be summarized briefly as follows: Attracted by jobs in the automobile industry, a wave of 5,000 Maltese came to the Detroit area in the 1910s and 1920s. This made Detroit home to the largest Maltese community in the United States. We read that these were hardworking people who migrated as families. This latter claim contrasts, however, with a statement on page 37 that the gender imbalance of Maltese in America in the 1920s was 1,000 (yes, 1,000) women for every 38 men! If the statistic is genuine, I imagine historians of gender would be fascinated to hear more...

Uncooled infrared sensor technology for hostile fire indication systems

An evolving combat arena poses an ever-growing hostile fire threat for various ground and airborne targets. Protecting both static posts and moving military platforms against these threats require high performance and affordable solutions, favoring uncooled sensing alert technologies. By analyzing accumulated target and clutter data using new algorithmic and hardware building blocks we establish improved hostile fire indication system configurations. The paper will review new system demonstrations harnessing uncooled IR sensors technology alongside empirical field testing results.

Cytoplasmic signaling in the control of mitochondrial uproar?

The concept of a pre-emptive strike as a good means to prevent greater harm may be frequently over-stressed in daily life. However, biological systems in a homeostatic balance are prepared to withstand a certain degree of hostile fire by rather passive means. This also applies to the maintenance of cell survival, where a plethora of protective proteins provide safeguard against erroneous activation of death pathways. Apart from these mechanisms active processes are also essential for the maintenance of cellular homeostasis, commonly referred to as survival signaling. Frequently their targets may be mitochondrial, assuring organelle integrity, which is essential for continued energy production and survival. Transient or permanent failures in these cellular defense strategies result in pathophysiological conditions, which manifest themselves e.g. as cancer or ischemia/reperfusion-associated organ damage.

Commentary: Women in combat and the risk of post-traumatic stress disorder and depression

Studies among civilian populations have consistently shown that when compared with men, women have significantly higher prevalence rates of depression and anxiety disorders, including post-traumatic stress disorder (PTSD). Studies of general military populations in garrison have paralleled findings from civilian studies. Research on the gender differences associated with military deployment, such as Vietnam, Persian Gulf War, or peacekeeping operations, has found inconsistent results. These studies are not representative of current extended combat deployments in Iraq or Afghanistan, war zones that lack traditional front lines and in which women are serving in roles that put them at greater risk than in the past. Although women are excluded from serving in direct combat specialties, such as infantry or armour, and are therefore not at the same risk as male soldiers, they do serve in a variety of support positions where they travel outside military bases, work alongside combat soldiers, come under direct fire and may become casualties. These positions include military police, transportation, intelligence, pilots, medics, mechanics, civil affairs and other roles. Among the 3004 US fatalities from Iraq reported through 31 December 2006, 66 (2.2%) were women; among 127 UK fatalities, 3 (2.4%) were women. About two-thirds of these deaths involved hostile fire. In contrast, only one woman was reported to have died by hostile fire in Vietnam and five in the Persian Gulf War. An important unanswered question is whether there are gender differences in the risk of PTSD and other mental health problems among men and women exposed to similar levels of combat. The article by Dr Rona and colleagues is notable for being one of the first studies of gender differences in mental health concerns associated with deployment to the Iraq combat theatre. This study paves the way for future efforts to understand gender differences in the mental health impact of operations in Iraq and Afghanistan. The article reports a number of different findings among veterans of two wars and era controls that includes a trend analysis of changes in the health of UK military veterans between 1997 and 2005 in addition to the gender comparisons. The trend analysis is difficult to interpret due to the crosssectional design, lack of uniformity in the survey instruments (especially for the alcohol measure), demographic differences between the samples, differences in the prevalence of combat experiences and markedly different time frames for surveying following the return from deployment. Within the context of this larger effort, however, there are important comparisons of the prevalence of mental health concerns by gender for each cross-sectional deployed sample. Among the deployed Iraq War study group in the Rona et al. study, 26.7% of women compared with 19.8% of men reported high levels of psychological distress on the General Health Questionnaire (GHQ), a measure made up of questions pertaining mostly to depression. However, this difference in prevalence between men and women is considerably smaller than the differences found in most studies of civilian and non-deployed military populations. In terms of post-traumatic stress symptoms among Iraq War veterans, most notable was the lack of gender differences, which contrasts with the marked gender differences reported in many studies on PTSD in both civilian and military populations. In the study by Rona et al., 8.4% of women and 7.1% of men met the criteria for post-traumatic stress reaction and a smaller percentage met full criteria for PTSD. This finding suggests that combat deployment to Iraq is not associated with a higher risk of mental health problems among female compared with male service members, at least during the time frame that was measured, relatively proximal to homecoming. Some additional evidence from the United States supports the findings by Rona and colleagues regarding the minimal gender differences in mental health outcomes. All US troops receive a brief mental health assessment for depressive symptoms, posttraumatic stress symptoms, and concerns about family and relationship functioning when they return from deployment. Among the first 222 620 Army and Marine service members (10.6% of whom were women) who completed this assessment after returning from Iraq, 24% of the women reported some sort of mental health concern compared with 19% of the men, prevalences remarkably similar to the GHQ measures seen among UK–Iraq War service members. A more detailed survey was conducted among a sample of 2064 US soldiers (including 288 females) from infantry and combat support units during the middle of a year-long deployment to Iraq or Kuwait (August–October 2004). Among this sample, 13% of the male soldiers and 12% of the female y To accompany the article by Rona RJ, Fear NT, Hull L, Wessely S. ‘‘Women in novel occupational roles: mental health trends in the UK armed forces.’’

Tactical Combat Casualty Care in the Assault on Punta Paitilla Airfield

Casualties incurred during the assault on Punta Paitilla Airfield during Operation Just Cause were evaluated through reviews of records and interviews with the participants. There were eight initial casualties. One-half of all subsequent casualties were wounded trying to move to these men while still under effective hostile fire. Consistent with other studies, the most common cause of death was internal hemorrhage; the second most common was catastrophic brain injury. Rapid control of external exsanguination was the technique most likely to prevent death. Tourniquets were applied to three lower extremities for two casualties, without sequelae.

Assessing possible exposures of ground troops to Agent Orange during the Vietnam War: the use of contemporary military records.

Assessing possible exposures of ground troops to Agent Orange during the Vietnam War: the use of contemporary military records.