Military Medics Research Articles

Gamification in the Design of Virtual Patients for Swedish Military Medics to Support Trauma Training: Interaction Analysis and Semistructured Interview Study.

This study explores gamification in the design of virtual patients (VPs) to enhance the training of Swedish military medics in trauma care. The challenges related to prehospital trauma care faced on the battlefield require tailored educational tools that support military medics' education and training. The aim of the study is to investigate how to design VPs with game elements for Swedish military medics to support learning in military trauma care. By understanding the reasoning and perceptions of military medics when interacting with VPs, this study aims to provide insights and recommendations for designing VPs with game elements that are specifically tailored to their needs. The study involved 14 Swedish military medics of the Home Guard-National Security Forces participating in a tactical combat care course. Participants interacted with 3 different VP cases designed to simulate military trauma scenarios. Data were collected through think-aloud sessions and semistructured interviews. The data were analyzed using interaction analysis, structured by the unawareness, problem identification, explanation, and alternative strategies or solutions (uPEA) framework, and reflexive thematic analysis to explore participants' reasoning processes and perceptions and identify possible game elements to inform the VP design. Mapping the military medics' reasoning to the uPEA framework revealed that study participants became more creative after making a mistake followed by feedback and after receiving a prompt to make a new decision. The thematic analysis revealed 6 themes: motivation, "keep on trying"; agency in interaction with VPs; realistic tactical experience; confidence, "I know that the knowledge I have works"; social influence on motivation; and personalized learning. Participants suggested that game elements such as scoring; badges; virtual goods; progress bars; performance tables; content unlocking; hints; challenge; control; imposed choice; narrative; avatars; sensation; randomness; difficulty adapting; competition; leaderboards; social pressure; progression; and renovation can promote engagement, motivation, and support confidence in decision-making. Gamification in the design of VPs represents a promising approach to military medical training, offering a platform for medics to practice medical and tactical decision-making in a risk-free environment. The insights gained by the study may encourage designing VPs with game elements, as well as including possibly wrong decisions, their consequences, and relevant feedback, that may support military medics' reflections and decision-making.

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save.

Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy-limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.

Діалог представників служб першої допомоги з травмованим комбатантом в умовах фронту: конструювання комунікативного тренінгу

Background. Communicative studies in professional discourse are highly effective when applied through practical workshops and training sessions. Modern education programs must incorporate a communicative component when developing professional training curricula. Researchers, drawing from over 70 years of focused efforts to alleviate the traumatic experiences of military conflicts, have compiled valuable materials from the works of linguists, psychotherapists, military medics, and chaplains. This compilation forms the basis for modeling professional dialogues with traumatized combatants and preventing misunderstandings of their emotional states. M e t h o d s. The analysis of global practices in training first aid services and combatants shows that military training should include exercises in using emotional language in first aid dialogues. The communicative training was developed using methods such as abstraction and logical generalization, surveys, reports, personal interviews, and testimonies from combat participants. Empirical data collection was ensured through observation and conversational analysis, based on the concepts of J. Heritage and S. Clayman. Results. Data from 14 combatants who are or were in the combat zone during the full-scale Russian invasion of Ukraine from March 2022 to March 2024, compared with data from previous research since 2015, show that accurate interpretation of emotional language is crucial for successful professional dialogue. By identifying the main types of emotions and states characteristic of combatants at the moment of trauma, the authors identified three types of first professional aid dialogues: algorithmization, refocusing, and facilitation. A communication training program was designed for these dialogues, including stages of analyzing the communicative situation and emotional signals experienced by the affected person, selecting language units, constructing responses, testing the dialogue, and reflecting on the process. Conclusions. The research presented in this article recommends organizing communicative training, particularly in military academies in Ukraine. The training plan provides an educational foundation for developing dialogical skills in military personnel, such as tracking and expressing emotional reactions, building trust, eliciting positive emotional responses from the interlocutor, and using linguistic techniques to establish emotional interaction with traumatized combatants and encourage their participation in the dialogue.

Risks of psychological traumatization and stress adaption of medical staff working under war conditions (analytical literature review)

Medical and psychological consequences of war have a destructive impact on mental health during the hostilities and after their cessation and determine a wide variety of different psychogenic disorders in an individual who was in the territory of hostilities. The purpose of the work is to analyze and summarize scientific literature data on the issue of mental traumatization of the medical staff under the conditions of working during war conflicts. The article is concerned with the analytical literature review, the analysis of experience of studying features of psychoemotional state of the medical workers and people who were in the territory of hostilities, and delivering medical and psychological aid to them. The features of psychological responsiveness of the individuals who participated in war conflicts and possible consequences of mental health damage are described. Scientific data on mental state of medical staff working under the conditions of the war conflict are limited. Most studies are concerned with military personnel and civilians. During war conflicts, medical workers face with chronic stress factors and take their own personal risk that may lead to deterioration of mental health, including post-traumatic stress disorder. International studies have shown that, regardless of the specialty, doctors who are working in stress situations, including war, have an increased risk of depression compared to civil population in general due to high risk of burnout. The incidence of depression among doctors ranges from 11% to 47%. Military medics can suffer severe stress due to the increased risk of death or injuries of other people, and they are also directly or indirectly impacted by a common traumatic reality. The impact of injuries, deaths, sexual assaults, and personal threats jeopardize health of combat nurses who participate in military, huma­nitarian, and aid missions after natural disasters. As a result, they suffer from unfavorable mental consequences. Compassion fatigue, exhaustion, and post-traumatic stress disorder are common. The importance of medical and psychological aid aimed at decreasing stress and stabilizing psychoemotional state of the medical staff who are working under the conditions of war led to development of a large number of programs in various psychotherapeutic areas that have shown their high effectiveness.

Comparing Capabilities ofSimulation Modalities forTraining Combat Casualty Care: Perspectives ofCombat Medics.

Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics. To provide a more complete understanding of the relative merits and limitations of modalities, military combat medics (N = 33) were surveyed on the capabilities of simulation modalities during a 5-day technical experimentation event where they observed medical simulations from industry developers. The survey asked them to rate each of eleven modalities on each of seven attributes. To elicit additional context for the strengths, limitations, and unique considerations of using each modality, we also collected open-ended comments to provide further insight on when and how to use specific simulation modalities. Results showed differences among the simulation modalities by attribute. Cadavers, role play, moulage, and live tissue all received high ratings on two or more attributes. However, there was no modality that was rated uniformly superior to the others. Instead, modalities appear to have unique strengths and limitations depending on the training context and objectives. For example, cadavers were seen as highly realistic, but not very reusable. The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.

Military Nursing Evidence-Based Practice Summit: A Descriptive Analysis ofEBP Barriers andSolutions Within the Military Healthcare System.

Evidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit. A qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team. The study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes. The results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.

Real-Time Measurements ofOral Mucosal Carbon Dioxide (POMCO2) Reveals an Inverse Correlation With Blood Pressure ina Porcine Model ofCoagulopathic Junctional Hemorrhage.

Shock states that occur during, for example, profound hemorrhage can cause global tissue hypoperfusion leading to organ failure. There is an unmet need for a reliable marker of tissue perfusion during hemorrhage that can be followed longitudinally. Herein, we investigated whether longitudinal POMCO2 tracks changes in hemodynamics in a swine model of coagulopathic uncontrolled junctional hemorrhage. Female Yorkshire-crossbreed swine (n = 7, 68.1 ± 0.7 kg) were anesthetized and instrumented for continuous measurement of mean arterial pressure (MAP). Coagulopathy was induced by the exchange of 50 to 60% of blood volume with 6% Hetastarch over 30 minutes to target a hematocrit of <15%. A 4.5-mm arteriotomy was made in the right common femoral artery with 30 seconds of free bleeding. POMCO2 was continuously measured from baseline through hemodilution, hemorrhage, and a subsequent 3-h intensive care unit period. Rotational thromboelastometry and blood gases were measured. POMCO2 and MAP showed no significant changes during the hemodilution phase of the experiment, which produced coagulopathy evidenced by prolonged clot formation times. However, POMCO2 increased because of the uncontrolled hemorrhage by 11.3 ± 3.1 mmHg and was inversely correlated with the drop (17.9 ± 5.9 mmHg) in MAP (Y = -0.4122*X + 2.649, P = .02, r2 = 0.686). In contrast, lactate did not significantly correlate with the changes in MAP (P = .35) or POMCO2 (P = .37). Despite the logical appeal of measuring noninvasive tissue CO2 measurement as a surrogate for gastrointestinal perfusion, prior studies have only reported snapshots of this readout. The present investigation shows real-time longitudinal measurement of POMCO2 to confirm that MAP inversely correlates to POMCO2 in the face of coagulopathy. The simplicity of measuring POMCO2 in real time can provide an additional practical option for military or civilian medics to monitor trends in hypoperfusion during hemorrhagic shock.

Psychological Safety of Volunteers During the War

Aim. The article is aimed at determining the indicators of psychological safety inherent in volunteers with signs of emotional exhaustion in combat zones. Methods. The study included the following methods: a) testing: Emotional Exhaustion Questionnaire (EEQ), Psychological Safety of Individual Questionnaire; b)statistical analysis: methods of descriptive statistics (percentage, minimum, maximum, range, standard error, mean, standard deviation). The group of respondents included 48 people, who were involved in volunteer activities in the Kharkiv region of Ukraine from March 2022 up to November 2022. Results. It was determined that the largest subgroup in the general group of respondents were volunteers with a high level of emotional exhaustion (46%) – these are people who feel general tension and do not remember the last time they experienced positive emotions. Among all the indicators of psychological safety, the indicators of moral-communicative and internal comfort turned out to be the least developed. Conclusions. Volunteer groups need specially organized psychological help and support, just like military or military medics. The constant danger of the activity, the need to be in contact with different people, moral fatigue lead to rapid emotional exhaustion and can causehealth disorders or even cost the volunteer's life.

A prospective assessment of the time required to obtain one unit of fresh whole blood by civilian phlebotomists and Army laboratory technicians (68 K).

Resuscitation with blood products improves survival after major hemorrhage. Blood product administration at or near the point-of-injury (POI) amplifies this benefit. Size, weight, and cold-chain management challenges all limit the amount of blood medics can carry. Warm fresh whole blood (WFWB) transfusions from a pre-screened donor within the unit represent an alternative source of blood at the POI. We measured the time required for civilian and Army technicians performing phlebotomy frequently to obtain one unit of blood to serve as a goal metric for combat medics being trained in this skill. We gathered demographic and experience data along with proportion of first intravenous cannulation attempt success, time to blood flow initiated, and time to unit draw complete. We prospectively enrolled 12 civilian phlebotomy technicians and 10 Army laboratory technicians performing whole blood collections on 50 and 68 donors respectively. The mean time from setup to needle insertion was 3.7 min for civilians versus 4.2 min for Army technicians. The mean time from blood flowing to the bag being full was 10.7 min versus 8.4 min for civilians versus Army technicians respectively. The mean bag weights were 514 g versus 522 g. First-pass intravenous cannulation success was 96% versus 98% respectively. We found a high first intravenous cannulation attempt success among both the civilian and Army technicians. Medians times were <5 min to obtain venipuncture and <11 min to obtain one unit. These findings provide time-based benchmarks for potential use during transfusion training among military medics.

A kaolin/calcium incorporated shape memory and antimicrobial chitosan-dextran based cryogel as an efficient haemostatic dressing for uncontrolled hemorrhagic wounds

Increased mortalities associated with uncontrolled and excessive bleeding is still of paramount concern in the clinics, caregivers and military medics. Herein, we designed a shape memory cryogel based on chitosan (C) and functionalized-dextran (D), incorporated with Kaolin (K) and calcium (Ca2+) as haemostatic agents. The developed cryogel (CDKCa) exhibits a uniform interconnected porous architecture with profound fluid absorption ability, rapid blood clotting, stable clot formation and good antibacterial activity. The CDKCa elucidates significantly less clotting time (~30 s; in-vitro) and increased aggregation and activation of platelets/red blood cells in comparison to the control groups and commercial dressings (Axiostat and QuikClot). The developed CDKCa also significantly reduced the aPTT and PT values by ~58 % and 31 % respectively, leading to the activation of intrinsic and extrinsic coagulation cascades. The CDKCa cryogel displays enhanced mechanical stability, flexibility and a good shape memory, a property quintessential to cease uncontrolled bleeding in irregular and non-compressible wounds. Further, the Kaolin and Ca2+ incorporated shape memory CDKCa cryogel demonstrates a rapid blood coagulation and stable clot formation in different compressible and non-compressible rat liver and femur hemorrhagic models. In summary, the endorsed results of CDKCa suggest that the design, fabrication and excellent clotting ability may attribute to high haemostatic efficiency of CDKCa dressing and have a great potential to prevent uncontrollable hemorrhages.

Articulating pathways for a diverse nursing workforce in a community college

To meet local nursing workforce needs, increase diversity in nursing, and promote education and economic development for low-income students, the nursing department at Columbus State Community College has developed various educational pathways for registered nurses, practical nurses, paramedics, military medics, and nurse aides. In this article, a variety of educational pathways toward nursing and further education are described that nursing faculty may use to develop strategies to promote enrollment and diversity. Information on demographics, barriers, and outcomes is provided.

Mathematical model of mechanobiology of acute and repeated synaptic injury and systemic biomarker kinetics.

Blast induced Traumatic Brain Injury (bTBI) has become a signature casualty of military operations. Recently, military medics observed neurocognitive deficits in servicemen exposed to repeated low level blast (LLB) waves during military heavy weapons training. In spite of significant clinical and preclinical TBI research, current understanding of injury mechanisms and short- and long-term outcomes is limited. Mathematical models of bTBI biomechanics and mechanobiology of sensitive neuro-structures such as synapses may help in better understanding of injury mechanisms and in the development of improved diagnostics and neuroprotective strategies. In this work, we formulated a model of a single synaptic structure integrating the dynamics of the synaptic cell adhesion molecules (CAMs) with the deformation mechanics of the synaptic cleft. The model can resolve time scales ranging from milliseconds during the hyperacute phase of mechanical loading to minutes-hours acute/chronic phase of injury progression/repair. The model was used to simulate the synaptic injury responses caused by repeated blast loads. Our simulations demonstrated the importance of the number of exposures compared to the duration of recovery period between repeated loads on the synaptic injury responses. The paper recognizes current limitations of the model and identifies potential improvements.

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool.

Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.

The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: A comparative study in a live tissue porcine model with evaluation of a concise training program.

Prompt bleeding control in the prehospital phase is essential to improve survival from catastrophic junctional hemorrhage. This study aimed to compare the effectiveness and practicality of Foley catheter balloon tamponade (FCBT), Celox-A, and XSTAT for the treatment of catastrophic hemorrhage from penetrating groin injuries with a small skin defect in a live-tissue porcine model. In addition, this study aimed to determine whether a training program could train military personnel in application of these advanced bleeding control adjuncts. A standardized wound was created in 18 groins from 9 anesthetized swine. Eighteen military medics participated in the training program and performed a bleeding control procedure after randomization over the swine and test products and after transection of the femoral neurovascular bundle. Primary endpoints were bleeding control, time to bleeding control, rebleeding, blood loss, medic performance, and user product rating. No significant differences were found in vital signs and laboratory values between the groups. In the Celox-A group, 3/6 groins achieved hemorrhage control. This was 6/6 in the XSTAT and FCBT groups. XSTAT scored best on application time, time to obtain hemorrhage control, hemorrhage control score, and practicality. No significant differences were found between groups for rebleeding, amount of blood loss, and medic performance. Military medics had a significant higher preference for XSTAT over Celox-A. This was not significant for FCBT. All tested products proved effective in obtaining hemorrhage control. XSTAT has the highest effectivity and shortest application time for the treatment of catastrophic bleeding from nonpackable, penetrating junctional groin injuries with a small skin defect, compared with Celox-A and FCBT. XSTAT scored best on practicality. This study shows that our training curriculum can be used to train military medics with limited prior experience in the use of advanced bleeding control techniques for penetrating junctional groin injuries with small skin defect.

Telehealth for geriatric post-emergency department visits to promote age-friendly care.

To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age-Friendly Health Systems via the emergency department (ED) follow-up home visits supported by telehealth. Data sources were a pre-implementation site survey and pilot phase individual-level patient data from six US Department of Veterans Affairs (VA) EDs. A pre-implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high-risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow-up telephone, or home visits. During the follow-up visit, ICTs identified "what matters," performed geriatric screens aligned with Age-Friendly Health Systems, observed home safety risks, assisted with video telehealth check-ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May-October 2021. Site surveys showed none of the EDs had a formalized way of identifying the 4M "what matters." During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n=244) or geriatrician (n=3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow-up. A post-ED follow-up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

Military medics – holders of military orders

The article is devoted to brief characteristics of the military medical service leaders and their activities during the Great Patriotic War. All those were awarded Orders of Suvorov, Kutuzov, Alexander Nevsky, Bogdan Khmelnitsky, the highest military orders for the success in battlefi elds and enemy’s defeat.

Neurosurgery at Pearl Harbor: Ralph Cloward’s legacy

Ralph B. Cloward (1908-2000) was the sole neurosurgeon present during the Japanese attack on Pearl Harbor on December 7, 1941. Cloward operated on 42 patients in a span of 4 days during the attacks and was awarded a commendation signed by President Franklin D. Roosevelt in 1945 for his wartime efforts. During the attacks, he primarily treated depressed skull fractures and penetrating shrapnel wounds, but he also treated peripheral nerve and spine injuries in the aftermath. His techniques included innovative advancements such as tantalum cranioplasty plates, electromagnets for intracranial metallic fragment removal, and the application of sulfonamide antibiotic powder within cranial wounds, which had been introduced by military medics for gangrene prevention in 1939 and described for penetrating cranial wounds in 1940. Despite the severity of injuries encountered, only 2 soldiers died in the course of Cloward's interventions. As the sole neurosurgeon in the Pacific Theater until 1944, he remained in Honolulu through World War II's duration and gained immense operative experience through his wartime service. Here, the authors review the history of Cloward's remarkable efforts, techniques, injury patterns treated, and legacy.

CALLS FOR UKRAINIAN MILITARY SERVANTS: REASONS FOR NOMINATION

Resume. The article is devoted to the study of call names of Ukrainian servicemen, participants of the Russian-Ukrainian war, in particular the question of the motives for the nomination of these onyms. This issue is important and relevant, because its coverage allows not only to explain the mechanism of production of a new type of informal anthroponyms, which is very important, but also to clarify how the motives for the nomination call represent self-expression and identification of their bearers (soldiers, military medics, chaplains, volunteers), as well as other persons involved in the formation of call names. Studying the motives for the nomination of call signs, we considered the real motivation, which in the nonverbal aspect means the situation that precedes the appearance of the call sign, in the verbal - the text that served as the motive for creating informal naming. The purpose of our work is to study the motives for the nomination of Ukrainian conscripts. The object of analysis is the call names of Ukrainian servicemen involved in the armed conflict in eastern Ukraine. Subject - motives for the nomination of call names. We set ourselves the following tasks: to determine, where possible, the motives for the nomination of call signs; classify them by nature of origin; to find out how the motives for the nomination of call names represent the self-expression and identification of their bearers, as well as those persons involved in the creation of these onyms. The results of the study will find practical application in the study of onomasiology, word formation, onomastics, etc. in universities, in the development of special courses and writing manuals on the problems of the above disciplines. Based on the study of 720 male conscripts, the real motives for the creation of 242 onyms were clarified. 11 groups of motives used in the process of nomination of call-up soldiers-defenders have been identified and characterized: official anthroponyms; profession, occupation, position and title; denotation capture; features of character, attitude of the person to others and features of behavior; external characteristics of the person; life situation related to the person; ethnicity of the carrier; place of birth or residence of the person; nicknames of servicemen in peaceful life, etc. Conclusions. The study of the motives for the nomination of call signs gives us a certain idea of ​​the bearer, his worldview, shows the linguistic picture of the world in the social group of servicemen. Often the call signs contain an indication of additional information about the bearers of the name - place of residence, occupation, ethnicity, etc., emphasize the physical, psychological, intellectual qualities of man, preferences and habits.

The origin, evolution, and future of prolonged field care in the Canadian Special Operations Forces Command

LAY SUMMARY As a result of the unpredictable nature of warfare, military medics deployed on missions may be required to manage seriously ill or injured patients for longer than expected. Because this type of care is not typically the focus of a military medic’s training or mandate, core skills and knowledge gaps were, not surprisingly, identified. For this reason, specialized training was developed, and the term prolonged field care (PFC) was coined. PFC takes on concepts associated with traditional hospital care and translates them into austere military medical environments with limited resources, including supplies, equipment, and trained medical providers to manage critically ill or wounded patients. This training program helps medics maximize their ability to save lives and improve outcomes for those who are ill or injured. This article discusses how PFC originated both internationally and within the Canadian Special Operations Forces Command and core concepts and applications for future operations.