Military Trauma Research Articles

ANTIOXIDANT ENZYMES ACTIVITY IN EXPERIMENTAL ISCHEMIA-REPERFUSION INJURY

Background. Blood loss during civil and military limb trauma is the most common cause of preventable death. Complications due to the use of a hemostatic tourniquet are widely investigated nowadays. Therefore, the standards of the past have to be improved.
 Objective. The aim of the research is to study the reaction of the enzyme chain of the liver antioxidant system in the presence of modifications of ischemia-reperfusion injury (IRI).
 Methods. 210 white male-rats, aged 5-5.5 months, were used in the research. The dynamics of antioxidant enzymes activity catalase (Cat) and superoxide dismutase (SOD) in liver tissue in cases of modifications of ischemia-reperfusion injury (IRI) were studied. The period of investigation was in 24 hours, 3, 7, 14 days after the injury.
 Results. In cases of simulated IRI the catalase level mainly decreased at each period of the experiment. The peak of SOD activity was evidenced on the 1st, 3rd or 7th days after the experimental IRI according to the degree of trauma severity. Thus, IRI combined with severe blood loss and mechanical trauma caused the severest affection of the antioxidant system. Even a single application of hemostatic tourniquet caused similar wavelike reactions at different times.
 Conclusions. The development of IRI is accompanied by a significant depression of the liver antioxidant system. The most significant changes were evidenced in cases of IRI combined with blood loss and mechanical trauma, but even a single application of a tourniquet caused active response of the antioxidant enzymes.

Promotion of Cadaver-Based Military Trauma Education: Integration of Civilian and Military Trauma Systems.

For the past few decades, there has been an emphasis on encouraging the partnership of civilian and military trauma care systems which would allow military personnel to maintain competency in life-saving skills and gain experience prior to or in between deployments. Currently, there are only five primary military-civilian training centers in the United States. Thus, the majority of service members do not get the opportunity to train at these facilities prior to scheduled deployments. To bridge this gap, a joint military-civilian hands-on supplemental training program was established to allow deploying National Guard Combat Medics to practice life-saving techniques on human cadaver tissue. The purpose of this report is to provide the feedback survey from this pilot training session in hopes to expand and improve the curriculum and encourage partnerships between military and civilian trauma centers. Survey respondents include the 13 National Guard Combat Medic Specialists who attended the 6-hour voluntary training session. The survey asked qualitative and quantitative (using a 5-point Likert rating scale; 1 = insufficient/unacceptable/disagree; 5 = outstanding/exceeded expectations/strongly agree) questions regarding the structure of the session, likes and improvements about the classroom and cadaver lab portions, implementation into training, confidence in techniques before and after the session and overall rating of the session. This report has been reviewed and approved by the Institutional Review Board (IRB) at Rutgers University. Most attendees (12 of 13) agreed that the 6-hour total time length and division of classroom versus lab time was appropriate. Most attendees (12 of 13) agreed that this type of supplemental hands-on cadaver training should be a mandatory part of their medical training. The attendees' rated confidence in covered techniques was significantly increased from 3.77 ± 0.73 to 4.85 ± 0.38 (p < 0.01) before and after the session, respectively. The overall satisfaction rating of the session was 4.92 ± 0.28. This collaboration between military and civilian trauma care system was successful in giving National Guard combat medic specialists the opportunity to practice life-saving techniques on human tissue prior to deployment. This type of partnership can assist in maintaining readiness for trauma care and increasing the confidence of military pre-hospital providers in performing life-saving techniques.

Heterogeneity in Military Trauma Casualty Care.

Military combat casualty care is at the forefront of military medical readiness, but there is little data on current proficiency of deployed personnel. A previous study identified a potential performance gap in military trauma teams. This study aims to evaluate a subsequent team to determine if heterogeneity of teams exists and to determine if this level of efficiency persists or can be improved. Military trauma teams at the Role 3 hospital in Bagram, Afghanistan, were evaluated over the course of a single deployment between April and October 2018. Trauma teams were directly observed and performance of the ATLS primary trauma survey timed. These results were compared to previously published times from Kandahar and Bagram Role 3 sites from Oct 2016 to Apr 2017. Time to completion of the primary survey in 2018 was statistically faster than the times reported from the Role 3 sites from Oct 2016 to Apr 2017 (344.75 s vs. 482.8 s, p < 0.05). The greatest improvements of efficiency were in the time periods between assessing the airway and breathing, evaluating the patient's circulation, and completing of the primary survey. Trauma teams can vary significantly in their efficiency in evaluating trauma patients. Whether this is clinically significant is currently debatable, but it highlights a possible readiness gap for deploying military personnel and the heterogeneity of military combat casualty care.

Prevalence and structure of psychotic disorders in participants of military action

Background. Military psychological trauma is today a very widespread phenomenon, which is an actual and socially significant problem of modern domestic psychiatry. Many of its aspects remain not fully disclosed, in particular, the clinical features of psychotic disorders in combatants. This necessitates the development of modern diagnostic and therapeutic approaches to the optimization of treatment-diagnostic and social-rehabilitation assistance in this category of patients.&#x0D; Objective. Оn the basis of the analysis of literature data and own research to determine the prevalence and structure of psychotic disorders in participants in participants of military action.&#x0D; Materials and methods. The analysis of the data of scientific researches and official statistics of the Ministry of Health concerning the prevalence and structure of psychotic disorders in the participants of combat operations is carried out.&#x0D; Results. It was found high level of comorbidity of a martial psychic trauma with other mental illnesses – up to 75%. Psychotic signs most often appear in the clinic of chronic post-traumatic stress disorder and determine its more severe course, which can be compared with progressive forms of schizophrenia.&#x0D; Conclusions. Significant prevalence of psychotic symptoms in the event of a military traumatic trauma in combatants indicates the urgent need for further study of signs of high risk of psychosis, as well as their early detection in order to optimize treatment and diagnostic and socio-rehabilitation care for this category of patients.

Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

BackgroundPenetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a...

DNA methylation profiles are associated with complex regional pain syndrome after traumatic injury.

Factors contributing to development of complex regional pain syndrome (CRPS) are not fully understood. This study examined possible epigenetic mechanisms that may contribute to CRPS after traumatic injury. DNA methylation profiles were compared between individuals developing CRPS (n = 9) and those developing non-CRPS neuropathic pain (n = 38) after undergoing amputation following military trauma. Linear Models for Microarray (LIMMA) analyses revealed 48 differentially methylated cytosine-phosphate-guanine dinucleotide (CpG) sites between groups (unadjusted P's < 0.005), with the top gene COL11A1 meeting Bonferroni-adjusted P < 0.05. The second largest differential methylation was observed for the HLA-DRB6 gene, an immune-related gene linked previously to CRPS in a small gene expression study. For all but 7 of the significant CpG sites, the CRPS group was hypomethylated. Numerous functional Gene Ontology-Biological Process categories were significantly enriched (false discovery rate-adjusted q value <0.15), including multiple immune-related categories (eg, activation of immune response, immune system development, regulation of immune system processes, and antigen processing and presentation). Differentially methylated genes were more highly connected in human protein-protein networks than expected by chance (P < 0.05), supporting the biological relevance of the findings. Results were validated in an independent sample linking a DNA biobank with electronic health records (n = 126 CRPS phenotype, n = 19,768 non-CRPS chronic pain phenotype). Analyses using PrediXcan methodology indicated differences in the genetically determined component of gene expression in 7 of 48 genes identified in methylation analyses (P's < 0.02). Results suggest that immune- and inflammatory-related factors might confer risk of developing CRPS after traumatic injury. Validation findings demonstrate the potential of using electronic health records linked to DNA for genomic studies of CRPS.

Preliminary Report on a Spiritually-Based PTSD Intervention for Military Veterans.

Military veterans can experience spiritual/religious struggles such as weakening of beliefs, loss of meaning, increased guilt, difficulty forgiving, and moral challenges as a result of military trauma. While mainstream treatments (e.g., exposure therapy) have been shown to be effective for many, they often fail to address these issues adequately. This paper describes an 8-session spiritually-based group intervention designed to treat trauma-related spiritual wounds among military veterans. A program evaluation conducted with 24 veterans revealed significant reductions in PTSD symptoms, spiritual injury, and negative religious coping from pretest to posttest. The findings support the need for additional PTSD treatment approaches.

Surgical help for the wounded persons, suffering combat abdominal injuries during the military conflict on the East of the Ukraine, at the stages of medical evacuation of the medical support of the second level

Objective. To determine the ways for the results improvement in the surgical help delivery to the wounded persons, suffering military abdominal trauma (MAT), оbtained during military conflict on the East of Ukraine.&#x0D; Маterials and methods. Analysis of surgical help to 727 wounded persons, suffering MAT, оbtained during combat conflict on the East of the Ukraine, on the medical evacuation stages (MES) of the second level for delivery of medical help was conducted. The wounded persons were divided into two groups. Tо the Group I 387 wounded persons were included, to whom surgical help was delivered in two first periods of the combat conflict during the biggest intensity of the military actions; tо the Group II - 340 wounded persons, to whom surgical help was delivered in the third period, which was characterized by lowering of the combat actions intensity, оptimization of the treatment-evacuation support (TES) system, systemic application of the scale proposed for estimation of the trauma severity (AdTS Admission trauma score), FAST-protocol (Focused assessment with sonography or trauma) and tactics of DCS (Damage Control Surgery).&#x0D; Results. The postoperative morbidity rate in the wounded persons of the Group II, comparing with the Group 1, have reduced from 5.2 tо 0.7%, аnd mortality - from 6.6 tо 4.4%.&#x0D; Conclusion. Application of the scale proposed for the trauma severity estimation AdTS, FAST-protocol and tactics of DCS on background of optimization of the TES system have leaded to improvement of the results in the surgical help delivery to the wounded persons, suffering MAT on the MES of the second level in delivery of medical help in conditions of the combat conflict on the East of the Ukraine.

Clinical implementation of the Humacyte human acellular vessel: Implications for military and civilian trauma care.

The incidence of wartime vascular injury has increased and is a leading cause of mortality and morbidity. While ligation remains an option, current resuscitation and damage control techniques have resulted in vascular repair being pursued in more than half of wartime injuries. Options for vascular reconstruction are currently limited to autologous vein or synthetic conduits, choices which have not changed in decades, both of which have problems. Autologous vein is preferable but requires time to harvest and may not be available. Synthetic grafts are poorly resistant to infection and associated with thrombotic complications. Recognizing this capability gap, the US Combat Casualty Care Research Program has partnered with academia and industry to support the development and clinical introduction of a bioengineered human acellular vessel. This human acellular vessel has the potential to be an off-the-shelf conduit that is resistant to infection and incorporates well into native tissues. This report reviews the rationale of this military-civilian partnership in medical innovation and provides an update on the clinical use and ongoing study of this new vascular technology. LEVEL OF EVIDENCE: Therapeutic, level III.

Prehospital whole blood resuscitation prevents coagulopathy and improves acid–base status at hospital arrival in a nonhuman primate hemorrhagic shock model

Hemorrhage remains the primary cause of preventable death in civilian and military trauma. The Committee on Tactical Combat Casualty Care recommends prehospital (PH) resuscitation with whole blood (WB). However, 6% hetastarch in lactated electrolyte (HEX) and crystalloids are more commonly available and used for PH resuscitation in military and civilian environments, respectively. The mechanistic benefits of PH WB resuscitation have not been well studied and remain to be elucidated. The aim of this study was to evaluate the differences in simulated PH WB and HEX resuscitation, specifically with regards to coagulation, physiologic, and metabolic outcomes to better elucidate the mechanistic benefits of WB. In a randomized study, the physiologic, coagulation, and metabolic responses to simulated PH WB (n = 12) or HEX (n = 12) were evaluated in a nonhuman primate model of severe polytraumatic hemorrhagic shock. Notable findings included 1) equivalence of shock reversal between simulated PH WB and HEX treatment groups as determined by hemodynamics and base deficit and 2) prevention of coagulopathy at simulated hospital arrival with initial WB resuscitation as determined by viscoelastic and plasmatic coagulation assays. The major benefit of WB, as compared to HEX, in simulated PH resuscitation appears to be prevention of coagulopathy at hospital arrival. Both fluids effectively reversed shock in this model, implying that efficacious provision preload (cardiac output support and hence oxygen delivery) and coagulation proteins (prevention of coagulopathy) are mechanisms underlying WB's effectiveness in early resuscitation of hemorrhagic shock.

Art therapy for military service members with post-traumatic stress and traumatic brain injury: Three case reports highlighting trajectories of treatment and recovery

Advances in both military and medical technology have led to decreased mortality rates among military service personnel in the United States, yet have led to an increase in occurrences of traumatic brain injuries and post-traumatic stress disorder in military service personnel, often resulting in prolonged unresolved symptoms. The purpose of this article is to illustrate the implementation and effects of an art therapy program on military service personnel attending an outpatient military treatment facility. To this end, we present case reports of three military service personnel diagnosed with comorbid traumatic brain injury and post-traumatic stress and describe their participation in the art therapy program at Intrepid Spirit One, the National Intrepid Center of Excellence satellite site at Fort Belvoir Community Hospital. Through discussion of the therapist’s subjective observations, as well as the patients’ visual art productions and their personal verbal and written reflections on their experiences in art therapy and, eventually, on community art programs, this article highlights how art therapy was used to treat military trauma as part of a comprehensive integrative treatment program. The cases highlight how participation in a long-term, stage-based, structured art therapy program (through both group and individual sessions), enabled military service personnel to identify and articulate the complexity of their lingering trauma symptoms, fostering improvement in their communication with other treatment providers and loved ones, which, in turn, led to improvements in their overall quality of life.

Predictors of survival after emergency department thoracotomy in trauma patients with predominant thoracic injuries in Southern Israel: a retrospective survey.

Introduction: Emergency department thoracotomy (EDT), also termed “resuscitative thoracotomy”, is indicated in some cases of life-threatening isolated thoracic injury, or as a part of CPR (cardiopulmonary resuscitation) in multiple trauma patients, or in thoracic trauma patients with massive bleeding (such as intra-abdominal exsanguination or injury to the great vessels). There is a lack of information in the literature concerning predictors of survival after EDT in patients with predominant or isolated thoracic trauma.Patients and methods: The study was retrospective and single-center. We collected clinical and laboratory data from all civil and military trauma patients admitted to our emergency department (ED) with predominant thoracic injuries who underwent EDT at Soroka Medical Center. A total of 31 patients were included in the study.Results: Of the patients in the study group, 58% presented with penetrating thoracic injuries and 42% presented with blunt thoracic injuries. 13 patients (42%) survived the EDT procedure. The following parameters predicted survival after EDT: signs of life and the presence of sinus rhythm on admission to the ED; heart rate at the end of the EDT procedure; short duration of EDT; and total positive balance (fluid and blood products) after EDT. Patients who sustained penetrating stab wound injuries had a better immediate post-operative survival rate after EDT than those who sustained penetrating gunshot wounds or predominant blunt chest trauma (30.8% vs 11.1%; p-0.034). Six patients (19%) survived until discharge from the hospital: 3 with penetrating injuries and 3 with blunt thoracic injuries.Conclusion: In patients undergoing EDT after thoracic injury we found that the clinical status on admission to the ED, the duration of the EDT procedure and the heart rate at the end of procedure were predictors of survival after EDT. We demonstrated a higher survival rate after EDT in patients with predominant penetrating thoracic trauma.

Use of Combat Casualty Care Data to Assess the US Military Trauma System During the Afghanistan and Iraq Conflicts, 2001-2017

Although the Afghanistan and Iraq conflicts have the lowest US case-fatality rates in history, no comprehensive assessment of combat casualty care statistics, major interventions, or risk factors has been reported to date after 16 years of conflict. To analyze trends in overall combat casualty statistics, to assess aggregate measures of injury and interventions, and to simulate how mortality rates would have changed had the interventions not occurred. Retrospective analysis of all available aggregate and weighted individual administrative data compiled from Department of Defense databases on all 56 763 US military casualties injured in battle in Afghanistan and Iraq from October 1, 2001, through December 31, 2017. Casualty outcomes were compared with period-specific ratios of the use of tourniquets, blood transfusions, and transport to a surgical facility within 60 minutes. Main outcomes were casualty status (alive, killed in action [KIA], or died of wounds [DOW]) and the case-fatality rate (CFR). Regression, simulation, and decomposition analyses were used to assess associations between covariates, interventions, and individual casualty status; estimate casualty transitions (KIA to DOW, KIA to alive, and DOW to alive); and estimate the contribution of interventions to changes in CFR. In aggregate data for 56 763 casualties, CFR decreased in Afghanistan (20.0% to 8.6%) and Iraq (20.4% to 10.1%) from early stages to later stages of the conflicts. Survival for critically injured casualties (Injury Severity Score, 25-75 [critical]) increased from 2.2% to 39.9% in Afghanistan and from 8.9% to 32.9% in Iraq. Simulations using data from 23 699 individual casualties showed that without interventions assessed, CFR would likely have been higher in Afghanistan (15.6% estimated vs 8.6% observed) and Iraq (16.3% estimated vs 10.1% observed), equating to 3672 additional deaths (95% CI, 3209-4244 deaths), of which 1623 (44.2%) were associated with the interventions studied: 474 deaths (12.9%) (95% CI, 439-510) associated with the use of tourniquets, 873 (23.8%) (95% CI, 840-910) with blood transfusion, and 275 (7.5%) (95% CI, 259-292) with prehospital transport times. Our analysis suggests that increased use of tourniquets, blood transfusions, and more rapid prehospital transport were associated with 44.2% of total mortality reduction. More critically injured casualties reached surgical care, with increased survival, implying improvements in prehospital and hospital care.

Interpersonal Psychotherapy for PTSD: Treating Trauma without Exposure.

Interpersonal Psychotherapy (IPT) is a time-limited, diagnosis-targeted psychotherapy originally developed for the treatment of major depression. Research studies have repeatedly demonstrated its efficacy in treating mood disorders and other psychiatric disorders over the past forty years. As IPT is a life-event based treatment that focuses on improving interpersonal functioning, it seemed natural to adapt it for the treatment of posttraumatic stress disorder (PTSD), a life-event based illness that affects interpersonal functioning. Preliminary data suggest that IPT has equal efficacy in alleviating PTSD symptoms as Prolonged Exposure, the best tested exposure-based treatment. We describe the principles of IPT and its modifications for treating PTSD. A case illustration describes a patient with PTSD related to military trauma. The authors discuss their reluctance to integrate IPT for PTSD with other psychotherapeutic perspectives.

Objective model to facilitate designation of military–civilian partnership hospitals for sustainment of military trauma readiness

BackgroundA major dilemma of the military surgeon is the requirement for battlefield trauma expertise without regular exposure to a traumatically injured patient. To solve this problem, the military is partnering...

Efficacy of Trauma Surgery Technical Skills Training Courses

Because open surgical skills training for trauma is limited in clinical practice, trauma skills training courses were developed to fill this gap, The aim of this report is to find supporting evidence for efficacy of these courses. The questions addressed are: What courses are available and is there robust evidence of benefit? We performed a systematic review of the training course literature on open trauma surgery procedural skills courses for surgeons using Kirkpatrick's framework for evaluating complex educational interventions. Courses were identified using Pubmed, Google Scholar and other databases. The review was carried out at the University of Maryland, Baltimore with input from civilian and military trauma surgeons, all of whom have taught and/or developed trauma skills courses. We found 32 course reports that met search criteria, including 21 trauma-skills training courses. Courses were of variable duration, content, cost and scope. There were no prospective randomized clinical trials of course impact. Efficacy for most courses was with Kirkpatrick level 1 and 2 evidence of benefit by self-evaluations, and reporting small numbers of respondents. Few courses assessed skill retention with longitudinal data before and after training. Three courses, namely: Advanced Trauma Life Support (ATLS), Advanced Surgical Skills for Exposure in Trauma (ASSET) and Advanced Trauma Operative Management (ATOM) have Kirkpatrick's level 2-3 evidence for efficacy. Components of these 3 courses are included in several other courses, but many skills courses have little published evidence of training efficacy or skills retention durability. Large variations in course content, duration, didactics, operative models, resource requirements and cost suggest that standardization of content, duration, and development of metrics for open surgery skills would be beneficial, as would translation into improved trauma patient outcomes. Surgeons at all levels of training and experience should participate in these trauma skills courses, because these procedures are rarely performed in routine clinical practice. Faculty running courses without evidence of training benefit should be encouraged to study outcomes to show their course improves technical skills and subsequently patient outcomes. Obtaining Kirkpatrick's level 3 and 4 evidence for benefits of ASSET, ATOM, ATLS and for other existing courses should be a high priority.

Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided

BackgroundSince 2001, the French Armed Forces have sustained many casualties during the Global War on Terror; however, even today, there is no French Military trauma registry. Some French service members (SMs) were treated in US Military Medical Treatment Facilities (MTFs) and were recorded in the US Department of Defense Trauma Registry (DoDTR). Our objective was to conduct a descriptive analysis of the injuries sustained by French SMs reported in the DoDTR and subsequent care provided to them to assist in understanding the importance of building a French Military trauma registry.MethodsUsing DoDTR data collected from 2001 to 2017, a retrospective descriptive analysis was conducted. We identified 59 French SMs treated in US MTFs. The characteristics of the SMs’ demographics, injuries, care provided to them, and discharge outcomes were summarized.ResultsAmong the 59 French SMs identified, 46 (78%) sustained battle injuries (BIs) and 13 (22%) sustained nonbattle injuries (NBIs). There were 47 (80%) SMs injured in Afghanistan (Opération Pamir), while 12 (20%) were injured in Opération Chammal in Iraq and Syria. Explosives accounted for 52.5% of injuries, while 25.4% were due to gunshot wounds; all were BIs. The majority of reported injuries were penetrating (59.3%), most of which were BIs (71.7%). The mean Injury Severity Score for BIs was 12 (SD = 8.9) compared to 6 (SD = 1.7) for NBIs. Around half of SMs (n = 30; 51%) were injured in Afghanistan between the years 2008–2010. Among a total of 246 injuries sustained by 59 patients, extremities were the body part most prone to BIs followed by the head and face. Four SMs died after admission (6.8%).ConclusionsThe DoDTR provides extensive data on trauma injuries that can be used to inform injury prevention and clinical care. The majority of injuries sustained by French SMs were BIs, caused by explosives, and predominantly occurring to the extremities; these findings are similar to those of other studies conducted in combat zones. There is a need to establish a French Military trauma registry to improve the combat casualty care provided to French SMs, and its creation may benefit from the DoDTR model.

Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort

ObjectiveVascular injury is a leading cause of death and disability in military and civilian settings. Most wartime and an increasing amount of civilian vascular trauma arises from penetrating mechanisms of injury due to gunshot or explosion. The objective of this study was to provide a comprehensive examination of penetrating lower extremity arterial injury and to characterize long-term limb salvage and differences related to mechanisms of injury. MethodsThe military trauma registries of the United States and the United Kingdom were analyzed to identify service members who sustained penetrating lower limb arterial injury (2001-2014). Treatment and limb salvage data were studied and comparisons made of patients whose penetrating vascular trauma arose from explosion (group 1) vs gunshot (group 2). Standardized statistical testing was used, with Bonferroni corrections for multiple comparisons. ResultsThe cohort consisted of 568 combat casualties (mean age, 25.2 years) with 597 injuries (explosion, n = 416; gunshot, n = 181). Group 1 had higher Injury Severity Score (P < .05) and Mangled Extremity Severity Score (P < .0001), required more blood transfusion (P < .05), and had more tibial (P < .01) and popliteal (P < .05) arterial injuries; group 2 had more profunda femoris injuries (P < .05). Initial surgical management for the whole cohort included vein interposition graft (33%), ligation (31%), primary repair with or without patch angioplasty (16%), temporary vascular shunting (15%), and primary amputation (6%). No difference in patency of arterial reconstruction was found between group 1 and group 2, although group 1 had a higher incidence of primary (13% vs 2%; P < .05) and secondary (19% vs 9%; P < .05) amputation. Similarly, longer term freedom from amputation was lower for group 1 than for group 2 (68% vs 89% at 5.5 years; Cox hazard ratio, 0.30; P < .0001), as was physical functioning (36-Item Short Form Health Survey data; mean, 39.80 vs 43.20; P < .05). ConclusionsThe majority of wartime lower extremity arterial injuries result from an explosive mechanism that preferentially affects the tibial vasculature and results in poorer long-term limb salvage compared with those injured with firearms. The mortality associated with immediate limb salvage attempts is low, and delayed amputations occur weeks later, affording the patient involvement in the decision-making and rehabilitation planning. We recommend assertive attempts at vascular repair and limb salvage for service members injured by explosive and gunshot mechanisms.

Examining the impact of different types of military trauma on suicidality in women veterans

Suicide rates amongst women veterans are significantly higher than rates for their civilian counterparts. However, risk factors for suicide among women veterans remain unclear. The current study examined the impact of exposure to a number of military stressors (e.g., perceived life threat, killing in combat, military sexual trauma) on suicidal ideation (SI) in women veterans. A total of 403 women veterans responded to mailed self-report surveys, 383 (ages 24–70 years) returned fully completed surveys and were included in analyses, and 16% of those included endorsed current SI. Rates of endorsement for military stressors were as follows: 43% being wounded, 34% loss of someone close, 36% perceived life threat, 30% witnessing a killing or injury, 4% seeing injured or dead bodies, 4% killing in combat, 65% military sexual harassment, and 33% military sexual assault. A logistic regression analysis was conducted with all of the military stressors entered simultaneously to determine the effect on SI. Life threat and sexual harassment had the strongest associations with SI compared to other military stressors. These findings suggest that particular military stressors may play an especially important role in SI in women veterans. Implications and future research considerations are discussed.

Hemorrhage simulated by lower body negative pressure provokes an oxidative stress response in healthy young adults.

We characterize the systemic oxidative stress response in young, healthy human subjects with exposure to simulated hemorrhage via application of lower body negative pressure (LBNP). Prior work has demonstrated that LBNP and actual blood loss evoke similar hemodynamic and immune responses (i.e. white blood cell count), but it is unknown whether LBNP elicits oxidative stress resembling that produced by blood loss. We show that LBNP induces a 29% increase in F2-isoprostanes, a systemic marker of oxidative stress. The findings of this investigation may have important implications for the study of hemorrhage using LBNP, including future assessments of targeted interventions that may reduce oxidative stress, such as novel fluid resuscitation approaches.