Military Trauma Research Articles

The use of finite element models for backface deformation and body armour design: a systematic review

While injuries sustained from body armour backface deformation (BFD) have not been well-documented in military injury trauma registries, data from US law enforcement officers, animal tests and currently available data pertaining to military combatants has shown that BFD can not only cause minor injuries, but also result in serious trauma. However, the nature and severity of injuries sustained depends on a multitude of factors including the projectile type, the impact location and velocity, and the specific type of body armour worn. The difficulties involved in current measurement techniques for ballistic testing has led researchers to seek alternative techniques to evaluate the level of protection from body armour, such as the finite element (FE) method. In the current study, a systematic review of the open literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. The aim was to summarise the literature pertaining to the development and application of FE models to investigate body armour BFD and behind armour blunt trauma (BABT), and included FE models representing the projectile, clay-based mediums, ballistic gelatine and the human torso. Using the keywords ‘behind armour*’, ‘ballistic blunt trauma’, ‘BABT’, ‘backface signature’, ‘backface deformation’, ‘BFS’, ‘BFD’, ‘wound ballistic’, ‘ballistic impact testing’, ‘body armour’, ‘bullet proof vest’, ‘ballistic vest’, ‘Finite Element*’ and ‘FE’, an electronic database search of EBSCOhost, Google Scholar, ProQuest, Scopus, Standards, Web of Science and PubMed was conducted, and included peer-reviewed journal articles, review papers, research reports, conference papers, and MSc or PhD theses. While this research demonstrates the potential of FE analysis for recreating realistic blunt impact scenarios and enhancing the current understanding of BABT mechanisms, a common limitation in most studies is the lack of validation. Thus, in order to address this issue, it is proposed that injury predictions from FE models be correlated with trauma data from soldiers who have sustained BABT. Consequently, pressure and energy distributions within the organs can be used to interpret the effects of non-penetrating ballistic impacts on the human torso. Bridging the gap between simulation and real-world data is essential in order to validate FE models and enhance their utility in optimising body armour design and employing injury mitigation strategies.

Vascular Reconstruction and Limb Loss in Military Tibial Artery Injuries

Selective operative management of injuries to the tibial arteries is controversial, with the necessity of revascularization in the face of multiple tibial arteries debated. Tibial artery injuries are frequently encountered in military trauma, but revascularization practices and outcomes are poorly defined. We aimed to investigate associations between the number of injured vessels and reconstruction and limb loss rates in military casualties with tibial arterial trauma. A US military database of lower extremity vascular injuries from Iraq and Afghanistan (2004-2012) was queried for limbs sustaining at least 1 tibial artery injury. Injury, intervention characteristics, and limb outcomes were analyzed by the number of tibial arteries injured (1, T1; 2, T2; 3, T3). Two hundred twenty one limbs were included (194 T1, 22 T2, 5 T3). The proportions with concomitant venous, orthopedic, nerve, or proximal arterial injuries were similar between groups. Arterial reconstruction (versus ligation) was performed in 29% of T1, 63% of T2, and universally in T3 limbs (P<0.001). Arterial reconstruction was via vein graft (versus localized repair) in 62% of T1, 54% of T2, and 80% of T3 (P=0.59). T3 received greater blood transfusion volume (P=0.02), and fasciotomy was used universally (versus 34% T1 and 14% T2, P=0.05). Amputation rates were 23% for T1, 26% for T2, and 60% for T3 (P=0.16), and amputation was not significantly predicted by arterial ligation in T1 (P=0.08) or T2 (P=0.34) limbs. Limb infection was more common in T3 (80%) than in T1 (25%) or T2 (32%, P=0.02), but other limb complication rates were similar. In this series of military lower extremity injuries, an increasing number of tibial arteries injured was associated with the increasing use of arterial reconstruction. Limbs with all 3 tibial arteries injured had high rates of complex vascular reconstruction and eventual amputation. Limb loss was not predicted by arterial ligation in 1-vessel and 2-vessel injuries, suggesting that selective reconstruction in these cases is advisable.

A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma.

The aim of this study was to address and enhance our ability to study the clinical outcome of limb salvage (LS), a commonly referenced but ill-defined clinical care pathway, by developing a data-driven approach for the identification of LS cases using existing medical code data to identify characteristic diagnoses and procedures, and to use that information to describe a cohort of US Service members (SMs) for further study. Diagnosis code families and inpatient procedure codes were compiled and analyzed to identify medical codes that are disparately associated with a LS surrogate population of SMs who underwent secondary amputation within a broader cohort of 3390 SMs with lower extremity trauma (AIS > 1). Subsequently, the identified codes were used to define a cohort of all SMs who underwent lower extremity LS which was compared with the opinion of a panel of military trauma surgeons. The data-driven approach identified a population of n = 2018 SMs who underwent LS, representing 59.5% of the combat-related lower extremity (LE) trauma population. Validation analysis revealed 70% agreement between the data-driven approach and gold standard SME panel for the test cases studied. The Kappa statistic (κ = 0.55) indicates a moderate agreement between the data-driven approach and the expert opinion of the SME panel. The sensitivity and specificity were identified as 55.6% (expert range of 51.8-66.7%) and 87% (expert range of 73.9-91.3%), respectively. This approach for identifying LS cases can be utilized to enable future high-throughput retrospective analyses for studying both short- and long-term outcomes of this underserved patient population.

THE MAIN TYPES OF TRAUMATIC INJURIES OF THE CHEST AFTER A EXPLOSIVE INJURY ACCORDING TO X-RAY DATA

Abstract. Introduction. Еxplosive lesions are one of the most severe and specific types of injuries in the structure of military trauma. A special role in the diagnosis of traumatic injuries of the chest belongs to the X-ray method of research, as the most accessible and fastest.&#x0D; The purpose of the work is to clarify the types and frequency of traumatic injuries of the chest, received as a result of a mine-explosive injury according to х-ray data.&#x0D; Materials and methods. The work presents an analysis of the materials of own observations of radiological methods of examination of 32 victims with explosive injuries of the chest organs who were undergoing inpatient treatment at the SI «Institute of General and Urgent Surgery named after V. T. Zaitsev NAMS of Ukraine» in the period from 23.02.2022 to 17.05.2023. All patients (100 %) underwent a digital polyposition X-ray examination of the chest organs, computer tomography of the chest organs was performed in 18,7 % of patients.&#x0D; Research results. It was established that the main types of traumatic injuries of the chest after a explosive injury are rib fractures (93,8 %), hemopneumothorax (93,8 %), the presence of fragments of metal density in soft tissues, in the chest cavity, in the heart (87,5 %) and a wound channel in the lung parenchyma (23,3 %), as well as lung contusion (78,1 %).&#x0D; Conclusions. Еxplosive chest trauma in most cases is combined, which significantly aggravates the condition of the victims, therefore, it is necessary to start an X-ray examination of severe patients directly in the operating room or intensive care unit. The main types of traumatic injuries are rib fractures, hemopneumothorax, the presence of fragments of metal density in the chest cavity and a wound channel in the lung parenchyma, as well as lung contusion.

Game Elements in the Design of Simulations in Military Trauma Management Training: Protocol for a Systematic Review.

Military trauma teams are commonly operating in civilian hospitals during peacetime; in a war situation they must adjust their practices to the austere conditions. Simulations can replicate austere conditions to allow training in a safe environment that tolerates errors. Gamification, understood as the use of game elements to motivate and engage learners in nongame contexts, is gaining interest in medical education and military training. Applying game elements in the design of military trauma management simulations has the potential to provide learners with active learning opportunities and prepare them for providing medical services under austere conditions. Although gamification is known for its engaging and motivational benefits, there are controversies about its pedagogical value. The controversies can be attributed to the fact that various gamification strategies may consist of a different combination of game elements, leading to different outcomes. This systematic review aims to understand how game elements are used in the design of simulations in military trauma management training and their reported outcomes. We have designed a search strategy for the purpose of the review. Two researchers will independently assess the identified studies based on the defined inclusion and exclusion criteria. The selection process will be represented using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. The search will be repeated and updated as necessary prior to publication of the review. Two reviewers will independently extract and manage the data for each of the articles using a structured data extraction form. Any disagreement that arises between reviewers will be resolved through discussion, and a third review author will be consulted when needed. We are going to conduct a thematic synthesis of the extracted game element descriptions. The results are going to be presented in a diagrammatic or tabular form, alongside a narrative summary. The quality of the studies will be assessed. We implemented and tested the developed search strategy in May 2023. We retrieved 1168 study abstracts, which were reduced to 630 abstracts after deduplication. We have piloted the screening on 20% (126/630) of the identified abstracts in groups of 2 reviewers. Although gamification has the potential to motivate learners in various ways, there is a lack of understanding about specific game elements and how they can inform instructional design in different contexts. Our findings will increase the understanding of how game elements are used in the design of simulations in military trauma management training and, thus, contribute to more effective development of future simulations. DERR1-10.2196/45969.

Damage control resuscitation in adult trauma patients: What you need to know.

Death after injury is a worldwide epidemic. Hemorrhage as a cause of death represents the leading potentially preventable condition. Based on hard-won experience from the recent wars, and two decades of military and civilian research, damage-control resuscitation (DCR) is now widely used. This article will briefly describe the history of blood transfusion, outline "why we do DCR," and then discuss "how we do DCR." Modern DCR occurs both prehospital and in the hospital and has several main tenants. Currently, DCR focuses on the liberal use of temporary hemorrhage-control adjuncts, early use of whole blood or balanced blood product-based transfusions, mitigation of crystalloid use, hypotensive resuscitation to promote hemostasis and decrease coagulopathy, and correction of ongoing metabolic derangements, followed by rapid definitive hemorrhage control. These concepts have evolved from a series of lessons learned over time from both civilian and military trauma casualties, and DCR is now the standard of care in trauma resuscitation.

Lifelong Association of Disorders Related to Military Trauma with Subsequent Parkinson's Disease.

Trauma-related disorders such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are emerging as risk factors for Parkinson's disease (PD), but their association with development of PD and independence from comorbid disorders remains unknown. To examine TBI and PTSD related to early trauma in military veterans using a case-control study. PD was identified by International Classification of Diseases (ICD) code, recurrent PD-specific prescriptions, and availability of 5+ years of earlier records. Validation was performed by chart review by a movement disorder-trained neurologist. Control subjects were matched 4:1 by age, duration of preceding health care, race, ethnicity, birth year, and sex. TBI and PTSD were identified by ICD code and onset based on active duty. Association and interaction were measured for TBI and PTSD with PD going back 60 years. Interaction was measured for comorbid disorders. A total of 71,933 cases and 287,732 controls were identified. TBI and PTSD increased odds of subsequent PD at all preceding 5-year intervals back to year -60 (odds ratio range: 1.5 [1.4, 1.7] to 2.1 [2.0, 2.1]). TBI and PTSD showed synergism (synergy index range: 1.14 [1.09, 1.29] to 1.28 [1.09, 1.51]) and additive association (odds ratio range: 2.2 [1.6, 2.8] to 2.7 [2.5, 2.8]). Chronic pain and migraine showed greatest synergy with PTSD and TBI. Effect sizes for trauma-related disorders were comparable with established prodromal disorders. TBI and PTSD are associated with later PD and are synergistic with chronic pain and migraine. These findings provide evidence for TBI and PTSD as risk factors preceding PD by decades and could aid in prognostic calculation and earlier intervention. © 2023 International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Refrigerated human mesenchymal stromal cells as an alternative to cryostorage for use in clinical investigation.

Mesenchymal stromal cells (MSCs) and other therapeutic cells show efficacy for cardiac damage, neurological disease, chronic lung disease, pediatric graft versus host disease, and several inflammatory conditions. Based on their anti-inflammatory and immune-modulatory activities, responsiveness, and secretion of beneficial factors, cellular therapeutics may provide benefits in acute and chronic traumatic injury. However, the use of live cells presents logistical challenges, especially for military trauma. MSCs are generally shipped and stored frozen but require sterile handling before infusion. This requires skilled personnel and equipment not readily available in a forward medical treatment facility or even a small community hospital. Commercial human bone marrow- and adipose-derived MSCs from multiple donors were cultured under standard conditions, harvested and stored at 4°C in solution for up to 21 days. Cell viability, ATP content, apoptosis, proliferation capability, immunomodulation activity, and responsiveness were assessed after different amounts of time. Human MSCs can be stored at 4°C in MSC culture medium for 14 days while maintaining a reasonable level of viability and function. Both viability and function are reduced when MSCs are stored in crystalloid solutions. This approach makes it feasible to prepare cellular therapeutic agents in a laboratory or commercial facility and ship them under refrigerated conditions. Once they reach their destination, they can be stored at 4°C under conditions similar to blood products. Cells prepared and stored this way could also be used directly with minimal handling, making them more practical for both civilian and military trauma.

Evaluation of novel hemostatic agents in a coagulopathic swine model of junctional hemorrhage.

Hemostatic dressings are used extensively in both military and civilian trauma to control lethal noncompressible hemorrhage. The ideal topical hemostatic agent would provide reliable hemostasis in patients with profound acidosis, coagulopathy, and shock. This study aimed to compare next-generation hemostatic agents against the current military standard in a translational swine model of vascular injury and coagulopathy. Female Yorkshire swine were randomized to eight groups (total n = 63; control n = 14, per group n = 7) of hemostatic agents and included: QuikClot Combat Gauze (Teleflex, Morrisville, NC), which served as the control; BloodSTOP IX (LifeScience Plus, Mountain View, CA); Celox Rapid (Medtrade Product, Crewe, United Kingdom); ChitoSAM 100 (Sam Medical, Tualatin, OR); EVARREST Fibrin Sealant Patch (Ethicon, Raritan, NJ); TAC Wrapping Gauze (H&H Medical, Williamsburg, VA); ChitoGauze XR Pro (Tricol Biomedical, Portland, OR); and X-Stat 30 (RevMedX, Wilsonville, OR). Hemodilution via exchange transfusion of 6% hetastarch was performed to induce acidosis and coagulopathy. An arteriotomy was created, allowing 30 seconds of free bleeding followed by application of the hemostatic agent and compression via an external compression device. A total of three applications were allowed for continued/recurrent bleeding. All blood loss was collected, and hemostatic agents were weighed to calculate blood volume loss. Following a 180-minute observation period, angiography was completed to evaluate for technical complication and distal perfusion of the limb. Finally, the limb was ranged five times to assess for rebleeding and clot stability. All swine were confirmed coagulopathic with rotational thromboelastography and acidotic (pH 7.2 ± 0.02). BloodSTOP IX allowed a significant increase in blood loss and number of applications required to obtain hemostasis compared with all other groups. BloodSTOP IX demonstrated a decreased survival rate (29%, p = 0.02). All mortalities were directly attributed to exsanguination as a result of device failure. In surviving animals, there was no difference in extravasation. BloodSTOP IX had an increased rebleeding rate after ranging compared with QuikClot Combat Gauze ( p = 0.007). Most novel hemostatic agents demonstrated comparable efficacy compared with the currently military standard hemostatic dressing, CG.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

Committee on Surgical Combat Casualty Care position statement: Neurosurgical capability for the optimal management of traumatic brain injury during deployed operations.

Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability. The need for deployed neurosurgical capability position statement was identified during the spring 2021 CoSCCC meeting. A triservice working group of experienced forward-deployed caregivers developed a preliminary statement. An extensive iterative review process was then conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. To provide additional context and a civilian perspective, statement commentaries were solicited from civilian clinical experts including a recently retired military trauma surgeon boarded in neurocritical care, a trauma surgeon instrumental in developing the Brain Injury Guidelines, a practicing neurosurgeon with world-renowned expertise in TBI, and the chair of the Committee on Trauma. After multiple revisions, the position statement was finalized, and approved by the CoSCCC membership in February 2023. Challenges identified include (1) military neurosurgeon attrition, (2) the lack of a doctrinal neurosurgical capabilities requirement during deployed combat operations, and (3) the need for neurosurgical telemedicine capability and in-theater computed tomography scans to triage TBI casualties requiring neurosurgical care. Challenges identified regarding neurosurgical capabilities within the deployed trauma system include military neurosurgeon attrition and the lack of a doctrinal requirement for neurosurgical capability during deployed combat operations. To mitigate risk to the force in a future peer-peer conflict, several evidence-based recommendations are made. The solicited civilian commentaries strengthen these recommendations by putting them into the context of civilian TBI management. This neurosurgical capabilities position statement is intended to be a forcing function and a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields. Prognostic and Epidemiological; Level V.

What do the Public Understand About Intimate Partner Violence in the Context of Military Veteran Status and PTSD?

Intimate Partner Violence (IPV) represents a significant public and social health concern and may present particular complexities in military veteran relationships which are subject to unique stressors including separations, transition to civilian life and increased risk of Post-Traumatic Stress Disorder (PTSD). Public understanding is vital in terms of ensuring access to services and appropriate intervention. However, little is known about the public perception of IPV in this context. This study sought to assess how public recognition and discourse is affected by military veteran status and a diagnosis of PTSD. Community participants (N = 269) were randomly allocated to one of four conditions and presented with a story containing IPV in which the profession (military veteran/civilian worker) and diagnostic status (PTSD/No PTSD) were manipulated. All participants rated the extent to which they felt the story contained IPV; additionally, half (n = 123) took part in a story completion task designed to elicit qualitative data with regards to public discourse. The mean scores in all conditions were weighted towards IPV recognition. Results indicated a small interaction between job role and PTSD (F[1265] = 7.888, p < 0.01, partial n2 = 0.029) meaning that the public are more likely to recognise IPV when it is perpetrated by a military veteran than a civilian with PTSD. Diagnostic status made no difference to recognising abuse perpetrated by a military veteran. However, the fit of the model was weak (r2 = .040) meaning that the large majority of variance was due to factors not accounted for. Qualitative findings indicated that in a military population trauma may be assumed even where not indicated and the public appear less likely to consider current stressors or acknowledge that PTSD cannot justify abuse. Victims of IPV in military relationships may therefore be particularly vulnerable to discourses that prioritise the victim status of the perpetrator.

Vascular Reconstruction and Limb Loss in Military Tibial Artery Injuries

Selective operative management of injuries to the tibial arteries is controversial, with the necessity of revascularization in the face of multiple tibial arteries debated. Tibial artery injuries are frequently encountered in military trauma, but revascularization practices and outcomes are poorly defined. We aimed to investigate associations between the number of injured vessels and reconstruction and limb loss rates in military casualties with tibial arterial trauma. A US military database of lower extremity vascular injuries from Iraq and Afghanistan (2004-2012) was queried for limbs sustaining at least one tibial artery injury. Injury and intervention characteristics and limb outcomes were analyzed by the number of tibial arteries injured (one, T1; two, T2; three, T3). We included 221 limbs (194 T1, 22 T2, 5 T3). The proportions with concomitant venous, orthopedic, nerve, or proximal arterial injuries were similar between groups. Arterial reconstruction (vs ligation) was performed in 29% of T1, 63% of T2, and universally in T3 limbs (P < .001) (Figure). Arterial reconstruction was via vein graft (vs localized repair) in 62% of T1, 54% of T2, and 80% of T3 (P = .59). T3 received greater blood transfusion volume (P = .02) and fasciotomy was used universally (vs 34% T1 and 14% T2; P = .05). Amputation rates were 23% for T1, 26% for T2, and 60% for T3 (P = .16), and amputation was not significantly predicted by arterial ligation in T1 (P = .08) or T2 (P = .34) limbs. Infection was more common in T3 (80%) than T1 (25%) or T2 (32%, P = .02), but other limb complication rates were similar. In this series of military lower extremity injuries, an increasing number of tibial arteries injured was associated with increasing use of arterial reconstruction. Limbs with all three tibial arteries injured had high rates of complex vascular reconstruction and eventual amputation. Limb loss was not predicted by arterial ligation in one- and two-vessel injuries, suggesting that selective reconstruction in these cases is advisable.

Citation versus disruption in the military: Analysis of the top disruptive military trauma research publications.

Bibliometric analysis of surgical research has become increasingly prevalent. Citation count (CC) is a commonly used marker of research quality, but may overlook impactful military research. The disruption score (DS) evaluates manuscripts on a spectrum from most innovative with more positive scores (disruptive [DR]) to most entrenched with more negative scores (developmental; DV). We sought to analyze the most DR and DV versus most cited research in military trauma. Top trauma articles by DS and by CC were identified via professional literature search. All publications in military journals were included. Military trauma-related keywords were used to query additional top surgical journals for military-focused publications. Publications were linked to the iCite NIH tool for CC and related metrics. The top 100 DR and DV publications by DS were analyzed and compared with the top 100 articles by CC. Overall, 32,040 articles published between 1954 and 2014 were identified. The average DS and CC were 0.01 and 22, respectively. Most articles were published in Mil Med ( 68%). The top 100 DR articles were frequently published in Mil Med (51%) with a mean DS of 0.148. Of these, the most cited article was only the 40th most disruptive. The top 100 CC articles averaged a DS of 0.009 and were commonly found in J Trauma (53%). Only five publications were on both the top 100 DR and top 100 CC lists; 19 were on both the top DV and CC lists. Citation count was not correlated with DR ( r = -0.134; p = 0.07) and only weakly correlated with DV ( r = 0.215; p = 0.003). DS identifies publications that changed military paradigms and future research directions previously overlooked by citation count alone. The DR and DV articles are distinct with little overlap between highly cited military articles. Multiple bibliometric measures should be employed to avoid overlooking impactful military trauma research. Diagnostic Test or Criteria; Level IV.

Operative management and outcomes of colorectal injuries after gunshot wounds in the deployed military setting versus civilian trauma centers.

Colon and rectal injuries have been diverted at higher rates in military trauma compared with civilian injuries. However, in the last few years, there has been a shift to more liberal primary anastomosis in wartime injuries. The purpose of this study was to compare the management and outcomes in colorectal gunshot wounds (GSWs) between military and civilian settings. The study included Department of Defense Trauma Registry and Trauma Quality Improvement Program database patients who sustained colorectal GSWs, during the period 2013 to 2016. Department of Defense Trauma Registry patients were propensity score matched 1:3 based on age, sex, grade of colorectal injury, and extra-abdominal Abbreviated Injury Scale. Patients without signs of life, transfers from an outside hospital, and nonspecific colorectal Organ Injury Scale were excluded. Operative management and outcomes were compared between the two groups. Subanalysis was performed on the military cohort to identify any differences in the use primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status. Overall, there were 2,693 patients with colorectal GSWs; 60 patients in the military group were propensity score matched with 180 patients in the civilian group. Overall, colectomy was the most common procedure performed (72.1%) and was used more frequently in the military group (83.3% vs. 68.3%; p < 0.05). However, the rate of fecal diversion was similar in the two groups (23.3% vs. 27.8%; p = 0.500). Among those in the military group, no difference was seen in primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status. The rates of in-hospital compilations and mortality were similar between the military and civilian groups. The severity of GSW colorectal injuries in military and civilian trauma was comparable. There was no significant difference in terms of fecal diversion, mortality, and complications between groups. Military personnel are treated similarly regardless of affiliation. Therapeutic/Care Management; Level III.

A scoping review of two decades of pediatric humanitarian care during wartime.

Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting. We sought to perform a scoping review of pediatric research from the recent US-led wars in Afghanistan, and Iraq conflicts beginning in 2001. We used Google Scholar and PubMed to identify pediatric combat literature published between 2001 and 2022. We utilized the PRISMA-ScR Checklist to conduct this review. We identified 52 studies that met inclusion for this analysis-1 prospective observational study, 50 retrospective studies, and 1 case report. All the original research studies were retrospective in nature except for one. We identified one prospective study that was a post hoc subanalysis from an overall study assessing the success of prehospital lifesaving interventions. Most of the articles came from varying registries created by the United States and British militaries for the purposes of trauma performance improvement. The deployed health service support mission often includes treatment of pediatric trauma patients. The deployed health service support mission often includes treatment of pediatric trauma patients. We found that available literature from this setting is limited to retrospective studies except for one prospective study. Our findings suggest that pediatric humanitarian care was a significant source of medical resource consumption within both of the major wars. Further, many of the lessons learned have directly translated into changes in civilian pediatric trauma care practices highlighting the need for collaborative scientific developments between the military and civilian trauma programs. Systematic Review/Meta-Analyses; Level III.

Determining the educational impact of virtual patients on trauma team training during a multinational, large-scale civil military simulation exercise.

With asymmetrical conflicts ongoing, many countries have an increasing number of major trauma events but limited capacity to cope with these events. Training for such events comprises primarily of simulations requiring significant resources and that are time-consuming and expensive. Virtual patients are defined as computer-based programs presenting authentic cases support training in trauma management. Assisted learning technologies augment simulated trauma team training and can improve trauma team competencies. The aim was to investigate if virtual patients increased competencies in decision making required and to identify deficiencies in care for the management of trauma patients during a multinational civil military trauma exercise. A prospective educational intervention study with mixed methods, measuring the effects of a novel virtual patient model on trauma teams, was performed. The population consisted of surgeons, anesthesiologists, emergency department physicians, nurses, and paramedics (n = 30) and constituted six trauma teams from eight countries; three trauma teams formed the participating group, and three were allocated as control group. The participating group was exposed to virtual patients before, during, and after the live simulation exercise. Data sources were derived from individual preassessments and postassessments, evaluations made by experts in trauma, and video recordings of performance during the live simulation exercise and analyzed by the thematic analysis method. Using virtual patients contributed to improved individual knowledge about the management of major trauma patients and improved teamwork. Virtual patients as support for reasoning in decision making were directly correlated to level of previous knowledge and experience. Two of the three participating trauma teams showed lower levels of existing knowledge and competence in managing major trauma patients and therefore made more efficient use of the virtual patients. Results demonstrated advantages using virtual patients during a major civil military trauma live simulation exercise and appear to be supportive especially for teams who are not as experienced. Therapeutic/Care Management; Level IV.

Profile of injuries in recent warfare.

The epidemiology of French military severe trauma patients injured during recent military operations remains poorly described, even if French operations, casualties sustained, and care rendered in a different trauma system are distinct from others. This study aimed at describing the characteristics of these patients upon arrival at hospital in France and during hospital stay. This five-year retrospective cohort study included all French military servicemen injured during military operations, and admitted to the intensive care unit. Data on the characteristics upon arrival at the P. hospital in France and during hospital stay were obtained from a national civilian trauma registry. Of 1990 military trauma patients injured in military operations, 39 were finally admitted to the intensive care unit of the P. hospital and included in the analysis. Traumas were related to battle injuries and non-battle injuries in 27 and 12 patients, respectively. Ninety-eight wounds were described: torso (n = 32), limbs (n = 32), head and neck (n = 25), and spine (n = 9). The mechanism of injury was explosion in 19 patients, gunshot wound in 8 patients, motor vehicular crash in 7 patients, or other mechanisms in 5 patients. The median ISS was 25.5 (IQR = 14-34). This study highlights the small number of military severe trauma patients injured in recent warfare and their characteristics. The use of dedicated systemic military trauma registries could improve the specific epidemiological knowledge on recent warfare and help better prepare for future conflicts that may include major engagements and large-scale combat operations. Level III, Prognostic/Epidemiological.

Welcoming a New Anesthesiology Editor: Peter Nagele, M.D., M.Sc.

Special Announcement| June 2023 Welcoming a New Anesthesiology Editor: Peter Nagele, M.D., M.Sc. Anesthesiology June 2023, Vol. 138, 584. https://doi.org/10.1097/ALN.0000000000004576 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Welcoming a New Anesthesiology Editor: Peter Nagele, M.D., M.Sc.. Anesthesiology 2023; 138:584 doi: https://doi.org/10.1097/ALN.0000000000004576 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: abdominal aortic aneurysm, american academy of arts and sciences, anesthesia for trauma procedures, arts, austria, awards and prizes, cardiac event, clinical method training, genetic epidemiology, major depressive disorder Peter Nagele, M.D., M.Sc., is the newest editor for Anesthesiology. Dr. Nagele is Professor of Anesthesiology at the University of Chicago with a secondary appointment in the Department of Psychiatry and Behavioral Neurosciences. He completed his M.D. at University of Innsbruck, Austria, and his clinical training at the Vienna General Hospital (AKH), Medical University of Vienna, Austria, and obtained M.Sc. degrees in both Clinical Investigation and Genetic Epidemiology at Washington University in St. Louis. His clinical interests are in civilian and military trauma anesthesia and perioperative medicine. He is a National Institutes of Health–funded investigator with an active research program in exploring the use of nitrous oxide in the treatment of major depression and studying cardiac events after noncardiac surgery. Nagele is a former recipient of a Foundation for Anesthesia Education and Research (FAER)–mentored research training grant (2008) and the Presidential Scholar Award from the American Society of Anesthesiologists... You do not currently have access to this content.

Exploring the characteristics of successful prehospital trauma care teams: Insights from military trauma care simulations.

Trauma care teams play a crucial role in determining the outcomes of trauma victims. The composition and training of these teams can vary. Our study seeks to examine the characteristics of successful military Advanced Life Support (ALS) teams and the factors that affect them. A retrospective study was conducted at the Israel Defense Force (IDF) Military Medical Academy throughout 2021, where prehospital medical teams were observed in trauma care simulations. Teams were led by ALS providers (military physicians or paramedics) trained in IDF Military Trauma Life Support. Demographic and training data were collected. Teams were categorized into high or subpar performance groups based on simulation scores. Specific skills were assessed by trauma instructors using a points system. Scores were compared between the groups and analyzed for correlations with demographic and training data. Overall, 63 team simulations were analyzed, with teams led by a military paramedic in 78% of simulations. The mean overall simulation performance was 81% ±6.2, and there were no differences in scores of single or multicasualty simulations. A total 3% of the teams achieved successful results and were more likely to have a paramedic as the ALS provider ( p = 0.028). A sensitivity analysis excluding physicians was conducted and showed that high-performance teams had significantly higher skill assessments for primary survey ( p = 0.004), injury recognition ( p = 0.002), exposure ( p = 0.006), adherence to clinical practice guidelines ( p = 0.032), and medical device use ( p = 0.002). Our study found that ALS provider is associated with overall simulation performance in prehospital ALS teams, with military paramedics more likely to be successful. These findings have implications for the training and staffing of prehospital ALS teams, suggesting that teams should be composed accordingly and that training should focus on skills affected by the ALS provider type. Prognostic and Epidemiological; Level IV.