Military Warfighters Research Articles

A combat casualty relevant dismounted complex blast injury model in swine.

Improvised explosive devices have resulted in a unique polytrauma injury pattern termed dismounted complex blast injury (DCBI), which is frequent in the modern military theater. Dismounted complex blast injury is characterized by extremity amputations, junctional vascular injury, and blast traumatic brain injury (bTBI). We developed a combat casualty relevant DCBI swine model, which combines hemorrhagic shock (HS) and tissue injury (TI) with a bTBI, to study interventions in this unique and devastating military injury pattern. A 50-kg male Yorkshire swine were randomized to the DCBI or SHAM group (instrumentation only). Those in the DCBI group were subjected to HS, TI, and bTBI. The blast injury was applied using a 55-psi shock tube wave. Tissue injury was created with bilateral open femur fractures. Hemorrhagic shock was induced by bleeding from femoral arteries to target pressure. A resuscitation protocol modified from the Tactical Combat Casualty Care guidelines simulated battlefield resuscitation for 240 minutes. Eight swine underwent the DCBI model and five were allocated to the SHAM group. In the DCBI model the mean base excess achieved at the end of the HS shock was -8.57 ± 5.13 mmol·L -1 . A significant coagulopathy was detected in the DCBI model as measured by prothrombin time (15.8 seconds DCBI vs. 12.86 seconds SHAM; p = 0.02) and thromboelastography maximum amplitude (68.5 mm DCBI vs. 78.3 mm in SHAM; p = 0.0003). For the DCBI models, intracranial pressure (ICP) increased by a mean of 13 mm Hg, reaching a final ICP of 24 ± 7.7 mm Hg. We created a reproducible large animal model to study the combined effects of severe HS, TI, and bTBI on coagulation and ICP in the setting of DCBI, with significant translational applications for the care of military warfighters. Within the 4-hour observational period, the swine developed a consistent coagulopathy with a concurrent brain injury evidenced by increasing ICP.

Pathophysiology of Hemorrhage as It Relates to the Warfighter.

Saving lives of wounded military warfighters often depends on the ability to resolve or mitigate the pathophysiology of hemorrhage, specifically diminished oxygen delivery to vital organs that leads to multiorgan failure and death. However, caring for hemorrhaging patients on the battlefield presents unique challenges that extend beyond applying a tourniquet and giving a blood transfusion, especially when battlefield care must be provided for a prolonged period. This review describes these challenges and potential strategies for treating hemorrhage on the battlefield in a prolonged casualty care situation.

DNA Methylation Patterns of Chronic Explosive Breaching in U.S. Military Warfighters.

Background: Injuries from exposure to explosions rose dramatically during the Iraq and Afghanistan wars, which motivated investigation of blast-related neurotrauma. We have undertaken human studies involving military “breachers” —exposed to controlled, low-level blast during a 3-days explosive breaching course.Methods: We screened epigenetic profiles in peripheral blood samples from 59 subjects (in two separate U.S. Military training sessions) using Infinium MethylationEPIC BeadChips. Participants had varying numbers of exposures to blast over their military careers (empirically defined as high ≥ 40, and conversely, low < 39 breaching exposures). Daily self-reported physiological symptoms were recorded. Tinnitus, memory problems, headaches, and sleep disturbances are most frequently reported.Results: We identified 14 significantly differentially methylated regions (DMRs) within genes associated with cumulative blast exposure in participants with high relative to low cumulative blast exposure. Notably, NTSR1 and SPON1 were significantly differentially methylated in high relative to low blast exposed groups, suggesting that sleep dysregulation may be altered in response to chronic cumulative blast exposure. In comparing lifetime blast exposure at baseline (prior to exposure in current training), and top associated symptoms, we identified significant DMRs associated with tinnitus, sleep difficulties, and headache. Notably, we identified KCNN3, SOD3, MUC4, GALR1, and WDR45B, which are implicated in auditory function, as differentially methylated associated with self-reported tinnitus. These findings suggest neurobiological mechanisms behind auditory injuries in our military warfighters and are particularly relevant given tinnitus is not only a primary disability among veterans, but has also been demonstrated in active duty medical records for populations exposed to blast in training. Additionally, we found that differentially methylated regions associated with the genes CCDC68 and COMT track with sleep difficulties, and those within FMOD and TNXB track with pain and headache.Conclusion: Sleep disturbances, as well as tinnitus and chronic pain, are widely reported in U.S. military service members and veterans. As we have previously demonstrated, DNA methylation encapsulates lifetime exposure to blast. The current data support previous findings and recapitulate transcriptional regulatory alterations in genes involved in sleep, auditory function, and pain. These data uncovered novel epigenetic and transcriptional regulatory mechanism underlying the etiological basis of these symptoms.

The 3:1 Rule

The 3:1 rule has a long history and has been used or criticized by scholars and military alike. The present article attempts to test of the 3:1 rule against historical data. It investigates the validity of the rule, whether expressed in terms of men, tanks, artillery, or combat power, by using and expanding data of past battles. Contrary to what has been stated by numerous researchers and by official publications, this study comes to the conclusion that the 3:1 rule has little applicability. This result has major implications concerning military planning and warfighting.

The Warrior Athlete Part 2-Return to Duty in the US Military: Advancing ACL Rehabilitation in the Tactical Athlete.

Rehabilitation following an anterior cruciate ligament reconstruction is a crucial component of the healing and recovery process and full return to duty/play in the tactical modern-day warfighter. The burden of anterior cruciate ligament injuries and subsequent loss of readiness in these military warfighters highlights one of the most significant gaps in musculoskeletal injury care today. Emphasis must be placed on early weight-bearing and range of motion (ROM), namely in this athlete population, to best facilitate a timely care and recovery process. Preoperative rehabilitation should commence immediately following the diagnosis of an anterior cruciate ligament tear, because one of the best predictors of postoperative ROM is preoperative ROM. Recent advances in rehabilitation technology such as Alter-G treadmills, inertial measurement units, and blood flow restriction therapy systems, have demonstrated success in the early rehabilitation of tactical athletes. Alter-G treadmills allow for early weight-bearing with reduced impact and progression in ROM following operative management, while inertial measurement units have been applied to tailoring rehabilitation protocols specifically to an athlete's unique functional deficits. When used in conjunction with a fined tune rehabilitation protocol, implemented by a well versed clinical team, these treatment techniques can greatly expedite the return to duty process and limit long-term complications.

Physiological and Cognitive Factors Related to Human Performance During the Grand Canyon Rim-to-Rim Hike

Exposure to extreme environments is both mentally and physically taxing, leading to suboptimal performance and even life-threatening emergencies. Physiological and cognitive monitoring could provide the earliest indicator of performance decline and inform appropriate therapeutic intervention, yet little research has explored the relationship between these markers in strenuous settings. The Rim-to-Rim Wearables at the Canyon for Health (R2RWATCH) study is a research project at Sandia National Laboratories funded by the Defense Threat Reduction Agency to identify which physiological and cognitive phenomena collected by non-invasive wearable devices are the most related to performance in extreme environments. In a pilot study, data were collected from civilians and military warfighters hiking the Rim-to-Rim trail at the Grand Canyon. Each participant wore a set of devices collecting physiological, cognitive, and environmental data such as heart rate, memory, ambient temperature, etc. Promising preliminary results found correlates between physiological markers recorded by the wearable devices and decline in cognitive abilities, although further work is required to refine those measurements. Planned follow-up studies will validate these findings and further explore outstanding questions.

Vehicle Exposure and Spinal Musculature Fatigue in Military Warfighters: A Meta-Analysis.

Spinal musculature fatigue from vehicle exposure may place warfighters at risk for spinal injuries and pain. Research on the relationship between vehicle exposure and spinal musculature fatigue is conflicting. A better understanding of the effect of military duty on musculoskeletal function is needed before sports medicine teams can develop injury-prevention programs. To determine if the literature supports a definite effect of vehicle exposure on spinal musculature fatigue. We searched the MEDLINE, Military & Government Collection (EBSCO), National Institute for Occupational Safety and Health Technical Information Center, PubMed, and Web of Science databases for articles published between January 1990 and September 2015. To be included, a study required a clear sampling method, preexposure and postexposure assessments of fatigue, a defined objective measurement of fatigue, a defined exposure time, and a study goal of exposing participants to forces related to vehicle exposure. Sample size, mean preexposure and postexposure measures of fatigue, vehicle type, and exposure time. Six studies met the inclusion criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for quality appraisal of each article. Unweighted random-effects model meta-analyses were conducted, and a natural log response ratio was used as the effect metric. The overall meta-analysis demonstrated that vehicle exposure increased fatigue of the spinal musculature (P = .03; natural log response ratio = -0.22, 95% confidence interval = -0.42, -0.02). Using the spinal region as a moderator, we observed that vehicle ride exposure significantly increased fatigue at the lumbar musculature (P = .02; natural log response ratio = -0.27, 95% confidence interval = -0.50, -0.04) but not at the cervical or thoracic region. Vehicle exposure increased fatigue at the lumbar region.

Exercise training with blood flow restriction has little effect on muscular strength and does not change IGF-1 in fit military warfighters

ObjectiveAerobic exercise with blood flow restriction (aBFR) has been proposed as an adjunctive modality in numerous populations, potentially via an enhanced growth factor response. However, the effects of aBFR on highly trained warfighters have yet to be examined. The purpose of this study was to determine if adjunctive aBFR as part of a regular physical training regimen would increase markers of aerobic fitness and muscle strength in elite warfighters. In addition, we sought to determine whether the changes in blood lactate concentration induced by aBFR would be associated with alterations in the insulin-like growth factor (IGF) axis. DesignActive-duty US Naval Special Warfare Operators (n=18, age=36.8±2.2years, weight=89.1±1.2kg, height=181.5±1.4cm) from Naval Amphibious Base Coronado were recruited to participate in 20days of adjunctive aBFR training. Peak oxygen consumption (VO2 peak), ventilatory threshold (VT), and 1-repetition max (1-RM) bench press and squat were assessed pre- and post-aBFR training. Blood lactate and plasma IGF-1 and IGF-binding protein-3 (IGFBP-3) were assessed pre-, 2min post-, and 30min post-aBFR on days 1, 9, and 20 of aBFR training. ResultsFollowing aBFR training there were no changes in VO2 peak or VT, but there was an increase in the 1-RM for the bench press and the squat (5.0 and 3.9%, respectively, P<0.05). Blood lactate concentration at the 2-min post-exercise time point was 4.5–7.2-fold higher than pre-exercise levels on all days (P<0.001). At the 30-min post-exercise time point, blood lactate was still 1.6–2.6-fold higher than pre-exercise levels (P<0.001), but had decreased by 49–56% from the 2-min post-exercise time point (P<0.001). Plasma IGF-1 concentrations did not change over the course of the study. On day 9, plasma IGFBP-3 concentration was 4–22% lower than on day 1 (P<0.01) and 22% lower on day 9 than on day 20 at the 30-min post-exercise time point (P<0.001). ConclusionsOur data suggest that aBFR training does not lead to practical strength adaptations or alterations in the IGF axis in a population of highly trained warfighters.

China's Military Procurement and Its Operational Implications: A Response to Yoram Evron

This article is a response to Evron's argument, offering readers another perspective to assess China's military modernization and war fighting capabilities, using the same framework and methodology. It examines three topics: China's national security and military strategy, the PLA's procurement decision-making process, and China's military support and mobilization system. It concludes that, China's military modernization is to fight and win local wars under the conditions of informatization, but if required the PLA can reliably supply large numbers of sophisticated weapons and spare parts, to wage a complex and prolonged conflict.

Range of Motion and Reaches of Warfighters in Body Armor

To better understand the performance impact of body armor on U.S. military Warfighters, NSRDEC conducted an evaluation examining the range of motion of 67 Soldiers. Four configurations were assessed: duty uniform only and duty uniform with three different body armor protection levels (BAPLs). Sixteen (16) measurements were collected using standard and modified methods. Test participants were dressed in their best fitting size body armor and performed a variety of mission relevant movements. Test participants repeated each movement three times, and a mean was calculated for data analysis. Significant differences were seen between the BAPLs across the movements and within each movement. Follow up analysis has shown significant differences between the duty uniform alone and the three BAPLs for most of the movements. Design modifications of the armor could reduce the performance degradation caused by wearing the body armor, thereby improving mission performance and reducing fatigue in Warfighters.

Phakic Intraocular Lens Implantation in United States Military Warfighters: A Retrospective Analysis of Early Clinical Outcomes of the Visian ICL

To assess short-term clinical outcomes after implantation of phakic intraocular lenses (Visian ICL, STAAR Surgical Co) in US military warfighters who are not good candidates for laser vision correction. A retrospective interventional consecutive case series analysis of all eyes that underwent ICL surgery during a 14-month time period was performed. Main outcome measures included indications for surgery, efficacy, predictability, and early adverse events. Three-month postoperative visual data were available for 135 eyes of 69 patients who underwent ICL implantation during the study period. Indications included abnormal corneal topography (37%), thin predicted residual bed following LASIK (32%), history of dry eye (13%), thin corneal thickness (11%), or other (7%). Mean patient age was 30.9 ± 6.6 years. Mean preoperative spherical equivalent refraction was -6.00 ± 1.92 diopters (D) (range: -2.63 to -11.50 D). Three months postoperative, uncorrected distance visual acuity of 20/20 or better was found in 129/135 (96%) eyes and 91/135 (67%) were 20/15 or better. Manifest refraction and corrected distance visual acuity (CDVA) data were available for 128 eyes. Forty-two (33%) eyes had improvement of one or more lines of CDVA. One hundred fifteen eyes (90%) were within ± 0.50 D of emmetropia, and predictability within ± 0.75 D was found in 127/128 (99%) eyes. No significant intra- or postoperative complications were observed. This retrospective analysis of 3-month outcomes suggests that Visian ICL implantation in myopic warfighters provides excellent refractive and visual results. Further study is needed to evaluate long-term results.

A Corrective for Cultural Studies: Beyond the Militarization Thesis to the New Military Intelligence

This paper theorizes a new military intelligence and offers a modest corrective to the orthodoxy of the militarization thesis prevalent in cultural studies and the critical human sciences. The biopolitical orientation of population-centric counterinsurgency (COIN) warfare in Afghanistan reveals the multidirectional travel of rationalities and forms of coherence between modern liberal ways of rule and Western-bloc expeditionary ways of war. Through the work of Michel Foucault, and drawing on Michael Dillon and Julian Reid’s analysis of the biopoliticization of war (2008), COIN is interrogated as a continuation of biopolitics by other means. Conceptualizing a continuum of “fast” and “slow” military violence to produce islands of security and stability, COIN generates a mix of persuasive material forces that, while not kinetic or combat-oriented, are internal to the battlespace of military warfighting. The aim of this theoretical intervention is to trouble our understanding of military violence and power. Rather than subscribe unconditionally to the idea of a domineering military contaminating domestic civilian environments, the paper establishes a different trajectory: perhaps there is always-already a spirit of counterinsurgency internal to the art of biopolitical governmentality, which in turn conjugates contemporary military ways of war.

Asymmetric competition: decision processes shaping the future

Presents a practical exploration of business manoeuvre theory, examining the application of a developing military war fighting doctrine and how this can be transferred to the business mindscape in order to influence future planning. Suggests that attackers have strategic advantage over defenders and describes decision processes and complementary systems designed to support aggressive attack. Argues that decision makers broaden their attention from a dual focus on product innovation and increased market share, to include processes and tactics aimed at undermining and destabilising a competitor’s C2 (command and control). Also calls for an increase in the study of competitive behaviour and the study of decision processes and psychological operations (“psyops”) as they occur under time and resource constraints within the combative business environment.

When Terror Strikes, Who Should Respond?

During the past decade, concerns about possible terrorist acts involving weapons of mass destruction (WMD) led Congress and the President to adopt a comprehensive counterterrorism plan focused on preventing a chemical, biological, or nuclear attack and enhancing domestic preparedness. The agency of choice for domestic consequence management has been the Department of Defense. Of the $1.4 billion appropriated in the FY 2000 budget specifically for WMD response, over half went to DOD. [1] Overreliance on the military for domestic WMD protection, however, may diminish the military's warfighting capability and holds the potential for infringement of individual rights. Presidential Decision Directive 39 (PDD-39), signed in 1995, and the Defense Against Weapons of Mass Destruction Act of 1996 are the cornerstones of the United States' WMD terrorism strategy. This strategy is divided into four elements: intelligence and warning; prevention and deterrence; crisis and consequence management; and acquisition of equipment and technology. While crisis management involves the criminal aspect of dealing with a WMD attack, consequence management (CM) involves treating victims of the attack, searching for survivors, ensuring the containment of victims who are infected or exposed, and cleaning up the attack area. A number of agencies are involved in domestic preparedness. The National Security Council is the interagency consequence management coordinator; the Justice Department, through the FBI, handles crisis management and is responsible for preventing an attack; the Federal Emergency Management Agency (FEMA) is responsible for consequence management after an attack; and first-responders include local municipalities and state governments. But DOD has been assigned a disproportionate amount of domestic consequence management responsibilities. This is due to the national security threat of WMD terrorism and the historical reliance on the military to solve complex domestic issues. The assumptions that led to PDD-39 and the Federal Response Plan may no longer be applicable, however, as new information and analysis draw differing conclusions on the threat of WMD terrorism. This article will discuss the Defense Department's role in domestic consequence management following a catastrophic terrorist attack. Catastrophic terrorism, weapons of mass destruction, and all refer to the use of nuclear, chemical, or biological agents to bring about a major disaster with death tolls of ten thousand or higher. [2] The scope of this article will be limited to the discussion of superterrorism and not include other types of terrorism, such as conventional terrorism or small-scale chemical or biological weapons (CBW) terrorism. Pan Am 103, Khobar Towers, and the East African embassy bombings were incidents of conventional terrorism, for example, and the Aum Shinrikyo's sarin attack in Tokyo was an example of small-scale CBW terrorism. While the threat is no less serious, the low probability and unique political circumstances of an incident of nuclear terrorism exclude such weapons from this discussion. [3] Bringing the Issue into Focus Four events of the 1990s significantly sharpened the nation's perception of chemical-biological warfare and catastrophic terrorism. First, Saddam Hussein used his intermediate-range Scud missiles to demonstrate the paralyzing possibility of operating in a contaminated environment during the Persian Gulf War. Second, the World Trade Center bombing in 1993 demonstrated that foreign terrorists could not only operate on American soil, but could launch a chemical attack. [4] Third, the Oklahoma City bombing in 1995 proved that domestic terrorists could harm the nation. And fourth, the sarin gas attack in the Tokyo subway by the Aum Shinrikyo cult made chemical warfare a reality. The United States responded to the threat of terrorism, particularly superterrorism, when President Clinton signed PDD-39 in June 1995, PDD-62 in May 1998, and the 1997 National Defense Authorization Act. …

The United Nations in East Timor: Intervention at the Military Operational Level

This is a study of a humanitarian intervention in Southeast Asia led by a neighbouring state. The focus of the article is the first month of the International Force East Timor (INTERFET) operation led by Australia on behalf of the international community, with strong regional support, at the invitation of Indonesia. The article deals with the practical considerations that confronted senior military commanders as they implemented INTERFET's United Nations Security Council mandate at the operational level. INTERFET sought to shape events in East Tim or through the deterrence of certain Indonesian force elements while at the same time developing effective co-operation with senior Indonesian military officers. Various aspects of the INTERFET operation are analysed. Introduction Australia, on behalf of the international community, led and implemented the United Nations-sanctioned intervention in what was still Indonesian territory in East Timor in late 1999. This article looks at how that this was done at the operational level -- the level at which military commanders plan and implement operations within a designated theatre. The time period employed here is the important first month of the International Force East Timor (INTERFET) operation. It was during this time that INTERFET (and Indonesian) military commanders confronted their greatest challenges. Developments in this small poor province were the focus of intense international attention. The smallest of incidents could have provoked an international incident. This article sheds light on how senior INTERFET (and where possible Indonesian) military officers managed the practical implementation of national responses to a humanitarian tragedy on the ground. It touches on how INTERFET's senior officers interpreted and responded to events. INTERFET sought to shape events with a combination of deterrence, engagement, and co-operation with the Indonesian armed forces (Tentara Nasional Indonesia, or TNI). The application of military operational warfighting concepts in a peacemaking environment is also touched on, including INTERFET's provision of higher level military protection for its lightly armed and unprotected supply ships in response to submarine and air combat threats. INTERFET was a remarkably successful peacemaking mission. It achieved its goals in co-operation with Indonesia. Little blood was shed. Yet, the success of this operation at the outset depended on INTERFET depriving any potential adversary the opportunity to use force in the expectation of achieving a realistic gain. This was achieved by the use of higher-level military capabilities along with very well equipped and determined soldiers on the ground. This approach was complemented by co-operation. TNI commanders responsible for East Timor were kept fully briefed on INTERFET's intentions and were given the space to retire gracefully from East Timor. Mechanisms were established to allow senior INTERFET and TNI officers to raise issues of concern and to work through problems. Potential sources of conflict were generally diffused. Methodology The study is weighted towards an INTERFET perception of events. This is a consequence of research access to officials and officers who influenced INTERFET's decision-making. It is hoped that in due course a corrective study capturing Indonesian perspectives derived from interviews with key relevant TNI officers will be possible. This study is drawn from interviews with senior officers of the staffs of the maritime and land components of INTERFET. Other very senior officials and officers kindly provided their time to explain some of the wider facets of the operation. These interviews were supplemented by an account of the INTERFET operation by its Commander, Major General Peter Cosgrove, and by specialist studies by the Australian Defence Force Maritime and Land Warfare Studies Centres. In addition, other participants shed light on the tactical level. …