Special Forces Research Articles

Use of Intranasal Analgesia in French Armed Forces: A Cross-Sectional Survey.

Pain management is essential in military medicine, particularly in Tactical Combat Casualty Care (TCCC) during deployments in remote and austere settings. The few previously published studies on intranasal analgesia (INA) focused only on the efficacy and onset of action of the medications used (ketamine, sufentanil, and fentanyl). Side-effects were rarely reported. The aim of our study was to evaluate the use of intranasal analgesia by French military physicians. We carried out a multicentric survey between 15 January and 14 April 2020. The survey population included all French military physicians in primary-care centers (n = 727) or emergency departments (n = 55) regardless of being stationed in mainland France or French overseas departments and territories. We collected 259 responses (33% responsiveness rate), of which 201 (77.6%) physicians reported being familiar with INA. However, regarding its use, of the 256 physicians with completed surveys, only 47 (18.3%) had already administered it. Emergency medicine physicians supporting highly operational units (e.g., Special Forces) were more familiar with this route of administration and used it more frequently. Ketamine was the most common medication used (n = 32; 57.1%). Finally, 234 (90%) respondents expressed an interest in further education on INA. Although a majority of French military physicians who replied to the survey were familiar with INA, few used it in practice. This route of administration seems to be a promising medication for remote and austere environments. Specific training should, therefore, be recommended to spread and standardize its use.

Биографии коммунистов «поколения революционного перелома» 1917-1920-х гг. На материалах архивов Тамбовской области

The relevance of studying biographies of the representatives of the revolutionary generation stems from public interest in the fate of the makers of the era of change, as well as from heuristic potential of the “history of generations” approach in historical science. Drawing on archival fonds containing personal data of the Tambov communists born in the 1890s, the biography of the "revolutionary turning point" generation has been studied. Prosopographic study permits to establish their origin, social status, activities, and life strategy. It uses autobiographies, personal data cards, materials of the party census of communists registered with the Tambov Provincial Committee of the RCP (B) in 1918–22. Most sources are being introduced into scientific use for the first time. The object of the study is biographies of five communists. Our “protagonists” occupied various positions in the punitive and repressive bodies of the Soviet government system and took an active part in the suppression of the peasant uprising of 1920–21 in the Tambov gubernia. The research is to identify factors of social mobility and determine forms of “revolutionary” career of the young party members. It is interesting to study the society’s means of survival during systemic crisis and operation of “social lift” mechanism during social upheavals. The research methodology is based on “history of generations” approach and interdisciplinary nature of the work. Historical-comparative, historical-genetic, retrospective, systemic methods, and method of cohort analysis have been used. The novelty lies in recreation of life paths of the representatives of the studied group through the prism of most important events of the era of wars and revolutions. It has been established that career advancement was facilitated by education (as a rule, town or uezd school), military experience (in the Red Guard and special forces), and mandatory membership in the Communist Party. Four of the five protagonists were not native to the uezd, the arrived from the capital as appointees to strengthen the activities of the local authorities. As a result, a typical biography of the representatives of the studied generation, young communists of the Russian periphery during the Civil War has been reproduced.

Epidemiology of Musculoskeletal Injuries Among Naval Special Warfare Personnel.

Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students. In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests. Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students. MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs.

Pain Control and Point-of-Care Ultrasound: An Approach to Rib Fractures for the Austere Provider.

Rib fractures are common injuries that cause significant discomfort and can lead to severe pulmonary complications. Rib injury most often results from high-velocity traumatic mechanisms, while rarely representing underlying metastatic disease or secondary injury due to pulmonary illness. Because most rib fractures are caused by obvious trauma, algorithms are focused on treatment rather than investigating the exact mechanism of rib fractures. Chest radiographs are often the initial imaging performed but have proven to be unreliable in identification of rib fracture. Computed tomography (CT) is a diagnostic option as it is more sensitive and specific than simple radiographs. However, both modalities are generally unavailable to Special Operations Forces (SOF) medical personnel working in austere locations. These medical providers could potentially diagnose and treat rib fractures in any environment using a standardized approach that includes clarity of mechanism, pain relief, and point-of-care ultrasound (POCUS). This case demonstrates an approach to the diagnosis and treatment of a rib fracture in a 47-year-old male who presented to a military treatment facility with unlocalized flank and back pain, but the methods employed have applicability to the austere provider working far from the resources of a medical center.

Crimean-Congo Hemorrhagic Fever: A Refresher and Update for the SOF Provider.

Crimean-Congo Hemorrhagic Fever (CCHF) is the most widespread tickborne virus causing human disease. CCHF wields a mortality rate up to 30% and was responsible for the death of a US Soldier in 2009. The virus is spread by the Hyalomma species of hard tick found across Central Europe, the Middle East, Africa, and Asia south of the 50° parallel. Infection typically consists of a 1-7-day non-specific viral prodrome, followed by onset of hemorrhagic disease on days 7-10. Severe disease may cause thrombocytopenia, transaminitis, petechial hemorrhage, hematemesis, and death typically by day 10 of illness. Education and insect control are paramount to disease prevention. Treatment is predominantly supportive care, though evidence suggests a benefit of early ribavirin administration. CCHF has caused multiple nosocomial outbreaks, and therefore consideration should be given to safe transport and evacuation of infected and exposed patients. Given the wide area of distribution, transmissibility, innocuous arthropod vectors, and high mortality rate, it is imperative that Special Operations Forces (SOF) providers be aware of CCHF and the existing countermeasures.

Unconventional Resilience: An Operational Model.

This is the third of nine planned papers drawn from the findings of our ethnographic study entitled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams." Building from our strategic framework, this paper will establish that resilience is better understood as cohesive adaptation within a Special Operation Forces (SOF) cultural ecosystem. Exploring unconventional resilience as the inter-relationship across the organization, team, and individual, we will use qualitative quotes to describe the ecosystem of dynamic freedom of maneuver in ambiguity. To achieve our goals, we will: 1) compare conventional and unconventional resilience to operationalize the components of our strategic framework; 2) use qualitative quotes to show how the ecosystem of unconventional resilience functions at each level supporting our operational model; and 3) describe how the operational model of unconventional resilience links to tactical performance through five social determinants. We conclude by gesturing to how transformational change-agency applies to practical performance of all SOF medics.

Женские образы в малой прозе А.Варламова

In the article, the author refers to female images in A.Varlamov’s short prose. The creative method of the writer, considered by researchers to be spiritual realism, allows us to reveal the features of female characters through the prism of Christian axiology. Female images created by Varlamov are distinguished by a special inner spiritual force, as a rule, not inherent in male images in his works. In the course of the analysis, typological parallels of the heroine with the image of the writer’s grandmother, Maria Anempodistovna, embodied by the author in his story “Eva and Myasoedov” are established. The heroines of the works “Angel”, “Valdez” are united by the idea of sacrificial service, the idea of spiritual transformation is connected with the image of Mary from the story “The Sacrament”. A complex system of Christian motives accompanies the image of Lisa Nepomiluyeva from the story “The Little Star” and places it in the context of the hagiographic tradition. The axiological imperative, which carries the idea of salvation and transformation of the world and neighbor, distinguishes the female images of A.Varlamov and asserts them in the constants of the national spiritual tradition.

Practical Recommendations for Prehospital Selection of Pediatric Pelvic Circumferential Compression Devices.

Although the instances of Special Operations Forces (SOF) medical providers treating pediatric pelvic fractures are rare, such fractures are notable injuries in terror attacks and are at high risk for morbidity and mortality for the patient as well as stress for the provider. Presently, guidelines for pediatric-sized pelvic stabilization device application are limited to measured pelvic circumference. This study aims to inform more practical sizing guidelines. Subjects aged 1 year to 14 years were enrolled. Subject height, weight, pelvic circumference, and fit on the Broselow Pediatric Emergency Tape® (Armstrong Medical Industries), fit with the Pediatric PelvicBinder® (PelvicBinder), and fit with the small SAM Pelvic Sling® (SAM® Medical) were collected. The primary outcome was the proportion of subjects fitting each device. Sixty-five subjects were recruited; median age was 5 years (interquartile range, 1-8 years); 40 (62%) subjects were male. Ninety-one percent of subjects fit within the scale of the Broselow Tape (height <143-cm). One hundred percent of subjects with a height <143-cm had an appropriate fit with the Pediatric PelvicBinder (95% confidence level [CI], 91.8-100%), while 91.7% of subjects with a height >143-cm fit the SAM Pelvic Sling (95%CI, 61.5-99.8%). Providers should attempt to fit the Pediatric PelvicBinder for children >1 year old with suspected unstable pelvic fracture who fall on the Broselow Tape (<143-cm). The small SAM Pelvic Sling should be used for those taller than 143-cm.

Unconventional Resilience: A Strategic Framework.

This will be the second in a series of nine articles in which we discuss findings from our ethnographic study entitled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams." Our goal in this article is to establish the practical importance of redefining resilience within a strategic framework. Our bottom-up approach to strategy development explores unconventional resilience as an integrated transformational process that promotes change-agency through the force of movement. Synthesis of empirical data derived from participant interviews and focus groups highlights conceptual attributes that make up the essential components of this framework. To achieve our goal, the authors (1) briefly remind readers how we have problematized conventional resilience; (2) explain how we analyzed qualitative quotes to extrapolate our definition of unconventional resilience; and (3) describe in detail our strategic framework. We conclude by gesturing to why this strategic framework is applicable to practical performance of all Special Operation Forces (SOF) medics.

Approach to Handling Atypical Field Blood Transfusion Scenarios.

Special Operations Forces (SOF) medical personnel have been at the forefront of administering blood products in the austere field medicine environment. These far-forward medical providers regularly treat patients and deliver blood transfusions in some of the world's most extreme environments with minimal resources. A multitude of questions have been raised on this topic based on the unique experiences of senior providers in this field. In this paper, we analyze the available literature and present the recommendations of several experts in transfusion medicine for managing atypical field transfusion scenarios.

Tick-Borne Encephalitis: An Update for the Special Operations Forces Provider.

Tick-borne encephalitis (TBE) is a severe disease caused by the tick-borne encephalitis virus (TBEV). TBEV is endemic throughout Eurasia and can cause persistent neurologic deficits and death. Special Operations Forces (SOF) participating in field exercises or operations in TBE-endemic countries are at significantly increased risk of infection. Unlike Lyme disease and other tick-borne illnesses, transmission of TBEV can be immediate, and early tick removal does not reduce the risk of infection. While there are no virus-specific treatments available, the US Food and Drug Administration (FDA) recently approved a TBE vaccine that has yet to be incorporated into formal Department of Defense (DoD) recommendations. SOF medical providers should be aware of this disease entity and consider the TBE vaccine when planning exercises and operations in areas of responsibility (AORs) with TBE-endemic countries. This review serves as a refresher and update on the epidemiology, transmission, and management of TBE for the SOF provider.

How the Five Principles of High Reliability Organizations Align with the Five Truths of Special Operations.

Special Operations medicine must provide highly reliable healthcare under intense and sometimes dangerous circumstances. In turn, it is important to understand the principles inherent to building a High Reliability Organization (HRO). These principles include (1) sensitivity to operations; (2) preoccupation with failure; (3) reluctance to simplify; (4) resilience; and (5) deference to expertise. Understanding them is crucial to turning good ideas into sound practical benefit in operational medicine. A prime teaching opportunity involves an interesting coincidence that occurred during the emergence of HROs. Specifically, United States Special Operations Command (USSOCOM) adopted five Special Operations Forces (SOF) Truths that contribute to success in Special Operations, including (1) humans are more important than hardware; (2) quality is better than quantity; (3) SOF cannot be mass produced; (4) competent SOF cannot be created after emergencies occur; and (5) most Special Operations require non-SOF support. These five Truths have more in common with the five HRO principles than merely quantity. They describe the same underlying ideas with a key focus on human performance in high-risk activities. As such, when presented alongside the five HRO principles, there is an opportunity to improve the overall health and performance of SOF personnel by integrating these principles across the range of Special Operations medicine from point of injury care to garrison human performance initiatives. The following discussion describes in greater detail the five HRO principles, the five SOF Truths, and how these similar ideas emerged as more than just a useful coincidence in illustrating the key concepts to produce high performance.

Hydration: Tactical and Practical Strategies.

Full-spectrum Human Performance Optimization (HPO) is essential for Special Operations Forces (SOF). Adequate hydration is essential to all aspects of performance (physical and cognitive) and recovery. Water losses occur as a result of physical activity and can increase further depending on clothing and environmental conditions. Without intentional and appropriate strategic hydration planning, Operators are at increased risk for degradation in performance and exertional heat illness. The purpose of this article is to highlight current best practices for maintaining hydration before, during, and after activity, while considering various environmental conditions. Effective leadership and planning are necessary for preparing Operators for successful military operations.

Legal Solutions to Health Misinformation and Disinformation During the Covid-19 Pandemic Outbreak

The spread of false information online has increased dramatically in recent years. Around the COVID-19 pandemic,a digital epidemic of misinformation, or “infodemic,” has arisen. Since the beginning of 2020, digital platformshave served as both a source of and a remedy for Disinformation. After a few months of the epidemic, it is clearthat ensuring health professionals access to necessary medical equipment and supplies is less crucial than fightingfalsehoods online. Actions such as (a) urging social media firms to delete material about the epidemic that iscontentious, (b) putting up special forces to counteract propaganda and false information (e.g., E.U., U.K.), and (c)incarcerating suspicious coronavirus false claims, including in connection to the public health interventions, werehigh priorities for many government agencies around the world in response to COVID-19. State of emergencymeasures used early on shaped future debates on how to strike a fair balance between free speech and censorshipon the internet by, among other things, restricting access to news and encouraging journalists to hold back on theirreporting.

Armed Forces in the present United States and Britain military policy. Main Trends

The article presents the United States and United Kingdom Armed Forces evolvement main trends in the warfare below the threshold of war context. The point at issue is United States Special Operations Forces (US SOF), British Army and United Kingdom Special Forces (UKSF). The focus of the research paper on: the US Theater Special Operations Commands - Special Operations Command Africa, Special Operations Command Europe and others; British Army new units - Ranger Regiment, Army Special Operations Brigade, 11th Security Force Assistance Brigade and others. The organizational and establishment of these units, their warfighting and combat training functions, tactical battle employment the spot is on. The article consciously thinks the Future Soldier British Army reform program and its role in the battle units adapting to the new type of conflicts - hybrid warfare below the threshold of war. The special attention is given to the US Military Operation in Syria (Operation Inherent Resolve) and American-British military assistance to Ukraine Armed Forces. The article is also reviewing the CIA Special Activities Center military role in Ukraine and 22nd Special Air Service regiment (UKSF) Syria combat presence.

Analyzing the "University Students’ Special Forces Traveling Style" with the Principles of Public Opinion Science

Analyzing the "University Students’ Special Forces Traveling Style" with the Principles of Public Opinion Science

Democracy in Myanmar: The failure of another Asian democracy in late modernity

Can Myanmar ever become a genuine democracy? It appears that ever since the exit of the British forces in the post-WWII era, any form of genuine democracy remains an impossible dream for that naturally wealthy regime. Democracy does not appear to be synonymous with Burma or what is now called Myanmar. On August 27, 2023, the Myanmar Junta expelled Timor-Leste’s ambassador over allegations of authoritarianism, calling the locallybased anti-coup shadow government a sham. The two Southeast Asian states have been at loggerheads since early 2021 due to widespread clashes in Naypyidaw over the National Unity Government (NUG) [(1):746]. The Southeast Asian nations have been locked in a crisis since the Myanmar military seized power (again) in February 2021 after another failed (and mostly public) experiment with democracy that had led to widespread political violence. The official Myanmar news agencies that remain the voice of the junta have condemned the anti-coup demonstrations. Most ASEAN states-Vietnam, Laos, Singapore, Cambodia, the Philippines, Malaysia, and Brunei– have failed to attempt to broker any compromise that could solve the problem. Only Thailand and Timor-Leste have attempted to resolve the political violence. Jakarta tends to remain “neutral” or uncommitted to any arguments over Timor-Leste (and in this case the expulsion of the Timor-Leste Ambassador to Myanmar in late August 2023) because Indonesia (under Suharto) had not only annexed Timor-Leste under Suharto but also was committed to the widespread use of political violence and other human rights’ atrocities by the Indonesian Special Forces (Kopassus) against the largely peaceful Catholics and Christians under former rebel leader Xanana Gusmao. The current crisis Napidydaw now faces invites many human rights observers and Amnesty International advocates to raise questions about Myanmar’s poor record since the British left after the post-WWII era. The paper attempts to explain why democracy remains a problem in Myanmar. It uses a seven-question democratic framework to determine feasibility of democracy in Myanmar today.

An Effective Model of Countering Terrorist Danger: Successful Experience of Mauritania

The article analyzes the approaches of the Mauritanian authorities to the fight against terrorism. While the countries of the Sahel region are suffering from a crisis caused by the actions of jihadist groups, Mauritania has become a positive exception in this regard. There have been no major terrorist attacks there in the last 10 years, although there are significant problems in the country that make it vulnerable to extremism. These are unresolved political issues, huge social and ethnic differences, and the weakness of the economy. The terrorist group Al-Qaeda in the Islamic Maghreb (AQIM), which has been organizing terrorist attacks in the country since 2005 and recruiting young Mauritanians into the ranks of jihadists, tried to take advantage of the numerous problems of Mauritania and the popularity of political Islam there. The peak of terrorist activity in Mauritania was 2005–2011, when more than ten attacks were carried out. Since coming to power in 2009, President Mohamed Ould Abdel Aziz began the formation of a new anti-terrorist strategy that took into account both the Algerian experience and the Mauritanian realities. This strategy was complex in nature and included both military measures and “soft approaches”. Among the military measures, a successful military reform should be noted, affecting military education, increasing the mobility of the armed forces and the capabilities of special forces units. The approach of the Mauritanian authorities to the internal religious and political arena has also undergone a radical change. In addition to offering dialogue to hardliners and the legalization of the Islamist Tevassul party, the approach aimed at involving the nomadic population of remote desert areas in the public space of Mauritania has fully justified itself.

И.Г. СТАРИНОВ И ОРГАНЫ ГОСУДАРСТВЕННОЙ БЕЗОПАСНОСТИ

The purpose of the article is to study the activities of Colonel I. G. Starinov and his interaction with state secu-rity bodies aimed at forming a strategy and tactics of sabotage work. It is stressed that his methods of work became a benchmark for carrying out special actions to destroy the critical infrastructure of the enemy and elimi-nate the leaders of enemy military and administrative structures. A wide range of historical research methods, such as comparative and historical methods, comparative meth-ods and others are used. Starinov' s activity is consid-ered as a reflection of the epoch in the military history of Russia. During his life, Starinov was called «the genius of the explosion», «the god of sabotage», «the grandfather of the Russian special forces». Being on duty, at various stages of his career, I. G. Starinov was in close coopera-tion with the security bodies: the OGPU, the NKVD, the MGB and the KGB. This cooperation took place during his work on the training of sabotage personnel in the 1930s in the Ukrainian Military District, and during his business trip to Spain. During the Great Patriotic War, I. G. Starinov, together with NKVD officers, trained CHEKA officers for sabotage and partisan work. In the postwar period I. G. Starinov worked again with KGB officers on a teaching job. As a result, the authors come to the conclusion that the activity of I. G. Starinov became the basis for the formation of special services in Soviet Russia. The au-thors emphasize that Starinov’ s methods of work in the field of sabotage are so perfect that they are of great importance to the present day, and are still in practical use by modern state security bodies and the Armed Forces of Russia.

Altered Sympathoadrenal Activity Following Cold-Water Diving.

Little data exist on the effect of extremely cold-water diving on thermo-metabolic hormone secretion. Moreover, the impact of repetitive dives on the stress response is unknown. The purpose of this study was to determine the effects of two daily bouts of cold-water diving on the hormonal and metabolic profile of elite military personnel and to measure the stress response. Healthy, male, Norwegian Special Forces operators (n = 5) volunteered for this study. Physiological and hormone data were analyzed prior to and following twice-daily Arctic dives (3.3°C). Core temperature was maintained (p > .05), whereas skin temperature was significantly reduced over the course of each dive (p < .01). Pairwise comparisons revealed adrenocorticotropic hormone (ACTH) and cortisol concentration significantly decreased across both dives and days (p < .001). Adrenaline and noradrenaline significantly increased across both time and day (p < .001). Leptin, testosterone, and IGF-1 significantly decreased over time but recovered between days. The main findings of this effort are that there is a rapid sympathetic-adreno-medullary (SAM/SNS) response to cold-water diving and a suppression of the hypothalamic-pituitary-adrenal (HPA) axis and hormones related to repair and recovery. While the sample size was too small to determine the role of SAM/SNS, HPA, and thyroid hormone effect on thermoregulation, it addresses a gap in our understanding of physiological adaptions that occurs in extreme environments.