U.S. Army Medical Department journal 

About: U.S. Army Medical Department journal is an academic journal. The journal publishes majorly in the area(s): Poison control & Population. It has an ISSN identifier of 1524-0436. Over the lifetime, 421 publications have been published receiving 4309 citations.

Combat duty in Iraq and Afghanistan, mental health problems and barriers to care.

Abstract: Background The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. Methods We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Results Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. Conclusions This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.

Causes of death in US Special Operations Forces in the global war on terrorism: 2001-2004.

Abstract: INTRODUCTION Effective combat trauma management strategies depend on an understanding of the epidemiology of death on the battlefield, resulting in evidence-based equipment, training, and research requirements. METHODS All Special Operations Forces (SOF) fatalities (combat and noncombat) in Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) from October 2001 until November 2004 were reviewed. All available autopsy and treatment records and photographs were used. In most cases, the immediate tactical situation was unknown. The review was performed by a multidisciplinary group including forensic pathologists, an SOF combat medic, and trauma surgeons. Fatalities were classified as having wounds that were either nonsurvivable or potentially survivable with existing training, equipment, and expertise on the battlefield. A structured review was performed evaluating the need for new equipment, training, or research requirements. Results were compared to autopsy data from Vietnam and modern civilian trauma center data. The study was approved by the Institutional Review Boards of the Armed Forces Institute of Pathology and the US Army Institute of Surgical Research. RESULTS During the study period, 82 SOF fatalities were identified. Autopsies were performed on 77 Soldiers. Five casualties died secondary to aircraft crash, their bodies were not recovered from the ocean. For the purposes of this study they were considered nonsurvivable. Eighty-five percent (n = 70) of the fatalities sustained wounds that were nonsurvivable, while the remaining 15% (n = 12) had wounds that were potentially survivable. Injury Severity Score (ISS) was higher in the nonsurvivable group (p < 0.05). Truncal hemorrhage accounted for 47% of deaths while extremity hemorrhage accounted for 33%. One casualty was noted at autopsy to have a tension pneumothorax as well as multiple sources of internal hemorrhage, one suffered an airway death, while another died of sepsis 56 days after injury. Of those casualties deemed to be nonsurvivable, there were 31 patients with 40 Abbreviated Injury Score (AIS) 6 injuries (p = .0011), and 53 patients with 104 AIS 5 injuries. Among the 12 deaths deemed to be potentially survivable, there were only 8 AIS 5 injuries. Deaths were largely caused by explosions (n = 35), gunshot wounds (n = 23), and aircraft accidents (n = 19). No new training or equipment needs were identified for 53% of the potentially survivable deaths while improved methods of truncal hemorrhage control need to be developed for the remainder. The review panel concluded that 85% of the deaths would not have been prevented at a civilian Level I facility. Available records, in most cases, did not contain information about the use of body armor, time to death after injury, or the ongoing tactical situation. CONCLUSIONS The majority of deaths on the modern battlefield are nonsurvivable. Current results are not different from previous conflicts. In Vietnam, reported potentially preventable death rates range from 5% to 35% and civilian data reports potentially preventable death rates ranging from 12% to 22%. Military munitions cause multiple lethal injuries. Current trauma training and equipment is sufficient to care for 53% of the potentially survivable deaths. Improved methods of intravenous or intracavitary noncompressible hemostasis combined with rapid surgery are required for the remaining 47% of the decedents.

New tourniquet device concepts for battlefield hemorrhage control.

Abstract: Background Given the recent success of emergency tourniquets, limb exsanguination is no longer the most common cause of preventable death on the battlefield; hemorrhage amenable to truncal tourniquets now is. The purpose of the present study is to discuss the gaps today in battlefield hemorrhage control and candidate solutions in order to stimulate the advancement of prehospital combat casualty care. Methods A literature review, a market survey of candidate devices, a request for devices, and an analysis of the current situation regarding battlefield hemorrhage control were performed. Results Hemorrhage control for wounds in the junction between the trunk and the limbs and neck is a care gap in the current war, and, of these, the pelvic (including buttock and groin proximal to the inguinal ligament) area is the most common. Historical and recent reports give background information indicating that truncal tourniquets are plausible devices for controlling junctional hemorrhage on the battlefield. A request for candidate devices yielded few prototypes, only one of which was approved by the US Food and Drug Administration. Conclusions In order to solve the now most common cause of preventable death on the battlefield, junctional hemorrhage from the pelvic area, the planned approach is a systematic review of research, device and model development, and the fielding of a good device with appropriate training and doctrine.

Strategies for optimizing military physical readiness and preventing musculoskeletal injuries in the 21st century.

Abstract: With downsizing of the military services and significant budget cuts, it will be more important than ever to optimize the health and performance of individual service members. Musculoskeletal injuries (MSIs) represent a major threat to the health and fitness of Soldiers and other service members that degrade our nation's ability to project military power. This affects both financial (such as the economic burden from medical, healthcare, and disability costs) and human manpower resources (Soldiers medically unable to optimally perform their duties and to deploy). For example, in 2012, MSIs represented the leading cause of medical care visits across the military services resulting in almost 2,200,000 medical encounters. They also result in more disability discharges than any other health condition. Nonbattle injuries (NBIs) have caused more medical evacuations (34%) from recent theaters of operation than any other cause including combat injuries. Physical training and sports are the main cause of these NBIs. The majority (56%) of these injuries are the direct result of physical training. Higher levels of physical fitness protect against such injuries; however, more physical training to improve fitness also causes higher injury rates. Thus, military physical training programs must balance the need for fitness with the risks of injuries. The Army has launched several initiatives that may potentially improve military physical readiness and reduce injuries. These include the US Army Training and Doctrine Command's Baseline Soldier Physical Readiness Requirements and Gender Neutral Physical Performance Standards studies, as well as the reimplementation of the Master Fitness Trainer program and the Army Medical Command's Soldier Medical Readiness and Performance Triad Campaigns. It is imperative for military leaders to understand that military physical readiness can be enhanced at the same time that MSIs are prevented. A strategic paradigm shift in the military's approach to physical readiness policies is needed to avoid further degradation of warfighting capability in an era of austerity. We believe this can be best accomplished through leveraging scientific, evidence-based best practices by Army senior leadership which supports, prioritizes, and implements innovative, synchronized, and integrated human performance optimization/injury prevention policy changes. Language: en

Relationships among self-reported shoe type, footstrike pattern, and injury incidence.

Abstract: Context Some runners are experimenting with barefoot or minimalist shoe running to reduce lower extremity overuse injuries. However, there has been little research to examine injury trends associated with barefoot or minimalist shoe running. Objective To assess the association of self-reported shoe selection with reported foot strike patterns, compare overall injury incidence associated with different shoe conditions, and identify differences in injury location between different shoe conditions. Design Retrospective descriptive epidemiology survey. Methods We recruited 2,509 runners (1,254 male, 1,255 female) aged 18 to 50 to complete an anonymous online survey. The survey assessed running tendencies, footstrike patterns, shoe preferences, and injury history. Reported footstrike patterns were compared among 3 shoe groups: traditionally shod, minimalist shoes, and barefoot runners. Overall and specific anatomical injury incidence was compared between traditionally shod and minimalist shoe-wearing runners. We did not include 1,605 runners in the analyses due to incomplete data or recent changes in footstrike patterns and/or shoe selection. Results Shoe selection was significantly associated with reported footstrike (χ² (4df) =143.4, P Conclusion Barefoot and minimalist shoe wearers reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were more likely to report injuries of the lower extremities than runners who wear minimalist shoes. Additional longitudinal prospective research is required to examine injury incidence among various footstrike patterns and shoe preferences.