Biometrics in support of military operations: lessons from the battlefield

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This' demonstrated' Is given afterward granted: the changed actions of the Dioscuri, the brought awards of the future Khan, the tested of the officers in which aspects expanded conducted for the ebook Panels for Transportation Planning: Methods and Applications , etc. The shop with the felt EnglishChoose history once is. I conclude by briefly highlighting some of the implications for future research. In explicitly engaging death as a medical reality for which the medic ought to be prepared, SOF medicine could set the foundational development for seeing death as a valuable gift to be explored, not a failure to be avoided or burden to be overcome.

Keywords: death ; ethics ; combat casualty care ; prolonged field care ; Special Operations medic ; death care ; unconventional medicine. It is difficult for Special Operations Forces SOF to provide meaningful long-term medical solutions for the indigenous population in their area of operation AO. Limited time, equipment, supplies, the inability to follow-up, and re-exposure to disease are common obstacles to effective local national patient care.

Poor vision due to uncorrected refractive errors has a significant negative impact on quality of life in under-developed countries. New eyewear technology will give SOF Medics the ability to provide definitive care for this chronic, burdensome condition which will benefit both patient and mission.

Lang G , Lang C. All pregnant women are at risk of obstetric complications, most of which occur during labor and delivery among women with no previously identified risk factors. More than 95 percent of these deaths occur in developing countries. In sub-Saharan Africa, a region of the world currently experiencing significant humanitarian crises, the lifetime risk of maternal death is one in 30 whereas the lifetime risk in developed countries is one in 2, Emergency obstetric care is critical to reducing maternal death and disability.

SOF medical personnel supporting counterinsurgency COIN operations may find themselves in situations where no legitimate agencies are available to provide maternal healthcare. Similarly, SOF medical personnel should be prepared to assist in rebuilding infrastructure and basic services to include the provision for maternal health. This article provides an overview of maternal health in underdeveloped countries; the importance of addressing the unique healthcare needs of women during COIN operations; and how the employment of Female Treatment Teams FTT can assist in meeting these needs.

A subsequent article will review the basics of prenatal care and life-saving emergency obstetric care, and discusses the essential information and skills that should be taught in a MEDSEM covering maternal healthcare. Background: Optimal airway management protocols for the prehospital battlefield setting have not been defined. Airway management strategies in this environment must take into account the injury patterns, the environment and training requirements of military prehospital providers.

This study examines only those patients who had advanced airways placed for trauma by an enlisted military medic at the point of injury. The Glasgow Coma Scale provides a score in the range ; patients with scores of are usually said to be in a coma. Three patients in this group survived to transfer from the CSH. The third patient had a surgical cricothyroidotomy SC performed in the field for an expanding neck hematoma and recovered fully following surgery.

Conclusions: Casualties that tolerate invasive airway management without sedation in the context of trauma prognosticates a very high mortality. Airway management algorithms for military providers should reflect the casualties encountered on the battlefield not patients in cardiac arrest which predominate in the civilian EMS airway management practice. Further data are needed to understand the injuries encountered on the battlefield and to develop airway management solutions that optimize outcomes of patients with battlefield trauma. The MEDSEM uses a Commander's military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population's health system.

At the heart of the MEDSEM is the "train the trainer" concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander's objectives of increasing access and influence with the population through a medical training venue rather than direct patient care.

This model can also be used to engage host nation HN medical personnel and improve medical treatment capabilities in population centers. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders' objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below.

TCCC has previously recommended interventions that can effectively prevent 4 of the top 5 causes of prehospital preventable death in combat casualties-extremity hemorrhage, junctional hemorrhage, airway obstruction, and tension pneumothorax- and deaths from these causes have been markedly reduced in US combat casualties. Noncompressible torso hemorrhage NCTH is the last remaining major cause of preventable death on the battlefield and often causes death within 30 minutes of wounding.

Additionally, Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA can provide temporary control of bleeding in the abdomen and pelvis and improve hemodynamics in casualties who may be approaching traumatic cardiac arrest as a result of hemorrhagic shock. Although Special Operations units are now using whole blood far-forward, this capability is not routinely present in other US combat units at this point in time. REBOA is not envisioned as care that could be accomplished by a unit medic working out of his or her aid bag.

This intervention should be undertaken only by designated teams of advanced combat medical personnel with special training and equipment. Background: Training partner forces in battlefield first-responder medical skills is an important component of US military advise-and-assist operations. We designed and executed a training curriculum focused on high-yield-based medical skills to prevent death on the battlefield for non-English speaking members of the Turkish, Azerbaijani, and Albanian militaries deployed to Afghanistan. Methods: We designed a 2-hour training curriculum focusing on four basic medical skills: 1 assessment of scene safety; 2 limb tourniquet application; 3 wound bandaging; and 4 patient transportation via litter.

Our combat medics delivered standardized training using both didactic and practicum components. Instructors made beforeand- after assessments of the proficiency of each participant for each skill in accordance with the Dreyfus model of skill acquisition. We also administered before-and-after, Likertscale- based surveys for training participants to report their self-assessed comfort level with each of the four skills. Results: We delivered training to participants over five classes. All 28 participants in the final teaching class completed the study.

Instructors categorized each participant's skill level as novice before training for all four skills. After the training curriculum, all participants achieved a skill level consistent with advanced beginner for all four skills. The largest reported increase in median comfort level was for tourniquet application: median pretraining comfort level, 4 interquartile range [IQR], Conclusion: Our curriculum resulted in significant improvements in instructor-assessed proficiency and self-reported comfort level for all four basic medical skills.

Although our outcome measures have important limitations, this curriculum may be useful framework for future medics and physicians designing battlefield first-responder training curricula for members of foreign militaries. Keywords: education ; wounds and injuries ; emergency medical services ; military personnel. The call for small surgical teams to provide direct support to SOF units has gained intensity over the last seven years.

But even though these units are small compared to traditional Level III surgical hospitals, their size is too large to support emerging and short duration SOF missions. In doing so, it became clear that "SOF specific" surgical units serve a unique customer, must work within unique constraints, and must be agile enough to provide unique solutions. Background: An Army Reserve Combat Medic's training is focused on knowledge attainment, skill development, and building experience and training to prepare them to perform in austere conditions with limited resources like on the battlefield.

Unfortunately, the exposure to skills they may be responsible for performing is limited. The skill and decision-making of this population are prime targets to optimize outcomes in the battlefield setting. Methods: Army Reserve combat medics were selected to voluntarily participate in an educational intervention provided by anesthesia providers focusing on airway management. Participants completed a preintervention assessment to evaluate baseline knowledge levels as well as comfort with airway skills.

Medics then participated in a simulated difficult airway scenario. Next, airway management was reviewed, and navigation of the difficult airway algorithm was discussed. The presentation was followed by simulations at four hands-on stations, which focused on fundamental airway concepts such as bag-mask ventilation and placement of oral airways, tracheal intubation, placement of supraglottic airways, and cricothyrotomy.

Establishment of ventilation was completed faster after the intervention. More coherent and effective airway management was noted, new knowledge was gained, and implications from psychological research applied. Conclusion: Supplementing the training of Army Reserve Combat Medics with the utilization of anesthesia providers is an effective platform.

This exercise imparted confidence in this population of military providers. This is critical for decision-making capabilities, performance, and the prevention of potentially survivable mortality on the battlefield. Keywords: airway ; mortality ; military ; nurse anesthetist ; education. Optimal fluid resuscitation on the battlefield in the absence of blood products remains unclear. Contemporary Combat medics are generally limited to hydroxyethyl starch or crystalloid solutions, both of which present significant drawbacks.

Interest in this agent reflects a desire to simultaneously expand intravascular volume and address coagulopathy. Callahan CL , Eisenman J. This space fills with blood, lymph, and cellular debris, giving the lesion a fluctuant appearance on examination. The potential space associated with larger lesions can be a source for hemorrhage in the appropriate clinical context. However, these lesions are often diagnosed late in their clinical course or are misdiagnosed, leading to long-term complications. Management of this injury typically depends upon the size of the lesion.

Special Operations medical provider must be familiar with the differential diagnosis for a patient with altered mental status since it includes multiple life-threatening illnesses. Potential diagnoses include meningitis, encephalitis, malaria and many others. While preparing to evacuate to definitive care from an austere location, they must also be prepared to initiate empiric therapy that is specific to the patient and the area of operations.

We present a case of a U.

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We will review the key differential diagnoses for this presentation with a focus on infectious etiologies. We will also summarize current diagnostic and therapeutic strategies. Our recommendation is to initiate oral acyclovir when IV acyclovir is not available and this diagnosis cannot be excluded. Mabry RL , Frankfurt A. This study examines the specific intervention of pre-hospital cricothyrotomy PC in the military setting using the largest studies of civilian medics performing PC as historical controls.

The goal of this paper is to help define optimal airway management strategies, tools and techniques for use in the military pre-hospital setting. Methods: This retrospective chart review examined all patients presenting to combat support hospitals following prehospital cricothyrotomy during combat operations in Iraq and Afghanistan during a month period. A PC was determined "successful" if it was documented as functional on arrival to the hospital. All PC complications that were documented in the patients' record were also noted in the review. Results: Two thirds of the patients died.

The most common injuries were caused by explosions, followed by gunshot wounds GSW and blunt trauma. Eighty-two percent of the casualties had injures to face, neck or head. Those injured by gunshot wounds to the head or thorax all died. Complications were not significantly different than those found in civilian PC studies, including incorrect anatomic placement, excessive bleeding, air leak and right main stem placement. The survival rate and complication rates are similar to previous civilian studies of medics performing PC.

However the failure rate for military medics is three to five times higher than comparable civilian studies. Further study is required to define the optimal equipment, technique, and training required for combat medics to master this infrequently performed but lifesaving procedure. Waterborne infection is an important cause of morbidity and mortality throughout the world. Personal hydration packs have been used by military personnel since the Gulf War and are now a common issue item.

Since military personnel tend to operate under austere conditions and may use a variety of water sources, preventing the acquisition of waterborne infections is extremely important. Further, since hydration pack water reservoir replacements may not be available during combat operations, the development of a reliable cleaning protocol for use in the field is essential. Several methods for cleaning have been described.

The study results suggest that the use of bleach and proprietary CAMELBAK tablets should be encouraged since they both operate by releasing bactericidal chlorine compounds into solution, which is more effective at reducing post-treatment bacterial burden. Background: Tactical combat casualty care TCCC is a system of prehospital trauma care designed for the combat environment. Although widely adopted, very few studies have reported on how TCCC interventions are actually delivered on the battlefield, from a quality of care perspective. Primary outcomes were whether or not two TCCC interventions were underused, overused, or misused.

Interventions studied were needle decompression of tension pneumothoraces and tourniquet application for exsanguinating extremity injuries. Results: One hundred thirty-four trauma patients were treated at the Role 3 MMU during the study period. Six patients had eight tourniquets applied. Five tourniquets were applied to four patients appropriately and saved their lives.

There was one case of misuse where a venous tourniquet was applied. There was one case of overuse where one patient had two tourniquets placed for 4 hours on extremities with no vascular injury. There were seven cases where needle decompression was underused: Seven patients presented with vital signs absent with no needle decompression. There was one case of overuse of needle decompression. There were seven cases of misuse where the patients were decompressed too medially. Conclusions: Tourniquets save lives. Needle decompression can save lives, but is usually performed in patients with multiple critical injuries.

TCCC instructors must reinforce proper techniques and indications for each procedure to ensure that the quality of care provided to injured soldiers on the battlefield remains high. The Department of Defense DoD faces unprecedented challenges as the Nation confronts balancing a strong military to confront threats with the realities of diminishing financial resources. That each warfighter is a critical resource was underscored the Special Operations principal tenet "humans are more important than hardware. This article is the first in a new series relating to HPO, and we define the term and concept of HPO, describe other phrases used e.

Last, we introduce an integrated model for HPO. Keywords: human performance optimization ; demands ; resource ; OODA loop. Keywords: interviews ; Viola, Steven. SERE schools are responsible for preparing military members for these situations, but the concept of SERE medicine is not particularly well defined.

To provide a comprehensive working description of SERE medicine, operational and training components were examined. Ideally, medical lessons taught in SERE training are based on actual documented events. Unfortunately, the existing body of literature is dated and does not appear to be expanding. In this article, four distinct facets of SERE medicine are presented to establish a basis for future discussion and research.

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Recommendations to improve SERE medical curricula and data-gathering processes are also provided. Keywords: SERE ; survival, evasion, resistance, escape ; captivity ; isolation ; wilderness. Introduction: Prehospital care documentation is crucial to improving battlefield care outcomes. This study documents length of time and accuracy of U.

Army Combat Medic trainees in completing the minimum preestablished required fields on the TCCC card, establishing a baseline for point-of-injury cards. Design and Methods: This was a prospective observational study in which U.

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Army combat medic trainees were timed while recording data on the TCCC card in both the classroom and simulated combat environment. Results: We enrolled U. Conclusion: Results imply that the TCCC card is well designed to quickly and accurately record prehospital combat injury information. Further investigation and future studies may compare other prehospital data collection methods with the TCCC card in terms of timely and accurate data collection.

Background: Public health personnel from the 28th Combat Support Hospital in Baghdad, Iraq, conducted an outbreak investigation in response to many local cases of gastrointestinal GI illness presenting to U. The investigation was conducted to identify the source of the illness, assess the extent of cases, and make recommendations to prevent similar outbreaks. Methods and Materials: For this retrospective cohort study, medical records and patient outbreak questionnaires were reviewed.

A patient case, relative to the outbreak, was defined as any person who had developed a GI illness and presented for medical evaluation to either sick call or an emergency service at a diplomatic or military medical facility in Baghdad from 30 September to 12 October Results: A total of people met the case definition.

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Other symptoms included abdominal cramps, fatigue, and headache. Five salad ingredients had significantly elevated levels of Escherichia coli. Conclusion: Mitigation strategies to reduce the probability of similar outbreaks include purchasing food solely from approved vendors or thoroughly cooking all foods, including fruits and vegetables. Keywords: gastrointestinal illness ; Escherichia coli ; public health. Closed circuit underwater breathing apparatus UBA have gained popularity in recreational diving. Closed circuit UBAs carry a unique set of risks to the diver. We present the case of a diver who lost consciousness while diving and had pulmonary abnormalities.

The case is illustrative of the diving related problems associated with closed circuit UBA that a physician may be faced with. The genus Acinetobacter has long been associated with war wounds. Indeed, A baumannii was responsible for so many infected wounds during Operation Iraqi Freedom that it was given the nickname "Iraqibacter. A junii is an infrequently reported human pathogen. Here, we report a case of a slow-healing wound infection with A junii in a woman on the island of Oahu. This case highlights the pathogenic potential of this organism and the need for proper wound care when dealing with slow-healing wounds of unknown etiology.

It also underscores the need for identifying species of Acinetobacter that are not A baumannii to better understand the epidemiology of slow-healing wound infections. Keywords: Acinetobacter junii ; emerging infection ; Hawaii ; Oahu ; wound. Keywords: sedation ; analgesia ; prolonged field care ; guidelines. Androgen use outside of legitimate medical therapy is a perceived concern that is drawing attention across military and specifically Special Operations Forces SOF communities.

For leadership and the medical community to properly address the issue and relate to those individuals who are using or considering use, it will be crucial to understand the scope of the problem. Limited data suggest that the prevalence of androgen use may be increasing, and inferences made from the scientific literature suggest that SOF may be a population of concern.

William C Buhrow (Author of Biometrics in Support of Military Operations)

While risks of androgen use are well known, there are little data specific to military performance that can be applied to a rigorous risk:benefit analysis, allowing myths and poorly supported theories to perpetuate within the community. Further efforts to define the potential benefits balanced against the short- and longterm risks should be undertaken.

Providers within the SOF community should arm themselves with information to engage androgen users and leadership in meaningful discussion regarding androgen use. Keywords: androgen steroids ; protein building. Increasing data and anecdotal operational reports are supporting the early, aggressive, prehospital application of tourniquets in potentially life-threatening extremity trauma. Especially in the civilian urban setting where transport times are short, the benefit in terms of lives saved far outweighs the potential risk to the extremity.

The popular press has reported frequently on law enforcement- applied tourniquets, but to date, no group has published a scientific review of any of these cases. This case report suggests that law enforcement personnel can be trained to safely identify indications for tourniquet application, properly apply them with limited training, and function as effective first care providers. Keywords: tourniquet ; law enforcement ; tactical medicine. Medical intelligence is an underused or sometimes misapplied tool in the protection of our Soldiers and the execution of nonkinetic operations.

The somewhat improved infrastructure of the operational environment in Iraq and Afghanistan led to an inevitable sense of complacency in regard to the threat of disease nonbattle injury DNBI. The picture changed somewhat in with the advent of the village stability program and the establishment of SOF camps in austere locations with degraded living situations rife with exposure risks. In addition, the increasing deployments to unstable locations around the globe, reminiscent of typical Special Operations Forces SOF missions before the Global War on Terrorism, indicate a need for better preparation for deployment from the standpoint of disease risk and force health protection.

A knowledge gap has developed because we simply did not need to apply as stringent an evaluation of DNBI risk in environments where improved life support mitigated the risk for us. The tools necessary to decrease or even eliminate the impact of DNBI exist but they must be shared and implemented.

This article will present four vignettes from current and former SOF Force Health Protection personnel starting with a simple method of executing Medical Intelligence Prep of the Environment MIPOE and highlighting situations in which it either was or could have been implemented to mitigate risk and decrease the impact on mission accomplishment and individual operators. A follow-on article will present vignettes of the successful application of MIPOE to nonkinetic operations.

Keywords: Medical Intelligence Prep of the Environment ; nonkinetic operations ; disease nonbattle injury. Regner D , Frykholm P. Background: Airway management is a critical skill that may be essential in the battlefield. Methods: Eight military medics with limited clinical experience and no airway management experience secured the airway on 19 intrahospital anesthetized patients using the LTS-D and the LMA.

Each patient was treated with both airway adjuncts in a randomized order. Each medic was studied on at least two and not more than three patients. Success of insertion, number of attempts, and time to correct placement with verified ventilation were recorded. With the second patient, the first-attempt success rate was For all patients, the accumulated first-attempt success rate was On the second intervention with the LMA, there was a significant decrease in mean time to verified ventilation, from Conclusion: This study suggests that for the safe use of the laryngeal tube suction by inexperienced airway providers, a clinical training program is required.

We therefore recommend the LMA as the primary airway adjunct for military medics, despite a hypothetically inferior protection from aspiration. Keywords: airway ; airway management ; combat ; education ; laryngeal tube ; laryngeal tube suction ; laryngeal mask ; military medicine ; supraglottic airway.

Military personnel are at an increased risk for exposure to arthropod- borne and zoonotic pathogens. The prevalence of these pathogens has not been adequately described in the country of Georgia. As the Georgian military moves toward an increased level of capability and the adoption of European Union and North Atlantic Treaty Organization standards, international field exercises will become more frequent and will likely involve an increasing number of international partners. This study was undertaken with the goal of defining the arthropod-borne and zoonotic pathogen threat in Georgia so force health protection planning can proceed in a rational and data-driven manner.

To estimate disease burden, blood was taken from 1, Georgian military recruits between October and February and screened for previous exposure to a set of bacterial and viral pathogens using a antibody-based, serologic procedure. The highest rate of exposure was to Salmonella enterica serovar Typhi, and the lowest rate of exposure was to Coxiella burnettii the causative agent of Q fever. These data provide insight into the prevalence of arthropod-borne infections in Georgia, fill a critical knowledge gap, will help guide future surveillance efforts, and will inform force health protection planning.

This enabled a single rescuer to focus attention and provide care for other critical aspects of a multisystem trauma patient. Keywords: articulating tactical traction splint ; pulseless forearm fracture ; fracture. Background: The purpose of this study was to assess the skills of trainers using different junctional tourniquet models to control groin bleeding in a manikin.

Materials and Methods: In assessments, 17 trainers used four junctional tourniquet models three times each to control simulated hemorrhage. The criteria of assessment included effectiveness i. Results: All uses were effective. The means sharing a level were not significantly different, but a mean in more than one level was not different from itself. The ease of use varied significantly; JETT was more difficult to use and all others were easier. Conclusion: Effectiveness was attained by all users with each of the four models of junctional tourniquet. Keywords: tourniquet ; hemorrhage prevention and control ; shock ; damage control ; resuscitation ; emergency medical services ; education ; standards ; methods ; military medicine ; medical device ; first aid ; inguinal.

Background: The effects of users, glove types, and tourniquet devices on the performance of limb tourniquet use in simulated first aid were measured. Materials and Methods: Four users conducted tests of tourniquet performance in eight glove groups compared with bare hands as a control. Glove effects impaired and slowed performance; three groups cold gloves layered under mittens, mittens, and cold gloves consistently had significant effects and five groups examination gloves, flight gloves, leather gloves, glove liners, and glove liners layered under leather gloves did not.

For time to bleeding control and blood loss, performance using these same three glove groups had worse results compared with bare hands by 26, 18, and 17 seconds and by , , and mL, respectively. Device effects occurred only with continuous metrics and were often dominated by user effects. Conclusion: In simulated first aid with tourniquets used to control bleeding, users had major effects on most performance metrics.

Glove effects were significant for three of eight glove types. Tourniquet device effects occurred only with continuous metrics and were often dominated by user effects. Keywords: glove ; mitten ; manual skill ; psychomotor performance ; tourniquet ; first aid ; hemorrhage, prevention and control. Background: Caffeine, tobacco, and alcohol are the most widely used substances globally, but the majority of research on the associations among legal substance use and physical health has focused on the general population, not elite military personnel. The purpose of the current study was to describe patterns of tobacco, alcohol, and caffeine use and to examine the relationship of legal substance use with self-reported physical health complaints among US Air Force Pararescuemen PJs and Combat Rescue Officers CROs.

Participants completed self-report measures of legal drug use and somatic symptoms. Generalized linear modeling with robust maximum likelihood estimation was used for multivariate regression analyses. Chi-square analyses were conducted for univariate comparisons of categorical variables. Results: Reported rates of tobacco use Participants with severe extremity pain also reported drinking approximately twice as many alcoholic beverages per week mean, 5. Conclusion: Back and extremity pain is associated with greater caffeine and alcohol consumption among PJs. Keywords: military ; caffeine ; alcohol ; tobacco ; pain ; Pararescuemen.

Our nation's servicemembers commonly use dietary supplements to enhance their performance. Despite this prolific use, many of these products have detrimental side-effects that compromise servicemembers' health and could, by proxy, compromise a mission. This paper presents the case of a year old Navy Special Operations Forces SOF Sailor who, prior to physical training, used a supplement containing 1,3 Dimethylamylamine DMAA , and then developed atrial fibrillation with rapid ventricular response.

He required intravenous calcium channel blocker administration, followed by beta blockers, for rate control. As military providers, we routinely ask our patients about their use of supplements and while the regulation of these products is beyond the scope of practice for most of us, it is our duty to become better educated about the risks and benefits of these supplements. We must educate our patients and our commands on the potential harm that these supplements may pose.

Nerve agents are a threat to military and civilian health. The antidote, atropine sulfate, is delivered by autoinjector, which is a limited resource. Keywords: nerve agent ; chemical warfare ; atropine ; antidote ; alternative treatment. Gay DG , Paul J. This article defines the concept of program-induced cumulative overload PICO , provides examples, and advises ways to mitigate the adverse effects.

PICO is the excessive cumulative physical workload that can be imparted to military personnel by a military training program with an embedded physical training component. PICO can be acute accumulating within a single day or chronic accumulating across the entirety of the program and results in adverse outcomes for affected personnel, including detrimental fatigue, performance degradation, injuries, or illness. Strategies to mitigate PICO include focusing administration and logistic practices during the development and ongoing management of a trainee program and implementing known musculoskeletal injury prevention strategies.

More training is not always better, and trainers need to consider the total amount of physical activity that military personnel experience across both operational training and physical training if PICO is to be mitigated. Keywords: injuries, overload ; training ; prevention ; programming. Previously Published in Psychiatry Edgemont ;5 7 Introduction: Although dissociation at the time of trauma peritraumatic dissociation has been shown to predict the development of posttraumatic stress disorder PTSD , it is not yet known whether the tendency to dissociate under nonstressful circumstances i.

Results: Soldiers who endorsed experiencing any symptoms of dissociation at baseline were significantly less likely to be successful in SFAS. The greater the number of symptoms of dissociation endorsed at baseline, the greater the likelihood of failure. Discussion: These data explain our earlier findings of fewer symptoms of dissociation in elite troops and may have relevance for the selection and hiring of personnel for nonmilitary, at-risk professions. Better screening may lead to improved primary intervention strategies, better job placement, and lowered risk of PTSD.

Keywords: biostatics, statistics ; tests ; specificity ; sensitivity. The reasons for this remain unclear. This study expands on previous reports by evaluating a larger prehospital dataset for determinants of analgesia administration. Methods: This was part of an approved quality assurance project evaluating adherence to TCCC guidelines across multiple modalities. Data were from the Prehospital Trauma Registry, which existed from January through September , and comprises data from TCCC cards, Department of Defense forms, and after-action reports to provide real-time feedback to units on prehospital medical care.

Results: Of total patient encounters, there were documented administrations of analgesic medications given to patients.