Humanitarian Assistance Lessons Learned From Providing Acute Medical Care for Afghan Nationals on a U.S. Military Base.

Operation Allies Welcome provided a unique opportunity for military medical personnel to engage in humanitarian assistance operations on military bases in the USA. With thousands of Afghan nationals evacuated from Kabul in August 2021 to various military installations across the USA, the Military Health System was tasked with health screening, emergency care, and disease prevention and surveillance in resource-limited settings. Marine Corps Base Quantico served as a "safe haven" site from August to December 2021, providing refuge to nearly 5000 travelers awaiting resettlement. During this time, active duty medical personnel provided 10,122 primary and acute patient encounters to patients aged < 1 to 90 years. Pediatrics represented 44% of the total encounters and children aged less than 5 years represented nearly 62% of the pediatric visits. In caring for this population, the authors were able to learn important lessons about humanitarian assistance capabilities, the difficulties of establishing acute care centers in a resource-limited environment, and the importance of cultural competency. Recommendations include staffing with medical providers that can see a large volume of pediatric, obstetrics, and urgent care visits, with less emphasis on trauma and surgical capabilities, which are the more traditional focus of military medicine. To this end, the authors advocate for the creation of specific humanitarian assistance supply blocks that would focus more on urgent and primary care treatments as well as an ample supply of pediatric, neonatal, and prenatal medicines. Further, early engagement with telecommunications companies when practicing in a remote location can be crucial to mission success. Finally, the medical care team should maintain continued mindfulness of the cultural norms of the population to which aid is given, particularly the gender norms and expectations of Afghan nationals. The authors hope that these lessons can prove informative and may provide increased readiness for future humanitarian assistance missions.

Expeditionary Immersion Circulating Heating Device: A Promising Technique for Treating Frostbite Injuries and Warming Intravenous Fluids in a Forward Deployed Cold Weather Environment.

INTRODUCTION: Cold weather injuries require prompt warm water immersion therapy, which proves to be a difficult task in the cold austere environment. Current guidelines recommend 104 °F water immersion, but producing and maintaining large volumes of warm water is challenging in sub-freezing temperatures. We describe a novel process of utilizing a sous vide immersion circulator to maintain warm fluids for immersion therapy and efficient fluid rewarming in a cold forward-deployed setting for the treatment of cold weather injuries in an effort to bridge the gap between current medical guidelines and practices. MATERIALS AND METHODS: Large water cans were warmed to 104 °F with the immersion circulator. A thermometer was inserted into a 1-inch steak, frozen to 30 °F, and placed in a basin with only the warmed water while the internal temperature was monitored until physiologic temperature was achieved. The time to this endpoint was recorded. A 1-L bag of normal saline and a 450-mL bag of whole blood were also separately warmed by the same technique. The temperature of the normal saline was monitored at 0-, 5-, 7-, 8-, 9-, and 10 -minute intervals. The process was similarly repeated, measuring the whole blood temperature at 0-, 5-, 7-, and 10-minute intervals. RESULTS: Ambient internal tent temperatures averaged 54 °F; outdoor temperatures were consistently sub-freezing. The 5-gallon cans of water at ambient temperature heated to 104 °F in 15 minutes. The water temperature remained constant for 3 weeks with the circulator running. The frozen steak started at 30 °F and reached 98 °F in 52 minutes and 45 seconds. The bag of normal saline and whole blood, refrigerated to 39 °F, achieved temperatures of 102 °F and 94 °F respectively after 10 minutes. CONCLUSION: A heating immersion circulator device is a lightweight, flameless, and inexpensive way to consistently heat large volumes of water for treatment of cold weather injuries, hypothermia, and whole blood rewarming in a cold austere environment.

Managing dislocations of the hip, knee, and ankle in the emergency department [digest].

Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture. This review presents an algorithmic approach to management that ensures that pain relief, imaging, reduction, vascular monitoring, and emergent orthopedic consultation are carried out in a timely fashion. [Points & Pearls is a digest of Emergency Medicine Practice.].

Managing dislocations of the hip, knee, and ankle in the emergency department

Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture. This review presents an algorithmic approach to management that ensures that pain relief, imaging, reduction, vascular monitoring, and emergent orthopedic consultation are carried out in a timely fashion.