Containing the good idea fairy: A deep dive into Navy firearms restriction policy.

STATEMENT OF PROBLEM: US Navy suicide is an ongoing concern, with more than half of suicide deaths each year related to firearms. Although decreasing firearms access by those who are at risk for suicide has been well-established as a tactic for reducing risk, implementation of firearms restrictions has a significant cultural and occupational impact among service members that may increase the stigma of seeking mental health care. During a recent Deep Dive review of all previous year suicide deaths, subject matter experts from across the US Navy identified significant variability in command utilization of firearms restriction. METHODOLOGY: Based on this finding, a review was conducted to identify best practice for firearms restriction related to suicide risk across the US military services and municipal police departments. FINDINGS: Findings from this review suggested that the Department of the Navy may benefit from adopting consistent standards for disarming and rearming service members at risk for suicide, base decisions on objective suicide risk rather than routine stressors, decrease access primarily when service members are off duty, and engage with service members to decrease core drivers of suicide behavior through command channels. IMPLICATIONS: Implementing these recommendations may be a crucial step in balancing precautions to decrease suicide risk with the stigma of firearms restriction in military settings.

Vacuum-assisted closure therapy for a complicated, open, above-the-knee amputation wound.

Negative-pressure wound therapy (NPWT) with a vacuum-assisted closure system has been successfully used in the management of various wounds on the trunk and distal extremities, including diabetic foot ulcers. However, reported successful NPWT cases have involved distal wounds that were below the knee. The authors report a case of an elderly diabetic patient with recalcitrant wounds in his left lower extremity from an above-the-knee amputation. The patient had undergone 27 surgical débridement or revision procedures over the course of 3 months. On entering rehabilitation, the patient had a full-thickness wound in his residual limb that measured 9 × 8 cm. The patient received NPWT with a vacuum-assisted closure system, which resulted in a fully healed residual limb. After 120 days, the patient was ready to begin prosthetic restoration.

Making mental health aerovac decisions in Afghanistan: a field report.

This article focuses on the clinical and administrative decision-making processes involved in medevacing psychiatric patients from Kandahar Airfield, Afghanistan, during major surge operations. This article highlights organizational realities pertaining to the medevac process and offers recommendations for incoming providers to optimize their effectiveness in managing at-risk patients in a combat zone.

The case of Do-Not-Resuscitate (DNR) orders and the intellectually disabled patient.

In the case of an intellectually disabled patient, the attending physician was restricted from writing a Do-Not-Resuscitate (DNR) order. Although the rationale for this restriction was to protect the patient from an inappropriate quality of life judgment, it resulted in a worse death than the patient would have experienced had he not been disabled. Such restrictions that are intended to protect intellectually disabled patients may violate their right to equal treatment and to a dignified death.