The Tägerwilen II report: Recommendations from the NATO Prehospital Care Improvement Initiative Task Force.

BACKGROUND: The Committee of the Chiefs of Military Medical Services (COMEDS) initiated the Prehospital Care Improvement Initiative Task Force (PHCII TF) to advise on how to improve prehospital care within NATO nations. The Task Force consisted of the NATO Military Health Care Working Group and its subordinated expert panels, including the Blood Panel, the Emergency Medicine Panel and the Special Operations Forces Medicine Panel. METHOD: The PHCII TF identified four key prehospital care themes for exploration: 1) Tactical Casualty Care, 2) Blood Far Forward), 3) Forward Surgical Capabilities), and 4) Prolonged Casualty Care. A consensus experimentation workshop explored the four themes, utilizing a modified Delphi technique and Utstein rotations during syndicate work, resulting in 83 consensus statements. The consensus statements were further evaluated on six criteria: actionable, measurable, urgent, interoperability, low risk/threat and impact. RESULTS: The 83 consensus statements, when weighted against the six criteria, resulted in 15 recommendations, focusing on standardization of training, ensuring provision of evidence-based practices and removing legislative barriers to improve prehospital care. CONCLUSION: The recommendations on these four themes reflect the most significant priorities in improving prehospital care, and must be incorporated in the on-going revision of NATO doctrine.

Transgender Policy in Sport, A Review of Current Policy and Commentary of the Challenges of Policy Creation.

This review starts with a brief history of sex policy in sport followed by an exploration of the current state of transgender sport policies. Transgender in sport, from the high school to the professional level, is a frequent news topic. Fairness in women's athletics is at the center of transgender sport policy deliberations and public debate. Despite a long history of policy attempts and revisions, the female category in sport is not precisely and universally established, complicating transgender athlete policy development. Scientific evidence is scant on fairness for transgender athletes. For a variety of social factors, many transgender athletes do not have a positive experience in sports and the younger is the athlete the more challenging it becomes to create inclusive rules. Challenges remain in making competition rules fair, but inclusive, so that transgender athletes participate in sport. The medical and scientific community will continue to provide key input.

Recognition and treatment of freezing and nonfreezing cold injuries.

This article reviews recent medical literature to provide an overview of the recognition and treatment of the two broad categories of cold injuries, freezing and nonfreezing. Frostbite, a freezing cold injury, is treated traditionally with rapid rewarming followed by tissue care and surgical debridement of necrotic tissue. Recently, newer therapies aimed at prevention of tissue necrosis have shown improved outcomes compared with more traditional therapies. These newer treatment regimens for frostbite include the use of various drugs such as ibuprofen, aspirin, warfarin, tissue plasminogen activator, and prostacyclin. The use of Tc bone scans, magnetic resonance imaging arthrogram, or angiography may have prognostic value for early determination of the extent of tissue loss. The more common nonfreezing cold injuries, though less severe than frostbite, may lead to short- and long-term complications requiring treatment and are discussed also.