Casualty evacuation in arctic and extreme cold environments: A paradigm shift for traumatic hypothermia management in tactical combat casualty care.

In Arctic or extreme cold environments of Alaska, trauma care is complicated by large expanses of geography and lack of forward-positioned resources. This paper presents four hypothetical vignettes highlighting austere cold medical priorities: (1) traumatic hypothermia management as part of Tactical Combat Casualty Care (TCCC) is clinically and tactically important and hypothermia needs to be reprioritized in the MARCH algorithm to MhARCH; (2) at present it is unknown which TCCC recommended medical equipment/supplies will function as designed in the extreme cold; (3) ensuring advanced resuscitative care measures are available serves as a temporal bridge until casualties can receive damage control resuscitation (DCR); and (4) current systems for managing traumatic hypothermia in TCCC and casualty evacuation (CASEVAC) are insufficient. In conclusion, numerous assessments recognise the DoD's current solutions for employing medical forces in Arctic operations are not optimally postured to save lives. There should be a joint standard for fielding an arctic supplement to current medical equipment sets. A new way of thinking in terms of an "ecosystem" approach of immediate casualty protection and movement in CASEVAC doctrine is needed to optimise these "Golden Minutes."

Medical Redeployment in Soldiers With and Without Medical Deployment Waivers.

BACKGROUND: Historically, disease and nonbattle injuries (DNBI) have caused more casualties during military operations than enemy combatants. Recent deployments to U.S. Central Commands (USCENTCOM) area of operation (AOR) have demonstrated similar outcomes. Intuitively, appropriate medical standards for our deploying Soldiers should result in no greater redeployments rates for those Soldiers who are waived for various medical conditions. However, no formal study has been published on redeployment rates of Soldiers with medical deployment waivers. The objective of this report was to evaluate the redeployment rates of Soldiers with and without medical waivers. METHODS: A matched retrospective cohort study design was used in this study. Data were obtained from USCENTCOM, Army Central Command, Transportation Command, and the Armed Forces Health Surveillance Center. All U.S. Soldiers deploying to USCENTCOM's AOR with a medical deployment waiver during the calendar years of 2008-2013 were eligible for inclusion into the exposure group of this study. Soldiers with a medical deployment waiver were matched 1:5 to Soldiers without a medical deployment waiver. The Soldiers with a medical deployment waiver and their matched counterparts were then subdivided into 5 strata on the basis of their diagnosis. A McNemar's χ2 test was performed to calculate risk ratios (RRs) per strata and for the group as a whole. RESULTS: The overall risk of being medically evacuated because of DNBI for all medical deployment waivers was an RR of 2.03 (CI: 1.74, 2.36). The greatest risk of being medically evacuated because of DNBI was from the group of Soldiers on a waiver for neurological conditions with an RR of 3.81 (CI: 1.99, 7.30). The RR of medical evacuation because of DNBI was increased and statistically significant for all strata (p < 0.05). CONCLUSION: There is a statistically significant increased RR of Soldiers with a Modification of the Operational Order waiver being medically redeployed for a DNBI reason from USCENTCOM's AOR from 2008 to 2013 compared with their matched peers without a waiver. The results of this study provide Commanders with additional information when making decisions regarding Soldier deployment.