Expanding a professional dental care system: experiences of Task Force 261 Multifunctional Medical Battalion during Operation Iraqi Freedom 07-09.

During Operation Iraqi Freedom 07-09, Task Force 261 Multifunctional Medical Battalion managed an extensive dental care system stretching throughout the Iraq theater of operations. We illustrate several of the unique challenges faced by Task Force 261's headquarters and its dental and area support companies, and describe the remedies emplaced by the Task Force. Personnel structure, the evacuation chain, supply and facility management, dental civil-military operations, detainee care, information technology applications, and public health initiatives are discussed in detail.

Satellite and mobile wireless transmission of focused assessment with sonography in trauma.

OBJECTIVES: Focused assessment with sonography in trauma (FAST) can define life-threatening injuries in austere settings with remote real-time review by experienced physicians. This study evaluates vest-mounted microwave, satellite, and LifeLink communications technology for image clarity and diagnostic accuracy during remote transmission of FAST examinations. METHODS: Using a SonoSite, FAST was obtained on three patients with pericardial and intraperitoneal effusions and two control subjects in a remotely located U.S. Army Combat Support Hospital. A miniature vest-mounted video transmitter attached to the SonoSite sent wireless ultrasound video 20 m to a receiving antenna. The signal was then transferred over VSAT satellite systems at 512 kilobaud per second (kbps), INMARSAT satellite systems at 64 kbps, and over LifeLink on a moving ambulance through a metropolitan wireless traffic-management network. Clarity and absence or presence of effusions were recorded by 15 staff emergency physicians. RESULTS: Average sensitivity, specificity, and accuracy were 87% (95% confidence interval [CI]=79% to 95%), 85% (95% CI=81% to 89%), and 86% (95% CI=82% to 90%) for the Premier Wireless Vest; 98% (95% CI=97% to 99%), 83% (95% CI=75% to 91%), and 86% (95% CI=82% to 90%) for VSAT; 95% (95% CI=94% to 96%), 70% (95% CI=58% to 82%), and 75% (95% CI=70% to 80%) for INMARSAT; and 82% (95% CI=73% to 91%), 83% (95% CI=74% to 92%), and 82% (95% CI=78% to 86%) for LifeLink with clarity of 3.0 (95% CI=2.7 to 3.3), 2.9 (95% CI=2.6 to 3.2), 1.3 (95% CI=1.2 to 1.4), and 2.1 (95% CI=1.8 to 2.4), respectively. CONCLUSIONS: Accuracy correlated with clarity. Roaming vest transmission of FAST provides interpretable, diagnostic imagery at the distances used in this study. VSAT provided the best clarity and diagnostic value with the lighter, more portable INMARSAT serving a lesser role for remote clinical interpretation. LifeLink performed well, and further infrastructure improvements may increase clarity and accuracy.

Unenhanced helical CT scanning of the abdomen and pelvis changes disposition of patients presenting to the emergency department with possible acute appendicitis.

This study sought to determine if obtaining an unenhanced abdominopelvic computed tomography (UHCT) scan alters the disposition of patients presenting to the Emergency Department (ED) with signs and symptoms of acute appendicitis. A convenience sample of 101 patients presenting with a clinical picture suggestive of appendicitis were prospectively enrolled. Emergency physicians (EPs) and general surgeons independently recorded their anticipated disposition of each patient as: discharge, admit for observation, or admit for appendectomy. A UHCT scan was then obtained and the patient's ultimate disposition recorded. EPs altered their dispositions after UHCT scanning in 35 patients (34.7%, 95% CI 25.4% to 44.0%), and general surgeons altered their dispositions in 27 patients (26.7%, 95% CI 18.1% to 35.3%). More patients underwent operative intervention than were originally selected by EPs [14 additional patients, (13.9%, 95% CI 7.1% to 20.6%)] or by surgeons [20 additional patients, (19.8%, 95% CI 12.0% to 27.6%)]. CT scan revealed alternative diagnoses in 20 patients (19.8%). UHCT scanning significantly alters patient disposition, and significantly increases the number of operative interventions performed in patients with suspected appendicitis. UHCT scanning may also identify alternate pathology that clinically mimics appendicitis.

Pertussis in a military and military beneficiary population: case series and review of the literature.

Three cases of pertussis (whooping cough) identified in a military emergency department are reported. Two of these cases involved infants with typical presentations. One of these infants was too young to have received immunizations, and the other child was only partially immunized. The third case involved an active duty soldier with a chronic cough. Pertussis has become increasingly important as a cause of chronic cough in adults. As a result of the infectivity of this organism, close-quarter situations, such as day care centers and military barracks, create the opportunity for substantial person-to-person transmission. Typical and atypical clinical presentations of pertussis are discussed, with an emphasis on currently available diagnostic modalities. The epidemiology and pathophysiology of this disease are also reviewed. The medical management of active duty soldiers and their dependents (both pediatric and adult) with this largely underappreciated infection and their close contacts is presented.