Evaluation of Gender Disparity in Tactical Combat Casualty Care.

INTRODUCTION: Women comprise nearly 19% of the U.S. military and now serve in almost all operational roles, increasing their risk of combat trauma and injuries.3 Data from the Joint Trauma Registry during Operation Enduring Freedom shows that battle-injured females had a higher case fatality rate at 36% compared to their male counterparts at 17%.1 The Tactical Combat Casualty Care curriculum is used to prepare battlefield medics to provide immediate care to wounded service members, but fails to address differences in the care of female versus male casualties. The students, who are presented with life-threatening injuries in simulated trauma scenarios, may be slower to assess, identify, and treat injuries in female patients as compared with male patients. MATERIALS AND METHODS: This observational program analysis was reviewed by the Uniformed Services University Human Research Protections Program and approved for execution as an exempt protocol under the provision of 32 CFR 219.104(d)(1). The study assessed the performance of male and female Mexican military personnel during a Tactical Combat Casualty Care course, using standardized trauma scenarios. Anatomically, correct male and female manikins were used to compare response time for different gender patients presenting with the same injuries. RESULTS: There was a statistically significant increase in time required to complete an initial blood sweep, identify a gunshot wound to the chest, and call for medical evacuation when treating a female patient compared to a male patient. CONCLUSIONS: A lack of female representation in trauma training may have contributed to the higher case fatality rate of female soldiers compared to male soldiers during Operation Enduring Freedom. Female live actors and Gender Retrofit Kits can augment trauma casualty assessment and treatment training scenarios and better prepare our forces to respond to life-threatening emergencies.

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients.

Background/propose. Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. MATERIAL AND METHODS: A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and pre-liver transplant clinics. RESULTS: We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). CONCLUSIONS: The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.