The Antietam Staff Walk at the Uniformed Services University: A Program Evaluation.

INTRODUCTION: The battle along Antietam Creek in September 1862 was pivotal in shaping future combat medical readiness practices. With the full confidence of his commander, Major (Dr) Jonathan Letterman implemented an innovative ambulance corps system, which contributed immensely to modern-day battlefield medicine. Each year, the Uniformed Services University (USU) holds the Antietam Staff Walk, during which military medical students are engaged by faculty at various "stops" along the 6-mile walk. The four learning objectives for the Antietam Staff Walk are to (1) introduce the role of the "staff ride," (2) orient learners to reading terrain, (3) reinforce the six principles of health service support, and (4) recall the heritage of the military medical officer. The Department of Military and Emergency Medicine at USU commissioned a program evaluation to determine if these course objectives were being met, evaluate the effectiveness of the Antietam Staff Walk as a teaching tool, and make recommendations for improving its educational impact. MATERIALS AND METHODS: We engaged in qualitative program evaluation to evaluate the Antietam Staff Walk course objectives. Our research team analyzed 156 reflection papers written by second-year military medical students attending Antietam in August 2021. We coded each of the papers, noting important words and phrases that were salient to the students' learning experiences at Antietam. Our research team then compiled each of these codes into a master list and then determined how to divide this list into major categories. We collectively defined each of these categories, which served as the resulting themes of this program evaluation. RESULTS: Three themes emerged: (1) creation of an ambulance corps allows for proximal battlefield medicine, (2) a lack of buddy aid inspires Tactical Casualty Combat Care, and (3) disease/nonbattle injury necessitates preventative medicine. The students foremost gained an appreciation for the impact of the ambulance corps and recognized that the ambulance corps not only impacted medical care, but also the mission as a whole. However, may not have completely understood the long, slow evolution of battlefield care and may have overestimated the knowledge of physicians practicing mid-19th century medicine. We provided recommendations for addressing these learning opportunities during future Antietam Staff Walks at USU. CONCLUSIONS: Our review of the Antietam Staff Ride resulted in several curricular recommendations for enhancing its learning impact. Our program evaluation serves as a model for line units and other military organizations to optimize the impact of the historical staff ride as a teaching tool.

Prehospital Pharmacotherapy in Moderate and Severe Traumatic Brain Injury: A Systematic Review.

BACKGROUND: Traumatic brain injury (TBI) affects civilian and military populations with high morbidity and mortality rates and devastating sequelae. As the US military shifts its operational paradigm to prepare for future large-scale combat operations, the need for prolonged casualty care is expected to intensify. Identifying efficacious prehospital TBI management strategies is therefore vital. Numerous pharmacotherapies are beneficial in the inpatient management of TBI, including beta blockers, calcium channel blockers, statins, and other agents. However, their utility in prehospital management of moderate or severe TBI is not well understood. We performed a systematic review to elucidate agents of potential prehospital benefit in moderate and severe TBI. METHODS: We searched 6 databases from January 2000 through December 2021 without limitations in outcome metrics using a variety of search terms designed to encapsulate all studies pertaining to prehospital TBI management. We identified 2,142 unique articles, which netted 114 studies for full review. Seven studies met stringent inclusion criteria for our aims. RESULTS: Studies meeting inclusion criteria assessed tranexamic acid (TXA) (n=6) and ethanol (n=1). Of the TXA studies, 3 were randomized controlled trials, 2 were retrospective cohort studies, 1 was a prospective cohort study, and 1 was a meta-analysis. Notably absent were papers investigating therapeutics shown to be beneficial in inpatient hospital treatment of TBI. Overall, data suggest TXA administration is potentially beneficial in moderate or severe TBI with or without intracranial hemorrhage. Severe TBI with or without penetrating trauma was associated with worse overall outcomes, regardless of TXA use. CONCLUSION: Effective interventions for treating moderate or severe TBI are lacking. TXA is the most widely studied pharmacologic intervention and appears to offer some benefit without adverse effects in moderate TBI (with or without intracranial hemorrhage) in the pre-hospital setting despite heterogeneous results. Limitations of these studies include heterogeneity in outcome metrics, patient populations, and circumstances of TXA use. We identified a gap in the literature in translating agents with demonstrated inpatient benefit to the prehospital setting. Further investigation into these and other novel therapeutic options in the prehospital arena is crucial to improving clinical outcomes in TBI.

History of US Army Whole Blood on the Battlefield.

Brigadier General Douglas Kendrick warned in his seminal work on the blood program of the Second World War, "It was only by the strictest attention to such matters that blood was able to achieve its miracles, and, equally important, was prevented from becoming a deadly agent. It must never be forgotten that without proper care, blood can be lethal." His point lay in the details offered. It was only by adherence to attention to detail in procurement, storage, and delivery the miraculous powers of blood can be achieved. Throughout his historical documentation, the requirement for special training of personnel handling blood was emphasized and documented. Deviating from prescribed storage temperatures, rough handling, exceeding shelf life, improperly matching blood types, and contaminating the blood are some of the various improper care that produce a negative patient outcome. Bacterial infection, toxicity, hypoxemia, and antibodies in the blood are just a few examples and could ultimately lead to death. This article focuses on the means of this miracle in briefly telling the story of whole blood on the battlefield by the US Army.

The AMSUS History of Military Medicine Essay Award. The story of the mobile army surgical hospital[corrected].

The critical task of the physician uniting effective surgical intervention within close proximity to the front lines, and therefore the wounded, must be matched with the challenge of not becoming a casualty as well. The U.S. Army Medical Services during the Korean War balanced the surgeon's ability to protect himself and save others. This article tells the story of perhaps one of the most characteristically highlighted medical aspects of the Korean War, the Mobile Army Surgical Hospital. Originally intended to be close to the front lines of fighting, the Mobile Army Surgical Hospital was equipped to move on its own. Initially, the unit was formed to provide surgical capabilities for one division. It transformed through the course of the war into a multidivision and multinational all-purpose hospital. With this expansion in workload (medical cases in addition to surgery) without an equitable increase in personnel, rapid evacuation of patients was the only means of keeping up.