Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.624
Filtrar
1.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 3-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666904

RESUMO

There is inconsistency in the training of military medical providers on the regulations and procedures outlining US Army-specific psychiatric readiness related competencies. These competencies are necessary to ensure the appropriate categorization of a soldier's psychiatric readiness. There exists a need for a formal, comprehensive training curriculum accessible to all providers that is time- and cost-effective. Due to the COVID-19 pandemic, there is are additional barriers of social distancing, remote virtual healthcare delivery, and geographic dispersion of healthcare personnel. To address these concerns, we developed a curriculum to target these competencies and deliver them virtually. The curriculum was developed and executed based on Kern's six-step approach to curriculum development, and the objective was to train military behavioral health providers on temporary duty limitations, administrative separations, and medical board referrals based on current US Army policies and procedures. The training was implemented virtually and conducted over the course of 3-hour training sessions to two separate groups. Evaluation of training objectives was conducted via a survey of paired before and after questions, analyzing the change in perceived confidence among learners. Among the 58 respondents, training resulted in statistically significant improvement in confidence in recognizing when a US Army soldier needs a temporary profile, writing a temporary e-profile, deciding when it is critical to contact a US Army soldier's commander, executing administrative separation, deciding when a US Army soldier is at medical retention determination point (MRDP), and in referring a US Army soldier to medical board. Results show the feasibility of virtual training to enhance medical readiness-related competencies of healthcare providers at the enterprise-level to help improve medical readiness. Limitations included immediate and subjective aspects of our results. It is unclear whether our training or similar training sessions resulted in changes in behaviors such as increased profiling or medical board referrals.


Assuntos
Medicina do Comportamento/educação , Competência Clínica , Currículo , Educação a Distância , Medicina Militar/educação , Psiquiatria/educação , /epidemiologia , /transmissão , Humanos , Autoimagem , Inquéritos e Questionários
2.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 104-107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666920

RESUMO

Since the onset of the COVID-19 pandemic in late 2019, the world community has responded with ever-evolving measures to reduce the spread of SARS CoV-2, the virus that causes COVID-19 (Coronavirus Disease 2019)1. One particular area of interest is understanding the risk of the in-person classroom setting and if any mitigation efforts are effective in preventing the spread of disease in that setting. In this paper, we present a case study of a US Army Advanced Individual Training (AIT) course/classroom wherein a student was diagnosed with COVID-19, and there was no apparent spread to others in his classroom. We discuss the mitigation efforts put in place that appear to be, in this case, effective in preventive onward spread of the virus. These are social distancing, face coverings/masks, and hygiene practices including hand washing and sanitation of surfaces.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Medicina Militar/educação , Militares , Adulto , /transmissão , Desinfecção das Mãos , Humanos , Masculino , Máscaras , Escolas de Enfermagem/organização & administração
3.
Br J Sports Med ; 54(22): 1314-1320, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32912847

RESUMO

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Medicina Militar/educação , Medicina Esportiva/educação , Atletas/educação , Técnica Delfos , Humanos , Medicina Militar/organização & administração , Militares/educação , Medicina Esportiva/organização & administração , Participação dos Interessados , Estados Unidos , Universidades
4.
Wilderness Environ Med ; 31(1): 110-115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32734896

RESUMO

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.


Assuntos
Medicina Aeroespacial/educação , Educação Médica/organização & administração , Terapia por Exercício/educação , Ambientes Extremos , Oxigenação Hiperbárica , Medicina Militar/educação , Medicina Selvagem/educação , Conflitos Armados , Humanos , Meio Selvagem
5.
J Spec Oper Med ; 20(2): 95-103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573744

RESUMO

At present, however, there is no systematic, comprehensive quality assurance program for TCCC training throughout the DoD. Individual courses and instructors may or may not use all of the materials in the JTS-approved curriculum; they may or may not add content that is not part of the JTS curriculum; and they may or may not add additional training in the form of advanced simulation, hands-on training with moulaged casualties, graded trauma lanes, or live-tissue training. A recent pilot appraisal of four Tactical Combat Casualty Care for Medical Personnel (TCCC-MP) training courses found that TCCC-MP courses are not presenting all of the course material recommended by the Joint Trauma System (JTS), despite TCCC training having been mandated by the Department of Defense (DoD) for all US military personnel. Some of the omitted material is essential to ensuring that students are fully prepared to perform TCCC on the battlefield. Further, there was incorrect messaging presented in the TCCC-MP courses that were appraised, some of which, if actually reflected in the care provided on the battlefield, would likely result in adverse casualty outcomes. Other aspects of the TCCC messaging presented in the appraised courses that is not at present part of the JTS-approved curriculum might, however, be appropriate for inclusion into the TCCC Guidelines and the course curriculum. Examples of material that should be considered for incorporation into the TCCC curriculum include modifying the method of tranexamic acid (TXA) administration (slow IV push vs the currently recommended 10-minute infusion) and a better technique for securing of the new CAT Generation 7 tourniquets after application. The course appraiser also noted that there were a number of excellent videos of actual TCCC interventions being performed that are not part of the current JTS-approved TCCC-MP curriculum. These videos should be forwarded to CoTCCC staff and the Joint Trauma Education and Training (JTET) branch of the JTS for consideration as potential additions to the TCCC-MP curriculum. Consideration should also be given to the inclusion of additional TCCC training modalities such as advanced simulators, moulaged casualties, graded trauma lanes, autologous blood transfusion training, and the use of live-tissue training (when logistically feasible) for selected course items such as surgical airways. Further, the 16-hour training time currently allotted for TCCC-MP training was found to be insufficient to present all of academic material and testing contained in the existing TCCC-MP curriculum. A 5-day course should be considered to include the entire JTS-recommended curriculum and to add graded trauma lanes and autologous blood transfusion training to the core JTS TCCC-MP curriculum. The post-course written testing also needs to use the standardized TCCC fund of knowledge questions and the TCCC Critical Decision Case Study questions developed by the JTS. Finally, there is a need to establish a systematic and standardized quality assurance program to ensure that TCCC training programs are carried out in accordance with the JTS-recommended TCCC curriculum. This program would best be performed as a new function of the CoTCCC with dedicated TCCC course appraisers.


Assuntos
Medicina Militar/educação , Garantia da Qualidade dos Cuidados de Saúde , Lesões Relacionadas à Guerra/terapia , Humanos
6.
Medicine (Baltimore) ; 99(20): e20230, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443354

RESUMO

Disaster medicine education in medical curricula is scarce and frequently nonexistent. It is reasonable to initiate educational approaches for physicians in this field at the medical school level. An understanding of disaster medicine and the health care system during massive casualty incidents has been recommended as an integral part of the medical curriculum in the United States and Germany.The goal of the reformed curriculum was to develop a longitudinal integrated disaster and military medicine education program extending from the first year to the sixth year based on previously separated clinical and military medicine topics. Emergency medicine physicians, military emergency medical technicians, and Tactical Combat Casualty Care instructors formed an interprofessional faculty group and designed a learning curriculum.A total of 230 medical students participated in the revised disaster preparedness curriculum. Satisfaction survey response rates were high (201/230, 87.4%). Most of the free-text comments on the program were highly appreciative. The students considered the number of teaching hours for the whole program to be adequate. The students showed significant improvements in knowledge and judgment regarding disaster medicine after the program.We found that medical students were highly interested, were appreciative of, and actively participated in this longitudinal integrated disaster and military medicine education program, but gaps existed between the students' scores and the educators' expectations. The educators believed that the students needed more disaster preparedness knowledge and skills.


Assuntos
Medicina de Desastres/educação , Medicina Militar/educação , Estudantes de Medicina/estatística & dados numéricos , Currículo , Medicina de Desastres/métodos , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Educação de Graduação em Medicina/tendências , Humanos , Medicina Militar/métodos , Projetos Piloto , Inquéritos e Questionários
7.
Nurse Educ Pract ; 42: 102654, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733526

RESUMO

The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community. Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology. Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory. Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice. These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community.


Assuntos
Bacharelado em Enfermagem/normas , Medicina Militar/educação , Cuidados de Enfermagem/normas , Estudantes de Enfermagem/psicologia , Adulto , Currículo , Bacharelado em Enfermagem/métodos , Bacharelado em Enfermagem/estatística & dados numéricos , Inglaterra , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade , Família Militar/psicologia , Família Militar/estatística & dados numéricos , Medicina Militar/métodos , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/psicologia , Pesquisa Qualitativa , Estudantes de Enfermagem/estatística & dados numéricos , Veteranos/psicologia , Veteranos/estatística & dados numéricos
8.
Unfallchirurg ; 123(6): 464-472, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31696247

RESUMO

BACKGROUND: The global rise of conflicts and catastrophes causes new challenges for western healthcare systems. There are obvious parallels between civilian disaster medicine and military combat care. The integration of disaster and deployment medicine into the medical curriculum thus seems necessary. OBJECTIVE: What do medical students think about disaster and deployment medicine as part of the curriculum? Does participation in a voluntary disaster medicine course affect their view? MATERIAL AND METHODS: While participating in an extracurricular lecture series on disaster and deployment medicine students (group 1) were asked about their personal views and prior experience in disaster medicine (20 questions). Students who did not attend the lecture (group 2) functioned as the control group. The statistical evaluation was performed descriptively and using Student's t test for independent subgroups. RESULTS: The questionnaire was completed by 152 students (group 1: n = 78, group 2: n = 74). Only 10 students in group 1 and none in group 2 felt they had received an adequate amount of teaching in the field of disaster medicine. Medical students in both groups considered disaster medicine to be inadequately represented in the medical curriculum (group 1: 64% and group 2: 66%). Both groups were in favor of further expanding teaching in the field of disaster medicine (group 1: 72%, group 2: 54%, p = 0.001) and the development of e­learning tools (group 1: 73%, group 2: 72%). DISCUSSION: The medical students questioned considered disaster and deployment medicine to be an integral part of the curriculum. Despite some statistical differences between the two groups, the survey showed that medical students possess a great interest in disaster medicine. Both groups were in favor of further integrating e­learning tools. A regular inclusion of disaster and deployment medicine into the spectrum of medical student teaching is warranted.


Assuntos
Medicina de Desastres/educação , Educação de Graduação em Medicina/métodos , Medicina Militar/educação , Currículo , Humanos , Comunicação Interdisciplinar , Projetos Piloto , Estudantes de Medicina
9.
Injury ; 51(1): 70-75, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31400810

RESUMO

BACKGROUND: Recent terrorist attacks and mass shooting incidents in major European and North American cities have shown the unexpected influx of large volumes of patients with complex multi-system injuries. The rise of subspecialisation and the low violence-related penetrating injuries among European cities, show the reality that most surgical programs are unable to provide sufficient exposure to penetrating and blast injuries. The aim of this study is to describe and create a collaborative program between a major South African trauma service and a NATO country military medical service, with synergistic effect on both partners. This program includes comprehensive cross-disciplinary training & teaching, and scientific research. METHODS: This is a retrospective descriptive study. The Pietermaritzburg hospital and Netherlands military trauma register databases were used for analysing patient data: Pietermaritzburg between September 2015 and August 2016, Iraq between May and July 2018 and Afghanistan from 2006 to 2010. Interviews were held to analyse the mutual benefits of the program. RESULTS: From the Pietermaritzburg study, mutual benefits focus on social responsibility, exchange of knowledge and experience and further mutual exploration. The comparison showed the numbers of surgical procedures over a one-month period performed in Iraq 12.7, in Afghanistan 68.8 and in Pietermaritzburg 152. CONCLUSION: This study has shown a significant volume of penetrating trauma in South Africa, that can provide substantial exposure over a relatively short period. This help to prepare civilian and military surgeons and deployable military medical personnel for casualties with blast - and/or penetrating injuries. The aforementioned findings and the willingness to shape the mutual benefits, create a platform for trauma electives, research, education and training.


Assuntos
Medicina Militar/educação , Militares , Traumatismo Múltiplo/cirurgia , Cirurgiões/educação , Traumatologia/educação , Ferimentos Penetrantes/cirurgia , Europa (Continente) , Humanos , Incidência , Traumatismo Múltiplo/epidemiologia , Estudos Retrospectivos , África do Sul/epidemiologia , Ferimentos Penetrantes/epidemiologia
12.
J Spec Oper Med ; 19(3): 26-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539431

RESUMO

The Special Operations Surgical Team Development Course (SOSTDC) is a 5-day course held two or three times a year at the North Atlantic Treaty Organization (NATO) training facility within the Special Operations Medical Branch (SOMB) of the Allied Centre for Medical Education (ACME). Its aim is to teach, train, develop, and encourage NATO partner nations to provide robust, hardened, and clinically able surgical resuscitation teams that are capable of providing close support to Special Operations Forces (SOF).


Assuntos
Medicina Militar/educação , Procedimentos Cirúrgicos Operatórios/educação , Currículo , Humanos
13.
J Spec Oper Med ; 19(3): 45-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539433

RESUMO

BACKGROUND: We sought opportunities to develop learning practices of individual first aid providers. In this study, we simulated deliberate practice in placing limb tourniquets. METHODS: This study comprised tourniquet uses by two experienced persons. Their practice sessions focused on developing a motor skill with periodic coaching. The Combat Application Tourniquet is 1.5-inches wide and was used in a technique of loop passage around the end of the limb to place it 2-3 inches above the wound. The simulated limb was a Z-Medica Hemorrhage Control Trainer. Both users applied the tourniquet six times over 5 days to accrue 30 uses individually (N = 60 tourniquet applications for the study). RESULTS: When represented as summary parameters, differences were small. For example, average ease of use was the same for both users, but such parameters only took a snapshot of performance, yielding a general assessment. However, for a learning curve by use number, a surrogate of experience accrual, application time revealed spiral learning. The amount that users compressed a limb averaged -15% compared with its unsqueezed state. Placement accuracy was classified relative to gap widths between the tourniquet and the wound, and of 60 performances, 55 were satisfactory and five were unsatisfactory (i.e., placement was <2 inches from the wound). When a tourniquet only overlaid the 2-inch edge of the placement zone (i.e., tourniquet was 2-3.5 inches away from the wound), no error was made, but errors were made in crossing that 2-inch edge. These gauging errors led us to create a template for learners to see and to demonstrate what the meaning of 2-3 inches is. CONCLUSION: Each metric had value in assessing first aid, but turning attention to gauging wound-tourniquet gaps revealed placement errors. Analysis of such errors uncovered what 2-3 inches meant in operation. Spiral learning may inform the development of best readiness practices such as coaching deliberate-practice sessions.


Assuntos
Primeiros Socorros , Hemorragia/prevenção & controle , Medicina Militar/educação , Torniquetes , Extremidades , Humanos
14.
J Spec Oper Med ; 19(3): 64-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539435

RESUMO

BACKGROUND: An Army Reserve Combat Medic's training is focused on knowledge attainment, skill development, and building experience and training to prepare them to perform in austere conditions with limited resources like on the battlefield. Unfortunately, the exposure to skills they may be responsible for performing is limited. Research shows that greater than 90% of battlefield deaths occur in the prehospital setting, 24% of which are potentially survivable. Literature demonstrates that 91% of these deaths are related to hemorrhage; the remaining are related to other causes, including airway compromise. The skill and decision-making of this population are prime targets to optimize outcomes in the battlefield setting. METHODS: Army Reserve combat medics were selected to voluntarily participate in an educational intervention provided by anesthesia providers focusing on airway management. Participants completed a preintervention assessment to evaluate baseline knowledge levels as well as comfort with airway skills. Medics then participated in a simulated difficult airway scenario. Next, airway management was reviewed, and navigation of the difficult airway algorithm was discussed. The presentation was followed by simulations at four hands-on stations, which focused on fundamental airway concepts such as bag-mask ventilation and placement of oral airways, tracheal intubation, placement of supraglottic airways, and cricothyrotomy. Pre/post knowledge assessments and performance evaluation tools were used to measure the effectiveness of the intervention. RESULTS: Statistically significant results were found in self-reported confidence levels with airway skills (z = -2.803, p = .005), algorithm progression (z = -2.807, p = .005), and predicting difficulty with airway interventions based on the patient's features (z = -2.809, p = .005). Establishment of ventilation was completed faster after the intervention. More coherent and effective airway management was noted, new knowledge was gained, and implications from psychological research applied. CONCLUSION: Supplementing the training of Army Reserve Combat Medics with the utilization of anesthesia providers is an effective platform. This exercise imparted confidence in this population of military providers. This is critical for decision-making capabilities, performance, and the prevention of potentially survivable mortality on the battlefield.


Assuntos
Manuseio das Vias Aéreas , Medicina Militar/educação , Humanos
15.
J Spec Oper Med ; 19(3): 71-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539436

RESUMO

BACKGROUND: The laryngeal handshake method (LHM) may be a reliable standardized method to quickly and accurately identify the cricothyroid membrane (CTM) when performing an emergency surgical airway (ESA). However, there is currently minimal available literature evaluating the method. Furthermore, no previous CTM localization studies have focused on success rates of military prehospital providers. This study was conducted with the goal of answering the question: Which method is superior, the LHM or the traditional method (TM), for identifying anatomical landmarks in a timely manner when performed by US Army combat medic trainees? METHODS: This prospective randomized crossover study was conducted at Ft Sam Houston, TX, in September 2018. Two Army medic trainees with similar body habitus volunteered as subjects, and the upper and lower borders and midline of their CTMs were identified by ultrasound (US). The participants were also recruited from the medic trainee population. After receiving initial training on the LHM and refresher training on the TM, participants were asked to localize the CTMs of each subject with one method per subject. Success was defined as a marking within the borders and 5mm of midline within 2 minutes. RESULTS: Thirty-two combat medic trainees participated; 78% (n = 25) successfully localized the CTM using the TM versus 41% (n = 13) using the LHM (p = .002). CONCLUSION: Findings of this study support that at present the TM is a superior method for successful localization of the CTM when performed by Army combat medic trainees.


Assuntos
Laringe , Medicina Militar/educação , Palpação/métodos , Estudos Cross-Over , Humanos , Laringe/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia
16.
Health Aff (Millwood) ; 38(8): 1274-1280, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31381398

RESUMO

US military forces have diverse missions, including combat, response to natural disasters, humanitarian assistance, training, and diplomacy. The military's medical forces, composed of clinical providers from the Army, Navy, and Air Force, support these operations-often on a moment's notice. The Military Health System (MHS) must ensure that medical providers are always trained and equipped to deliver care when deployed on missions in often austere environments. As part of its approach to this challenge, the MHS has initiated a data-driven effort to determine required clinical competencies by identifying and measuring the knowledge, skills, and abilities required for care in these environments. These efforts are being implemented while the MHS is undergoing significant organizational change. In this article we describe past and current efforts to maintain a "ready medical force" as well as current challenges and opportunities related to maintaining the readiness of medical providers while the MHS intends to evolve into an integrated health system.


Assuntos
Serviços de Saúde Militar , Administração Financeira/organização & administração , Humanos , Serviços de Saúde Militar/economia , Medicina Militar/educação , Militares/educação , Política Organizacional , Traumatologia/educação , Estados Unidos
17.
Explore (NY) ; 15(6): 429-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378632

RESUMO

BACKGROUND AND PURPOSE: Medical acupuncture is an additional treatment for pain management, in which physicians are increasingly being trained. METHODS: We surveyed graduates of the Nellis Family Medicine Residency/Acus Foundation Acupuncture Training initiative. We asked them about their acupuncture practice patterns, satisfaction with their practice, and queried other aspects affecting their practice. RESULTS: 85% (50/59) graduates responded. All graduates were still practicing acupuncture, and reported that the most common ailment treated was back pain. Respondents reported that they are happier and prescribe fewer opioids than they did before learning acupuncture. CONCLUSIONS: Medical acupuncture can be learned during Family Medicine Residency and results in more satisfied physicians who report prescribing fewer opioids.


Assuntos
Acupuntura/educação , Medicina de Família e Comunidade/educação , Padrões de Prática Médica/estatística & dados numéricos , Terapia por Acupuntura/estatística & dados numéricos , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Internato e Residência , Masculino , Medicina Militar/educação , Inquéritos e Questionários
18.
J Trauma Acute Care Surg ; 87(1S Suppl 1): S191-S196, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246926

RESUMO

BACKGROUND: During military combat operations and civilian night-time aeromedical transport, medical providers are frequently required to perform lifesaving interventions (LSIs) in low-light environments. Because definitive surgical care is often delayed until a white light environment is permissible, we sought to determine if night optical device (NOD) technology could enable surgical capabilities in blackout conditions. METHODS: Using a crossover design, six surgeons performed 11 different procedures on six swine, three in normal light conditions (LC) and 3 in blackout conditions (BC) using two-chamber NODs after familiarization with the procedures in both conditions on manikins. Successful completion and procedural times were compared between groups. RESULTS: Blackout conditions were confirmed with ambient light reading of 0.2 lux during BC versus 3962.9 lux for LC (p < 0.001). There were no significant differences in success rates for any procedure. There were no differences in operative times between BC and LC for extremity tourniquet placement, femoral artery cut-down and clamping, resuscitative thoracotomy, or percutaneous resuscitative endovascular balloon occlusion of the aorta placement. The following procedures took significantly longer in BC vs. LC: Focused Assessment with Sonography for Trauma examination (98 seconds vs. 62 seconds), peripheral IV placement (140 seconds vs. 35 seconds), intraosseous access (51 seconds vs. 26 seconds), jugular vein cut-down and access (237 seconds vs. 104 seconds), laparotomy and packing (71 seconds vs. 51 seconds), stapled splenectomy (137 seconds vs. 74 seconds), resuscitative endovascular balloon occlusion of the aorta placement via cutdown (1,008 seconds vs. 338 seconds), and cricothyroidotomy (177 seconds vs. 109 seconds) (all p < 0.05). CONCLUSION: Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed. LEVEL OF EVIDENCE: Basic science.


Assuntos
Escuridão , Tratamento de Emergência/métodos , Medicina Militar/instrumentação , Medicina Militar/métodos , Militares , Procedimentos Cirúrgicos Operatórios/métodos , Lesões Relacionadas à Guerra/cirurgia , Animais , Humanos , Medicina Militar/educação , Treinamento por Simulação , Procedimentos Cirúrgicos Operatórios/educação , Suínos
19.
J Spec Oper Med ; 19(2): 128-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201768

RESUMO

Effectively and rapidly controlling significant junctional hemorrhage is an important effort of Tactical Combat Casualty Care (TCCC) and can potentially contribute to greater survival on the battlefield. Although the US Food and Drug Administration (FDA) has approved labeling of four devices for use as junctional tourniquets, many Special Operations Forces (SOF) medics do not carry commercially marketed junctional tourniquets. As part of ongoing educational improvement during Special Operations Combat Medical Skills Sustainment Courses (SOCMSSC), the authors surveyed medics to determine why they do not carry commercial tourniquets and present principles and methods of improvised junctional tourniquet (IJT) application. The authors describe the construction and application of IJTs, including the use of available pressure delivery devices and emphasizing that successful application requires sufficient and repetitive training.


Assuntos
Hemorragia/prevenção & controle , Medicina Militar/educação , Torniquetes , Lesões Relacionadas à Guerra/terapia , Currículo , Virilha , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...