Military trauma life support: a comprehensive training program for military physicians

The Israel Defense Forces Medical Corps prepares Israeli physicians for their field duty as providers of prehospital trauma care under combat conditions. Many physicians have no previous experience with emergency medicine. Military trauma education has been improving continuously to meet this challenge. In 1990, the Advanced Trauma Life Support program was launched in Israel. In 1998, a task-oriented approach to military trauma. Military Trauma Life Support, was introduced. This course is integrated in the 3-month training period of medical officers. Its objectives are to provide a comprehensive curriculum in prehospital military trauma, to simulate realistic combat scenarios and injury patterns, and to add practical skills and prehospital experience. The practical section includes definitive airway management in hospital operating rooms, emergency procedures training on cadavers, and prehospital experience on civilian emergency medical services ambulances.     

Humanitarian assistance medicine: perceptions of preparedness: a survey-based needs assessment of recent U.S. Army internal medicine residency graduates

The U.S. military provides humanitarian assistance in many areas around the globe. With recent changes in the force structure of the U.S. Army, internal medicine physicians are now at the forefront of providing this care, but the extent of their involvement is not known. This study measured the frequency with which recently trained Army internists provided humanitarian assistance, and it assessed their perceived preparedness for such missions. All graduates from Army internal medicine programs for 4 consecutive years were invited by e-mail to participate in an Internet-based survey. Eighty-nine personnel (49% of those contacted) completed the survey. Of those in a deployable position for >6 months, 72% provided medical humanitarian assistance. Most thought that additional training was needed, especially in tropical disease management, sanitation, and the practices of civilian humanitarian workers. This study demonstrates that military-trained internists are frequently involved in humanitarian assistance medicine, and it suggests that they might benefit from additional training.     

Military internal medicine resident performance on the American Board of Internal Medicine Certifying Examination

The mission of military graduate medical education in internal medicine is to produce high-quality military internists prepared to practice in military environments. Board certification in internal medicine is an important outcome of internal medicine residency training. The American Board of Internal Medicine Certifying Examination (ABIMCE) first-taker pass rate of the graduates of an internal medicine residency program is a key measure of the quality of the program. We compared the ABIMCE first-taker pass rates for military and civilian internal medicine residency program graduates. Military internal medicine residency graduates had higher first-taker pass rates than their civilian counterparts. This is likely a reflection of the high-quality residents and the faculty at military programs. These results support the notion that military internal medicine residency programs continue to fulfill their mission of training high-quality internists.     

Tactical medicine training for SEAL mission commanders

The Tactical Combat Casualty Care (TCCC) project initiated by the Naval Special Warfare Command and continued by the U.S. Special Operations Command has developed a new set of combat trauma care guidelines that seek to combine good medical care with good small-unit tactics. The principles of care recommended in TCCC have gained increasing acceptance throughout the Department of Defense in the 4 years since their publication, and increasing numbers of combat medical personnel and military physicians have been trained in this concept. Because casualty scenarios in small-unit operations typically present tactical as well as medical problems, however, it has become apparent that a customized version of this course suitable for small-unit mission commanders is a necessary addition to the program. This paper describes the development of a course in tactical medicine for SEAL mission commanders and its transition into use in the Naval Special Warfare community.     

Military graduate medical education in internal medicine: an outcomes study

Military graduate medical education has come under increasing scrutiny in recent years as the size of the military medical force declines. To document the outcomes of military graduate medical education in internal medicine, a cohort of Air Force internal medicine residency graduates from Wright-Patterson Medical Center were studied and their residency performance, staff performance, and active duty retention recorded. The study cohort had an outstanding residency performance, as measured by research experience and board certification rate. They also performed well as military staff physicians, receiving numerous individual military medals while holding important administrative and supervisory positions in the military. Finally, the study cohort had a higher than expected active duty retention rate. These findings support the notion that military graduate medical education in internal medicine produces outstanding military internists.     

Simulation and the future of military medicine

The U.S. military currently faces serious difficulties in training medical personnel in peacetime for the tasks of war. The military beneficiary population comprises fit young service men and women, their dependents, and retirees. Their peacetime care, although vital, does little to prepare military medical personnel for war. Medical commanders have instituted an array of training programs to compensate for this shortfall, but there remains a large gap between operational medical needs and training opportunities in peacetime. The military has begun to examine whether simulation can fill this gap. An array of commercial, off-the-shelf technologies are already being used with varying degrees of success, and major initiatives are under way in both academia and industry, supported by the military, to develop virtual reality products for combat medical training. Even as the military exploits emerging technology and begins to articulate a simulation strategy, there is a growing interest in civilian medicine in the potential for simulation to affect patient safety--how medical simulation might mitigate the injuries and deaths caused by medical errors--and how it might also improve the quality of medical education and training.     

Physicians' perceptions of the status of adolescent health care within the military health system.

OBJECTIVE: To describe the nature of the health care delivered to dependent adolescents throughout the military and compare services provided in adolescent medicine clinics with those provided in other medical departments and clinics. METHOD: Questionnaires were sent to physicians in pediatrics, internal medicine, family practice, primary care, emergency care, and adolescent medicine at 101 randomly selected military treatment facilities. A subsample of experts was selected to provide facility-specific, informed, representative information on the care provided to adolescents. RESULTS: Sixty-six percent (N = 345) of physicians returned completed questionnaires, providing information on 100% of the facilities sampled. More than half of responders felt that adolescents avoided care in their department. Two-thirds of all physicians, and three-fourths of the expert subsample, believed that adolescents are best served within adolescent medicine clinics. The expert subsample reported that adolescents served in facilities with adolescent medicine clinics received broader services. Only 28% of the facilities sampled provided any specialized adolescent medicine services. CONCLUSION: The military health care system has made progress in providing care to adolescent dependents, but reaching larger numbers of adolescents requires additional efforts.     

Role of the battalion surgeon in the Iraq and Afghanistan War

The battalion surgeon is an invaluable asset to a deploying unit. The primary role of a battalion surgeon is to provide basic primary care medicine and combat resuscitation. Other expectations include health care screening, vaccinations, supervision of medics, and being a medical advisor to the unit's commander. As many physicians who fill this role previously worked at medical treatment facilities or medical centers without prior deployment experience, the objective of this article is to highlight some of the challenges a battalion surgeon may encounter before, during, and following deployment.     

Development of an advanced life support patient transfer training program

Bayne-Jones Army Community Hospital is relatively isolated from major military or civilian medical centers. Patients there who require a higher level of care are transferred to tertiary facilities. It is standard for nurses or physicians to accompany patients requiring Advanced Cardiac Life Support care during transfer to another facility. A 2-day course was developed to provide nurses and physicians with advanced training in caring for patients during transport. The purpose was to develop a pool of nurses and other health care providers who would be trained and experienced as medical attendants on ground ambulance, rotary-wing aircraft, and fixed-wing aircraft. Nurses were awarded 16.6 contact hours of continuing education, and the course has been submitted for continuing medical education units. On after-action reports, students indicated favorable results but needed more scenario and intubation training. The course is being offered quarterly, has been updated, and continues to be evaluated.     

Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation

Military medicine has made numerous enduring contributions to the advancement of pulmonary medicine. Acute respiratory distress syndrome was first recognized as a complication in battlefield casualties in World War I and continued to play a significant role in the treatment of casualties through the Vietnam War. Innovative surgeons during World War II devised methods to assist their patients with positive pressure breathing. This concept was later adopted and applied to the development of mechanical ventilation in the late 1940s and early 1950s. The continued treatment of acute respiratory distress syndrome in combat casualties by military physicians has provided a major impetus for advances in modern mechanical ventilation and intensive care unit medicine.     

Military Medicine的知识图谱分析

目的：剖析Military Medicine的2966条文献记录,宏观把握美军军事医学发展态势。方法：基于Java平台的知识图谱分析软件CiteSpaceⅡ。结果：美国军事医学与普通医学联系密切,联系对象和重点明确;美军各军事医学研究机构的分工较为明确,任务有一定交叉重叠但不特别明显;美国一些国家级机构和军队机构以及部分专家是美国发展军事医学的坚实基础;军事医学关键文献可被直观展示;美军的军事医学关注焦点主要涉及战时卫勤保障、战后及退役军人的健康维护、口腔卫生保障和军人健康促进。结论：知识图谱分析方法在军事医学领域的应用具有新颖性、必要性和适用性。     

The Walter Reed Army Medical Center Nephrology Service website: a tool for military-wide provider and patient education

OBJECTIVES: Military medical subspecialists consult with referring physicians, direct patient care and education, support isolated subspecialists, and maintain cohesive readiness plans. The World Wide Web appears promising in fulfilling these roles. METHODS: A website providing directed resources, the Walter Reed Army Medical Center Nephrology Service website (http:@www.wramc.amedd.army. mil/departments/medicine/nephro/NEPHROLOGY/index.htm!), is described in the context of its role in military medicine and online publishing. RESULTS: The Walter Reed Army Medical Center Nephrology Service website provides educational resources for both patients and physicians worldwide. It remains the only Army internal medicine website to offer online category I continuing medical education credits free to military physicians, and it also allows online graduate medical education. CONCLUSIONS: Military medical subspecialty programs can use the World Wide Web to provide consultation and education to distant and isolated patients and providers in a practical, feasible manner. This process can be expanded to education in operational medicine and other military-specific medical topics.     

Physician versus paramedic in the setting of ground forces operations: are they interchangeable?

BACKGROUND: The setting of military ground force operations can be demanding and requires a matched medical assistance plan. A major consideration is the type of medical caregiver that is assigned to the mission. We studied the similarities, differences, advantages, and disadvantages of physicians versus paramedics in this scenario. METHODS: We interviewed 20 ground force physicians, highly experienced in this setting. We summarized their responses and formulated quantitative decision-making tables regarding two sorts of missions: a long-duration mission, far from friendly definitive care, and a short-duration mission, close to friendly hospitals. RESULTS: The major areas in which physicians and paramedics differ, pertinent to a ground force operation are: formal education, on-job training, knowledge base, ability to treat a wide variety of medical conditions, ability to perform manual lifesaving procedures, social and moral impact, availability, physical fitness, combat skills, and cost. Of a maximum score of 100 points, for a long-term mission a physician scores 77.7 points while a paramedic scores 63.6 points. The scores for a short-term mission are 72.7 and 67.9, respectively. Discussion: Physicians and paramedics are distinct groups of medical caregivers and this is also true for the setting of ground force operations. They are not interchangeable. Our data show that a physician has a relative advantage over a paramedic, especially in long-term missions, far from friendly facilities. CONCLUSION: A physician is the first choice for all kinds of military ground force missions while a paramedic can be a reasonable substitute for missions of short duration, close to definitive care.     

论军事医学系统的价值要素

论文研究目的是揭示军事医学系统的价值要素。作者研究提出了价值要素对军事医学工程系统发挥导向和支配作用;军事易损性和医学目标对象特殊性是军事医学特殊的价值属性;军事医学实践活动的价值主要是其军事价值、医学价值、科技价值和文化价值;军事医学知识体系的价值主要是丰富了医学、科学技术和军事学等知识体系;军事医学的价值观主要包括其军事价值观、医学价值观、经济价值观和人文价值观等;战斗力的演化,改变了军事医学价值的客观目标体系;对战斗力认识的深化,拓展了对军事医学价值的主观认识;军事医学的军事价值观决定了其发展目的和效果评价;军事医学的特殊价值属性决定了其认识和实践重点。     

论军事医学系统的价值要素

论文研究目的是揭示军事医学系统的价值要素。作者研究提出了价值要素对军事医学工程系统发挥导向和支配作用;军事易损性和医学目标对象特殊性是军事医学特殊的价值属性;军事医学实践活动的价值主要是其军事价值、医学价值、科技价值和文化价值;军事医学知识体系的价值主要是丰富了医学、科学技术和军事学等知识体系;军事医学的价值观主要包括其军事价值观、医学价值观、经济价值观和人文价值观等;战斗力的演化,改变了军事医学价值的客观目标体系;对战斗力认识的深化,拓展了对军事医学价值的主观认识;军事医学的军事价值观决定了其发展目的和效果评价;军事医学的特殊价值属性决定了其认识和实践重点。     

Knowledge attainment, perceptions, and professionalism in participants completing the didactic phase of an Army reserve critical care nursing residency program

Combat hospitals in today's Army demand nurses with critical care nursing "8A" additional skills identifiers. The intensity of future wars and operations other than war, together with highly technological weapons, forecast a large number of casualties evacuated rapidly from combat with wounds that require skillful and intensive nursing care. Many of the critical care nurses providing future care are positioned in the reserve components and require creative approaches to education and training concentrated into one weekend per month. An Army Reserve critical care nursing residency program was designed in one midwestern combat support hospital. The didactic course, phase I, was evaluated for effectiveness in achieving outcomes of increased knowledge attainment, enhanced perceptions of critical care nursing, and higher degrees of professionalism. Twenty-seven registered nurses completed the course, and 30 nurses from the same hospital served as controls. A repeated-measures analysis examined outcomes before intervention (time 1), at course completion (time 2), and at a 6-month follow-up (time 3). The course was effective at increasing scores on knowledge attainment and perceptions of critical care nursing; however; professionalism scores were initially high and remained so throughout the study. This research extends information about critical care nursing education and evaluates a training mechanism for meeting the unique requirements and time constraints of nurses in the reserve components who need to provide a high level of skill to soldiers in combat.     

Organization of medical support U.S. Armed Forces

The article describes the structure of the medical service of the U.S. Army, presented by seven corps,principles of planning of capabilities of medical services and their management, personnel policy of the Medical Service, that focuses on the staffing of the medical service of the officers of the possibilities. Organization of medical care during the combat theater provided by 4 echelons is represented. The first echelon "battlefield-Battalion", the second--"brigade combat team", the third is the rear of the theater of operations, the fourth--stationary hospitals outside the theater of operations. The basic direction of reducing the medical costs of all the troops: military personnel, their families, civilian employees of the Ministry of Defence, members of their families, veterans of military service and their families.     

Medic for the millennium: the U.S. Army 91W health care specialist

The new millennium challenges the Army Medical Department to provide good care in a variety of circumstances from peacetime to operations other than war to combat. To provide care in this broad variety of missions, the Army Medical Department needs flexible providers. The new 91W health care specialist enlisted medic is designed to meet this need. By coupling skills in emergency care, evacuation, medical force protection, and primary care with certification in emergency medical technology, the 91W initiative will fill the needs of the Army now and into the new millennium.     

海军基层军医战伤救治培训课程设计与评价

目的 研究创建适合新战场的海军战伤培训模式。方法 设计了舰队基层军医战救技能培训课程,海战伤救治培训课程模块采用了理论授课与专家演示方式进行,基础生命支持采用美国心脏学会标准化模拟教学进行。结果 海战伤救治培训课程模块授课前后测试成绩差异比较有统计学意义,基础生命支持培训课程授课前后测试成绩差异比较有统计学意义,两个模块的课后测试成绩之间差值差异比较有统计学意义。结论 海军基层军医战伤救治意识和能力需要提高,医学模拟教学形式有利于较短时间内掌握战救基本技能和知识,急需建立适应海军基层军医战救培训体系。