Visceral leishmaniasis in a soldier returning from Operation Enduring Freedom

This report presents a case of visceral leishmaniasis in a soldier returning from Operation Enduring Freedom. During the United States' last major military conflict, Operation Desert Storm, the diagnosis of multiple cases of visceral leishmaniasis led to policy changes, including a temporary ban on troop blood donation. This case demonstrates the applicability of recently developed Leishmania polymerase chain reaction and serological assays when conventional methods of diagnosis, such as tissue microscopy and culture, fail.     

Process of care for battle casualties at Walter Reed Army Medical Center: Part II. Physical therapy service

Physical therapists, physical therapy assistants, and physical therapy technicians provide care to soldiers, sailors, Marines, and airmen returning from Operation Enduring Freedom and Operation Iraqi Freedom. We describe the inpatient and outpatient services provided, the problems and solutions encountered, and the lessons learned at the beginning of the war.     

Implications of venom hypersensitivity for a deploying soldier

Venom immunotherapy (VIT) is a life-saving medical treatment for individuals allergic to Hymenoptera species. Delivery of VIT is a complex process that requires proper extract preparation, shipping, storage, refrigeration, and administration by qualified medical personnel in a facility that can manage a life-threatening allergic emergency (anaphylaxis). Successful VIT requires 3 to 5 years of uninterrupted maintenance injections, which may be difficult to maintain during deployments, particularly in combat operations. The complexity of VIT has resulted in service members being deemed nondeployable and has led to interruption or discontinuation of VIT for deployed service members in the past. We report the case of a 34-year-old Army National Guard soldier who successfully received maintenance VIT while deployed to Operation Iraqi Freedom. This case demonstrates that, with proper coordination and appropriate risk assessment, continuation of complex medical care, such as VIT, can be supported in a combat zone.     

An uncommon cause of chest pain in the deployed soldier

Chest pain is a common complaint at medical treatment facilities during combat operations. The initial evaluation focuses on potentially life-threatening conditions (acute coronary syndrome, aortic dissection, pulmonary embolus), in addition to pericarditis and benign musculoskeletal conditions such as costochondritis. Pulmonary arteriovenous malformation is a rare condition, but an important diagnostic consideration in soldiers who present with chest pain and/or hypoxia and in whom other life-threatening conditions, such as cardiovascular disasters and pulmonary embolus, are excluded. We present the case of a male soldier deployed to Operation Iraqi Freedom, who was air-evacuated back to Washington, DC, for definitive care. We present his case and a review of the relevant literatures on the diagnosis and treatment of patients with pulmonary arteriovenous malformations.     

The prevalence and impact of respiratory symptoms in asthmatics and nonasthmatics during deployment

OBJECTIVE: The purpose of this study was to compare the prevalence, severity, and impact of respiratory symptoms in asthmatics and nonasthmatics during Operation Enduring Freedom and Operation Iraqi Freedom. METHODS: A survey was given to 1,250 active duty soldiers and Department of Defense contractors returning from Operation Enduring Freedom/Operation Iraqi Freedom. Subjects were asked about demographics, smoking habits, respiratory symptoms, and impact on job performance before and during deployment. Patients with a history of asthma were asked method of diagnosis, current symptoms, and asthma therapy. RESULTS: A total of 1,193 subjects returned the completed questionnaire (95% response rate). Mean age of respondents was 38 +/- 11 years, 83% (n = 977) were male, and 31% (n = 375) were past or present smokers. Sixty-one subjects (5%) reported a previous diagnosis of asthma. Both asthmatics and nonasthmatics had increased respiratory symptoms of wheezing, cough, sputum production, chest pain/tightness, and allergy symptoms during deployment compared to predeployment (p < 0.05 for all). When compared to nonasthmatics, asthmatic subjects reported more wheezing, sputum production, and chest pain/tightness during deployment (p < 0.0001, 0.05, 0.05 respectively), had more difficulty with military duties (p < 0.05), and were more likely to seek medical attention and receive duty restrictions (p < 0.0001). Twenty-six percent (n = 16) of asthmatics reported poor baseline symptom control, and this group had significantly increased symptoms, functional limitations, and health care utilization when compared to asthmatics who were symptom-controlled at baseline. CONCLUSIONS: Respiratory symptoms were common among both asthmatics and nonasthmatics during deployment. Differences in symptoms and health care utilization in this group of asthmatics were primarily due to subjects with poor baseline control.     

Assessment of changes in mental health conditions among sailors and marines during postdeployment phase

Previous research regarding the mental health ramifications of military deployments focused on the U.S. Army population. As part of its deployment health surveillance mission, Navy and Marine Corps Public Health Center conducted a study of the Department of Navy population to identify reported mental health effects associated with Operation Iraqi Freedom, describe mental health care utilization by returning service members previously deployed in support of Operation Iraqi Freedom, and examine the relationships between self-identified risks and provider referral practices. Despite a considerable number of self-reported mental health concerns, referral for mental health consultations and health care utilization were rare. The psychological well-being of service members is essential to the military's optimum functionality and operational readiness; therefore, continued research in this area has significant bearing on future force health protection efforts. Additionally, this study highlights the need for further research on deployment-related mental health concerns.     

Successful removal of a cerebellar hemangioblastoma in a combat support hospital

The case of a 24-year-old male U.S. Marine Corps sergeant who presented with headache and ataxia to a combat support hospital (CSH) in Kuwait, during Operation Iraqi Freedom, is described. Imaging studies revealed a cystic brain neoplasm causing hydrocephalus and increased intracranial pressure. Because of the patient's deteriorating clinical condition and the high risk of further brain injury during a prolonged air evacuation flight, immediate surgery at the CSH was deemed the safest treatment option. The tumor was completely removed and the patient's symptoms resolved, allowing safe evacuation. A CSH is not intended to provide comprehensive neurosurgical capabilities and some equipment usually considered necessary to perform this surgery was unavailable, but field-expedient methods were devised to overcome these deficiencies. This is the first reported case of a brain tumor successfully removed in a CSH.     

Ophthalmomyiasis during Operation Desert Shield

A case of fly larva infestation of the eye (ophthalmomyiasis) is reported in an American soldier serving in Operation Desert Shield. Background information, prognosis, and treatment are discussed.     

Glucose-6-phosphate dehydrogenase deficiency in two returning Operation Iraqi Freedom soldiers who developed hemolytic anemia while receiving primaquine prophylaxis for malaria

Use of antimalarial prophylaxis continues to be routine practice among military personnel returning from areas where malaria is endemic. Primaquine may be used for terminal prophylaxis against Plasmodium ovale and Plasmodium vivax. Serious complications of this regimen are infrequent. We report the occurrence of significant hemolytic anemia for two soldiers returning from Operation Iraqi Freedom. They presented with dark urine, headaches, and classic laboratory findings of hemolysis. Both soldiers were subsequently found to have glucose-6-phosphate dehydrogenase deficiency, and both responded to conservative treatment and cessation of medication. Although this complication is unusual, medical personnel involved in the care of recently returned deployed service members should be alert to its potential occurrence among patients who are receiving antimalarial prophylaxis. This complication could be completely avoided with prescreening of personnel for glucose-6-phosphate dehydrogenase deficiency, as is currently done in the Air Force and Navy, before the use of primaquine.     

Nonconventional uses of the rocket-propelled grenade and its consequences

Operation Iraqi Freedom and Operation Enduring Freedom have forced U.S. and allied medical personnel caring for wounded soldiers to reassess nonconventional uses of the rocket-propelled grenade. The effects can be devastating when this device is used as an antipersonnel weapon, producing large blast injuries that are limb and life threatening. A classic case presentation followed by a short historical perspective on the rocket-propelled grenade and a proposed algorithm for initial care of these wounds is presented.     

Developing an effective medication soldier readiness process

With the ever high operation tempo that our Armed Forces experience, it is imperative that military providers understand their soldiers' medication needs and how to ensure that those medications are properly processed by the supporting military pharmacy. Without a definitive plan, the surgeons responsible for soldiers' health will fail. This article outlines the experiences of the 4th Infantry Division and Darnall Army Community Hospital while preparing the 4th Infantry Division soldiers for deployment in support of Operation Iraqi Freedom 2005-2007. It details some important statistics that medical planners and unit surgeons can use when preparing their soldiers for deployment. Finally, we outline the lessons learned from this latest deployment and suggest components of an effective medication soldier readiness process.     

Process of care for battle casualties at the Walter Reed Army Medical Center: Part III. Physical medicine and rehabilitation service

The Physical Medicine and Rehabilitation Service provides a critical role in the assessment, management, and disposition of the newly injured combatant. This role has been well demonstrated during Operation Enduring Freedom and Operation Iraqi Freedom. Military physiatrists are uniquely suited to support military service members as they maximize their function and either return to duty or transition to civilian life.     

Process of care for battle casualties at Walter Reed Army Medical Center: Part I. Orthopedic surgery service

Walter Reed Army Medical Center has been a primary hub in the United States for receiving Army battle casualties from Operation Enduring Freedom and Operation Iraqi Freedom. We detail the process of care that was developed to effect the timely effective management of these casualties.     

Deployment experiences of Army nurse practitioners

Army Nurse Practitioners (NPs) provide immediate and lifesaving care during combat operations. The most recent conflicts of Operation Iraqi Freedom and Operation Enduring Freedom have seen an increasing number of NP deployments. The uniqueness of these conflicts has also seen NPs being used in nontraditional roles. This study surveyed 50 Army NPs with deployment experience to explore and elucidate their clinical practices in a combat environment. Over 70% reported seeing greater than 11 patients a day with the top three diagnoses of musculoskeletal/soft tissue (noncombat), spinal pain (mechanical, sciatica), and gastrointestinal complaints. Over 74% reported having a physician available for collaboration, but 50% reported providing independent emergency care and 58% treating life-threatening injuries. The NPs in this study report standard credentialing privileges with most care falling within this realm. However, a few report nontraditional roles such as hospital admitting privileges. This study adds to the growing body of knowledge on NP practice in a combat environment, which shows increased decision making and advanced clinical skills. NPs are battlefield multipliers who bring additional skills and abilities to the combat environment.     

美军联合战场创伤系统的发展及应用

联合战场创伤系统是美军为了提高伊拉克和阿富汗战场上的战伤救治效果而建立的一种创伤救治系统。2004年美军开始在伊拉克战场应用该系统,2005年开始在伊拉克和阿富汗战场全面应用。本文梳理了美军联合战场创伤系统的发展历史,探讨了该系统的任务、目标及组织构成,分析了其在伊拉克和阿富汗战场上的应用效果。     

U.S. Army disease and nonbattle injury model, refined in Afghanistan and Iraq

Previous analysis of Operation Desert Shield/Operation Desert Storm data yielded a disease and nonbattle injury (DNBI) model using distinct 95th percentile daily admission rates during the three phases of a war-fighting operation to predict medical requirements. This study refines the model with data from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Inpatient health care records of U.S. Army soldiers deployed to OEF and OIF who were admitted with DNBI diagnoses were analyzed. DNBI admission rates for OEF and OIF were compared with rates for Operation Desert Shield/Operation Desert Storm. DNBI admission rates for OEF and OIF were lower than those for Operation Desert Shield/Operation Desert Storm. Rates among the phases of OIF were distinctly different. DNBI admission rates have been reduced during recent deployments. The concepts of the original model based on Operation Desert Shield/Operation Desert Storm data were validated by experiences during OEF and OIF. Continuous surveillance of DNBI admission rates is recommended.     

A review of 41 upper extremity war injuries and the protective gear worn during Operation Enduring Freedom and Operation Iraqi Freedom

Forty-one patients with upper extremity war injuries sustained during combat operations Operation Enduring Freedom and Operation Iraqi Freedom were reviewed to report on protective gear availability and usage at the time of injury. Participants treated at the Madigan Army Medical Center occupational therapy clinic from August 2004 until February 2005 completed a questionnaire regarding injuries sustained during deployment. Overall, 6 injuries were to upper extremity regions that were covered with issued protective gear; 21 injuries were to areas not covered with issued protective gear (i.e., participant was not wearing issued gear), and 22 injuries were to regions that were not covered because no protective gear was issued for that body area. Although this study is limited, future research would provide valuable insights about the efficacy of current body armor and the need for additional or modified gear.     

透视美军自杀防控工作

过去10年间,尤其是阿富汗和伊拉克战争爆发以来,美军的自杀问题日益突出,其自杀率呈持续上升趋势,为此,美国国防部和各军种采取了一系列自杀防控措施,取得了一定效果.本文对美军自杀问题现状、采取的防控措施及面临的主要挑战进行了分析,并对中国军队做好相关工作提出了若干启示.     

Reported stressors and health care needs of active duty Navy personnel during three phases of deployment in support of the war in Iraq

Literature has generously documented the stress of military members and their families during deployments in noncombat periods. Deployment has been shown to increase the needs of family members for health care, both physical and psychological. The purpose of this study was to describe the health care needs and perceived stressors of active duty members deployed to Iraq during the predeployment, mid-deployment, and postdeployment phases. Active duty Navy service members deployed on three aircraft carriers during Operation Enduring Freedom and Operation Iraqi Freedom in 2002-2003 were randomly selected to participate in an anonymous study that evaluated member well-being, adaptation, coping, anxiety, stress, and health care needs during three phases of deployment. Data were obtained from 474 Navy members in predeployment, 445 in mid-deployment, and 276 in postdeployment. Logistic regression analyses indicated that many variables predicted extreme anxiety during deployment, including mid-deployment phase, age of under 25 years, being childless, nonattendance at church, being enlisted, zero- or one-deployment history; no high school education, and being currently in counseling. Active duty members in all phases of deployment had equally disturbing levels of anxiety. All phases reported suicidal ideation at alarming rates (2.4% in predeployment, 4.9% in mid-deployment, and 3% in postdeployment). This study sheds new light on the stressors and subsequent health care needs of active duty members on carriers during war and provides valuable information for the prevention of high-risk anxieties and subsequent health risks for all service members during similar deployments.