Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE: The purpose of this study was to evaluate pregnancy during war-time deployment. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 77 demonstrated a positive pregnancy test. These charts were evaluated for factors that may lead to important information for future deployments. RESULTS: The average age of the female soldier with a positive pregnancy test in theater was 27 +/- 7 years. The primary presenting complaint was amenorrhea. Ninety-two percent had an ultrasound. Fifty-four percent of visits were active duty, followed by Reserve, National Guard, and civilian government employees. Ninety-two percent were administratively redeployed. Seventy-seven percent of the soldiers became pregnant in country. Twenty-three percent arrived in country pregnant. CONCLUSIONS: Given the number of pregnancies before and during deployment, current screening procedures as well as new concepts in prevention need to be addressed.     

Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care

INTRODUCTION: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. METHODS: For a 3-month period in 2005, all service members (N=296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. RESULTS: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). CONCLUSIONS: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.     

Orthopedic injuries during Operation Enduring Freedom

Orthopedic injuries comprise a majority of combat injuries seen in recent U.S. military conflicts. Interventions in the forward deployed area have played an important role in improving mortality rates of soldiers as well as outcome at a medical center level. A retrospective review was conducted on orthopedic injuries from Operation Enduring Freedom evaluated at Walter Reed Army Medical Center (WRAMC). Patients were grouped into one of five injury categories (open fracture, amputation, arterial injuries, neurological injuries, and soft tissue injury) with evacuation time (days from time of injury to arrival at WRAMC) and procedures performed before arrival at WRAMC evaluated. The average evacuation time for all orthopedic casualties was 7.9 days. There was an average of 2.6 procedures performed per patient before arrival at WRAMC. There was no difference in evacuation time among the injury groups. Those with only soft tissue injuries underwent fewer procedures than the other injury groups; however, there was no difference among the injury groups in terms of procedures performed. The number of procedures performed did not affect the evacuation time. Fifty-six percent of casualties required operative intervention after arrival at WRAMC. With the unavoidable evacuation time that all casualties must endure regardless of severity of the injury, early operative intervention in forward deployed medical assets, such as the forward surgical team and combat support hospital, remains a necessity for rehabilitative and reconstructive efforts of the soldiers at the medical center level.     

Air medical evacuations of soldiers due to oral-facial disease and injuries, Operations Enduring Freedom/Iraqi Freedom

This retrospective study was conducted to assess the nature and causes of serious oral-facial illnesses and injuries among U.S. Army personnel deployed to Iraq and Afghanistan in 2003 and 2004. Information for this study came from the U.S. Air Force Transportation Regulating and Command & Control Evacuation System database for medical evacuations (MEDEVACS) for 2003 to 2004. The study found 327 oral-facial MEDEVACS out of Iraq (cumulative incidence: 11/10,000 soldiers per year) and 47 out of Afghanistan (cumulative incidence: 21/10,000 soldiers per year), for a total of 374 MEDEVACS. Forty-two percent (n = 158) of all oral-facial MEDEVACS were due to diseases of the oral cavity, salivary glands, and jaw. Another 36% (n = 136) of oral-facial MEDEVACS were for battle injuries, primarily fractures of the mandible, caused by acts of war. Twenty-one percent (n = 80) of oral-facial MEDEVACS were due to nonbattle injuries, primarily fractures of the mandible, mainly caused by motor vehicle accidents and fighting.     

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.     

美军伊拉克和阿富汗战争战伤救治新理念

“战术战伤救治”的概念最早由美海军特种作战部队于1996年首次提出,在伊拉克和阿富汗战争中成为美军战术环境中伤员救治的标准规范,也是美军伊拉克和阿富汗战争中战伤救治取得的一大进展.战术战伤救治的应用使美军达到了有史以来最低的伤亡率.该文梳理了美军战术战伤救治理念的发展,分析了战术战伤救治的阶段划分,探讨了美军战术战伤救治的组织实施,并提出了对我军的启示.     

Drowning deaths of U.S. Service personnel associated with motor vehicle accidents occurring in Operation Iraqi Freedom and Operation Enduring Freedom, 2003-2005

OBJECTIVE: We examined common factors in vehicular drowning deaths that might lead to changes in equipment or training. METHODS: Drowning deaths among service members deployed to Operations Iraqi Freedom or Enduring Freedom, 2003 to 2005, were ascertained using the Armed Forces Medical Examiner Tracking System database. Cases were linked to Army and Navy safety and investigative files. RESULTS: Fifty-two cases of vehicular drowning deaths were identified. These occurred mostly at night, were almost always the result of a rollover, and were most frequently associated with a high-mobility medium-weight vehicle. Seat belts were rarely worn, but the majority of injuries should not have been severe enough to affect egress from the vehicle. These drowning deaths seldom occurred while engaged with the enemy and were rarely associated with bad road conditions or bad weather. CONCLUSIONS: Effective preventive strategies might focus on training and equipment to reduce rollover events and on the expeditious extrication of victims.     

Dental satisfaction survey at an expeditionary dental clinic in support of Operations Enduring Freedom and Iraqi Freedom

This study used a survey to gather information about soldiers' perceptions of the quality of dental treatment delivered at a deployed clinic. An ordinal scale of 1 through 5 scored access, dental facility and equipment, pain control, technical skill, and interpersonal skills of the provider. Four additional items identified whether the respondent was new to military or deployment dentistry, was in pain before arriving at the clinic, or had any concerns about being treated at a deployed dental clinic. Percentages for each type of response were recorded. Data were further analyzed by the Mann-Whitney U test to investigate the relationship between respondent variables and how they rated the attributes of quality. Deployed service members reported a high degree of satisfaction with the quality of care they received. Ninety-seven percent of respondents believed that the care they received was as good as the care they would have received at their regular stateside military dental facility.     

Utility of ultrasound in the combat theater: experiences of a gynecologist during Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE: The purpose of this study was to evaluate the utility of ultrasound in a combat theater. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 237 required pelvic ultrasound. Demographic information, as well as the indications, diagnosis, and disposition of the patients, was compiled. RESULTS: The average age of the patient requiring ultrasound was 28 +/- 8 years. The primary presenting complaint was pelvic pain. Forty percent with pelvic pain had no identifiable cause. The most common final diagnosis was pregnancy. Of the 237 visits, the use of ultrasound resulted in 136 return-to-duty dispositions. Of the 31% who were administratively redeployed, the majority were secondary to pregnancy. CONCLUSION: Gynecologic ultrasound was found to be a very useful tool in the combat theater. Ultrasound resulted in improved diagnostic ability and enhanced reassurance to both provider and patient.     

Effects of transcendental meditation in veterans of Operation Enduring Freedom and Operation Iraqi Freedom with posttraumatic stress disorder: a pilot study

We conducted an uncontrolled pilot study to determine whether transcendental meditation (TM) might be helpful in treating veterans from Operation Enduring Freedom or Operation Iraqi Freedom with combat-related posttraumatic stress disorder (PTSD). Five veterans were trained in the technique and followed for 12 weeks. All subjects improved on the primary outcome measure, the Clinician Administered PTSD Scale (mean change score, 31.4; p = 0.02; df = 4). Significant improvements were also observed for 3 secondary outcome measures: Clinician's Global Inventory-Severity (mean change score, 1.60; p < 0.04; df = 4), Quality of Life Enjoyment and Satisfaction Questionnaire (mean change score, -13.00; p < 0.01; df = 4), and the PTSD Checklist-Military Version (mean change score, 24.00; p < 0.02; df = 4). TM may have helped to alleviate symptoms of PTSD and improve quality of life in this small group of veterans. Larger, placebo-controlled studies should be undertaken to further determine the efficacy of TM in this population.     

Operation Enduring Freedom: trends in combat casualty care by forward surgical teams deployed to Afghanistan

This study examined the clinical experience of a U.S. Army Forward Surgical Team (FST) deployed to Afghanistan in 2005 and compared the findings with those of 3 previously deployed FSTs. Medical records of all patients evaluated by the FST were abstracted for analysis. Demographically, the cohort (n = 614) was predominantly male (94%), with a median age of 24, and distributed according to the following: disease (8.6%), nonbattle injury (42%), and battle injury (49%). Combat casualties were mostly Afghan National Army or Police (56%) and U.S. military (21%). Predominant wounding instruments were small arms (34%), improvised explosive devices (33%), and rocket-propelled grenades (15%). Anatomical sites of battle injury were extremities (38%), external soft tissue (35%), and head/neck/torso (28%). Operative procedures for combat injury (n = 227) were primarily orthopedic (45%) or thoracic/abdominal (36%). Combat casualty statistics provide insight to trauma epidemiology, patterns, and trends vital for surgical management. Workload statistics guides the structuring, training, and employment of FSTs.     

Preventive medicine in Task Force 1st Armored Division during Operation Iraqi Freedom

Task Force 1st Armored Division (TF1AD) deployed to Baghdad and South Central Iraq from April 2003 through July 2004. TF1AD preventive medicine had responsibility for ensuring divisional force health protection, including soldier health, disease and nonbattle injury mitigation, health promotion, and civil affairs operations. Heat injury, diarrheal disease, skin and respiratory disease, and eye and musculoskeletal injury rates were high. Command emphasis and preventive medicine action resulted in better living conditions and personal sanitation. To counter the threat, the TF1AD preventive medicine/ division surgeon team used a "spiraling out" approach that focused attention first on hand-washing, potable water, vector control, waste disposal, and food sanitation and later on noise, asbestos, environmental contamination, and radiation. In April 2004, TF1AD shifted focus to the Multinational Division Central-South region of Iraq and many similar problems occurred as in May 2003, although they were less severe, in part because of the lessons learned in Baghdad.     

The beneficial relationship of the colocation of orthopedics and physical therapy in a deployed setting: Operation Iraqi Freedom

In a deployment setting, orthopedic and musculoskeletal injuries represent the majority of both combat-related and noncombat-related injuries. To expeditiously and efficiently manage the large influx of patients, our experience revealed the tremendous benefits of having physical therapy colocated with an orthopedic surgeon in a level III combat support hospital. A physical therapist, working in a physician extender role, can treat the majority of nonsurgical orthopedic patients, thus allowing the orthopedic surgeon to focus his or her skills and time on surgical interventions. This physician extender role, although often overlooked during peacetime, becomes essential during wartime, when critically injured patients are abundant and physicians are in short supply. The lessons learned support the continued colocation of physical therapy and orthopedics in a deployment setting and recognize the need to have more physical therapists placed at level I and II echelons of care.     

Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom

This study compared the impact of the 2003 Operation Iraqi Freedom on heart rate (HR) and blood pressure (BP) and self-reported stress levels among three groups of self-categorized adolescents: (1) military dependents with family members deployed; (2) military dependents with no family members deployed; (3) civilian dependents. At the onset and end of the "major hostilities" of Operation Iraqi Freedom, 121 adolescents (mean age = 15.8 +/- 1.1 years) completed questionnaires evaluating the psychological impact of the war and were evaluated for HR and BP. The military deployed dependents exhibited significantly higher HR than other groups at both evaluations (both p < 0.04). Ethnicity by group interactions indicated that European American-deployed dependents had higher stress scores at both time points (p < 0.02). Military dependent European Americans exhibited higher systolic BP compared to the other groups on the second evaluation (p < 0.03).     

Dental emergency rates at an expeditionary medical support facility supporting Operation Enduring Freedom

The purpose of this study was to report the dental emergency rate and the distribution of cause of dental emergencies at an Expeditionary Medical Support +25 medical facility during a 6-month deployment in support of Operation Enduring Freedom. A retrospective cohort analysis of 1,972 soldiers stationed at Seeb Air Base, Sultanate of Oman, was accomplished from a phased deployment from March to September 2002. Procedures were divided into 11 categories: endodontic, extraction of teeth other than third molars, extraction of third molar teeth, restoration of teeth (caries), restoration of broken teeth (not caries), orthodontic bracket/wire problem, sensitive teeth, temperomandibular pain, periodontal, oral pathology, and prosthodontic. One hundred thirty-five dental emergency visits were recorded, corresponding to a rate of 137 dental emergencies per 1,000 soldiers per year. Most of the emergencies (34.8%) were due to caries. Pain from third molars was the second most common reason for visiting the dental clinic (19.3%).