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.     

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.     

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.     

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.     

Medical problems of detainees after the conclusion of major ground combat during Operation Iraqi Freedom

After the conclusion of major ground combat operations during Operation Iraqi Freedom, the focus of the mission changed, although intense armed conflict continued. Included in this mission was management of security detainees, including provision of their medical care. We retrospectively reviewed the admission records identified at a short-term holding facility over 2 months and diagnoses of detainees admitted to a combat support hospital over 4 months as a health care service utilization statistics review. Six thousand six hundred thirty-one detainee encounters occurred at the short-term facility with approximately 45% of detainees reporting medical problems during each daily evaluation. Most frequent complaints were neurological (11%), gastrointestinal (10%), and respiratory (8%). Two hundred nineteen detainees' admission diagnoses were retrospectively reviewed from the combat support hospital, 98 (45%) due to gunshot or fragmentary injuries and 121 (55%) to other medical problems. Medical problems included cardiac (29%), gastrointestinal (17%), neurological (14%), musculoskeletal (11%), and pulmonary (6%) disease. Medical problems not traditionally dealt with in a combat theater, including management of transplant recipients, patients with cardiac valve replacement, and cancer patient, were also seen.     

Review of non-battle injuries in Air Force personnel deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom

This study examines non-battle injuries among U.S. Air Force members deployed during Operations Iraqi and Enduring Freedom. A cohort of 275,843 Active Duty, Guard, and Reserve members were identified for the period September 11, 2001 through October 31, 2006. Data on injuries were obtained from electronic medical records and deployment time was obtained from manpower records. Poisson regression was used to estimate adjusted incidence rate ratios (IRRs). The most common non-battle injuries were sprains and strains (53%) followed by open wounds (27%). Guard and Reserve members tended to have a lower rate of orthopedic non-battle injuries than Active Duty members in crude analyses and after adjustment for age, previous deployment, sex, race/ethnicity, and occupation (IRR = 0.95; 95% CI = 0.89-1.02 and IRR = 0.85; 95% CI = 0.77-0.93). Results from this study are intended to facilitate further research of potential differences between Air Force components to reduce non-battle injuries in a deployed environment.     

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.     

Wounding patterns for U.S. Marines and sailors during Operation Iraqi Freedom, major combat phase

This investigation examined the wounds incurred by 279 U.S. Navy-Marine personnel (97% Marines and 3% sailors) identified as wounded in action during Operation Iraqi Freedom, from March 23 through April 30, 2003. The goal was to assess the potential impact of each causative agent by comparing the differences in anatomical locations, types of injuries caused, and medical specialists needed to treat the casualties. The overall average number of diagnoses per patient was 2.2, and the overall average number of anatomical locations was 1.6. The causative agents were classified into six major categories, i.e., small arms, explosive munitions, motor vehicle accidents, falls, weaponry accidents, and other/unknown. Explosive munitions and small arms accounted for approximately three of four combat-related injuries. Upper and lower extremities accounted for approximately 70% of all injuries, a percentage consistent for battlefield injuries since World War II.     

Combat casualty care: the Alpha Surgical Company experience during Operation Iraqi Freedom

BACKGROUND: Operation Iraqi Freedom was the first large-scale combat operation involving the U.S. Marine Corps since the Persian Gulf War in 1991. Data from a combat surgical company are presented. METHODS: Records of all U.S. and Iraqi combat casualties admitted to the surgical company were reviewed. RESULTS: Fifty-three (57%) of 93 patients suffered penetrating injuries. Most wounds were produced by high-explosive munitions (mines, hand grenades, and rocket-propelled grenades), and the majority (51%) of wounds were to the extremities. The time to surgical care averaged 4.7 hours (range, 1.5-48 hours), and 98% of the patients seen at our facility survived. CONCLUSIONS: The time from injury to surgical care was considered long by civilian standards; however, this did not appear to affect outcomes substantially. A small percentage (5.2%) of injuries were to the torso. Hypothermia was commonly present. Because of the nature of their wounds, all patients required additional surgery after evacuation to rear area facilities. The outcomes of individual patients are not known, although it is known that only one Marine died after reaching medical care and, to date, no Marines have subsequently died of their wounds.     

Diagnosis and treatment of a ruptured ectopic pregnancy in a combat support hospital during Operation Iraqi Freedom: case report and critique of a field-ready sonographic device

This case report describes a novel diagnostic approach for ectopic pregnancy in a combat environment. We diagnosed a ruptured ectopic pregnancy at our combat support hospital by using the SonoSite 180 Plus ultrasound device (SonoSite, Bothell, WA). The live ectopic pregnancy was immediately identified and the entire pelvic anatomy was easily assessed within 5 minutes. The SonoSite ultrasound device proved to be easy to use, durable, and reliable. It produced high-quality images in a variety of applications. The handheld SonoSite 180 ultrasound device is sufficiently portable to be used effectively in a combat support hospital or field situation, such as a forward surgical team. This combat experience suggests that a handheld ultrasound device may also have great utility during patient transport for civilian hospitals.     

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.     

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.     

Physical medicine and rehabilitation in the military: Operation Iraqi Freedom

This article describes the role of a physical medicine and rehabilitation (physiatry) physician (physiatrist) as a general medical officer within a forward support battalion during the invasion and nation-building phases of Operation Iraqi Freedom. Between March 10 and May 3, 2003 (invasion phase), 364 patients were evaluated. Thirty-two percent had musculoskeletal noncombat injuries, 9% had combat-related traumatic injuries, and the remaining 59% had nontrauma/nonmusculoskeletal conditions. Between May 4 and July 25, 2003 (nation-building phase), 1,387 patients were evaluated. Of these, 19% had musculoskeletal injuries, 1% had combat-related traumatic injuries, and the remaining 80% had nontrauma/nonmusculoskeletal conditions. During this nation-building phase, the musculoskeletal workload seen at the division-level combat support hospital was 4 times the workload seen in the forward support battalion. This experience underscores the role of physiatry in wartime casualty management and profiles the combat support hospital as the most suitable place for the physiatrist during wartime. Interventions focused on acute management and rehabilitation counseling for all musculoskeletal injuries, as well as consultation services to the combat support hospital and local civilian hospitals for the evaluation of complex neuromusculoskeletal trauma cases.     

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.     

Use of surgisis for abdominal wall reconstruction/closure in battlefield casualties during Operation Iraqi Freedom

A case series and discussion based on experiences gained during Operation Iraqi Freedom are presented. The Army previously published an article on the use of Gore-Tex mesh in the staged closure of open abdominal wounds. We thought that use of a biomaterial could shorten the overall course of abdominal closure and improve outcomes. This is mainly a "proof of concept" type of study. Although class I data are not presented, a useful concept is discussed. To our knowledge, no other report of the use of biomaterials for battle casualties has been published. Several issues that are faced by the military medical system are presented. The use of Surgisis (lyophilized porcine small intestinal submucosa; Cook Biotech, West Lafayette, Indiana) in the described setting is presented as one possible solution.