美陆军自救互救及战斗救生员培训情况

目前，全球反恐形势严峻，加之美国深陷伊拉克、阿富汗战场，致使美军士兵不断付出伤亡代价。独特的战争环境和敌方所采用的非传统战术使美军的战伤救治工作越来越困难。由于院前救治是战伤救治的重要环节，因此，美军把不断强化士兵的战伤自救互救能力作为降低伤亡率的重要手段。     

I-gel喉罩在美军战术区伤员急救中的应用与启示

在伊拉克和阿富汗战场,窒息是美军可预防性战伤死亡的伤情之一.该文介绍了美军战术区伤员急救声门外通气采用的新型器材I-gel喉罩,包括其发展概况、设计特点、应用范围和技术特点.I-gel喉罩套囊采用医用级热塑性弹性体材质,是免充气双腔喉罩,临床证据显示其有效性、安全性和易用性较好.美军战术战伤救治指南推荐声门外通气首选I...     

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。     

美军战术作战伤员救护解读

战术作战伤员救护(TCCC)是美军近十余年建立起来的战场急救原则和方法,在此基础上制定的《战术作战伤员救护指南》则用于指导部队在战术背景下实施战场急救。TCCC将战场急救分为三个阶段——火力下救护、战术区域救护和战术后送救护。在确保战术得当的基础上,其技术重点在于针对"可预防性"战伤死亡的主要原因——致命性出血、张力气胸和气道阻塞等,及时采取急救措施,包括战伤止血带止血、战伤止血敷料填塞、抗休克、胸膜腔穿刺减压、解除气道阻塞与防止窒息等。此外,烧伤补液、伤员保温、止痛与防感染等也是值得关注的技术问题。鉴于美军在阿富汗战争和伊拉克战争中伤员死亡率降至历史最低,可以肯定地说,TCCC功不可没。     

伊拉克战争战伤救治研究进展

美军医科大学危重症医学系吉奥弗雷教授在《年度医学综述》杂志2010年第12期发表文章,对伊拉克战争中美军的战伤救治研究进展进行了总结。文章指出,美军有18.1万名官兵参与了伊拉克战争,至2009年6月18日,共发生伤员3.4万例,占参战人员     

伊拉克战争和阿富汗战争中美军烧伤医疗后送体系和伤员烧伤特点

烧伤是现代战场上高发生率和高病死率的主要战伤之一。在伊拉克战争和阿富汗战争中,为能使伤员尽快得到救治并重返战斗岗位,美军投入使用了新的五级医疗后送体系。实践证实该体系能够有效提高批量烧伤伤员的救治效率。尽管在该体系下伤员后送时间得到了极大缩短,但如何有效救治、后送烧伤伤员仍需进一步深入研究。本文回顾总结美军烧伤医疗后送体系及烧伤伤员的特点,不仅可为我国未来战时批量烧伤伤员的救治工作提供一定思路,也能为平时突发灾难性事故伤员的救治提供借鉴。     

美军战场镇痛药物的应用与启示

镇痛是战场战伤救治的重要内容,镇痛药物在美军战术战伤救治(TCCC)中占有重要地位,并且美军已形成战伤镇痛药物使用的基本策略.从卫勤保障的角度选择镇痛药物、用循证医学证据评价应用效果是美军的重要特点.该文概述了美军战伤镇痛药物的应用策略,分析了美军轻、中和重度镇痛药物的应用及效果,最后提出对我军的借鉴启示.     

现代战伤救治的新概念和新策略

战伤救治是军事医学的核心内容。武器的发展、战争模式的改变及卫勤的需要使得战伤救治必须适应新形势的要求。现代战伤多是全域环境下混合战争造成的损伤。外军特别是美军通过局部战争和相关军事行动, 实施或完善了不少有关战伤救治技术和卫勤对策, 提出战伤救治相关新概念和新策略, 对未来作战条件下我国战伤救治体系建设、构建适合中国特色的战伤救治体系极具参考价值。为此, 笔者从整体健康、自救互救训练及救援力量前伸和新技术在战伤救治中的应用两方面阐述现代战伤救治新概念和新策略, 为构建未来作战条件下具有我国特色的战伤救治体系提供参考。     

美军心理健康问题研究进展

自伊拉克战争和阿富汗战争以来,美军士兵出现创伤后应激障碍(PTSD)、抑郁症、创伤性脑损伤(TBI)、自杀等心理健康问题的比例持续上升。2013年底,美军发布了心理健康问题的研究报告。现将美军心理健康问题研究情况简要介绍如下。1美军心理健康问题现状根据美国国防兵力数据中心提供的数据,2001年以来,美军先后向伊拉克战场和阿富汗战场派遣了135万名士兵。长期部署和作战使得越来越多的美军     

美军2010年前战伤救治的研究与发展计划

美军在1997财政年度医学研究计划中，根据现代高技术战争条件下战伤救治的需求和美军联合参谋部“战伤救治的研究和发展重点应放在对伤员的立即救命处理、紧急复苏、稳定伤情、在有效的医疗支持下快速后送和小型轻便的卫生装备上”的要求，提出了ZO10年以前有关战伤救治研究和发展计划。正研究目标1．目近期目标改进战伤的诊断和分类方法，提高对各种特异性创伤的医学指数快速测定的信息处理；减轻前线救治器材的重量、缩小体积、减少件数，使其更有效地满足战伤救治的需要。1．2中期目标改进血液和血液制品的保存方法，缓解在战争环境中血…     

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.     

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.     

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.     

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.     

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.     

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.