A mass casualty while in garrison during Operation Desert Storm.

In the theater of operations, rear echelon hospitals by doctrine receive patients who have been stabilized by forward hospitals. Occasionally, mass casualties will occur in the rear area, but rarely from combat causes. This report documents a mass casualty occurring in garrison from an anti-tank weapon misfiring. All rear echelon hospitals, regardless of their mission, must be prepared for the acute care of combat mass casualties.     

Heightened anxiety in Army Reserve nurses anticipating mobilization during Operation Desert Storm.

Research was conducted in January 1991 to compare anxiety levels of Army Reserve and civilian registered nurses and to identify factors contributing to high anxiety. It was predicted that anxiety would be greater in reservist nurses who were anticipating mobilization during Operation Desert Storm. This hypothesis was supported through the examination of t test statistical analyses and stepwise multiple regression, which demonstrated that years of military service, gender, and the presence and number of children in nurses' families related to higher anxiety levels. Army Reserve nurses identified separation from loved ones and financial concerns as the largest contributors to anxiety, while significant interventions for alleviating anxiety included detailed and consistent information from Army commands.     

Female health care during Operation Desert Storm: the Eighth Evacuation Hospital experience.

Little has been published concerning female soldiers' health care during combat. Therefore, a retrospective review of the Eighth Evacuation Hospital's gynecological records was performed while involved in Operation Desert Shield/Storm. Additionally, a health care survey was distributed to female soldiers. This review revealed that a large part of the hospital's gynecological resources during this conflict were employed treating preventable conditions. These problems could have been avoided if appropriate measures had been taken prior to deployment. It was concluded that all female soldiers should be required to undergo a gynecological health care screen prior to deployments.     

Establishing a neurology service in support of Operation Desert Storm.

As a result of Operation Desert Storm, a neurology service was established in the Fort Leonard Wood MEDDAC. Between January 1 and April 30, 1991, a total of 315 new neurology patients were seen in consultation. This number plus all the follow-up visits add up to a total of 750 clinical encounters during that period. The characteristics of this service (population served, reasons for referral, and diagnoses) were not significantly different than has been previously reported. The level of activity, by MS3 standards, qualifies this MEDDAC to have two neurologists.     

Investigational drugs and vaccines fielded in support of Operation Desert Storm.

Development of medical countermeasures for chemical and biological threats is a mission of the U.S. Army Medical Research and Development Command. Several such countermeasures were fielded during Operation Desert Shield/Storm and a controversy developed in the press and in the courts over the use of these "experimental drugs" in service members. Far from experimental, these drugs were, however, fielded as "investigational" products. Describing the products as investigational is a result of Food and Drug Administration regulations, not a comment on the extent to which the products have been tested.     

Treatment of acute diarrhea with norfloxacin during Desert Storm deployment.

A retrospective study on the treatment of diarrhea in a U.S. Air Force Wing deployed to Egypt during Operation Desert Storm was conducted. Two groups of patients were compared for treatment efficacy. One group was treated with norfloxacin 800 mg as a single dose with the onset of symptoms. The other group was treated conservatively. The group treated with norfloxacin was noted to become asymptomatic in one-fourth the time of the group treated conservatively. This was highly significant, statistically, and in practice. It is recommended that diarrhea be treated aggressively during deployments to third world countries.     

Gender differences in subjective distress attributable to anticipation of combat among U.S. Army soldiers deployed to the Persian Gulf during Operation Desert Storm

This study compares perceptions of stress, cohesion, and psychological well-being among 856 male soldiers and 169 female soldiers from combat support and combat service support units deployed to the Persian Gulf during Operation Desert Storm. Three different types of stressors were measured: anticipation of combat, operational stress, and personal stress. Female soldiers scored higher than male soldiers on all three measures of stress but scored lower than males on horizontal and vertical cohesion. In a stepwise discriminant function analysis, anticipation of combat was the most significant discriminator between the genders, followed by horizontal cohesion. Anticipation of combat was a significant predictor of increased psychological symptoms for both genders, but it had a greater effect on the psychological symptoms of female soldiers compared with male soldiers.     

Preliminary assessment of computed tomography and satellite teleradiology from Operation Desert Storm

Computed tomography at military transportable hospitals was used for the first time during the recent Operation Desert Storm in the Saudi Arabian desert. Scan quality was excellent and the scans proved clinically important in patient management. A teleradiology link via satellite to the U.S. mainland was also successfully employed. The objectives of the teleradiology link were to validate the concept distant interpretation of images obtained on the battlefield and to provide specialty radiology consultation. This technology shows great promise for future applications, both for combat casualty care and for civilian disaster medical support operations.     

Operational medical support of an aviation brigade deployed during Operation Desert Shield

This is a brief report on the medical support provided to an aviation brigade from September 1, 1990 to November 1, 1990, deployed during Operation Desert Shield. The aviation brigade consisted of 1,400 personnel including attachments. Medical support was provided by 3 physicians, a physician's assistant, and 24 enlisted personnel. Daily patient load was 2.5% of the unit strength.     

Role of the independent duty corpsman on the USNS Comfort (T-AH 20): the Operation Desert Shield/Desert Storm experience.

Independent duty corpsmen (IDCs) have a significant role in providing health care on the USNS Comfort (T-AH 20). The IDCs are responsible for staffing sick call, emergency response teams, and resuscitation/stabilization teams. IDCs are trained in advanced patient care and in medical administrative and logistical duties. During peacetime, their function often focuses on primary care to the decrement of skills necessary to perform in medical emergencies. The Operation Desert Shield/Desert Storm mobilization has emphasized the need for Navy medicine to continue its support of IDC training so that they are kept in a state of preparedness to competently deliver the full spectrum of care that is expected of them.     

A brief survey of chemical defense, crew rest, and heat stress/physical training issues related to Operation Desert Storm.

A brief questionnaire was administered to 148 soldiers, over two-thirds of whom were aviators, at the conclusion of Desert Storm. Questions were asked about chemical defense, work/rest schedules, an aspect of pharmacological support, and heat stress/physical training during Operations Desert Shield and Desert Storm. Follow-up face-to-face interviews also were conducted with some respondents. Some of the most noteworthy findings concerned (1) training issues and side effects related to pyridostigmine bromide, (2) problems with chemical defense clothing, (3) suggestions for improving crew rest, and (4) facts about the ways in which heat-related difficulties were minimized.     

Successful treatment of multiple organ system failure in a wartime environment: a case report from Operation Desert Storm.

Military weapons produce massive traumatic injuries. Multiple organ system failure can be expected to occur frequently as a result of such injuries. This case report from the recent conflict with Iraq is representative of wartime injuries and complications and the positive impact of modern intensive care capability on such injuries. Availability of critical care in future conflicts is essential.     

Systems analysis of an aeromedical evacuation mission

The author applies general systems theory to the analysis of a social system. Through an examination of information processing in an aeromedical evacuation mission, more meaningful levels of coordination evolve. Thus system analysis, as applied here, is an approach used to not only describe an organization but, more importantly, to clearly discern the interrelationships inherent in an activity of major significance such that change or improvement, if needed, may the more readily result.     

Arthroscopic surgery of the knee on the U.S. Naval Hospital Ships during Operation Desert Shield.

Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield, 118 patients underwent arthroscopic surgery of the knee on the U.S. Naval Hospital Ships USNS Mercy and USNS Comfort. There were 113 men and 5 women, with an average age of 28 years (range, 19-59 years). The most common findings at the time of arthroscopy were meniscus tears (53%), anterior cruciate ligament tears (29%), and normal arthroscopic examinations (9%). There were three complications, two hemarthroses and one superficial portal site infection. Seventy patients (59%) were able to be returned to duty at an average of 6 days post-operatively, obviating the need to evacuate these patients out of the Middle East theater to Europe or the United States, thus avoiding additional delay, expense, and loss of the service member to his military unit.     

An audit of resuscitation and anaesthesia during Operation 'Safe Haven'.

The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P < 0.05). ICV patients recovered more quickly than with HTCV (P < 0.05), but were significantly older and heavier (P < 0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only 127 pounds. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.     

Operation Desert Shield: medical aspects of weapons of mass destruction.

Our concern over possible use of weapons of mass destruction against U.S. forces in the Middle East has increased because Iraq has violated the Geneva Protocol of 1925 and the 1972 Biological Weapons Convention, attempted to acquire nuclear capability and delivery systems, and is reported to be developing biological weapons. The Army Medical Department has had no experience, since World War I, in the management and treatment of mass casualties contaminated by chemical agents, and has never treated casualties resulting from the use of nuclear or biological weapons used against our soldiers. Management and diagnosis of casualties will be complicated by their possible exposure to a mixture of chemical warfare and biological warfare agents. Triage is an essential aspect in the management of mass casualties since the number of injured patients will exceed the maximum medical capability to treat each patient on arrival. All levels of medical support must be prepared to protect themselves, their equipment and supplies, and their patients from contamination. In contaminated operations on the integrated battlefield, it will be of utmost importance to incorporate flexibility and innovation to match the medical and tactical situation.     

Where have all the captains gone? A comparison of active and reserve MC ranks and ages, Vietnam to Desert Storm.

An analysis of ages and ranks of hospital-based physicians in one area of the Persian Gulf War was used for a comparison with similar data from the Vietnam War. Mean age in the latter was 33.4 years; rank was Captain (0-3.24). In Desert Storm, mean age and rank significantly increased to 46.0 years and close to Lieutenant Colonel (0-4.73), respectively. The large proportion of Reserve Component Physicians (75%) in the Persian Gulf War is the probable explanation for these findings. Medical Corps recruitment and retention problems may result from this most recent war and pose potential threats to success in future U.S. conflicts.     

Feasibility of deploying a U.S. simulation-based gynecological brachytherapy educational workshop to an international setting

PurposeA decline in brachytherapy (BT) use for cervical cancer has negatively affected cure rates in the United States and abroad. To improve trainee exposure to BT, a simulation-based educational curriculum incorporating a pelvic mannequin was developed and implemented at several U.S. residency programs. We sought to describe an initial experience with deployment of this curriculum to an international setting.Methods and MaterialsThe setting was in Israel, a middle eastern country with cervical cancer incidence of 5–8 cases per 100,000 women. Israel was selected for this pilot because of its desire to increase exposure to trainees, lack of mandatory BT case requirements, and few residencies nationally. In determining the feasibility of deployment to this setting, a partnership was formed between a U.S. and Israeli brachytherapist to understand cultural context and institutional and logistical needs. Feasibility was defined as successful completion of the workshop. Trainee comfort and knowledge with BT was assessed with preworkshop and postworkshop surveys, with changes compared.ResultsThe curriculum was incorporated into a 1-day course on gynecologic malignancies, with adaptation to local setting and routine. Among 15 attendees, eight were residents, from four programs. All completed the workshop. All domains assessed by the surveys improved and all respondents found the program to be helpful.ConclusionsInternational deployment of the simulation-based educational BT curriculum was feasible and well-received. Further collaboration is needed to deploy and adapt the curriculum to countries of high cervical cancer incidence that could benefit from increased education.