Systematic review of physical fitness testing to evaluate the physical combat readiness of Royal Thai Armed Forces

Physical combat readiness of military personnel ensures maximal effectiveness of combat forces during wartime. Combat readiness has always been linked to the Army Physical Fitness Test (APFT). Each raw score is converted to a standard score and corrected for age and gender. There is no standard measurement to evaluate combat readiness in the Royal Thai Army. To determine standardized criteria for physical combat readiness of Royal Thai Army personnel through systematic review, the APFT was used to determine fitness levels and to promote health. To pass the test, each soldier in each unit must attain a minimal standard score for each individual subtest. At present, each unit in the armed forces derives its own standard, based on different missions. The APFT might be an acceptable method to measure physical combat readiness. However, no studies have established the general measurements to evaluate combat readiness.     

Permanent press allergy in an active duty U.S. Army soldier

Ethylene urea/melamine formaldehyde resin (permanent press) is a common fabric finishing agent added to Army Combat Uniforms for a wrinkle-free appearance and to strengthen the fabric. We describe the case of an active duty U.S. Army soldier with a diffuse eczematous dermatitis in whom patch testing was used to identify an allergy to permanent press, a ubiquitous fabric finishing agent in the Army combat uniform. To our knowledge, this is the first case report of a soldier with an allergic contact dermatitis to ethylene urea/melamine formaldehyde resin. This case highlights the importance of considering the diagnosis of allergic contact dermatitis in patients with a recurrent eczematous dermatitis that does not respond appropriately to therapy and the unique occupational impact of diagnosing an Army soldier with permanent press allergy.     

The Combitube, self-inflating bulb, and colorimetric carbon dioxide detector to advance airway management in the first echelon of the battlefield

Combat lifesavers and Army medics are regular combat soldiers who possess skills that enable them to provide lifesaving assistance to combat casualties. Although their training is not equal to that of paramedics, combat lifesavers and Army medics are trained to assess casualties for airway obstruction, as well as the presence or absence of spontaneous ventilation. They are also familiar with the same basic airway maneuvers that are required for blind insertion of the esophageal-tracheal double-lumen airway (ETDLA). Use of the ETDLA in combination with an esophageal detector device and a colorimetric carbon dioxide detector would require skill similar to that which they already possess in performing many mission-essential and combat lifesaver tasks. Because the U.S. Army has introduced the ETDLA for use, it is important that providers at all echelons understand the dynamics of the ETDLA. Inclusion of the ETDLA, esophageal detector device, and colorimetric carbon dioxide detector in combination with the bag-valve ventilation device could provide a viable alternative to mouth-to-mouth rescue breathing with the oral airway, as currently used by combat lifesavers on the battlefield. Improved airway management, in conjunction with other lifesaving measures, could potentially improve survival rates for combat casualties and assist in stabilizing them for evacuation to higher echelons of combat medical care.     

Knowledge attainment, perceptions, and professionalism in participants completing the didactic phase of an Army reserve critical care nursing residency program

Combat hospitals in today's Army demand nurses with critical care nursing "8A" additional skills identifiers. The intensity of future wars and operations other than war, together with highly technological weapons, forecast a large number of casualties evacuated rapidly from combat with wounds that require skillful and intensive nursing care. Many of the critical care nurses providing future care are positioned in the reserve components and require creative approaches to education and training concentrated into one weekend per month. An Army Reserve critical care nursing residency program was designed in one midwestern combat support hospital. The didactic course, phase I, was evaluated for effectiveness in achieving outcomes of increased knowledge attainment, enhanced perceptions of critical care nursing, and higher degrees of professionalism. Twenty-seven registered nurses completed the course, and 30 nurses from the same hospital served as controls. A repeated-measures analysis examined outcomes before intervention (time 1), at course completion (time 2), and at a 6-month follow-up (time 3). The course was effective at increasing scores on knowledge attainment and perceptions of critical care nursing; however; professionalism scores were initially high and remained so throughout the study. This research extends information about critical care nursing education and evaluates a training mechanism for meeting the unique requirements and time constraints of nurses in the reserve components who need to provide a high level of skill to soldiers in combat.     

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.     

Anger in the combat zone

A U.S. Army Reserve Combat Stress Control prevention team was dispatched to Afghanistan in support of Operation Enduring Freedom to provide preventative mental health care to a U.S. Army airborne division and Special Operations forces. The team's mission was to ensure mental health readiness of units in the area of operations. In Bagram, Afghanistan, the Combat Stress Control team identified anger as a very prevalent emotion in the combat zone. Anger management interventions with individual and group counseling were implemented to help soldiers cope with anger. Of 7,000 military personnel stationed there during the team's rotation, there was not one completed suicide or homicide. This article describes how the 113th Medical Company identified, treated, and controlled anger at Bagram Airbase, Afghanistan, between June 20, 2002, and December 20, 2002, with anger management interventions. This article does not address the psychophysiological features of anger.     

The Macy reports: Combat fatigue in World War II fliers

Having supported psychiatric investigation into the psychosomatic aspects of "war neurosis" since 1931, the Josiah Macy, Jr., Foundation published five volumes on combat fatigue and its prophylaxis, recognition, treatment, and administrative aspects during World War II. The five volumes were as follows: "War Neuroses in North Africa," by R. R. Grinker and J. P. Spiegel (1943); "Psychiatric Experiences of the Eighth Air Force," by D. W. Hasting, D. G. Wright, and B. G. Glueck (1944); "How Can the Flight Surgeon Better Treat Anxiety?" by D. D. Bond, and "Notes on Men and Groups Under Stress of Combat," by D. G. Wright (a single volume, 1945); "Personality Disturbances in Combat Fliers," by N. A. Levy (1945); and "Observations on Combat Flying Personnel," by D. G. Wright (1945). The author corresponded with Drs. Spiegel, Grinker, Glueck, and Levy about the circumstances leading to these monographs, and has combined their reminiscences and observations with a brief historical view of psychiatric practice in the U.S. Army Air Force during the war. This review contrasts two therapeutic philosophies concerning combat fatigue, and comments on the lack of more modern psychiatric data about combat flying.     

Training resident surgeons in combat: an experience during the Persian Gulf War.

The Persian Gulf War necessitated the activation of many Army Reserve and National Guard physicians, including a number in residency training. No prototype existed for the continued training of resident surgeons in a combat setting. The 159th Mobile Army Surgical Hospital (MASH) deployed in support of the Allied invasion of Iraq. A structured training program for two general surgery residents attached to the 159th MASH was developed and implemented. This program combined supervised operating room experience, perioperative management, morbidity and mortality conferences, and orthopedic grand rounds, all with careful professional documentation. A planned reading program could not be realized, due to the physical setting of wartime. Residents and attending staff interacted positively and the residents were able to continue their formal training as an integral part of the hospital. The model developed by the 159th MASH is a practical method of continuing structured resident training in a combat setting.     

The contingency medical force: chronic challenge, new solution

To keep pace with the changing requirements of the U.S. Army's combat doctrine, the U.S. Army Medical Department continually modifies its combat health support doctrine and unit organizations. This includes creating more capable, deployable, and mobile units. Unfortunately, as units become more capable, they become less mobile and deployable. As a result, striking a proper balance between capability, mobility, and deployability poses a significant challenge. In 1998, the 212th Mobile Army Surgical Hospital designed a rapidly deployable, air transportable medical module capable of supporting a brigade-sized contingency force (approximately 3,000 personnel) with level or echelon I to III medical care in an austere and ambiguous environment. This module, known as the contingency medical force (CMF), also provides command and control capabilities for this initial medical force and the transition to a more robust health care structure. Conducted over an 8-month period, the design process began with a staff exercise using the deliberate planning process model and culminated in a validation exercise monitored by external observers/controllers at the Combat Maneuver Training Center in Germany. This article describes the planning process, development, and initial deployment of the CMF. The CMF was then deployed on short notice to Albania in support of Task Force Hawk, the Army component of Joint Task Force Noble Anvil.     

A historical overview of combat stress control units of the U.S. Army

Combat stress control units have been deployed to the Gulf War, Somalia, Haiti, Guantanamo Bay, Bosnia, and Kosovo. They have been very flexible and useful mental health tools for commanders in both combat and peacekeeping operations for the past decade. In their operational role they have been effective, but their garrison mission remains unclear. This article summarizes the uses, missions, and lessons learned from the various combat stress control missions around the world.     

Evaluation of a combat medic skills validation test

The purpose of this study was to describe validity and reliability of a skills-based test (the Semi-Annual Combat Medic Skills-Validation Test) used by the Army to determine combat medic competency. An instrumentation design was used in which a panel of experts completed a content validity index on all skills. Simulation testing was used to determine criterion validity, intrarater, interrater, and test-retest reliability. Findings revealed that needle chest decompression, Combitube insertion, and automatic external defibrillator were the only skills with low validity (content validity index < or = 0.75). Splinting was recommended as an addition to the skill test. The validity criterion of a modified postcourse Emergency Medical Technician-Basic examination score was significantly related to the Semi-Annual Combat Medic Skills-Validation Test scores (r = 0.409, p = 0.006, two tailed). There was high intra- and interrater agreement on performance steps and skills. Higher subject scores were seen on the medical skills than on the trauma skills. When retested, there was significant improvement (t = 3.268, df = 7, p < 0.014, two tailed).     

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.     

Acanthamoeba keratitis in a U.S. Army soldier after unauthorized use of contact lenses in the combat theater

A 25-year-old active duty Army E-5 developed severe infectious keratitis in his left eye secondary to soft contact lens (CL) wear while deployed in Iraq, necessitating evacuation to Walter Reed Army Medical Center for further evaluation and treatment. Initial clinical examination at Walter Reed Army Medical Center was suggestive of Acanthamoeba keratitis, a serious corneal pathogen associated with CL wear. In vivo confocal microscopy demonstrated Acanthamoeba cysts in the epithelium and anterior stroma, and smears and cultures from an epithelial biopsy specimen confirmed the diagnosis of Acanthamoeba keratitis. To our knowledge this is the first reported case of Acanthamoeba keratitis in a soldier wearing CLs in the combat theater. Because of the inability to maintain proper lens hygiene in a combat or field environment, the risk of developing a potentially sight-threatening corneal infection is significant. This unfortunate case of a devastating eye infection serves as a reminder of the current Army policy, which prohibits the use of CLs during gas chamber exercises, field training, and combat.     

The war-related illness and injury study centers: a resource for deployment-related health concerns

Combat veterans often return from deployment having experienced a wide range of exposures, symptoms, and medical conditions. The Department of Veterans Affairs established war-related illness and injury study centers to serve combat veterans with unexplained illnesses. We report the exposures, clinical status, and utilization of 53 combat veterans who participated in the National Referral Program (NRP) from January 2002 until March 2004. Participants were primarily male (81%) and served in the Persian Gulf War (79%). Common diagnoses were chronic fatigue syndrome (n = 23, 43%), neurotic depression (n = 21, 40%), and post-traumatic stress disorder (n = 20, 38%). Self-reported exposures related to weaponry, disease prophylaxis, environmental hazards, stress, and poor hygiene. A small increase in mean SF-36V mental component scores (2.8 points, p = 0.009) and use of rehabilitation therapies (1.6 additional visits, p = 0.018) followed the NRP referral. The small gain in mental function suggests that the NRP may benefit combat veterans with long and complex medical histories.     

Patterns of accreditation performance in army family practice residencies.

Army leadership emphasizes training in all segments of its population, including family medicine. Standards for medical professional training, however, are provided by a civilian agency, the Accreditation Council for Graduate Medical Education (ACGME). In order to search for performance patterns, the authors reviewed the last two accreditation documents of each Army Family Practice residency. After independently scoring the documents against the written standards, the scores were compared with the actual written findings from the ACGME Residency Review Committee. The authors discuss patterns and trends resulting from this analysis, and recommend areas for future growth in the military training of family physicians.     

Discrepancies in clinical definitions of stress fractures: implications for the United States Army

ABSTRACT In the United States Army initial entry training (IET) environment, stress fractures are common musculoskeletal injuries. Due to the repetitive physical demands placed on soldiers, stress fractures are particularly common in individuals matriculating through basic combat training (BCT) and advanced individual training (AIT). Within the Army medical department, the clinical definitions of stress fractures vary widely among providers who are directly responsible for diagnosing these injuries. The use of diversified definitions of stress fractures in patient evaluations, treatment, communication measures, and injury data collection negatively affect patient dispositions and soldier training outcomes. This report identifies discrepancies in clinical definitions of stress fractures and the implications for the Army regarding the lack of a standardized definition for stress fractures.     

Psychiatric medications for deployment: an update

OBJECTIVE: This article discusses issues regarding the usage of psychotropic medications during military deployments, with emphasis on Operation Iraqi Freedom. METHOD: The role of psychotropic medications in the Army combat stress control doctrine is reviewed and compared with operational experiences of psychiatrists who have deployed to Iraq, Bosnia, and Egypt. RESULTS: Many issues regarding psychotropic medications experienced by deployed psychiatrists are not discussed in the Army combat stress control doctrine. CONCLUSION: The advent of new psychotropic medications, the changes in the types of conflicts fought, and the role of National Guard and Reserve forces in current conflicts have all had an impact on the role and usage of psychotropic medications during military deployments.     

Advising and assisting an Iraqi Army medical clinic: observations of a U.S. military support mission

Medical civil-military operations are important for deployed military medical units engaged in counter-insurgency missions. There are few reports on military support for a host nation's military medical infrastructure, and we describe an initiative of the 21st Combat Support Hospital in 2010 during the postsurge phase of Operation Iraqi Freedom and Operation New Dawn. The goal was to incrementally improve the quality of care provided by Iraqi 7th Army medical personnel using existing clinic infrastructure and a low budget. Direct bedside teaching to include screening and treatment of ambulatory patients (sick call), focused pharmacy and medical supply system support, medical records documentation, and basic infection control compliance were the objectives. Lessons learned include the requirement to implement culturally relevant changes, maintain focus on system processes, and maximize education and mentorship through multiple modalities. In summary, a combat hospital can successfully implement an advise and assist mission with minimal external resources.