INTRODUCTION The Military Health System serves to globally provide health services and trained medical forces. Military providers possess variable levels of deployment preparedness. The aim of the Clinical Readiness Program is to develop and assess the knowledge, skills, and abilities (KSAs) needed for combat casualty care. METHODS The Clinical Readiness Program developed a KSA metric for general and orthopedic surgery. The KSA methodology underwent a proof of concept in six medical treatment facilities. RESULTS The KSA metric feasibly quantifies the combat relevance of surgical practice. Orthopedic surgeons are more likely than general surgeons to meet the threshold. Medical treatment facilities do not provide enough demand for general surgery services to achieve readiness. CONCLUSION The Clinical Readiness Program identifies imbalances between the health care delivery and readiness missions. To close the readiness gap, the Military Health System needs to recapture high KSA value procedures, expand access to care, and/or partner with civilian institutions.

/pdf/clinical-readiness-program-refocusing-the-military-health-1sxwlij29e.pdf

Clinical Readiness Program: Refocusing the Military Health System.

Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons.

T he 2017Military Health System Research Symposium (MHSRS) supplement marks a decade of the Journal of Trauma and Acute Care Surgery hosting publications resulting from the military's premier medical research meeting. Among the manuscripts in this 10th consecutive military supplement are projects presented at the 2016MHSRS. Since its origins as Advanced Technology Applications for Combat Casualty Care or ATACCC, a primary aim of the symposium has been to accelerate research and innovation through information sharing among the military and civilian academic and entrepreneurial communities. The MHSRS and the efforts featured in this publication embody the military-civilian partnership, which has now been formalized through a strategic partnership between the Military Health System and the American College of Surgeons (October 2014), publication of a National Academy of Medicine report (June 2016), and language in the 2017 National Defense Authorization Act. Today, the military is at crossroads where potentially more sophisticated, near-peer adversaries pose a challenge to past successes in casualty care, a projection that requires development of newer life-saving and resuscitative capabilities for military medicine. Planners have challenged medical research to innovate for the mid-term and far-term to continue to build a casualty care capability able to sustain the force in more complex and logistically constrained battles with fewer resources, and potentially without direct support for long periods of time. These scenarios, many of which are encountered by military medics today, are referred to as tactical combat casualty care-extended and prolonged field care (PFC). As stated in the United States Army-Marine Corps white paper entitled The Multi-Domain Battlefield, “A decade and a half of counterinsurgency campaigns––against an asymmetrical terrorist threat––coupled with the drawdown and repositioning of forward deployed forces to [the Continental U.S.], and the continued stagnation of close fight capabilities has eroded the ability of the U.S. military to confront a peer adversary.” The document assesses the implications of losing air superiority and its effect on forces accustomed to unfettered air access, including evacuation of the injured. A similar assessment was echoed in parts of the 2017 congressional testimony of the surgeon general of the Air Force. While the Army-Marine Corps document focuses on the broad challenges of combat, it projects a future where sustaining the sub-10% case fatality rate achieved in the recent wars would be threatened by the absence of rapid aeromedical evacuation to robust medical facilities, the lack of numbers of specialty trained medical staff at or near the site of injury, inability to reliably communicate with a health care system, and the potential for mass casualties. The document suggests that “forces will require enhanced prolonged care capability at the point of injury to increase survivability because of potential higher casualty numbers against peer threats and possible delays in medical evacuation due to force disruption.” The Combat Casualty Care Research Program anticipated this charge, as it documented a need for sustained investment in trauma and injury care in its No Drift and Ahead of the Curve papers in 2014 and 2015. These publications articulated the need for innovation to address future challenges and were followed by a $50-million program announcement in 2016 that will support and direct research aimed at enhancing the military's PFC capability. With this new urgency and a

Combat casualty care research for the multidomain battlefield.

BACKGROUND The Blue Book , published in conjunction with the Military Health System Strategic Partnership with the American College of Surgeons, serves as a reference manual for institutions wishing to establish a military-civilian partnership (MCP). To evaluate the applicability of the criteria contained in the Blue Book , we created a survey to be distributed to MCP military surgeons and their civilian host champions. METHODS E-mail surveys were sent to MCP military surgeons and civilian host champions. Military surgeons were queried about basic demographic information and aspects of the MCP including type, duration of assignment, onboarding, malpractice coverage, and billing for services. We gathered information on the role of military surgeons at the MCP, workload information, and trauma cases. The civilian host champions survey focused on institutional activities including trauma surgical volume, clinical and educational opportunities for the military surgeons, and exposure to research. Military-civilian partnership military surgeons and civilian host champions were questioned on program attributes: administrative support, budget, and profile of the program within the institution. RESULTS Ten MCP military surgeons and 7 host champions completed surveys. The majority of military surgeons were assigned to the MCP for a 3-year instructor role (90%), and most were trauma surgeons (80%). Clinical activities for the military surgeon were where 60% spent ≥13 weeks annually on trauma. Military surgeons identified host program support in academic growth, deployment preparation, and sense of value at the MCP as positive attributes. Civilian host champions unanimously reported that exposure to research, opportunities to lead trauma teams, dedicated intensive care unit time, and patient volume were positive program attributes. CONCLUSION This preliminary survey demonstrates that the criteria put forth in the Blue Book align with experiences of MCP military surgeons and host champions. Continued development of this survey and others like it may be useful in the MCP program selection and evaluation process. LEVEL OF EVIDENCE Therapeutic/care management; Level V. 

Military-civilian partnerships and the clinical readiness mission: A preliminary study from the Military Health System and the American College of Surgeons

A Perfect Storm: 2019 Scudder Oration on Trauma.

INTRODUCTION
Post-traumatic seizure (PTS) prophylaxis is recommended in patients with traumatic brain injury (TBI) at high risk for PTSs, but consensus on the optimal pharmacologic therapy has not yet been established. Levetiracetam is frequently used for seizure prophylaxis in combat-related TBI, but its efficacy and safety in this patient population has not yet been described.


METHODS
A retrospective cohort of 687 consecutive casualties transferred to the CONUS from October 2010 to December 2015 was analyzed. Seventy-one patients with combat-related injuries and radiographic evidence of skull fractures or intracranial hemorrhage were included. Data collection included demographics and injury characteristics including initial Glasgow Coma Scale, computed tomography findings, interventions, and 6-month Glasgow Outcome Score.


RESULTS
All patients in this cohort were male, with an average age of 25 (median 24; Interquartile range (IQR) 4.5) and an average Injury Severity Score of 28 (median 27; IQR 15). The most common mechanism of injury was explosive blast (76%). Penetrating TBI was common (51%). Most patients (88.7%) were administered seizure prophylaxis. Of these, the majority (61/63) received levetiracetam, and the additional two were administered phenytoin. The remaining 11.3% of patients were deemed not to require seizure prophylaxis. The incidence of seizures while on prophylaxis was low (2.8%) and occurred in patients who suffered transcranial gunshot wounds and ultimately died. No serious adverse effects were attributed to levetiracetam.


CONCLUSIONS
Levetiracetam appears to be a safe and effective medication for PTS prophylaxis in combat casualties. The rate of PTSs in combat-related TBI on appropriate prophylaxis is low.

/pdf/use-of-levetiracetam-for-post-traumatic-seizure-prophylaxis-1c1vygp1.pdf

Use of Levetiracetam for Post-Traumatic Seizure Prophylaxis in Combat-Related Traumatic Brain Injury.

Improving Care During Peacetime, War and Disasters: A Call for Agile Military Civilian Strategic Alliances.

To Scan or Not to Scan: Development of a Clinical Decision Support Tool to Determine if Imaging Would Aid in the Diagnosis of Appendicitis

The purpose of this study was to evaluate whether assessment of cell phenotypes using flow cytometry (FCM), combined with clinical data, could identify pulmonary infection immediately following thoracic trauma. BACKGROUND Thoracic injury can cause impairment of lung function leading to respiratory complications such as pneumonia (PNA). There is increasing evidence that central memory T cells of the adaptive immune system play a key role in pulmonary immunity. We sought to explore whether assessment of cell phenotypes using flow cytometry (FCM) could be used to identify pulmonary infection after thoracic trauma. METHODS We prospectively studied trauma patients with thoracic injuries who survived >48 hours at a Level 1 trauma center from 2014 to 2020. Clinical and FCM data from serum samples collected within 24 hours of admission were considered as potential variables. Random forest and logistic regression models were developed to estimate the risk of hospital-acquired and ventilator-associated PNA. Variables were selected using backwards elimination, and models were internally validated with leave-one-out. RESULTS Seventy patients with thoracic injuries were included (median age, 35 years [interquartile range (IQR), 25.25–51 years]; 62.9% [44 of 70] male, 61.4% [42 of 70] blunt trauma). The most common injuries included rib fractures (52 of 70 [74.3%]) and pulmonary contusions (26 of 70 [37%]). The incidence of PNA was 14 of 70 (20%). Median Injury Severity Score was similar for patients with and without PNA (30.5 [IQR, 22.6–39.3] vs. 26.5 [IQR, 21.6–33.3]). The final random forest model selected three variables (Acute Physiology and Chronic Health Evaluation score, highest pulse rate in first 24 hours, and frequency of CD4+ central memory cells) that identified PNA with an area under the curve of 0.93, sensitivity of 0.91, and specificity of 0.88. A logistic regression with the same features had an area under the curve of 0.86, sensitivity of 0.76, and specificity of 0.85. CONCLUSION Clinical and FCM data have diagnostic utility in the early identification of patients at risk of nosocomial PNA following thoracic injury. Signs of physiologic stress and lower frequency of central memory cells appear to be associated with higher rates of PNA after thoracic trauma. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level IV.

A random forest model using flow cytometry data identifies pulmonary infection after thoracic injury

Balancing Military Surgeon Readiness and Healthcare Delivery.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Eric E. Elster

Author Tools

Chat about Author

Papers

Use of Levetiracetam for Post-Traumatic Seizure Prophylaxis in Combat-Related Traumatic Brain Injury.

Improving Care During Peacetime, War and Disasters: A Call for Agile Military Civilian Strategic Alliances.

To Scan or Not to Scan: Development of a Clinical Decision Support Tool to Determine if Imaging Would Aid in the Diagnosis of Appendicitis

A random forest model using flow cytometry data identifies pulmonary infection after thoracic injury

Balancing Military Surgeon Readiness and Healthcare Delivery.