Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

DTIC Science & Technology

2009-01-01

WITH EMERGENCY TOURNIQUET USE TO STOP LIMB BLEEDING John F. Kragh, Jr, COL, MC, USA,* Michelle L. Littrel, CPT, AN, USA,† John A. Jones ,* Thomas J...battlefield: a 4-year accumulated expe- rience. J Trauma 2003;54(Suppl 5):S221–5. 0. Mucciarone JJ, Llewellyn CH, Wightman JM. Tactical combat casualty care

Past and present role of extracorporeal membrane oxygenation in combat casualty care: How far will we go?

PubMed

Cannon, Jeremy W; Mason, Phillip E; Batchinsky, Andriy I

2018-06-01

Advanced extracorporeal therapies have been successfully applied in the austere environment of combat casualty care over the previous decade. In this review, we describe the historic underpinnings of extracorporeal membrane oxygenation, review the recent experience with both partial and full lung support during combat operations, and critically assess both the current status of the Department of Defense extracorporeal membrane oxygenation program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty care.

Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

PubMed

Buehner, Michelle F; Eastridge, Brian J; Aden, James K; DuBose, Joseph J; Blackbourne, Lorne H; Cestero, Ramon F

2017-09-01

Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90. Transfers from role 2 facilities were excluded. Data captured included demographics, admission vital signs, laboratory values, blood products, and mortality. Relationships between admission physiology, blood product utilization, and mortality were developed. Independent associations between variables were determined by logistic regression analysis. 1,703 patients were identified who met our inclusion criteria and composite mortality was 23%. Mortality in those receiving a balanced transfusion ratio was 18% versus 27% (p < 0.0001). Hypotensive casualties who survived were significantly more likely to have a higher presenting Glasgow Coma Score (GCS), temperature, SBP, shock index, and pH. In addition, this group was also more likely to have a lower international normalized ratio, pCO2, and base deficit (p < 0.001). Age, heart rate, and pulse pressure were not significantly different between groups. Independent predictors of mortality included Injury Severity Score, presentation GCS, and initial pH value (p < 0.0001). In contrast, independent predictors of survival included those with above-knee amputation and a balanced transfusion (p < 0.0001). Combat casualties hypotensive on arrival to surgical facilities have a significant expected mortality. Those receiving balanced transfusions demonstrated improved survival. Of the five independent risk factors, pH, GCS, and the

Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012.

PubMed

Penn-Barwell, Jowan G; Roberts, Stuart A G; Midwinter, Mark J; Bishop, Jon R B

2015-05-01

The United Kingdom was at war in Iraq and Afghanistan for more than a decade. Despite assertions regarding advances in military trauma care during these wars, thus far, no studies have examined survival in UK troops during this sustained period of combat. The aims of this study were to examine temporal changes of injury patterns defined by body region and survival in a population of UK Military casualties between 2003 and 2012 in Iraq and Afghanistan. The UK Military Joint Theatre Trauma Registry was searched for all UK Military casualties (survivors and fatalities) sustained on operations between January 1, 2003, and December 31, 2012. The New Injury Severity Score (NISS) was used to stratify injury severity. There were 2,792 UK Military casualties sustaining 14,252 separate injuries during the study period. There were 608 fatalities (22% of all casualties). Approximately 70% of casualties injured in hostile action resulted from explosive munitions. The extremities were the most commonly injured body region, involved in 43% of all injuries. The NISS associated with a 50% chance of survival rose each year from 32 in 2003 to 60 in 2012. An improvement in survival during the 10-year period is demonstrated. A majority of wounds are a result of explosive munitions, and the extremities are the most commonly affected body region. The authors recommend the development of more sophisticated techniques for the measuring of the performance of combat casualty care systems to include measures of morbidity and functional recovery as well as survival. Epidemiologic study, level III.

The Military Casualty with Combat Related Acute Post Traumatic Stress Disorder

DTIC Science & Technology

1984-05-01

explored. A researcher designed "Combat Fatigue Questionnaire" was mailed to 600 USAF nurses selected randomly. Three hundred sixty one USAF nurses...psychiatry noted: "Exhaustion was selected because it best described the appearance of most psychia- tric casualties" (p. xvii). Ernie Pyle, a World War II...Haber & Runyon, PL 1977), 600 (13.3% of the total USAF nurse population) names were selected . The "Combat Fatigue Questionnaire" was mailed between

Combat Ready Clamp Addition to the Tactical Combat Casualty Care Guidelines

DTIC Science & Technology

2011-09-23

Combat Gauze™ is currently the onl ( CoTCCC-endorsed intervention for bleeding in areas not amenable to a tourniquet. L Research and anecdotal evidence...them effectively as a battlefield trauma care research , development, test and evaluation (RDT&E) project. 17 In anticipation of this recommendation...the United States Army Medical Research and Materiel Command (USAMRMC) posted a Request for Information (RFI) for devices that could potentially stop

[Principles of surgical care organization and structural characteristics of sanitary casualties in counter-terrorist operations in the Northern Caucasus (Report I)].

PubMed

Gumanenko, E K; Samokhvalov, I M; Trusov, A A; Severin, V V

2005-01-01

Two operational-and-tactical factors had the main influence on organization of the surgical care rendered to the casualties on the Northern Caucasus: the fulminant and maneuverable nature of combat operations at the beginning of both armed conflicts and rather small territory of war theatre. The main special features of organization of surgical care to the casualties were the use of Medical Squads of Special Purpose in the combat conditions and maximal approximation of the specialized surgical care to the wounded by echelonment of medical units and wide use of helicopter evacuation. The structure of sanitary losses was characterized by the increase in the frequency of mechanical traumas, thermal and combined injuries, by the high share of the casualties with head injuries. Besides the number of seriously wounded and critical casualties has increased.

Experience with Proctectomy to Manage Combat Casualties Sustaining Catastrophic Perineal Blast Injury Complicated by Invasive Mucor Soft-Tissue Infections

DTIC Science & Technology

2014-03-01

Complicated by Invasive Mucor Soft-Tissue Infections MAJ Jonathan B. Lundy, MC USA; MAJ Ian R. Driscoll, MC USA ABSTRACT Catastrophic pelviperineal injuries...invasive Mucor species infection. The purpose of this report is to describe two catastrophi- cally injured combat casualties with pelviperineal blast...loss of anal sphincter complex, invasive Mucor species pelvic soft- tissue infection, and continued soilage of perineal wounds. Combat Casualty 1 A 25

Predicting Resource Needs for Multiple and Mass Casualty Events in Combat: Lessons Learned From Combat Support Hospital Experience in Operation Iraqi Freedom

DTIC Science & Technology

2009-04-01

from rocket attack near a forward operating base (Photo courtesy of Tommy A. Brown). Predicting Resource Needs for Mass Casualty in Combat Volume 66...combat support hospital. J Trauma 2008; 64(2 suppl):S79–S85. 19. Wedmore I, McManus JG, Pusateri AE, et al. A special report on the chitosan -based

Healthcare-Associated Pneumonia among United States Combat Casualties, 2009–2010

PubMed Central

Yun, Heather C.; Weintrob, Amy C.; Conger, Nicholas G.; Li, Ping; Lu, Dan; Tribble, David R.; Murray, Clinton K.

2014-01-01

Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the U.S., 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0, versus 6.0; p<0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care. PMID:25562865

Died of wounds on the battlefield: causation and implications for improving combat casualty care.

PubMed

Eastridge, Brian J; Hardin, Mark; Cantrell, Joyce; Oetjen-Gerdes, Lynne; Zubko, Tamara; Mallak, Craig; Wade, Charles E; Simmons, John; Mace, James; Mabry, Robert; Bolenbaucher, Rose; Blackbourne, Lorne H

2011-07-01

Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Battle injury died of wounds (DOW) deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners (OAFME). A panel of military trauma experts classified the injuries as nonsurvivable (NS) or potentially survivable (PS), in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. DOW casualties (n = 558) accounted for 4.56% of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 (48.6%) cases and PS in 287 (51.4%) cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 (83%) NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 (80%) PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso (48%), extremity (31%), and junctional (neck, axilla, and groin) (21%). Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.

Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma

DTIC Science & Technology

2015-02-01

of Combat Casualties in a Swine Polytrauma PRINCIPAL INVESTIGATOR: Richard McCarron, PhD CONTRACTING ORGANIZATION: Henry M. Jackson Foundation for the...Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma 5a. CONTRACT NUMBER...of neurotrauma and polytrauma . We plan to investigate the effects of aero-medical evacuation on neurophysiology and lung function in swine models of

Blood transfusion is associated with infection and increased resource utilization in combat casualties.

PubMed

Dunne, James R; Riddle, Mark S; Danko, Janine; Hayden, Rich; Petersen, Kyle

2006-07-01

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P < 0.01), a higher pulse rate (105 +/- 4 vs. 93 +/- 3, P < 0.0001), and a lower admission HCT (27 +/- 1 vs. 33 +/- 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 +/- 2.1 days vs. 1.4 +/- 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high

A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center.

PubMed

Gaylord, Kathryn M; Holcomb, John B; Zolezzi, Maria E

2009-04-01

Posttraumatic stress disorder (PTSD) has been identified in 12% to 20% of noninjured veterans and in 32% of combat casualties. Eight percent of the US general population experience PTSD symptoms, whereas 25.5% of civilians with major burns have PTSD. Known predictors of physical outcomes of patients with burn are age, total body surface area (TBSA) burned, and Injury Severity Score (ISS). The United States Army Institute of Surgical Research Burn Center provides burn care for combat casualties and civilians. We hypothesized that we would find no difference in PTSD incidence between these two populations and that age, TBSA, and ISS are associated with PTSD. We retrospectively examined the clinical records of 1,792 patients admitted between October 2003 and May 2008. Records were stratified by PTSD, age, TBSA, and ISS. PTSD scores were compared. Descriptive analyses were used. Four hundred ninety-nine patients (372 military [74.5%]; 127 civilians [25.5%]) were assessed for PTSD using PTSD checklist military and civilian versions. PTSD was defined as >or=44 on the PTSD checklist instruments. We found no significant difference in PTSD between combat casualties and civilians (25% vs. 17.32%, p = 0.761). TBSA and ISS were significantly associated with PTSD; however, no association between age and PTSD was found. The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury.

Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation.

PubMed

Morris, Michael James

2006-11-01

Military medicine has made numerous enduring contributions to the advancement of pulmonary medicine. Acute respiratory distress syndrome was first recognized as a complication in battlefield casualties in World War I and continued to play a significant role in the treatment of casualties through the Vietnam War. Innovative surgeons during World War II devised methods to assist their patients with positive pressure breathing. This concept was later adopted and applied to the development of mechanical ventilation in the late 1940s and early 1950s. The continued treatment of acute respiratory distress syndrome in combat casualties by military physicians has provided a major impetus for advances in modern mechanical ventilation and intensive care unit medicine.

The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

PubMed

Kotwal, Russ S; Howard, Jeffrey T; Orman, Jean A; Tarpey, Bruce W; Bailey, Jeffrey A; Champion, Howard R; Mabry, Robert L; Holcomb, John B; Gross, Kirby R

2016-01-01

The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes. A retrospective descriptive analysis of battlefield data examined 21,089 US military casualties that occurred during the Afghanistan conflict from September 11, 2001, to March 31, 2014. Analysis was conducted from September 1, 2014, to January 21, 2015. Data for all casualties were analyzed according to whether they occurred before or after the mandate. Detailed data for those who underwent prehospital helicopter transport were analyzed according to whether they occurred before or after the mandate and whether they occurred in 60 minutes or less vs more than 60 minutes. Casualties with minor wounds were excluded. Mortality and morbidity outcomes and treatment capability-related variables were compared. For the total casualty population, the percentage killed in action (16.0% [386 of 2411] vs 9.9% [964 of 9755]; P < .001) and the case fatality rate ([CFR] 13.7 [469 of 3429] vs 7.6 [1344 of 17,660]; P < .001) were higher before vs after the mandate, while the percentage died of wounds (4.1% [83 of 2025] vs 4.3% [380 of 8791]; P = .71) remained unchanged. Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved. Among 4542 casualties (mean injury severity score, 17.3; mortality, 10.1% [457 of 4542]) with detailed data, there was a decrease in median transport time after the mandate (90 min vs 43 min; P < .001) and an increase in missions achieving prehospital helicopter

Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries

DTIC Science & Technology

2017-11-13

information and proposes a series of findings and recommendations to improved airway management in the prehospital combat environment. The key...Airway Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries...75 General Information and Device Usability

Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

PubMed

Stewart, Ian J; Faulk, Tarra I; Sosnov, Jonathan A; Clemens, Michael S; Elterman, Joel; Ross, James D; Howard, Jeffrey T; Fang, Raymond; Zonies, David H; Chung, Kevin K

2016-03-01

Rhabdomyolysis has been associated with poor outcomes in patients with traumatic injury, especially in the setting of acute kidney injury (AKI). However, rhabdomyolysis has not been systematically examined in a large cohort of combat casualties injured in the wars in Iraq and Afghanistan. We conducted a retrospective study of casualties injured during combat operations in Iraq and Afghanistan who were initially admitted to the intensive care unit from February 1, 2002, to February 1, 2011. Information on age, sex, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), mechanism of injury, shock index, creatine kinase, and serum creatinine were collected. These variables were examined via multivariate logistic and Cox regression analyses to determine factors independently associated with rhabdomyolysis, AKI, and death. Of 6,011 admissions identified, a total of 2,109 patients met inclusion criteria and were included for analysis. Rhabdomyolysis, defined as creatine kinase greater than 5,000 U/L, was present in 656 subjects (31.1%). Risk factors for rhabdomyolysis identified on multivariable analysis included injuries to the abdomen and extremities, increased ISS, male sex, explosive mechanism of injury, and shock index greater than 0.9. After adjustment, patients with rhabdomyolysis had a greater than twofold increase in the odds of AKI. In the analysis for mortality, rhabdomyolysis was significantly associated with death until AKI was added, at which point it lost statistical significance. We found that rhabdomyolysis is associated with the development of AKI in combat casualties. While rhabdomyolysis was strongly associated with mortality on the univariate model and in conjunction with both ISS and age, it was not associated with mortality after the inclusion of AKI. This suggests that the effect of rhabdomyolysis on mortality may be mediated by AKI. Prognostic and epidemiologic study, level III.

Combat musculoskeletal wounds in a US Army Brigade Combat Team during operation Iraqi Freedom.

PubMed

Belmont, Philip J; Thomas, Dimitri; Goodman, Gens P; Schoenfeld, Andrew J; Zacchilli, Michael; Burks, Rob; Owens, Brett D

2011-07-01

A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed. A detailed description of the musculoskeletal combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a US Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Among the 4,122 soldiers deployed, there were 242 musculoskeletal combat wounds in 176 combat casualties. The musculoskeletal combat casualty rate for the Brigade Combat Team was 34.2 per 1,000 soldier combat-years. Spine, pelvis, and long bone fractures comprised 55.9% (33 of 59) of the total fractures sustained in combat. Explosions accounted for 80.7% (142 of 176) of all musculoskeletal combat casualties. Musculoskeletal combat casualty wound incidence rates per 1,000 combat-years were as follows: major amputation, 2.1; minor amputation, 0.6; open fracture, 5.0; closed fracture, 6.4; and soft-tissue/neurovascular injury, 32.8. Among musculoskeletal combat casualties, the likelihood of a gunshot wound causing an open fracture was significantly greater (45.8% [11 of 24]) when compared with explosions (10.6% [15 of 142]) (p = 0.0006). Long bone amputations were more often caused by explosive mechanisms than gunshot wounds. A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.

The Pros And Cons Of Various Optical Media For The Soldier's Interfacility Radiographic Record (SIRR) In The Combat Casualty Care System

NASA Astrophysics Data System (ADS)

Kerlin, Barbara D.; Johnson, William P.

1989-05-01

Ongoing research and evaluation projects sponsored by the Army Medical Research and Development Command are leading towards filmless radiography in the combat casualty care system of the 1990s. With the elimination of film, the question arises as to the most appropriate medium for archiving and transporting x-ray images and related patient data with the wounded between facilities. This paper considers the pros and cons of the various candidate media in relation to their specifications, availability, and appropriateness under simulated combat casualty care conditions.

Combat injury coding: a review and reconfiguration.

PubMed

Lawnick, Mary M; Champion, Howard R; Gennarelli, Thomas; Galarneau, Michael R; D'Souza, Edwin; Vickers, Ross R; Wing, Vern; Eastridge, Brian J; Young, Lee Ann; Dye, Judy; Spott, Mary Ann; Jenkins, Donald H; Holcomb, John; Blackbourne, Lorne H; Ficke, James R; Kalin, Ellen J; Flaherty, Stephen

2013-10-01

The current civilian Abbreviated Injury Scale (AIS), designed for automobile crash injuries, yields important information about civilian injuries. It has been recognized for some time, however, that both the AIS and AIS-based scores such as the Injury Severity Score (ISS) are inadequate for describing penetrating injuries, especially those sustained in combat. Existing injury coding systems do not adequately describe (they actually exclude) combat injuries such as the devastating multi-mechanistic injuries resulting from attacks with improvised explosive devices (IEDs). After quantifying the inapplicability of current coding systems, the Military Combat Injury Scale (MCIS), which includes injury descriptors that accurately characterize combat anatomic injury, and the Military Functional Incapacity Scale (MFIS), which indicates immediate tactical functional impairment, were developed by a large tri-service military and civilian group of combat trauma subject-matter experts. Assignment of MCIS severity levels was based on urgency, level of care needed, and risk of death from each individual injury. The MFIS was developed based on the casualty's ability to shoot, move, and communicate, and comprises four levels ranging from "Able to continue mission" to "Lost to military." Separate functional impairments were identified for injuries aboard ship. Preliminary evaluation of MCIS discrimination, calibration, and casualty disposition was performed on 992 combat-injured patients using two modeling processes. Based on combat casualty data, the MCIS is a new, simpler, comprehensive severity scale with 269 codes (vs. 1999 in AIS) that specifically characterize and distinguish the many unique injuries encountered in combat. The MCIS integrates with the MFIS, which associates immediate combat functional impairment with minor and moderate-severity injuries. Predictive validation on combat datasets shows improved performance over AIS-based tools in addition to improved face

From the battlefields to the states: the road to recovery. The role of Landstuhl Regional Medical Center in US military casualty care.

PubMed

Tenuta, Joachim J

2006-01-01

The transformation of the modern battlefield with respect to weaponry, modes of transportation, enemy capabilities and location, as well as technological advances, has greatly altered the tactical approach to the mission. Combat casualty care must continually evolve in response to the differences in types of injury, the number and triage of casualties, timing of treatment, and location of care. These battlefield changes have been demonstrated on a large scale in the global war on terrorism, which includes the military operations in Afghanistan and Iraq. The medical response has kept pace with this 21st-century conflict. Even in the new environment of armed conflict and with the advent of new technologies, the principles of managing orthopaedic combat casualties remain clear: preservation of life and limb, skeletal stabilization, and aggressive wound débridement. For United States service members wounded in the current conflicts, Landstuhl Regional Medical Center is a crucial stop along the road to recovery.

Predeployment training for forward medicalisation in a combat zone: the specific policy of the French Military Health Service.

PubMed

Pasquier, Pierre; Dubost, Clément; Boutonnet, Mathieu; Chrisment, Anne; Villevieille, Thierry; Batjom, Emmanuel; Bordier, Emmanuel; Ausset, Sylvain; Puidupin, Marc; Martinez, Jean-Yves; Bay, Christian; Escarment, Jacques; Pons, François; Lenoir, Bernard; Mérat, Stéphane

2014-09-01

To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury. The aim of our article is to describe the process and the result of the SC training. Records from the French Military Health Service Academy - École du Val-de-Grâce administration, head of the SC teaching programme, defining its guidelines, and supporting its structure and its execution, were examined and analyzed, since the standardisation of the SC training programme in 2008. The total number of trainees was listed following the different courses (SC1, SC2, SC3). At the end of 2013, every deployed combatant underwent SC1 courses (confidential data), 785 health-qualified combatants were graduated for SC2 courses and 672 Role 1 physician-nurse pairs for SC3 courses. The SC concept and programmes were defined in France in 2007 and are now completely integrated into the predeployment training of all combatants but also of French Military Health Service providers. Finally, SC teaching programmes enhance the importance of teamwork in forward combat medicalisation settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield.

PubMed

Mabry, R L; Holcomb, J B; Baker, A M; Cloonan, C C; Uhorchak, J M; Perkins, D E; Canfield, A J; Hagmann, J H

2000-09-01

This study was undertaken to determined the differences in injury patterns between soldiers equipped with modern body armor in an urban environment compared with the soldiers of the Vietnam War. From July 1998 to March 1999, data were collected for a retrospective analysis on all combat casualties sustained by United States military forces in Mogadishu, Somalia, on October 3 and 4, 1993. This was the largest and most recent urban battle involving United States ground forces since the Vietnam War. There were 125 combat casualties. Casualty distribution was similar to that of Vietnam; 11% died on the battlefield, 3% died after reaching a medical facility, 47% were evacuated, and 39% returned to duty. The incidence of bullet wounds in Somalia was higher than in Vietnam (55% vs. 30%), whereas there were fewer fragment injuries (31% vs. 48%). Blunt injury (12%) and burns (2%) caused the remaining injuries in Somalia. Fatal penetrating injuries in Somalia compared with Vietnam included wounds to the head and face (36% vs. 35%), neck (7% vs. 8%), thorax (14% vs. 39%), abdomen (14% vs. 7%), thoracoabdominal (7% vs. 2%), pelvis (14% vs. 2%), and extremities (7% vs. 7%). No missiles penetrated the solid armor plate protecting the combatants' anterior chests and upper abdomens. Most fatal penetrating injuries were caused by missiles entering through areas not protected by body armor, such as the face, neck, pelvis, and groin. Three patients with penetrating abdominal wounds died from exsanguination, and two of these three died after damage-control procedures. The incidence of fatal head wounds was similar to that in Vietnam in spite of modern Kevlar helmets. Body armor reduced the number of fatal penetrating chest injuries. Penetrating wounds to the unprotected face, groin, and pelvis caused significant mortality. These data may be used to design improved body armor.

Chapter 3 innovations in the en route care of combat casualties.

PubMed

Hatzfeld, Jennifer J; Dukes, Susan; Bridges, Elizabeth

2014-01-01

The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status. In addition to institutionalizing these innovations, future efforts are needed to eliminate secondary insults to patients with traumatic brain injuries and technologies to provide closed-loop sedation and ventilation.

Applying Neuroscience to Enhance Tactical Leader Cognitive Performance in Combat

DTIC Science & Technology

2011-12-16

to respond emotionally, (2) stress degrades the form of conscious attention know as “working memory ,” and (3) certain brain areas can be...Combat, Prefrontal Cortex, Tactical, Army, Working Memory 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a...sacrifices cognitive resources to respond emotionally, (2) stress degrades the form of conscious attention know as “working memory ,” and (3) certain

Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response.

PubMed

Baker, Michael S

2007-03-01

How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events.

Immune cytokine response in combat casualties: blast or explosive trauma with or without secondary sepsis.

PubMed

Surbatovic, Maja; Filipovic, Nikola; Radakovic, Sonja; Stankovic, Nebojsa; Slavkovic, Zoran

2007-02-01

The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. Blood was drawn on the first day of trauma. Concentrations of IL-8, TNF-alpha, IL-4, and IL-10 were determined in plasma using enzyme-linked immunosorbent assays. Mean values of IL-8 were 230-fold, IL-10 were 42-fold, and TNF-alpha were 17-fold higher in trauma and sepsis group (p < 0.01). Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.01). IL-4 had no significance as a predictor of severity and outcome.

Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis.

PubMed

Schauer, Steven G; April, Michael D; Simon, Erica; Maddry, Joseph K; Carter, Robert; Delorenzo, Robert A

2017-08-01

Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included. Data Fifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as "routine." Follow-up data were available for 36 of the subjects and 97% were discharged alive. The most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines. Schauer SG , April MD , Simon E , Maddry JK , Carter R III , Delorenzo RA . Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465-468.

Effects of training and simulated combat stress on leg tourniquet application accuracy, time, and effectiveness.

PubMed

Schreckengaust, Richard; Littlejohn, Lanny; Zarow, Gregory J

2014-02-01

The lower extremity tourniquet failure rate remains significantly higher in combat than in preclinical testing, so we hypothesized that tourniquet placement accuracy, speed, and effectiveness would improve during training and decline during simulated combat. Navy Hospital Corpsman (N = 89), enrolled in a Tactical Combat Casualty Care training course in preparation for deployment, applied Combat Application Tourniquet (CAT) and the Special Operations Forces Tactical Tourniquet (SOFT-T) on day 1 and day 4 of classroom training, then under simulated combat, wherein participants ran an obstacle course to apply a tourniquet while wearing full body armor and avoiding simulated small arms fire (paint balls). Application time and pulse elimination effectiveness improved day 1 to day 4 (p < 0.005). Under simulated combat, application time slowed significantly (p < 0.001), whereas accuracy and effectiveness declined slightly. Pulse elimination was poor for CAT (25% failure) and SOFT-T (60% failure) even in classroom conditions following training. CAT was more quickly applied (p < 0.005) and more effective (p < 0.002) than SOFT-T. Training fostered fast and effective application of leg tourniquets while performance declined under simulated combat. The inherent efficacy of tourniquet products contributes to high failure rates under combat conditions, pointing to the need for superior tourniquets and for rigorous deployment preparation training in simulated combat scenarios. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Understanding combat casualty care statistics.

PubMed

Holcomb, John B; Stansbury, Lynn G; Champion, Howard R; Wade, Charles; Bellamy, Ronald F

2006-02-01

Maintaining good hospital records during military conflicts can provide medical personnel and researchers with feedback to rapidly adjust treatment strategies and improve outcomes. But to convert the resulting raw data into meaningful conclusions requires clear terminology and well thought out equations, utilizing consistent numerators and denominators. Our objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care. We first clarified three essential terms: 1) the case fatality rate (CFR) as percentage of fatalities among all wounded; 2) killed in action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty); and 3) died of wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty). These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism. Using this clear set of definitions we used the equations to ask two basic questions: What is the overall lethality of the battlefield? How effective is combat casualty care? To answer these questions with current data, the three services have collaboratively created a joint theater trauma registry (JTTR), cataloging all the serious injuries, procedures, and outcomes for the current war. These definitions and equations, consistently applied to the JTTR, will allow meaningful comparisons and help direct future research and appropriate application of personnel.

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

PubMed

Marshall, Thomas J

2005-06-01

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. Records of all U.S. and Iraqi combat casualties admitted to the surgical company were reviewed. 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. 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.

The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion

DTIC Science & Technology

2008-02-01

The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion Philip C...REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE The Effect of Recombinant Activated Factor VII on Mortality in Combat...Boffard study,17 the effect of rFVIIa on 24-hour blood product ad- ministration was only determined for patients who lived for at least 24 hours

Feasibility of negative pressure wound therapy during intercontinental aeromedical evacuation of combat casualties.

PubMed

Fang, Raymond; Dorlac, Warren C; Flaherty, Stephen F; Tuman, Caroline; Cain, Steven M; Popey, Tracy L C; Villard, Douglas R; Aydelotte, Jayson D; Dunne, James R; Anderson, Adam M; Powell, Elisha T

2010-07-01

The objective of this study was to assess the feasibility of utilizing negative pressure wound therapy (NPWT) for the treatment of wartime soft-tissue wounds during intercontinental aeromedical evacuation. Attempts to use NPWT during early phases of overseas contingency operations resulted in occasional vacuum system failures and potentially contributed to wound complications. These anecdotal episodes led to a perception that NPWT during aeromedical evacuation carried a high risk of wound complications and limited its use. As a result, NPWT was not frequently applied in the management of soft-tissue wounds before US casualty arrival in the continental United States (CONUS) for wounds sustained in the combat theaters. Concurrently, early NPWT on the traumatic wounds of host nation casualties not requiring aeromedical evacuation seemed to provide many benefits typically associated with the therapy such as decreased infection rates, earlier wound closure, and improved pain management. On a daily basis, study investigators reviewed the trauma in-patient census at Landstuhl Regional Medical Center, Germany, to identify patient candidates with soft-tissue extremity or torso wounds that required packing. Patient demographics, injuries, and previous wound treatments were recorded. Surgeons inspected wounds in the operating room and applied a NPWT dressing if deemed appropriate. NPWT was continued throughout the remainder of the patient's hospitalization and also during aeromedical evacuation to CONUS. A study investigator escorted the patient during aeromedical evacuation to educate the flight crews, to record the impact on crew workload, and to troubleshoot the system if necessary. Thirty enrolled patients with 41 separate wounds flew from Germany to CONUS with a portable NPWT system (VAC Freedom System; Kinetic Concepts Incorporated, San Antonio, TX). All 30 patients arrived at the destination facilities with intact and functional systems. No significant in

Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

PubMed

Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

2013-01-01

During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. 2013.

The effect of enemy combat tactics on PTSD prevalence rates: A comparison of Operation Iraqi Freedom deployment phases in a sample of male and female veterans.

PubMed

Green, Jonathan D; Bovin, Michelle J; Erb, Sarah E; Lachowicz, Mark; Gorman, Kaitlyn R; Rosen, Raymond C; Keane, Terence M; Marx, Brian P

2016-09-01

Research suggests that the nature of combat may affect later development of posttraumatic stress disorder (PTSD) in combat veterans. Studies comparing rates of PTSD across different conflicts indicate that the use of asymmetric or guerilla-style tactics by enemy fighters may result in higher rates of PTSD among U.S. military personnel than the use of symmetric tactics, which mirror tactics used by U.S. forces. Investigations of the association between enemy combat tactics and PTSD across conflicts were limited because of cohort effects and a focus on male veterans. The current study examined rates of PTSD diagnosis in a sample of male and female veterans deployed to Operation Iraqi Freedom (OIF), a conflict with 3 distinct phases marked by varying enemy tactics. Participants were 738 veterans enrolled in Project VALOR (Veterans' After-Discharge Longitudinal Registry) who deployed once to OIF. Participants completed a clinician interview as well as self-report measures. Male veterans deployed during the OIF phase marked by asymmetric tactics were more than twice as likely to be diagnosed with PTSD as those deployed during the other 2 phases, even after controlling for extent of combat exposure, demographic characteristics, and other deployment-related risk factors for PTSD. Differing rates of PTSD across the 3 OIF phases were not observed among female participants. The nature of combat (specifically, asymmetric enemy tactics) may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Proceedings of the Conference on Fleet Marine Force Combat Casualty Information System Held at San Diego, California on 2-4 April 1984

DTIC Science & Technology

1984-10-01

Ryack Sub~marine Medlical Researchl ILahOratorv tiehlavioral Scxences C De ~partment Naval Submarinte base New London Groton, CT 06349 Dr. William J. Sacco...Computer- Based Patient Management System 1 to Fleet Marine Force Medical Care George Moeller, Ph.D., Naval Submarine Medical Research Laboratory, Groton...combat casualty1 medical record, develop soitware tailor-ed aor cach echelon at casualty care, and ] identity applopridate hardware based on the most

Battlefield trauma care then and now: a decade of Tactical Combat Casualty Care.

DTIC Science & Technology

2012-01-01

use of tranexamic acid to help prevent death from noncompressible hemorrhage35 37 The use of the Combat Ready Clamp to control junctional...hemorrhage38 The use as described for fentanyl lozenges, tranexamic acid , moxifloxacin, ertapenem, and cefotetan is unlabeled use of Food and Drug Administration...2011;377:1096 1101. 35. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military appli- cation of tranexamic acid in trauma emergency resuscitation

Combat casualties undergoing lifesaving interventions have decreased heart-rate complexity at multiple time scales

PubMed Central

Cancio, Leopoldo C.; Batchinsky, Andriy I.; Baker, William L.; Necsoiu, Corina; Salinas, José; Goldberger, Ary L.; Costa, Madalena D.

2013-01-01

Purpose We found that heart-rate (HR) complexity metrics, such as sample entropy (SampEn), identified trauma patients receiving lifesaving interventions (LSIs). We now aimed: 1) to test a new multiscale entropy (MSE) index; 2) to compare it to single-scale measures including SampEn; and 3) to assess different parameter values for calculation of SampEn and MSE. Methods This was a study of combat casualties in an Emergency Department (ED) in Iraq. ECGs of 70 acutely injured adults were recorded. Twelve underwent LSIs and 58 did not. LSIs included endotracheal intubation (9); tube thoracostomy (9); and emergency transfusion (4). From each ECG, a segment of 800 consecutive beats was selected. Off-line, R waves were detected and R-to-R (RR) interval time series were generated. SampEn, MSE, and time-domain measures of HR variability (mean HR, standard deviation, pNN20, pNN50, rMSSD) were computed. Results Differences in mean HR (LSI=111±33, NonLSI=90±17) were not significant. Systolic arterial pressure was statistically but not clinically different (LSI=123±19, NonLSI=135±19). SampEn (LSI=0.90±0.42, NonLSI=1.19±0.35, p<0.05) and MSE index (LSI = 2.58±2.55, NonLSI=5.67±2.48, p<0.001) differed significantly. Conclusions Complexity of HR dynamics over a range of time scales was lower in high-risk than in low-risk combat casualties and outperformed traditional vital signs. PMID:24140167

[Contribution of the Vishnevsky Central Military Clinical Hospital N 3 to the history of combat casualty care and delivery of care to the injured soldiers].

PubMed

Beliakin, S A; Dolgikh, R N; Fokin, Iu N

2013-05-01

The article is dedicated to the 45-year history of combat casualty care in the Vishnevsky Central Military Clinical Hospital N 3. In the echelon system of medical care the Vishnevsky Central Military Clinical Hospital N 3 ranks the echelon (level) N 3. Specialists of the hospital, along with a medical and preventive activity, practice methodological, educational and innovative activity, participate in different scientific forums. Temporary duty assignment to the combat, human-made disaster and natural disaster areas is a real functional test. 64 physicians have an extreme situation experience. The Vishnevsky Central Military Clinical Hospital N 3 is a clinical base of department of surgery, advanced physician training department, combat casualty care department of the Institute for advanced physician training of Mandryka scientific and educational clinical center. For the purpose of reducing the terms and improving the quality of medical care it was suggested to make the integration connections with leading hospitals of the Ministry of Defense of the Russian Federation.

Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace

PubMed Central

Manzano Nunez, Ramiro; Parra, Michael W; Herrera, Juan Pablo; Naranjo, Maria Paula; Escobar, Sara Sofia; Badiel, Marisol; Morales, Monica; Cevallos, Cecibel; Bayona, Juan G; Sanchez, Alvaro Ignacio; Puyana, Juan Carlos; García, Alberto F

2017-01-01

Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation. PMID:29662256

Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace.

PubMed

Ordoñez, Carlos A; Manzano Nunez, Ramiro; Parra, Michael W; Herrera, Juan Pablo; Naranjo, Maria Paula; Escobar, Sara Sofia; Badiel, Marisol; Morales, Monica; Cevallos, Cecibel; Bayona, Juan G; Sanchez, Alvaro Ignacio; Puyana, Juan Carlos; García, Alberto F

2017-12-30

Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods. A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

Infrared imaging-based combat casualty care system

NASA Astrophysics Data System (ADS)

Davidson, James E., Sr.

1997-08-01

A Small Business Innovative Research (SBIR) contract was recently awarded to a start up company for the development of an infrared (IR) image based combat casualty care system. The company, Medical Thermal Diagnostics, or MTD, is developing a light weight, hands free, energy efficient uncooled IR imaging system based upon a Texas Instruments design which will allow emergency medical treatment of wounded soldiers in complete darkness without any type of light enhancement equipment. The principal investigator for this effort, Dr. Gene Luther, DVM, Ph.D., Professor Emeritus, LSU School of Veterinary Medicine, will conduct the development and testing of this system with support from Thermalscan, Inc., a nondestructive testing company experienced in IR thermography applications. Initial research has been done with surgery on a cat for feasibility of the concept as well as forensic research on pigs as a close representation of human physiology to determine time of death. Further such studies will be done later as well as trauma studies. IR images of trauma injuries will be acquired by imaging emergency room patients to create an archive of emergency medical situations seen with an infrared imaging camera. This archived data will then be used to develop training material for medical personnel using the system. This system has potential beyond military applications. Firefighters and emergency medical technicians could directly benefit from the capability to triage and administer medical care to trauma victims in low or no light conditions.

The implicit rules of combat.

PubMed

Romero, Gorge A; Pham, Michael N; Goetz, Aaron T

2014-12-01

Conspecific violence has been pervasive throughout evolutionary history. The current research tested the hypotheses that individuals implicitly categorize combative contexts (i.e., play fighting, status contests, warfare, and anti-exploitative violence) and use the associated contextual information to guide expectations of combative tactics. Using U.S. and non-U.S. samples, Study 1 demonstrated consistent classification of combative contexts from scenarios for which little information was given and predictable shifts in the acceptability of combative tactics across contexts. Whereas severe tactics (e.g., eye-gouging) were acceptable in warfare and anti-exploitative violence, they were unacceptable in status contests and play fights. These results suggest the existence of implicit rules governing the contexts of combat. In Study 2, we explored the reputational consequences of violating these implicit rules. Results suggest that rule violators (e.g., those who use severe tactics in a status contest) are given less respect. These are the first studies to implicate specialized mechanisms for aggression that use contextual cues of violence to guide expectations and behavior.

Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma Model

DTIC Science & Technology

2014-02-01

Chamber construction has been completed and swine experiments have been initiated. The NMRC Center for Hypobaric Experimentation, Simulation and...Aeromedical evacuation, en-route care, hypobaric conditions, hypobaric chamber, swine model 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...diminished morbidity and mortality among combat casualties. However, not much is known about the effects of long range aero-medical evacuation in hypobaric

Combat and Operational Stress: Minimizing Its Adverse Effects on Service Members

DTIC Science & Technology

2008-04-18

munitions. Combat stress has received many labels since the First World War. These labels include “shell shock, war neurosis , psychoneurosis, combat...war neurosis and psychoneurosis carried an inherently negative connotation because they implied by their name that a mental illness or disorder...who became combat stress casualties. In 1916, the term war neurosis replaced shell shocked as the number of combat stress casualties continued due

Optimizing the use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02

DTIC Science & Technology

2014-02-01

Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB, 31 st Combat Support Hospital Research Group...K, Dixon P, Cowart J, Spencer J, Rasmussen TE. Hemorrhagic shock worsens neuromuscular recovery in a porcine model of hind limb vascular injury and

Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned.

PubMed

Bilski, Tracy R; Baker, Bruce C; Grove, Jay R; Hinks, Robert P; Harrison, Michael J; Sabra, John P; Temerlin, Steven M; Rhee, Peter

2003-05-01

Operation Enduring Freedom is an effort to combat terrorism after an attack on the United States. The first large-scale troop movement (> 1,300) was made by the U.S. Marines into the country of Afghanistan by establishing Camp Rhino. Data were entered into a personal computer at Camp Rhino, using combat casualty collecting software. Surgical support at Camp Rhino consisted of two surgical teams (12 personnel each), who set up two operating tables in one tent. During the 6-week period, a total of 46 casualties were treated, and all were a result of blast or blunt injury. One casualty required immediate surgery, two required thoracostomy tube, and the remainder received fracture stabilization or wound care before being transported out of Afghanistan. The casualties received 6 major surgical procedures and 11 minor procedures, which included fracture fixations. There was one killed in action and one expectant patient. The major problem faced was long delay in access to initial surgical care, which was more than 5 hours and 2 hours for two of the casualties. Smaller, more mobile surgical teams will be needed more frequently in future military operations because of inability to set up current larger surgical facilities, and major problems will include long transport times. Future improvements to the system should emphasize casualty evacuation, en-route care, and joint operations planning between services.

Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities.

PubMed

Baker, Michael S

2007-03-01

Current events highlight the need for disaster preparedness. We have seen tsunamis, hurricanes, terrorism, and combat in the news every night. There are many variables in a disaster, such as damage to facilities, loss of critical staff members, and overwhelming numbers of casualties. Each medical treatment facility should have a plan for everything from caring for staff members to getting the laundry done and providing enhanced security or mortuary services. Communication and agreements with local, regional, and federal agencies are vital. Then we must train and drill to shape the tools to impose order on chaos and to provide the most care to the greatest number.

Incidence and epidemiology of combat injuries sustained during "the surge" portion of operation Iraqi Freedom by a U.S. Army brigade combat team.

PubMed

Belmont, Philip J; Goodman, Gens P; Zacchilli, Michael; Posner, Matthew; Evans, Clifford; Owens, Brett D

2010-01-01

A prospective, longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed. A detailed description of the combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a U.S. Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Among the 4,122 soldiers deployed, there were 500 combat wounds in 390 combat casualties. The combat casualty rate for the Brigade Combat Team was 75.7 per 1,000 soldier combat-years. The % killed in action (KIA) was 22.1%, and the %died of wounds was 3.2%. The distribution of these wounds was as follows: head/neck 36.2%, thorax 7.5%, abdomen 6.9%, and extremities 49.4%. The percentage of combat wounds showed a significant increase in the head/neck region (p < 0.0001) and a decrease in the extremities (p < 0.03) compared with data from World War II, Korea, and Vietnam. The percentage of thoracic wounds (p < 0.03) was significantly less than historical data from World War II and Vietnam. The %KIA was significantly greater in those soldiers injured by an explosion (26.3%) compared with those soldiers injured by a gunshot wound (4.6%; p = 0.003). Improvised explosive devices accounted for 77.7% of all combat wounds. There was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts. The 22.1% KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices. The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6% with the use of individual body armor.

Hydrodynamic rupture of liver in combat patient: a case of successful application of "damage control" tactic in area of the hybrid war in East Ukraine.

PubMed

Khomenko, Igor; Shapovalov, Vitalii; Tsema, Ievgen; Makarov, Georgii; Palytsia, Roman; Zavodovskyi, Ievgen; Ishchenko, Ivan; Dinets, Andrii; Mishalov, Vladimir

2017-08-15

The hybrid war of Russia against Ukraine has been started in certain districts of Donetsk and Luhansk oblasts within the Donbas area in 2014. We report a clinical case of a combat patient who was injured after the multiple launcher rocket system "Grad" shelling, diagnosed with hydrodynamic liver rupture followed by medical management with application of damage control (DC) tactic in conditions of hybrid war. The patient underwent relaparatomy, liver resection, endoscopic papillosphincterotomy, endoscopic retrograde cholecystopancreatography, stenting of the common bile duct, and VAC-therapy. Applied treatment modalities were effective; the patient was discharged on the 49th day after injury. To our best knowledge, this is the first report describing a successful application of DC tactic in the hybrid war in East Ukraine. From this case, we suggest that application of DC tactic at all levels of combat medical care could save more lives.

Graduate Medical Education in Tactical Medicine and the Impact of ACGME Accreditation of EMS Fellowships.

PubMed

Tang, Nelson; Levy, Matthew J; Margolis, Asa M; Woltman, Nathan

Physician interest in tactical medicine as an area of professional practice has grown significantly over the past decade. The prevalence of physician involvement in terms of medical oversight and operational support of civilian tactical medicine has experienced tremendous growth during this timeframe. Factors contributing to this trend are multifactorial and include enhanced law enforcement agency understanding of the role of the tactical physician, support for the engagement of qualified medical oversight, increasing numbers of physicians formally trained in tactical medicine, and the ongoing escalation of intentional mass-casualty incidents worldwide. Continued vigilance for the sustenance of adequate and appropriate graduate medical education resources for physicians seeking training in the comprehensive aspects of tactical medicine is essential to ensure continued advancement of the quality of casualty care in the civilian high-threat environment. 2017.

Reprioritization of Research for Combat Casualty Care

DTIC Science & Technology

2012-01-01

Today it is not un- common for a war casualty to sur- vive massive head trauma, multiple extremity loss, significant soft-tissue injury, and sensory ...disorder, depres- sion, and/or anxiety and the coexis- tence of debilitating pain syndromes, presents significant challenges to re- habilitation

Evaluation and management of combat-related spinal injuries: a review based on recent experiences.

PubMed

Schoenfeld, Andrew J; Lehman, Ronald A; Hsu, Joseph R

2012-09-01

The current approach to the evaluation and treatment of military casualties in the Global War on Terror is informed by medical experience from prior conflicts and combat encounters from the last 10 years. In an effort to standardize the care provided to military casualties in the ongoing conflicts, the Department of Defense (DoD) has published Clinical Practice Guidelines (CPGs) that deal specifically with the combat casualty sustaining a spinal injury. However, the combat experience with spine injuries in the present conflicts remains incompletely described. To describe the CPGs for the care of the combat casualty with suspected spine injuries and discuss them in light of the published military experience with combat-related spinal trauma. Literature review. A literature review was conducted regarding published works that discussed the incidence, epidemiology, and management of combat-related spinal trauma. The CPGs, established by the DoD, are discussed in light of actual military experiences with spine trauma, the present situation in the forward surgical teams and combat support hospitals treating casualties in theater, and recent publications in the field of spine surgery. In the conventional wars fought by the United States between 1950 and 1991 (Korea, Vietnam, Gulf War I), the incidence of spine injuries remained close to 1% of all combat casualties. However, in the Global War on Terror, the enemy has relied on implements of asymmetric warfare, including sniper attacks, ambush, roadside bombs, and improvised explosive devices. The increase in explosive mechanisms of injury has elevated the number of soldiers exposed to blunt force trauma and, consequently, recent publications reported the highest incidence of combat-related spinal injuries in American military history. Wounded soldiers are expeditiously evacuated through the echelons of care but typically do not receive surgical management in theater. The current CPGs for the care of soldiers with combat

The 2004 Fitts Lecture: Current Perspective on Combat Casualty Care

DTIC Science & Technology

2005-07-01

deliver this lecture, I actually wondered whether he had called the wrong number. Dr. Basil Pruitt described Dr. William P. Fitts in his 1992 Fitts Lecture...in our ability to care for injured casualties in a deployed setting. Dr. Basil Pruitt eloquently described the interaction between the AAST and...ation ( ABA ) verified burn centers (Fig. 3) in proximity to the USAF hubs.11 We anticipated between 500 and 2,500 burn casualties and created a

Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers.

PubMed

Schwartz, Richard; Lerner, Brooke; Llwewllyn, Craig; Pennardt, Andre; Wedmore, Ian; Callaway, David; Wightman, John; Casillas, Raymond; Eastman, Alex; Gerold, Kevin; Giebner, Stephen; Davidson, Robert; Kamin, Richard; Piazza, Gina; Bollard, Glenn; Carmona, Phillip; Sonstrom, Ben; Seifarth, William; Nicely, Barbara; Croushorn, John; Carmona, Richard

2014-01-01

Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught. An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated. The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain. This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public. 2014.

An Examination of the Conceptual Basis of a Tactical, Logistical, and Air Simulation (ATLAS).

DTIC Science & Technology

1980-03-01

guides the simulation from the start. From this scenario and the de - veloping tactical situation comes information which triggers the tactical-decision...effect of tactical aircraft in a combat situation together with the effect of weapons to destroy the aircraft. The presence of transport aircraft is...sector, the ability of that sector to resupply existing combat units, to transport replacement items and supplies, and to move the new unit through

Tactics: A Soviet View

DTIC Science & Technology

1984-01-01

the greatest revolutionizing influence on the nature of combined arms combat and the methods for conducting it, and on the development of tactics as...their combat employment. Meanwhile, the penetrating radiation of a neutron burst has a destructive effect not only on humans and animals , but on...agents may be most diverse. It has been noted in the foreign press that in the American armed forces the Air Force has the greatest capability for

Improved characterization of combat injury.

PubMed

Champion, Howard R; Holcomb, John B; Lawnick, Mary M; Kelliher, Timothy; Spott, Mary Ann; Galarneau, Michael R; Jenkins, Donald H; West, Susan A; Dye, Judy; Wade, Charles E; Eastridge, Brian J; Blackbourne, Lorne H; Shair, Ellen Kalin

2010-05-01

Combat injury patterns differ from civilian trauma in that the former are largely explosion-related, comprising multiple mechanistic and fragment injuries and high-kinetic-energy bullets. Further, unlike civilians, U.S. armed forces combatants are usually heavily protected with helmets and Kevlar body armor with ceramic plate inserts. Searchable databases providing actionable, statistically valid knowledge of body surface entry wounds and resulting organ injury severity are essential to understanding combat trauma. Two tools were developed to address these unique aspects of combat injury: (1) the Surface Wound Mapping (SWM) database and Surface Wound Analysis Tool (SWAT) software that were developed to generate 3D density maps of point-of-surface wound entry and resultant anatomic injury severity; and (2) the Abbreviated Injury Scale (AIS) 2005-Military that was developed by a panel of military trauma surgeons to account for multiple injury etiology from explosions and other high-kinetic- energy weapons. Combined data from the Joint Theater Trauma Registry, Navy/Marine Combat Trauma Registry, and the Armed Forces Medical Examiner System Mortality Trauma Registry were coded in AIS 2005-Military, entered into the SWM database, and analyzed for entrance site and wounding path. When data on 1,151 patients, who had a total of 3,500 surface wounds and 12,889 injuries, were entered into SWM, surface wounds averaged 3.0 per casualty and injuries averaged 11.2 per casualty. Of the 3,500 surface wounds, 2,496 (71%) were entrance wounds with 6,631 (51%) associated internal injuries, with 2.2 entrance wounds and 5.8 associated injuries per casualty (some details cannot be given because of operational security). Crude deaths rates were calculated using Maximum AIS-Military. These new tools have been successfully implemented to describe combat injury, mortality, and distribution of wounds and associated injuries. AIS 2005-Military is a more precise assignment of severity to

Situation assessment in the Paladin tactical decision generation system

NASA Technical Reports Server (NTRS)

Mcmanus, John W.; Chappell, Alan R.; Arbuckle, P. Douglas

1992-01-01

Paladin is a real-time tactical decision generator for air combat engagements. Paladin uses specialized knowledge-based systems and other Artificial Intelligence (AI) programming techniques to address the modern air combat environment and agile aircraft in a clear and concise manner. Paladin is designed to provide insight into both the tactical benefits and the costs of enhanced agility. The system was developed using the Lisp programming language on a specialized AI workstation. Paladin utilizes a set of air combat rules, an active throttle controller, and a situation assessment module that have been implemented as a set of highly specialized knowledge-based systems. The situation assessment module was developed to determine the tactical mode of operation (aggressive, defensive, neutral, evasive, or disengagement) used by Paladin at each decision point in the air combat engagement. Paladin uses the situation assessment module; the situationally dependent modes of operation to more accurately represent the complex decision-making process of human pilots. This allows Paladin to adapt its tactics to the current situation and improves system performance. Discussed here are the details of Paladin's situation assessment and modes of operation. The results of simulation testing showing the error introduced into the situation assessment module due to estimation errors in positional and geometric data for the opponent aircraft are presented. Implementation issues for real-time performance are discussed and several solutions are presented, including Paladin's use of an inference engine designed for real-time execution.

Bite Protection Analysis of Permethrin-Treated US Military Combat Uniforms

USDA-ARS?s Scientific Manuscript database

Historically, casualties from diseases have greatly outnumbered those from combat during military operations. Since 1951, US military combat uniforms have been chemically treated to protect personnel from arthropod attack. In the 1970s and 1980s, permethrin was one of several insecticides evaluate...

Postural Stability of Special Warfare Combatant-Craft Crewmen With Tactical Gear.

PubMed

Morgan, Paul M; Williams, Valerie J; Sell, Timothy C

The US Naval Special Warfare's Special Warfare Combatant-Craft Crewmen (SWCC) operate on small, high-speed boats while wearing tactical gear (TG). The TG increases mission safety and success but may affect postural stability, potentially increasing risk for musculoskeletal injury. Therefore, the purpose of this study was to examine the effects of TG on postural stability during the Sensory Organization Test (SOT). Eight SWCC performed the SOT on NeuroCom's Balance Manager with TG and with no tactical gear (NTG). The status of gear was performed in randomized order. The SOT consisted of six different conditions that challenge sensory systems responsible for postural stability. Each condition was performed for three trials, resulting in a total of 18 trials. Overall performance, each individual condition, and sensory system analysis (somatosensory, visual, vestibular, preference) were scored. Data were not normally distributed therefore Wilcoxon signed-rank tests were used to compare each variable (ρ = .05). No significant differences were found between NTG and TG tests. No statistically significant differences were detected under the two TG conditions. This may be due to low statistical power, or potentially insensitivity of the assessment. Also, the amount and distribution of weight worn during the TG conditions, and the SWCC's unstable occupational platform, may have contributed to the findings. The data from this sample will be used in future research to better understand how TG affects SWCC. The data show that the addition of TG used in our study did not affect postural stability of SWCC during the SOT. Although no statistically significant differences were observed, there are clinical reasons for continued study of the effect of increased load on postural stability, using more challenging conditions, greater surface perturbations, dynamic tasks, and heavier loads. 2016.

Tactical visualization module

NASA Astrophysics Data System (ADS)

Kachejian, Kerry C.; Vujcic, Doug

1999-07-01

The Tactical Visualization Module (TVM) research effort will develop and demonstrate a portable, tactical information system to enhance the situational awareness of individual warfighters and small military units by providing real-time access to manned and unmanned aircraft, tactically mobile robots, and unattended sensors. TVM consists of a family of portable and hand-held devices being advanced into a next- generation, embedded capability. It enables warfighters to visualize the tactical situation by providing real-time video, imagery, maps, floor plans, and 'fly-through' video on demand. When combined with unattended ground sensors, such as Combat- Q, TVM permits warfighters to validate and verify tactical targets. The use of TVM results in faster target engagement times, increased survivability, and reduction of the potential for fratricide. TVM technology can support both mounted and dismounted tactical forces involved in land, sea, and air warfighting operations. As a PCMCIA card, TVM can be embedded in portable, hand-held, and wearable PCs. Thus, it leverages emerging tactical displays including flat-panel, head-mounted displays. The end result of the program will be the demonstration of the system with U.S. Army and USMC personnel in an operational environment. Raytheon Systems Company, the U.S. Army Soldier Systems Command -- Natick RDE Center (SSCOM- NRDEC) and the Defense Advanced Research Projects Agency (DARPA) are partners in developing and demonstrating the TVM technology.

Tactical Firefighter Teams: Pivoting Toward the Fire Service’s Evolving Homeland Security Mission

DTIC Science & Technology

2016-09-01

critical response command C-TECC Committee on Tactical Emergency Casualty Care EMS emergency medical services EMT emergency medical technician ESU...Interagency Tactical Response Model: Integrating Fire and EMS with Law Enforcement to Mitigate Mumbai-Style Terrorist Attacks (New York: FDNY Center...the assailants, several traditional fire and EMS activities must often occur simultaneously to successfully mitigate the threat. Although rare

Initial experience of US Marine Corps forward resuscitative surgical system during Operation Iraqi Freedom.

PubMed

Chambers, Lowell W; Rhee, Peter; Baker, Bruce C; Perciballi, John; Cubano, Miguel; Compeggie, Michael; Nace, Michael; Bohman, Harold R

2005-01-01

Modern US Marine Corps (USMC) combat tactics are dynamic and nonlinear. While effective strategically, this can prolong the time it takes to transport the wounded to surgical capability, potentially worsening outcomes. To offset this, the USMC developed the Forward Resuscitative Surgical System (FRSS). By operating in close proximity to active combat units, these small, rapidly mobile trauma surgical teams can decrease the interval between wounding and arrival at surgical intervention with resultant improvement in outcomes. Case series. Echelon 2 surgical units during the invasion phase of Operation Iraqi Freedom. Ninety combat casualties, consisting of 30 USMC and 60 Iraqi patients, were treated in the FRSS between March 21 and April 22, 2003. Tactical surgical intervention consisting of selectively applied damage control or definitive trauma surgical procedures. Time to surgical intervention and outcome following treatment in the FRSS. Ninety combat casualties with 170 injuries required 149 procedures by 6 FRSS teams. The USMC patients were received within a median of 1 hour of wounding with the critically injured being received within a median of 30 minutes. Fifty-three USMC personnel were killed in action and 3 died of wounds for a killed in action rate of 13.5% and a died of wounds rate of 0.8% during the invasion phase of Operation Iraqi Freedom. All Marines treated in the FRSS survived. The use of the FRSS in close proximity to the point of engagement during the initial, dynamic combat phase of Operation Iraqi Freedom prevented delays in surgical intervention of USMC combat casualties with resultant beneficial effects on patient outcomes.

A Report on Deliverable Three: Determine a Standard Performance Test for Military Suction Device Use

DTIC Science & Technology

2017-09-20

prehospital combat casualty care have unique performance requirements and should be tested in a manner that effectively simulates the anticipated...artificial airway or assisted ventilation . Loss of patient airway in tactical and combat environments commonly occurs. The proximate cause can be...points related to avoidance of adverse effects in the performance of suction:  There are no contraindications to suctioning, however prolonged

Journal of Special Operations Medicine, Spring 2008, Training Supplement

DTIC Science & Technology

2008-01-01

Tactical Combat Casualty Care (CoTCCC), have been changed in the TME Protocols. (2007) • The Fentanyl oral dosage of 800 mcg, as recommended by the...14aTMEP Behavioral Changes (Includes Psychosis, Depression, Suicidal Impulses)------------------------- 15 aTMEP Bronchitis/ Pneumonia

Tactical lighting in special operations medicine: survey of current preferences.

PubMed

Calvano, Christopher J; Enzenauer, Robert W; Eisnor, Derek L; Laporta, Anthony J

2013-01-01

Success in Special Operations Forces medicine (SOFMED) is dependent on maximizing visual capability without compromising the provider or casualty position when under fire. There is no single ideal light source suitable for varied SOFMED environments. We present the results of an online survey of Special Operations Medical Operators in an attempt to determine strengths and weaknesses of current systems. There was no consensus ideal hue for tactical illumination. Most Operators own three or more lights, and most lights were not night vision compatible. Most importantly, nearly 25% of respondents reported that lighting issues contributed to a poor casualty outcome; conversely, a majority (50 of 74) stated their system helped prevent a poor outcome. Based on the results of this initial survey, we can affirm that the design and choice of lighting is critical to SOFMED success. We are conducting ongoing studies to further define ideal systems for tactical applications including field, aviation, and marine settings. 2013.

Eliminating Preventable Death on the Battlefield

DTIC Science & Technology

2011-08-15

Phases of Tactical Combat Casualty Care Between October 1, 2001, and March 31, 2010 Intervention IVF Dose, mL Casualties, No. Saline lock only NA 35...Saline lock and IVF NA 55 Normal saline 250 1 500 25a 1000 6 1500 1 Hextendb 250 2 500 12a,c 1000 1 Normal salineHextendb 500500 3 1000250 1 500100...1a Lactated ringers 500 2a Abbreviations: IVF , intravenous fluid; NA, not applicable. aFour casualties received 2 saline locks and IVF . bHextend is

2010 Combat Vehicles Conference

DTIC Science & Technology

2010-11-09

7 The Tactical Wheeled Vehicle Challenge… Performance ProtectionPayload Weight Mobility Transportability Cost / Benefit The fully burdened cost of...employment of robotic systems 10 Ground Combat Vehicle… Versatility – Configuration and employment options – Employed across full range of military...Synchronization 11-12 13-14 15-16 17-18 19-20 21-22 23-24 25-26 = Increment Point STOP STOP ~ 2034 Developing a Combat Vehicle Strategy… 11 “… robotics

Infectious disease complications of combat-related injuries.

PubMed

Murray, Clinton K

2008-07-01

: Strategies currently used to prevent morbidity and mortality associated with combat-related injuries include better training of frontline medical personnel, improved personal protective equipment, and deployment of fast-forward surgical assets with state-of-the-art equipment. These strategies allow patients to survive near-catastrophic injuries, placing a greater emphasis on the medical infrastructure to mitigate short- and long-term complications associated with these injuries. : Wounds have certain characteristics that promote the development of infections: the presence of devitalized tissue, foreign bodies, clots, fluid collections, and contamination of wounds with bacteria from the casualty's skin, the environment, and the hospital. All of these factors culminate in placing the casualty at risk of developing an infection. : This article reviews the lessons learned from combat-related wound infections throughout history and in the current conflicts in Iraq and Afghanistan. Many of the management strategies used to prevent infections of combat-related injuries are applicable to the management of civilian trauma, whether associated with small arms fire or related to natural disasters such as earthquakes or tornadoes.

Challenges to Improving Combat Casualty Survivability on the Battlefield

DTIC Science & Technology

2015-01-01

Rescue Medic in Mogadishu , Somalia, and Special Forces battalion surgeon during Operation Enduring Freedom. He is currently the Director of the Military...the CoTCCC, an organization born outside the traditional military medical establishment, exposes a void in ownership and expertise in battle - field...serve as bat- talion surgeons responsible for the resuscitation of battle casualties in the battalion aid station. This is reminiscent of how

Tactical medical skill requirements for law enforcement officers: a 10-year analysis of line-of-duty deaths.

PubMed

Sztajnkrycer, Matthew D

2010-01-01

In the absence of other data, military Tactical Combat Casualty Care (TCCC) precepts are increasingly being adapted to law enforcement needs. The purpose of this study is to better describe the nature of potentially preventable law enforcement Line-of-Duty Deaths (LODDs) occurring as a result of felonious assaults. A retrospective analysis was performed of open source data available through the US Federal Bureau of Investigation Uniform Crime Reporting (UCR) Law Enforcement Officers Killed and Assaulted (LEOKA) program for the years 1998-2007 inclusive. After applying exclusion criteria, 341 victim officers were included in the study. The most common cause of death was head trauma (n=198), followed by chest trauma (n=90). There were 123 victim officers that suffered potentially preventable deaths; the majority of these injuries involved the chest. Over the 10-year study period, only two officers (0.6%) died from isolated extremity hemorrhage. The current emphasis of TCCC on control of exsanguinating extremity hemorrhage may not meet the needs of law enforcement personnel in an environment with expedited access to well-developed trauma systems. Further study is needed to better examine the causes of preventable deaths in law enforcement officers, as well as the most appropriate law enforcement tactical medical skill set and treatment priorities.

A Comparison of the Incidence of Cricothyrotomy in the Deployed Setting to the Emergency Department at a Level 1 Military Trauma Center: A Descriptive Analysis

DTIC Science & Technology

2015-03-01

the providers in the deployed setting and include the Tactical Combat Casualty Care casualty card. Data are then coded for query and analysis. All...intubate, can’t ventilate” and disruption of head/neck anatomy. Of the four procedures performed in the ED setting, three patients survived to hospital...data from SAMMC are limited by the search methods and data extraction. We searched by Current Procedural Ter- minology code , which requires that the

Factors that affect mosquito bite prevention from permethrin-treated US military combat uniforms

USDA-ARS?s Scientific Manuscript database

Historically, casualties from diseases have greatly outnumbered those from combat during military operations. Since 1951, US military combat uniforms have been chemically treated to protect personnel from arthropod attack. In the 1970s and 1980s, permethrin was one of several insecticides evaluate...

Trial Maneuver Generation and Selection in the Paladin Tactical Decision Generation System

NASA Technical Reports Server (NTRS)

Chappell, Alan R.; McManus, John W.; Goodrich, Kenneth H.

1992-01-01

To date, increased levels of maneuverability and controllability in aircraft have been postulated as tactically advantageous, but little research has studied maneuvers or tactics that make use of these capabilities. In order to help fill this void, a real time tactical decision generation system for air combat engagements, Paladin, has been developed. Paladin models an air combat engagement as a series of discrete decisions. A detailed description of Paladin's decision making process is presented. This includes the sources of data used, methods of generating reasonable maneuvers for the Paladin aircraft, and selection criteria for choosing the "best" maneuver. Simulation results are presented that show Paladin to be relatively insensitive to errors introduced into the decision process by estimation of future positional and geometric data.

Trial maneuver generation and selection in the Paladin tactical decision generation system

NASA Technical Reports Server (NTRS)

Chappell, Alan R.; Mcmanus, John W.; Goodrich, Kenneth H.

1993-01-01

To date, increased levels of maneuverability and controllability in aircraft have been postulated as tactically advantageous, but little research has studied maneuvers or tactics that make use of these capabilities. In order to help fill this void, a real-time tactical decision generation system for air combat engagements, Paladin, has been developed. Paladin models an air combat engagement as a series of discrete decisions. A detailed description of Paladin's decision making process is presented. This includes the sources of data used, methods of generating reasonable maneuvers for the Paladin aircraft, and selection criteria for choosing the 'best' maneuver. Simulation results are presented that show Paladin to be relatively insensitive to errors introduced into the decision process by estimation of future positional and geometric data.

Comparison of combat and non-combat burns from ongoing U.S. military operations.

PubMed

Kauvar, David S; Cancio, Leopoldo C; Wolf, Steven E; Wade, Charles E; Holcomb, John B

2006-05-15

Military burns result from either combat or non-combat causes. We compared these etiologies from patients involved in ongoing conflicts to evaluate their impact and provide prevention recommendations. All military patients with significant burns treated at the United States Army Institute of Surgical Research from April 2003 to May 2005 were reviewed. Injuries were categorized as having resulted from combat or non-combat causes. Demographics, burn severity and pattern, mortality, and early outcomes were compared. There were 273 burn patients seen with 63% injured in combat. A high early rate of non-combat injuries was noted. Feedback on non-combat burn prevention was provided to the combat theater, and the incidence of non-combat burns decreased. Mean age and time from injury to admission did not differ. The majority of combat injuries resulted from explosive device detonation. Waste burning, ammunition handling, and gasoline caused most non-combat injuries. Combat casualties had more associated and inhalation injuries and greater full-thickness burn size; total body surface area burned was equivalent. The hands and the face were the most frequently burned body areas. Mortality was 5% in combat and 2% in non-combat patients. The majority of survivors in both groups returned to military duty. The disparity in full-thickness burn size and incidence of inhalation and associated injuries resulted from differing mechanisms of injury, with explosions and penetrating trauma more common in combat wounds. Despite the severity of combat burns, mortality was low and outcomes generally good. Non-combat burns are preventable and have decreased in incidence.

Influence of Personality Traits on the Effective Performance of Lifesaving Interventions: Example of the Tourniquet Application in Forward Combat Casualty Care.

PubMed

Vuillemin, Quentin; Schwartzbrod, Pierre-Eric; Pasquier, Pierre; Sibille, Florian; Trousselard, Marion; Ferrer, Marie-Hélène

2018-01-01

Health care delivery in military conflicts implies high-stress environments. Hemorrhage is the first cause of survivable death among combat casualties, and tourniquet application is one of the most critical lifesaving interventions on the battlefield. However, previous studies have shown high failure rates in tourniquet application. Our study aimed to assess the correlation between personality traits that may interfere with effective tourniquet application in a simulated extremity hemorrhage. Seventy-two French soldiers, previously trained to forward combat casualty care, were evaluated by self-administered questionnaires and submitted to the simulation in group of six. We focused on measuring the empathic personality of the subjects, their peer-to-peer relationships (altruism), as well as their relationship to themselves (mindfulness and self-esteem). The effectiveness of the tourniquet was evidenced by the interruption of the popliteal artery flow Doppler signal. A composite variable called "efficiency" was defined by elimination of popliteal pulse Doppler signal in less than 60 s. Tourniquet application interrupted arterial flow in 37 participants (51.39%). Efficiency was obtained by 19 participants (26.39%). We observed that soldiers with high active altruism applied less-efficient tourniquet (odds ratio = 0.15; 95% confidence interval = 0.04-0.59). On the contrary, soldiers with high self-esteem scores applied more efficient tourniquet (odds ratio = 3.95; 95% confidence interval = 1.24-12.56). There was no significant difference concerning empathy and mindfulness scores. Tourniquet application is technically simple but painful and may involve personal sensitivity. These initial findings highlight the necessity to further explore the psychological processes involved in lifesaving interventions. Self-esteem stands out as a real asset in terms of military competence and resilience, a major prerequisite in stressful situations. Changing altruistic motivations of

Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom.

PubMed

Masini, Brendan D; Waterman, Scott M; Wenke, Joseph C; Owens, Brett D; Hsu, Joseph R; Ficke, James R

2009-04-01

Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits. Descriptive epidemiologic study and cost analysis. The Department of Defense Medical Metrics (M2) database was queried for the hospital admissions and billing data of a previously published cohort of soldiers injured in Iraq and Afghanistan between October 2001 and January 2005 and identified from the Joint Theater Trauma Registry. The US Army Physical Disability Administration database was also queried for Physical Evaluation Board outcomes for these soldiers, allowing calculation of disability benefit cost. Primary body region injured was assigned using billing records that gave a primary diagnosis International Classification of Diseases Ninth Edition code, which was corroborated with Joint Theater Trauma Registry injury mechanisms and descriptions for accuracy. A total of 1333 soldiers had complete admission data and were included from 1566 battle injuries not returned to duty of 3102 total casualties. Extremity-injured patients had the longest average inpatient stay at 10.7 days, accounting for 65% of the $65.3-million total inpatient resource utilization, 64% of the 464 patients found "unfit for duty," and 64% of the $170-million total projected disability benefit costs. Extrapolation of data yields total disability costs for this conflict, approaching $2 billion. Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability

Technical-tactical analysis of youth olympic taekwondo combat.

PubMed

Tornello, Francesco; Capranica, Laura; Minganti, Carlo; Chiodo, Salvatore; Condello, Giancarlo; Tessitore, Antonio

2014-04-01

The purpose of this study was to define the technical and tactical profiles of official youth taekwondo competitions played under the most recent rules of the International Taekwondo Federation. Tactical actions (i.e., attack, defense, and block), technical executions (from 1- to 4-point scores), kicking legs (i.e., front/rear and right/left), and overall technical effectiveness were investigated in relation to match outcome of semifinal and final competitions (n = 50) of youth (aged 13-14 years) black belt athletes during the Italian Taekwondo Cadet Championship. Differences (p < 0.001) were found among all action typologies (Attack: 50.9 ± 2.2%; Defense: 27.7 ± 1.5%; Block: 21.3 ± 1.6%), with winners showing fewer (p = 0.005) offensive actions and more (p = 0.001) defensive actions with respect to non-winners. Independently from match outcome, technical exchanges showed differences (p < 0.001) for technical executions. Winners resulted more efficient (p < 0.001) for both technical and tactical variables. In general, these findings showed that Cadets tend to adopt an offensive strategy. In considering that the adoption of the new electronic system requires athletes to execute correct technical actions to have a score assigned, coaches should emphasize the effectiveness of scoring techniques and help athletes to effectively improve their defense and counterattack capabilities.

Intelligently interactive combat simulation

NASA Astrophysics Data System (ADS)

Fogel, Lawrence J.; Porto, Vincent W.; Alexander, Steven M.

2001-09-01

To be fully effective, combat simulation must include an intelligently interactive enemy... one that can be calibrated. But human operated combat simulations are uncalibratable, for we learn during the engagement, there's no average enemy, and we cannot replicate their culture/personality. Rule-based combat simulations (expert systems) are not interactive. They do not take advantage of unexpected mistakes, learn, innovate, and reflect the changing mission/situation. And it is presumed that the enemy does not have a copy of the rules, that the available experts are good enough, that they know why they did what they did, that their combat experience provides a sufficient sample and that we know how to combine the rules offered by differing experts. Indeed, expert systems become increasingly complex, costly to develop, and brittle. They have face validity but may be misleading. In contrast, intelligently interactive combat simulation is purpose- driven. Each player is given a well-defined mission, reference to the available weapons/platforms, their dynamics, and the sensed environment. Optimal tactics are discovered online and in real-time by simulating phenotypic evolution in fast time. The initial behaviors are generated randomly or include hints. The process then learns without instruction. The Valuated State Space Approach provides a convenient way to represent any purpose/mission. Evolutionary programming searches the domain of possible tactics in a highly efficient manner. Coupled together, these provide a basis for cruise missile mission planning, and for driving tank warfare simulation. This approach is now being explored to benefit Air Force simulations by a shell that can enhance the original simulation.

The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015.

PubMed

Butler, Frank K; Blackbourne, Lorne H; Gross, Kirby

2015-01-01

While the list presented here is by no means a comprehensive list of all of the research areas of interest in battlefield trauma care, much less a list of research needs across the entire continuum of combat casualty care, it does provide the collective judgment of the CoTCCC about the highest priorities for RDT&E that relate to battlefield trauma care. Two additional observations should be made regarding that point: (1) As the landmark Eastridge et al. 2012 study convincingly documented, most combat fatalities occur in the prehospital phase of care, so research efforts that enable Combat medics, corpsmen, and PJs to care for their casualties more effectively will convey the highest probability of further reducing the case fatality rate and preventable deaths among US Combat casualties; and (2) inasmuch as the mission of the CoTCCC is to update the TCCC Guidelines as needed, this group has excellent visibility of the most important current research questions in battlefield trauma care.

Ratio-driven resuscitation predicts early fascial closure in the combat wounded.

PubMed

Glaser, Jacob; Vasquez, Matthew; Cardarelli, Cassandra; Dunne, James; Elster, Eric; Hathaway, Emily; Bograd, Benjamin; Safford, Shawn; Rodriguez, Carlos

2015-10-01

Operation Iraqi Freedom and Operation Enduring Freedom have seen the highest rates of combat casualties since Vietnam. These casualties often require massive transfusion (MT) and immediate surgical attention to control hemorrhage. Clinical practice guidelines dictate ratio-driven resuscitation (RDR) for patients requiring MT. With the transition from crystalloid to blood product resuscitation, we have seen fewer open abdomens in combat casualties. We sought to determine the effect RDR has on achieving early definitive abdominal fascial closure in combat casualties undergoing exploratory laparotomy. Records of 1,977 combat casualties admitted to a single US military hospital from April 2003 to December 2011 were reviewed. Patients receiving an MT and laparotomy in theater constituted the study cohort. The cohort was divided into RDR, defined as a ratio of 0.8-U to 1.2-U packed red blood cells to 1-U fresh frozen plasma, and No-RDR groups. Age, injury patterns, mechanism of injury, injury severity, blood products, number of laparotomies, and days to fascial closure were collected. Assessed outcomes were number of days (early ≤ 2 days) and number of laparotomies to achieve fascial closure. The mean age of the study cohort (n = 172) was 24.0 years, and mean Injury Severity Score (ISS) was 24.8. Improvised explosive device blast was the most common mechanism of injury (74.4%). The cohort was divided into RDR patients (n = 73) and no RDR (n = 99). There was no difference in mean age, mean ISS, or rate of nontherapeutic exploratory laparotomies between the groups. RDR patients had a significantly lower abdominal injury rate (34.2% vs. 72.7%, p < 0.01), had fewer laparotomies (2.7 vs. 4.3, p = 0.003), and achieved primary fascial closure faster (2.4 days vs. 7.2 days, p = 0.004). On multivariate analysis, RDR (2.74; 95% confidence interval, 1.44-5.2) was an independent predictor for early fascial closure. Adherence to RDR guidelines resulted in significantly decreased

Casualties of War: Combat Trauma and the Return of the Combat Veteran

ERIC Educational Resources Information Center

Kiely, Denis O.; Swift, Lisa

2009-01-01

The experience of the combat soldier and the road back to civilian life are recurrent themes in American literature and cinema. Whether the treatment is tragic (Stephen Crane's "Red Badge of Courage", Tim O'Brien's "The Things They Carried", or Tony Scott's "Blackhawk Down"), satirical (Joseph Heller's "Catch Twenty-Two" and Robert Altman's…

From the laboratory to the soldier: providing tactical behaviors for Army robots

NASA Astrophysics Data System (ADS)

Knichel, David G.; Bruemmer, David J.

2008-04-01

The Army Future Combat System (FCS) Operational Requirement Document has identified a number of advanced robot tactical behavior requirements to enable the Future Brigade Combat Team (FBCT). The FBCT advanced tactical behaviors include Sentinel Behavior, Obstacle Avoidance Behavior, and Scaled Levels of Human-Machine control Behavior. The U.S. Army Training and Doctrine Command, (TRADOC) Maneuver Support Center (MANSCEN) has also documented a number of robotic behavior requirements for the Army non FCS forces such as the Infantry Brigade Combat Team (IBCT), Stryker Brigade Combat Team (SBCT), and Heavy Brigade Combat Team (HBCT). The general categories of useful robot tactical behaviors include Ground/Air Mobility behaviors, Tactical Mission behaviors, Manned-Unmanned Teaming behaviors, and Soldier-Robot Interface behaviors. Many DoD research and development centers are achieving the necessary components necessary for artificial tactical behaviors for ground and air robots to include the Army Research Laboratory (ARL), U.S. Army Research, Development and Engineering Command (RDECOM), Space and Naval Warfare (SPAWAR) Systems Center, US Army Tank-Automotive Research, Development and Engineering Center (TARDEC) and non DoD labs such as Department of Energy (DOL). With the support of the Joint Ground Robotics Enterprise (JGRE) through DoD and non DoD labs the Army Maneuver Support Center has recently concluded successful field trails of ground and air robots with specialized tactical behaviors and sensors to enable semi autonomous detection, reporting, and marking of explosive hazards to include Improvised Explosive Devices (IED) and landmines. A specific goal of this effort was to assess how collaborative behaviors for multiple unmanned air and ground vehicles can reduce risks to Soldiers and increase efficiency for on and off route explosive hazard detection, reporting, and marking. This paper discusses experimental results achieved with a robotic countermine system

Development of a lightweight portable ventilator for far-forward battlefield combat casualty support

NASA Astrophysics Data System (ADS)

Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. Alex

1999-07-01

Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

LG based decision aid for naval tactical action officer's (TAO) workstation

NASA Astrophysics Data System (ADS)

Stilman, Boris; Yakhnis, Vladimir; Umanskiy, Oleg; Boyd, Ron

2005-05-01

In the increasingly NetCentric battlespace of the 21st century, Stilman Advanced Strategies Linguistic Geometry software has the potential to revolutionize the way that the Navy fights in two key areas: as a Tactical Decision Aid and for creating a relevant Common Operating Picture. Incorporating STILMAN's software into a prototype Tactical Action Officers (TAO) workstation as a Tactical Decision Aid (TDA) will allow warfighters to manage their assets more intelligently and effectively. This prototype workstation will be developed using human-centered design principles and will be an open, component-based architecture for combat control systems for future small surface combatants. It will integrate both uninhabited vehicles and onboard sensors and weapon systems across a squadron of small surface combatants. In addition, the hypergame representation of complex operations provides a paradigm for the presentation of a common operating picture to operators and personnel throughout the command hierarchy. In the hypergame technology there are game levels that span the range from the tactical to the global strategy level, with each level informing the others. This same principle will be applied to presenting the relevant common operating picture to operators. Each operator will receive a common operating picture that is appropriate for their level in the command hierarchy. The area covered by this operating picture and the level of detail contained within it will be dependent upon the specific tasks the operator is performing (supervisory vice tactical control) and the level of the operator (or command personnel) within the command hierarchy. Each level will inform the others to keep the picture concurrent and up-to-date.

Marine Tactical Command and Control System (MTACCS) Field Development System-1 (FDS-1) assessment: Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Avery, L.W.; Hunt, S.T.; Savage, S.F.

1992-04-01

The United State Marine Corps (USMC) is continuing the development and fielding of the Marine Corps Tactical Command and Control System (MTACCS), a system which exists in varying states of development, fielding, or modernization. MTACCS is currently composed of the following components: Tactical Combat Operations System (TCO) for ground command and control (C2), Intelligence Analysis System (IAS) with a Genser terminal connected to a TCO workstation for intelligence C2, Marine Integrated Personnel System (MIPS) and a TCO workstation using the Marine Combat Personnel System (MCPERS) software for personnel C2, Marine Integrated Logistics System (MILOGS) which is composed of the Landingmore » Force Asset Distribution System (LFADS), the Marine Air-Ground Task Force (MAGTF) II, and a TCO terminal using the Marine Combat Logistics System (MCLOG) for logistics C2, Marine Corps Fire Support System (MCFSS) for fire support C2, and Advanced Tactical Air Command Central (ATACC) and the Improved Direct Air Support Central for aviation C2.« less

LOAD-ENHANCED MOVEMENT QUALITY SCREENING AND TACTICAL ATHLETICISM: AN EXTENSION OF EVIDENCE

PubMed Central

Schmitz, Randy J.; Rhea, Christopher K.; Ross, Scott E.

2017-01-01

Background Military organizations use movement quality screening for prediction of injury risk and performance potential. Currently, evidence of an association between movement quality and performance is limited. Recent work has demonstrated that external loading strengthens the relationship between movement screens and performance outcomes. Such loading may therefore steer us toward robust implementations of movement quality screens while maintaining their appeal as cost effective, field-expedient tools. Purpose The purpose of the current study was to quantify the effect of external load-bearing on the relationship between clinically rated movement quality and tactical performance outcomes while addressing the noted limitations. Study Design Crossover Trial. Methods Fifty young adults (25 male, 25 female, 22.98 ± 3.09 years, 171.95 ± 11.46 cm, 71.77 ± 14.03 kg) completed the Functional Movement Screen™ with (FMS™W) and without (FMS™C) a weight vest in randomized order. Following FMS™ testing, criterion measures of tactical performance were administered, including agility T-Tests, sprints, a 400-meter run, the Mobility for Battle (MOB) course, and a simulated casualty rescue. For each performance outcome, regression models were selected via group lasso with smoothed FMS™ item scores as candidate predictor variables. Results For all outcomes, proportion of variance accounted for was greater in FMS™W (R2 = ;0.22 [T-Test], 0.29 [Sprint], 0.17 [400 meter], 0.29 [MOB], and 0.11 [casualty rescue]) than in FMS™C (R2 = ;0.00 [T-Test], 0.11 [Sprint], 0.00 [400 meter], 0.19 [MOB], and 0.00 [casualty rescue]). From the FMS™W condition, beneficial performance effects (p<0.05) were observed for Deep Squat (sprint, casualty rescue), Hurdle Step (T-Agility, 400 meter run), Inline Lunge (sprint, MOB), and Trunk Stability Push Up (all models). Similar effects for FMS™C item scores were limited to Trunk Stability Push Up (p<0.05, all models

LOAD-ENHANCED MOVEMENT QUALITY SCREENING AND TACTICAL ATHLETICISM: AN EXTENSION OF EVIDENCE.

PubMed

Glass, Stephen M; Schmitz, Randy J; Rhea, Christopher K; Ross, Scott E

2017-06-01

Military organizations use movement quality screening for prediction of injury risk and performance potential. Currently, evidence of an association between movement quality and performance is limited. Recent work has demonstrated that external loading strengthens the relationship between movement screens and performance outcomes. Such loading may therefore steer us toward robust implementations of movement quality screens while maintaining their appeal as cost effective, field-expedient tools. The purpose of the current study was to quantify the effect of external load-bearing on the relationship between clinically rated movement quality and tactical performance outcomes while addressing the noted limitations. Crossover Trial. Fifty young adults (25 male, 25 female, 22.98 ± 3.09 years, 171.95 ± 11.46 cm, 71.77 ± 14.03 kg) completed the Functional Movement Screen™ with (FMS™W) and without (FMS™C) a weight vest in randomized order. Following FMS™ testing, criterion measures of tactical performance were administered, including agility T-Tests, sprints, a 400-meter run, the Mobility for Battle (MOB) course, and a simulated casualty rescue. For each performance outcome, regression models were selected via group lasso with smoothed FMS™ item scores as candidate predictor variables. For all outcomes, proportion of variance accounted for was greater in FMS™W (R 2 = ;0.22 [T-Test], 0.29 [Sprint], 0.17 [400 meter], 0.29 [MOB], and 0.11 [casualty rescue]) than in FMS™C (R 2 = ;0.00 [T-Test], 0.11 [Sprint], 0.00 [400 meter], 0.19 [MOB], and 0.00 [casualty rescue]). From the FMS™W condition, beneficial performance effects (p<0.05) were observed for Deep Squat (sprint, casualty rescue), Hurdle Step (T-Agility, 400 meter run), Inline Lunge (sprint, MOB), and Trunk Stability Push Up (all models). Similar effects for FMS™C item scores were limited to Trunk Stability Push Up (p<0.05, all models). The present study extends evidence supporting the

RTO Technical Publications: A Quarterly Listing

NASA Technical Reports Server (NTRS)

2005-01-01

A quarterly listing of RTO technical publications is presented. The topics include: Handbook on the Analysis of Smaller-Scale Contingency Operations in Long Term Defence Planning; 2) Radar Polarimetry and Interferometry; 3) Combat Casualty Care in Ground-Based Tactical Situations: Trauma Technology and Emergency Medical Procedures; and 4) RTO Technical Publications: A Quarterly Listing

Surgeon preparedness for mass casualty events: Adapting essential military surgical lessons for the home front.

PubMed

Remick, Kyle N; Shackelford, Stacy; Oh, John S; Seery, Jason M; Grabo, Daniel; Chovanes, John; Gross, Kirby R; Nessen, Shawn C; Tai, Nigel Rm; Rickard, Rory F; Elster, Eric; Schwab, C W

2016-01-01

Military surgeons have gained familiarity and experience with mass casualty events (MCEs) as a matter of routine over the course of the last two conflicts in Afghanistan and Iraq. Over the same period of time, civilian surgeons have increasingly faced complex MCEs on the home front. Our objective is to summarize and adapt these combat surgery lessons to enhance civilian surgeon preparedness for complex MCEs on the home front. The authors describe the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a MCE on the home front. Military Damage Control Surgery (mDCS) combines the established concept of clinical DCS (cDCS) with key combat situational awareness factors that enable surgeons to optimally care for multiple, complex patients, from multiple simultaneous events, with limited resources. These additional considerations involve the surgeon's role of care within the deployed trauma system and the battlefield effects. The proposed new concept of mass casualty DCS (mcDCS) similarly combines cDCS decisions with key factors of situational awareness for civilian surgeons faced with complex MCEs to optimize outcomes. The additional considerations for a civilian MCE include the surgeon's role of care within the regional trauma system and the incident effects. Adapting institutionalized lessons from combat surgery to civilian surgical colleagues will enhance national preparedness for complex MCEs on the home front.

Information technologies for Marine Corps combat medicine.

PubMed

Carey, N B; Rattelman, C R; Nguyen, H Q

1998-09-01

Future Marine Corps warfighting concepts will make it more difficult to locate casualties, which will complicate casualty evacuation, lengthen casualty wait times, and require infantrymen or corpsmen to provide more extensive treatment. In these future scenarios, information flow and communications will be critical to medical functions. We asked, for Navy medical support to the Marines, what information will future combat medicine require and what technologies should supply those information needs? Based on analyses of patient data streams, focus groups of Navy medical personnel, and our estimates of the cost and feasibility of communications systems, we recommend the following: (1) increase medical training for some fraction of Marines, especially in hemorrhage control; (2) augment corpsmen's training; (3) furnish data systems for evacuation and supply that would provide in-transit visibility and simplify requests; (4) provide all ground medical personnel with access to treatment information systems and limited voice communications; and (5) exploit e-mail systems to reduce reliance on voice communications. Implementation time frames are discussed.

Preparedness for treating victims of terrorist attacks in Australia: Learning from recent military experience.

PubMed

Rosenfeld, Jeffrey V; Mitra, Biswadev; Smit, De Villiers; Fitzgerald, Mark C; Butson, Benjamin; Stephenson, Michael; Reade, Michael C

2018-05-09

The Australian health system is generally well prepared for mass casualty events. Fortunately, there have been very few terrorist attacks and these have involved low numbers of casualties compared with events overseas. Nevertheless, Australian health professionals need to be prepared to treat mass casualties with blast and ballistic trauma. The US military and its allies including Australia have had extensive experience with mass casualty management in the Middle East and Afghanistan wars for more than a decade. To define their experience, they developed the Tactical Combat Casualty Care Guidelines that have saved many lives. It is now prudent to incorporate this knowledge and experience into civilian practice in Australia. © 2018 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Integrating Chemical Biological, Radiologic, and Nuclear (CBRN) Protocols Into TCCC Introduction of a Conceptual Model - TCCC + CBRN = (MARCHE)2.

PubMed

DeFeo, Devin R; Givens, Melissa L

The authors would like to introduce TCCC [Tactical Combat Casualty Care] + CBRN [chemical, biological, radiological, and nuclear] = (MARCHE)2 as a conceptual model to frame the response to CBRN events. This model is not intended to replace existing and well-established literature on CBRNE events but rather to serve as a response tool that is an adjunct to agent specific resources. 2018.

Artificial intelligence (AI) based tactical guidance for fighter aircraft

NASA Technical Reports Server (NTRS)

Mcmanus, John W.; Goodrich, Kenneth H.

1990-01-01

A research program investigating the use of artificial intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS), a second generation TDG, is presented. The knowledge-based systems used by CLAWS to aid in the tactical decision-making process are outlined in detail, and the results of tests to evaluate the performance of CLAWS versus a baseline TDG developed in FORTRAN to run in real time in the Langley Differential Maneuvering Simulator, are presented. To date, these test results have shown significant performance gains with respect to the TDG baseline in one-versus-one air combat engagements, and the AI-based TDG software has proven to be much easier to modify and maintain than the baseline FORTRAN TDG programs.

A Serious Game for Massive Training and Assessment of French Soldiers Involved in Forward Combat Casualty Care (3D-SC1): Development and Deployment.

PubMed

Pasquier, Pierre; Mérat, Stéphane; Malgras, Brice; Petit, Ludovic; Queran, Xavier; Bay, Christian; Boutonnet, Mathieu; Jault, Patrick; Ausset, Sylvain; Auroy, Yves; Perez, Jean Paul; Tesnière, Antoine; Pons, François; Mignon, Alexandre

2016-05-18

The French Military Health Service has standardized its military prehospital care policy in a ''Sauvetage au Combat'' (SC) program (Forward Combat Casualty Care). A major part of the SC training program relies on simulations, which are challenging and costly when dealing with more than 80,000 soldiers. In 2014, the French Military Health Service decided to develop and deploy 3D-SC1, a serious game (SG) intended to train and assess soldiers managing the early steps of SC. The purpose of this paper is to describe the creation and production of 3D-SC1 and to present its deployment. A group of 10 experts and the Paris Descartes University Medical Simulation Department spin-off, Medusims, coproduced 3D-SC1. Medusims are virtual medical experiences using 3D real-time videogame technology (creation of an environment and avatars in different scenarios) designed for educational purposes (training and assessment) to simulate medical situations. These virtual situations have been created based on real cases and tested on mannequins by experts. Trainees are asked to manage specific situations according to best practices recommended by SC, and receive a score and a personalized feedback regarding their performance. The scenario simulated in the SG is an attack on a patrol of 3 soldiers with an improvised explosive device explosion as a result of which one soldier dies, one soldier is slightly stunned, and the third soldier experiences a leg amputation and other injuries. This scenario was first tested with mannequins in military simulation centers, before being transformed into a virtual 3D real-time scenario using a multi-support, multi-operating system platform, Unity. Processes of gamification and scoring were applied, with 2 levels of difficulty. A personalized debriefing was integrated at the end of the simulations. The design and production of the SG took 9 months. The deployment, performed in 3 months, has reached 84 of 96 (88%) French Army units, with a total of 818

Combat Wound Initiative program.

PubMed

Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

2010-07-01

The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

Combat Orders: An Analysis of the Tactical Orders Process

DTIC Science & Technology

1990-06-01

119 How Each System was Adapted to Doctrine .................. 120 T im e, the Critical Factor...Order ............................. 127 Decision Sequencing ... .......................... .............. ........................ 134 Adapting Tactical...overcentralization slows action and leads to inertia." 15 Agility Is the ability of friendly forces to act faster than the enemy. Initiative stresses the ability

Use of recombinant factor VIIA for control of combat-related haemorrhage.

PubMed

Woodruff, Susan I; Dougherty, Amber L; Dye, Judy L; Mohrle, Charlene R; Galarneau, Michael R

2010-02-01

Recombinant activated human coagulation factor VII (rFVIIa), an intravascular strategy to promote clotting, is being used as an adjunct to surgical control of bleeding in combat trauma patients. To describe the initial experiences with rFVIIa administered to combat casualties at US Navy-Marine Corps medical treatment facilities in Iraq, and to compare survival outcomes of those treated with rFVIIa to controls not receiving rFVIIa. Medical encounter data from the US Navy-Marine Corps Combat Trauma Registry were retrospectively reviewed to identify all battle-injured patients documented as having received rFVIIa during the period May 2004 to January 2006 of Operation Iraqi Freedom. Available clinical and injury related data are presented to characterise the patients. To assess effects of rFVIIa on survival outcomes, rFVIIa cases were matched to controls on injury severity and age. 22 battle-injured patients from the Combat Trauma Registry received rFVIIa. Primarily young US Marines, these patients typically had penetrating injuries from improvised explosive devices and gunshot wounds. Injuries were often abdominal. The average dose used was similar to that reported in another study of civilian trauma patients, although dosing varies widely in the existing experimental and anecdotal literature. Over two-thirds (68%) of the rFVIIa patients survived-an identical outcome seen for a matched control group of 22 patients. Survival of seriously injured combat casualties was good, although identical to that of a control group. Methodological limitations of this retrospective study preclude making firm conclusions about the effectiveness of rFVIIa. Future controlled studies are needed for safety and efficacy testing of rFVIIa in combat trauma patients.

Advanced technology development for remote triage applications in bleeding combat casualties.

PubMed

Ryan, Kathy L; Rickards, Caroline A; Hinojosa-Laborde, Carmen; Gerhardt, Robert T; Cain, Jeffrey; Convertino, Victor A

2011-01-01

Combat developers within the Army have envisioned development of a "wear-and-forget" physiological status monitor (PSM) that will enhance far forward capabilities for assessment of Warrior readiness for battle, as well as for remote triage, diagnosis and decision-making once Soldiers are injured. This paper will review recent work testing remote triage system prototypes in both the laboratory and during field exercises. Current PSM prototypes measure the electrocardiogram and respiration, but we have shown that information derived from these measurements alone will not be suited for specific, accurate triage of combat injuries. Because of this, we have suggested that development of a capability to provide a metric of circulating blood volume status is required for remote triage. Recently, volume status has been successfully modeled using low-level physiological signals obtained from wearable devices as input to machine-learning algorithms; these algorithms are already able to discriminate between a state of physical activity (common in combat) and that of central hypovolemia, and thus show promise for use in wearable remote triage devices.

A high-fidelity, six-degree-of-freedom batch simulation environment for tactical guidance research and evaluation

NASA Technical Reports Server (NTRS)

Goodrich, Kenneth H.

1993-01-01

A batch air combat simulation environment, the tactical maneuvering simulator (TMS), is presented. The TMS is a tool for developing and evaluating tactical maneuvering logics, but it can also be used to evaluate the tactical implications of perturbations to aircraft performance or supporting systems. The TMS can simulate air combat between any number of engagement participants, with practical limits imposed by computer memory and processing power. Aircraft are modeled using equations of motion, control laws, aerodynamics, and propulsive characteristics equivalent to those used in high-fidelity piloted simulations. Data bases representative of a modern high-performance aircraft with and without thrust-vectoring capability are included. To simplify the task of developing and implementing maneuvering logics in the TMS, an outer-loop control system, the tactical autopilot (TA), is implemented in the aircraft simulation model. The TA converts guidance commands by computerized maneuvering logics from desired angle of attack and wind-axis bank-angle inputs to the inner loop control augmentation system of the aircraft. The capabilities and operation of the TMS and the TA are described.

Carrier Air Wing Tactics Incorporating Navy Unmanned Combat Air System (NUCAS)

DTIC Science & Technology

2010-03-01

Profile Curves of Mean Target Casualty Rate Versus GBU-31 Phit and NUCAS Sensor Aperture (After SAS Institute, 2010...Prediction Profile Curve of Mean Blue Survivability Percent Versus AIM- 120 Weapons Phit (After SAS Institute, 2010...Weapons Phit is a major factor in target destruction and blue survivability. Our approach shows how simulation, data farming techniques, and data

Artificial immune system approach for air combat maneuvering

NASA Astrophysics Data System (ADS)

Kaneshige, John; Krishnakumar, Kalmanje

2007-04-01

Since future air combat missions will involve both manned and unmanned aircraft, the primary motivation for this research is to enable unmanned aircraft with intelligent maneuvering capabilities. During air combat maneuvering, pilots use their knowledge and experience of maneuvering strategies and tactics to determine the best course of action. As a result, we try to capture these aspects using an artificial immune system approach. The biological immune system protects the body against intruders by recognizing and destroying harmful cells or molecules. It can be thought of as a robust adaptive system that is capable of dealing with an enormous variety of disturbances and uncertainties. However, another critical aspect of the immune system is that it can remember how previous encounters were successfully defeated. As a result, it can respond faster to similar encounters in the future. This paper describes how an artificial immune system is used to select and construct air combat maneuvers. These maneuvers are composed of autopilot mode and target commands, which represent the low-level building blocks of the parameterized system. The resulting command sequences are sent to a tactical autopilot system, which has been enhanced with additional modes and an aggressiveness factor for enabling high performance maneuvers. Just as vaccinations train the biological immune system how to combat intruders, training sets are used to teach the maneuvering system how to respond to different enemy aircraft situations. Simulation results are presented, which demonstrate the potential of using immunized maneuver selection for the purposes of air combat maneuvering.

The Silent Enemy. Combat Stress Reaction.

DTIC Science & Technology

1986-04-01

intense anxiety, thus the term "shell shock." Such men were thought to have brain damage resulting from the concussion of high explosive shell blasts...French casualties returning to combat. (23:989) Upon the entrance of United States forces into World War I, Thomas W. Salmon, who held the job as...that battle stress is directly related to battle intensity. This was clearly 9 Shown in the Battle of Metz from September to November, 1944. The 5th

Documentation and tagging of casualties in multiple casualty incidents.

PubMed

Garner, Alan

2003-01-01

The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence-based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad-based educational approach that encourages critical reappraisal of existing procedures is recommended.

Risk Management Analysis of Air Ambulance Blood Product Administration in Combat Operations

DTIC Science & Technology

2014-11-01

examining pre-hospital blood product use substantiated that re- mote transfusion programs can deliver life-saving ther- apy without waste. In a series...combat casualty patients . J Trauma 2008 ; 64 : S57 – 63 . 15. Nunez TC, Voskresensky IV, Dossett LA, Shinall R, Dutton WD, Cotton

Towards Organized Disorder: The Evolution of American Infantry Assault Tactics, 1778-1919

DTIC Science & Technology

1979-12-17

military training. 5 3 Many officers who would hold this post would play key roles in shaping infantry tactical doctrine. During Thayer’s admlnis...produce more. Meanwhile Scott would insure that these officers had a tactical system they could use. General Scott was to play a large part in the...Gettysburg in 1863. 5 2Wiley, p. 76. tth 5 3The bayonet played a very small role in Civil War combat compared to the destruction caused by the Minie

Old Tricks for New Dogs? John Caddy and the Victorian Origins of TCCC.

PubMed

Reynolds, Penny S

2018-01-01

The success of Tactical Combat Casualty Care (TCCC) in reducing potentially preventable combat deaths may rely on both specific interventions (such as tourniquets) and the systematized application of immediate care. Essential elements of a combat care system include clear specification of immediate care priorities, standardized methodology, and inclusion and training of all nonmedical personnel in early response. Although TCCC is fairly recent, the construct is similar to that first suggested during the mid-nineteenth century by John Turner Caddy (1822-1902), a British Royal Navy staff surgeon. Although naval warfare engagements at the time were relatively infrequent, casualties could be numerous and severe and often overwhelmed the small medical staff on board. Caddy recognized that nonmedical personnel properly trained in the fundamentals of combat injury management would result in lives saved and greatly improved morale. The novelty was in his attempt to make procedures simple enough to be performed by nonmedical personnel under stress. However, Caddy's guidelines were completely overlooked for nearly two centuries. The principles of best practice for managing combat trauma injuries learned in previous wars have often been lost between conflicts. Understanding the historical roots of combat first responder care may enable us to better understand and overcome barriers to recognition and retention of essential knowledge. 2018.

Tactical Decision Making: A Proposed Evaluation Criteria Model for the Infantry Battalion’s Tactical Estimate during Offensive Operations

DTIC Science & Technology

1993-06-04

34 J In a paper entitled "Understanding and Developing Combat Power," by Colonel Huba Vass de Czege, a method identifying analytical techniques for...reiterates several important doctrinal and theoretical requirements for the de ’elopment of 9« an optimal «valuation criteria nodal. Although...Methode de Ralsonnenent Tactlque" (The Tactical Reasoning Method)’". Is a version of concurrent COA analysis under conditions at uncertainty. Figure

Physical fitness predicts technical-tactical and time-motion profile in simulated Judo and Brazilian Jiu-Jitsu matches.

PubMed

Coswig, Victor S; Gentil, Paulo; Bueno, João C A; Follmer, Bruno; Marques, Vitor A; Del Vecchio, Fabrício B

2018-01-01

Among combat sports, Judo and Brazilian Jiu-Jitsu (BJJ) present elevated physical fitness demands from the high-intensity intermittent efforts. However, information regarding how metabolic and neuromuscular physical fitness is associated with technical-tactical performance in Judo and BJJ fights is not available. This study aimed to relate indicators of physical fitness with combat performance variables in Judo and BJJ. The sample consisted of Judo ( n  = 16) and BJJ ( n  = 24) male athletes. At the first meeting, the physical tests were applied and, in the second, simulated fights were performed for later notational analysis. The main findings indicate: (i) high reproducibility of the proposed instrument and protocol used for notational analysis in a mobile device; (ii) differences in the technical-tactical and time-motion patterns between modalities; (iii) performance-related variables are different in Judo and BJJ; and (iv) regression models based on metabolic fitness variables may account for up to 53% of the variances in technical-tactical and/or time-motion variables in Judo and up to 31% in BJJ, whereas neuromuscular fitness models can reach values up to 44 and 73% of prediction in Judo and BJJ, respectively. When all components are combined, they can explain up to 90% of high intensity actions in Judo. In conclusion, performance prediction models in simulated combat indicate that anaerobic, aerobic and neuromuscular fitness variables contribute to explain time-motion variables associated with high intensity and technical-tactical variables in Judo and BJJ fights.

Imaging of Combat-Related Thoracic Trauma - Review of Penetrating Trauma.

PubMed

Lichtenberger, John P; Kim, Andrew M; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, P Gabriel; Carter, Brett W

2018-03-01

Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF. The assessment of radiologic findings in patients who suffer from combat-related thoracic trauma is the basis of this review article. The imaging modalities for this study include multi-detector computed tomography and chest radiography. High-velocity penetrating projectile injuries appear as hemorrhage and re-expansion pulmonary edema from the temporary cavity and a linear, blood-filled track from the permanent cavity. In cases where the projectile passes totally through the body, entrance wounds at the skin surface and tracks through the subcutaneous tissues may be the only indications of penetrating trauma. When assessing vascular injury, special attention should be paid to the right hilum in contrast-enhanced multi-detector computed tomography, as contrast is concentrated in the superior vena cava and superior cavoatrial junction may obscure small fragments. Additionally, CT angiography may show vessel disruption or extravasation of contrast distal to normal vessel location in addition to intraluminal filling defects and pseudo-aneurysms. Tension pneumopericardium may rarely complicate penetrating or blunt chest trauma. On imaging, distension of the pericardial sack by pneumopericardium and compression of the heart support the diagnosis of tension. On multi-detector computed tomography in the acute trauma setting, fluid in the pleural space should be considered hemothorax, particularly when Hounsfield units are above 35. Acutely, extravasated blood will

Troop Carriers at Normandy and Corregidor: Enduring Lessons for Tactical Airlift

DTIC Science & Technology

During World War II, troop carrier aviation developed as a new form of combat flying in order to support emerging airborne tactics. Throughout the...of World War II. The second is that modern airlift doctrine and joint practices can improve in how they address air integration and cooperation

Red Tides: Mass casualty and whole blood at sea Red Tides.

PubMed

Miller, Benjamin T; Lin, Andrew H; Clark, Susan C; Cap, Andrew P; Dubose, Joseph J

2018-02-13

The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP). The blood supply can be augmented with WFWB collected from a "walking blood bank" (WBB). Following a helicopter crash, six patients were transported by MV-22 Osprey to the USS Bataan. Patient 1 had a pelvic fracture, was managed with a pelvic binder, and received 4 units of pRBC, 2 units of FFP, and 6 units of WFWB. Patient 2, with a comminuted tibia and fibula fracture, underwent lower extremity four-compartment fasciotomy, and received 4 units of WFWB. Patient 3 underwent several procedures, including left anterior thoracotomy, aortic cross-clamping, exploratory laparotomy, small bowel resection, and tracheostomy. He received 8 units of pRBC, 8 units of FFP, and 28 units of WFWB. Patients 4 and 5 had suspected spine injuries and were managed non-operatively. Patient 6, with open tibia and fibula fractures, underwent lower extremity four-compartment fasciotomy with tibia external fixation and received 1 unit of WFWB. All patients survived aeromedical evacuation to a Role 4 medical facility and subsequent transfer to local hospitals. Maritime military mass casualty incidents are challenging, but the U.S. Navy's casualty-receiving ships are ready to perform RDCR at sea. Activation of the ship's WBB to transfuse WFWB is essential for hemostatic resuscitations afloat. V STUDY TYPE: Case series.

Needle Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations

DTIC Science & Technology

2012-07-06

Oxford Centre for Evidence - Based Medicine (OCEBM) method. 11. FINDINGS Thoracic injuries are one of the leading causes of death in trauma...for Evidence - Based Medicine . http://www.cebm.net/index.aspx?o=5653. Accessed on May 24, 2012 12. Davis DP, Pettit K, Rom CD, et al: The safety...TABLE Oxford Centre for Evidence - Based Medicine 2011 Levels of Evidence * Level may be graded down on the basis of study quality, imprecision

Artificial Intelligence (AI) Based Tactical Guidance for Fighter Aircraft

NASA Technical Reports Server (NTRS)

McManus, John W.; Goodrich, Kenneth H.

1990-01-01

A research program investigating the use of Artificial Intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range (WVR) air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS), a second generation TDG, is presented. The Knowledge-Based Systems used by CLAWS to aid in the tactical decision-making process are outlined in detail, and the results of tests to evaluate the performance of CLAWS versus a baseline TDG developed in FORTRAN to run in real-time in the Langley Differential Maneuvering Simulator (DMS), are presented. To date, these test results have shown significant performance gains with respect to the TDG baseline in one-versus-one air combat engagements, and the AI-based TDG software has proven to be much easier to modify and maintain than the baseline FORTRAN TDG programs. Alternate computing environments and programming approaches, including the use of parallel algorithms and heterogeneous computer networks are discussed, and the design and performance of a prototype concurrent TDG system are presented.

Physical fitness predicts technical-tactical and time-motion profile in simulated Judo and Brazilian Jiu-Jitsu matches

PubMed Central

Gentil, Paulo; Bueno, João C.A.; Follmer, Bruno; Marques, Vitor A.; Del Vecchio, Fabrício B.

2018-01-01

Background Among combat sports, Judo and Brazilian Jiu-Jitsu (BJJ) present elevated physical fitness demands from the high-intensity intermittent efforts. However, information regarding how metabolic and neuromuscular physical fitness is associated with technical-tactical performance in Judo and BJJ fights is not available. This study aimed to relate indicators of physical fitness with combat performance variables in Judo and BJJ. Methods The sample consisted of Judo (n = 16) and BJJ (n = 24) male athletes. At the first meeting, the physical tests were applied and, in the second, simulated fights were performed for later notational analysis. Results The main findings indicate: (i) high reproducibility of the proposed instrument and protocol used for notational analysis in a mobile device; (ii) differences in the technical-tactical and time-motion patterns between modalities; (iii) performance-related variables are different in Judo and BJJ; and (iv) regression models based on metabolic fitness variables may account for up to 53% of the variances in technical-tactical and/or time-motion variables in Judo and up to 31% in BJJ, whereas neuromuscular fitness models can reach values up to 44 and 73% of prediction in Judo and BJJ, respectively. When all components are combined, they can explain up to 90% of high intensity actions in Judo. Discussion In conclusion, performance prediction models in simulated combat indicate that anaerobic, aerobic and neuromuscular fitness variables contribute to explain time-motion variables associated with high intensity and technical-tactical variables in Judo and BJJ fights. PMID:29844991

Effect of Parachute Jump in the Psychophysiological Response of Soldiers in Urban Combat.

PubMed

Sánchez-Molina, Joaquín; Robles-Pérez, José J; Clemente-Suárez, Vicente J

2017-06-01

The study of organic and psychological response during combat situations has been poorly reported despite its importance for soldiers training and specific instruction, so it was proposed as aim of the present investigation to analyze the effect of a tactical parachute simulated jump in psycho-physiological response of paratroopers' warfighters during an urban combat simulation. 19 male paratroopers (31.9 ± 6.2 year old; 173.6 ± 5.3 cm; 73.8 ± 8.3 Kg) of the Spanish Army were divided in two groups: parachute jump group (n:11) that conducted a simulated parachute jump and a urban combat maneuver and a non-parachute jump group (n:8) that only conducted an urban combat maneuver. We analyzed before and after the maneuver the rated perceived exertion, legs strength manifestation, blood lactate, cortical activation, heart rate variability, blood oxygen saturation and pressure, skin temperature, fine motor skills, and anxiety state. A tactical parachute simulated jump prior to an urban combat maneuver produce significantly (p < 0.05) higher heart rate and decrease in specific fine motor skills in comparison with no jump situation in professional Army paratroopers. Independently of the parachute jump, an urban combat maneuver produces a significant increase in rated perceived exertion, blood lactate, heart rate, legs strength, sympathetic modulation and anxiety response as well as a significant decrease in blood oxygen saturation and parasympathetic modulation.

Trauma Induced Pain and Wound Management in Emergency Environment by Low Energy Photonic Therapy

DTIC Science & Technology

2004-09-01

Technology and Emergency Medical Procedures”, held in St. Pete Beach, USA, 16-18 August 2004, and published in RTO-MP-HFM-109. Report Documentation Page...Casualty Care in Ground-Based Tactical Situations: Trauma Technology and Emergency Medical Procedures (Soins aux blessés au combat dans des situations...tactiques : technologies des traumas et procédures médicales durgence)., The original document contains color images. 14. ABSTRACT 15. SUBJECT TERMS 16

Providing for the Casualties of War: The American Experience Through World War II

DTIC Science & Technology

2013-01-01

Freud sug- gested that this may be an inherent trait, that “conflicts of interest between man and man are resolved, in principle, by the recourse to...violence” (Einstein and Freud , 1931– 1932). Although people have not been able to overcome their essential proclivity to make war on one another over...and methods of treatment of combat casualties. (Bliss, 1949) Army Psychiatry on the Eve of World War II After World War I, the writings of Sigmund

An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast.

PubMed

Bauman, Richard A; Ling, Geoffrey; Tong, Lawrence; Januszkiewicz, Adolph; Agoston, Dennis; Delanerolle, Nihal; Kim, Young; Ritzel, Dave; Bell, Randy; Ecklund, James; Armonda, Rocco; Bandak, Faris; Parks, Steven

2009-06-01

Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs).

A High-Fidelity Batch Simulation Environment for Integrated Batch and Piloted Air Combat Simulation Analysis

NASA Technical Reports Server (NTRS)

Goodrich, Kenneth H.; McManus, John W.; Chappell, Alan R.

1992-01-01

A batch air combat simulation environment known as the Tactical Maneuvering Simulator (TMS) is presented. The TMS serves as a tool for developing and evaluating tactical maneuvering logics. The environment can also be used to evaluate the tactical implications of perturbations to aircraft performance or supporting systems. The TMS is capable of simulating air combat between any number of engagement participants, with practical limits imposed by computer memory and processing power. Aircraft are modeled using equations of motion, control laws, aerodynamics and propulsive characteristics equivalent to those used in high-fidelity piloted simulation. Databases representative of a modern high-performance aircraft with and without thrust-vectoring capability are included. To simplify the task of developing and implementing maneuvering logics in the TMS, an outer-loop control system known as the Tactical Autopilot (TA) is implemented in the aircraft simulation model. The TA converts guidance commands issued by computerized maneuvering logics in the form of desired angle-of-attack and wind axis-bank angle into inputs to the inner-loop control augmentation system of the aircraft. This report describes the capabilities and operation of the TMS.

Evaluation of Role 2 (R2) Medical Resources in the Afghanistan Combat Theater: Past, Present and Future

DTIC Science & Technology

2017-10-01

casualty care using descriptive statistical analysis and modeling techniques. Aim 2: Identify the ideal provider training and competency assessment... Methodologies , Course  Type,  Course  Availability,  Assessment  Criteria,  Requirements,  Funding,  Alignment  with Clinical  Practice  Guidelines  (CPGs...Aim 1:  Descriptive study of all available information for combat casualties in Afghanistan.  Specific Tasks:  1) who – patients treated; clinician mix

Air Combat Training: Good Stick Index Validation. Final Report for Period 3 April 1978-1 April 1979.

ERIC Educational Resources Information Center

Moore, Samuel B.; And Others

A study was conducted to investigate and statistically validate a performance measuring system (the Good Stick Index) in the Tactical Air Command Combat Engagement Simulator I (TAC ACES I) Air Combat Maneuvering (ACM) training program. The study utilized a twelve-week sample of eighty-nine student pilots to statistically validate the Good Stick…

Preliminary assessment of the impact of incorporating a detailed algorithm for the effects of nuclear irradiation on combat crew performance into the Janus combat simulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warshawsky, A.S.; Uzelac, M.J.; Pimper, J.E.

The Crew III algorithm for assessing time and dose dependent combat crew performance subsequent to nuclear irradiation was incorporated into the Janus combat simulation system. Battle outcomes using this algorithm were compared to outcomes based on the currently used time-independent cookie-cutter'' assessment methodology. The results illustrate quantifiable differences in battle outcome between the two assessment techniques. Results suggest that tactical nuclear weapons are more effective than currently assumed if performance degradation attributed to radiation doses between 150 to 3000 rad are taken into account. 6 refs., 9 figs.

A modern combat trauma.

PubMed

Popivanov, Georgi; Mutafchiyski, V M; Belokonski, E I; Parashkevov, A B; Koutin, G L

2014-03-01

The world remains plagued by wars and terrorist attacks, and improvised explosive devices (IED) are the main weapons of our current enemies, causing almost two-thirds of all combat injuries. We wished to analyse the pattern of blast trauma on the modern battlefield and to compare it with combat gunshot injuries. Analysis of a consecutive series of combat trauma patients presenting to two Bulgarian combat surgical teams in Afghanistan over 11 months. Demographics, injury patterns and Injury Severity Scores (ISS) were compared between blast and gunshot-injured casualties using Fisher's Exact Test. The blast victims had significantly higher median ISS (20.54 vs 9.23) and higher proportion of ISS>16 (60% vs 33.92%, p=0.008) than gunshot cases. They also had more frequent involvement of three or more body regions (47.22% vs 3.58%, p<0.0001). A significantly higher frequency of head (27.27% vs 3.57%), facial (20% vs 0%) and extremities injuries (85.45% vs 42.86%) and burns (12.72% vs 0%) was noted among the victims of explosion (p<0.0001). Based on clinical examination and diagnostic imaging, primary blast injury was identified in 24/55 (43.6%), secondary blast injury in 37 blast cases (67.3%), tertiary in 15 (27.3%) and quaternary blast injury (all burns) in seven (12.72%). Our results corroborate the 'multidimensional' injury pattern of blast trauma. The complexity of the blast trauma demands a good knowledge and a special training of the military surgeons and hospital personnel before deployment.

Nomonhan: Japanese-Soviet Tactical Combat, 1939 (Leavenworth Papers, Number 2)

DTIC Science & Technology

1981-01-01

describes the evolution of thatiJA tactical doctrine, and then pre- sents a detailed examination of how a partkular Japanese infantry battalion applied...transpmtation, and a field sanitation unit composed the task force. They set out to hack down and destroy an elu- 21 s1ve foe in the barren desert steppes...this sandy covering, the desert surface was genexally firm enough to support wheeled transport. South of the Holsten Rivex eucalyptus trees grew

Unintended Relevance: The Role of the Stryker Brigade Combat Team in the Decisive Action Environment

DTIC Science & Technology

2017-05-25

Systems , 30MM 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON Walter C. Gray II...Facilities- Policy FCS Future Combat System FM Field Manual FMTV Family of Medium Tactical Vehicles GCV Ground Combat Vehicle GWOT...Vehicle MGS Mobile Gun System MPF Mobile Protected Firepower NATO North Atlantic Treaty Organization ONS Operational Needs Statement RPG

An experimental predeployment training program improves self-reported patient treatment confidence and preparedness of Army combat medics.

PubMed

Gerhardt, Robert T; Hermstad, Erik L; Oakes, Michael; Wiegert, Richard S; Oliver, Jeffrey

2008-01-01

To develop and assess impact of a focused review of International Trauma Life Support (ITLS) and combat casualty care with hands-on procedure training for U.S. Army medics deploying to Iraq. The setting was a U.S. Army Medical Department Center and School and Camp Eagle, Iraq. Investigators developed and implemented a command-approved prospective educational intervention with a post hoc survey. Subjects completed a three-day course with simulator and live-tissue procedure laboratories. At deployment's end, medics were surveyed for experience, confidence, and preparedness in treating various casualty severity levels. Investigators used two-tailed t-test with unequal variance for continuous data and chi-square for categorical data. Twenty-nine medics deployed. Eight completed the experimental program. Twenty-one of 25 (84%) available medics completed the survey including six of the eight (75%) experimental medics. The experimental group reported significantly greater levels of preparedness and confidence treating "minimal," "delayed," and "immediate" casualties at arrival in Iraq. These differences dissipated progressively over the time course of the deployment. This experimental program increased combat medic confidence and perceived level of preparedness in treating several patient severity levels. Further research is warranted to determine if the experimental intervention objectively improves patient care quality and translates into lives saved early in deployment.

A review of casualties during the Iraqi insurgency 2006--a British field hospital experience.

PubMed

Ramasamy, Arul; Harrisson, Stuart; Lasrado, Irwin; Stewart, Michael P M

2009-05-01

Following the invasion of Iraq in April 2003, British and coalition forces have been conducting counter-insurgency operations in the country. As this conflict has evolved from asymmetric warfare, the mechanism and spectrum of injury sustained through hostile action (HA) was investigated. Data was collected on all casualties of HA who presented to the British Military Field Hospital Shaibah (BMFHS) between January and October 2006. The mechanism of injury, anatomical distribution, ICD-9 diagnosis and initial discharge information was recorded for each patient in a trauma database. There were 104 HA casualties during the study period. 18 were killed in action (KIA, 21%). Of the remaining 86 surviving casualties, a further three died of their wounds (DOW, 3.5%). The mean number of diagnoses per survivor was 2.70, and the mean number of anatomical regions injured was 2.38. Wounds to the extremities accounted for 67.8% of all injuries, a percentage consistent with battlefield injuries sustained since World War II. Open wounds and fractures were the most common diagnosis (73.8%) amongst survivors of HA. Improvised explosive devices (IEDs) accounted for the most common cause of injury amongst casualties (54%). Injuries in conflict produce a pattern of injury that is not seen in routine UK surgical practice. In an era of increasing surgical sub-specialisation, the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. IEDs have become the modus operandi for terrorists. In the current global security situation, these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries is relevant to both military and civilian surgeons.

New Technologies for Treating Severe Bleeding in Far-Forward Combat Areas

DTIC Science & Technology

2010-04-01

Kheirabadi US Army Institute of Surgical Research 3400 Rawley East Chambers Avenue San Antonio, TX 78234-6315 USA michael.dubick@amedd.army.mil...inadequate to control a more severe hemorrhage and is often diminished after traumatic injuries. Therefore, the use of blood clotting drugs/devices is...threatening hemorrhage relevant to battlefield injury, have been one of the main focuses of the Combat Casualty Care Research program in the US Army

Using agility to combat cyber attacks.

PubMed

Anderson, Kerry

2017-06-01

Some incident response practitioners feel that they have been locked in a battle with cyber criminals since the popular adoption of the internet. Initially, organisations made great inroads in preventing and containing cyber attacks. In the last few years, however, cyber criminals have become adept at eluding defence security technologies and rapidly modifying their exploit strategies for financial or political gains. Similar to changes in military combat tactics, cyber criminals utilise distributed attack cells, real-time communications, and rapidly mutating exploits to minimise the potential for detection. Cyber criminals have changed their attack paradigm. This paper describes a new incident response paradigm aimed at combating the new model of cyber attacks with an emphasis on agility to increase the organisation's ability to respond rapidly to these new challenges.

Prevention and management of infections associated with combat-related extremity injuries.

PubMed

Murray, Clinton K; Hsu, Joseph R; Solomkin, Joseph S; Keeling, John J; Andersen, Romney C; Ficke, James R; Calhoun, Jason H

2008-03-01

Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

Comparisons: Technical-Tactical and Time-Motion Analysis of Mixed Martial Arts by Outcomes.

PubMed

Miarka, Bianca; Vecchio, Fabrício B D; Camey, Suzi; Amtmann, John A

2016-07-01

Miarka, B, Vecchio, FBD, Camey, S, and Amtmann, JA. Comparisons: technical-tactical and time-motion analysis of mixed martial arts by outcomes. J Strength Cond Res 30(7): 1975-1984, 2016-The aim of this study was to compare time-motion and technical-tactical analysis between paired outcomes and rounds of mixed martial arts (MMA) matches. The sample consisted of 645 rounds of MMA competition paired by outcomes (first round, winners n = 215 and losers n = 215; second round, winners n = 215 and losers n = 215; third round, winners n = 215 and losers n = 215). The time-motion variables were categorized into low-intensity or high-intensity, stand-up or groundwork situations. Stand-up techniques were analyzed by observing total strikes to the head and body, and takedowns. The actions on the ground were analyzed by observing submission activity, including successful choking and joint locking actions, and also positional improvements, including advances to the mount, half guard, and side and back positions. Chi-squared and Wilcoxon tests were conducted with a significance level of p ≤ 0.05. Results showed that winners had higher values for total strikes and submissions in all rounds, and also positional improvements, over losers. The standing combat with low-intensity comparisons presented differences between the rounds first, with a median of 2:33.5 (P25-P75%: 1:20-3:56) minute, second, with 2:37 (1:24-3:59) minute, and third, with 2:07 (1:06-3:39.2) minute. These data suggest a focus on the intermittent demand presented in combat phases with a special attention to the strike and ground technical-tactical skills; strength and conditioning coaches could emphasize the effort pause ratios for both standing and ground combat that mimic the requirements of MMA, especially during the third round.

An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan.

PubMed

Schauer, Steven G; Naylor, Jason F; Oliver, Joshua J; Maddry, Joseph K; April, Michael D

2018-05-02

During the past 17 years of conflict the deployed US military health care system has found new and innovative ways to reduce combat mortality down to the lowest case fatality rate in US history. There is currently a data dearth of emergency department (ED) care delivered in this setting. We seek to describe ED interventions in this setting. We used a series of ED procedure codes to identify subjects within the Department of Defense Trauma Registry from January 2007 to August 2016. During this time, 28,222 met inclusion criteria. The median age of causalities in this dataset was 25 years and most (96.9%) were male, US military (41.3%), and part of Operation Enduring Freedom (66.9%). The majority survived to hospital discharge (95.5%). Most subjects sustained injuries by explosives (55.3%) and gunshot wound (GSW). The majority of subjects had an injury severity score that was considered minor (74.1%), while the preponderance of critically injured casualties sustained injuries by explosive (0.7%). Based on AIS, the most frequently seriously injured body region was the extremities (23.9%). The bulk of administered blood products were packed red blood cells (PRBC, 26.4%). Endotracheal intubation was the most commonly performed critical procedure (11.9%). X-ray (79.9%) was the most frequently performed imaging study. US military personnel comprised the largest proportion of combat casualties and most were injured by explosive. Within this dataset, ED providers most frequently performed endotracheal intubation, administered blood products, and obtained diagnostic imaging studies. Published by Elsevier Inc.

Personnel Attrition Rates in Historical Land Combat Operations: An Annotated Bibliography

DTIC Science & Technology

1993-06-01

1986, Combat Casualties Among US Navy Personnel in Vietnam. Cochrane-1959, The 3rd Division at Chateau Thierry , July 1918. Cockrell-1974, Research Study...Chateau Thierry , July 1918. CIVIL Fox-1889, Regimental Losses in the American Civil War, 1861-1865. Livermore-1900, Numbers and Losses in the Civil War... Thierry , July 1918. Wainstein-1973b, Rates of Advance in Infantry Division Attacks in the Normandy-Northern France and Siegfried Line Campaigns. DURATION

A Descriptive Analysis of US Prehospital Care Response to Law Enforcement Tactical Incidents.

PubMed

Aberle, Sara J; Lohse, Christine M; Sztajnkrycer, Matthew D

2015-01-01

Law enforcement tactical incidents involve high-risk operations that exceed the capabilities of regular, uniformed police. Despite the existence of tactical teams for 50 years, little is known about the frequency or nature of emergency medical services (EMS) response to tactical events in the United States. The purpose of this study was to perform a descriptive analysis of tactical events reported to a national EMS database. Descriptive analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) Public Release research data set, containing EMS emergency response data from 41 states. A total of 17,479,328 EMS events were reported, of which 3,953 events were coded as "Activation-Tactical or SWAT Specialty Service/Response Team." The most common level of prehospital care present on scene was basic life support (55.2%). The majority (72.3%) of tactical incident activations involved a single patient; mass casualty incidents occurred in 0.5% of events. The most common EMS response locations were homes (48.4%), streets or highways (37.0%), and public buildings (6.3%). The mean age of treated patients was 44.1 years ± 22.0 years; 3.5% of tactical incident activation patients were aged 8 years or less. Injuries were coded as firearm assault in 14.8% and as chemical exposure in 8.9% of events. Cardiac arrest occurred in 5.1% of patients, with the majority (92.2%) occurring prior to EMS arrival. The primary symptoms reported by EMS personnel were pain (37.4%), change in responsiveness (13.1%), and bleeding (8.1%). Advanced airway procedures occurred in 30 patients. No patients were documented as receiving tourniquets or needle thoracostomy. Approximately 11 EMS responses in support of law enforcement tactical operations occur daily in the United States. The majority occur in homes and involve a single patient. Advanced airway procedures are required in a minority of patients. Cardiac arrest is rare and occurs prior to EMS response in the majority of

Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care.

PubMed

Noorman, Femke; van Dongen, Thijs T C F; Plat, Marie-Christine J; Badloe, John F; Hess, John R; Hoencamp, Rigo

2016-01-01

The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties. Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP. No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products. This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.

Law enforcement and the long gun: do we need a new face in the fight?

PubMed

Cannon, Mark

2013-11-01

The threat of rifles in the hands of criminals is now well recognized within law enforcement. Current emergency response systems are not equipped to operate in this combat-like environment. Growing statistics indicate that of the peace officers that were killed in the line of duty in the United States nearly half died by gunfire evidence. As Emergency Medical Services ("EMS") training and standards evolve, the lessons learned from the Tactical Combat Casualty Care doctrine should be incorporated to improve the safety and outcomes of injured law enforcement officers. Statistics show that deaths by gunfire have the highest average percentage of all officer deaths. Although new weapons, armor, and tactics are continually evolving to meet the challenge of officer safety, in the past decade, little has changed in how our EMS system responds to a critically wounded officer. Combat data from the US military leads us to believe that to save a wounded officer, emergency care must start immediately, regardless of the ongoing gun battle. It is time for the emergency medical system to evolve to meet the critical needs of today's law enforcement environment. Copyright © 2013 Elsevier Inc. All rights reserved.

U.S. Army Physical Demands Study: Reliability of Simulations of Physically Demanding Tasks Performed by Combat Arms Soldiers.

PubMed

Foulis, Stephen A; Redmond, Jan E; Frykman, Peter N; Warr, Bradley J; Zambraski, Edward J; Sharp, Marilyn A

2017-12-01

Foulis, SA, Redmond, JE, Frykman, PN, Warr, BJ, Zambraski, EJ, and Sharp, MA. U.S. Army physical demands study: reliability of simulations of physically demanding tasks performed by combat arms soldiers. J Strength Cond Res 31(12): 3245-3252, 2017-Recently, the U.S. Army has mandated that soldiers must successfully complete the physically demanding tasks of their job to graduate from their Initial Military Training. Evaluating individual soldiers in the field is difficult; however, simulations of these tasks may aid in the assessment of soldiers' abilities. The purpose of this study was to determine the reliability of simulated physical soldiering tasks relevant to combat arms soldiers. Three cohorts of ∼50 soldiers repeated a subset of 8 simulated tasks 4 times over 2 weeks. Simulations included: sandbag carry, casualty drag, and casualty evacuation from a vehicle turret, move under direct fire, stow ammunition on a tank, load the main gun of a tank, transferring ammunition with a field artillery supply vehicle, and a 4-mile foot march. Reliability was assessed using intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs), and 95% limits of agreement. Performance of the casualty drag and foot march did not improve across trials (p > 0.05), whereas improvements, suggestive of learning effects, were observed on the remaining 6 tasks (p ≤ 0.05). The ICCs ranged from 0.76 to 0.96, and the SEMs ranged from 3 to 16% of the mean. These 8 simulated tasks show high reliability. Given proper practice, they are suitable for evaluating the ability of Combat Arms Soldiers to complete the physical requirements of their jobs.

[Patterns of injury in a combat environment. 2007 update].

PubMed

Willy, C; Voelker, H-U; Steinmann, R; Engelhardt, M

2008-01-01

Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas. MEDLINE (1949-2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed. The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8-15% of the deaths appeared to be preventable. Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.

Management of mass casualty: a review.

PubMed

Adesunkanmi, A R K; Lawal, A O

2011-09-01

The aim of this article is to discuss the management of mass casualty and sensitise authorities at various levels and trauma surgeons the need for awareness and training in the management of mass casualty. Thorough Medline and bibliography search and available local literatures relevant to the management of mass casualty was reviewed. The available articles were reviewed in order to decipher the management pattern in various forms and degree of disasters resulting in mass casualty. Little attention was paid to mass casualty management in civilian population until mid nineties, even, in developed countries. Knowledge in this area has expanded in the last 10 years due to terrorist attacks in the United State America. In developing countries, nothing is known to be on the ground in form of planning for appropriate response to mass casualty. Mass casualty usually associated with straining of existing facilities, and with high morbidity and mortality. Pre-incident and adequate training is necessary to reduce morbidity and mortality from major incident which occurrence is often not predictable.

Maritime Casualty Tabulation (1972)

DOT National Transportation Integrated Search

1975-01-01

The report creates a data base of the maritime casualties during 1972 which would have been candidates for a distress channel in a satellite communications service. There are 1546 casualties recorded in this report for the calendar year 1972; of thes...

Student and School Staff Strategies to Combat Cyberbullying in an Urban Student Population

ERIC Educational Resources Information Center

Pelfrey, William V., Jr.; Weber, Nicole L.

2015-01-01

Research indicates that cyberbullying is occurring among middle and high school student populations at increasing rates. There is limited research, however, on strategies students use to combat cyberbullying, as well as how schools implement policies, intervention tactics, and prevention strategies. This qualitative study aimed to explore, among a…

The surgical management of facial trauma in British soldiers during combat operations in Afghanistan.

PubMed

Wordsworth, Matthew; Thomas, Rachael; Breeze, John; Evriviades, Demetrius; Baden, James; Hettiaratchy, Shehan

2017-01-01

The recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan. Hospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013. 566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK. The presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury. Copyright © 2016. Published by Elsevier Ltd.

Tsunami Casualty Model

NASA Astrophysics Data System (ADS)

Yeh, H.

2007-12-01

More than 4500 deaths by tsunamis were recorded in the decade of 1990. For example, the 1992 Flores Tsunami in Indonesia took away at least 1712 lives, and more than 2182 people were victimized by the 1998 Papua New Guinea Tsunami. Such staggering death toll has been totally overshadowed by the 2004 Indian Ocean Tsunami that claimed more than 220,000 lives. Unlike hurricanes that are often evaluated by economic losses, death count is the primary measure for tsunami hazard. It is partly because tsunamis kill more people owing to its short lead- time for warning. Although exact death tallies are not available for most of the tsunami events, there exist gender and age discriminations in tsunami casualties. Significant gender difference in the victims of the 2004 Indian Ocean Tsunami was attributed to women's social norms and role behavior, as well as cultural bias toward women's inability to swim. Here we develop a rational casualty model based on humans' limit to withstand the tsunami flows. The application to simple tsunami runup cases demonstrates that biological and physiological disadvantages also make a significant difference in casualty rate. It further demonstrates that the gender and age discriminations in casualties become most pronounced when tsunami is marginally strong and the difference tends to diminish as tsunami strength increases.

Establishing a Suitable Tactical Design Model for Clear-Hold-Build Counterinsurgency Operations

DTIC Science & Technology

2009-06-12

Vietnam capitol of Saigon. Cedar Falls was tactically designed to achieve this result through two measures . First, U.S. Army forces would separate...provide a higher force ratio for the operation. This tethering would mitigate risk for the Soldiers themselves. Because risk management is so integrated...Vietnam) BCT Brigade Combat Team BCTP Battle Command Training Program BN Battalion BSP Baghdad Security Plan CF Coalition Forces C-H-B Clear-Hold

Multi-Agent Coordination Techniques for Naval Tactical Combat Resources Management

DTIC Science & Technology

2008-07-01

resource coordination and cooperation problems. The combat resource allocation planning problem is treated in the companion report [2]. 2.3 Resource...report focuses on the resource coordination problem, while allocation algorithms are discussed in the companion report [2]. First, coordination in...classification of each should be indicated as with the title.) Canada’s Leader in Defence and National Security Science and Technology Chef de file au Canada en

[The organizational aspects of treating light casualties in modern warfare (2)].

PubMed

Nechaev, E A; Maksimov, G K; Agapov, V K; Golov, Iu S

1993-07-01

The experience gathered by Medical Service during the war in Afghanistan and during liquidation of the consequences of various disasters and accidents has shown that the most rational method of treatment of minor wounded near the combat area or zone of disaster was a two-staged (and sometimes a three-staged) management system. At the combat tactical zone it is expedient to render the secondary surgical care and reanimation procedures of vital cases, and also provide treatment of minor wounded who could be returned to their ranks in 10 days. For this purpose it is necessary to integrate the sections of medical triage and minor wounded treatment into organic structure of the Brigade medical company and Divisional hospital. As for Army Medical Brigade it must have in its structure a hospital for minor wounded who could be returned to their ranks in 20 days. All the wounded who have to be treated more than 20 days must be evacuated to the Front hospital for minor wounded.

Population and energy elasticity of tornado casualties

NASA Astrophysics Data System (ADS)

Fricker, Tyler; Elsner, James B.; Jagger, Thomas H.

2017-04-01

Tornadoes are capable of catastrophic destruction and mass casualties, but there are yet no estimates of how sensitive the number of casualties are to changes in the number of people in harm's way or to changes in tornado energy. Here the relationship between tornado casualties (deaths and injuries), population, and energy dissipation is quantified using the economic concept of "elasticity." Records of casualties from individual tornadoes over the period 2007-2015 are fit to a regression model. The coefficient on the population term (population elasticity) indicates that a doubling in population increases the casualty rate by 21% [(17, 24)%, 95% credible interval]. The coefficient on the energy term (energy elasticity) indicates that a doubling in energy dissipation leads to a 33% [(30, 35)%, 95% credible interval] increase in the casualty rate. The difference in elasticity values show that on average, changes in energy dissipation have been relatively more important in explaining tornado casualties than changes in population. Assuming no changes in warning effectiveness or mitigation efforts, these elasticity estimates can be used to project changes in casualties given the known population trends and possible trends in tornado activity.

Journal of Special Operations Medicine, Volume 7, Edition 4. Training Supplement: Tactics, Techniques, and Procedures

DTIC Science & Technology

2007-01-01

fatigued. The majority of the OIL and TTP listed here are oriented to the Level I management of combat CAX or management at the point of injury (POI) or...carried into the field by medical personnel. Time to evacuation from the POI or other casualty evacuation point (CEP) to an MTF may vary considerably...must be avoided during this time. Care must be rendered once the mission has reached an anticipated evacuation point , without pursuit, awaiting CASEVAC

A Concurrent Distributed System for Aircraft Tactical Decision Generation

NASA Technical Reports Server (NTRS)

McManus, John W.

1990-01-01

A research program investigating the use of artificial intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range (WVR) air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of a concurrent version of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS) program, a second generation TDG, is presented. Concurrent computing environments and programming approaches are discussed and the design and performance of a prototype concurrent TDG system are presented.

Strategies for Preparing United States Combat Organizations for the Inevitability of Casualties

DTIC Science & Technology

2012-06-08

heart, nausea and diarrhea , and anxiety and indecisiveness (Bethea 2010, 79). These mild stress reactions seem to align with what is occurring during...The technique used to exercise combat fear inoculation was by requesting the cooperation of police attack dogs . The members of de Beckers...organization all became attack dog victims by donning the appropriate protective gear and allowing attack dogs to have their way with them. Grossman explains

Task Force 62 Medical Brigade combat healthcare support system in the mature Iraq theater of operations.

PubMed

Sargent, Patrick D

2008-01-01

Leading a deployed combat healthcare system is a very complex task and requires a command and control structure that is a unique blend of technical and tactical expertise to efficaciously deliver world-class medical care to America's sons and daughters. The medical task force in Iraq has successfully managed the transformation of the medical footprint from a tactically arrayed set of disparate medical units to a nascent integrated healthcare system with many features similar to the best healthcare systems in the United States. The American public demands, and Soldiers, Marines, Sailors, Airmen, and Coast Guardsmen deserve US quality medical care, whether they are being treated at a military medical center in the US, or a US medical facility in Iraq. This article presents an overview of the 62nd Medical Brigade's development of the combat healthcare support system during its tenure leading the US medical task force in Iraq.

Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital.

PubMed

Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Azarow, Kenneth; Holcomb, John B

2008-01-01

United States military doctrine permits the use of fresh whole blood (FWB), donated by U.S. military personnel on site, for casualties with life-threatening injuries at combat support hospitals. U.S. Military Medical Department policy dictates that all patients treated at military facilities during combat (coalition military personnel, foreign nationals, and enemy combatants) are to be treated equally. The objectives of this study were to describe admission vital signs and laboratory values and injury location for patients transfused with FWB, and to determine if FWB was employed equally among all patient personnel categories at a combat support hospital. This retrospective cohort study evaluated admission vital signs and laboratory values, injury location, and personnel category for all patients receiving FWB at a U.S. Army combat support hospital in Baghdad, Iraq, between January and December 2004. Eighty-seven patients received 545 units of FWB. Upon admission, the average (+/-S.D.) heart rate was 144 bpm (+/-25); systolic blood pressure, 106 mmHg (+/-33); base deficit, 9 (+/-6.5); hemoglobin, 9.0 g/dl (+/-2.6); platelet concentration, 81.9 x 10(3)/mm(3) (+/-81); international normalized ratio (INR), 2.0 (+/-1.1); and temperature 95.7 degrees F (+/-2.6). The percentages of intensive care patients who received FWB by personnel category were as follows: coalition soldiers, 51/592 (8.6%); foreign nationals, 25/347 (7.2%); and enemy combatants, 11/128 (8.5% (p = 0.38). The amount of FWB transfused by personnel category was as follows: coalition soldier, 4 units (1-35); foreign national, 4 units (1-36); and enemy combatant, 4 units (1-11) (p = 0.9). Fresh whole blood was used for anemic, acidemic, hypothermic, coagulopathic patients with life-threatening traumatic injuries in hemorrhagic shock, and it was transfused in equal percentages and amounts for coalition soldiers, foreign nationals, and enemy combatants.

33 CFR 173.55 - Report of casualty or accident.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty or...

Multi Service Tactics, Techniques, and Procedures for Treatment of Chemical Warfare Agent Casualties and Conventional Military Chemical Injuries

DTIC Science & Technology

2016-08-02

at mechanical ventilation of a severely exposed casualty until atropine takes effect . Administering supplemental oxygen as available. Chapter 3 3-10...Scavengers; hydroxocobalamin, and dicobalt edetate (2) Provision of S-Groups, thiosulfate (3) Assisted ventilation (4) Oxygen cyanogen... temperature index for light work. Refer to table 1-3 on page 1-12 for work and rest cycles and also water consumption chart. Chapter 1 1-12 ATP 4

Amputation: Not a failure for severe lower extremity combat injury.

PubMed

van Dongen, Thijs T C F; Huizinga, Eelco P; de Kruijff, Loes G M; van der Krans, Arie C; Hoogendoorn, Jochem M; Leenen, Luke P H; Hoencamp, Rigo

2017-02-01

The use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. All Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. In comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. Sustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate

American War and Military Operations Casualties: Lists and Statistics

DTIC Science & Technology

2015-01-02

Service 10 Table 7. Vietnam Conflict: Casualty Summary (as of December 22, 2014) Casualty Type Total Army Air Force Marines Navya Killed in Action...December 22, 2014) Casualty Type Total Army Air Force Marines Navya Killed in Action 144 96 20 22 6 Died of Wounds 4 2 0 2 0 Missing in Action—Declared...Service 17 Table 12. Operation Iraqi Freedom (OIF): Casualty Summary by Casualty Category (as of December 22, 2014) Casualty Type Total Army Navya

Improving Soldier and Unit Effectiveness with the Stryker Brigade Combat Team Warfighters’ Forum

DTIC Science & Technology

2011-01-01

Figures S.1. Differences Attributable to the ICEA Handbook During a Training Rotation . . . . . . . . . . . xiii 2.1. Distribution of Respondents...of Differences Attributable to the Handbook During a Training Rotation ...in an SBCT that received the ICEA did significantly better on tactical tasks during combat training center rotations than platoons that did not

Imaging of Combat-Related Thoracic Trauma - Blunt Trauma and Blast Lung Injury.

PubMed

Lichtenberger, John P; Kim, Andrew M; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, P Gabriel; Carter, Brett W

2018-03-01

Combat-related thoracic trauma (CRTT) is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries are the most common mechanisms of trauma to the chest. Imaging plays a key role in the battlefield management of CRTT casualties. This work discusses the imaging manifestations of thoracic injuries from blunt trauma and blast injury, emphasizing epidemiology and diagnostic clues seen during OEF and OIF. The assessment of radiologic findings in patients who suffer from combat-related blunt thoracic trauma and blast injury is the basis of this work. The imaging modalities for this work include multi-detector computed tomography (MDCT) and chest radiography. Multiple imaging modalities are available to imagers on or near the battlefront, including radiography, fluoroscopy, and MDCT. MDCT with multi-planar reconstructions is the most sensitive imaging modality available in combat hospitals for the evaluation of CRTT. In modern combat, blunt and blast injuries account for a significant portion of CRTT. Individual body armor converts penetrating trauma to blunt trauma, leading to pulmonary contusion that accounted for 50.2% of thoracic injuries during OIF and OEF. Flail chest, a subset of blunt chest injury, is caused by significant blunt force to the chest and occurs four times as frequently in combat casualties when compared with the civilian population. Imaging features of CRTT have significant diagnostic and prognostic value. Pulmonary contusions on chest radiography appear as patchy consolidations in the acute setting with ill-defined and non-segmental borders. MDCT of the chest is a superior imaging modality in diagnosing and evaluating pulmonary contusion. Contusions on MDCT appear as crescentic ground-glass opacities (opacities through which lung interstitium and vasculature are still visible) and areas of consolidation that often do not

Cockpit resource management skills enhance combat mission performance in a B-52 simulator

NASA Technical Reports Server (NTRS)

Povenmire, H. Kingsley; Rockway, Marty R.; Bunecke, Joseph L.; Patton, Mark W.

1989-01-01

A cockpit resource management (CRM) program for mission-ready B-52 aircrew is developed. The relationship between CRM performance and combat mission performance is studied. The performances of six crew members flying a simulated high workload mission in a B-52 weapon system trainer are evaluated. The data reveal that CRM performance enhances tactical maneuvers and bombing accuracy.

Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

PubMed

Clark, Susz; Van Steenvort, Jon K

2008-01-01

Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

Human casualties in earthquakes: Modelling and mitigation

USGS Publications Warehouse

Spence, R.J.S.; So, E.K.M.

2011-01-01

Earthquake risk modelling is needed for the planning of post-event emergency operations, for the development of insurance schemes, for the planning of mitigation measures in the existing building stock, and for the development of appropriate building regulations; in all of these applications estimates of casualty numbers are essential. But there are many questions about casualty estimation which are still poorly understood. These questions relate to the causes and nature of the injuries and deaths, and the extent to which they can be quantified. This paper looks at the evidence on these questions from recent studies. It then reviews casualty estimation models available, and finally compares the performance of some casualty models in making rapid post-event casualty estimates in recent earthquakes.

SMART Fires: A COTS Approach to Tactical Fire Support Using a Smartphone

DTIC Science & Technology

2011-09-01

Battalion Landing Team C2 Command and Control C2PC Command and Control Personal Computer CAC Common Access Card COC Combat Operation Center COIN...functionality to way-points. It is currently available on the iTunes App Store for $5.99 (Tactical NAV, 2010). 11 MILS are a unit...download on both the iTunes App Store and the Android Marketplace. Apps for the Army (A4A) also created a repository for the applications submitted, along

Combat cueing

NASA Astrophysics Data System (ADS)

Kachejian, Kerry C.; Vujcic, Doug

1998-08-01

The combat cueing (CBT-Q) research effort will develop and demonstrate a portable tactical information system that will enhance the effectiveness of small unit military operations by providing real-time target cueing information to individual warfighters and teams. CBT-Q consists of a network of portable radio frequency (RF) 'modules' and is controlled by a body-worn 'user station' utilizing a head mounted display . On the battlefield, CBT-Q modules will detect an enemy transmitter and instantly provide the warfighter with an emitter's location. During the 'fog of battle', CBT-Q would tell the warfighter, 'Look here, right now individuals into the RF spectrum, resulting in faster target engagement times, increased survivability, and reduce the potential for fratricide. CBT-Q technology can support both mounted and dismounted tactical forces involved in land, sea and air warfighting operations. The CBT-Q system combines robust geolocation and signal sorting algorithms with hardware and software modularity to offer maximum utility to the warfighter. A single CBT-Q module can provide threat RF detection. Three networked CBT-Q modules can provide emitter positions using a time difference of arrival (TDOA) technique. The TDOA approach relies on timing and positioning data derived from a global positioning systems. The information will be displayed on a variety of displays, including a flat-panel head mounted display. The end results of the program will be the demonstration of the system with US Army Scouts in an operational environment.

Saving Lives on the Battlefield (Part II) ? One Year Later A Joint Theater Trauma System and Joint Trauma System Review of Prehospital Trauma Care in Combined Joint Operations Area?Afghanistan (CJOA-A) Final Report, 30 May 2014.

PubMed

Sauer, Samual W; Robinson, John B; Smith, Michael P; Gross, Kirby R; Kotwal, Russ S; Mabry, Robert L; Butler, Frank K; Stockinger, Zsolt T; Bailey, Jeffrey A; Mavity, Mark E; Gillies, Duncan A

2015-01-01

The United States has achieved unprecedented survival rates, as high as 98%, for casualties arriving alive at the combat hospital. Our military medical personnel are rightly proud of this achievement. Commanders and Servicemembers are confident that if wounded and moved to a Role II or III medical facility, their care will be the best in the world. Combat casualty care, however, begins at the point of injury and continues through evacuation to those facilities. With up to 25% of deaths on the battlefield being potentially preventable, the prehospital environment is the next frontier for making significant further improvements in battlefield trauma care. Strict adherence to the evidence-based Tactical Combat Casualty Care (TCCC) Guidelines has been proven to reduce morbidity and mortality on the battlefield. However, full implementation across the entire force and commitment from both line and medical leadership continue to face ongoing challenges. This report on prehospital trauma in the Combined Joint Operations Area?Afghanistan (CJOA-A) is a follow-on to the one previously conducted in November 2012 and published in January 2013. Both assessments were conducted by the US Central Command (USCENTCOM) Joint Theater Trauma System (JTTS). Observations for this report were collected from December 2013 to January 2014 and were obtained directly from deployed prehospital providers, medical leaders, and combatant leaders. Significant progress has been made between these two reports with the establishment of a Prehospital Care Division within the JTTS, development of a prehospital trauma registry and weekly prehospital trauma conferences, and CJOA-A theater guidance and enforcement of prehospital documentation. Specific prehospital trauma-care achievements include expansion of transfusion capabilities forward to the point of injury, junctional tourniquets, and universal approval of tranexamic acid. 2015.

Knowledge-based reasoning in the Paladin tactical decision generation system

NASA Technical Reports Server (NTRS)

Chappell, Alan R.

1993-01-01

A real-time tactical decision generation system for air combat engagements, Paladin, has been developed. A pilot's job in air combat includes tasks that are largely symbolic. These symbolic tasks are generally performed through the application of experience and training (i.e. knowledge) gathered over years of flying a fighter aircraft. Two such tasks, situation assessment and throttle control, are identified and broken out in Paladin to be handled by specialized knowledge based systems. Knowledge pertaining to these tasks is encoded into rule-bases to provide the foundation for decisions. Paladin uses a custom built inference engine and a partitioned rule-base structure to give these symbolic results in real-time. This paper provides an overview of knowledge-based reasoning systems as a subset of rule-based systems. The knowledge used by Paladin in generating results as well as the system design for real-time execution is discussed.

Thoracic Injuries in US Combat Casualties: A 10-Year Review of Operation Enduring Freedom and Iraqi Freedom

DTIC Science & Technology

2012-01-01

explosive devices were the most common cause of injury (61.9%). Of 6,030 thoracic injuries identified, pneumothorax and pulmonary contusions were most...1890s and was used to treat pulmonary edema in combat ca- sualties during WWI.1 Transfusions with whole blood were also performed in combat hospitals...received prehospital cardio- pulmonary resuscitation (CPR), and 53 patients (2.6%) under- went CPR after arrival to the treatment facility. Complications

[Ethical considerations in mass casualty situation].

PubMed

Priel, I E; Dolev, E

2001-07-01

Mass casualty is a situation, in which, the physician is compelled to make critical decisions under heavy pressure load, due to severe shortage in time, personnel and information. This task is extremely difficult to fulfill, as the physician has to consider not only professional tools, but needs also to utilize ethical principles, in order to provide the best possible care to most of the casualties who might benefit from it. By definition, in the mass casualty situation the medical facility lacks temporarily the ability to deliver effective therapy to all, as the injured outnumber the medical capacity for a given time. The ethical conflicts and dilemmas that arise during such an event are enormous. Amazingly, only a few articles have addressed the issue of ethical considerations during mass casualty situation. Ethical decision making is based on four principles: beneficence, nonmaleficence, autonomy and justice. Compassion, trustworthiness, discernment and integrity are the four qualities required from those practicing medicine. These virtues should be manifested in mass casualty situations, one of the most demanding situations a physician may face.

Co-occurring Mental Health and Alcohol Misuse Symptoms: Dual Disorder Symptoms in Combat Injured Veterans

DTIC Science & Technology

2014-03-03

required from Department of Veterans Af fairs hospitals. The rate of alcohol misuse among veterans screening for PTSD or de pression in the present...facilities only (casualties treated at forward deployed Army facilities, and those transported directly to Combat Support Hospitals from the point of injury...Psychiatry, 163, 1777–1783. Hien, D. A., Jiang, H., Campbell, A. N. C., Hu, M. C., Miele , G. M., Cohen, L. R., et al. (2010). Do treatment improvements

Serious game training improves performance in combat life-saving interventions.

PubMed

Planchon, Jerome; Vacher, Anthony; Comblet, Jeremy; Rabatel, Eric; Darses, Françoise; Mignon, Alexandre; Pasquier, Pierre

2018-01-01

In modern warfare, almost 25% of combat-related deaths are considered preventable if life-saving interventions are performed. Therefore, Tactical Combat Casualty Care (TCCC) training for soldiers is a major challenge. In 2014, the French Military Medical Service supported the development of 3D-SC1 ® , a serious game designed for the French TCCC program, entitled Sauvetage au Combat de niveau 1 (SC1). Our study aimed to evaluate the impact on performance of additional training with 3D-SC1 ® . The study assessed the performance of soldiers randomly assigned to one of two groups, before (measure 1) and after (measure 2) receiving additional training. This training involved either 3D-SC1 ® (Intervention group), or a DVD (Control group). The principal measure was the individual performance (on a 16-point scale), assessed by two investigators during a hands-on simulation. First, the mean performance score was compared between the two measures for Intervention and Control groups using a two-tailed paired t-test. Second, a multivariable linear regression was used to determine the difference in the impacts of 3D-SC1 ® and DVD training, and the order of presentation of the two scenarios, on the mean change from baseline in performance scores. A total of 96 subjects were evaluated: seven could not be followed-up, while 50 were randomly allocated to the Intervention group, and 39 to the Control group. Between measure 1 and measure 2, the mean (SD) performance score increased from 9.9 (3.13) to 14.1 (1.23), and from 9.4 (2.97) to 12.5 (1.83), for the Intervention group and Control group, respectively (p<0.0001). The adjusted mean difference in performance scores between 3D-SC1 ® and DVD training was 1.1 (95% confidence interval -0.3, 2.5) (p=0.14). Overall, the study found that supplementing SC1 training with either 3D-SC1 ® or DVD improved performance, assessed by a hands-on simulation. However, our analysis did not find a statistically significant difference between the

Modern Tactics in the Moral Domain: Smart Weapons and the Production of the Combat Stress Reaction

DTIC Science & Technology

1992-12-19

Kubie , Karl A. Menninger, John Romano, and John C. Whitehorn, "Combat Exhaustion," The Journal of Nervous and Mental Disease, v. 104 (July-Dec, 1946), pp...Bartemeier, Leo H., Kubie , Lawrence, Menninger, Karl A.,Romano, John, & Whitehorn, John C., "Combat Exhaustion." The Journal of Nervous and Mental Disease, v

46 CFR 4.03-1 - Marine casualty or accident.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means...

46 CFR 4.03-1 - Marine casualty or accident.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means...

46 CFR 4.03-1 - Marine casualty or accident.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means...

48 CFR 552.270-7 - Fire and Casualty Damage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Fire and Casualty Damage. As prescribed in 570.603, insert the following clause: Fire and Casualty Damage (SEP 1999) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fire and Casualty Damage...

48 CFR 552.270-7 - Fire and Casualty Damage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Fire and Casualty Damage...

48 CFR 552.270-7 - Fire and Casualty Damage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Fire and Casualty Damage...

48 CFR 552.270-7 - Fire and Casualty Damage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Fire and Casualty Damage...

48 CFR 552.270-7 - Fire and Casualty Damage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Fire and Casualty Damage...

46 CFR 4.05-1 - Notice of marine casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a...

46 CFR 4.05-1 - Notice of marine casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a...

46 CFR 4.05-1 - Notice of marine casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a...

46 CFR 4.05-1 - Notice of marine casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a...

46 CFR 4.05-1 - Notice of marine casualty.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a...

Op HERRICK primary care casualties: the forgotten many.

PubMed

Nelson, T G; Wall, C; Driver, J; Simpson, R

2012-09-01

The number of battle casualties generated during war is far outnumbered by non-battle casualties. Each year the current conflict in Afghanistan sees hundreds of service personnel medically evacuated direct from the front line to the care of their home units' primary care facility. To date these casualties remain undiscovered by medical research. This is the first study to look at the care pathway of primary care casualties from Operation HERRICK using information from the Defence Patient Tracking System (DPTS). Information relating to all casualties from Afghanistan discharged at the airhead between 1 January 2009 and 31 December 2010 was collected from the DPTS. Common conditions were identified and information relating to the follow up care extracted to provide an overview of the care pathway. 387 aeromedical evacuations were identified as primary care casualties. The three commonest conditions were musculoskeletal (183 cases), mental health (29) and noise-induced hearing loss (26). 205 (53%) were not seen outside of primary care for the tracked condition. 166 (81%) of those that remained under primary care had two or less consultations during the time period of the study. The mean time frame between the 1st and 2nd consultation was 5.4 weeks. A significant number of aeromedical evacuations from Afghanistan are for primary care casualties. The DPTS can be used to provide a basic overview of the care pathway of repatriated personnel. Little contact with the medical services would appear to occur for these types of casualties. There is a significant gap in military medical research looking at primary care casualties repatriated from operations.

46 CFR 122.202 - Notice of marine casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

46 CFR 122.202 - Notice of marine casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

46 CFR 122.202 - Notice of marine casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

46 CFR 122.202 - Notice of marine casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

46 CFR 122.202 - Notice of marine casualty.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients

PubMed Central

Escolas, Sandra M.; Orman, Jean A.; Chung, Kevin K.; Renz, Evan M.

2017-01-01

Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner’s Office and the Office of the Secretary of Defense’s National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors. PMID:26629656

The Realities of War: Assessing the Operational Risk of Revoking the Combat Exclusion Policy

DTIC Science & Technology

2013-05-23

Grenade RSOI Reception , Staging, and Onward Integration SEAD Suppression of Enemy Air Defenses SOF Special Operations Forces vii TAA Tactical Assembly...Diego Garcia[,] brought rations, cots, tents, blankets, and medical supplies, as well as refrigerated trailers , reverse-osmosis water- purification...78 In all, Desert Dragon II enabled the reception , staging, and onward integration (RSOI) of such a significant amount of combat power that the

Pre-hospital management of mass casualty civilian shootings: a systematic literature review.

PubMed

Turner, Conor D A; Lockey, David J; Rehn, Marius

2016-11-08

Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

Rating of Perceived Exertion for Quantification of Training and Combat Loads During Combat Sport-Specific Activities: A Short Review.

PubMed

Slimani, Maamer; Davis, Philip; Franchini, Emerson; Moalla, Wassim

2017-10-01

The aim of this short review was to summarize data pertaining to the rating of perceived exertion (RPE) methods (RPE value and session-RPE) during combat sport-specific activities (i.e., competition and training) based on many factors, including contest type (i.e., official vs. simulated vs. training), combat rounds, age of participants and muscle groups, and their correlation with physiological variables (i.e., blood lactate concentration [La] and heart rate [HR]). The current review shows higher RPE in a match of mixed martial arts (MMAs) than Brazilian jiu-jitsu and kickboxing matches and during the competitive period compared with the precompetitive period. This could be explained by the longer duration of bouts, the higher percentage contribution of aerobic metabolism in MMA than other combat sports and contest type differences (simulated vs. official matches). Thus, this review found significant correlations between RPE or session-RPE, [La] and HR. Particularly, there was a stronger correlation between RPE and [La] during official striking (r = 0.81) than grappling combat sports matches (r = 0.53). In addition, a variation of correlation (moderate to large) between session-RPE and HR-based methods has been reported (i.e., Edwards' training load [r ranged between 0.58 and 0.95] and Banister training impulse [r ranged between 0.52 and 0.86]). Specifically, stronger correlation was apparent in combat sport competition that required a much higher percentage contribution of aerobic metabolism (e.g., karate) and in adult athletes than anaerobic-based combat sports (e.g., taekwondo) and young athletes, respectively. Indeed, the current review highlights that the correlations between session-RPE and HR-based methods were higher during official competition than training sessions. Session-RPE was affected by participants' competitive level, the intensity of session (high vs. low), the training modalities (tactical-technical vs. technical-development vs. simulated

In search of technological solutions to battlefield management of combat casualties

NASA Astrophysics Data System (ADS)

Ling, Geoffrey S. F.; Day, Keith; Rhee, Peter; Ecklund, James M.

1999-07-01

It is accepted that so long as men and women are sent into combat, some will be wounded or killed. In order to minimize those that are killed, efforts must be made to optimize medical treatment for those who are not fatally wounded. The nature of warfare is changing. The pattern of wounding is changing as well. However, what remains constant is the need to provide effective treatment as soon as possible. In war, it means acting at the level of the battlefield. To be effective demands new approaches to diagnosis and treatment. Novel diagnostic tools are needed to identify location of foreign bodies, determine extents of injury, monitor vital signs, and ascertain adequacy of resuscitation. Treatment devices that can provide hemostasis, support organ perfusion, stabilize limbs and neck and relieve a pneumothorax are lacking. Our young soldiers of tomorrow need solutions to their injuries today.

Impact of Prehospital Medical Evacuation (MEDEVAC) Transport Time on Combat Mortality in Patients with Non-Compressible Torso Injury and Traumatic Amputations

DTIC Science & Technology

2018-12-28

MED EV AC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations Sb. GRANT NUMBER Sc. PROGRAM...increased morbidity and mortality. Limited data exists on the influence of transport time on patient outcomes with specific injury types. The...treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI). Methods: We

Tactical Infrasound

DTIC Science & Technology

2005-05-01

received briefings on a variety of infra - sonic sensor systenis. Materials were also received from the 2001 and 2002 Infrasonic Technology Workshops and...Systems to Tactical Acoustic Sys- tems One issue to be considered in the evaluation of a p)otential tactical infra - sonic system is the ability to...Communication range Fixed Fixed 5 km 7.4 A Design Approach for a Future Tactical Infra - sonic Sensor System This section describes a procedure used to

Heuristic approach to the development of ratings and tactics applicable to the one-on-one aerial combat (dogfight) encounter

NASA Technical Reports Server (NTRS)

Hague, D. S.

1977-01-01

Computer simulations of the one-on-one aerial combat encounter are generated under the control of specified guidance laws. Given an initial state, the vehicle and atmospheric characteristics, and the guidance laws, the aerial combat encounter is simulated by forward integration of the two vehicles' motions. The development of a combat guidance law which converts positional advantage into an improved firing opportunity is reported. A combination of lag, line of sight, and lead pursuit steering paths are followed in the guidance law. The law is based on steering error, target angle-off and the relative velocities. It readily is automated either as an onboard aid to manned aircraft pilots or as a combat guidance law for unmanned vehicles.

Do lower income areas have more pedestrian casualties?

PubMed

Noland, Robert B; Klein, Nicholas J; Tulach, Nicholas K

2013-10-01

Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas. Copyright © 2013 Elsevier Ltd. All rights reserved.

46 CFR 4.03-1 - Marine casualty or accident.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means... efficiency of the vessel. (b) The term “marine casualty or accident” applies to events caused by or involving... of life of any person. (2) Any occurrence involving a vessel that results in— (i) Grounding; (ii...

46 CFR 4.03-1 - Marine casualty or accident.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means... efficiency of the vessel. (b) The term “marine casualty or accident” applies to events caused by or involving... of life of any person. (2) Any occurrence involving a vessel that results in— (i) Grounding; (ii...

46 CFR 122.206 - Written report of marine casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent, or...

46 CFR 185.206 - Written report of marine casualty.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by 185...

46 CFR 185.206 - Written report of marine casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by 185...

46 CFR 185.206 - Written report of marine casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by 185...

46 CFR 122.206 - Written report of marine casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent, or...

46 CFR 185.206 - Written report of marine casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by 185...

46 CFR 122.206 - Written report of marine casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent, or...

46 CFR 122.206 - Written report of marine casualty.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent, or...

46 CFR 122.206 - Written report of marine casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent, or...

46 CFR 185.206 - Written report of marine casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by 185...

46 CFR 109.415 - Retention of records after casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... casualty. (a) The owner, agent, master, or person in charge of a unit for which a report of casualty is... of casualty. (6) Navigation work books. (7) Compass deviation cards. (8) Gyrocompass records. (9...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person in...

46 CFR 4.40-15 - Marine casualty investigation by the Board.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 4.40-15... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations § 4.40-15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation...

46 CFR 185.260 - Reports of potential vessel casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.260 Reports of potential vessel casualty. (a) An owner, charterer, managing...

Application of Artificial Intelligence (AI) programming techniques to tactical guidance for fighter aircraft

NASA Technical Reports Server (NTRS)

Mcmanus, John W.; Goodrich, Kenneth H.

1989-01-01

A research program investigating the use of Artificial Intelligence (AI) programming techniques to aid in the development of a Tactical Decision Generator (TDG) for Within-Visual-Range (WVR) air combat engagements is discussed. The application of AI methods for development and implementation of the TDG is presented. The history of the Adaptive Maneuvering Logic (AML) program is traced and current versions of the (AML) program is traced and current versions of the AML program are compared and contrasted with the TDG system. The Knowledge-Based Systems (KBS) used by the TDG to aid in the decision-making process are outlined and example rules are presented. The results of tests to evaluate the performance of the TDG against a version of AML and against human pilots in the Langley Differential Maneuvering Simulator (DMS) are presented. To date, these results have shown significant performance gains in one-versus-one air combat engagements.

Study of a very low cost air combat maneuvering trainer aircraft

NASA Technical Reports Server (NTRS)

Hill, G. C.; Bowles, J. V.

1976-01-01

A very low cost aircraft for performing Air Combat Maneuvering (ACM) training was studied using the BD-5J sport plane as a point of departure. The installation of a larger engine and increased fuel capacity were required to meet the performance and mission objectives. Reduced wing area increased the simulation of the ACM engagement, and a comparison with current tactical aircraft is presented. Other factors affecting the training transfer are considered analytically, but a flight evaluation is recommended to determine the concept utility.

Use of recombinant factor VIIa in US military casualties for a five-year period.

PubMed

Wade, Charles E; Eastridge, Brian J; Jones, John A; West, Susan A; Spinella, Philip C; Perkins, Jeremy G; Dubick, Michael A; Blackbourne, Lorne H; Holcomb, John B

2010-08-01

Two prospective randomized trauma trials have shown recombinant factor VIIa (rFVIIa) to be safe and to decrease transfusion requirements. rFVIIa is presently used in 22% of massively transfused civilian trauma patients. The US Military has used rFVIIa in combat trauma patients for five years, and two small studies of massively transfused patients described an association with improved outcomes. This study was undertaken to assess how deployed physicians are using rFVIIa and its impact on casualty outcomes. US combat casualties (n = 2,050) receiving any blood transfusion from 2003 to 2009 were reviewed to compare patients receiving rFVIIa (n = 506) with those who did not (n = 1,544). Propensity-score matching (primary analysis) and multivariable logistic regression were used to compare outcomes. Differences were determined at p < 0.05. Twenty-five percent of patients received rFVIIa. Significant differences were noted between groups in indices of injury severity (Injury Severity Score, Abbreviated Injury Scale score, and Glasgow Coma Scale score), admission physiology (systolic blood pressure, diastolic blood pressure, heart rate, temperature, base deficit, hemoglobin, and international normalization ratio), and use of blood products, indicating that patients treated with rFVIIa were more severely injured, in shock, and coagulopathic. For propensity-score matching, factors associated with death were used: Injury Severity Score, Glasgow Coma Scale score, heart rate, systolic blood pressure, diastolic blood pressure, Hgb, and total packed red blood cell. A total of 266 patients per group were matched; 52% of the rFVIIa group. After pairing, there were no significant differences in any of the demographics, including incidence of massive transfusion (53% vs. 51%). There was no difference in the rate of complications (21% vs. 21%) or mortality (14% vs. 20%) for patients not treated or receiving rFVIIa, respectively. In military casualties, rFVIIa is used in the most

These Honored Dead: The Battle of Rivers Bridge and Civil War Combat Casualties. Teaching with Historic Places.

ERIC Educational Resources Information Center

Bell, Dan

Encountering the U.S. Civil War on a smaller, human scale makes the conflict more approachable, vivid, and real. Rivers Bridge State Historic Site (South Carolina) offers a glimpse of the Civil War on such a scale. The small area allows visitors to comprehend the entire battlefield, its tactics, and to see how veteran troops near the end of the…

Mass casualty education for undergraduate nursing students in Australia.

PubMed

Currie, Jane; Kourouche, Sarah; Gordon, Christopher; Jorm, Christine; West, Sandra

2018-01-01

With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula. Copyright © 2017 Elsevier Ltd. All rights reserved.

Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.

PubMed

Bolster, Ferdia; Linnau, Ken; Mitchell, Steve; Roberge, Eric; Nguyen, Quynh; Robinson, Jeffrey; Lehnert, Bruce; Gross, Joel

2017-02-01

The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.

Casualty Handling Simulation Using the Scenario-based Engineering Process

DTIC Science & Technology

2000-02-28

HERPES ZOSTER ENCEPHALITIS HEPATITIS INFECTIOUS VIRAL ANIMAL BITES/RABIES EXPOSURE MUMPS INFECTIOUS MONONUCLEOSIS TRACHOMA STD-SYPHILIS STD...casualties as they flow through the system. Identifying the proper mix is complicated by many factors, including the specific casualty stream, the...casualties as they flow through the system. Identifying the proper mix is complicated by its dependence on mission types. For example, the types and

American War and Military Operations Casualties: Lists and Statistics

DTIC Science & Technology

2008-05-14

War — Casualty Summary Desert Shield/Desert Storm (as of June 15, 2004) Casualty Type Total Army Air Force Marines Navya ,b Killed in Action 143 96 20...Through April 5, 2008 Casualty Type Totals Army Navya Marines Air Force Hostile 3,158 2,304 60 770 24 Nonhostile 708 521 29 141 17 Total 3,866 2,825 89

Changes in combat task performance under increasing loads in active duty marines.

PubMed

Jaworski, Rebecca L; Jensen, Andrew; Niederberger, Brenda; Congalton, Robert; Kelly, Karen R

2015-03-01

U.S. Marines perform mission tasks under heavy loads which may compromise performance of combat tasks. However, data supporting this performance decrement are limited. The aim of this study was to determine the effects of load on performance of combat-related tasks. Subjects (N=18) ran a modified Maneuver Under Fire ([MANUF], 300 yards [yd] total: two 25-yd sprints, 25-yd crawl, 75-yd casualty drag, 150-yd ammunition can carry, and grenade toss) portion of the U.S. Marine Corps Combat Fitness Test under 4 trial conditions: neat (no load), 15%, 30%, and 45% of body weight, with a shooting task pre- and post-trial. There was a significant increase in total time to completion as a function of load (p<0.0001) with a relationship between load and time (r=0.592, p<0.0001). Pre- to post-MANUF shot accuracy (p=0.005) and precision (p<0.0001) was reduced. Short aerobic performance is significantly impacted by increasing loads. Marksmanship is compromised as a function of fatigue and load. These data suggest that loads of 45% body weight increase time to cover distance and reduce the ability to precisely hit a target. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Physiological and Technical-tactical Analysis in Brazilian Jiu-jitsu Competition

PubMed Central

Andreato, Leonardo V.; Franchini, Emerson; de Moraes, Solange M.F.; Pastório, Juliana J.; da Silva, Danilo F.; Esteves, João V.D.C; Branco, Braulio H.M.; Romero, Paulo V.dS.; Machado, Fabiana A.

2013-01-01

Purpose The present study aims at investigating the physiological response and technical-tactical parameters in Brazilian jiu-jitsu competition. Methods The study included 35 male Brazilian jiu-jitsu athletes (adult category, body mass: 80.2 ± 13.0 kg), graded from white to brown belt, during combats fought at regional level. Twenty-two fights were analyzed in terms of technique and time structure. Blood glucose, lactate and maximal isometric grip strength were determined before and after the fights. The rate of perceived exertion was also assessed after the fight, using the 6-20 Borg rating. The fights were recorded and the following variables were determined: the exertion/pause ratio and subjective intensity of actions, categorized between low and high intensity. Results The results indicated that during Brazilian jiu-jitsu fights, the glycolytic pathway is only moderately activated (lactate before: 4.4 (4.0 – 4.6) mmol/L, after: 10.1 (8.0 – 11.3) mmol/L; glucose before: 112.4 ± 22.3 mg/dL, after: 130.5 ± 31.0 mg/dL). The exertion during the fight resulted in significant reductions in handgrip strength (right hand grip before: 45.9 ± 10.3 kgf, after: 40.1 ± 9.5 kgf; left hand grip before: 44.2 ± 11.1 kgf, after: 37.0 ± 10.2 kgf). The athletes rated the fight as hard: 15 (13 – 15). Effort/pause ratio was 6:1, while high-intensity actions lasted approximately 4 s, resulting in a low/high intensity? ratio of 8:1. Conclusion It is recommended that coaches direct the training loads to simulate the energy demand imposed by the competitive matches, activating moderately the glycolytic pathway. Moreover, the time structure of combats can be used to prescribe both physical and technical-tactical training. PMID:23802056

Physiological and Technical-tactical Analysis in Brazilian Jiu-jitsu Competition.

PubMed

Andreato, Leonardo V; Franchini, Emerson; de Moraes, Solange M F; Pastório, Juliana J; da Silva, Danilo F; Esteves, João V D C; Branco, Braulio H M; Romero, Paulo V Ds; Machado, Fabiana A

2013-06-01

The present study aims at investigating the physiological response and technical-tactical parameters in Brazilian jiu-jitsu competition. The study included 35 male Brazilian jiu-jitsu athletes (adult category, body mass: 80.2 ± 13.0 kg), graded from white to brown belt, during combats fought at regional level. Twenty-two fights were analyzed in terms of technique and time structure. Blood glucose, lactate and maximal isometric grip strength were determined before and after the fights. The rate of perceived exertion was also assessed after the fight, using the 6-20 Borg rating. The fights were recorded and the following variables were determined: the exertion/pause ratio and subjective intensity of actions, categorized between low and high intensity. The results indicated that during Brazilian jiu-jitsu fights, the glycolytic pathway is only moderately activated (lactate before: 4.4 (4.0 - 4.6) mmol/L, after: 10.1 (8.0 - 11.3) mmol/L; glucose before: 112.4 ± 22.3 mg/dL, after: 130.5 ± 31.0 mg/dL). The exertion during the fight resulted in significant reductions in handgrip strength (right hand grip before: 45.9 ± 10.3 kgf, after: 40.1 ± 9.5 kgf; left hand grip before: 44.2 ± 11.1 kgf, after: 37.0 ± 10.2 kgf). The athletes rated the fight as hard: 15 (13 - 15). Effort/pause ratio was 6:1, while high-intensity actions lasted approximately 4 s, resulting in a low/high intensity? ratio of 8:1. It is recommended that coaches direct the training loads to simulate the energy demand imposed by the competitive matches, activating moderately the glycolytic pathway. Moreover, the time structure of combats can be used to prescribe both physical and technical-tactical training.

49 CFR 850.15 - Marine casualty investigation by the Board.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

33 CFR 164.61 - Marine casualty reporting and record retention.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

33 CFR 164.61 - Marine casualty reporting and record retention.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

49 CFR 850.15 - Marine casualty investigation by the Board.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

33 CFR 164.61 - Marine casualty reporting and record retention.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

49 CFR 850.15 - Marine casualty investigation by the Board.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

Multiservice Tactics, Techniques, and Procedures for Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries

DTIC Science & Technology

2007-09-01

respiration. bullae— Medical term for blister. C cannabinols—An alkaloid derived from the hemp plant. (See cannabis .) cannabis —The upper portion of the hemp...TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Army Medical Department Center and School,Fort Sam Houston,TX...appropriate. RUSSELL J. CZERW JAMES F. AMOS Major General, DC Lieutenant General, US Marine Corps Commander, US Army Medical Deputy Commandant for Combat

Increasing combat realism: the effectiveness of stun belt use on soldiers for the enhancement of live training and testing exercises

NASA Astrophysics Data System (ADS)

Schricker, Bradley C.; Antalek, Christopher

2006-05-01

The ability to make correct decisions while operating in a combat zone enables American and Coalition warfighters to better respond to any threats they may encounter due to the minimization of negative training the warfighter encountered during their live, virtual, and constructive (LVC) training exercises. By increasing the physical effects encountered by one's senses during combat scenarios, combat realism is able to be increased, which is a key component in the reduction in negative training. The use of LVC simulations for training and testing augmentation purposes depends on a number of factors, not the least of which is the accurate representation of the training environment. This is particularly true in the realm of tactical engagement training through the use of Tactical Engagement Simulation Systems (TESS). The training environment is perceived through human senses, most notably sight and hearing. As with other haptic devices, the sense of touch is gaining traction as a viable medium through which to express the effects of combat battle damage from the synthetic training environment to participants within a simulated training exercise. New developments in this field are promoting the safe use of an electronic stun device to indicate to a trainee that they have been hit by a projectile, from either direct or indirect fire, through the course of simulated combat. A growing number of examples suggest that this added output medium can greatly enhance the realism of a training exercise and, thus, improve the training value. This paper serves as a literature survey of this concept, beginning with an explanation of TESS. It will then focus on how the electronic stun effect may be employed within a TESS and then detail some of the noted pros and cons of such an approach. The paper will conclude with a description of potential directions and work.

Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival.

PubMed

Shackelford, Stacy A; Del Junco, Deborah J; Powell-Dunford, Nicole; Mazuchowski, Edward L; Howard, Jeffrey T; Kotwal, Russ S; Gurney, Jennifer; Butler, Frank K; Gross, Kirby; Stockinger, Zsolt T

2017-10-24

Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion. To examine the association of prehospital transfusion and time to initial transfusion with injury survival. Retrospective cohort study of US military combat casualties in Afghanistan between April 1, 2012, and August 7, 2015. Eligible patients were rescued alive by MEDEVAC from point of injury with either (1) a traumatic limb amputation at or above the knee or elbow or (2) shock defined as a systolic blood pressure of less than 90 mm Hg or a heart rate greater than 120 beats per minute. Initiation of prehospital transfusion and time from MEDEVAC rescue to first transfusion, regardless of location (ie, prior to or during hospitalization). Transfusion recipients were compared with nonrecipients (unexposed) for whom transfusion was delayed or not given. Mortality at 24 hours and 30 days after MEDEVAC rescue were coprimary outcomes. To balance injury severity, nonrecipients of prehospital transfusion were frequency matched to recipients by mechanism of injury, prehospital shock, severity of limb amputation, head injury, and torso hemorrhage. Cox regression was stratified by matched groups and also adjusted for age, injury year, transport team, tourniquet use, and time to MEDEVAC rescue. Of 502 patients (median age, 25 years [interquartile range, 22 to 29 years]; 98% male), 3 of 55 prehospital transfusion recipients (5%) and 85 of 447 nonrecipients (19%) died within 24 hours of MEDEVAC rescue (between-group difference, -14% [95% CI, -21% to -6%]; P = .01). By day 30, 6 recipients (11%) and 102 nonrecipients (23%) died (between-group difference, -12% [95% CI, -21% to -2%]; P = .04). For the 386 patients without missing

American War and Military Operations Casualties: Lists and Statistics

DTIC Science & Technology

2010-02-26

Air Force Marines Navya Killed in Action 144 96 20 22 6 Died of Wounds 4 2 2 Missing in Action—Declared Dead Captured—Declared Dead...Operation Enduring Freedom by Casualty Category Within Service (from October 7, 2001 through February 6, 2010) Casualty Type Total Army Navya Marines...Table 12. Operation Enduring Freedom, Military Wounded in Action (from October 7, 2001, through February 6, 2010) Casualty Type Totals Army Navya

Application of Artificial Intelligence (AI) Programming Techniques to Tactical Guidance for Fighter Aircraft

NASA Technical Reports Server (NTRS)

McManus, John W.; Goodrich, Kenneth H.

1989-01-01

A research program investigating the use of Artificial Intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within-Visual-Range (WVR) air combat engagements is discussed. The application of AI methods for development and implementation of the TDG is presented. The history of the Adaptive Maneuvering Logic (AML) program is traced and current versions of the AML program are compared and contrasted with the TDG system. The Knowledge-Based Systems (KBS) used by the TDG to aid in the decision-making process are outlined in detail and example rules are presented. The results of tests to evaluate the performance of the TDG versus a version of AML and versus human pilots in the Langley Differential Maneuvering Simulator (DMS) are presented. To date, these results have shown significant performance gains in one-versus-one air combat engagements, and the AI-based TDG software has proven to be much easier to modify than the updated FORTRAN AML programs.

33 CFR 146.35 - Written report of casualty.

Code of Federal Regulations, 2013 CFR

2013-07-01

... casualty; (5) Gives the name, address, and phone number of persons involved in or witnessing the casualty... number 1625-0001) [CGD 78-160, 47 FR 9383, Mar. 4, 1982, as amended by CGD 82-023a, 47 FR 35741, Aug. 16...

46 CFR 4.05-5 - Substance of marine casualty notice.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of marine...

46 CFR 4.05-5 - Substance of marine casualty notice.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of marine...

46 CFR 4.05-5 - Substance of marine casualty notice.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of marine...

46 CFR 4.05-5 - Substance of marine casualty notice.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of marine...

46 CFR 4.05-10 - Written report of marine casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine...

46 CFR 4.05-10 - Written report of marine casualty.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine...

46 CFR 4.05-10 - Written report of marine casualty.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine...

46 CFR 4.05-10 - Written report of marine casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine...

46 CFR 4.05-10 - Written report of marine casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine...

46 CFR 4.05-5 - Substance of marine casualty notice.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of marine...

Mass-casualty triage: time for an evidence-based approach.

PubMed

Jenkins, Jennifer Lee; McCarthy, Melissa L; Sauer, Lauren M; Green, Gary B; Stuart, Stephanie; Thomas, Tamara L; Hsu, Edbert B

2008-01-01

Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.

Reducing and Mitigating Civilian Casualties: Enduring Lessons

DTIC Science & Technology

2013-04-12

the start of operations, international media began reporting incidents of civilian casualties. Many of these incidents involved villages where...operations. These incidents resulted in a significant outcry from nongovernmental organizations (NGOs) and the media ; the shooting of a vehicle... media ) also suggest that the applicability of lessons regarding ways to minimize civilian casualties and mitigate their impact

Graphical user interface concepts for tactical augmented reality

NASA Astrophysics Data System (ADS)

Argenta, Chris; Murphy, Anne; Hinton, Jeremy; Cook, James; Sherrill, Todd; Snarski, Steve

2010-04-01

Applied Research Associates and BAE Systems are working together to develop a wearable augmented reality system under the DARPA ULTRA-Vis program†. Our approach to achieve the objectives of ULTRAVis, called iLeader, incorporates a full color 40° field of view (FOV) see-thru holographic waveguide integrated with sensors for full position and head tracking to provide an unobtrusive information system for operational maneuvers. iLeader will enable warfighters to mark-up the 3D battle-space with symbologic identification of graphical control measures, friendly force positions and enemy/target locations. Our augmented reality display provides dynamic real-time painting of symbols on real objects, a pose-sensitive 360° representation of relevant object positions, and visual feedback for a variety of system activities. The iLeader user interface and situational awareness graphical representations are highly intuitive, nondisruptive, and always tactically relevant. We used best human-factors practices, system engineering expertise, and cognitive task analysis to design effective strategies for presenting real-time situational awareness to the military user without distorting their natural senses and perception. We present requirements identified for presenting information within a see-through display in combat environments, challenges in designing suitable visualization capabilities, and solutions that enable us to bring real-time iconic command and control to the tactical user community.

The 274th Forward Surgical Team experience during Operation Enduring Freedom.

PubMed

Peoples, George E; Gerlinger, Tad; Craig, Robert; Burlingame, Brian

2005-06-01

The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. Overall, the 274th FST took care of approximately 90% of U.S. combat casualties during this period and treated a total of 221 combat casualties. The FST treated 103 total surgical cases, including 73 with combat wounds. At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.

Mass casualty tracking with air traffic control methodologies.

PubMed

Hoskins, Jason D; Graham, Ross F; Robinson, Duane R; Lutz, Clifford C; Folio, Les R

2009-06-01

An intrahospital casualty throughput system modeled after air traffic control (ATC) tracking procedures was tested in mass casualty exercises. ATC uses a simple tactile process involving informational progress strips representing each aircraft, which are held in bays representing each stage of flight to prioritize and manage aircraft. These strips can be reordered within the bays to indicate a change in priority of aircraft sequence. In this study, a similar system was designed for patient tracking. We compared the ATC model and traditional casualty tracking methods of paper and clipboard in 18 four-hour casualty scenarios, each with 5 to 30 mock casualties. The experimental and control groups were alternated to maximize exposure and minimize training effects. Results were analyzed with Mann-Whitney statistical analysis with p value < 0.05 (two-sided). The ATC method had significantly (p = 0.017) fewer errors in critical patient data (eg, name, social security number, diagnosis). Specifically, the ATC method better tracked the mechanism of injury, working diagnosis, and disposition of patients. The ATC method also performed considerably better with patient accountability during mass casualty scenarios. Data strips were comparable with the control method in terms of ease of use. In addition, participants preferred the ATC method to the control (p = 0.003) and preferred using the ATC method (p = 0.003) to traditional methods in the future. The ATC model more effectively tracked patient data with fewer errors when compared with the clipboard method. Application of these principles can enhance trauma management and can have application in civilian and military trauma centers and emergency rooms.

Blended Training for Combat Medics

NASA Technical Reports Server (NTRS)

Fowlkes, Jennifer; Dickinson, Sandra; Lazarus, Todd

2010-01-01

Bleeding from extremity wounds is the number one cause of preventable death on the battlefield and current research stresses the importance of training in preparing every Soldier to use tourniquets. HapMed is designed to provide tourniquet application training to combat medics and Soldiers using a blended training solution encompassing information, demonstration, practice, and feedback. The system combines an instrumented manikin arm, PDA, and computer. The manikin arm provides several training options including stand-alone, hands-on skills training in which soldiers can experience the actual torque required to staunch bleeding from an extremity wound and be timed on tourniquet application. This is more realistic than using a block of wood to act as a limb, which is often how training is conducted today. Combining the manikin arm with the PDA allows instructors to provide scenario based training. In a classroom or field setting, an instructor can specify wound variables such as location, casualty size, and whether the wound is a tough bleed. The PDA also allows more detailed feedback to be provided. Finally, combining the manikin arm with game-based technologies, the third component, provides opportunities to build knowledge and to practice battlefield decision making. Not only do soldiers learn how to apply a tourniquet, but when to apply a tourniquet in combat. The purpose of the paper is to describe the learning science underlying the design of HapMed, illustrate the training system and ways it is being expanded to encompass other critical life-saving tasks, and report on feedback received from instructors and trainees at military training and simulation centers.

Provision of nutrition support therapies in the recent Iraq and Afghanistan conflicts.

PubMed

Stankorb, Susan M; Ramsey, Casside; Clark, Heidi; Osgood, Tamara

2014-10-01

This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

Effect of Combat Stress in the Psychophysiological Response of Elite and Non-Elite Soldiers.

PubMed

Tornero-Aguilera, José Francisco; Robles-Pérez, José Juan; Clemente-Suárez, Vicente Javier

2017-06-01

We aimed to analyse the effect of combat stress in the psychophysiological responses of elite and non-elite soldiers. We analysed heart rate, cortical arousal, skin temperature, blood lactate concentration and lower body muscular strength before and after a tactical combat simulation in 40 warfighters divided in two groups: elite (n: 20; 28.5 ± 6.38 years) and non-elite (n:20; 31.94 ± 6.24 years) group. Elite presented a significantly higher lactate concentration after combat than non elite soldiers (3.8 ± 1.5 vs 6.6 ± 1.3 mmol/L). Non-elite soldiers had a higher heart rate pre and post the simulation than elite (82.9 ± 12.3 vs 64.4 ± 11. pre non elite and elite respectively; 93.0 ± 12.8 vs 88 ± 13.8 bpm post non elite and elite respectively). Elite soldiers presented higher lower muscular strength than elite in all test and before and after the combat simulation. Cortical arousal was not modified significantly in both groups. We conclude elite soldiers presented in combat a higher anaerobic metabolism activation and muscular strength than non-elite soldiers, but cardiovascular, cortical, and muscular strength manifestation presented the same response in both elite and non-elite soldiers.

Tourniquet pressures: strap width and tensioning system widths.

PubMed

Wall, Piper L; Coughlin, Ohmar; Rometti, Mary; Birkholz, Sarah; Gildemaster, Yvonne; Grulke, Lisa; Sahr, Sheryl; Buising, Charisse M

2014-01-01

Pressure distribution over tourniquet width is a determinant of pressure needed for arterial occlusion. Different width tensioning systems could result in arterial occlusion pressure differences among nonelastic strap designs of equal width. Ratcheting Medical Tourniquets (RMTs; m2 inc., http://www.ratcheting buckles.com) with a 1.9 cm-wide (Tactical RMT) or 2.3 cm-wide (Mass Casualty RMT) ladder were directly compared (16 recipients, 16 thighs and 16 upper arms for each tourniquetx2). Then, RMTs were retrospectively compared with the windlass Combat Application Tourniquet (C-A-T ["CAT"], http://combattourniquet.com) with a 2.5 cm-wide internal tensioning strap. Pressure was measured with an air-filled No. 1 neonatal blood pressure cuff under each 3.8 cm-wide tourniquet. RMT circumferential pressure distribution was not uniform. Tactical RMT pressures were not higher, and there were no differences between the RMTs in the effectiveness, ease of use ("97% easy"), or discomfort. However, a difference did occur regarding tooth skipping of the pawl during ratchet advancement: it occurred in 1 of 64 Tactical RMT applications versus 27 of 64 Mass Casualty RMT applications. CAT and RMT occlusion pressures were frequently over 300 mmHg. RMT arm occlusion pressures (175-397 mmHg), however, were lower than RMT thigh occlusion pressures (197-562 mmHg). RMT effectiveness was better with 99% reached occlusion and 1% lost occlusion over 1 minute versus the CAT with 95% reached occlusion and 28% lost occlusion over 1 minute. RMT muscle tension changes (up to 232 mmHg) and pressure losses over 1 minute (24±11 mmHg arm under strap to 40±12 mmHg thigh under ladder) suggest more occlusion losses may have occurred if tourniquet duration was extended. The narrower tensioning system Tactical RMT has better performance characteristics than the Mass Casualty RMT. The 3.8 cm-wide RMTs have some pressure and effectiveness similarities and differences compared with the CAT. Clinically

β-alanine supplementation improves tactical performance but not cognitive function in combat soldiers

PubMed Central

2014-01-01

Background There are no known studies that have examined β-alanine supplementation in military personnel. Considering the physiological and potential neurological effects that have been reported during sustained military operations, it appears that β-alanine supplementation may have a potential benefit in maintaining physical and cognitive performance during high-intensity military activity under stressful conditions. The purpose of this study was to examine the effect of 28 days of β-alanine ingestion in military personnel while fatigued on physical and cognitive performance. Methods Twenty soldiers (20.1 ± 0.9 years) from an elite combat unit were randomly assigned to either a β-alanine (BA) or placebo (PL) group. Soldiers were involved in advanced military training, including combat skill development, navigational training, self-defense/hand-to-hand combat and conditioning. All participants performed a 4-km run, 5-countermovement jumps using a linear position transducer, 120-m sprint, a 10-shot shooting protocol with assault rifle, including overcoming a misfire, and a 2-min serial subtraction test to assess cognitive function before (Pre) and after (Post) 28 days of supplementation. Results The training routine resulted in significant increases in 4-km run time for both groups, but no between group differences were seen (p = 0.597). Peak jump power at Post was greater for BA than PL (p = 0.034), while mean jump power for BA at Post was 10.2% greater (p = 0.139) than PL. BA had a significantly greater (p = 0.012) number of shots on target at Post (8.2 ± 1.0) than PL (6.5 ± 2.1), and their target engagement speed at Post was also significantly faster (p = 0.039). No difference in serial subtraction performance was seen between the groups (p = 0.844). Conclusion Results of this study indicate that 4-weeks of β-alanine ingestion in young, healthy soldiers did not impact cognitive performance, but did enhance power

Casualty Crash Types for which Teens are at Excess Risk

PubMed Central

Bingham, C. R.; Shope, J. T.

2007-01-01

This study identified casualty crash types for which teen drivers experience excess risk relative to adults. Michigan State Police crash records were used to examine casualty crashes in two statewide populations of drivers who experienced at least one crash from 1989–1996 (pre-graduated driver licensing in Michigan): teens (ages 16–19) and adults (ages 45–65). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two statewide populations. Excess risk was defined as a RR for a specific type of crash that was significantly greater than the RR for all crashes combined. The RRs for all crashes combined for teenage males was 2.41 and 1.75 for teenage females. RRs for teenage males ranged from a low of 2.16 for casualty crashes attributed to alcohol to 8.98 for casualty road departure crashes at night. Among teenage females, RRs ranged from 2.06 for casualty crashes on the weekend to 7.86 for casualty crashes at night with passengers. Casualty crash rates for teenage males ranged from 0.21 per 100,000 PMD for rollover crashes to 1.95 per 100,000 PMD for crashes with passengers. Among teen females, casualty crash rates ranged from 0.21 per 100,000 PMD for drink/driving with passengers to 3.31 per 100,000 PMD for crashes with passengers. Implications for graduated driver licensing, teen driver supervision, and policy are discussed. This study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. PMID:18184510

33 CFR 146.35 - Written report of casualty.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Written report of casualty. 146... (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.35 Written report of casualty... written report which: (1) Identifies the facility involved, its owner, operator, and person in charge; (2...

[Managing an influx of casualties in Afghanistan].

PubMed

Planchet, Mathieu; Cazes, Nicolas; Pudupin, Alain; Leyral, Jarome; Lefort, Hugues

2014-09-01

Forward medical support is a fundamental principle of French army health service doctrine. During operations, the mission of army doctors and nurses is to treat casualties as high up the rescue chain as possible. This article describes the example of Afghanistan, in 2012, when the French army had to manage in a hostile environment an influx of casualties, sometimes massive and causing resources to become saturated.

Comparison Of The I-Gel Supraglottic And King Laryngotracheal Airways In A Simulated Tactical Environment.

PubMed

March, Juan A; Tassey, Theresa E; Resurreccion, Noel B; Portela, Roberto C; Taylor, Stephen E

2018-01-01

When working in a tactical environment there are several different airway management options that exist. One published manuscript suggests that when compared to endotracheal intubation, the King LT laryngotracheal airway (KA) device minimizes time to successful tube placement and minimizes exposure in a tactical environment. However, comparison of two different blind insertion supraglottic airway devices in a tactical environment has not been performed. This study compared the I-Gel airway (IGA) to the KA in a simulated tactical environment, to determine if one device is superior in minimizing exposure and minimizing time to successful tube placement. This prospective randomized cross over trial was performed using the same methods and tactical environment employed in a previously published study, which compared endotracheal intubation versus the KA in a tactical environment. The tactical environment was simulated with a one-foot vertical barrier. The participants were paramedic students who wore an Advanced Combat Helmet (ACH) and a ballistic vest (IIIA) during the study. Participants were then randomized to perform tactical airway management on an airway manikin with either the KA or the IGA, and then again using the alternate device. The participants performed a low military type crawl and remained in this low position during each tube placement. We evaluated the time to successful tube placement between the IGA and KA. During attempts, participants were videotaped to monitor their height exposure above the barrier. Following completion, participants were asked which airway device they preferred. Data was analyzed using Student's t-test across the groups for time to ventilation and height of exposure. In total 19 paramedic students who were already at the basic EMT level participated. Time to successful placement for the KA was 39.7 seconds (95%CI: 32.7-46.7) versus 14.4 seconds (95%CI: 12.0-16.9) for the IGA, p < 0.001. Maximum height exposure of the helmet

Management of Junctional Hemorrhage in Tactical Combat Casualty Care: TCCC Guidelines-Proposed Change 13-03

DTIC Science & Technology

2013-01-01

application resulted in the interruption of blood flow in the common femoral artery in seven of nine volunteer subjects. Cessation of flow was...expected to be occluded. Application time should not exceed 1 hour. The AAT is absolutely contraindicated in pregnancy and in patients with known...with dumb- bells weighing from 80 to 140 lb.19 The study noted that: “The amount of time the volunteers could tolerate the compression was not

46 CFR 197.486 - Written report of casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Written report of casualty. 197.486 Section 197.486... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... report, in narrative form, when the diving installation is on a facility. The written report must contain...

33 CFR 174.107 - Contents of casualty or accident report form.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Contents of casualty or accident... System Requirements § 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in § 173.57 of this chapter. ...

33 CFR 174.107 - Contents of casualty or accident report form.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Contents of casualty or accident... System Requirements § 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in § 173.57 of this chapter. ...

Patient distribution in a mass casualty event of an airplane crash.

PubMed

Postma, Ingri L E; Weel, Hanneke; Heetveld, Martin J; van der Zande, Ineke; Bijlsma, Taco S; Bloemers, Frank W; Goslings, J Carel

2013-11-01

Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam. Analysis of the patient distribution of 126 surviving casualties of the crash by collecting data on medical treatment capacity, number of patients received per hospital, triage classification, Injury Severity Score (ISS), secondary transfers, distance from the crash site, and the critical mortality rate. The PDP holds ambiguous definitions of medical treatment capacity and was not followed. There were 14 receiving hospitals (distance from crash: 5.8-53.5 km); four hospitals received 133-213% of their treatment capacity, and 5 hospitals received 1 patient. Three hospitals within 20 km of the crash did not receive any casualties. Level I trauma centres received 89% of the 'critical' casualties and 92% of the casualties with ISS ≥ 16. Only 3 casualties were secondarily transferred, and no casualties died in, or on the way to hospital (critical mortality rate=0%). Patient distribution worked out well after the crash as secondary transfers were low and critical mortality rate was zero. However, the regional PDP was not followed in this MCI and casualties were unevenly distributed among hospitals. The PDP is indistinctive, and should be updated in cooperation between Emergency Services, surrounding hospitals, and Schiphol International Airport as a high risk area. Copyright © 2013 Elsevier Ltd. All rights reserved.

Amputations in natural disasters and mass casualties: staged approach.

PubMed

Wolfson, Nikolaj

2012-10-01

Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.

Evaluation of tourniquet application in a simulated tactical environment.

PubMed

Sanak, Tomasz; Brzozowski, Robert; Dabrowski, Marek; Kozak, Magdalena; Dabrowska, Agata; Sip, Maciej; Naylor, Katarzyna; Torres, Kamil

2018-01-01

Application of a tourniquet in a tactical environment is implemented in two ways: the so-called self-aid, which is the application of a tourniquet by the injured, and the so-called buddy aid, which is the application of a tourniquet by the person provide aid. This study aimed to test the quality of tourniquet use in a simulated situation, close quarter battle. The study involved 24 injured operators and 72 operators in the whole simulation, implying 12 sections of six individuals. To validate the application of tourniquets, the recommendations of the Committee of Tactical Combat Care of the Injured were used, and ultrasound with Doppler function was employed to assess the hemodynamic effect of applying tourniquets. Native flow was observed in 15 operators; in three people, a trace flow was noticed, whereas in six people, a full flow was observed. No significant difference was found between the qualities of tourniquet application by the operators themselves compared with those of tourniquet application by another person. The median distance of tourniquet application from the armpit was 9.5 cm for self-aid and buddy aid. In 16 participants the outer arrangement of tourniquets was observed, and in only eight participants tourniquets were correctly located on the internal part of the arm. In 18 participants, tourniquets were not correctly prepared for use in the tactical environment, whereas in only six participants, they were correctly prepared. Most operators with a negative ultrasound flow revealed negative distal observed pulse (DOP). Positive DOP occurred in the majority of operators with full ultrasound flow. The application of tourniquets poses a challenge even in case of specialized units; therefore, there is a need to provide regular training for implementing that procedure.

Evacuation Priorities in Mass Casualty Terror-Related Events

PubMed Central

Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

2004-01-01

Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

An Analysis of the Perceptions of Division Senior Combat Arms Leaders of the Tactical Competence of Division Signal Officers and Assistant Division Signal Officers.

DTIC Science & Technology

1987-06-05

field the equipment ( Valletta , 1980). The need for signal officers to be trained to employ new communications systems in support of the tactical...Gordon, GAO 30905). Valletta , A. M. (1980). Tactical automnation-communications: Supporting corps rear to front line. Army Magazine, 1(4), 25-28

The balance and harmony of control power for a combat aircraft in tactical maneuvering

NASA Technical Reports Server (NTRS)

Bocvarov, Spiro; Cliff, Eugene M.; Lutze, Frederick H.

1992-01-01

An analysis is presented for a family of regular extremal attitude-maneuvers for the High Angle-of-Attack Research Vehicle that has thrust-vectoring capability. Different levels of dynamic coupling are identified in the combat aircraft attitude model, and the characteristic extremal-family motion is explained. It is shown why the extremal-family trajectories develop small sideslip-angles, a highly desirable feature from a practical viewpoint.

Environmental Assessment: Recapitalization of the 49th WG Combat Capabilities and Capacities, Holloman Air Force Base, New Mexico

DTIC Science & Technology

2011-07-01

of Liquid Oxygen (LOX). The new facilities would provide for the specific needs to maintain the F-16 engine, electronics , and maintenance... electronic countermeasures, and electronic counter countermeasures. 500 AGL to 40,000 MSL 0.5 to 1.0 hour Night Operations Aircraft intercepts (1...defensive maneuvering, chaff/flare, and electronic countermeasures. 2,000 AGL to 40,000 MSL 0.75 to 1.5 hour (Dissimilar) Air Combat Tactics

Review of the tactical evaluation tools for youth players, assessing the tactics in team sports: football.

PubMed

González-Víllora, Sixto; Serra-Olivares, Jaime; Pastor-Vicedo, Juan Carlos; da Costa, Israel Teoldo

2015-01-01

For sports assessment to be comprehensive, it must address all variables of sports development, such as psychological, social-emotional, physical and physiological, technical and tactical. Tactical assessment has been a neglected variable until the 1980s or 1990s. In the last two decades (1995-2015), the evolution of tactical assessment has grown considerably, given its importance in game performance. The aim of this paper is to compile and analyze different tactical measuring tools in team sports, particularly in soccer, through a bibliographical review. Six tools have been selected on five different criteria: (1) Instruments which assess tactics, (2) The studies have an evolution approach related to the tactical principles, (3) With a valid and reliable method, (4) The existence of publications mentioning the tool in the method, v. Applicable in different sports contexts. All six tools are structured around seven headings: introduction, objective(s), tactical principles, materials, procedures, instructions/rules of the game and published studies. In conclusion, the teaching-learning processes more tactical oriented have useful tactical assessment instrument in the literature. The selection of one or another depends some context information, like age and level of expertise of the players.

Decontamination of mass casualties--re-evaluating existing dogma.

PubMed

Levitin, Howard W; Siegelson, Henry J; Dickinson, Stanley; Halpern, Pinchas; Haraguchi, Yoshikura; Nocera, Anthony; Turineck, David

2003-01-01

The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response. Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.

Evaluation of Why the Air Force Dedicated Personnel Recovery Mission Should Remain with Air Combat Command

DTIC Science & Technology

2016-03-01

Many of the tactics still in use today were tested and executed in combat during the Vietnam War. One of the major benefits that resulted from...AFSOF to support the planning for Project Honey Badger, the re-attempt at recovering the hostages in Iran.43 Project Honey Badger would eventually be...14 scrapped as the hostages would be released in early 1981. The damage for the ARRS had been done. Even with the termination of Project Honey

Children and terror casualties receive preference in ICU admissions.

PubMed

Peleg, Kobi; Rozenfeld, Michael; Dolev, Eran

2012-03-01

Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events. Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry. All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU. Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

Advanced Product Development for Combat Casualty Care at the U.S. Army Institute of Surgical Research

DTIC Science & Technology

2010-04-01

for predicting central blood volume changes to focus on the development of software algorithms and systems to provide a capability to track, and...which creatively fills this Critical Care gap. Technology in this sense means hardware and software systems which incorporate sensors, processors...devices for use in forward surgical and combat areas. Mil Med 170: 76-82, 2005. [10] Gaylord KM, Cooper DB, Mercado JM, Kennedy JE, Yoder LH, and

A literature review of dental casualty rates.

PubMed

Mahoney, G D; Coombs, M

2000-10-01

The ability to determine dental casualty rates for the Australian Defence Force in a given situation is vital for military planners. This article reviews the literature and the available Australian Defence Force data on the subject to give some guide to planners. The review found the studies to be fairly consistent in that a well-prepared dentally fit force can expect 150 to 200 dental casualties per 1,000 soldiers per year. If the force were less prepared, as in the case of a reserve call out, this figure would be likely to increase; in the extreme case of an ill-prepared force or a force assisting in humanitarian aid, the emergency rate could be five times that figure. The literature also indicates a change in the nature of dental casualties. Although maxillofacial cases have remained steady at 25%, dental disease has decreased and endodontic cases have had a corresponding increase.

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

The Casualty Actuarial Society: Helping Universities Train Future Actuaries

ERIC Educational Resources Information Center

Boa, J. Michael; Gorvett, Rick

2014-01-01

The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb.

PubMed

Fox, Charles J; Perkins, Jeremy G; Kragh, John F; Singh, Niten N; Patel, Bhavin; Ficke, James R

2010-07-01

Popliteal artery war wounds can bleed severely and historically have high rates of amputation associated with ligation (72%) and repair (32%). More than before, casualties are now surviving the initial medical evacuation and presenting with severely injured limbs that prompt immediate limb salvage decisions in the midst of life-saving maneuvers. A modern analysis of current results may show important changes because previous limb salvage strategies were limited by the resuscitation and surgical techniques of their eras. Because exact comparisons between wars are difficult, the objective of this study was to calculate a worst-case (a pulseless, fractured limb with massive hemorrhage from popliteal artery injury) amputation-free survival rate for the most severely wounded soldiers undergoing immediate reconstruction to save both life and limb. We performed a retrospective study of trauma casualties admitted to the combat support hospital at Ibn Sina Hospital in Baghdad, Iraq, between 2003 and 2007. US military casualties requiring a massive transfusion (> or = 10 blood units transfused within 24 hours of injury) were identified. We extracted data on the subset of casualties with a penetrating supra or infrageniculate popliteal arterial vascular injury. Demographics, injury mechanism, Injury Severity Score, tourniquet use, physiologic parameters, damage control adjuncts, surgical repair techniques, operative time, and outcomes (all-cause 30-day mortality, amputation rates, limb salvage failure, and graft patency) were investigated. Forty-six massively transfused male casualties, median age 24 years (range, 19-54 years; mean Injury Severity Score, 19 +/- 8.0), underwent immediate orthopedic stabilization and vascular reconstruction. There was one early death. The median operative time for the vascular repairs was 217 minutes (range, 94-630 minutes) and included all damage control procedures. Combined arterial and venous injuries occurred in 17 (37%). Ligation was

Assessment of the Combat Developer’s Role in Post-Deployment Software Support (PDSS) 30 June 1980 - 28 February 1981. Volume II.

DTIC Science & Technology

1980-09-30

systems is provided by the Intelligence School, Fort Devens , Massachusetts. 3. TRADOC System Manager for specified Corps Tactical EW/Intelligence...UNITED STATES ARMY COMBINED ARMS COMBAT DEVELOPMENT ACTIVITY E, FORT LEAVENWORTH, KANSAS 66027 BOM SERVICES COMPANY LEAVENWORTH, KANSAS 66048 SION...ATZLCA-CI-M, Mr. R. K. Schwabe UNCLASSIFIED Fort eavenorth Kanss 6607I15. DECLASSI FICATION/ DOWNGRADINGFortLeaenwothKanss 6027SCHEDULE 16

The Art and Science of Tactics

DTIC Science & Technology

1977-01-01

THE ART AND SCIENCE OF TACTICS by MAJOR ROBERT A. DOUGHTY, US ARMY E stablishing the nature of tactics has been a pastime of professional...tactics in the US Army have implicitly begun to assume that tactics is more an exact science than an " art and science ." As one recent military writer...and 19th centuries generally agreed that tactics was more an art than it was a science . Many agreed with the terse definition given by Antoine

Long-Term Follow-Up and Amputation-Free Survival in 497 Casualties with Combat-Related Vascular Injuries and Damage-Control Resuscitation

DTIC Science & Technology

2012-01-01

minutes). US casualties (n 111) had limb salvage attempted for 113 extremity vascular injuries (3 [2%] iliac , 33 [30%] femoral, 23 [20%] popliteal...Patients Amputation Survival Follow-Up, Mean (Range), d Iliac 1 1 1 3 3 (100%) 3 (100%) 347 (29 1,079) Femoral 10 20 3 33 29 (87.9%) 4 (12.1%) 33 (100...3 4 3 (75%) 1 (25%) 4 (100%) Radial 2 2 4 4 (100%) 4 (100%) Total 28 80 5 113 96 (84.9%) 16 (14.2%) 110 (99.1%) *One bilateral repair. J Trauma Acute

Prehospital Medicine and the Future Will ECMO Ever Play a Role?

PubMed

Macku, David; Hedvicak, Pavel; Quinn, John; Bencko, Vladimir

Due to the hybrid warfare currently experienced by multiple NATO coalition and NATO partner nations, the tactical combat casualty care (TCCC) paradigm is greatly challenged. One of the major challenges to TCCC is the ad hoc extension phase in resource-poor environments, referred to as prolonged field care (PFC) and forward resuscitative care (FRC). The nuanced clinical skills with limited resources required by warfighters and auxiliary health care professionals to mitigate death on the battlefield and prevent morbidity and mortality in the PFC phase represent a balance that is still under review. The aim of our article is to describe the connection between extracorporeal membrane oxygenation (ECMO) or the extracorporeal life support (ECLS) treatment and its possible improvement in prehospital trauma care, at a Role 1 or 2 facility and, more provocatively, in the PFC phase of care in the future through innovative technology and how it connects with FRC. We report and describe here the primary components of ECMO/ECLS and present the main concept of a human extracorporeal circulation cocoon as a transitional living form for the cardiopulmonary stabilization of wounded combatants on the battlefield and their transportation to higher echelons of care and treatment facilities (to include damage control resuscitation [DCR] and damage control surgery [DCS]). As clinical governance, these matters would fall within the remit of the Committee on Surgical Combat Casualty Care (CoSCCC) and the Committee on Enroute Combat Casualty Care (CoERCCC), and it is within this framework that we propose this concept piece of ECMO in the prehospital space. We caution that this report is a proposed innovation to TCCC but also serves to push the envelope of the PFC and FRC paradigm. What we propose will not change the practice this year, but as ECMO technology progresses, it may change our practice within the next decade. We conclude with proposed novel future research to save life on the

Joint Threater Trauma System: Saving Lives on the Battlefield

DTIC Science & Technology

2008-04-23

Guerre, Analysis d’observations. Bul.Med Soc.Chir. 44 (1918), 205. 30 SSG Kile , “Operational Medicine Overview,” Combat Care Casualty Course, Powerpoint...U.S. Naval Institute Proceedings 1237, no. 11 (November 2001):68-71 SSG Kile , “Operational Medicine Overview,” Combat Care Casualty Course

Temporary and definitive external fixation of war injuries: use of a French dedicated fixator.

PubMed

Mathieu, Laurent; Ouattara, Naklan; Poichotte, Antoine; Saint-Macari, Erwan; Barbier, Olivier; Rongiéras, Fréderic; Rigal, Sylvain

2014-08-01

External fixation is the recommended stabilization method for both open and closed fractures of long bones in forward surgical hospitals. Specific combat surgical tactics are best performed using dedicated external fixators. The Percy Fx (Biomet) fixator was developed for this reason by the French Army Medical Service, and has been used in various theatres of operations for more than ten years. The tactics of Percy Fx (Biomet) fixator use were analysed in two different situations: for the treatment of French soldiers wounded on several battlefields and then evacuated to France and for the management of local nationals in forward medical treatment facilities in Afghanistan and Chad. Overall 48 externals fixators were implanted on 37 French casualties; 28 frames were temporary and converted to definitive rigid frames or internal fixation after medical evacuation. The 77 Afghan patients totalled 85 external fixators, including 13 temporary frames applied in Forward Surgical Teams (FSTs) prior to their arrival at the Kabul combat support hospital. All of the 47 Chadian patients were treated in a FST with primary definitive frames because of delayed surgical management and absence of higher level of care in Chad. Temporary frames were mostly used for French soldiers to facilitate strategic air medical evacuation following trauma damage control orthopaedic principles. Definitive rigid frames permitted achieving treatment of all types of war extremity injuries, even in poor conditions.

Audit of the effectiveness of command and control arrangements for medical evacuation of seriously ill or injured casualties in southern Afghanistan 2007.

PubMed

Cordell, R F; Cooney, M S; Beijer, D

2008-12-01

convergence of median and mean at this time indicates a reduction in "outliers", providing evidence that collocation of medical and operations staff improves incident response and should be the "default setting" in deployed tactical formation headquarters. Regular audit of MEDEVAC response should be routine for Medical Operations staff, in order to ensure the optimal casualty care pathway from point of wounding to field hospital.

46 CFR 122.260 - Reports of potential vessel casualty.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Reports of potential vessel casualty. 122.260 Section 122.260 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS CARRYING MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.260...

Field and en route resuscitative endovascular occlusion of the aorta: A feasible military reality?

PubMed

Reva, Viktor A; Hörer, Tal M; Makhnovskiy, Andrey I; Sokhranov, Mikhail V; Samokhvalov, Igor M; DuBose, Joseph J

2017-07-01

Severe noncompressible torso hemorrhage remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of noncompressible torso hemorrhage in the civilian early hospital and even prehospital settings-but the application of this technology for military prehospital use has not been well described. We aimed to assess the feasibility of both field and en route prehospital REBOA in the military exercise setting, simulating a modern armed conflict. Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care interventions-one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate forward surgical teams by rotary wing platform where the balloon position was confirmed by chest x-ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia. The first swine underwent immediate successful REBOA at the point of injury 7 minutes and 30 seconds after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take off (17 minutes and 40 seconds after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-French (Fr) sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the forward surgical team, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No

An Expected Value Air Combat Model Simulation Algorithm to Predict Missions Performance in Tactical Air Operations.

DTIC Science & Technology

1983-09-01

Approved by: Me<i W4 1tsZ7 CaifI ,KDpartmento I inistrative Science 3 ( ABSTRACT >This thesis intends to create the basic...a need for a small scale model which allows a student analyst of tactical air operations to create his own battles and to test his own strategies with...iconic model is a large or small-scale repre- sentation of states-objects, or events. For example a scale model airplance resembles the system under the

Greasy tactics in the plant-pathogen molecular arms race.

PubMed

Boyle, Patrick C; Martin, Gregory B

2015-03-01

The modification of proteins by the attachment of fatty acids is a targeting tactic involved in mechanisms of both plant immunity and bacterial pathogenesis. The plant plasma membrane (PM) is a key battleground in the war against disease-causing microbes. This membrane is armed with an array of sensor proteins that function as a surveillance system to detect invading pathogens. Several of these sensor proteins are directed to the plasma membrane through the covalent addition of fatty acids, a process termed fatty acylation. Phytopathogens secrete effector proteins into the plant cell to subvert these surveillance mechanisms, rendering the host susceptible to infection. The targeting of effectors to specific locales within plant cells, particularly the internal face of the host PM, is critical for their virulence function. Several bacterial effectors hijack the host fatty acylation machinery to be modified and directed to this contested locale. To find and fight these fatty acylated effectors the plant leverages lipid-modified intracellular sensors. This review provides examples featuring how fatty acylation is a battle tactic used by both combatants in the molecular arms race between plants and pathogens. Also highlighted is the exploitation of a specific form of host-mediated fatty acid modification, which appears to be exclusively employed by phytopathogenic effector proteins. © The Author 2015. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Ultrasound applications in mass casualties and extreme environments.

PubMed

Ma, O John; Norvell, Jeffrey G; Subramanian, Srikala

2007-05-01

A mass-casualty incident is one in which the number of patients with injuries exceeds the available medical resources to care for them in a timely manner. In such a situation, the numerous advantages of ultrasonography make it an ideal triage tool for helping clinicians rapidly screen patients. Experiences during the 1988 Armenian earthquake and the 1999 Turkish earthquake demonstrated the proficiency of ultrasound in providing rapid clinical data to the physicians caring for the mass-casualty patients. Wireless and satellite transmission of ultrasound images also has been shown to be feasible and may be applied to mass-casualty situations. In addition, ultrasound applications have been demonstrated to aid in the diagnosis of various conditions, including pneumothorax, in the International Space Station. Ultrasound's portability, reproducibility, accuracy, and ease of use will make it an important diagnostic instrument for future space missions.

American War and Military Operations Casualties: Lists and Statistics

DTIC Science & Technology

2007-06-29

DesertShield/Desert Storm (as of June 15, 2004) Casualty Type Total Army Air Force Marines Navya ,b Killed in Action 143 96 20 22 5 Died of Wounds 4 2 2...Operation Iraqi Freedom — Military Deaths, May 1, 2003, Through June 2, 2007 (As of June 2, 2007) Casualty Type Totals Army Navya Marines Air Force

19 CFR 158.27 - Accidental fire or other casualty.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Casualty, Loss, or Theft While in Customs Custody § 158.27 Accidental fire or other casualty. In the case... submitted: (a) A declaration of the master of the vessel, the conductor or driver of the vehicle, the... merchandise was on board the vessel or vehicle, in the warehouse, or otherwise in his charge, as the case may...

Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data

PubMed Central

Egan, Joseph R.; Amlôt, Richard

2012-01-01

In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit. PMID:23202768

Airborne ladar man-in-the-loop operations in tactical environments

NASA Astrophysics Data System (ADS)

Grobmyer, Joseph E., Jr.; Lum, Tommy; Morris, Robert E.; Hard, Sarah J.; Pratt, H. L.; Florence, Tom; Peddycoart, Ed

2004-09-01

The U.S. Army Research, Development and Engineering Command (RDECOM) is developing approaches and processes that will exploit the characteristics of current and future Laser Radar (LADAR) sensor systems for critical man-in-the-loop tactical processes. The importance of timely and accurate target detection, classification, identification, and engagement for future combat systems has been documented and is viewed as a critical enabling factor for FCS survivability and lethality. Recent work has demonstrated the feasibility of using low cost but relatively capable personal computer class systems to exploit the information available in Ladar sensor frames to present the war fighter or analyst with compelling and usable imagery for use in the target identification and engagement processes in near real time. The advantages of LADAR imagery are significant in environments presenting cover for targets and the associated difficulty for automated target recognition (ATR) technologies.

Communication networks for the tactical edge

NASA Astrophysics Data System (ADS)

Evans, Joseph B.; Pennington, Steven G.; Ewy, Benjamin J.

2017-04-01

Information at the tactical level is increasingly critical in today's conflicts. The proliferation of commercial tablets and smart phones has created the ability for extensive information sharing at the tactical edge, beyond the traditional tactical voice communications and location information. This is particularly the case in Gray Zone conflicts, in which tactical decision making and actions are intertwined with information sharing and exploitation. Networking of tactical devices is the key to this information sharing. In this work, we detail and analyze two network models at different parts of the Gray Zone spectrum, and explore a number of networking options including Named Data Networking. We also compare networking approaches in a variety of realistic operating environments. Our results show that Named Data Networking is a good match for the disrupted networking environments found in many tactical situations

Survey of trauma registry data on tourniquet use in pediatric war casualties.

PubMed

Kragh, John F; Cooper, Arthur; Aden, James K; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H

2012-12-01

Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009. Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use. The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training. Level 4; case series, therapeutic study.

The Potential Utility of Urinary Biomarkers for Risk Prediction in Combat Casualties: A Prospective Observational Cohort Study

DTIC Science & Technology

2015-06-16

are associated with poor outcomes, including death and the need for renal replacement therapy. Methods : We conducted a prospective, observational study...penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 16 JUN 2015...2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE The Potential Utility of Urinary Biomarkers for Risk Prediction in Combat

Strategies for Improved Hospital Response to Mass Casualty Incidents.

PubMed

TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas

2018-03-19

Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

A new methodology for estimating nuclear casualties as a function of time.

PubMed

Zirkle, Robert A; Walsh, Terri J; Disraelly, Deena S; Curling, Carl A

2011-09-01

The Human Response Injury Profile (HRIP) nuclear methodology provides an estimate of casualties occurring as a consequence of nuclear attacks against military targets for planning purposes. The approach develops user-defined, time-based casualty and fatality estimates based on progressions of underlying symptoms and their severity changes over time. This paper provides a description of the HRIP nuclear methodology and its development, including inputs, human response and the casualty estimation process.

MODIFIED FUNCTIONAL MOVEMENT SCREENING AS A PREDICTOR OF TACTICAL PERFORMANCE POTENTIAL IN RECREATIONALLY ACTIVE ADULTS.

PubMed

Glass, Stephen M; Ross, Scott E

2015-10-01

Failure to meet minimum performance standards is a leading cause of attrition from basic combat training. A standardized assessment such as the Functional Movement Screen™ (FMS™) could help identify movement behaviors relevant to physical performance in tactical occupations. Previous work has demonstrated only marginal association between FMS™ tests and performance outcomes, but adding a load challenge to this movement assessment may help highlight performance-limiting behaviors. The purposes of this investigation were to quantify the effect of load on FMS™ tests and determine the extent to which performance outcomes could be predicted using scores from both loaded and unloaded FMS™ conditions. Crossover Trial. Thirteen female and six male recreationally active college students (21 ± 1.37 years, 168 ± 9.8 cm, 66 ± 12.25 kg) completed the FMS™ under (1) a control condition (FMS™C), and (2) an 18.10kg weight vest condition (FMS™W). Balance was assessed using a force plate in double-legged stance and tactical physical performance was evaluated via completion times in a battery of field tests. For each condition, penalized regression was used to select models from the seven FMS™ component tests to predict balance and performance outcomes. Data were collected during a single session lasting approximately three hours per participant. For balance, significant predictors were identified from both conditions but primarily predicted poorer balance with increasing FMS™ scores. For tactical performance, models were retained almost exclusively from FMS™W and generally predicted better performance with higher item scores. The current results suggest that FMS™ screening with an external load could help predict performance relevant to tactical occupations. Sports medicine and fitness professionals interested in performance outcomes may consider assessing movement behaviors under a load. 3.

33 CFR 174.121 - Forwarding of casualty or accident reports.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... § 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has an approved numbering system must forward a copy of that report to the...

33 CFR 174.121 - Forwarding of casualty or accident reports.

Code of Federal Regulations, 2011 CFR

2011-07-01

... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... § 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has an approved numbering system must forward a copy of that report to the...

AN F-16 COMMUNITY PUSHED TO THE LIMIT: CAN THEY HANDLE ADDING COMBAT SEARCH AND RESCUE (CSAR)

DTIC Science & Technology

2015-10-01

recovery. Traditionally, the HH-60G Pave Hawk is the RV expected to be used in a majority of scenarios. An article from www.military.com stated that...the HH-60G Pave Hawk is the U.S. Air Force’s primary combat search and rescue helicopter used by Air Force special tactics teams and pararescuemen...16 This aircraft is a version of the Army Black Hawk helicopter that has been modified to meet the needs of the Air Force.17 The locations of

Benefits of multidisciplinary collaboration for earthquake casualty estimation models: recent case studies

NASA Astrophysics Data System (ADS)

So, E.

2010-12-01

Earthquake casualty loss estimation, which depends primarily on building-specific casualty rates, has long suffered from a lack of cross-disciplinary collaboration in post-earthquake data gathering. An increase in our understanding of what contributes to casualties in earthquakes involve coordinated data-gathering efforts amongst disciplines; these are essential for improved global casualty estimation models. It is evident from examining past casualty loss models and reviewing field data collected from recent events, that generalized casualty rates cannot be applied globally for different building types, even within individual countries. For a particular structure type, regional and topographic building design effects, combined with variable material and workmanship quality all contribute to this multi-variant outcome. In addition, social factors affect building-specific casualty rates, including social status and education levels, and human behaviors in general, in that they modify egress and survivability rates. Without considering complex physical pathways, loss models purely based on historic casualty data, or even worse, rates derived from other countries, will be of very limited value. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from

[Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery : Presentation of a treatment concept].

PubMed

Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M

2017-10-01

The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a "normal" MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

A concurrent distributed system for aircraft tactical decision generation

NASA Technical Reports Server (NTRS)

Mcmanus, John W.

1990-01-01

A research program investigating the use of AI techniques to aid in the development of a tactical decision generator (TDG) for within visual range (WVR) air combat engagements is discussed. The application of AI programming and problem-solving methods in the development and implementation of a concurrent version of the computerized logic for air-to-air warfare simulations (CLAWS) program, a second-generation TDG, is presented. Concurrent computing environments and programming approaches are discussed, and the design and performance of prototype concurrent TDG system (Cube CLAWS) are presented. It is concluded that the Cube CLAWS has provided a useful testbed to evaluate the development of a distributed blackboard system. The project has shown that the complexity of developing specialized software on a distributed, message-passing architecture such as the Hypercube is not overwhelming, and that reasonable speedups and processor efficiency can be achieved by a distributed blackboard system. The project has also highlighted some of the costs of using a distributed approach to designing a blackboard system.

Level I center triage and mass casualties.

PubMed

Hoey, Brian A; Schwab, C William

2004-05-01

The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.

Traffic accidents involving fatigue driving and their extent of casualties.

PubMed

Zhang, Guangnan; Yau, Kelvin K W; Zhang, Xun; Li, Yanyan

2016-02-01

The rapid progress of motorization has increased the number of traffic-related casualties. Although fatigue driving is a major cause of traffic accidents, the public remains not rather aware of its potential harmfulness. Fatigue driving has been termed as a "silent killer." Thus, a thorough study of traffic accidents and the risk factors associated with fatigue-related casualties is of utmost importance. In this study, we analyze traffic accident data for the period 2006-2010 in Guangdong Province, China. The study data were extracted from the traffic accident database of China's Public Security Department. A logistic regression model is used to assess the effect of driver characteristics, type of vehicles, road conditions, and environmental factors on fatigue-related traffic accident occurrence and severity. On the one hand, male drivers, trucks, driving during midnight to dawn, and morning rush hours are identified as risk factors of fatigue-related crashes but do not necessarily result in severe casualties. Driving at night without street-lights contributes to fatigue-related crashes and severe casualties. On the other hand, while factors such as less experienced drivers, unsafe vehicle status, slippery roads, driving at night with street-lights, and weekends do not have significant effect on fatigue-related crashes, yet accidents associated with these factors are likely to have severe casualties. The empirical results of the present study have important policy implications on the reduction of fatigue-related crashes as well as their severity. Copyright © 2015 Elsevier Ltd. All rights reserved.

Job Stress and Coping in Army Casualty Operations Workers

DTIC Science & Technology

1991-01-14

available, stress leading to burnout appears finely balanced , teetering back and forth among particular conditions and situations in casualty work . Many CAO...al., 1986) and brought more in accord with the U.S. Army’s casualty work experience. As with the original, burnout is measured through 22 overall...than 11 miles from work and commute during irregular hours. In respect to general trends among Army NCOs, the characteristics described above appear to

Heavy truck casualty collisions, 2001-2005

DOT National Transportation Integrated Search

2010-04-01

This document reviews casualty collisions (fatalities and injuries) involving heavy trucks in Canada : from 2001 to 2005. Collisions involving heavy trucks include all vehicles in these collisions, such as : passenger cars, light trucks and vans, hea...

Casualty Risk From Tornadoes in the United States is Highest in Urbanized Areas Across the Mid South

NASA Astrophysics Data System (ADS)

Fricker, T.; Elsner, J.

2017-12-01

Risk factors for tornado casualties are well known. Less understood is how and to what degree these determinants, after controlling for strength and urban density, vary spatially and temporally. Here we fit models to casualty counts from all casualty-producing tornadoes since 1995 in order to quantify the interactions between urbanization and energy on casualty rates. Results from the models show that the more urbanized areas of the Mid South are substantively and significantly more vulnerable to casualties from tornadoes than elsewhere in the country. Casualty rates are significantly higher on the weekend for tornadoes in this region. Night and day casualty rates are similar regardless of where they occur. Higher vulnerability to casualties from tornadoes occurring in more urbanized areas correspond significantly with greater percentages of elderly people. Many of the micro cities in the Mid South are threatened by tornadoes annually and this threat might potentially be exacerbated by climate change.

A numerical simulation strategy on occupant evacuation behaviors and casualty prediction in a building during earthquakes

NASA Astrophysics Data System (ADS)

Li, Shuang; Yu, Xiaohui; Zhang, Yanjuan; Zhai, Changhai

2018-01-01

Casualty prediction in a building during earthquakes benefits to implement the economic loss estimation in the performance-based earthquake engineering methodology. Although after-earthquake observations reveal that the evacuation has effects on the quantity of occupant casualties during earthquakes, few current studies consider occupant movements in the building in casualty prediction procedures. To bridge this knowledge gap, a numerical simulation method using refined cellular automata model is presented, which can describe various occupant dynamic behaviors and building dimensions. The simulation on the occupant evacuation is verified by a recorded evacuation process from a school classroom in real-life 2013 Ya'an earthquake in China. The occupant casualties in the building under earthquakes are evaluated by coupling the building collapse process simulation by finite element method, the occupant evacuation simulation, and the casualty occurrence criteria with time and space synchronization. A case study of casualty prediction in a building during an earthquake is provided to demonstrate the effect of occupant movements on casualty prediction.

New combat laser and ballistic eye protection goggles

NASA Astrophysics Data System (ADS)

Belkin, Michael

1996-04-01

Up to 10% of all combat casualties involve eye injuries which are becoming more severe, bilateral and likely to lead to a retained intraocular foreign body. The modern battlefield is permeated with laser radiation from range finders, target designators and perhaps laser weapons aimed at producing visual incapacitation. In future wars, therefore, the likelihood of eye injuries is very high. We sought to devise means to protect the eye from military relevant injurious agents. Almost all ballistic injuries can be prevented by using polycarbonate goggles. They must not, however, interfere with the soldier's functions such as the use of binoculars or limit his visual fields. These problems are not insurmountable and we shall demonstrate new goggles design which we believe will be acceptable to the troops. The solution to laser protection is more difficult. For that purpose the goggles include outserts filters for various groups of laser wavelengths. The soldier will use the appropriate filter according to a reading from a laser detector which will indicate which filter is protective against the wavelength detected.

Heavy truck casualty collisions, 1994-1998

DOT National Transportation Integrated Search

2001-12-01

This document reviews the number of collisions, vehicles involved, and casualties (fatalities and injuries) resulting from heavy truck collisions for each of straight trucks (greater than 4.536 kg) and tractor-trailers. The report also presents table...

Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

PubMed

Remick, Kyle N

2016-01-01

The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

Remote operation of the Black Knight unmanned ground combat vehicle

NASA Astrophysics Data System (ADS)

Valois, Jean-Sebastien; Herman, Herman; Bares, John; Rice, David P.

2008-04-01

The Black Knight is a 12-ton, C-130 deployable Unmanned Ground Combat Vehicle (UGCV). It was developed to demonstrate how unmanned vehicles can be integrated into a mechanized military force to increase combat capability while protecting Soldiers in a full spectrum of battlefield scenarios. The Black Knight is used in military operational tests that allow Soldiers to develop the necessary techniques, tactics, and procedures to operate a large unmanned vehicle within a mechanized military force. It can be safely controlled by Soldiers from inside a manned fighting vehicle, such as the Bradley Fighting Vehicle. Black Knight control modes include path tracking, guarded teleoperation, and fully autonomous movement. Its state-of-the-art Autonomous Navigation Module (ANM) includes terrain-mapping sensors for route planning, terrain classification, and obstacle avoidance. In guarded teleoperation mode, the ANM data, together with automotive dials and gages, are used to generate video overlays that assist the operator for both day and night driving performance. Remote operation of various sensors also allows Soldiers to perform effective target location and tracking. This document covers Black Knight's system architecture and includes implementation overviews of the various operation modes. We conclude with lessons learned and development goals for the Black Knight UGCV.

Association of bacterial colonization at the time of presentation to a combat support hospital in a combat zone with subsequent 30-day colonization or infection.

PubMed

Kaspar, Robert L; Griffith, Matthew E; Mann, Paul B; Lehman, Devon J; Conger, Nicholas G; Hospenthal, Duane R; Murray, Clinton K

2009-09-01

U.S. casualties have developed multidrug-resistant (MDR) bacterial infections. A surveillance project to evaluate U.S. military patients for the presence of MDR pathogens from wounding through the first 30 days of care in the military healthcare system (MHS) was performed. U.S. military patients admitted to a single combat support hospital in Iraq during June-July of 2007 had screening swabs obtained for the detection of MDR bacteria and a subsequent retrospective electronic medical records review for presence of colonization or infection in the subsequent 30 days. Screening of 74 U.S. military patients in Iraq found one colonized with methicillin-resistant Staphylococcus aureus. Fifty-six patients of these were screened for Acinetobacter in Germany and one found colonized. Of patients evacuated to the U.S., 9 developed infections. Carefully obtained screening cultures immediately after injury combined with look-back monitoring supports the role of nosocomial transmission. Consistent infection control strategies are needed for the entire MHS.

Home Advantage in Judo: Analysis by the Combat Phase, Penalties and the Type of Attack

PubMed Central

Brito, Ciro José; Miarka, Bianca; de Durana, Alfonso López Díaz; Fukuda, David H

2017-01-01

Abstract Previous studies indicate positive home advantage in judo; however, the factors that influence home advantage have yet to be fully explored. This study investigated the potential differences in technical-tactical variables between home and visiting athletes. A total of 1411 video recorded matches were analyzed (123 home, 1288 away) from 36 international judo competitions contested in 2011-12. The matches were analyzed by the following criteria: combat phases (approach, gripping, attack, defense, groundwork and pause), penalties (by the athlete or the opponent) and the types of attacks (with or without a score). Elite judo athletes competing in their home country attacked more frequently using trunk/leg couple techniques (p < 0.011) and scored more frequently with arm/leg couple techniques (p < 0.001), while visiting judo athletes received fewer scores from penalties (p < 0.001) and engaged in more frequent pauses during competition (p < 0.01). The results of this study provide an outline of technical-tactical differences that may contribute to home advantage in judo. PMID:28713473

Airborne Tactical Crossload Planner

DTIC Science & Technology

2017-12-01

set out in the Airborne Standard Operating Procedure (ASOP). 14. SUBJECT TERMS crossload, airborne, optimization, integer linear programming ...they land to their respective sub-mission locations. In this thesis, we formulate and implement an integer linear program called the Tactical...to meet any desired crossload objectives. xiv We demonstrate TCP with two real-world tactical problems from recent airborne operations: one by the

[The role of patient flow and surge capacity for in-hospital response in mass casualty events].

PubMed

Sefrin, Peter; Kuhnigk, Herbert

2008-03-01

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

Disasters and mass casualties: I. General principles of response and management.

PubMed

Born, Christopher T; Briggs, Susan M; Ciraulo, David L; Frykberg, Eric R; Hammond, Jeffrey S; Hirshberg, Asher; Lhowe, David W; O'Neill, Patricia A

2007-07-01

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.

Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

PubMed

Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

2014-10-01

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.

Improvised explosive device-related lower genitourinary trauma in current overseas combat operations.

PubMed

Banti, Matthew; Walter, Jack; Hudak, Steven; Soderdahl, Douglas

2016-01-01

The use of improvised explosive devices (IEDs) has had a profound effect on battlefield trauma in the 21st century. Historically, wounds to the genitourinary (GU) structures have been less common than extremity and penetrating abdominal trauma in combat operations. GU injury incidence, severity, and associated injuries secondary to the use of this weapon in Operations Iraqi and Enduring Freedom has not been described. Data from the Department of Defense Trauma Registry was reviewed for combat-related GU injuries in Operations Iraqi and Enduring Freedom from 2001 to 2011. All wounded US armed service members are included in this database. Subjects were selected by a query of current procedural terminology and DRG International Classification of Diseases-9th Rev. codes related to traumatic injury of the penis, scrotum, testicles, and urethra. A retrospective chart review was performed for each patient to identify the date of injury, the mechanism of injury, and the associated traumatic wounds. Subjects' follow-up records were reviewed until present time or separation from active duty. A total of 501 soldiers sustained lower GU trauma, with a total of 729 injuries. Of these casualties, 448 (89%) were wounded by IEDs. Dismounted injuries (87%) made up more of the cohort than did vehicular. Specific trauma sites include 149 (20%) penile, 260 (36%) testicular, 284 (39%) scrotal, and 36 (5%) urethral injuries. The 180 limb amputations (36%) and 86 fractures (17%) were the most encountered concomitant skeletal wounds among service members with GU injuries. This is the first review of all lower GU trauma sustained by all US armed service members in current overseas combat operations. Combat-related lower GU trauma is primarily caused by IEDs in the spectrum of complex dismounted blast injuries. The mechanism primarily results in multisystem injury, with isolated GU involvement being uncommon. Continued evaluation of long-term sequelae, including sexual, urinary, and

[AUTONOMIC CONTROL OF HEART RATE, BLOOD LACTATE AND ACCELERATION DURING COMBAT SIMULATION IN TAEKWONDO ELITE ATHLETES].

PubMed

Cerda-Kohler, Hugo; Aguayo Fuentealba, Juan Carlos; Francino Barrera, Giovanni; Guajardo-Sandoval, Adrián; Jorquera Aguilera, Carlos; Báez-San Martín, Eduardo

2015-09-01

the aim of the study was to measure the heart rate recovery, blood lactate and movement acceleration during simulated taekwondo competition. twelve male subjects who belong to the national team, with at least five years of experience participated in this research. They performed a simulated combat to evaluate the following variables: (i) Blood lactate after one minute recovery between each round, (ii) Heart rate recovery (HRR) at thirty and sixty seconds in each minute rest between rounds, (iii) Peak acceleration (ACCp) in each round performed. The significance level was set at p < 005. the results showed no significant differences between winners and losers in the HRR at both, thirty and sixty seconds (p > 0.05), blood lactate (p > 0.05), peak acceleration (p > 0.05) and the average acceleration of combat (p = 0.18). There was no correlation between delta lactate and ACCp (r = 0.01; p = 0.93), delta lactate and HRR (r = -0.23; p = 0.18), and ACCp and HRR (r = 0.003; p = 0.98). these data suggest that studied variables would not be decisive in the simulated combat outcomes. Other factors such as technical-tactical or psychological variables could have a significant impact on athletic performance. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Estimating shaking-induced casualties and building damage for global earthquake events: a proposed modelling approach

USGS Publications Warehouse

So, Emily; Spence, Robin

2013-01-01

Recent earthquakes such as the Haiti earthquake of 12 January 2010 and the Qinghai earthquake on 14 April 2010 have highlighted the importance of rapid estimation of casualties after the event for humanitarian response. Both of these events resulted in surprisingly high death tolls, casualties and survivors made homeless. In the Mw = 7.0 Haiti earthquake, over 200,000 people perished with more than 300,000 reported injuries and 2 million made homeless. The Mw = 6.9 earthquake in Qinghai resulted in over 2,000 deaths with a further 11,000 people with serious or moderate injuries and 100,000 people have been left homeless in this mountainous region of China. In such events relief efforts can be significantly benefitted by the availability of rapid estimation and mapping of expected casualties. This paper contributes to ongoing global efforts to estimate probable earthquake casualties very rapidly after an earthquake has taken place. The analysis uses the assembled empirical damage and casualty data in the Cambridge Earthquake Impacts Database (CEQID) and explores data by event and across events to test the relationships of building and fatality distributions to the main explanatory variables of building type, building damage level and earthquake intensity. The prototype global casualty estimation model described here uses a semi-empirical approach that estimates damage rates for different classes of buildings present in the local building stock, and then relates fatality rates to the damage rates of each class of buildings. This approach accounts for the effect of the very different types of buildings (by climatic zone, urban or rural location, culture, income level etc), on casualties. The resulting casualty parameters were tested against the overall casualty data from several historical earthquakes in CEQID; a reasonable fit was found.

Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenwalt, R. J.; Hibbard, W. J.

2016-05-04

Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less

Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenwalt, R.; Hibbard, W.

2016-08-09

Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less

[Mass casualty incidents - current concepts and developments].

PubMed

Savinsky, Godo; Stuhr, Markus; Kappus, Stefan; Trümpler, Stefan; Wenderoth, Stephan; Wohlers, Jan-Hauke; Paschen, Hans-Richard; Kerner, Thoralf

2014-12-01

Medical concepts and strategies are permanently changing. Due to the emergency response in a mass casualty incident everyone who is involved has to work together with different organisations and public authorities, which are not part of the regular emergency medical service. Within the last 25 years throughout the whole country of Germany the role of a "chief emergency physician" has been implemented and in preparation for the FIFA World Cup 2006 mobile treatment units were set up. In 2007, special units of the "Medical Task Force" - funded by the german state - were introduced and have been established by now. They will be a permanent part of regional plannings for mass casualty incidents. This article highlights current concepts and developments in different parts of Germany. © Georg Thieme Verlag Stuttgart · New York.

Yale and the Atomic Bomb Casualty Commission.

PubMed Central

Bowers, J. Z.

1983-01-01

This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation. PMID:6349145

Training and Tactical Operationally Responsive Space Operations

NASA Astrophysics Data System (ADS)

Sorensen, B.; Strunce, R., Jr.

Current space assets managed by traditional space system control resources provide communication, navigation, intelligence, surveillance, and reconnaissance (ISR) capabilities using satellites that are designed for long life and high reliability. The next generation Operationally Responsive Space (ORS) systems are aimed at providing operational space capabilities which will provide flexibility and responsiveness to the tactical battlefield commander. These capabilities do not exist today. The ORS communication, navigation, and ISR satellites are being designed to replace or supplement existing systems in order to enhance the current space force. These systems are expected to rapidly meet near term space needs of the tactical forces. The ORS concept includes new tactical satellites specifically designed to support contingency operations such as increased communication bandwidth and ISR imagery over the theater for a limited period to support air, ground, and naval force mission. The Concept of Operations (CONOPS) that exists today specifies that in addition to operational control of the satellite, the tasking and scheduling of the ORS tactical satellite for mission data collection in support of the tactical warfighter will be accomplished within the Virtual Mission Operations Center (VMOC). This is very similar to what is currently being accomplished in a fixed Mission Operations Center on existing traditional ISR satellites. The VMOC is merely a distributed environment and the CONOPS remain virtually the same. As a result, there is a significant drawback to the current ORS CONOPS that does not account for the full potential of the ORS paradigm for supporting tactical forces. Although the CONOPS approach may be appropriate for experimental Tactical Satellites (TacSat), it ignores the issues associated with the In-Theater Commander's need to own and operate his dedicated TacSat for most effective warfighting as well as the Warfighter specific CONOPS. What is needed

19 CFR 158.21 - Allowance in duties for casualty, loss, or theft while in Customs custody.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Allowance in duties for casualty, loss, or theft... LOST, DAMAGED, ABANDONED, OR EXPORTED Casualty, Loss, or Theft While in Customs Custody § 158.21 Allowance in duties for casualty, loss, or theft while in Customs custody. Section 563(a), Tariff Act of...

Alternative reproductive tactics and the propensity of hybridization.

PubMed

Tynkkynen, K; Raatikainen, K J; Häkkilä, M; Haukilehto, E; Kotiaho, J S

2009-12-01

One explanation for hybridization between species is the fitness benefits it occasionally confers to the hybridizing individuals. This explanation is possible in species that have evolved alternative male reproductive tactics: individuals with inferior tactics might be more prone to hybridization provided it increases their reproductive success and fitness. Here we experimentally tested whether the propensity of hybridization in the wild depends on male reproductive tactic in Calopteryx splendens damselflies. Counter to our expectation, it was males adopting the superior reproductive tactic (territoriality) that had greatest propensity to hybridize than males adopting the inferior tactics (sneakers and floaters). Moreover, among the territorial males, the most ornamented males had greatest propensity to hybridize whereas the pattern was reversed in the sneaker males. Our results suggest that there is fluctuating selection on male mate discrimination against heterospecific females depending on both ornament size and the male's reproductive tactic.

Joint Tactical Networks (JTN)

DTIC Science & Technology

2013-12-01

Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-284 Joint Tactical Networks (JTN) As of FY 2015 President’s Budget... Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection...to 00-00-2013 4. TITLE AND SUBTITLE Joint Tactical Networks (JTN) 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

PubMed Central

Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.

2016-01-01

Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the “ladder-pipe system” for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

Embracing a Revolution - Telemedicine.

PubMed

Dheer, Ajay; Chaturvedi, R K

2005-01-01

The recent advances in information and communication technologies offer real and practical opportunities to health professionals to share expertise and resources in health care over distances. For a country like India with pockets of medical excellence surrounded by a vast number of badly equipped hospitals with limited specialists, telemedicine could revolutionize health care. The potential of telemedicine seem to be vital in avoiding the frame of travel, in timely getting specialist advise to remote areas, minimizing the cost and of course an opportunity to learn from each other. In developed countries the technological advancement and research aims primarily to satiate the needs of their armed forces and to ensure tactical and technical supremacy. The medical community in the Indian Armed Forces should harness the technologies and embrace this revolution of the information age to provide world class combat casualty care.

Combat games

NASA Technical Reports Server (NTRS)

Ardema, M. D.; Heymann, M.; Rajan, N.

1985-01-01

A mathematical formulation is proposed of a combat game between two opponents with offensive capabilities and offensive objective is proposed. Resolution of the combat involves solving two differential games with state constraints. Depending on the game dynamics and parameters, the combat can terminate in one of four ways: the first player wins; the second player wins; a draw (neither wins); or joint capture. In the first two cases, the optimal strategies of the two players are determined from suitable zero-sum games, whereas in the latter two the relevant games are nonzero-sum. Further, to avoid certain technical difficulties, the concept of a delta-combat game is introduced.

Armored Family of Vehicles (AFV). Phase 1 Report. Book 3. Volumes 5 thru 8

DTIC Science & Technology

1987-08-31

tactical mobility /agility, tactical and strategic deployability, rapid repair/replacement of damaged or destroyed equipment, lethality, reduced...Mover (CEM). (15) Combat Mobility Vehicle (CMV). (16) Combat Gap Crosser (CGC). (17) Combat Excavator (CEX). (18) Mine Dispensing Vehicle (MDV). (19...economic decision analysis (IAW AR 700-XX, AR 700-127 and AR 700-17) and consideration of mobilization requirements. 7. Transportability

Occupational safety data and casualty rates for the uranium fuel cycle. [Glossaries

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Donnell, F.R.; Hoy, H.C.

1981-10-01

Occupational casualty (injuries, illnesses, fatalities, and lost workdays) and production data are presented and used to calculate occupational casualty incidence rates for technologies that make up the uranium fuel cycle, including: mining, milling, conversion, and enrichment of uranium; fabrication of reactor fuel; transportation of uranium and fuel elements; generation of electric power; and transmission of electric power. Each technology is treated in a separate chapter. All data sources are referenced. All steps used to calculate normalized occupational casualty incidence rates from the data are presented. Rates given include fatalities, serious cases, and lost workdays per 100 man-years worked, per 10/supmore » 12/ Btu of energy output, and per other appropriate units of output.« less

Applications of Capstone depleted uranium aerosol risk data to military combat risk management.

PubMed

Daxon, Eric G; Parkhurst, Mary Ann; Melanson, Mark A; Roszell, Laurie E

2009-03-01

Risks to personnel engaged in military operations include not only the threat of enemy firepower but also risks from exposure to other hazards such as radiation. Combatant commanders of the U.S. Army carefully weigh risks of casualties before implementing battlefield actions using an established paradigm that takes these risks into consideration. As a result of the inclusion of depleted uranium (DU) anti-armor ammunition in the conventional (non-nuclear) weapons arsenal, the potential for exposure to DU aerosols and its associated chemical and radiological effects becomes an element of the commanders' risk assessment. The Capstone DU Aerosol Study measured the range of likely DU oxide aerosol concentrations created inside a combat vehicle perforated with a DU munition, and the Capstone Human Health Risk Assessment (HHRA) estimated the associated doses and calculated risks. This paper focuses on the development of a scientific approach to adapt the risks from DU's non-uniform dose distribution within the body using the current U.S. Department of Defense radiation risk management approach. The approach developed equates the Radiation Exposure Status categories to the estimated radiological risks of DU and makes use of the Capstone-developed Renal Effects Group as a measure of chemical risk from DU intake. Recommendations are provided for modifying Army guidance and policy in order to better encompass the potential risks from DU aerosol inhalation during military operations.

Disclose or not? Effect of impression management tactics on hireability of persons with epilepsy.

PubMed

Sung, Connie; Lin, Chien-Chun; Connor, Annemarie; Chan, Fong

2017-01-01

The purpose of this study is to determine the effect of assertive impression management (IM) tactics, such as personal storytelling and self-promotion, on job interview outcomes of people with epilepsy. Specifically, the effect of IM on interviewers' subjective impressions and evaluation of hireability of job candidates with epilepsy were examined. Ninety-nine master's level graduate students majoring in business or human resources were randomly assigned to three experimental conditions to view one of three 15-min video clips of a job applicant interviewing for a technical computer sales position. The three experimental conditions were (1) job applicant who did not disclose any disability, (2) job applicant with epilepsy who did not use IM tactics, and (3) job applicant with epilepsy who used IM tactics. After watching the job interview video portraying the experimental conditions, participants were asked to rate the job applicant in terms of general impression and hireability for the described position. The use of IM was found to have a significant effect on job interview outcomes (p < 0.01). Post hoc comparisons indicated that the average rating of business/human resources students on both general impression and hireability for the job applicant with epilepsy and IM condition were significantly higher than for the job applicant with epilepsy who did not use IM condition. Furthermore, mediation analysis revealed that general impression is a mediator for the relationship between IM and interview outcomes. This study demonstrates that IM has a significant and positive effect on job interview outcomes for persons with epilepsy. IM can be used as a powerful strategy for empowering people with epilepsy to combat disability stigma, and offset negative perceptions of employers about the potential of this population to be productive workers. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Two faces of death: fatalities from disease and combat in America's principal wars, 1775 to present.

PubMed

Cirillo, Vincent J

2008-01-01

Throughout America's first 145 years of war, far more of the country's military personnel perished from infectious diseases than from enemy action. This enduring feature of war was finally reversed in World War II, chiefly as a result of major medical advances in prevention (vaccines) and treatment (antibiotics). Safeguarding the health of a command is indispensable for the success of any campaign. Wars are lost by disease, which causes an enormous drain on the military's resources and affects both strategy and tactics. Disease and combat mortality data from America's principal wars (1775-present) fall into two clearly defined time periods: the Disease Era (1775-1918), during which infectious diseases were the major killer of America's armed forces, and the Trauma Era (1941-present), in which combat-related fatalities predominated. The trend established in World War II continues to the present day. Although there are currently more than 3,400 U.S. military fatalities in Iraq, the disease-death toll is so low that it is exceeded by the number of suicides.

Tactical expertise assessment in youth football using representative tasks.

PubMed

Serra-Olivares, Jaime; Clemente, Filipe Manuel; González-Víllora, Sixto

2016-01-01

Specific football drills improve the development of technical/tactical and physical variables in players. Based on this principle, in recent years it has been possible to observe in daily training a growing volume of small-sided and conditioned games. These games are smaller and modified forms of formal games that augment players' perception of specific tactics. Despite this approach, the assessment of players' knowledge and tactical execution has not been well documented, due mainly to the difficulty in measuring tactical behavior. For that reason, this study aims to provide a narrative review about the tactical assessment of football training by using representative tasks to measure the tactical expertise of youth football players during small-sided and conditioned games. This study gives an overview of the ecological approach to training and the principles used for representative task design, providing relevant contribution and direction for future research into the assessment of tactical expertise in youth football.

Load index model: An advanced tool to support decision making during mass-casualty incidents.

PubMed

Adini, Bruria; Aharonson-Daniel, Limor; Israeli, Avi

2015-03-01

In mass-casualty events, accessing information concerning hospital congestion levels is crucial to improving patient distribution and optimizing care. The study aimed to develop a decision support tool for distributing casualties to hospitals in an emergency scenario involving multiple casualties. A comprehensive literature review and structured interviews with 20 content experts produced a shortlist of relevant criteria for inclusion in the model. A "load index model" was prepared, incorporating results of a modified Delphi survey of 100 emergency response experts. The model was tested in three simulation exercises in which an emergency scenario was presented to six groups of senior emergency managers. Information was provided regarding capacities of 11 simulated admitting hospitals in the region, and evacuation destinations were requested for 600 simulated casualties. Of the three simulation rounds, two were performed without the model and one after its presentation. Following simulation experiments and implementation during a real-life security threat, the efficacy of the model was assessed. Variability between experts concerning casualties' evacuation destinations decreased significantly following the model's introduction. Most responders (92%) supported the need for standardized data, and 85% found that the model improved policy setting regarding casualty evacuation in an emergency situation. These findings were reaffirmed in a real-life emergency scenario. The proposed model improved capacity to ensure evacuation of patients to less congested medical facilities in emergency situations, thereby enhancing lifesaving medical services. The model supported decision-making processes in both simulation exercises and an actual emergency situation.

Behavioural Thermoregulatory Tactics in Lacustrine Brook Charr, Salvelinus fontinalis

PubMed Central

Bertolo, Andrea; Pépino, Marc; Adams, Julie; Magnan, Pierre

2011-01-01

The need to vary body temperature to optimize physiological processes can lead to thermoregulatory behaviours, particularly in ectotherms. Despite some evidence of within-population phenotypic variation in thermal behaviour, the occurrence of alternative tactics of this behaviour is rarely explicitly considered when studying natural populations. The main objective of this study was to determine whether different thermal tactics exist among individuals of the same population. We studied the behavioural thermoregulation of 33 adult brook charr in a stratified lake using thermo-sensitive radio transmitters that measured hourly individual temperature over one month. The observed behavioural thermoregulatory patterns were consistent between years and suggest the existence of four tactics: two “warm” tactics with both crepuscular and finer periodicities, with or without a diel periodicity, and two “cool” tactics, with or without a diel periodicity. Telemetry data support the above findings by showing that the different tactics are associated with different patterns of diel horizontal movements. Taken together, our results show a clear spatio-temporal segregation of individuals displaying different tactics, suggesting a reduction of niche overlap. To our knowledge, this is the first study showing the presence of behavioural thermoregulatory tactics in a vertebrate. PMID:21490935

Bite protection analysis of permethrin-treated U.S. Military uniforms

USDA-ARS?s Scientific Manuscript database

Historically, combat casualties from diseases have greatly outnumbered battle injuries received from actual combat during military operations. Since 1951, United States military combat uniforms have been treated within insecticides to protect personnel from arthropod attack. In the 1970s and 1980s,...

Development and validation of a mass casualty conceptual model.

PubMed

Culley, Joan M; Effken, Judith A

2010-03-01

To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

Certification of tactics and strategies in aviation

NASA Technical Reports Server (NTRS)

Koelman, Hartmut

1994-01-01

The paper suggests that the 'tactics and strategies' notion is a highly suitable paradigm to describe the cognitive involvement of human operators in advanced aviation systems (far more suitable than classical functional analysis), and that the workload and situational awareness of operators are intimately associated with the planning and execution of their tactics and strategies. If system designers have muddled views about the collective tactics and strategies to be used during operation, they will produce sub-optimum designs. If operators use unproven and/or inappropriate tactics and strategies, the system may fail. The author wants to make a point that, beyond certification of people or system designs, there may be a need to go into more detail and examine (certify?) the set of tactics and strategies (i.e., the Operational Concept) which makes the people and systems perform as expected. The collective tactics and strategies determine the information flows and situational awareness which exists in organizations and composite human-machine systems. The available infrastructure and equipment (automation) enable these information flows and situational awareness, but are at the same time the constraining factor. Frequently, the tactics and strategies are driven by technology, whereas we would rather like to see a system designed to support an optimized Operational Concept, i.e., to support a sufficiently coherent, cooperative and modular set of anticipation and planning mechanisms. Again, in line with the view of MacLeod and Taylor (1993), this technology driven situation may be caused by the system designer's and operator job designer's over-emphasis on functional analysis (a mechanistic engineering concept), at the expense of a subject which does not seem to be well understood today: the role of the (human cognitive and/or automated) tactics and strategies which are embedded in composite human-machine systems. Research would be needed to arrive at a generally

The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011.

PubMed

Schoenfeld, Andrew J; Dunn, John C; Bader, Julia O; Belmont, Philip J

2013-08-01

Previous studies regarding combat wounding have a limited translational capacity due to inclusion of soldiers from all military branches and occupational specialties as well as a lack of information regarding soldiers who died in theater. A search was performed of the Department of Defense Trauma Registry and Armed Forces Medical Examiner data set for the years 2003 to 2011 to identify all injured personnel with the military specialty 19D (cavalry scout). A manual search was conducted for each record identified, and age, rank, location and manner of injury, mechanism of injury, Injury Severity Score (ISS), and extent of wounding were abstracted. The incidence of injuries by body region and rates for specific types of wounds were determined. Statistically significant associations between rank, location of injury, manner of injury, body region involved, and injury mechanism were assessed using χ2 analysis. Associations between ISS, rank, manner of injury, and survival were evaluated by t test with Satterthwaite correction. A total of 701 casualties were identified with 3,189 distinct injuries. Mean (SD) age of injured personnel was 25.9 (6.0) years. Thirty-five percent of the cohort was composed of soldiers who died in theater. Explosions were the most common mechanism of injury (70%), while 18% of wounds occurred owing to gunshot. Extremity wounds and injuries to the head and neck represented 34% of casualty burden. Thoracic trauma occurred in 16%, and abdominal injuries occurred in 17%. Wounds with a frequency exceeding 5% included skin, extremity, facial, brain, and gastrointestinal injuries. Vascular injury occurred in 4%. Gunshot wounds were a greater cause of injury in Afghanistan (p = 0.001) and resulted in a higher percentage of thoracic injuries (p < 0.001). The nature and extent of trauma sustained by combat-specific personnel seems to be different from that experienced by all soldiers deployed to a war zone.

Organizational Commitment through Organizational Socialization Tactics

ERIC Educational Resources Information Center

Filstad, Cathrine

2011-01-01

Purpose: The aim of this paper is to investigate how organizational socialization tactics affect newcomers' organizational commitment and learning processes. Design/methodology/approach: A survey was conducted using a measurement tool based on Van Maanen and Schein's theory on organizational socialization tactics and Kuvaas' measurement tools of…

Physical Training Strategies for Military Women's Performance Optimization in Combat-Centric Occupations.

PubMed

Nindl, Bradley C

2015-11-01

injuries; (f) flexible nonlinear periodized programs should be considered to best accommodate the unpredictability and operational functional needs of the military training environment; and (g) serious consideration should be given to revamping the manner in which the military conducts physical readiness training, with a departure from "field expediency" as the major criteria for determining PT policies. With an increased emphasis on the human dimension of soldiering and concerted strategic, operational, and tactical efforts to maximize individual physical readiness and performance, the science of training physiology exists to leverage and better physically prepare women as they enter more combat-centric occupations.

Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack.

PubMed

Bloch, Yuval H; Leiba, Adi; Veaacnin, Nurit; Paizer, Yohanan; Schwartz, Dagan; Kraskas, Ahuva; Weiss, Gali; Goldberg, Avishay; Bar-Dayan, Yaron

2007-01-01

Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to

Tactical AI in Real Time Strategy Games

DTIC Science & Technology

2015-03-26

TACTICAL AI IN REAL TIME STRATEGY GAMES THESIS Donald A. Gruber, Capt, USAF AFIT-ENG-MS-15-M-021 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR FORCE...protection in the United States. AFIT-ENG-MS-15-M-021 TACTICAL AI IN REAL TIME STRATEGY GAMES THESIS Presented to the Faculty Department of Electrical...DISTRIBUTION STATEMENT A APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. AFIT-ENG-MS-15-M-021 TACTICAL AI IN REAL TIME STRATEGY GAMES THESIS Donald A

Cyber threat model for tactical radio networks

NASA Astrophysics Data System (ADS)

Kurdziel, Michael T.

2014-05-01

The shift to a full information-centric paradigm in the battlefield has allowed ConOps to be developed that are only possible using modern network communications systems. Securing these Tactical Networks without impacting their capabilities has been a challenge. Tactical networks with fixed infrastructure have similar vulnerabilities to their commercial counterparts (although they need to be secure against adversaries with greater capabilities, resources and motivation). However, networks with mobile infrastructure components and Mobile Ad hoc Networks (MANets) have additional unique vulnerabilities that must be considered. It is useful to examine Tactical Network based ConOps and use them to construct a threat model and baseline cyber security requirements for Tactical Networks with fixed infrastructure, mobile infrastructure and/or ad hoc modes of operation. This paper will present an introduction to threat model assessment. A definition and detailed discussion of a Tactical Network threat model is also presented. Finally, the model is used to derive baseline requirements that can be used to design or evaluate a cyber security solution that can be scaled and adapted to the needs of specific deployments.

Tactics for Improving Parenting Skills (TIPS).

ERIC Educational Resources Information Center

Algozzine, Bob, Ed.; Ysseldyke, Jim, Ed.

This manual presents 99 one-sheet informational brochures designed to improve parenting skills. Each brochure is in a format suitable for duplicating, folding, and distributing. Each parenting "tactic" offers references to related brochures. Tactics are grouped under the following broad areas: (1) home/family involvement (e.g., accepting "The…

Soft-assembled Multilevel Dynamics of Tactical Behaviors in Soccer

PubMed Central

Ric, Angel; Torrents, Carlota; Gonçalves, Bruno; Sampaio, Jaime; Hristovski, Robert

2016-01-01

This study aimed to identify the tactical patterns and the timescales of variables during a soccer match, allowing understanding the multilevel organization of tactical behaviors, and to determine the similarity of patterns performed by different groups of teammates during the first and second halves. Positional data from 20 professional male soccer players from the same team were collected using high frequency global positioning systems (5 Hz). Twenty-nine categories of tactical behaviors were determined from eight positioning-derived variables creating multivariate binary (Boolean) time-series matrices. Hierarchical principal component analysis (PCA) was used to identify the multilevel structure of tactical behaviors. The sequential reduction of each set level of principal components revealed a sole principal component as the slowest collective variable, forming the global basin of attraction of tactical patterns during each half of the match. In addition, the mean dwell time of each positioning-derived variable helped to understand the multilevel organization of collective tactical behavior during a soccer match. This approach warrants further investigations to analyze the influence of task constraints on the emergence of tactical behavior. Furthermore, PCA can help coaches to design representative training tasks according to those tactical patterns captured during match competitions and to compare them depending on situational variables. PMID:27761120

46 CFR 169.807 - Notice of casualty.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school student...

46 CFR 169.807 - Notice of casualty.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school student...

Departure Queue Prediction for Strategic and Tactical Surface Scheduler Integration

NASA Technical Reports Server (NTRS)

Zelinski, Shannon; Windhorst, Robert

2016-01-01

A departure metering concept to be demonstrated at Charlotte Douglas International Airport (CLT) will integrate strategic and tactical surface scheduling components to enable the respective collaborative decision making and improved efficiency benefits these two methods of scheduling provide. This study analyzes the effect of tactical scheduling on strategic scheduler predictability. Strategic queue predictions and target gate pushback times to achieve a desired queue length are compared between fast time simulations of CLT surface operations with and without tactical scheduling. The use of variable departure rates as a strategic scheduler input was shown to substantially improve queue predictions over static departure rates. With target queue length calibration, the strategic scheduler can be tuned to produce average delays within one minute of the tactical scheduler. However, root mean square differences between strategic and tactical delays were between 12 and 15 minutes due to the different methods the strategic and tactical schedulers use to predict takeoff times and generate gate pushback clearances. This demonstrates how difficult it is for the strategic scheduler to predict tactical scheduler assigned gate delays on an individual flight basis as the tactical scheduler adjusts departure sequence to accommodate arrival interactions. Strategic/tactical scheduler compatibility may be improved by providing more arrival information to the strategic scheduler and stabilizing tactical scheduler changes to runway sequence in response to arrivals.

Enabling information management systems in tactical network environments

NASA Astrophysics Data System (ADS)

Carvalho, Marco; Uszok, Andrzej; Suri, Niranjan; Bradshaw, Jeffrey M.; Ceccio, Philip J.; Hanna, James P.; Sinclair, Asher

2009-05-01

Net-Centric Information Management (IM) and sharing in tactical environments promises to revolutionize forward command and control capabilities by providing ubiquitous shared situational awareness to the warfighter. This vision can be realized by leveraging the tactical and Mobile Ad hoc Networks (MANET) which provide the underlying communications infrastructure, but, significant technical challenges remain. Enabling information management in these highly dynamic environments will require multiple support services and protocols which are affected by, and highly dependent on, the underlying capabilities and dynamics of the tactical network infrastructure. In this paper we investigate, discuss, and evaluate the effects of realistic tactical and mobile communications network environments on mission-critical information management systems. We motivate our discussion by introducing the Advanced Information Management System (AIMS) which is targeted for deployment in tactical sensor systems. We present some operational requirements for AIMS and highlight how critical IM support services such as discovery, transport, federation, and Quality of Service (QoS) management are necessary to meet these requirements. Our goal is to provide a qualitative analysis of the impact of underlying assumptions of availability and performance of some of the critical services supporting tactical information management. We will also propose and describe a number of technologies and capabilities that have been developed to address these challenges, providing alternative approaches for transport, service discovery, and federation services for tactical networks.

Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009-2011.

PubMed

Tribble, David R; Rodriguez, Carlos J; Weintrob, Amy C; Shaikh, Faraz; Aggarwal, Deepak; Carson, M Leigh; Murray, Clinton K; Masuoka, Penny

2015-10-01

During the recent war in Afghanistan (2001-2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions.

Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.

PubMed

Leatherman, Matthew L; Held, Jenny M; Fluke, Laura M; McEvoy, Christian S; Inaba, Kenji; Grabo, Daniel; Martin, Matthew J; Earley, Angela S; Ricca, Robert L; Polk, Travis M

2017-07-01

for thoracic decompression of tPTX during combat casualty transport. Therapeutic study, level III.

Combat Leadership

DTIC Science & Technology

1990-05-01

concern that the Army and other services will breed managers instead of leaders, and they will lack the leadership skills necessary for combat. Colonel...AD-A 2 4 1 101 AiL WAR COLLEGE COMBAT LEADERSHIP LIEUTENANT COLONEL J.kyMES M. FISHER, USA 1990 i 91-12129 -. ROVED F R PUBLIC AIR UNIVERSPL" A...tELEASE; 01IRBUIBiMA UN. D STATES AIR FORCE MAXWELL AIR FORCE BASE, ALABAA UF7 AIR WAR COLLEGE AIR UNIVERSITY COMBAT LEADERSHIP by James M. Fisher

Definitions of Tactical and Strategic: An Informal Study

NASA Technical Reports Server (NTRS)

Schutte, Paul C.

2004-01-01

Seventeen subject matter experts defined tactical and strategic within the aviation domain. They provided five verbs and a sentence describing both behaviors. The verbs for strategic behavior were Plan, Think, Arrange, Formulate, Intend, Devise, Anticipate, and Order. The verbs for tactical behavior were Act, Fly, Respond, Do, Avoid, Control, React, and Move. Verbs that were common to both were Get Information, Navigate, Know, Execute, Manage, Perceive, Understand, Direct, Concentrate, and Point. The responses highlight the difference between planning (strategic) and carrying out those plans (tactical). Tactical verbs are more action-oriented that change the state of the world after they have been accomplished. Strategic verbs are more prescriptive in that they do not change the state of the world but offer a procedure or program for changing the world. The pilot is in a tactical mode when actually moving the aircraft and in a strategic mode when thinking about moving it.

Casualties of peace: an analysis of casualties admitted to the intensive care unit during the negotiation of the comprehensive Colombian process of peace.

PubMed

Ordoñez, Carlos A; Manzano-Nunez, Ramiro; Naranjo, Maria Paula; Foianini, Esteban; Cevallos, Cecibel; Londoño, Maria Alejandra; Sanchez Ortiz, Alvaro I; García, Alberto F; Moore, Ernest E

2018-01-01

After 52 years of war in 2012, the Colombian government began the negotiation of a process of peace, and by November 2012, a truce was agreed. We sought to analyze casualties who were admitted to the intensive care unit (ICU) before and during the period of the negotiation of the comprehensive Colombian process of peace. Retrospective study of hostile casualties admitted to the ICU at a Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (November 2012-December 2016). Patients were compared with respect to time periods. Four hundred forty-eight male patients were admitted to the emergency room. Of these, 94 required ICU care. Sixty-five casualties presented before the truce and 29 during the negotiation period. Median injury severity score was significantly higher before the truce. Furthermore, the odds of presenting with severe trauma (ISS > 15) were significantly higher before the truce (OR, 5.4; (95% CI, 2.0-14.2); p  < 0.01). There was a gradual decrease in the admissions to the ICU, and the performance of medical and operative procedures during the period observed. We describe a series of war casualties that required ICU care in a period of peace negotiation. Despite our limitations, our study presents a decline in the occurrence, severity, and consequences of war injuries probably as a result in part of the negotiation of the process of peace. The hysteresis of these results should only be interpreted for their implications in the understanding of the peace-health relationship and must not be overinterpreted and used for any political end.

Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01 - 2 June 2014

DTIC Science & Technology

2014-06-02

colleagues note that much of the resistance to the use of far-forward fresh whole blood is the perceived risk associated with its use but that this...and hyper-oncotic (e.g., dextrans, hydroxyethyl starches [HESs], and 20% or 25% albumin). The dose of HES used could not exceed 30 mL per kg of body...different types of starch solutions may have different physiologic ef- fects.101 Results after treatment with an assortment of HES options do not

Applications of Capstone Depleted Uranium Aerosol Risk Data to Military Combat Risk Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daxon, Eric G.; Parkhurst, MaryAnn; Melanson, Mark A.

2009-03-01

Risks to personnel engaged in military operations include not only the threat of enemy firepower but also risks from exposure to other hazards such as radiation. Combatant commanders of the U. S. Army carefully weigh risks of casualties before implementing battlefield actions using an established paradigm that take these risks into consideration. As a result of the inclusion of depleted uranium (DU) anti-armor ammunition in the conventional (non-nuclear) weapons arsenal, the potential for exposure to DU aerosols and its associated chemical and radiological effects becomes an element of the commanders’ risk assessment. The Capstone DU Aerosol Study measured the rangemore » of likely DU oxide aerosol concentrations created inside a combat vehicle perforated with a DU munition, and the Capstone Human Health Risk Assessment (HHRA) estimated the associated doses and calculated risks. This paper focuses on the development of a scientific approach to adapt the risks from DU’s non uniform dose distribution within the body using the current U.S. Department of Defense (DoD) radiation risk management approach. The approach developed equates the Radiation Exposure Status (RES) categories to the estimated radiological risks of DU and makes use of the Capstone-developed Renal Effects Group (REG) as a measure of chemical risk from DU intake. Recommendations are provided for modifying Army guidance and policy in order to better encompass the potential risks from DU aerosol inhalation during military operations.« less

Analysis of interference performance of tactical radio network

NASA Astrophysics Data System (ADS)

Nie, Hao; Cai, Xiaoxia; Chen, Hong

2017-08-01

Mobile Ad hoc network has a strong military background for its development as the core technology of the backbone network of US tactical Internet. And which tactical radio network, is the war in today's tactical use of the Internet more mature form of networking, mainly used in brigade and brigade following forces. This paper analyzes the typical protocol AODV in the tactical radio network, and then carries on the networking. By adding the interference device to the whole network, the battlefield environment is simulated, and then the throughput, delay and packet loss rate are analyzed, and the performance of the whole network and the single node before and after the interference is obtained.

The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China.

PubMed

Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi

2017-02-21

The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China . 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research.

The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China

PubMed Central

Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi

2017-01-01

The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China. 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research. PMID:28230810

Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009–2011

PubMed Central

Rodriguez, Carlos J.; Weintrob, Amy C.; Shaikh, Faraz; Aggarwal, Deepak; Carson, M. Leigh; Murray, Clinton K.; Masuoka, Penny

2015-01-01

During the recent war in Afghanistan (2001–2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions. PMID:26401897

Investigation of work zone crash casualty patterns using association rules.

PubMed

Weng, Jinxian; Zhu, Jia-Zheng; Yan, Xuedong; Liu, Zhiyuan

2016-07-01

Investigation of the casualty crash characteristics and contributory factors is one of the high-priority issues in traffic safety analysis. In this paper, we propose a method based on association rules to analyze the characteristics and contributory factors of work zone crash casualties. A case study is conducted using the Michigan M-94/I-94/I-94BL/I-94BR work zone crash data from 2004 to 2008. The obtained association rules are divided into two parts including rules with high-lift, and rules with high-support for the further analysis. The results show that almost all the high-lift rules contain either environmental or occupant characteristics. The majority of association rules are centered on specific characteristics, such as drinking driving, the highway with more than 4 lanes, speed-limit over 40mph and not use of traffic control devices. It should be pointed out that some stronger associated rules were found in the high-support part. With the network visualization, the association rule method can provide more understandable results for investigating the patterns of work zone crash casualties. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prescribing of benzodiazepines by casualty officers.

PubMed Central

Nazareth, I D; King, M B

1989-01-01

The prescribing of benzodiazepines by casualty officers in a busy district hospital over a three month period was examined by a retrospective review of case notes. Benzodiazepines, mainly diazepam, were given to 1.1% of attenders, the majority of whom had disorders involving minor muscle spasm. The efficacy of diazepam in these conditions, as well as its potential for dependence, is discussed. PMID:2569040

Virtually-augmented interfaces for tactical aircraft.

PubMed

Haas, M W

1995-05-01

The term Fusion Interface is defined as a class of interface which integrally incorporates both virtual and non-virtual concepts and devices across the visual, auditory and haptic sensory modalities. A fusion interface is a multi-sensory virtually-augmented synthetic environment. A new facility has been developed within the Human Engineering Division of the Armstrong Laboratory dedicated to exploratory development of fusion-interface concepts. One of the virtual concepts to be investigated in the Fusion Interfaces for Tactical Environments facility (FITE) is the application of EEG and other physiological measures for virtual control of functions within the flight environment. FITE is a specialized flight simulator which allows efficient concept development through the use of rapid prototyping followed by direct experience of new fusion concepts. The FITE facility also supports evaluation of fusion concepts by operational fighter pilots in a high fidelity simulated air combat environment. The facility was utilized by a multi-disciplinary team composed of operational pilots, human-factors engineers, electronics engineers, computer scientists, and experimental psychologists to prototype and evaluate the first multi-sensory, virtually-augmented cockpit. The cockpit employed LCD-based head-down displays, a helmet-mounted display, three-dimensionally localized audio displays, and a haptic display. This paper will endeavor to describe the FITE facility architecture, some of the characteristics of the FITE virtual display and control devices, and the potential application of EEG and other physiological measures within the FITE facility.

The use of analgesia in mountain rescue casualties with moderate or severe pain.

PubMed

Ellerton, John Alexander; Greene, Mike; Paal, Peter

2013-06-01

To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR. Prospective, descriptive study. Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010. 92 MR casualties with a pain scoreof 4/10 or greater. 38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover. The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5 ± 2.4 at 15 min and 3.9 ± 2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer. Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.

The Petsamo-Kirkenes Operation: Soviet Breakthrough and Pursuit in the Arctic, October 1944 (Leavenworth Papers, Number 17)

DTIC Science & Technology

1989-09-01

Roschmann , "Small Unit Tactics, Combats in Taiga and Tundra," Foreign Military Studies no. MS P-060m (Historical Division, U.S. Army, Europe, 1952), 148...Brockelmann, Klaus, and Hans Roschmann . "Small Unit Tactics, Combats in Taiga and Tundra." Foreign Military Studies no. MS P-060m. Historical Division

The Role of Military Plastic Surgeons in the Management of Modern Combat Trauma: An Analysis of 645 Cases.

PubMed

Maitland, Laura; Lawton, Graham; Baden, James; Cubison, Tania; Rickard, Rory; Kay, Alan; Hettiaratchy, Shehan

2016-04-01

Plastic surgery has historically been linked to war. Between 2008 and the end of combat operations in Afghanistan in 2014, British military plastic surgeons formed part of the multinational military surgical team at the Role 3 Medical Treatment Facility, Camp Bastion, Helmand Province. The present study aimed to analyze the activity of these surgeons objectively and to determine the utility of their deployment. Data were gathered prospectively from four periods (2009 to 2012). This coincided with different surgeons, types of combat activity, wounding patterns, and mission emphases for the hospital. Various metrics were employed. Plastic surgeons were involved in 40 percent of surgical cases (645 of 1654). This was consistent, despite changes in the predominant wounding mechanism and casualty population. One-third of cases involved the plastic surgeon as the lead or sole surgeon and two-thirds involved working with surgeons from other disciplines. Caseload by anatomical region was as follows: hand and upper limb, 64 percent; head and neck, 46 percent; lower limb, 40 percent; and trunk, 25 percent. A median of 1.75 body areas were operated on per patient. Involvement did not differ between patients wearing combat body armor when injured and those who were not. Plastic surgeons played a significant role in the management of modern military trauma. This reflects the types of injuries sustained and the expertise of military plastic surgeons complementing the skill set of the other surgical team members. The level of activity was independent of wounding patterns, suggesting that the specialty may be useful, irrespective of the nature of the conflict.

Distributed tactical reasoning framework for intelligent vehicles

NASA Astrophysics Data System (ADS)

Sukthankar, Rahul; Pomerleau, Dean A.; Thorpe, Chuck E.

1998-01-01

In independent vehicle concepts for the Automated Highway System (AHS), the ability to make competent tactical-level decisions in real-time is crucial. Traditional approaches to tactical reasoning typically involve the implementation of large monolithic systems, such as decision trees or finite state machines. However, as the complexity of the environment grows, the unforeseen interactions between components can make modifications to such systems very challenging. For example, changing an overtaking behavior may require several, non-local changes to car-following, lane changing and gap acceptance rules. This paper presents a distributed solution to the problem. PolySAPIENT consists of a collection of autonomous modules, each specializing in a particular aspect of the driving task - classified by traffic entities rather than tactical behavior. Thus, the influence of the vehicle ahead on the available actions is managed by one reasoning object, while the implications of an approaching exit are managed by another. The independent recommendations form these reasoning objects are expressed in the form of votes and vetos over a 'tactical action space', and are resolved by a voting arbiter. This local independence enables PolySAPIENT reasoning objects to be developed independently, using a heterogenous implementation. PolySAPIENT vehicles are implemented in the SHIVA tactical highway simulator, whose vehicles are based on the Carnegie Mellon Navlab robots.

In-flight hypoxia events in tactical jet aviation: characteristics compared to normobaric training.

PubMed

Deussing, Eric C; Artino, Anthony R; Folga, Richard V

2011-08-01

Hypoxia continues to be a significant threat in military aviation. In an attempt to counter the hypoxia threat, military jet aviators receive periodic training using a reduced oxygen breathing device (ROBD). This study explored the characteristics of in-flight hypoxia events among tactical jet aviators and compared reported symptoms to those experienced during ROBD training. An anonymous survey was administered to naval aviators prior to aviation physiology training. The survey queried them about previous in-flight hypoxia encounters and the symptoms they experienced. These data were then compared to symptom data from a previous ROBD training survey using Chi-square analyses. Of the 566 aviators who completed the survey, 112 (20%) reported experiencing hypoxia symptoms in a tactical jet aircraft and 64 aviators (57%) indicated they were not wearing the required oxygen mask when the incident first occurred. The results also revealed only 21% of hypoxia events were reported in aviation hazard reports and the three most commonly recorded in-flight hypoxia symptoms were tingling (54%), difficulty concentrating (32%), and dizziness (30%). Chi-square analyses revealed statistically significant differences in frequency of reporting between 5 of 16 symptoms encountered in flight compared to ROBD training. The present investigation is the first survey-based study of hypoxia events in U.S. naval aviation. The study reveals in-flight, mask-on hypoxia has a similar overall reported symptom profile to ROBD training. Further, results suggest increased oxygen-mask compliance among these aviators may be necessary to effectively combat in-flight hypoxia.

Advocates and critics for tactical behaviors in UGV navigation

NASA Astrophysics Data System (ADS)

Hussain, Talib S.; Vidaver, Gordon; Berliner, Jeffrey

2005-05-01

Critical to the development of unmanned ground vehicle platforms is the incorporation of adaptive tactical behaviors for the planning of high-level navigation and tactical actions. BBN Technologies recently completed a simulation-based project for the Army Research Lab (ARL) in which we applied an evolutionary computation approach to navigating through a terrain to capture flag objectives while faced with one or more mobile enemies. Our Advocates and Critics for Tactical Behaviors (ACTB) system evolves plans for the vehicle that control its movement goals (in the form of waypoints), and its future actions (e.g., pointing cameras). We apply domain-specific, state-dependent genetic operators called advocates that promote specific tactical behaviors (e.g., adapt a plan to stay closer to walls). We define the fitness function as a weighted sum of a number of independent, domain-specific, state-dependent evaluation components called critics. Critics reward plans based upon specific tactical criteria, such as minimizing risk of exposure or time to the flags. Additionally, the ACTB system provides the capability for a human commander to specify the "rules of engagement" under which the vehicle will operate. The rules of engagement determine the planning emphasis required under different tactical situations (e.g., discovery of an enemy), and provide a mechanism for automatically adapting the relative selection probabilities of the advocates, the weights of the critics, and the depth of planning in response to tactical events. The ACTB system demonstrated highly effective performance in a head-to-head testing event, held by ARL, against two competing tactical behavior systems.

The effect of deliberate play on tactical performance in basketball.

PubMed

Greco, Pablo; Memmert, Daniel; Morales, Juan C P

2010-06-01

This field-based study analyzed effects of a deliberate-play training program in basketball on tactical game intelligence and tactical creativity. 22 youth basketball players, ages 10 to 12 years, completed basketball training in one of two equal-sized groups. The deliberate-play training program contained unstructured game forms in basketball. The placebo group played in traditional structured basketball game forms. Tactical intelligence and creativity was assessed before and after an 18-lesson intervention. Analysis showed significant training improvement only for the deliberate-play group. In addition, this outperformance of the placebo group was not only observed for tactical creativity but also for tactical intelligence.

Fasciotomy Rates in Operations Enduring Freedom and Iraqi Freedom: Association with Injury Severity and Tourniquet Use

DTIC Science & Technology

2011-03-01

civilian trauma care, more evidence supports their use for hemorrhage control in combat casualties.7–9 With the recent widespread reintroduction of...KK, Juncos LA, Wolf SE, et al. Continuous renal replacement therapy improves survival in severely burned military casualties with acute kidney injury

A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry.

PubMed

Schauer, Stephen G; April, Michael D; Naylor, Jason F; Oliver, Joshua J; Cunningham, Cord W; Fisher, Andrew D; Kotwal, Russ S

2017-01-01

The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. The chaos of the prehospital combat setting has led to limitations in the availability of data for performance improvement and research. The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR). We conducted a descriptive analysis of data from the DoDTR PHTR. The JTS collected trauma-associated data which comprise the PHTR are consolidated from TCCC cards and TCCC AARs. Where possible (requires 2 patient identifiers), JTS linked data from the PHTR module to other modules in the DoDTR to maximize availability of prehospital data and gain additional information regarding clinical outcomes. From January 2013 through September 2014, there were 705 patients available for research, of which 94.8% (668/705) had data from TCCC AARs, 3.3% (23/705) had data from TCCC cards, and 2.0% (14/705) had data available from DoDTR collection forms. There were one or more of the following data points per subject: pulse rate (77.4%, n=546), blood pressure (75.9%, n=535), respiratory rate (76.5%, n=539), pulse oximetry (61.8%, n=436), mental status (96.0%, n=677) and pain score (24.5%, n=173). Only 42.4% (647/1,527) of vital sign metrics had an associated time stamp. Documented interventions included limb tourniquets, of which only 27.3% (113/414) had an associated documentation of application time. Only 27.0% (190/705) of patients in the PHTR could be linked to the DoDTR due to missing identifiers. The PHTR data capture was suboptimal with many patients lacking documentation of vital

Blast and ballistic trajectories in combat casualties: a preliminary analysis using a cartesian positioning system with MDCT.

PubMed

Folio, Les R; Fischer, Tatjana; Shogan, Paul; Frew, Michael; Dwyer, Andrew; Provenzale, James M

2011-08-01

The purpose of this study is to determine the agreement with which radiologists identify wound paths in vivo on MDCT and calculate missile trajectories on the basis of Cartesian coordinates using a Cartesian positioning system (CPS). Three radiologists retrospectively identified 25 trajectories on MDCT in 19 casualties who sustained penetrating trauma in Iraq. Trajectories were described qualitatively in terms of directional path descriptors and quantitatively as trajectory vectors. Directional descriptors, trajectory angles, and angles between trajectories were calculated based on Cartesian coordinates of entrance and terminus or exit recorded in x, y image and table space (z) using a Trajectory Calculator created using spreadsheet software. The consistency of qualitative descriptor determinations was assessed in terms of frequency of observer agreement and multirater kappa statistics. Consistency of trajectory vectors was evaluated in terms of distribution of magnitude of the angles between vectors and the differences between their paraaxial and parasagittal angles. In 68% of trajectories, the observers' visual assessment of qualitative descriptors was congruent. Calculated descriptors agreed across observers in 60% of the trajectories. Estimated kappa also showed good agreement (0.65-0.79, p < 0.001); 70% of calculated paraaxial and parasagittal angles were within 20° across observers, and 61.3% of angles between trajectory vectors were within 20° across observers. Results show agreement of visually assessed and calculated qualitative descriptors and trajectory angles among observers. The Trajectory Calculator describes trajectories qualitatively similar to radiologists' visual assessment, showing the potential feasibility of automated trajectory analysis.

Corrugated QWIP for Tactical Army Applications

DTIC Science & Technology

2008-12-01

1 CORRUGATED QWIP FOR TACTICAL ARMY APPLICATIONS David. P. Forrai, Darrel W. Endres L-3 Communications Cincinnati Electronics Mason, OH 45040...Directorate (NVESD) have been developing the corrugated quantum well infrared photodetector (C- QWIP ) technology for applications in tactical LWIR...imaging. The C- QWIP was invented at ARL and shows promise to overcome some of the limitations in commercially available QWIPs . The C- QWIP uses micro

33 CFR 150.815 - How must casualties be reported?

Code of Federal Regulations, 2010 CFR

2010-07-01

... first aid and, if the person is engaged or employed on the deepwater port, that renders the individual... casualties be reported? (a) Immediately after aiding the injured and stabilizing the situation, the owner...

Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents

PubMed Central

Ramesh, Aruna C.; Kumar, S.

2010-01-01

In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury. PMID:21829319

Decision-support information system to manage mass casualty incidents at a level 1 trauma center.

PubMed

Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

2013-12-01

Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events.

14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

Code of Federal Regulations, 2012 CFR

2012-01-01

...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

Code of Federal Regulations, 2013 CFR

2013-01-01

...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

Code of Federal Regulations, 2014 CFR

2014-01-01

...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

Cognitive representations and cognitive processing of team-specific tactics in soccer.

PubMed

Lex, Heiko; Essig, Kai; Knoblauch, Andreas; Schack, Thomas

2015-01-01

Two core elements for the coordination of different actions in sport are tactical information and knowledge about tactical situations. The current study describes two experiments to learn about the memory structure and the cognitive processing of tactical information. Experiment 1 investigated the storage and structuring of team-specific tactics in humans' long-term memory with regard to different expertise levels. Experiment 2 investigated tactical decision-making skills and the corresponding gaze behavior, in presenting participants the identical match situations in a reaction time task. The results showed that more experienced soccer players, in contrast to less experienced soccer players, possess a functionally organized cognitive representation of team-specific tactics in soccer. Moreover, the more experienced soccer players reacted faster in tactical decisions, because they needed less fixations of similar duration as compared to less experienced soccer players. Combined, these experiments offer evidence that a functionally organized memory structure leads to a reaction time and a perceptual advantage in tactical decision-making in soccer. The discussion emphasizes theoretical and applied implications of the current results of the study.

Cognitive Representations and Cognitive Processing of Team-Specific Tactics in Soccer

PubMed Central

Lex, Heiko; Essig, Kai; Knoblauch, Andreas; Schack, Thomas

2015-01-01

Two core elements for the coordination of different actions in sport are tactical information and knowledge about tactical situations. The current study describes two experiments to learn about the memory structure and the cognitive processing of tactical information. Experiment 1 investigated the storage and structuring of team-specific tactics in humans’ long-term memory with regard to different expertise levels. Experiment 2 investigated tactical decision-making skills and the corresponding gaze behavior, in presenting participants the identical match situations in a reaction time task. The results showed that more experienced soccer players, in contrast to less experienced soccer players, possess a functionally organized cognitive representation of team-specific tactics in soccer. Moreover, the more experienced soccer players reacted faster in tactical decisions, because they needed less fixations of similar duration as compared to less experienced soccer players. Combined, these experiments offer evidence that a functionally organized memory structure leads to a reaction time and a perceptual advantage in tactical decision-making in soccer. The discussion emphasizes theoretical and applied implications of the current results of the study. PMID:25714486

Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

PubMed

Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

2009-07-01

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was casualties did not necessitate immediate medical treatment. Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

Management of Mass Casualty Burn Disasters

DTIC Science & Technology

2005-05-01

jet fuel, to complex and hard-to-deploy weapons such as biologic and chemical agents’ (3). The purpose of this article is to review recent experience ...1994 Pope Air Force Base (AFB) aircraft crash from an anaesthesiology perspective (14). Those authors noted critical shortages of laryngoscopes...responses of nearby hospitals have been described (18–20). In addition, Yurt and colleagues reviewed their experi - ence with casualties from that disaster who

Testing of Tactical Performance in Youth Elite Soccer

PubMed Central

2010-01-01

This is a twofold study with the goals of evaluating tactical oriented game test situations for 12-13-year old highly-talented soccer players and to analyze dynamic, intra-individual developments of the players. A cross-sectional design was carried in study 1, using game test situations to measure specific tactics and creative performance for 195 expert players. The results from five evaluation criteria show that both diagnostic instruments can be used for recording football-specific creativity and game intelligence in talented young players. They produced tactical indicators that can be described as objective and valid, exhibit a sufficient degree of differentiation and are easy to record. Study 2 uses a longitudinal design to present a dynamic performance diagnostic tool for analyzing intra-individual improvements of German Soccer Foundation talents according to football-specific creativity and game intelligence. The results with respect to divergent tactical thinking clearly show that very different change processes were observed in the German Soccer Foundation players. Finally, the practical implications for the training process are discussed on the basis of both studies. Key points With game test situations it is possible to assess tactical performance as game intelligence and creativity objective, valid, with a sufficient degree of differentiation, and economically. The results with respect to game intelligence and creativity show that very different change processes were observed in the German Soccer Foundation players dependend on the bases (trainers). Current literature on tactics for school sports as well as for children’s, youth and high performance soccer at the club level should place much more emphasis on individual and group-tactical requirements in soccer. PMID:24149686

Testing of tactical performance in youth elite soccer.

PubMed

Memmert, Daniel

2010-01-01

This is a twofold study with the goals of evaluating tactical oriented game test situations for 12-13-year old highly-talented soccer players and to analyze dynamic, intra-individual developments of the players. A cross-sectional design was carried in study 1, using game test situations to measure specific tactics and creative performance for 195 expert players. The results from five evaluation criteria show that both diagnostic instruments can be used for recording football-specific creativity and game intelligence in talented young players. They produced tactical indicators that can be described as objective and valid, exhibit a sufficient degree of differentiation and are easy to record. Study 2 uses a longitudinal design to present a dynamic performance diagnostic tool for analyzing intra-individual improvements of German Soccer Foundation talents according to football-specific creativity and game intelligence. The results with respect to divergent tactical thinking clearly show that very different change processes were observed in the German Soccer Foundation players. Finally, the practical implications for the training process are discussed on the basis of both studies. Key pointsWith game test situations it is possible to assess tactical performance as game intelligence and creativity objective, valid, with a sufficient degree of differentiation, and economically.The results with respect to game intelligence and creativity show that very different change processes were observed in the German Soccer Foundation players dependend on the bases (trainers).Current literature on tactics for school sports as well as for children's, youth and high performance soccer at the club level should place much more emphasis on individual and group-tactical requirements in soccer.

A Method for Evaluation of Microcomputers for Tactical Applications.

DTIC Science & Technology

1980-06-01

application. The computational requirements of a tactical application are specified in terms of performance parameters. The presently marketed microcomputer...computational requirements of a tactical application are specified in terms of performance parameters. The presently marketed microcomputer and multi...also to provide a method to evaluate microcomputer systems for tactical applications, i.e., Command Control Communications (C 3), weapon systems, etc

Fatal head and neck injuries in military underbody blast casualties.

PubMed

Stewart, Sarah K; Pearce, A P; Clasper, Jon C

2018-04-21

Death as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is at a higher rate and somewhat more predictable than injury caused by more classical forms of tertiary injury. Recent studies have focused on the transmission of axial load through the cervical spine with clinically relevant injury caused by resultant compression and flexion. This paper seeks to clarify the pattern of head and neck injuries in fatal UBB incidents using a pragmatic anatomical classification. This retrospective study investigated fatal UBB incidents in UK triservice members during recent operations in Afghanistan and Iraq. Head and neck injuries were classified by anatomical site into: skull vault fractures, parenchymal brain injuries, base of skull fractures, brain stem injuries and cervical spine fractures. Incidence of all injuries and of each injury type in isolation was compared. 129 fatalities as a consequence of UBB were identified of whom 94 sustained head or neck injuries. 87 casualties had injuries amenable to analysis. Parenchymal brain injuries (75%) occurred most commonly followed by skull vault (55%) and base of skull fractures (32%). Cervical spine fractures occurred in only 18% of casualties. 62% of casualties had multiple sites of injury with only one casualty sustaining an isolated cervical spine fracture. Improvement of UBB survivability requires the understanding of fatal injury mechanisms. Although previous biomechanical studies have concentrated on the effect of axial load transmission and resultant injury to the cervical spine, our work demonstrates that cervical spine injuries are of limited clinical relevance for UBB survivability and that research should focus on severe brain injury secondary to direct head impact. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use

Variation in Post-Injury Antibiotic Prophylaxis Patterns over Five Years in a Combat Zone

PubMed Central

Lloyd, Col Bradley A; Murray, COL Clinton K.; Bradley, William; Shaikh, Faraz; Aggarwal, Deepak; Carson, M. Leigh; Tribble, David R.

2016-01-01

In 2008, a clinical practice guideline (CPG) was developed for the prevention of infections among combat casualties and was later revised in 2011. We evaluated utilization of antimicrobials within 48 hours following injury in the combat zone over a five-year period (June 2009–May 2014) with regard to number of regimens, type of antimicrobial, and adherence to the 2011 CPG. The study population consisted of 5196 wounded military personnel. Open fractures and skin and soft-tissue injuries were the most frequent injuries. Closed injuries had the highest overall compliance (83%), while open fractures and maxillofacial injuries had significant improvement in compliance from 2009–2010 (34% and 50%, respectively) to 2013–2014 (73% and 76%; p<0.05). Part of the improvement with open fractures was a significant reduction of expanded Gram-negative coverage (61% received it in 2009–2010 compared to 7% in 2013–2014; p<0.001). Use of Gram-negative coverage with maxillofacial injuries also significantly declined (37% to 12%; p=0.001). Being injured during 2011–2014 compared to 2009–2010 was associated with CPG compliance (p<0.001), while high injury severity scores (≥10) and admission to the intensive care unit in Germany were associated with noncompliance (p<0.001). Our analysis demonstrates an increasing trend toward CPG compliance with significant reduction of expanded Gram-negative coverage. PMID:28291497

Tactical Synthesis Of Efficient Global Search Algorithms

NASA Technical Reports Server (NTRS)

Nedunuri, Srinivas; Smith, Douglas R.; Cook, William R.

2009-01-01

Algorithm synthesis transforms a formal specification into an efficient algorithm to solve a problem. Algorithm synthesis in Specware combines the formal specification of a problem with a high-level algorithm strategy. To derive an efficient algorithm, a developer must define operators that refine the algorithm by combining the generic operators in the algorithm with the details of the problem specification. This derivation requires skill and a deep understanding of the problem and the algorithmic strategy. In this paper we introduce two tactics to ease this process. The tactics serve a similar purpose to tactics used for determining indefinite integrals in calculus, that is suggesting possible ways to attack the problem.

26 CFR 1.165-7 - Casualty losses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... planted trees and ornamental shrubs on the grounds surrounding the building. In 1961 the land, building, trees, and shrubs are damaged by hurricane. At the time of the casualty the adjusted basis of the land is $18,000 and the adjusted basis of the building is $66,000. At that time the trees and shrubs have...

Israeli psychological casualties of the Persian Gulf war: characteristics, therapy, and selected issues.

PubMed

Bleich, A; Kron, S; Margalit, C; Inbar, G; Kaplan, Z; Cooper, S; Solomon, Z

1991-01-01

The Persian Gulf war in 1991 presented Israel with its first experience of a threat of chemical attack on the home front. Ground-to-ground missiles were aimed directly at civilian populations, threatening death and destruction over a period of several weeks. Uncertainty as to time, place, and nature of the missile attacks affected the civilian population psychologically. The psychological responses of the population were the result of the continuous nature of the emergency which affected the entire population, and the destruction, injury, and displacement which affected those who were the targets of the attacks. The primary psychological effects of the emergency were investigated in several ways: surveys of samples of civilian and rear-echelon military populations, studies of the military personnel who asked for ambulatory psychological treatment as a result of the war, and studies of the specific populations that bore the brunt of the actual physical attacks were conducted. These studies show a high level of distress in the samples, with considerable differentiation between the populations. Levels of functioning generally remained intact even among the displaced or injured. Interventions were based on experience gained in the treatment of combat stress reaction. The issues of evacuation of psychological casualties to hospitals, psychiatric aspects of chemical attacks, and secondary traumatization of therapeutic and other staff are emphasized.

Combat aircraft operations: Training requirements for the German Air Force tactical flying units and the noise problem

NASA Astrophysics Data System (ADS)

Jertz, W.

1992-04-01

The deterrence potential of an Air Force, and by that the capability to fulfill their mission in times of war, relies on threat oriented training in peacetime. Low level flying is a major tactical means to help aircrews reduce the anticipated threat imposed to them by enemy air defence systems to an acceptable degree. The demand for this capability applies also to air defence tasks against attacking fighter bombers. Military low level flying requires a high degree of proficiency, which can only be reached and maintained by constant training. A high performance level is then the key to air power. The possibilities for this kind of necessary training are restricted by superior demands concerning, amongst others, flying safety and environmental reasons. Too intensive restrictions might reduce the fighting capability of the wings to such an extent, that mission fulfillment could be seriously endangered.

Tradeoff Analysis for Combat Service Support Wireless Communications Alternatives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burnette, John R.; Thibodeau, Christopher C.; Greitzer, Frank L.

2002-02-28

As the Army moves toward more mobile and agile forces and continued sustainment of numerous high-cost legacy logistics management systems, the requirement for wireless connectivity and a wireless network to supporting organizations has become ever more critical. There are currently several Army communications initiatives underway to resolve this wireless connectivity issue. However, to fully appreciate and understand the value of these initiatives, a Tradeoff Analysis is needed. The present study seeks to identify and assess solutions. The analysis identified issues that impede Interim Brigade Combat Team (IBCT) communication system integration and outlined core requirements for sharing of logistics data betweenmore » the field and Army battle command systems. Then, the analysis examined wireless communication alternatives as possible solutions for IBCT logistics communications problems. The current baseline system was compared with possible alternatives involving tactical radio systems, wireless/near term digital radio, cellular satellite, and third-generation (3G) wireless technologies. Cellular satellite and 3G wireless technologies offer clear advantages and should be considered for later IBCTs.« less

Photogrammetric point cloud compression for tactical networks

NASA Astrophysics Data System (ADS)

Madison, Andrew C.; Massaro, Richard D.; Wayant, Clayton D.; Anderson, John E.; Smith, Clint B.

2017-05-01

We report progress toward the development of a compression schema suitable for use in the Army's Common Operating Environment (COE) tactical network. The COE facilitates the dissemination of information across all Warfighter echelons through the establishment of data standards and networking methods that coordinate the readout and control of a multitude of sensors in a common operating environment. When integrated with a robust geospatial mapping functionality, the COE enables force tracking, remote surveillance, and heightened situational awareness to Soldiers at the tactical level. Our work establishes a point cloud compression algorithm through image-based deconstruction and photogrammetric reconstruction of three-dimensional (3D) data that is suitable for dissimination within the COE. An open source visualization toolkit was used to deconstruct 3D point cloud models based on ground mobile light detection and ranging (LiDAR) into a series of images and associated metadata that can be easily transmitted on a tactical network. Stereo photogrammetric reconstruction is then conducted on the received image stream to reveal the transmitted 3D model. The reported method boasts nominal compression ratios typically on the order of 250 while retaining tactical information and accurate georegistration. Our work advances the scope of persistent intelligence, surveillance, and reconnaissance through the development of 3D visualization and data compression techniques relevant to the tactical operations environment.

Provenancing of unidentified World War II casualties: Application of strontium and oxygen isotope analysis in tooth enamel.

PubMed

Font, Laura; Jonker, Geert; van Aalderen, Patric A; Schiltmans, Els F; Davies, Gareth R

2015-01-01

In 2010 and 2012 two sets of unidentified human remains of two World War II soldiers were recovered in the area where the 1944-1945 Kapelsche Veer bridgehead battle took place in The Netherlands. Soldiers of four Allied nations: British Royal Marine Commandos, Free Norwegian Commandos, Free Poles and Canadians, fought against the German Army in this battle. The identification of these two casualties could not be achieved using dental record information of DNA analysis. The dental records of Missing in Action soldiers of the Allied nations did not match with the dental records of the two casualties. A DNA profile was determined for the casualty found in 2010, but no match was found. Due to the lack of information on the identification of the casualties provided by routine methods, an isotope study was conducted in teeth from the soldiers to constrain their provenance. The isotope study concluded that the tooth enamel isotope composition for both casualties matched with an origin from the United Kingdom. For one of the casualties a probable origin from the United Kingdom was confirmed, after the isotope study was conducted, by the recognition of a characteristic belt buckle derived from a Royal Marine money belt, only issued to British Royal Marines, found with the remains of the soldier. Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

Personal Area Networks in Tactical Mobile Devices

DTIC Science & Technology

2014-08-01

TECHNICAL DOCUMENT 2047 August 2014 Personal Area Networks in Tactical Mobile Devices Brian Visser...Tactical Mobile Devices Brian Visser Approved for public release. SSC Pacific San Diego, CA 92152-5001 SB...consistent power source, which is normally not available to patrols. In addition to the lack of computer resources, robust network infrastructure

Fluctuations of Lightning Casualties in the United States: 1959-1990.

NASA Astrophysics Data System (ADS)

López, Raúl E.; Holle, Ronald L.

1996-03-01

Long-term fluctuations in the number of lightning deaths and injuries from 1959 to 1990 have been examined for the contiguous United States. After taking into account the population increase, there was an overall trend amounting to a 30% reduction in casualties during the period. It is possible that this trend resulted from improved forecasts and warnings, increased education efforts of the public, and socioeconomic changes.In addition, there was a 40% reduction in the number of deaths but not of nonfatal injuries. This additional reduction in deaths was probably due to improved medical attention given to lightning victims and a wider knowledge of cardiopulmonary resuscitation techniques among the public. Improved medical care would increase the chances of a person surviving a lightning strike but would not affect the total number of casualties.Superimposed on the overall downward trend there were fluctuations of one or two decades in duration. From 1959 until 1968 there was a sharp reduction in the number of casualties, but starting in 1969 and continuing until the present, there was an overall increase. These oscillations appear to be climatologically related. The patterns of these fluctuations were parallel to nationwide changes in thunder-day frequencies, cyclone frequencies, and surface temperature values, representing thunderstorm, synoptic, and continental scales.

The Impact of Combat Status on Veterans' Attitudes Toward Help Seeking: The Hierarchy of Combat Elitism.

PubMed

Ashley, Wendy; Brown, Jodi Constantine

2015-01-01

Many veterans do not seek assistance for mental health concerns despite the staggering prevalence of trauma-related symptomatology. Barriers to service provision include personal and professional stigma and inter-veteran attitudes that dictate who is more or less deserving of services. Veteran attitudes are shaped by military culture, which promotes a hyper-masculine paradigm upholding combat experience as the defining feature of the "ideal soldier." The stratification of soldiers into combat or non-combat status creates a hierarchy of combat elitism that extends far beyond active duty. This pilot study surveyed veterans (n = 24) to explore how combat experience may affect attitudes toward help seeking. Findings indicate combat and non-combat veterans are less accepting of non-combat veterans' help-seeking behavior, supporting the notion that veterans' attitudes toward help seeking are influenced by combat status. Despite limitations, the results of this study reflect a need for increased attention to the attitudes veterans have about each other and themselves.

Multistage Deployment of the Army Theater Hospital

DTIC Science & Technology

2013-12-01

analysis on the effects warfare tactics, casualty timing, and casualty types had on the medical treatment facility (Cecchine et al., 2001). This proved...the 44-bed mobile portion of the current CSH was potentially inadequate to support approximately four brigades in an asymmetrical warfare scenario...systems and its increased force effectiveness on the fleet. He utilized quantitative analysis with Lanchester and Hughes-Salvo models to show that

Affective Decision-Making and Tactical Behavior of Under-15 Soccer Players

PubMed Central

Gonzaga, Adeilton dos Santos; Albuquerque, Maicon Rodrigues; Malloy-Diniz, Leandro Fernandes; Greco, Pablo Juan; Teoldo da Costa, Israel

2014-01-01

Affective decision-making is a type of Executive Function related to cost benefit analysis in situations where gains and losses imply direct consequences for the subject. The purpose of this study was to explore the influence of the affective decision-making on tactical behavior in soccer players under the age of 15 years old. The System of Tactical Assessment in Soccer (FUT-SAT) was used to assess tactical behavior. To evaluate affective decision-making, we used the neuropsychological test called The Iowa Gambling Task (IGT). The values of the offensive, defensive and game tactical behavior of participants were used to create performance groups. The low (≤25%) and high (≥75%) groups, according to offensive, defensive and game tactical behavior, were compared and shown to be different. The values of the IGT net score of the participants with low and high tactical behavior were compared using the non-parametric Mann-Whitney test. Statistically significant differences between the groups were observed for Defensive Tactical Behavior (Z = −3.133; p = 0.002; r = −0.355) and Game Tactical Behavior (Z = −2.267; p = 0.023; r = −0.260). According to these results, it is possible to state that affective decision-making can influence the tactical behavior of under-15 soccer players. PMID:24978030

The influence of personal protection equipment, occupant body size, and restraint system on the frontal impact responses of Hybrid III ATDs in tactical vehicles.

PubMed

Zaseck, Lauren Wood; Orton, Nichole Ritchie; Gruber, Rebekah; Rupp, Jonathan; Scherer, Risa; Reed, Matthew; Hu, Jingwen

2017-08-18

Although advanced restraint systems, such as seat belt pretensioners and load limiters, can provide improved occupant protection in crashes, such technologies are currently not utilized in military vehicles. The design and use of military vehicles presents unique challenges to occupant safety-including differences in compartment geometry and occupant clothing and gear-that make direct application of optimal civilian restraint systems to military vehicles inappropriate. For military vehicle environments, finite element (FE) modeling can be used to assess various configurations of restraint systems and determine the optimal configuration that minimizes injury risk to the occupant. The models must, however, be validated against physical tests before implementation. The objective of this study was therefore to provide the data necessary for FE model validation by conducting sled tests using anthropomorphic test devices (ATDs). A secondary objective of this test series was to examine the influence of occupant body size (5th percentile female, 50th percentile male, and 95th percentile male), military gear (helmet/vest/tactical assault panels), seat belt type (3-point and 5-point), and advanced seat belt technologies (pretensioner and load limiter) on occupant kinematics and injury risk in frontal crashes. In total, 20 frontal sled tests were conducted using a custom sled buck that was reconfigurable to represent both the driver and passenger compartments of a light tactical military vehicle. Tests were performed at a delta-V of 30 mph and a peak acceleration of 25 g. The sled tests used the Hybrid III 5th percentile female, 50th percentile male, and 95th percentile male ATDs outfitted with standard combat boots and advanced combat helmets. In some tests, the ATDs were outfitted with additional military gear, which included an improved outer tactical vest (IOTV), IOTV and squad automatic weapon (SAW) gunner with a tactical assault panel (TAP), or IOTV and rifleman with

Assessing and Improving Hospital Mass-Casualty Preparedness: A No-Notice Exercise.

PubMed

Waxman, Daniel A; Chan, Edward W; Pillemer, Francesca; Smith, Timothy Wj; Abir, Mahshid; Nelson, Christopher

2017-12-01

In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals' true capacity to respond to a no-notice event under real-world conditions. To address this gap, the US Department of Health and Human Services (Washington, DC USA), Office of the Assistant Secretary for Preparedness and Response (ASPR), sponsored development of a set of tools meant to allow any hospital to run a real-time, no-notice exercise, focusing on the first hour and 15 minutes of a hospital's response to a sudden MCI, with the goals of minimizing burden, maximizing realism, and providing meaningful, outcome-oriented metrics to facilitate self-assessment. The resulting exercise, which was iteratively developed, piloted at nine hospitals nationwide, and completed in 2015, is now freely available for anyone to use or adapt. This report demonstrates the feasibility of implementing a no-notice exercise in the hospital setting and describes insights gained during the development process that might be helpful to future exercise developers. It also introduces the use of ED "immediate bed availability (IBA)" as an objective, dynamic measure of an ED's physical capacity for new arrivals. Waxman DA , Chan EW , Pillemer F , Smith TWJ , Abir M , Nelson C . Assessing and improving hospital mass-casualty preparedness: a no-notice exercise. Prehosp Disaster Med. 2017;32(6):662-666.

AirLand Battle and Tactical Command and Control Automation,

DTIC Science & Technology

1987-01-07

Army Tactical Command and Control System (ATCCS) are the primary subjects of the last period. The precepts of AirLand Battle doctrine are examined to...AirLand Battle and the Army Tactical Command and Control System (ATCCS) are thE primary subjects of the last period. The precepts of AirLand Battle...centralized control is identified. AirLand Battle and the Army Tactical Command and Control System (ATCCS) are the primary subjects of the last

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

Salvage of Combat Hindfoot Fractures in 2003-2014 UK Military.

PubMed

Bennett, Philippa M; Stevenson, Thomas; Sargeant, Ian D; Mountain, Alistair; Penn-Barwell, Jowan G

2017-07-01

Hindfoot fractures pose a considerable challenge to military orthopaedic surgeons, as combat injuries are typically the result of energy transfers not seen in civilian practice. This study aimed to characterize the pattern of hindfoot injuries sustained by UK military casualties in recent conflicts, define the early amputation and infection rate, and identify factors associated with poor early outcomes. The UK Joint Theatre Trauma Registry was searched for British military casualties sustaining a hindfoot fracture from Iraq and Afghanistan between 2003 and 2014. Data on the injury pattern and management were obtained along with 18-month follow-up data. Statistical analysis was performed with the chi-square test and binomial logistic regression analysis. The threshold for significance was set at P < .05. One hundred fourteen patients sustained 134 hindfoot injuries. Eighteen-month follow-up was available for 92 patients (81%) and 114 hindfeet (85%). The calcaneus was fractured in 116 cases (87%): 54 (47%) were managed conservatively, 32 (28%) underwent K-wire fixation, and 30 (26%) underwent internal fixation. Nineteen patients (17%) required transtibial amputation during this time. A deep infection requiring operative treatment occurred in 13 cases (11%) with Staphylococcus aureus, the most common infectious organism (46%). A deep infection was strongly associated with operative fracture management ( P = .0016). When controlling for multiple variables, the presence of a deep infection was significantly associated with a requirement for amputation at 18 months ( P = .023). There was no association between open fractures and a requirement for amputation at 18 months ( P = .640), nor was conservative management associated with a requirement for amputation ( P = .999). Thirty-six fractures (32%) required unplanned revision surgery within the first 18 months following salvage, of which 19 (53%) involved amputation. A deep infection was the sole variable significantly

Tactical missile aerodynamics

NASA Technical Reports Server (NTRS)

Hemsch, Michael J. (Editor); Nielsen, Jack N. (Editor)

1986-01-01

The present conference on tactical missile aerodynamics discusses autopilot-related aerodynamic design considerations, flow visualization methods' role in the study of high angle-of-attack aerodynamics, low aspect ratio wing behavior at high angle-of-attack, supersonic airbreathing propulsion system inlet design, missile bodies with noncircular cross section and bank-to-turn maneuvering capabilities, 'waverider' supersonic cruise missile concepts and design methods, asymmetric vortex sheding phenomena from bodies-of-revolution, and swept shock wave/boundary layer interaction phenomena. Also discussed are the assessment of aerodynamic drag in tactical missiles, the analysis of supersonic missile aerodynamic heating, the 'equivalent angle-of-attack' concept for engineering analysis, the vortex cloud model for body vortex shedding and tracking, paneling methods with vorticity effects and corrections for nonlinear compressibility, the application of supersonic full potential method to missile bodies, Euler space marching methods for missiles, three-dimensional missile boundary layers, and an analysis of exhaust plumes and their interaction with missile airframes.

Combating terrorism : how five foreign countries are organized to combat terrorism

DOT National Transportation Integrated Search

2000-04-01

In fiscal year 1999, the federal government spent about $10 billion to combat terrorism. Over 40 federal departments, agencies, and bureaus have a role in combating terrorism. Recognizing that other governments have had more experience dealing with t...

Association of AKI with adverse outcomes in burned military casualties.

PubMed

Stewart, Ian J; Tilley, Molly A; Cotant, Casey L; Aden, James K; Gisler, Christopher; Kwan, Hana K; McCorcle, Jeffery; Renz, Evan M; Chung, Kevin K

2012-02-01

Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan. Patients evacuated from Iraq and Afghanistan to a burn unit were examined. AKI was classified by the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss-End Stage (RIFLE) schemas. Age, sex, percentage of total body surface area burned (TBSA), percentage of full-thickness burn, inhalation injury, and injury severity score were recorded. Additional data that could be associated with poor outcomes were recorded for patients with TBSA ≥20%. Multivariate logistic regression analyses were performed to determine factors associated with morbidity and mortality. AKI prevalence rates by the RIFLE and AKIN criteria were 23.8% and 29.9%, respectively. After logistic regression, RIFLE categories of risk (odds ratio [OR], 15.34; 95% confidence interval [CI], 1.75-134; P=0.01), injury (OR, 46.28; 95% CI, 5.02-427; P<0.001), and failure (OR, 126; 95% CI, 13.39->999; P<0.001); AKIN-2 (OR, 23.70; 95% CI, 2.32-242; P=0.008); and AKIN-3 (OR, 130; 95% CI, 13.38->999; P<0.001) were significantly associated with death. AKIN-3, injury, and failure remained significant in the subset of patients with ≥20% TBSA. There was also a strong interaction between TBSA and the stage of AKI with respect to ventilator and intensive care unit days. AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.

Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution.

PubMed

Shartar, Samuel E; Moore, Brooks L; Wood, Lori M

2017-12-01

Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care. Working with hospitals within the region, we refined emergency department surge capacity for MCIs and developed a prepopulated tool for EMS providers to use to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to nontrauma hospitals. A mechanism to remove a hospital from the list of available resources, if it is overwhelmed with patients who self-transport to the location, also was put into place. The number of critically injured survivors from an MCI has proven to be consistent, averaging 7% to 10%. Moving critically injured patients to level 1 trauma centers can result in a 25% reduction in mortality, when compared with care at nontrauma hospitals. US cities face major gaps in the surge capacity needed to manage an MCI. Sixty percent of "walking wounded" casualties self-transport to the closest hospital(s) to the incident. Directing critically ill patients to designated trauma centers has the potential to reduce mortality associated with the event. When applied to MCI responses, damage-control principles reduce resource utilization and optimize surge capacity. A universal system for mass casualty triage was identified and incorporated into the region's EMS. Flagship regional coordinating hospitals were designated

Space System Applications to Tactical Operations.

DTIC Science & Technology

1984-10-01

AD-AI51 884 SPACE SYSTEM APPLICATIONS TO TACTICAL OPERATIONSIU) I, ADVISORY GROU)P FOR AEROSPACE RESEARCH AND DEVELOPMENT NEUILIT-SUR-SEINE (FRANCE...FOR1’ AIIII [ I [IiP[E REEAC [ [llllvd[ N I AGARD CONFERENCE PROCEEDINGS No.344 Space System Applications to Tactical Operations DTIC ELECTE...nota %ii. .tm’ ih1.1i .Il t oning oiii.ian later oil Ili thre centturv are charaeteri/ed. Bloth the ad’.antage’. and limitation%. iii space ’.’.’tem

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with “Office of Marine Insurance, Maritime Administration, Department of Transportation.” ...

Mass Casualty Decontamination in a Chemical or Radiological/ Nuclear Incident: Further Guiding Principles.

PubMed

Carter, Holly; Amlôt, Richard; Williams, Richard; Rubin, G James; Drury, John

2016-09-15

This short report presents a response to an article written by Cibulsky et al. (2016). The paper by Cibulsky et al. presents a useful and timely overview of the evidence surrounding the technical and operational aspects of mass casualty decontamination. It identifies three priority targets for future research, the third of which is how casualties' needs can be met in ways that best support compliance with and effectiveness of casualty decontamination. While further investigation into behavioural, communication and privacy issues during mass decontamination is warranted, there is now a substantial body of research in this area which is not considered in detail in the succinct summary provided by Cibulsky et al. (2016). In this short report, we summarise the available evidence around likely public behaviour during mass decontamination, effective communication strategies, and potential issues resulting from a lack of privacy. Our intention is to help further focus the research needs in this area and highlight topics on which more research is needed.

Mass Casualty Decontamination in a Chemical or Radiological/ Nuclear Incident: Further Guiding Principles

PubMed Central

Carter, Holly; Amlôt, Richard; Williams, Richard; Rubin, G. James; Drury, John

2016-01-01

This short report presents a response to an article written by Cibulsky et al. (2016). The paper by Cibulsky et al. presents a useful and timely overview of the evidence surrounding the technical and operational aspects of mass casualty decontamination. It identifies three priority targets for future research, the third of which is how casualties' needs can be met in ways that best support compliance with and effectiveness of casualty decontamination. While further investigation into behavioural, communication and privacy issues during mass decontamination is warranted, there is now a substantial body of research in this area which is not considered in detail in the succinct summary provided by Cibulsky et al. (2016). In this short report, we summarise the available evidence around likely public behaviour during mass decontamination, effective communication strategies, and potential issues resulting from a lack of privacy. Our intention is to help further focus the research needs in this area and highlight topics on which more research is needed. PMID:27790381

Vented chest seals for prevention of tension pneumothorax in a communicating pneumothorax.

PubMed

Kotora, Joseph G; Henao, Jose; Littlejohn, Lanny F; Kircher, Sara

2013-11-01

Tension pneumothorax accounts for 3%-4% of combat casualties and 10% of civilian chest trauma. Air entering a wound via a communicating pneumothorax rather than by the trachea can result in respiratory arrest and death. In such cases, the Committee on Tactical Combat Casualty Care advocates the use of unvented chest seals to prevent respiratory compromise. A comparison of three commercially available vented chest seals was undertaken to evaluate the efficacy of tension pneumothorax prevention after seal application. A surgical thoracostomy was created and sealed by placing a shortened 10-mL syringe barrel (with plunger in place) into the wound. Tension pneumothorax was achieved via air introduction through a Cordis to a maximum volume of 50 mL/kg. A 20% drop in mean arterial pressure or a 20% increase in heart rate confirmed hemodynamic compromise. After evacuation, one of three vented chest seals (HyFin(®), n = 8; Sentinel(®), n = 8, SAM(®), n = 8) was applied. Air was injected to a maximum of 50 mL/kg twice, followed by a 10% autologous blood infusion, and finally, a third 50 mL/kg air bolus. Survivors completed all three interventions, and a 15-min recovery period. The introduction of 29.0 (±11.5) mL/kg of air resulted in tension physiology. All three seals effectively evacuated air and blood. Hemodynamic compromise failed to develop with a chest seal in place. HyFin(®), SAM(®), and Sentinel(®) vented chest seals are equally effective in evacuating blood and air in a communicating pneumothorax model. All three prevented tension pneumothorax formation after penetrating thoracic trauma. Published by Elsevier Inc.

Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

PubMed

Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

Management of External Hemorrhage in Tactical Combat Casualty Care: Chitosan-Based Hemostatic Gauze Dressings. TCCC Guidelines Change 13-05

DTIC Science & Technology

2014-09-23

dramatically decreased. Coagulation parameters improved significantly over the next 36 hours. Muzzi et al./2012 CEG Acute prosthetic endocarditis ; 4 months...prosthetic endocarditis ; 4 months post aortic dissection surgery Preoperative IV heparin with impaired coagulation state. Yes; discharged

Fusion interfaces for tactical environments: An application of virtual reality technology

NASA Technical Reports Server (NTRS)

Haas, Michael W.

1994-01-01

The term Fusion Interface is defined as a class of interface which integrally incorporates both virtual and nonvirtual concepts and devices across the visual, auditory, and haptic sensory modalities. A fusion interface is a multisensory virtually-augmented synthetic environment. A new facility has been developed within the Human Engineering Division of the Armstrong Laboratory dedicated to exploratory development of fusion interface concepts. This new facility, the Fusion Interfaces for Tactical Environments (FITE) Facility is a specialized flight simulator enabling efficient concept development through rapid prototyping and direct experience of new fusion concepts. The FITE Facility also supports evaluation of fusion concepts by operation fighter pilots in an air combat environment. The facility is utilized by a multidisciplinary design team composed of human factors engineers, electronics engineers, computer scientists, experimental psychologists, and oeprational pilots. The FITE computational architecture is composed of twenty-five 80486-based microcomputers operating in real-time. The microcomputers generate out-the-window visuals, in-cockpit and head-mounted visuals, localized auditory presentations, haptic displays on the stick and rudder pedals, as well as executing weapons models, aerodynamic models, and threat models.

Changing tactics in the abortion argument: does a fetus feel pain?

PubMed

Goodman, N W

1997-12-10

The 30th anniversary of the passing of the abortion law in England sparked off yet another skirmish in the continuing struggle. Not only the Catholic Church but also anti-lobby groups have protested against the abortion law. Anti-lobby groups consider abortion as an evil that must be fought. To further explain their point, the anti-lobby groups used the conclusions on pediatric anesthetic practice to change their tactics in combating the abortion issue from the emotional point of view to the apparently rational. A group of pediatricians, anesthetists, bioethicists and neuroanatomists has considered the problem of when the fetus may first be able to feel pain. They have decided that the fetus cannot feel pain before the 26th week and recommended that the fetus be given an anesthetic for any abortion later than the 24th week. The anti-lobby groups say that this view limits the perception of pain to the cerebral cortex and that the thalamus is well enough developed by the 10th week for the growing embryo to feel the pain. However, as to the question of fetal pain, one can never know whether fetuses feel pain, because they can never tell.

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-26... RAILROADS 1 Operating Expenses-Equipment § 1242.41 Other and casualties and insurance (accounts XX-26-99 and... administration (account XX-26-01). freight cars ...

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-51... RAILROADS 1 Operating Expenses-Transportation § 1242.65 Other and casualties and insurance (accounts XX-51... separation of administration (account XX-51-01). yard operations ...

Monitoring combat wound healing by IR hyperspectral imaging

NASA Astrophysics Data System (ADS)

Howle, Chris R.; Spear, Abigail M.; Gazi, Ehsan; Crane, Nicole J.

2016-03-01

In recent conflicts, battlefield injuries consist largely of extensive soft injuries from blasts and high energy projectiles, including gunshot wounds. Repair of these large, traumatic wounds requires aggressive surgical treatment, including multiple surgical debridements to remove devitalised tissue and to reduce bacterial load. Identifying those patients with wound complications, such as infection and impaired healing, could greatly assist health care teams in providing the most appropriate and personalised care for combat casualties. Candidate technologies to enable this benefit include the fusion of imaging and optical spectroscopy to enable rapid identification of key markers. Hence, a novel system based on IR negative contrast imaging (NCI) is presented that employs an optical parametric oscillator (OPO) source comprising a periodically-poled LiNbO3 (PPLN) crystal. The crystal operates in the shortwave and midwave IR spectral regions (ca. 1.5 - 1.9 μm and 2.4 - 3.8 μm, respectively). Wavelength tuning is achieved by translating the crystal within the pump beam. System size and complexity are minimised by the use of single element detectors and the intracavity OPO design. Images are composed by raster scanning the monochromatic beam over the scene of interest; the reflection and/or absorption of the incident radiation by target materials and their surrounding environment provide a method for spatial location. Initial results using the NCI system to characterise wound biopsies are presented here.

The Impacts of Air Temperature on Accidental Casualties in Beijing, China.

PubMed

Ma, Pan; Wang, Shigong; Fan, Xingang; Li, Tanshi

2016-11-02

Emergency room (ER) visits for accidental casualties, according to the International Classification of Deceases 10th Revision Chapters 19 and 20, include injury, poisoning, and external causes (IPEC). Annual distribution of 187,008 ER visits that took place between 2009 and 2011 in Beijing, China displayed regularity rather than random characteristics. The annual cycle from the Fourier series fitting of the number of ER visits was found to explain 63.2% of its total variance. In this study, the possible effect and regulation of meteorological conditions on these ER visits are investigated through the use of correlation analysis, as well as statistical modeling by using the Distributed Lag Non-linear Model and Generalized Additive Model. Correlation analysis indicated that meteorological variables that positively correlated with temperature have a positive relationship with the number of ER visits, and vice versa. The temperature metrics of maximum, minimum, and mean temperatures were found to have similar overall impacts, including both the direct impact on human mental/physical conditions and indirect impact on human behavior. The lag analysis indicated that the overall impacts of temperatures higher than the 50th percentile on ER visits occur immediately, whereas low temperatures show protective effects in the first few days. Accidental casualties happen more frequently on warm days when the mean temperature is higher than 14 °C than on cold days. Mean temperatures of around 26 °C result in the greatest possibility of ER visits for accidental casualties. In addition, males were found to face a higher risk of accidental casualties than females at high temperatures. Therefore, the IPEC-classified ER visits are not pure accidents; instead, they are associated closely with meteorological conditions, especially temperature.

Predicting casualties implied by TIPs

NASA Astrophysics Data System (ADS)

Trendafiloski, G.; Wyss, M.; Wyss, B. M.

2009-12-01

When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral

Tactical Nuclear Weapons: Their Purpose and Placement

DTIC Science & Technology

2015-06-01

War II, nuclear scientists argued against the development of fusion weapons .3 In the 1970s, politicians debated the use of neutron bombs, weapons ...Tactical Nuclear Weapons : Their Purpose and Placement BY EDWARD G. FERGUSON A THESIS SUBMITTED TO THE FACULTY OF THE...This study answers the question -- Why does America have tactical nuclear weapons (TNWs) in Europe today? – treating America and the North

Mass-casualty events at schools: a national preparedness survey.

PubMed

Graham, James; Shirm, Steve; Liggin, Rebecca; Aitken, Mary E; Dick, Rhonda

2006-01-01

Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

Online Pedagogical Tutorial Tactics Optimization Using Genetic-Based Reinforcement Learning.

PubMed

Lin, Hsuan-Ta; Lee, Po-Ming; Hsiao, Tzu-Chien

2015-01-01

Tutorial tactics are policies for an Intelligent Tutoring System (ITS) to decide the next action when there are multiple actions available. Recent research has demonstrated that when the learning contents were controlled so as to be the same, different tutorial tactics would make difference in students' learning gains. However, the Reinforcement Learning (RL) techniques that were used in previous studies to induce tutorial tactics are insufficient when encountering large problems and hence were used in offline manners. Therefore, we introduced a Genetic-Based Reinforcement Learning (GBML) approach to induce tutorial tactics in an online-learning manner without basing on any preexisting dataset. The introduced method can learn a set of rules from the environment in a manner similar to RL. It includes a genetic-based optimizer for rule discovery task by generating new rules from the old ones. This increases the scalability of a RL learner for larger problems. The results support our hypothesis about the capability of the GBML method to induce tutorial tactics. This suggests that the GBML method should be favorable in developing real-world ITS applications in the domain of tutorial tactics induction.

Online Pedagogical Tutorial Tactics Optimization Using Genetic-Based Reinforcement Learning

PubMed Central

Lin, Hsuan-Ta; Lee, Po-Ming; Hsiao, Tzu-Chien

2015-01-01

Tutorial tactics are policies for an Intelligent Tutoring System (ITS) to decide the next action when there are multiple actions available. Recent research has demonstrated that when the learning contents were controlled so as to be the same, different tutorial tactics would make difference in students' learning gains. However, the Reinforcement Learning (RL) techniques that were used in previous studies to induce tutorial tactics are insufficient when encountering large problems and hence were used in offline manners. Therefore, we introduced a Genetic-Based Reinforcement Learning (GBML) approach to induce tutorial tactics in an online-learning manner without basing on any preexisting dataset. The introduced method can learn a set of rules from the environment in a manner similar to RL. It includes a genetic-based optimizer for rule discovery task by generating new rules from the old ones. This increases the scalability of a RL learner for larger problems. The results support our hypothesis about the capability of the GBML method to induce tutorial tactics. This suggests that the GBML method should be favorable in developing real-world ITS applications in the domain of tutorial tactics induction. PMID:26065018

U.S. Unmanned Aerial Vehicles (UAVs) and Network Centric Warfare (NCW): Impacts on Combat Aviation Tactics from Gulf War I Through 2007 Iraq

DTIC Science & Technology

2008-03-01

early warning AIM Air-intercept missile AJCN Adaptive, joint, C4ISR node AOR Area of responsibility ARM Anti-radiation missile ATARS Advanced...Tactical Airborne Reconnaissance System ( ATARS ) on F-16 and F/A-18 aircraft, and satellites. Manned platforms were adapted to multiple mission scenarios... Psychological Ops X Tern/Leaflet Dispensing, 2004 All Weather/ Night Strike X DASH/Vietnam, 1960s Predator/Afghanistan/Iraq, 2001 36

Ophthalmic Care of the Combat Casualty

DTIC Science & Technology

2003-01-01

World War I and World War II made evident the need to maintain well-trained military ophthalmologists on continual active duty to provide care for...the military ( active and retired), their dependents, and selected civilians has continued to this day. Military conflicts, peacekeeping efforts, and... Philippines , tropical ophthalmology became very important. This made Fig. 1-8. Fort Seldon, Texas, 1865– 1892. Eye care could be provided at this

Transfusion-Associated Microchimerism in Combat Casualties

DTIC Science & Technology

2007-10-01

Hathaway WE, Brangle RW, Nelson TL, Roeckel IE. Aplastic anemia and alyphocytosis in an infant with hypogammaglobulinemia: graft-versus-host...multiple organ failure. Arch Surg. 1997; 132:620–624. 32. Dunne JR, Malone DL, Tracy JK, et al. Perioperative anemia : an independent risk factor for

Friendly Combat Casualties and Operational Narratives

DTIC Science & Technology

2015-06-21

turn for the worse on March 31, 2004. On that date, insurgents ambushed a convoy operated by the private security firm Blackwater in the center of the...2011), IV-6. 95 Ibid., III-17 34 Despite its name, the term operational risk management (ORM) as used by the United States Navy reflects

[Lay emphasis on the treatment of massive burn casualties in conflagration].

PubMed

Tang, Hong-tai; Ma, Bing; Xia, Zhao-fan

2012-06-01

Burn surgery belongs to disaster medicine. Burn is a common trauma that occurs in social activities of human beings in all ages, either in the time of peace or war. During the development of human medicine in modern times, the summary of experience in treating massive burn casualties due to severe fire accidents has effectively promoted the renovation of treating technology and theory of burns and the development of burn surgery. The results of treatment of burn injury in casualties occurred in the fire of Cocoanut Grove night club in Boston in 1942, and the high-rise apartment house fire in Shanghai in 2010 were summarized and analyzed in this article, emphasizing the correlating issues of inhalation injury.

Fluctuating asymmetry, sociosexuality, and intrasexual competitive tactics.

PubMed

Simpson, J A; Gangestad, S W; Christensen, P N; Leck, K

1999-01-01

Heterosexual men and women were told they were competing with another same-sex individual for a date with an attractive opposite-sex interviewer. After answering 6 questions, participants were asked to tell the competitor why the interviewer should choose them over the competitor. Participants' videotaped behavior was coded for different behavioral tactics. Men who were more symmetrical and who had a more unrestricted sociosexual orientation were more likely to use direct competition tactics than were less symmetrical and restricted men. Restricted men accentuated their positive personal qualities, presenting themselves as "nice guys." Structural equation modeling revealed that fluctuating asymmetry (FA) was directly associated with the use of direct competition tactics. However, the link between FA and presenting oneself as a nice guy was mediated through sociosexuality. No effects were found for women.

Abductive networks applied to electronic combat

NASA Astrophysics Data System (ADS)

Montgomery, Gerard J.; Hess, Paul; Hwang, Jong S.

1990-08-01

A practical approach to dealing with combinatorial decision problems and uncertainties associated with electronic combat through the use of networks of high-level functional elements called abductive networks is presented. It describes the application of the Abductory Induction Mechanism (AIMTM) a supervised inductive learning tool for synthesizing polynomial abductive networks to the electronic combat problem domain. From databases of historical expert-generated or simulated combat engagements AIM can often induce compact and robust network models for making effective real-time electronic combat decisions despite significant uncertainties or a combinatorial explosion of possible situations. The feasibility of applying abductive networks to realize advanced combat decision aiding capabilities was demonstrated by applying AIM to a set of electronic combat simulations. The networks synthesized by AIM generated accurate assessments of the intent lethality and overall risk associated with a variety of simulated threats and produced reasonable estimates of the expected effectiveness of a group of electronic countermeasures for a large number of simulated combat scenarios. This paper presents the application of abductive networks to electronic combat summarizes the results of experiments performed using AIM discusses the benefits and limitations of applying abductive networks to electronic combat and indicates why abductive networks can often result in capabilities not attainable using alternative approaches. 1. ELECTRONIC COMBAT. UNCERTAINTY. AND MACHINE LEARNING Electronic combat has become an essential part of the ability to make war and has become increasingly complex since

Independent Research Annual Report 1990 (Naval Medical Research and Development Command)

DTIC Science & Technology

1990-01-01

main research topic areas studied by NMRDC scientists Include combat casualty care and combat dentistry , infectious dis- eases and AIDS, diving and...performance of psychomotor and cognitive tasks. Ergonomics 30:1431-1445; 1987. 17. Gehres, L D.; Randall, C.; Riccio, D. C.; Vardans, R. M

Heart rate and performance during combat missions in a flight simulator.

PubMed

Lahtinen, Taija M M; Koskelo, Jukka P; Laitinen, Tomi; Leino, Tuomo K

2007-04-01

The psychological workload of flying has been shown to increase heart rate (HR) during flight simulator operation. The association between HR changes and flight performance remains unclear. There were 15 pilots who performed a combat flight mission in a Weapons Tactics Trainer simulator of an F-18 Hornet. An electrocardiogram (ECG) was recorded, and individual incremental heart rates (deltaHR) from the HR during rest were calculated for each flight phase and used in statistical analyses. The combat flight period was divided into 13 phases, which were evaluated on a scale of 1 to 5 by the flight instructor. HR increased during interceptions (from a mean resting level of 79.0 to mean value of 96.7 bpm in one of the interception flight phases) and decreased during the return to base and slightly increased during the ILS approach and landing. DeltaHR appeared to be similar among experienced and less experienced pilots. DeltaHR responses during the flight phases did not correlate with simulator flight performance scores. Overall simulator flight performance correlated statistically significantly (r = 0.50) with the F-18 Hornet flight experience. HR reflected the amount of cognitive load during the simulated flight. Hence, HR analysis can be used in the evaluation of the psychological workload of military simulator flight phases. However, more detailed flight performance evaluation methods are needed for this kind of complex flight simulation to replace the traditional but rough interval scales. Use of a visual analog scale by the flight instructors is suggested for simulator flight performance evaluation.

The use of impression management tactics in structured interviews: a function of question type?

PubMed