Page 8 - JSOM Fall 2024

FEATURE ARTICLES Tactical Psychiatric Care: Proposed Guideline: In this pro-
Enhanced Manual Ventilation with a Handheld Audiovisual posed model for battlefield care, Jared W. Bollinger outlines
Device – ‘BENGI’ – Insights from a Pilot Study in Special Op- best practices for the treatment of suicidality, psychosis, agita-
erations Medicine: White and colleagues evaluated the effects tion, malingering, and combat stress reactions, in accordance
of a handheld manual ventilation guidance device on provider with multiple clinical practice guidelines.
performance. Twenty medical school students were randomly REBOA Use in a Medicalized Prehospital Setting: Proposal
assigned in 2 blocks to perform manual ventilation either with for a First Protocol Based on the Delphi Method: The research
or without the bag-valve-mask emergency narration guided in- team of Thabouillot and colleagues, from France, conducted
strument (BENGI). The researchers found that delivered tidal a Delphi study to clarify the indications for and contraindi-
volumes and respiratory rates more closely approached target cations to resuscitative endovascular balloon occlusion of the
values with audiovisual feedback, and use of the BENGI re- aorta (REBOA) in a two-tiered prehospital emergency med-
duced inter- and intra-participant variation in manual ventila- ical system. Nineteen experts participated in three rounds of
tion. They conclude that these devices are not only valuable for consultation to achieve consensus on 10 questions related to
resuscitation but also manual ventilation training. prehospital REBOA. The resulting protocol clarifies that hem-
orrhagic shock, even with administration of norepinephrine at
a dose of 0.6μg/kg/min, is considered too serious a condition
for the patient to be transported to the trauma center without
Schematic REBOA. It also confirms that a zone 1 REBOA should be in-
of manikin flated for maximum 30 minutes and with a partial occlusion
simulation.
strategy, if possible.
The Effect of Radiological Assessment of Volunteers for
French Paratrooper Training: A Five-Year Retrospective Study:
In this retrospective, epidemiological, cross-sectional single-
Military Medical Student Specialty Preferences During the
DHA Transition: A Retrospective Analysis: Brooke and col- center study, Montagnon and colleagues reviewed the medical
leagues performed a retrospective analysis of 5 years of data records and full-spine X-ray reports of all enlisted members
from the Association of American Medical Colleges Graduation at the French paratroopers’ initial training center, between
Questionnaire to determine the impact of changes the DHA September 2011 and August 2016. The researchers sought to
made to prioritize operational specialties. Surveys were sepa- determine whether radiological assessment excludes too many
rated into two periods: pre-DHA (2015–2017) and post-DHA recruits from airborne training and whether medical standards
(2018–2020) transition. Medical students at the Uniformed might be lowered without increasing the risk of harm. The
Services University of the Health Sciences (USU) reported sim- findings, supported by a literature review of foreign military
ilar preferences for operational specialties and similar levels of data, suggest that spondylolisthesis above grade I and low
satisfaction in having attended medical school before and after back pain are more significant than scoliosis and kyphosis for
the initial DHA transition. These finding suggest that the DHA’s establishing airborne standards.
changes may not have had a large impact on students’ choice of
specialty or desire to pursue military medicine.
Rethinking Prehospital Response to Mass Casualty Events: Enlisted personnel
Move, Treat, and Transport: Rush and colleagues present a completing airborne
new protocol for prehospital mass casualty event (MASCAL) training (6 static-line
management—Move, Treat, and Transport. This simplified ap- jumps) at the French
proach, which uses common terminology, emphasizes speed Airborne School in
Pau, France.
and efficiency of response; considers time, tactics, and scale
of the event; and focuses on interventions and evacuation to
definitive care, if needed.
Self-Described Training Needs of Special Operations Forces
Medics and the Birth of the TACMED Division: Yue and col-
leagues surveyed 57 Special Operations Forces (SOF) medics
to evaluate their beliefs regarding whether additional training
would make them more proficient in 70 medical knowledge
and procedural skills, grouped and categorized by a panel of
experts. Responses revealed differences in both levels of con-
fidence and perceived need for more training across the items.
Open-ended responses revealed that SOF medics want more
training in all areas, but particularly desired hands-on experi-
ence with real patients, guided by experienced SOF medics. In
response to present findings, Tactical Medicine divisions have
Proposed “Move, Treat, and Transport” approach to MASCAL developed improved sustainment training courses for SOF
management. medics.

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