Page 11 - JSOM Summer 2025

CASE REPORTS PROLONGED CASUALTY CARE
Use of an Intraoral Neuroprosthesis for the Treatment of Maritime Applications of Prolonged Casualty Care: Drown-
Posttraumatic Stress Disorder (PTSD)-Associated Nocturnal ing and Hypothermia on an Amphibious Warship: Less and
Behavior Disorder: Case Series of Four Patients: Moeller and colleagues detail two hypothetical drowning and hypothermia pa-
Davidson revisited four veterans treated with a custom-designed, tient scenarios to present an innovative approach to teaching com-
intraoral neuroprosthesis for disruptive nocturnal behaviors plex operational medicine concepts, including the management of
(DNBs) associated with PTSD / traumatic brain injury. Sleep part- hypothermia and acute respiratory distress syndrome, as well as
ners observed complete or near-complete resolution of DNBs in all Prolonged Casualty Care to austere Role 1 maritime caregivers
cases, while patients reported improvements in sleep quality, oral using the Joint Trauma System PCC Clinical Practice Guidelines
posture, temporomandibular joint conditions, rest, and overall (CPGs) and other standard references.
well-being. This device shows promise as a non-pharmacological
intervention to enhance mission readiness and improve treatment THERE I WAS
compliance in PTSD-associated DNB. GWOT Lessons Learned: Metal in Africa: Cantong and col-
leagues provide a first-hand account of how a medic managed the
Undersea and Hyperbaric Medicine: Case Studies and Re- care of a Special Forces Operator with a retained intra-articular
view: Day and colleagues present three cases of divers who round from marksmanship during deployment to AFRICOM. The
experienced different dive-related medical events: arterial gas article focuses on lessons learned for optimal care and preserva-
embolism; subconjunctival hemorrhage from barotrauma due to tion of functional movement.
mask squeeze; and middle ear barotrauma, with recovery compli-
cated by migraine headaches, which had initially raised concerns UNCONVENTIONAL MEDICINE
for type II (neurogenic) decompression sickness. The authors stress Proof of Concept: Is Small-scale Production of Diethyl Ether
that, as the types and presentations of dive injuries are vast, it is for Anesthetic Use Possible?: In this proof of concept study,
particularly important for Special Operations providers to have a Dhanjal and colleagues demonstrate how relatively pure diethyl
general awareness of the causes, symptoms, and treatments for the ether (Et O) can be produced and isolated on a small scale us-
2
most common and most severe dive injuries. ing an acid-catalyzed dehydration reaction with fractional distil-
lation. While further investigation is needed to ensure reliability
and safety, this study offers initial insight into the small-scale pro-
duction of Et O, a once used anesthetic agent, which may still be
2
useful in resource-limited settings, such as disasters, conflict, and
Emergency evacuation humanitarian crises.
hyperbaric stretchers
“Hyperlite” portable
recompression chamber,
assembled.
Image of equipment for the
acid-catalyzed dehydration of
ethanol to form diethyl ether and
the fractional distillation of the
diethyl ether. (A) 50mL flask in
which sulfuric acid was added to
Severe Rheumatic Heart Disease Requiring Mechanical Valve a solution of ethanol. (B) distilling
Placement in a Special Operations Forces Soldier: Osborne column, containing a thermometer.
and colleagues describe the case of a 29-year-old Special Opera- (C) condenser. (D) receiving flask,
tions Forces (SOF) Soldier who presented for multiple recurrent in an ice bath.
episodes of exertional near-syncope and progressive exercise in-
tolerance. Eventual cardiology evaluation with transthoracic and
transesophageal echocardiograms revealed severe mitral regur-
gitation and rheumatic appearing mitral valve leaflets, requiring UNCONVENTIONAL RESILIENCE
replacement with a mechanical valve. Given that rheumatic heart
disease is rare within the SOF population but carries serious risks Unconventional Resilience: A Holistic, Humanistic Infrastruc-
if untreated, the authors stress that SOF providers must remain ture of Integrated Performance: In this last installment of a
vigilant to the possibility of this resurging disease process. nine-part series, Jeschke and colleagues develop a holistic, human-
istic infrastructure of integrated performance in Special Operation
ONGOING SERIES Forces medicine. According to the authors, the pragmatic value of
LAW ENFORCEMENT AND TACTICAL MEDICINE this infrastructure is that it enables cohesive integration of their
theory at all levels of unconventional resilience.
Injuries in Specialist Police Officers: A Scoping Review: Lyons
and colleagues searched four academic databases to synthesize the THE WORLD OF SPECIAL OPERATIONS MEDICINE
available evidence on injuries sustained by specialist police and to “The Future of Special Operations Forces Medicine”: Review
compare these injuries with those of other law enforcement offi- of the Paris Special Operations Forces Combat Medical Care Con-
cers and wider Special Forces populations. Out of 3,266 articles ference, Fall 2024.
screened, only 2 studies met the inclusion criteria. Their findings
show that musculoskeletal injuries occur frequently in the spe-
cialist police population and may bear some similarities to those
among general duties police officers and Military Special Forces.
However, the scarcity of research highlights the need for further BOOK REVIEW
work in this area as well as the potential for organizational change Tell Them Yourself, It’s Not Your Day
in how injuries are reported. To Die – Including Interview with
Frank Butler

In This Issue | 9