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ISSN 1553-9768 Summer 2008 Volume 8, Edition 3 V JJoouurrnnaall ooff SSppeecciiaall OOppeerraattiioonnss MMeeddiicciinnee o l u m A Peer Reviewed Journal for SOF Medical Professionals e 8 , E d i t i o n 3 / S u m m e r 0 8 J o u r n a l o f S p e c i a l O p e r a t i o n s M e d i c i n e N THIS DITION PDATED ACTICAL OMBAT ASUALTY ARE UIDELINES I E : U T C C C G THIS EDITION’S FEATURE ARTICLES: I ● Thoughts on Aid Bags: Part One S S ● Canine Tactical Field Care: Part One – Physical Examination and Medical Assessment N ● Intermittent Hypoxic Exposure Protocols to Rapidly Induce Altitude Acclimatization in the SOF Operator 1 5 ● A Series of Special Operations Forces Patients with Sexual Dysfunction in Association with a Mental Health 5 3 Condition - 9 ● CME - Mild Traumatic Brain Injury: Situational Awareness for Special Operations Medical Providers 7 6 ● Spontaneous Pneumopericardium, Pneumomediastinum and Subcutaneous Emphysema in a 22-year old 8 Active Duty Soldier Dediicated to the Indomiitablle Spiiriit & Sacriifiices of the SOF Mediic Journal of Special Operations Medicine EXECUTIVE EDITOR MANAGING EDITOR Farr, Warner D., MD, MPH, MSS Landers, Michelle DuGuay, MBA, BSN [email protected] [email protected] Medical Editor Gilpatrick, Scott, APA-C [email protected] Assistant Editor Contributing Editor Parsons, Deborah A., BSN Schissel, Daniel J., MD (Med Quiz “Picture This”) CME MANAGERS Kharod, Chetan U. MD, MPH -- USUHS CME Sponsor Officers Enlisted Landers, Michelle DuGuay, MBA, BSN Gilpatrick, Scott, PA-C [email protected] [email protected] EDITORIAL BOARD Ackermann, Bret T., DO Hoyt, Robert E. MD, FACP Anders, Frank A., MD Kauvar, David S., MD Antonacci Mark A., MD Kersch, Thomas J., MD Baer David G., PhD Keenan, Kevin N., MD Baskin, Toney W., MD, FACS Kirby, Thomas R., OD Black, Ian H., MD Kleiner Douglas M., PhD Bower, Eric A., MD, PhD, FACP LaPointe, Robert L., SMSgt (Ret) Briggs, Steven L., PA-C Llewellyn, Craig H., MD Bruno, Eric C., MD Lorraine, James R., BSN Cloonan, Clifford C., MD Lutz, Robert H., MD Coldwell, Douglas M., PH.D., M.D. Mason, Thomas J. MD Davis, William J., COL (Ret) McAtee, John M., PA-C Deuster Patricia A., PhD, MPH McManus, John G., MD Doherty, Michael C., BA, MEPC, MSS Mouri, Michael P., MD, DDS Flinn, Scott D., MD Murray Clinton K., MD, FACP Fudge, James M., DVM, MPVM Ong, Ricardo C., MD Gandy, John J., MD Ostergaard, Cary A., MD Garsha, Larry S., MD Pennardt, Andre M., MD Gephart, William, PA-S Peterson, Robert D., MD Gerber, Fredrick E., MMAS Riley, Kevin F., PhD, MSC Giebner, Steven D., MD Risk, Gregory C., MD Giles, James T., DVM Tubbs, Lori A., MS, RD Greydanus, Dominique J., EMT-P VanWagner, William, PA-C Godbee, Dan C., MD Wedmore, Ian S., MD, FACEP Hammesfahr, Rick, MD Wightman, John M., EMT-T/P, MD Holcomb, John B., MD Yevich, Steven J., MD TEXT EDITORS Boysen, Hans Doherty, Michael C., MEPC, MSS Gephart, William, PA-S Godbee, Dan C., MD Hesse, Robert W., RN Parsons, Deborah A., BSN Peterson, Robert D., MD VanWagner, William, PA-C Journal of Special Operations Medicine Volume 8, Edition 1 / Winter 08 Summer 08 Contents Volume 8, Edition 3 From the Editor I FEATURE ARTICLES continued Ediitoriiall 65 Dedication 1 Acute Mountain Sickness Prophylaxis in the SOF Sergeant 1st Class Michael J. Tully Operator Andre M. Pennardt, MD; Timothy Talbot, MD From the Command Surgeon 2 A Series of Special Operations Forces Patients with Sex- 67 COL Rocky Farr USSOCOM ual Dysfunction in Association with a Mental Health Condition Enlisted Corner 4 Gregory Lang, MD SOCM Glenn Mercer USSOCOM CME 74 Mild Traumatic Brain Injury: Situational Awareness for Component Surgeons 5 Special Operations Medical Providers COL Virgil Deal USASOC Robert D. Forsten D.O., MC; Richard J. Roberts Ph.D.; Col Timothy Jex AFSOC Charles Stewart M.D., FACEP, FAAEM; Benjamin E. CAPT Jay Sourbeer NAVSPECWAR Solomon M.D., MC; Mark R. Baggett Ph.D., MS CAPT Stephen McCartney MARSOC Spontaneous Pneumopericardium, Pneumomedasti- 88 TSOC Surgeons 8 num and Subcutaneous Emphysema in a 22-year old Active Duty Soldier LTC Ricardo Ong SOCCENT David Thompson, MPAS, PA-C COL Frank Newton SOCPAC COL Rusty Rowe SOCEUR USASFC Surgeon 13 CME Test and Evaluation 91 LTC Peter Benson USASFC Abstracts from Current Literature 102 Education & Training 14 CPT Scott M. Gilpatrick APA-C, DMO Book Reviews 106 Director of Medical Education and Training ● Sun Zi’s Art of War and Health Care by Warner Farr,MD Correspondence 38 ● Behind the Wire by Frank Anders, MD ● War & Public Health by Joe Patterson, MSC Current Events 39 ● Combat Surgeons by Scott Gilpatrick, PA-C ● U.S. Army Special Operations in World War II by Keith • SF Medic Receives Second Highest Medal Vollenweider, MSC • Legendary SOF Heroes • AFSOC Pararescueman receives 2008 AFSA Pitsenbarger Award Previously Published 112 What’s New 42 ● Does intraosseous equal intravenous? A pharmacokinetic Tactical Combat Casualty Care Guidelines study by Daniel D. Von Hoff MD, et al. ● Tourniquets for the control of traumatic hemorrhage: A EATURE RTICLES review of the literature by Stephen L Richey F A ● Three-Step Emergency Cricothyroidotomy by Allan MacIn- Thoughts on Aid Bags: Part 1 47 tyre, DO et al. Michael R. Hetzler, 18D; Justin A. Ball, 18D Canine Tactical Field Care: Part One Med Quiz 133 The Physical Examination and Medical Assessment 54 Wesley M. Taylor, DVM; Diplomat, ACLAM Picture This… Rusty Rowe MD; Daniel Schissel, MD Intermittent Hypoxic Exposure Protocols to Rapidly 61 Induce Altitude Acclimatization in the SOF Operator Brian L. Delmonaco, MD, FACEP; Jason Andrews, Parares- Meet the JSOM Staff 137 cueman; Aaron May, Combat Control Technician Submission Criteria 138 Table of Contents The battle for Iwo Jima resulted in over 28,000 U.S. casualties before the island was finally secured in March 1945. “A Warrior Homeward Bound,” painted by William F. Draper, is from the Navy Art Collection, Washington, DC. This painting was on the cover of Navy ISSN 1553-9768 Medicine Jan / Feb 2007. From the Editor The Journal of Special Operations Medicine (JSOM) is an authorized official military quarterly publication of the United States Spe- cial Operations Command (USSOCOM), MacDill Air Force Base, Florida. The JSOM is not a publication of the Special Operations Medical Association (SOMA). Our mission is to promote the professional development of Special Operations medical personnel by providing a forum for the examination of the latest advancements in medicine and the history of unconventional warfare medicine. JSOM Disclaimer Statement: The JSOM presents both medical and nonmedical professional information to expand the knowledge of SOF military medical issues and promote collaborative partnerships among services, components, corps, and specialties. It conveys med- ical service support information and provides a peer-reviewed, quality print medium to encourage dialogue concerning SOF medical initia- tives. The views contained herein are those of the authors and do not necessarily reflect the Department of Defense. The United States Special Operations Command and the Journal of Special Operations Medicine do not hold themselves responsible for statements or products dis- cussed in the articles. Unless so stated, material in the JSOM does not reflect the endorsement, official attitude, or position of the USSO- COM-SG or of the Editorial Board. Content: Content of this publication is not copyrighted. Published works may be reprinted provided credit is given to the JSOM and the au- thors. Articles, photos, artwork, and letters are invited, as are comments and criticism, and should be addressed to Editor, JSOM, USSOCOM, SOC-SG, 7701 Tampa Point Blvd, MacDill AFB, FL 33621-5323. Telephone: DSN 299-5442, commercial: (813) 826-5442, fax: -2568; e- mail [email protected]. The JSOM is serial indexed (ISSN) with the Library of Congress and all scientific articles are peer-reviewed prior to publication. The Journal of Special Operations Medicine reserves the right to edit all material. No payments can be made for manuscripts sub- mitted for publication. Distribution: This publication is targeted to SOF medical personnel. There are several ways for you to obtain the Journal of Special Opera- tions Medicine (JSOM). 1) USSOCOM-SG distributes the JSOM to all our SOF units and our active editorial consultants. 2) SOMA mem- bers receive the JSOM as part of membership. Please note, if you are a SOMA member and are not receiving the subscription, you can contact SOMA through http://www.trueresearch.org/soma/ or contact Jean Bordas at [email protected]. SOMA pro- vides a very valuable means of obtaining SOF related CME, as well as an annual gathering of SOF medical folks to share current is- sues. 3) For JSOM readers who do not fall into either of the above mentioned categories, the JSOM is available through paid subscription from the Superintendent of Documents, U.S. Government Printing Office (GPO), for only $30 a year. Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. GPO order desk -- telephone (202) 512-1800; fax (202) 512-2250; or visit http://bookstore.gpo.gov/sub- scriptions/alphabet.html. You may also use this link to send a email message to the GPO Order Desk — [email protected]. 4) The JSOM is on- line through the Joint Special Operations University’s new SOF Medical Gateway; it is available to all DoD employees at https://jsoupublic.socom.mil/publications/index.php. On the left you will have several tabs; you must first “log-in” using your SS#, DOB, and name; then go to “publications.” Scroll down until you get to the JSOM and click on the picture.
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