Army Medicine: Maintaining, restoring, and improving health October – December 2012 Perspectives 1 MG Philip Volpe; COL Mustapha Debboun; Richard Burton Weight Change, Lifestyle, and Dietary Behavior in the US Military’s 6 Warrior in Transition Units CPT Adam J Kieffer; MAJ Renee E. Cole Negative Health Behavior, A Personal Responsibility or Not? 14 MAJ Derek Licina Synthetic Cannabinoid and Cathinone Use Among US Soldiers 19 Cristobal S. Berry-Caban, PhD; Paul E. Kleinschmidt, MD; et al Relationships Among Self-reported Shoe Type, Footstrike Pattern, and Injury Incidence 25 LTC Donald L. Goss; Michael T. Gross, PhD The Effects of BleedArrest on Hemorrhage Control in a Porcine Model 31 Brian Gegel, MSN; James Burgert, MSNA; et al The Effects of QuikClot Combat Gauze on Hemorrhage Control 36 in the Presence of Hemodilution Don Johnson, PhD; CPT Samantha Agee; CPT Amanda Reed; et al Myofibroma of the Mandible: A Case Report 40 COL Collins T. Lyons; COL Preston Q. Welch; et al Dentistry’s Role in the History of the Walter Reed Army Medical Center 44 COL Samuel A. Passo; Nolan A. Watson Developing an Operational Casualty Estimate in a Multinational Headquarters 51 to Inform and Drive Medical Resource Allocation LTC Soo Lee Davis; Col Martin Bricknell, RMC, British Army Strategies to Support Nurse Work Reintegration After Deployment 59 Constructed from Analysis of Army Nurses’ Redeployment Experiences COL Denise L. Hopkins-Chadwick Combat Casualty Care Nursing Research and the Joint Combat Casualty Research Team 64 LTC Laura L. Feider; Lynn S. Platteborze, MS, RAC; et al Registered Nurses as Permanent Members of Medical Evacuation Crews: The Critical Link 72 MAJ Michael W. Wissemann; MAJ Christopher A. VanFosson Clinical Nurse Leader: Emerging Role to Optimize Unit Level Performance 77 MAJ Scott Phillips; MAJ Pauline A. Swiger; et al Lessons Learned Small Unit Postdeployment Survey Results and Analysis 84 MAJ (Ret) David W. Cannon A Professional Publication of the AMEDD Community Online issues of the AMEDD Journal are available at http://www.cs.amedd.army.mil/amedd_journal.aspx October – December 2012 The Army Medical Department Center & School PB 8-12-10/11/12 LTG Patricia D. Horoho The Surgeon General Commander, US Army Medical Command MG Philip Volpe Commanding General US Army Medical Department Center & School By Order of the Secretary of the Army: Official: JOYCE E. MORROW RAYMOND T. ODIERNO Administrative Assistant to the General, United States Army Secretary of the Army Chief of Staff DISTRIBUTION: Special 1220806 The Army Medical Department Journal [ISSN 1524-0436] is published quarterly for components, Corps, and specialties; convey clinical and health service support The Surgeon General by the US Army Medical Dept Center & School, Journal Office, AHS information; and provide a peer-reviewed, high quality, print medium to encourage CDD Bldg 4011, 2377 Greeley RD STE T, Fort Sam Houston, TX 78234-7584. dialogue concerning healthcare initiatives. Articles published in The Army Medical Department Journal are listed and indexed in Appearance or use of a commercial product name in an article published in the MEDLINE, the National Library of Medicine’s premier bibliographic database of life AMEDD Journal does not imply endorsement by the US Government. sciences and biomedical information. As such, the Journal’s articles are readily Views expressed are those of the author(s) and do not necessarily reflect official US accessible to researchers and scholars throughout the global scientific and academic Army or US Army Medical Department positions, nor does the content change or communities. supersede information in other Army Publications. The AMEDD Journal reserves the CORRESPONDENCE: Manuscripts, photographs, official unit requests to receive right to edit all material submitted for publication (see inside back cover). copies, and unit address changes or deletions should be sent to the Journal at the CONTENT: Content of this publication is not copyright protected. Material may be above address. Telephone: (210) 221-6301, DSN 471-6301 reprinted if credit is given to the author(s). DISCLAIMER: The AMEDD Journal presents clinical and nonclinical professional OFFICIAL DISTRIBUTION: This publication is targeted to US Army Medical information to expand knowledge of domestic & international military medical issues Department units and organizations, and other members of the medical community and technological advances; promote collaborative partnerships among Services, worldwide. Perspectives COMMANDER’S INTRODUCTION MG Philip Volpe Health is a state of complete physical, mental health of the individual, indeed, the very lifestyle fac- and social well-being and not merely the tors that affect personal health, and, by extension, the absence of disease or infi rmity. health of our Army and our nation. That statement is the fi rst of the basic principles enu- Since its inception in 1994 by then Army Surgeon merated in the preamble to the Constitution of the General LTG Alcide LaNoue, the AMEDD Journal World Health Organization, adopted on July 22, 1946.* has been on the forefront, providing information sup- The simplicity and clarity of those 21 words are as true porting the three basic strategies for of health promo- today as 66 years ago, without a single amendment or tion: advocacy, enabling, and mediation as present- elaboration. It is as applicable to an organization, a so- ed in the WHO Charter for Health Promotion. The ciety, or a nation as it is to an individual. The interre- Journal presents articles that cover the entire range lationship of those levels of health is clearly captured of health and healthcare. Over the last 7 years, the in the stated vision of Army Medicine: AMEDD Journal has regularly featured articles dedi- Strengthening the health of our Nation by cated to force health protection and public health, re- improving the health of our Army. fl ecting the diverse skills and expertise of Army medi- cal professionals. In the recently issued Army Medicine Strategy (Au- gust 10, 2012), The Surgeon General lays out a shift This issue of the AMEDD Journal maintains the in perspective for our profession, “from a healthcare standard, incorporating articles on nutrition, personal system to a system for health.” The history of Army health responsibility, physical fi tness, and drug abuse. Medicine is rich in groundbreaking success in re- It also contains articles on trauma care, operational search and proactive efforts in preventive medicine, planning, Army nursing, dentistry, and lessons learned public health, and health promotion for our forces. from the combat theaters. Throughout theses pages, Routinely, these achievements are extended beyond the Journal continues to showcase the diversity, the military and greatly benefi t the healthof people sophistication, and talent of medical professionals around the world. The transformation of our health- who accept the responsibility for the health of our care system will build on those achievements and military personnel and their families, both today and expand the perspective to more directly address the tomorrow. EDITOR’S PERSPECTIVE weight-related chronic conditions such as diabetes. In the opening article in this issue, CPT Adam Kief- The Warrior Transition Unit (WTU) program has fer and MAJ Renee Cole report on their study of nu- been very successful in its primary mission, provid- trition choices and weight gain among Wounded War- ing extended treatment and/or rehabilitation ser- riors assigned to WTUs at four Army medical centers. vices to Wounded Warriors to return them to active Their examination revealed that the Warrior recovery duty or prepare them for the transition to civilian process presents a dichotomy in weight management: life. Their wounds are healed, they adapt to losses during healing the major concern is prevention of of limbs and other disabilities, and their psychologi- weight loss; following release to the WTU for out- cal and behavioral health issues are addressed and patient treatment and rehabilitation, weight gain be- treated. However, even as their bodies are being re- comes problematic. The article presents detailed data stored from combat injuries, their lifestyle choices gathered from Warfi ghters as to their body mass in- may become detrimental to their overall health, dex, the nature of their injuries, and their self-assess- both immediate, complicating the rehabilitation ments of their lifestyle choices related to nutrition and and treatment efforts, and over the long term, with weight management. Further, the study subjects were *http://www.who.int/governance/eb/who_constitution_en.pdf asked their opinions of their own weight and physical October – December 2012 1 PERSPECTIVES condition. This article should be of great interest to comparison to the population as a whole. However, those charged with assisting Wounded Warfi ghters military people are still products of society, and it is through their recovery, rehabilitation, and transition inevitable that a certain percentage bring society’s periods, presenting another, more subtle aspect of ills into the service with them. Drug abuse is one of restoring the health of those who have sacrifi ced so the more pernicious of those societal problems that much. the military must address on a continuing basis. Dr Cristobal Berry-Caban and his coauthors have con- MAJ Derek Licina opens his article with the tributed a sobering article describing one of the latest following: dangerous drug abuse practices