IISSSSNN 11555533--99776688 WWiinntteerr 22001111 VVoolluummee 1111,, EEddiittiioonn 11 V V o o l l u u JJoouurrnnaall ooff SSppeecciiaall OOppeerraattiioonnss MMeeddiicciinnee m m e e A Peer Reviewed Journal for SOF Medical Professionals 1 1 1 1 , , E E d d i i t t i i o o n n 1 1 / / W W i i n n t t e e r r 1 1 1 1 J J o o u u r r n n a a l l o o f f S S p EE ROM THE DITOR FOR ANTIMPORT CHANGES TO THE p S EE “F ROM THE E DITOR” FOR IMPORTANT CHANGES TO THE JSO JSOM!M! e e c c i i a a l l O O p p e e r r a a t t i i o o n n s s M M e e d d i i c c i i n n e e THIS EDITION’S FEATURE ARTICLES: ● Publliic Heallth Operatiions iin the JSOTF-P I I S S ● Masllow’s Hiierarchy of Needs: A Miissiing Liink iin COIN Strategy S S ● Optimizing Nutrition for Performance at Altitude: A Literature Review N ● Optimizing Nutrition for Performance at Altitude: A Literature Review N ● Soldiers Can Take It – A Conceptual Analysis of Trauma 1 ● Soldiers Can Take It – A Conceptual Analysis of Trauma 1 5 5 ● Feedback to the Field: An Assessment of Sternal Intraosseous (IO) Infusion 5 ● Feedback to the Field: An Assessment of Sternal Intraosseous (IO) Infusion 5 3 3 ● Mentall Status iin a U..S.. Army Speciiall Forces Solldiier - - 9 9 7 7 ● Survey of the Indiicatiions for Use of Emergency Tourniiquets 6 6 8 8 ● Physiiollogiicall and Psychollogiicall Characteriistiics of Successfull Combat Controllller Traiinees D ediicated to the Indomiitablle Spiiriit & Sacriifiices of the SOF Mediic Journal of Special Operations Medicine EXECUTIVE EDITOR MANAGING EDITOR Deal, Virgil T. MD, FACS Landers, Michelle DuGuay, RN, BSN, MBA [email protected] [email protected] MEDICAL EDITOR McDowell, Doug, APA-C PEER-REVIEW BOARD Ackerman, Bret T., DO Kane, Shawn F., MD FAAFP Antonacci, Mark A., MD Kacprowicz, Robert, MD, FAAEM Barnes, Scott D., MD Kauvar, David S., MD Behar, Jean-Marc, EMT-P, Tactical Medic, Special Agent Kersch, Thomas J., MD Butler, Frank, K., MD Keenan, Kevin N., MD Chalfin, Steven, MD Kirby, Thomas R., OD Christian, John, PsyD Kleiner, Douglas M., PhD Coldwell, Douglas M., PhD, MD, FSIR Lephart, Scott M. PhD Cook, Gray, MSPT, OCS, CSCS Logan, Bret W., M.D. Davis, William J., COL (Ret) Lutz, Robert H., MD Diebold, Carroll J. , MD Mandry, Cris V., MD, FACEP Doherty, Michael C., BA, MEPC, MSS Miller, Robert M., NREMT-P Flinn, Scott D., MD Montgomery,. Harold R., EMT, ATP Forsten, Robert D., DO, FS, DMO Mouri, Michael P., MD, DDS Froede, Kate, BNSc., MSN, RN Murray, Clinton K., MD, FACP Fudge, James M., DVM, MPVM Noback, Robert K., MD, SFS, MPH-TM Gandy, John J., MD Ong, Richardo C., MD Gephart, William, PA-S Ostergaard, Cary A., MD Gerber, Fredrick E., MMAS Parks, Philip D. II, MD, MPH-TM, MOccH Giebner, Steven D., MD Pennardt, Andre M., MD Giles, James T., DVM Peterson, Robert D., MD Greydanus, Dominique J., EMT-P Risk, Gregory C., MD Gosch, Terry L., DMV, MPH Ritchie, Elspeth C., MD, MPH Goss, Donald L.,DPT, OCS, ATC, CSCS Rosenthal, Michael D. PT, DSc Godbee, Dan C., MD Steinberg, Barry, MD, DDS, PhD, FACS Hammesfahr, Rick, MD Talbot, Timothy S., MD Hanel, Rita M., DVM, DACVIM, DACVECC Taylor, Wesley M. DVM Harris, Kevin D., DPT, OCS, CSCS Williams, Christopher S., MD, SFS Hesse, Robert W., RN, CFRN, FP-C VanWagner, William, PA-C Heath, Donald C., Jr., EMT/P, SWAT, Tactical Medic Veliz, Cesar E., NREMT-P, ATP Holcomb, John B., MD Viola, Steven P., (SEAL) 18D/NREMT-P Hoyt, Robert E. MD FACP TEXT EDITORS Ackermann, Bret T. DO, FACEP Godbee, Dan C., MD, FS, DMO Boysen, Hans Hesse, Robert W., RN, CFRN, FP-C Doherty, Michael C., BA, MEPC, MSS Kleiner, Douglas M. , PhD Forsten, Robert D., DO, FS Mayberry, Robert, RN, CFRN, EMT-P Gephart, William J., PA-S Peterson, Robert D., MD VanWagner, William, PA-C 2 Journal of Special Operations Medicine Volume 11, Edition 1 / Winter 11 Winter 11 CCOONNTTEENNTTSS Volume 11, Edition 1 Medic Recognition 1 Book Review 52 Wartime: Understanding and Behavior in the Second World War Dedication 3 Review by LTC Craig A. Myatt FEATURE ARTICLES From the USSOCOM Command Surgeon 54 Public Health Operations in the JSOTF-P 4 CPT Dennis Rufolo; CPT Cyndie Facciolla, DVM COL Tom Deal Maslow’s Hierarchy of Needs: A Missing Link in COIN 8 Strategy Component Surgeons 55 LTC Jennifer Caci, MSC, MS COL Peter Benson USASOC Optimizing Nutrition for Performance at Altitude: 12 Col Timothy Robinette AFSOC A Literature Review CAPT Gary Gluck NAVSPEC SSgt Doug Kechijan Soldiers Can Take It – A Conceptual Analysis of Trauma 18 USASFC Surgeons 59 Kate Froede, BNSc, MSN, RN LTC Andrew Landers Feedback to the Field: 23 An Assessment of Sternal Intraosseous (IO) Infusion COL H. Theodore Harcke, MD; Lt Col Geoffrey Crawley, MD; USSOCOM Psychologist 60 Lt Col (Sel) Edward Mazuchowski, MD LTC Craig Myatt, PhD Altered Mental Status in a U.S. Army Special Forces Soldier 27 SFC Jonathan Brandon, 18D and MAJ Guyon J. Hill, MD SOMA Updates 68 Survey of the Indications for Use of Emergency Tourniquets 30 LTC Robert Harrington, SOMA President COL John F. Kragh, Jr., MD; CPT Michelle L. O’Neill, AN; LTC Dorothy F. Beebe, AN; LTC Charles J. Fox, MD; Alec C. Beekley, MD; Jeffrey S. Cain, MD; Donald L. Parsons, PA-C; MAJ Robert L. Mabry, MD; COL Lorne H. Blackbourne, MD TCCC Updates 71 Frank Butler, MD, CAPT (Ret) Physiological and Psychological Characteristics of 39 TCCC Related Article Abstracts Successful Combat Controller Trainees Maj Thomas B. Walker, BSC, PhD; 1 Lt Lynette M. Lenne- mann; Capt Julia N. McGregor; Camilla Mauzy, PhD; Lt Col Need to Know 91 Michael F. Zupan, BSC, PhD SOFTT-W Voluntary Exchange Bolin Chest Seal Safety Alert Notice Abstracts from Current Literature 48 Meet the JSOM Staff 93 Submission Criteria 94 Table of Contents I Top image: Barangay children participate in proper hand-washing exercises. Photo by: MC2 Joshua Scott. Bottom image: An AFP Marine medic injects a cow with Ivermectin dewormer (Jolo) ISSN 1553-9768 Images are part of the Public Health Operations in the JSOTF-P article by CPT Dennis Rufolo and CPT Cyndie Facciolla, DVM. FROM THE EDITOR JSOM DISCLAIMER STATEMENT: The Journal of Special Operations Medicine (JSOM) presents both medical and non-medical professional information to expand the knowledge of military SOF, civilian Tactical EMS, and gov- ernmental agencies with tactical medical assets. It promotes collaborative partnerships among services, compo- nents, corps, and various specialties. The JSOM conveys medical service support information and provides a peer-reviewed, quality print medium to encourage dialogue concerning SOF medical initiatives. The views con- tained herein are those of the authors and do not necessarily reflect the Department of Defense. The United States Special Operations Command and the JSOM do not hold themselves responsible for statements or prod- ucts discussed in the articles. Unless so stated, material in the JSOM does not reflect the endorsement, official attitude, or position of the USSOCOM-SG or of the Editorial Board. The Journal of Special Operations Medicine’s (JSOM) mission is to promote the professional development of Spe- cial Operations and TEMS medical personnel by providing a forum for the examination of the latest advancements in medi- cine and the history of unconventional warfare medicine. Starting with the Spring 2011 edition, the JSOM will become the Official Journal of the Special Operations Medical Assocoiation (SOMA). Contact information for the JSOM will change starting 1 May, 2011. I will post more information in the Spring Edition regarding where to go to submit, subscribe, or advertise. In the meantime, all submissions and any JSOM related issues can be answered by emailing me at [email protected]. CONTENT: All scientific articles are peer-reviewed prior to publication. The Journal of Special Operations Medicine reserves the right to edit all submitted material. Content of this publication is not copyrighted. Published works may be reprinted pro- vided credit is given to the JSOM and the authors. Articles, photos, artwork, and letters are invited, as are comments and crit- icism, and should be addressed to JSOM Editor, Breakaway Media, 3961 26th Ave North, St Petersburg, FL 33713. Telephone: 727-409-8603, fax: 727-521-4704; e-mail [email protected]. As we continue to grow and become more competitive with the other peer-reviewed medical journals on the market, all articles submitted by USSOCOM members must continue to be reviewed and pre-approved by your commander, compo- nent surgeon, and PAO prior to submission to the JSOM. Authors must adhere to standard OPSEC practices and refrain from mentioning specific units, specific locations, troop strengths, names of actively serving SOCOM personnel, TTPs, vulnerabil- ities, and any other information that could be of use to an adversary. The JSOM is serial indexed (ISSN) with the Library of Congress. Articles published in the peer-reviewed Journal of Special Operations Medicine are indexed in MEDLINE® the National Library of Medicine’s (NLM) bibliographic database of life sciences and biomedical informa- tion. Inclusion in the MEDLINE database ensures that citations to the JSOM will be identified to researchers during searches for relevant information using any of several bibliographic search tools, including the NLM’s DISTRIBUTION: 1) SOMA members receive the JSOM as part of membership.