DTIC ADA495462: Journal of Special Operations Medicine. Volume 8, Edition 1, Winter 2008

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by  Defense Technical Information Center

ISSN 1553-9768 Winter 2008 Volume 8, Edition 1
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1 THIS EDITION’S FEATUREARTICLES:
5
5 ● Fentanyl for Pain Control in Special Operations
3
-
9 ● Lateral Canthotomy in Orbital Compartment Syndrome: Special Operations Medics on the Battlefield Can Save the Eye
7
6
8 ● CCMMEE Fascioliasis and Fasciolopsiasis: Similar Names, Similar Diseases?

● The Military Acute Concussion Evaluation (MACE)
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Journal of Special Operations Medicine, Volume 8, Edition 1
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Building,Hurlburt Field,FL,32544
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Journal of Special Operations Medicine
EXECUTIVEEDITOR MANAGING EDITOR
Farr, Warner D., MD, MPH, MSS Landers, Michelle DuGuay, MBA, BSN
[email protected] [email protected]
Senior Medical Editor
Vogelsang, Robert , DVM, MS, DACVS
[email protected]
Assistant Editor Contributing Editor
Parsons, Deborah A., BSN Schissel, Daniel J., MD
(Med Quiz)
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
Ackerman, Bret T., DO Holcomb, John B., MD
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, Richardo 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
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
Contents
Winter 08 Volume 8, Edition 1
From the Editor 1 FEATURE ARTICLES continued
Dedication 2 Lateral Canthotomy in Orbital Compartment Syn- 54
drome: Special Operations Medics on the Battlefield
SFC Nathan L Winder
Can Save the Eye
From the Command Surgeon 3 Glenn D. Burns, MD;Stephen M. DeLellis MPAS, PA-C
COL Rocky Farr USSOCOM CCMMEE Fascioliasis and Fasciolopsiasis: Similar Names, 58
Enlisted Corner 9 Similar Diseases?
Lynden Bowden, MD, MPH
SOCM Glenn Mercer USSOCOM
The Military Acute Concussion Evaluation (MACE)
68
Component Surgeons 10 Louis French, PsyD, Michael McCrea, PhD,
MarkBaggett, PhD
COL Dalton Diamond USASOC
Col Timothy Jex AFSOC
CME Test and Evaluation Forms 78
CAPT Jay Sourbeer NAVSPECWAR
CAPT Stephen McCartney MARSOC
Abstracts from Current Literature 90
TSOC Surgeons 18
COL Robert Noback SOCCENT Book Reviews by COL Warner Farr 94
LTC William John Gill SOCSOUTH ●Beating Goliath: Why Insurgencies Win
Jeffrey Record
USASFC Surgeon 21
●Science, Strategy, and War: The Strategic Theory of John
LTC Peter Benson USASFC Boyd: Strategy and History Series
FransP.B. Osinga
Education & Training 22
●United States Special Operations Forces
COL Robert Vogelsang, DVM David Tucker, Christopher J. Lamb
Deputy Surgeon of USSOCOM Clinical Services
CPT Scott Gilpatrick Medical History 99
USSOCOM Physician Assistant and ATP coordinator
The Tao (or is it Dao?) of SOF Medicine
Lessons Learned 26 Warner D. Farr
Better Living Through Lessons Learned: Casualty Treatment Previously Published 101
and Evacuation Vignettes From Operation Iraqi Freedom
●Surgery in Afghanistan: A Light Model for Field Surgery
(OIF) and Operation Enduring Freedom (OEF)
During War
CPT Scott M. Gilpatrick, APA-C, DMO; LTC Shawn Kane, MD,
E. Fosse and H. Husurn
SFS, DMO
●Tactical Combat Casualty Care in the Assault on Punta
Correspondence 33 Paitilla Airfield
LCDRJames J. Mucciarone,MC USN; COLCraigH.Llewellyn,
Current Events 34 USAFSMC(Ret.);LtCol John M. Wightman, USAF MC FS
Special Operations Medics Training Center Opens ●Pain Management in the Prehospital Environment
Published in The Fayetteville Observer John G. McManus Jr, MD, FACEP; Donald R. Sallee Jr, MD,
A Medal is Born FAAEMe
Published in Airman, Fall 2007 ● Gunshot Wounds in Military Working Dogs
Memo - Management of Soldiers with Tension Pneumothorax MAJ Janice Baker and CPT Christine Truesdale
Memo - Implementation of New Army Sleep Guidance Med Quiz 122
Upcoming Events 47
Picture This…
JSOMOOC Matthew Lambdin, SSG;Daniel Schissel, MD
Kharod, Chetan, MD, MPH
FEATURE ARTICLES
Fentanyl for Pain Control in Special Operations 48 Meet the JSOM Staff 130
Robert F. Kacprowicz, MD; Troy R. Johnson, MD; Dan S.
Mosely, MD Submission Criteria 131
TableofContents
PastandpresentSeniorEnlistedMedicalAdvisors
ISSN 1553-9768
FromtheEditor
TheJournalofSpecialOperationsMedicine(JSOM)isanauthorizedofficialmilitaryquarterlypublicationoftheUnitedStatesSpe-
cialOperationsCommand(USSOCOM),MacDillAirForceBase,Florida. TheJSOMisnotapublicationoftheSpecialOperationsMedical
Association(SOMA). OurmissionistopromotetheprofessionaldevelopmentofSpecialOperationsmedicalpersonnelbyprovidingaforum
fortheexaminationofthelatestadvancementsinmedicineandthehistoryofunconventionalwarfaremedicine.
JSOMDisclaimerStatement:TheJSOMpresentsbothmedicalandnonmedicalprofessionalinformationtoexpandtheknowledgeof
SOFmilitarymedicalissuesandpromotecollaborativepartnershipsamongservices,components,corps,andspecialties. Itconveysmed-
icalservicesupportinformationandprovidesapeer-reviewed,qualityprintmediumtoencouragedialogueconcerningSOFmedicalinitia-
tives. TheviewscontainedhereinarethoseoftheauthorsanddonotnecessarilyreflecttheDepartmentofDefense. TheUnitedStatesSpecial
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Distribution:ThispublicationistargetedtoSOFmedicalpersonnel. ThereareseveralwaysforyoutoobtaintheJournalofSpecialOpera-
tionsMedicine(JSOM). 1)USSOCOM-SGdistributestheJSOMtoallourSOFunitsandouractiveeditorialconsultants. 2)SOMAmem-
bersreceivetheJSOMaspartofmembership. Pleasenote,ifyouareaSOMAmemberandarenotreceivingthesubscription,youcancontact
SOMAthroughhttp://www.trueresearch.org/soma/[email protected]. SOMAprovidesaveryvaluable
meansofobtainingSOFrelatedCME,aswellasanannualgatheringofSOFmedicalfolkstosharecurrentissues. 3)ForJSOMreaderswho
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Operations University’s new SOF Medical Gateway; it is available to all DoD employees at
https://jsoupublic.socom.mil/publications/index.php. Ontheleftyouwillhaveseveraltabs;youmustfirst“log-in”usingyourSS#,DOB,and
name;thengoto“publications.” ScrolldownuntilyougettotheJSOMandclickonthepicture. Fromthissite,youcanlinkstraighttothe
GovernmentPrintingOfficetosubscribetotheJSOM. WeareworkingwiththeJSOUtohaveaSOCOM-SGmedicalsite;wewillkeepyou
postedasthatprogresses. 5)TheJSOMcanalsobeemailedinPDFformat;ifyouwouldliketobeaddedtothePDFlistpleasesendyourre-
[email protected].
WeneedContinuingMedicalEducation(CME)articles!!!! Remember,ourcontinuingeducationisforallSFmedics,PJs,andSEAL
corpsmen. IncoordinationwiththeUniformedServicesUniversityofHealthSciences(USUHS),wealsoofferCME/CNEtophysicians,PAs,
andnurses.
JSOMCMEconsistsofaneducationalarticlewhichservestomaintain,develop,orincreasetheknowledge,skills,andprofessional
performanceandrelationshipsthataphysicianusestoprovideservicesforpatients,thepublic,ortheprofession. ThecontentofCMEisthat
bodyofknowledgeandskillsgenerallyrecognizedandacceptedbytheprofessionaswithinthebasicmedicalsciences,thedisciplineofclin-
icalmedicine,andtheprovisionofhealthcaretothepublic. AformallyplannedCategory1educationalactivityisonethatmeetsallaccredi-
tationstandards,coversaspecificsubjectareathatisscientificallyvalid,andisappropriateindepthandscopefortheintendedphysician
audience. Morespecifically,theactivitymust:
• Bebasedonaperceivedordemonstratededucationalneedwhichisdocumented
• Beintendedtomeetthecontinuingeducationneedsofanindividualphysicianorspecificgroupofphysicians
• Havestatededucationalobjectivesfortheactivity
• Havecontentwhichisappropriateforthespecifiedobjectives
• Useteaching/learningmethodologiesandtechniqueswhicharesuitablefortheobjectivesandformatoftheactivity
• Useevaluationmechanismsdefinedtoassessthequalityoftheactivityanditsrelevancetothestatedneedsandobjectives
Toqualifyfor1CME,itmusttake60mintobothreadthearticleandtaketheaccompanyingtest. Toaccomplishthis,yourarticles
needtobeapproximately12-15pageslongwitha10-15questiontest. TheJSOMcontinuestosurvivebecauseofthegenerousandtime-
consumingcontributionssentinbyphysiciansandSOFmedics,bothcurrentandretired,aswellasresearchers. Weneedyourhelp! Getpub-
lishedinapeer-reviewjournalNOW! SeeGeneralRulesofSubmissioninthebackofthisjournal. WearealwayslookingforSOF-related
articlesfromcurrentand/orformerSOFmedicalveterans. Weneedyoutosubmitarticlesthatdealwithtrauma,orthopedicinjuries,infectious
diseaseprocesses,and/orenvironmentandwildernessmedicine. Morethananything,weneedyoutowriteCMEarticles. Helpkeepeachother
currentinyourre-licensurerequirements. Don’tforgettosendphotostoaccompanythearticlesoralonetobeincludedinthephotogallery
associatedwithmedicalguysand/ortraining. Ifyouhavecontributionsgreatorsmall…sendthemourway. Oure-mailis:[email protected].
LtColMichelleDuGuayLanders
1
SFC Nathan L. Winder
SFCNathanWinderdiedfromaGSWtotheneckJune26,2007whileassistingthe984thMPnorthofDi-
waniyah,Iraq.
BorninSeoul,SouthKorea,Winder,32,wasraisedinUtah. Hewasassignedto2ndBattalion,1stSpecial
ForcesGroup(Airborne)atFortLewis,WAanddeployedtoIraqinsupportofOperationIraqiFreedomasamem-
beroftheCombinedJointSpecialOperationsTaskForce–ArabianPeninsula.
WinderenlistedintheArmyAugust31,1993,asamechanizedinfantryman. Aftercompletingbasicandadvanced
individualtrainingatFortBenning,GA,hewasassignedtoCompanyB,1stBattalion,41stInfantryRegimentatFort
Riley,KS. HelaterservedasaBradleyFightingvehiclesectionleaderwith1stBn,9thInfantryRegimentatCamp
Hovey,Koreaandasadismountedsquadleaderwith1stBn,5thCavalryRegimentatFortHood,TX.
In2003,hewasselectedtoattendtheSpecialForcesQualificationCourseatFortBragg,tobecomeaSpe-
cialForcesMedic. HeearnedthecovetedGreenBeretin2006andwasassignedtothe1stSpecialForcesGroup(Air-
borne)atFortLewis,WA.
Winder’s military education also includes the Warrior Leaders Course, Basic Noncommissioned Officer
Course,andBasicAirborneCourse.
Hisawardsanddecorationsinclude:ArmyCommendationMedal,ArmyAchievement,GoodConductMedal,
National Defense Service Medal, Global War on Terrorism Service Medal, Korean Service Medal, Noncommis-
sioned Officer Professional Development Ribbon, Army Service Ribbon, Overseas Service Ribbon, Expert In-
fantrymanBadge,ParachutistBadge,Driver/MechanicsBadge,SpecialForcesTab,BronzeStarMedal,PurpleHeart,
MeritoriousServiceMedal,IraqiCampaignMedal,andtheCombatInfantrymanBadge.
Nathanissurvivedbyhiswife,son,andparents.
2 JournalofSpecialOperationsMedicine Volume8,Edition1/Winter08
From the Command Surgeon
WARNERD.“Rocky”FARR
COLONEL,U.S.ARMY
CommandSurgeon
HQUSSOCOM
Several issues ago we published a cover with speak so step up to the plate. SFC Miguel Davila from
someoftheformerUSSOCOMCommandSurgeonson USASOCgaveanexcellenttalkentitled“StrategicLes-
itwhohadcontributedtomakingtheJournalofSpecial sonsfromaUWClinic.”
OperationsMedicine(JSOM)thequalitymedicalpubli- The conference arrangements were, for the first
cationthatitistoday. However,allthechanges,mostly time, run by a professional corporation and it showed.
forthegoodIhope,thathavecomeoutoftheCommand The SOMA website is now run by them at:
Surgeon’s office would not have been possible without http://www.trueresearch.org/soma/. There were some
the quality senior enlisted medical advisors working as bobbles as SOMAtransitions from a small, personal or-
partners with the surgeons, so this JSOM cover is for ganization to a professional enterprise but all in all I
them. We included a chart with the names of ones we thoughitagreatimprovement. Weshouldbeabletoac-
could not find pictures of. These predecessors of ours commodate even more vendors with this change. The
haveleftaproudlegacy. Twoofthemstillworkhereon vendorsarelikefamily,Isay,sincetheyarewithusevery
postandIamprivilegedtoseethemonarecurringbasis. yearandverysupportive. Weowethemavoteofthanks.
Weoweallofthemagreatdealofthanks. It was also nice to see the “gray beards,” the former
This issue of the JSOM follows the December SOMApresidents,there: AllenMoloff,CraigLlewellyn,
2007 Special Operations MedicalAssociation (SOMA) andJimmyCoy. Thiswasthetwentiethanniversary,de-
meeting here in Tampa. SOMAcontinues to grow; we pendingonhowyouarecounting;itistrulybreathtaking
expected1000attendeesperhaps,upfrom800lastyear, toseethechangeandgrowth.
andendedupgettingmorelike1200. Iattachedsomeof Itriedtoattendallofthecomponentconferences
theslidesthatIpresentedatSOMAattheendofthiscol- the weekend before SOMA. The Army conference
umn. WeplantopublishanotherJSOMLessonLearned seemed the biggest, but the Navy was a very close sec-
Supplement, which will include more from the SOMA ond. ItwasalsonicetoseetheMarinesinfullparticipa-
conference. For preparing such an outstanding confer- tion. All seemed very useful to getting component
ence I heartily congratulate the SOMAleadership: Bob business done. One thought to consider is how SOMA
Saum,BobHarrington,RussJustice,SammyRodriguez, candothings,mostprobablythroughthesmallgroupses-
and Dave Davis! Dr. Harrington continues to grow a sions,thatwillcounttowardcomponentmediccertifica-
more robust program each meeting and the attendees tion training? An example would be if SOMAcan be a
overwhelminglylikedthesmallgroupsessions. Partic- portionofSpecialForces’requirementonitsMedicsfor
ularlynoteworthywerethenumberofforeignSOFmed- non-traumamoduletraining. Thismightnotonlybegood
ical soldiers in attendance. With the growth ofTheater forourMedicsbutwouldbeawaytoensureattendance
Special Operations Command Surgeons I hope even ifitcheckedoffsomecommander’sbox. Passanycom-
moreallieswillparticipateandgivepresentations. Bob mentsonthistomyChiefofTraining,LieutenantCom-
Harrington continues to search for enlisted Medics to manderPatterson,[email protected].
3
FromtheSurgeon
CaptainScottyGilpatrickfrommytrainingsection,pre- have no plan and are sticking to it”) on SOF surgical
senteddataontheAdvancedTacticalPractitioner(ATP) careandevacuationintheimmaturetheatersthatweusu-
testandcardatseveralofthecomponentsessions. Send ally work in. These surgeons can advocate with their
any card or certification issues concerning the SOF in- commanding generals on the need for better plans and
teroperablemedicstandardanditssustainmenttohimat: can write better war plans and medical annexes. They
[email protected]. canalsorequirethegeographiccombatantcommandsto
Inaddition,afirstattheSOMAconferencewas support you. I consider them so important that I have
ameetingofalloftheTheaterSpecialOperationsCom- askedthemtoeachprovideacolumnineachissueofthe
mand(TSOC)Surgeons! WehadLTCRustyRowefrom JSOM. ThelastissuestartedwithSOCCENT’sfirstcol-
SOCEUR;LTCJohnGillfromSOCSOUTH;COLBob umnandthisissuestartsSOCSOUTH’sfirst.
Noback from SOCCENT; his incoming replacement, We also had a Biomedical Initiatives Steering
LTC Ric Ong; and LTC(P) Frank Newton on his way Committee meeting crammed into SOMAweek, along
from1stSFG(A)toSOCPAC. TheseTSOCSurgeonsare withourCurriculumEvaluationBoard,orRequirements
your key contact for theater evacuation issues and for- Board, our MedicalAcquisitions and Logistics board.
wardSOFsurgicalsupportissues. Fortoolongwehave Goodthingtheholidaysweretheretorecuperate!
accepted high-risk plans (that is a nice way to say, “We
4 JournalofSpecialOperationsMedicine Volume8,Edition1/Winter08
5
FromtheSurgeon
6 JournalofSpecialOperationsMedicine Volume8,Edition1/Winter08