DTIC ADA533753: Journal of Special Operations Medicine. Volume 10, Edition 2, Spring 2010

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1. REPORT DATE 3. DATES COVERED
2010 2. REPORT TYPE 00-00-2010 to 00-00-2010
4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER
Journal of Special Operations Medicine. Volume 10, Edition 2, Spring
5b. GRANT NUMBER
2010
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION
United States Special Operations Command (USSOCOM),SOC-SG,7701 REPORT NUMBER
Tampa Point Blvd,MacDill AFB,FL,33621-5323
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Journal of Special Operations Medicine
EXECUTIVEEDITOR MANAGING EDITOR
Deal, Virgil T. MD, FACS Landers, Michelle DuGuay, RN, BSN, MBA
[email protected] [email protected]
MEDICALEDITOR
McDowell, Doug, APA-C
[email protected]
ASSISTANTEDITOR CONTRIBUTINGEDITOR
Parsons, Deborah A., RN, BSN Schissel, Daniel J., MD
(“Picture This” Med Quiz)
CME MANAGERS
Kharod, Chetan U. MD, MPH – USUHS CME Sponsor
Officers Enlisted
Landers, Michelle DuGuay, RN, BSN, MBA McDowell, Doug, APA-C
[email protected] [email protected]
PEER-REVIEW BOARD
Ackerman, Bret T., DO Holcomb, John B., MD
Anders, Frank A., MD Kane Shawn F., MD FAAFP
Antonacci Mark A., MD Kauvar, David S., MD
Baer David G., PhD Kersch, Thomas J., MD
Baskin, Toney W., MD, FACS Keenan, Kevin N., MD
Black, Ian H., MD Kirby, Thomas R., OD
Bower, Eric A., MD, PhD, FACP Kleiner Douglas M., PhD
Briggs, Steven L., PA-C LaPointe, Robert L., SMSgt (Ret)
Bruno, Eric C., MD Llewellyn, Craig H., MD
Cloonan, Clifford C., MD Lorraine, James R., RN, BSN
Coldwell, Douglas M., PhD, MD Lutz, Robert H., MD
Davis, William J., COL (Ret) Mason, Thomas J. MD
Deuster Patricia A., PhD, MPH McAtee, John M., PA-C
Diebold, Carroll J. , MD 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
Giebner, Steven D., MD Risk, Gregory C., MD
Giles, James T., DVM Rosenthal, Michael D. PT, DSc
Greydanus, Dominique J., EMT-P Taylor Wesley M. DVM
Goss, Donald L.,DPT, OCS, ATC, CSCS Tubbs, Lori A., MS, RD
Godbee, Dan C., MD VanWagner, William, PA-C
Harris, Kevin D., DPT, OCS, CSCS Wedmore, Ian S., MD, FACEP
Hammesfahr, Rick, MD Wightman, John M., EMT-T/P, MD
Hesse, Robert W., RN, CFRN, FP-C Yevich, Steven J., MD
TEXT EDITORS
Ackermann, Bret T. DO, FACEP Hesse, Robert W., RN, CFRN, FP-C
Boysen, Hans Kleiner, Douglas M.
Doherty, Michael C., BA, MEPC, MSS Mayberry, Robert, RN, CFRN, EMT-P
Gephart, William J., PA-S Parsons, Deborah A., RN, BSN
Godbee, Dan C., MD, FS, DMO Peterson, Robert D., MD
VanWagner, William, PA-C
Journal of Special Operations Medicine Volume 10, Edition 2 / Spring 10
Contents
Spring 10 Volume 10, Edition 2
Dedication 1 BookReview 40
SFCBradleyS.Bohle
● Don'tTreadonMe:A400-YearHistoryofAmericaatWar,
MedicRecognition 2 fromIndianFightingtoTerroristHunting
ReviewbyLTCCraigA.Myatt
SGTBryanC.Rippee
● TheSurvivorsClub:TheSecretsandSciencethatCould
SaveYourLife
FEATURE ARTICLES
ReviewbyWilliamJ.Gephart
● DitchMedicine:AdvancedFieldProcedures
160thSOAR(A)FlightMedicSpecializedTraining:The 4
forEmergencies
SpecialOperationsAviationMedicalIndoctrination
ReviewbyLTCCraigA.Myatt
Course
CPTL.KyleFaudreeAPA-C,FP-C
FromtheUSSOCOMCommandSurgeon 44
TheUltrasoundDetectionofSimulatedLongBone 7
COLTomDeal
FracturesbyU.S.ArmySpecialForcesMedics
CPTJasonD.Heiner,MD;CPTBenjaminL.Baker,DO;CPT
ComponentSurgeons 45
ToddJ.McArthur,MD
COLPeterBenson USASOC
FractureDetectioninaCombatTheater:FourCases
11 BrigGenBartIddins AFSOC
ComparingUltrasoundtoConventionalRadiography
CAPTGaryGluck NAVSPECWAR
WilliamN.Vasios,APA-C;DavidA.Hubler,18D;Robert
CAPTAnthonyGriffay MARSOC
Lopez,18D;AndrewR.Morgan,MD
SpecialOperatorLevelClinicalUltrasound: 16 TSOCSurgeons 51
AnExperienceinApplicationandTraining COLFrankNewton SOCPAC
AndrewR.Morgan,MD;WilliamN.Vasios,APA-C;David
A.Hubler,18D;PeterJ.Benson,MD
USASFC Surgeon 53
InjuryProfileforAirborneOperationsUtilizingthe 22 LTCAndrewLanders
SF-10AManeuverableParachute
TravisG.Deaton,MD;JasonL.Roby,DO
USSOCOM Psychologist 54
SpecialForcesMedic(18D)andMedicalPlanning 26 LTCCraigMyatt,PhD
MSGOscarL.Ware,BS,MSA,MPH,PhDCandidate
TCCCUpdates 56
Abstractsfrom CurrentLiterature 28 FrankButler,MDCAPT(Ret)
EducationalResources 74
PreviouslyPublished 31
DouglasM.Kleiner,PhD
● InternalDecapitation-HighLigamentusCervicalInjury
NeedtoKnow 83
PelegBen-Galim,MD
● Photographic&MeasurementComparisonofthe
● InternalDecapitation:SurvivalAfterHeadtoNeck CombatApplicationTourniquet(GENIIIvs.E-CAT)
DissociationInjuries
PelegJ.Ben-Galim,MD,TarekA.Sibai,MD,JohnA.Hipp,PhD, ClinicalPearls 103
MichaelH.Heggeness,MD,PhD,andCharlesA.Reitman,MD EasyFilthFlyAbatementduringDeployment
MAJJohnWaynePaul,PA-C
Lesson’sLearned 104
Dr.BruceC.Arne
Meet theJSOM Staff 107
SubmissionCriteria 108
TableofContents
I
FracturedetectionoftheopaquestudymodelviatheSonoSiteM-Turbo
portable ultrasound. From The Ultrasound Detection of Simulated
Long Bone Fractures by U.S.Army Special Forces Medics by CPT
JasonD.Heiner,MDinthisedition. InsetpictureisfromtheWinter
ISSN 1553-9768 2010editionarticlePortableUSEmpowersSpecialForcesMedics
bySSgtJeremyCrisp.
FROMTHEEDITOR
TheJournalofSpecialOperationsMedicine(JSOM)isanauthorizedofficialmilitaryquarterlypub-
licationoftheUnitedStatesSpecialOperationsCommand(USSOCOM),MacDillAirForceBase,Florida.
TheJSOMisnotapublicationoftheSpecialOperationsMedicalAssociation(SOMA). Ourmissionisto
promotetheprofessionaldevelopmentofSpecialOperationsmedicalpersonnelbyprovidingaforumforthe
JSOM DISCLAIMER STATEMENT: The JSOM presents both medical and nonmedical professional in-
formationtoexpandtheknowledgeofSOFmilitarymedicalissuesandpromotecollaborativepartner-
ships among services, components, corps, and specialties. It conveys medical service support
informationandprovidesapeer-reviewed,qualityprintmediumtoencouragedialogueconcerningSOF
medical initiatives. 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 Spe-
cialOperationsMedicinedonotholdthemselvesresponsibleforstatementsorproductsdiscussedinthe
articles. Unless so stated, material in the JSOM does not reflect the endorsement, official attitude, or
positionofthe USSOCOM-SG oroftheEditorialBoard.
examinationofthelatestadvancementsinmedicineandthehistoryofunconventionalwarfare medicine.
CONTENT:Contentofthispublicationisnotcopyrighted. Publishedworksmaybereprintedprovidedcredit
isgiventotheJSOMandtheauthors. Articles,photos,artwork,andlettersareinvited,asarecommentsand
criticism,andshouldbeaddressedtoEditor,JSOM,USSOCOM,SOC-SG,7701TampaPointBlvd,MacDill
AFB, FL 33621-5323. Telephone: DSN 299-5442, commercial: [phone], fax: -2568; e-mail
[email protected]. The JSOM is serial indexed (ISSN) with the Library of Congress and all scientific ar-
ticlesarepeer-reviewedpriortopublication. TheJournalofSpecialOperationsMedicinereservestheright
toeditall material. Nopaymentscanbemadeformanuscriptssubmittedforpublication.
DISTRIBUTION:ThispublicationistargetedtoSOFmedicalpersonnel. Thereareseveralwaysforyouto
obtaintheJournalofSpecialOperationsMedicine(JSOM).
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andarenotreceivingthe subscription,youcancontactSOMAthrough
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averyvaluablemeansofobtainingSOFrelatedCME,aswellasanannualgatheringofSOFmedical
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2)TheJSOMisavailablethroughpaidsubscriptionfromtheSuperintendentofDocuments,U.S.Govern-
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(https://jsoupublic.socom.mil/publications/index.php#jsom);andtoSOMAmembersat
(http://www.truersearch.org/soma).
New!!!!! The Journal of Special Operations Medicine Training Supplement, “2010 Edition” is now
availableforpurchasethroughGPO. Itcanbepurchasedasa(pk/10–S/N:008-070-00817-3–ISBN:978-
0-16-085037-0);or(pk/25–S/N:008-070-00818-1–ISBN:978-0-16-085038-7). Itcanbeorderedonline,
viaphone, fax,email,orpostalmailasabove.
LtColMichelleDuGuayLanders
II
JournalofSpecialOperationsMedicine Volume10,Edition2/Spring10
III
FromtheEditor
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P.O.Box979050
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IV
JournalofSpecialOperationsMedicine Volume10,Edition2/Spring10
SFC BRADLEYS. BOHLE
SFCBradleyS.Bohle,29,diedon16September2009withtwootherSoldiers,afterhisvehiclewas
struckbyanimprovisedexplosivedevice,whileconductingamountedpatrolintheAfghancityofGhur
Ghuri,insupportofcombatoperationswhileservingwith7thSpecialForcesGroup(Airborne).
ASpecialForcesmedicalsergeant,hedeployedinsupportofOperationEnduringFreedominJuly
2009asamemberoftheCombinedJointSpecialOperationsTaskForce–Afghanistan. Thiswashissec-
ond deployment toAfghanistan in support of the Global War on Terror. He also deployed twice to the
Philippines.
Bohle,anativeofGlenBurnie,MD,attendedGlenBurnieHighSchoolforthreeyearsandgrad-
uatedfromNorthCountyHighSchoolin1998. HeenlistedintotheU.S.ArmyasanInformationSystems
Operator. Hewasassignedto2ndBn,8thInfantryRegiment,4thInfantryDivision(Mechanized). Helater
served with 112th Signal Bn (Airborne) and 4th Psychological Operations Group (A) before deciding to
pursuethegoalofbecomingaSpecialForcesSoldierin2006byattendingtheSpecialForcesSelectionand
Assessment. He completed the Special Forces Qualification Course March 2008 and earned the coveted
“GreenBeret”asaSpecialForcesMedicalSergeant(18D). HewasassignedtoCoA,3rdBn,7thSFG(A).
Bohle’s military education includes the Warrior Leader’s Course, Basic NCO Course, Survival,
Evasion,ResistanceandEscapeCourse,BasicAirborneCourse,JumpmasterCourse,andSpecialForces
QualificationCourse.
HisawardsanddecorationsincludetheBronzeStarMedal,PurpleHeartMedal,ArmyCommen-
dationMedal,ArmyAchievementMedal,MeritoriousUnitCitation,ArmyGoodConductMedal,National
Defense Service Medal,Afghanistan Campaign Medal, Global War on Terrorism Expeditionary Medal,
GlobalWaronTerrorismServiceMedal,non-commissionedofficerprofessionaldevelopmentribbon,Army
ServiceRibbon,OverseasServiceRibbon,NATOMedal,CombatInfantrymanBadge,SeniorParachutist
Badge,DriverandMechanicsBadge,andtheSpecialForcesTab.
Bohleissurvivedbyhiswife,threedaughters,asister,andhisparents.
Dedication
1
SGTBryanC.Rippee,congratulationsfromthe
JournalofSpecialOperationsMedicineonyour
selectionasthe 2009USASOC SpecialOperations
Combat MedicoftheYear.
77775555tttthhhh RRRRaaaannnnggggeeeerrrr nnnnaaaammmmeeeedddd UUUUSSSSAAAASSSSOOOOCCCC MMMMeeeeddddiiiicccc ooooffff tttthhhheeee YYYYeeeeaaaarrrr
Tracy A. Bailey
75th Ranger Regiment Public Affairs
FortBenning,GA(USASOCNewsService,16FEB2010)–Bravingahailofautomaticgunfireduringanintense
firefight,SGTBryanC.Rippee,lessthan10feetawayfromthetipoftheenemy’sweapon,assessedthesituation,
tookchargeandrapidlybegantreatmentofthewounded.
Theintenseclose-quartersgunfireexchangebetweenmilitantsandRangerswhileclearingthecompound
hadleftoneRangerwoundedandunresponsiveinthecenteroftheroom. Withgunfireandgrenadescontinuing
tocrosstheroom,RangermedicSGTRippeeexposedhimselftoenemyfireinordertosuppresstheenemy. Gain-
ingfiresuperiorityhenoticedanotherRangeralsowounded.
“Someoneoncesaidthebestmedicineonthebattlefieldisfiresuperiority,”saysRippee,underplayingthe
roleheplayed. “Asamedic,Iaminapositiontobenefittheforceandstrivetobeabletohelpincombatbothas
amedicandaSoldier.”
HebegantreatingthechestwoundswhileaRangerassaultelementmovedforwardtoneutralizetheenemy
threatwithsmallarmsandhandgrenades. Rippeeusedhisbodytoshieldthecasualtyfromtheexplosionsandcon-
tinuedtreatment.
As an emergency medical technician moved into the room Rippee directed him to assess and treat the se-
verelydamagedleftarmofasecondcausality. Hecontinuedtodirectcareandtreatmentuntiladditionalmedical
personnelarrived.
CPTAndrewD.Fisher,1stRangerBattalionPhysicianAssistant,andamanwhoknowsSGTRippeewell,
hadthistosayoftheRangermedicthatday.
“Recognizingtheseverityofthewounds,SGTRippeerapidlybeganhisinitialassessmentandtreatment.
Attheriskofbeingengagedbytheenemy,hetookthenecessarystepstosecureandtreatthecasualty,”hesaid. “I
havedeployedwithSGTRippeeonallofhisdeploymentsandhavewitnessedmanyofhisheroicandvalorousac-
tions…”
2 JournalofSpecialOperationsMedicine Volume10,Edition2/Spring10
For that day in Iraq, he was awarded the Army Commendation Medal with Valor device. It was for this
type of repeated selfless service and courage that, Rippee, a native of Riverside, CA and combat medic assigned to
the 75thRanger Regiment stationed at Hunter Army Airfield, was named the 2009 U.S. Army Special Operations
Command Medic of the Year.
The nomination consisted of a two-page recommendation from the combat medic’s supervisors and en-
dorsement from the his chain of command. Eighteen nominee packets were submitted and reviewed by the Com-
mand Sergeant Major of U.S. Army Special Operations Command, Command SGM Parry Baer. While all the
candidate’s packets were strong, Rippee’s consistent bravery and efforts as a combat medic in multiple actions
seemed to set him apart.
SGT Rippee has been with the battalion since August 2007. Throughout his time in the 75thRanger Regi-
ment, Rippee has proven over and over his mettle as a combat medic both on and off the battlefield.
In the fall of 2009, serving with 1st Ranger Battalion in Afghanistan, while conducting a night time opera-
tion, a team of Rangers were critically wounded when they encountered an improvised explosive device. Rippee,
who witnessed the event from about 40 meters away, ran into the unsecure blast area without regard for his own
safety, and begin treating and conducting triage.
“My first reaction was to run like hell towards the explosion and the Rangers; I knew there would be a lot
of casualties,” said Rippee. “I bolted down the road through the smoke and dust and came upon a wounded Ranger
and began assessing and treating him. We are trained to treat wounded Rangers by the severity of the wounds, not
how bad the wounds look,” said Rippee.
After the casualty collection point was established, Rippee assisted in the movement of the wounded and con-
tinued treating the Rangers until medical evacuation arrived.
In that encounter, Rippee, was credited with saving the lives of two of the six wounded. In another inci-
dent during that same rotation, a mid-air collision of two helicopters in route to a target compound instantly turned
the assault mission into a combat search and rescue, as the remainder of the force quickly landed at the crash.
Rapidly exiting the helicopter he was on, Rippee immediately ran to the burning wreckage.
With ammunition and fuel cooking off around him, and the screams of the injured trapped in the flaming
aircraft piercing the night, Rippee and a Ranger squad leader pulled one of the survivors from the burning airframe,
carrying him 40 meters then conducting the medical efforts that would save that Soldier’s life.
For Rippee, who doesn’t consider himself a hero, courage seems to be an ingrained trait, apparent to his fel-
low Rangers and supervisors.
“SGT Rippee is a devoted and extraordinary medic. His performance both in training and in combat are
the epitome what a United States Army Special Operations Non-commissioned Officer should Be, Know and Do,”
said Fisher. “He is an immeasurable asset to our organization. His sense of ethics and discipline is beyond reproach.”
Rippee’s training includes Basic Combat Training, Advanced Individual Training—Combat Medic Course,
Basic Airborne Course, Ranger Assessment and Selection Program and Ranger School. The Combat Medic Course
is taught at Fort Sam Houston, Texas and provided Rippee with his EMT-Basic Certification and qualified him as
a combat medic.
Following these courses, Rippee attended the Special Operations Combat Medic Course at Fort Bragg, NC.
The intensive six month course teaches extensive training in anatomy and physiology, kinetics of trauma, advanced
trauma skills and procedures, Trauma Combat Casualty Care,and combat trauma management.
He also completed a one month emergency room and EMT rotation at Tampa General Hospital and Tampa
Fire and Rescue in Tampa, FL. Upon graduation, he received a certification as an Advanced Tactical Practitioner
(ATP).
Rippee has deployed three times in support of the Operations Enduring Freedom and Operation Iraqi Free-
dom; twice to Iraq and once to Afghanistan.
His awards include the Ranger Tab and Parachutists Badge, Meritorious Service Medal, Joint Service Com-
mendation Medal, Army Commendation Medal for Valor, Army Achievement Medal Army Good Conduct Medal,
National Defense Service Medal, Afghanistan Campaign Medal, Iraq Campaign Medal, Global War on Terrorism
Service Medal and Army Service Ribbon.
Medic Recognition 3