DTIC ADA548859: Journal of Special Operations Medicine. Volume 9, Edition 2, Spring 2009

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1. REPORT DATE 3. DATES COVERED
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Journal of Special Operations Medicine. Volume 9, Edition 2, Spring
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2009
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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]
MEDICALEDITOR
Gilpatrick, Scott, APA-C, DMO
[email protected]
ASSISTANTEDITOR CONTRIBUTINGEDITOR
Parsons, Deborah A., BSN Schissel, Daniel J., MD
(“Picture This” 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
Diebold, Carroll J. , MD Mouri, Michael P., MD, DDS
Michael C., BA, MEPC, MSS Murray Clinton K., MD, FACP
Flinn, Scott D., MD Ong, Richardo C., MD
Fudge, James M., DVM, MPVM Ostergaard, Cary A., MD
Gandy, John J., MD Pennardt, Andre M., MD
Garsha, Larry S., MD Peterson, Robert D., MD
Gephart, William, PA-S Riley, Kevin F., PhD, MSC
Gerber, Fredrick E., MMAS Risk, Gregory C., MD
Giebner, Steven D., MD Rosenthal, Michael D. PT, DSc
Giles, James T., DVM Taylor Wesley M. DVM
Greydanus, Dominique J., EMT-P Tubbs, Lori A., MS, RD
Goss, Donald L.,DPT, OCS, ATC, CSCS VanWagner, William, PA-C
Godbee, Dan C., MD Wedmore, Ian S., MD, FACEP
Harris, Kevin D., DPT, OCS, CSCS Wightman, John M., EMT-T/P, MD
Hammesfahr, Rick, MD 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., MEPC, MSS Mayberry, Robert, RN, CFRN, EMT-P
Gephart, William J., PA-S Parsons, Deborah A., BSN
Godbee, Dan C., MD, FS, DMO Peterson, Robert D., MD
VanWagner, William, PA-C
Journal of Special Operations Medicine Volume 9, Edition 2 / Spring 09
ASpecial Forces medic cleans and bandages an Iraqi man’s thumb
duringacordonandknockmissioninthevillageofAl-Ma’ejeel,Iraq.
The medic also dispensed antibiotics to the man, who burned his
thumb. (PhotobySgt.1stClassChuckJoseph,196thMobilePublic
AffairsDetachment)
ISSN 1553-9768
FromtheEditor
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LtColMichelleDuGuayLanders
I FromtheEditor
Contents
Spring 09 Volume 9, Edition 2
Dedication 1 BookReviews 109
SSGMarcJ.Small ● BiobehavioralResiliencetoStress
● TheU.S.ArmyandIrregularWarfare,1775-2007:Selected
FEATURE ARTICLES
Papersfromthe2007ConferenceofArmyHistorians
FieldEvaluationandManagementofNon-BattleRelated 2 ● UnitedStatesArmyLogistics1775-1992: AnAnthology
KneeandAnkleInjuriesbytheATPintheAustere Volume1
Environment–PartTwo ● TheOath
JFRickHammesfahr,MD ● TheyFoughtAlone
● TheAirForceRoleinLow-IntensityConflict
CanineTacticalFieldCarePartTwo–Massive 13 ● TheCompanyTheyKeep:LifeInsidetheU.S.Army
HemorrhageControlandPhysiologicStabilizationofthe
SpecialForces
VolumeDepleted,Shock-Affected,orHeatstroke-
AffectedCanine
FromtheCommandSurgeon 121
WesleyM.Taylor,DVM
COLRockyFarr USSOCOM
ACaseofReactiveArthritisinaRangerIndoctrination 22
ComponentSurgeons 125
Program(RIP)Student
CPTRobertS.Hart,DO,FS;MAJJohnF.Detro,PA-C COLVirgilDeal USASOC
FunctionalTrainingProgramBridgesRehabilitation 29 ColBartIddins AFSOC
andReturntoDuty CDRLannyBoswell NAVSPECWAR
MAJDonaldL.Goss,DPT,OCS;MAJGreerE.Christo- CAPTStephenMcCartney MARSOC
pher,MSPT;SSG(P)RobertT.Faulk;COLJoeMoore,PT,
TSOCSurgeons 131
PhD,SCS,ATC
COLRicOng SOCAfrica
TheImpedanceThresholdDevice(ITD-7)—ANew 49
LTCRustyRowe SOCEUR
DeviceforCombatCasualtyCaretoAugmentCirculation
COLFrankNewton SOCPAC
andBloodPressureinHypotensiveSpontaneouslyBreath-
ingWarFighters USASFCSurgeon 135
DonParsons,PA-C;VicConvertinoPhD;AhamedIdris,
LTCPeterBenson USASFC
MD;StephenSmith,MD;DavidLindstrom,MD;BrentPar-
quette,Medic;TomAufderheide,MD
USSOCOMMedicalLogistics 136
MilitaryMedicalHistory 54 MAJPeteFranco
TheUnitedStatesArmySpecialForces—WalterReed
USSOCOMOPS 138
ArmyInstituteofResearchFieldEpidemiologicSurvey
Team(Airborne) MAJAnthonyKing
LTCTheodoreDorogi,MSC(USARRet)
USSOCOMPsychologist 140
AbstractsfromCurrent Literature 72
LTCCraigA.Myatt,PhD
PreviouslyPublished 77 USSOCOMVeterinarian 141
● Sort(ing)OuttheCasualties:TheSpecialOperations LTCBillBosworth,DVM
ResuscitationTeaminAfghanistan
NeedtoKnow 142
● BaselineDissociationandProspectiveSuccessinSpecial
ForcesAssessmentandSelectionofAdvancesintheMan- PolicyforDecreasingUseofAspirin(AcetylsalicylicAcid)in
agementofSeverePenetratingTrauma CombatZones
● ResultsofVietnameseAcupunctureSeenattheSecondSur-
MedQuiz 145
gicalHospital
● OverviewofCombatTraumainMilitaryWorkingDogsin PictureThis…
IraqandAfghanistan
LCDRKentHandfield,MD;LCDRWileySmith,MD
Meet theJSOMStaff 149
SubmissionCriteria 150
JournalofSpecialOperationsMedicine Volume9,Edition2/Spring09
Staff Sergeant Marc J. Small
SSGMarcJ.Small,29,diedofwoundssustainedfromenemyfireduringacombatreconnaissancepa-
trolon12February2009. HewasaSpecialForcesOperationalDetachment-Alphateammedicalsergeantas-
signedtoCompanyB,1stBattalion,3rdSpecialForcesGroup(Airborne). HedeployedinsupportofOperation
Enduring Freedom in January 2009 as a member of the Combined Joint Special Operations Task Force –
Afghanistan. ThiswashisfirstdeploymentinsupportoftheGlobalWaronTerror.
Small,anativeofCollegeville,PA,volunteeredformilitaryserviceandenteredtheArmyinDecember
2004asaSpecialForcestrainee. AfterBasicandAdvancedIndividualTrainingatFortBenning,GA,hewas
assignedtotheJohnF.KennedySpecialWarfareCenterandSchoolatFortBragg,NC,inMay2005forSpe-
cial Forces training. His medical training was with John F. Kennedy Special Warfare Center and School at
Joint Special Operation MedicalTraining Center. He earned the coveted “Green Beret” in 2007 and was as-
signedto1stBn,3rdSFG(A)atFortBragg,NC,asaSpecialForcesMedicalSergeant.
Small’smilitarytrainingandeducationincludestheSurvival,Evasion,ResistanceandEscapeCourse,
SniperCourse,BasicAirborneCourse,BasicNoncommissionedOfficerCourse,WarriorLeadersCourse,and
SpecialForcesQualificationCourse. HisawardsanddecorationsincludethePurpleHeartMedal,ArmyCom-
mendation Medal, Army Achievement Medal, Good Conduct Medal, National Defense Service Medal,
AfghanistanCampaignMedal,GlobalWaronTerrorismServiceMedal,NoncommissionedOfficerProfessional
DevelopmentRibbon,ArmyServiceRibbon,OverseasServiceMedal,NATOMedal,ParachutistBadge,Com-
batInfantryBadge,andtheSpecialForcesTab.
Small is survived by his mother and stepfather of Collegeville, PA; his father and stepmother of Me-
chanicsburg,PA;andthreebrothersandthreesisters.
Dedication
1
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JF Rick Hammesfahr, MD
Editor’s Note:The following article is being published in three parts due to its size and amount of pictures.
Part One–In Vol. 9 Ed. 1 (Winter 2009) consisted of evaluation of knee injuries;
Part Two–Continues on from Part One and consists of taping procedures for the various knee injuries;
Part Three–Will be in the 2009 Summer Edition and will consist of ankle injury evaluation and taping.
Please keep in mind that this entire article applies only to the austere situation. No one would be able to carry all the
braces and sleeves for the various joints in different sizes and for right or left that are available in CONUS on the missions.
KNEELIGAMENTTAPING
KneetapingisagoodtoolfortheATPtohave
in his rucksack treatment categories. By using stan-
dard adhesive tape applied directly to the skin, or by
usingducttape,itispossibletotapethekneesothatthe
kneeandthedamagedligamentsaresupported. Inad-
dition, the taping will also restrict the motion of the
kneejoint.
Prior to taping, the type and area of damage
mustbeidentifiedastowhetheritisapatellardisloca-
Figure 22:Elevate heel about 2 inches.
tion,torncartilage,tornmedialcollateralligament,torn
lateralcollateralligament,ortornanteriorcruciatelig-
ament. Once the area of the injury is identified, the
skiniscleanedtoremoveanyunderlyingdirtordebris.
With the skin dry, the tape may be applied directly to
theskin.
Theinitialstepistoelevatetheheelabouttwo
inches. ThiscouldbeonarolloftapeasshowninFig-
ure 22 or on any other object. By elevating the heel,
thekneeisflexed,givingtheoptimalpositionfortap-
ing(Figure23).
Figure 23: Heel elevation forces knee flexion for opti-
mal taping position.
JournalofSpecialOperationsMedicine Volume9,Edition2/Spring09
2
Figure 26:Initial crossing stability tape strip.
Figure 24:Proximal anchoring strips of tape applied. Ap-
proximately 50% of the thigh is taped with anchoring strips.
Once the anchoring strips have been applied,
an X pattern of overlapping tape is applied on each side
Initially, three or four anchoring strips are ap-
of the joint (Figure 26 and Figure 27). The crossing of
plied at the distal thigh and three or four anchoring
the tape occurs at the mid-portion of the side of the
strips are applied in a circumferential fashion at the
joint, which is where the ligaments lie.
proximal foreleg (Figure 24). These anchoring strips
are NOT applied in a spiral fashion, but as independ-
ent, overlapping circumferential strips. If possible, the
leg should be shaved. As an alternative, tape prewrap
may be used to protect the skin. In an austere situa-
tion, if supplies are limited and prewrap is not avail-
able, the tape should be applied directly to the skin.
The tape is applied with approximately a 30 – 50%
overlap (Figure 25).
Figure 27: First set of crossing stability tape strips are
applied.
Figure 25: Distal anchoring strips of tape applied cover-
ing approximately 50% of the lower leg.
Field Evaluation and Management of Non-Battle Related Knee and Ankle Injuries by the Advanced Tactical Practitioner 3
(ATP) in the Austere Environment — Part Two
This is then reinforced with a second set of Once a double layer of crossing tape strips has
crossing tape strips (Figures 28 and 29). been applied, a final single vertical strip is applied
(Figure 30).
Figure 28:Application of 2nd set of crossing tape strips.
Figure 30:Vertical reinforcing strip which further anchors
the central X of tape.
Once the strips are applied on one side of the
joint, similar taping is done on the opposite side of the
joint (Figure 31).
Figure 29:Final crossing strip applied.
Figure 31: Same crossing tape applied to
opposite of the knee, centered at the mid-
joint line.
Journal of Special Operations Medicine Volume 9, Edition 2 / Spring 09
4
During the process of taping, it is important to
recognize that the popliteal fossa (posterior aspect of
the joint) must be left open to prevent the development
of tape blisters (Figure 34).
Figure 32: Proximal circumferential anchoring strips applied
proximal to the joint.
Figure 34:Popliteal fossa left open to allow for flexion and
Once both sides have the X-crossed tapes ap-
extension, minimizing the probability of development of skin
plied along with the vertical reinforcing strip, more cir-
blisters beneath the tape as the knee moves.
cumferential anchoring strips are applied to anchor the
medial and lateral X-crossed strips (Figures 32 and 33).
In addition, the kneecap must be left open to
allow normal superior and inferior glide motion (Fig-
ure 33). This taping techniquewill provide rotational
stability as well as stability against varus and valgus
forces. In addition, flexion and extension will also be
somewhat limited.
MENSICUS
When checking for a torn meniscus, it is nec-
essary to palpate the medial and lateral joint lines for
tenderness. A McMurray’s test is then performed. The
medial McMurray’s test (Figure 35) is performed by
forcibly flexing the knee and palpating the posterome-
dial joint line (to check the medial meniscus) with one
hand. With the other hand, grasp the foot and exter-
nally rotate the leg at the hip and apply a varus force at
the knee (compressing the medial side of the femur and
tibia against the medial meniscus) and extendthe knee.
Figure 33:Distal circumferential anchoring strips applied.
If there is a torn meniscus, a click may be felt or heard,
and the test is usually painful if there is a damaged me-
dial meniscus.
Field Evaluation and Management of Non-Battle Related Knee and Ankle Injuries by the Advanced Tactical Practitioner 5
(ATP) in the Austere Environment — Part Two