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Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with noncompressible torso injury and traumatic amputations: a retrospective study

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Military Medical Research 2019年第1期6卷 23-30页

作者： Joseph K.Maddry Crystal A.Perez Alejandra G.Mora Jill D.Lear shelia C.savell vikhyat s.bebar.a Us Air Force En route Care Research Center 59th MDW/sT Chief Scientist's Office –US Army Institute of Surgical research JBSA Ft.Sam Houston Department of Emergency Medicine San Antonio Military Medical CenterJBSA Ft. Sam Houston Us Air Force En route Care Research Center 59th MDW/sT Chief Scientist's Office –US Army Institute of Surgical researchJBSA Ft.Sam Houston Department of Emergency Medicine University of Colorado School of Medicine

Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury(NCTI).Methods: We completed a retrospective review of MEDEVAC patient care records for United states military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI(AMP+NCTI), traumatic amputation only(AMP),and neither AMP nor NCTI(Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests,Cochran-Armitage Trend tests, shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression ***: We reviewed 1267 records, of which 669 had an injury severity score(Iss) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries(n=104, AMP only), 10.8% sustained amputation and NCTI(n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI(n=493,Non-AMP/NCTI). AMP+NCTI had the highest mortality(16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same ***: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time

关键词： Transport time Non-compressible torso injury Traumatic amputation Combat

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self-reported dietary supplement use in deployed United states service members pre-deployment *** deployment,Afghanistan,2013-2014

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Military Medical Research 2018年第3期5卷 207-215页

作者： shawn M.Varney Patrick C.Ng Crystal A.Perez Allyson A.Arana Edwin R.Austin Rosemarie G.Ramos vikhyat s.bebar.as University of Texas Health science Center san Antonio 7709Floyd Curl DrSan AntonioTX 78229USA san Antonio Military Medical Center 3551Roger Brooke DriveSan AntonioTX 78234USA Rocky Mountain Poison and Drug Center Denver Health and Hospital AuthorityDenverCOUSA U.s.Army Institute of surgical Research USAF En Route Care Research Center3698Chambers Pass STE BJBSA Ft Sam HoustonSan AntonioTX 78234USA Department of Emergency Medicine University of Colorado School of Medicine13001E 17th PlaceAuroraCO 80045USA

Background: Dietary supplement use(protein/amino acids, weight-loss supplements, performance enhancers) is common among U.s. military members. Reported dietary supplement use in deployed troops is limited and is of concern in settings where troops are exposed to high ambient temperatures, increased physical demands, and dehydration. Our objective was to describe dietary supplement use and adverse events(AEs) among deployed U.s. service members compared with their pre-deployment ***: We conducted an institutional review board(IRB) approved, descriptive study in Afghanistan using a written questionnaire and collected demographic information, dietary supplement use before and during deployment, AEs associated with supplement use, and physical workout routines. Participants were U.s. military personnel of all branches of service deployed to Afghanistan. They were recruited in high-traffic areas in the combat theater. We analyzed the data with descriptive statistics. Paired t-test/Wilcoxon signed-rank test was conducted to examine the before/during deployment changes for continuous data, and Mc Nemar's chi-square test was conducted for categorical data. We constructed separate logistic regression models to determine the best predictors of increases or decreases in dietary supplement use, with demographic information, reasons for using supplements, and education requested/received as covariates in each model. All statistical tests were two-sided at a significance level of 5%(Psults: Data were collected on 1685 participants. Ninety-seven of the participants were in the Army or Air Force. The participants were more likely to work out daily or more than once a day during deployment. Thirty-five percent of the participants reported no supplement use before or during deployment. The remaining 65% of participants reported increased use and increased frequency of use of supplements(e.g., daily) during deployment compared with predeployment. Additionally, more pe

关键词： Military Dietary supplement Workout Exercise Adverse events

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Emergency medicine providers＇ opioid prescribing practices stratified by gender, age, and years in practice

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World Journal of Emergency Medicine 2016年第2期7卷 106-110页

作者： shawn M. Varney vikhyat s. bebarta Lisa M. Mannina Rosemarie G. Ramos Victoria J. Ganem Katherine R. Carey Department of Emergency Medicine University of Texas Health Science Center San Antonio 78229 USA Department of Emergency Medicine University of Colorado School of Medicine Aurora 80045 USA Department of Emergency Medicine Mike O'Callaghan Federal Medical Center Nellis 89191 USA Air Force Enroute Care Research Center Fort Sam Houston 78208 USA The Geneva Foundation Tacoma 98402 USA

BACKGROUND: Emergency medicine providers(EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that infl uence EMP risk and opioid prescribing ***: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square ***: Eighty-nine EMPs completed the questionnaire(100% response). Respondents were primarily younger male physicians(80%) in practice under fi ve years(55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse(Pspectively). Of the providers, 70% stated that patient age would inf luence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused ***: Female EM providers reported prescribing fewer opioid tablets. Patient age infl uenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.

关键词： Prescription opioid misuse Emergency medicine provider Prescribing practices

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