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PubMed2005

Combat casualty care: the Alpha Surgical Company experience during Operation Iraqi Freedom.

BACKGROUND: Operation Iraqi Freedom was the first large-scale combat operation involving the U.S. Marine Corps since the Persian Gulf War in 1991. Data from a combat surgical company are presented. METHODS: Records of all U.S. and Iraqi combat casualties admitted to the surgical company were reviewed. RESULTS: Fifty-three (57%) of 93 patients suffered penetrating injuries. Most wounds were produced by high-explosive munitions (mines, hand grenades, and rocket-propelled grenades), and the majority (51%) of wounds were to the extremities. The time to surgical care averaged 4.7 hours (range, 1.5-48 hours), and 98% of the patients seen at our facility survived. CONCLUSIONS: The time from injury to surgical care was considered long by civilian standards; however, this did not appear to affect outcomes substantially. A small percentage (5.2%) of injuries were to the torso. Hypothermia was commonly present. Because of the nature of their wounds, all patients required additional surgery after evacuation to rear area facilities. The outcomes of individual patients are not known, although it is known that only one Marine died after reaching medical care and, to date, no Marines have subsequently died of their wounds.

Craniocerebral Trauma↗
PubMed2005

Anesthesia services aboard USNS COMFORT (T-AH-20) during Operation Iraqi Freedom.

USNS COMFORT (T-AH-20), the only U.S. hospital ship to be deployed in support of combat operations during Operation Iraqi Freedom, sailed from Baltimore, Maryland, on January 6, 2003, and returned on June 12, 2003. During the course of her deployment, 648 anesthetic procedures were performed. We describe the anesthesia services provided, lessons learned, and recommendations for future concepts of employment.

Adolescent↗
PubMed2005

Survey of repellent use by service members arriving in Kuwait for Operation Iraqi Freedom 2.

The 8th Medical Brigade, deployed to Kuwait in January 2004 in support of Operation Iraqi Freedom provided theater-wide health service support and medical command and control. An historic "surge" of troops and equipment occurred during our deployment as 140,000 service members (SMs) redeployed out of theater and 110,000 arrived to take their place. The brigade's preventive medicine personnel conducted a questionnaire-based survey at military camps in northwestern Kuwait in mid-March to determine whether SMs had been provided with supplies and information to protect them against endemic vector-borne diseases. Of 1,200 questionnaires distributed, 870 (73%) were returned. In addition to military affiliation information, the survey contained specific questions related to the provision of n-diethyl-m-toluamide repellents, permethrin and treated uniforms, and medical threat briefings. On average, less than one-half of the SMs received these resources before their arrival in Kuwait. Significant differences of resource provision existed among service branches, components, and mobilization or deployment stations.

Humans↗
PubMed2005

Medical problems of detainees after the conclusion of major ground combat during Operation Iraqi Freedom.

After the conclusion of major ground combat operations during Operation Iraqi Freedom, the focus of the mission changed, although intense armed conflict continued. Included in this mission was management of security detainees, including provision of their medical care. We retrospectively reviewed the admission records identified at a short-term holding facility over 2 months and diagnoses of detainees admitted to a combat support hospital over 4 months as a health care service utilization statistics review. Six thousand six hundred thirty-one detainee encounters occurred at the short-term facility with approximately 45% of detainees reporting medical problems during each daily evaluation. Most frequent complaints were neurological (11%), gastrointestinal (10%), and respiratory (8%). Two hundred nineteen detainees' admission diagnoses were retrospectively reviewed from the combat support hospital, 98 (45%) due to gunshot or fragmentary injuries and 121 (55%) to other medical problems. Medical problems included cardiac (29%), gastrointestinal (17%), neurological (14%), musculoskeletal (11%), and pulmonary (6%) disease. Medical problems not traditionally dealt with in a combat theater, including management of transplant recipients, patients with cardiac valve replacement, and cancer patient, were also seen.

Delivery of Health Care↗
PubMed2005

Spectrum of care provided at an echelon II Medical Unit during Operation Iraqi Freedom.

We describe the types of medical problems encountered at a U.S. Army echelon II medical facility during Operation Iraqi Freedom in the period after completion of major ground combat operations, a time of nation restructuring and intermittent, intense, armed conflict. A total of 4,831 patients were assessed between October 1, 2003 and June 30, 2004, 74% with disease and nonbattle injury presentations, 19% with dental complaints, and 7% wounded in action (WIA). Disease and nonbattle injury evaluations were predominantly musculoskeletal. Improvised explosive devices or mortars caused 78% of the WIA casualties. The most frequent dental evaluations were for restorations (47%). Thirty-eight individuals were admitted to holding beds, most commonly to receive intravenous antibiotic treatment for cellulitis (29%). Three hundred forty-one individuals were evacuated, including 150 WIA. Determining the types of casualties seen at forward echelons of medical care during different phases of conflict can aid medical planning and help predict the type of medical resources required.

Delivery of Health Care↗
PubMed2005

Aeromedical evacuations from Operation Iraqi Freedom: a descriptive study.

OBJECTIVE: To describe health patterns in evacuated military members during Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and postdeployment health information to understand the utility of data collected for aeromedical evacuations. METHODS: We conducted a descriptive analysis of U.S. evacuees from 2003 using data from the U.S. Transportation Command's Regulating and Command & Control Evacuation System and the Defense Medical Surveillance System. RESULTS: The typical patient was an Army male under the age of 29 requiring orthopedic or surgical care. Disease/nonbattle injuries were six times as common as battle injuries and 94% were classified as routine evacuees. Eighty-six percent had health data available in the Defense Medical Surveillance System. Two thirds had pre- and/or postdeployment questionnaire data. CONCLUSIONS: Combining data sources increases our understanding of disease patterns in deployed troops. Targeted preventive interventions can then be implemented. Changes in the U.S. Transportation Command's Regulating and Command & Control Evacuation System database can improve its utility as an epidemiological tool.

Adult↗
PubMed2006

Sexually transmitted diseases in Operation Iraqi Freedom/Operation Enduring Freedom.

OBJECTIVE: To identify the incidence of sexually transmitted diseases (STDs) in a female active duty population deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom was the objective of this study. METHODS: Retrospective chart review was completed on all soldiers seeking outpatient gynecologic care at Camp Doha, Kuwait, from September 2003 through March 2004. Descriptive statistical analysis was performed on data from all patients identified as having an STD. RESULTS: Forty-four soldiers (2.5% of all encounters) were diagnosed with STDs during the study period. Genital herpes, Condyloma acuminata, and chlamydia were the most commonly identified infections accounting for 30, 25, and 21% of the diagnoses, respectively. CONCLUSION: Transmission of STDs in the deployed environment continues to be problematic. Viral infections were more commonly encountered than were bacterial infections. Patient education and prevention should be emphasized. Consideration should be given to STD screening upon redeployment.

Adult↗
PubMed2006

Physical medicine and rehabilitation in the military: Operation Iraqi Freedom.

This article describes the role of a physical medicine and rehabilitation (physiatry) physician (physiatrist) as a general medical officer within a forward support battalion during the invasion and nation-building phases of Operation Iraqi Freedom. Between March 10 and May 3, 2003 (invasion phase), 364 patients were evaluated. Thirty-two percent had musculoskeletal noncombat injuries, 9% had combat-related traumatic injuries, and the remaining 59% had nontrauma/nonmusculoskeletal conditions. Between May 4 and July 25, 2003 (nation-building phase), 1,387 patients were evaluated. Of these, 19% had musculoskeletal injuries, 1% had combat-related traumatic injuries, and the remaining 80% had nontrauma/nonmusculoskeletal conditions. During this nation-building phase, the musculoskeletal workload seen at the division-level combat support hospital was 4 times the workload seen in the forward support battalion. This experience underscores the role of physiatry in wartime casualty management and profiles the combat support hospital as the most suitable place for the physiatrist during wartime. Interventions focused on acute management and rehabilitation counseling for all musculoskeletal injuries, as well as consultation services to the combat support hospital and local civilian hospitals for the evaluation of complex neuromusculoskeletal trauma cases.

Adult↗
PubMed2006

Women's health care in Operation Iraqi Freedom: a survey of camps with echelon I or II facilities.

OBJECTIVE: To assess women's perceptions of health care delivery in Operation Iraqi Freedom. METHODS: An anonymous questionnaire was distributed through command channels to female soldiers stationed in camps receiving echelon I or II care. Questions covered predeployment screening, contraceptive method availability and side effects, accessibility of gynecologic care, field hygiene counseling, and smoking status. RESULTS: Two hundred fifty-one (91%) of 275 surveys were returned. Twenty-two percent of respondents had received no annual gynecologic examination including the Papanicolaou test/cervical cytologic study in the past year. Irregular bleeding was the most common gynecologic side effect. Ortho Evra patches fell off in 58% of cases; 23% of soldiers changed contraceptive methods because of unavailability, 21% experienced gynecologic problems, and 44% could not access gynecologic care. Twenty-six percent received predeployment menstrual hygiene counseling, and 77% attempting cycle control succeeded. CONCLUSIONS: Gynecologic screening, contraceptive options, and cycle control counseling must occur before deployments. Specialty gynecologic care and medications for cycle control should be readily accessible to all female soldiers during deployments.

Adult↗
PubMed2006

Wounding patterns for U.S. Marines and sailors during Operation Iraqi Freedom, major combat phase.

This investigation examined the wounds incurred by 279 U.S. Navy-Marine personnel (97% Marines and 3% sailors) identified as wounded in action during Operation Iraqi Freedom, from March 23 through April 30, 2003. The goal was to assess the potential impact of each causative agent by comparing the differences in anatomical locations, types of injuries caused, and medical specialists needed to treat the casualties. The overall average number of diagnoses per patient was 2.2, and the overall average number of anatomical locations was 1.6. The causative agents were classified into six major categories, i.e., small arms, explosive munitions, motor vehicle accidents, falls, weaponry accidents, and other/unknown. Explosive munitions and small arms accounted for approximately three of four combat-related injuries. Upper and lower extremities accounted for approximately 70% of all injuries, a percentage consistent for battlefield injuries since World War II.

Blast Injuries↗
PubMed2006

A novel device developed, tested, and used for warming and maintaining intravenous fluids in a forward surgical team during Operation Enduring Freedom.

OBJECTIVE: To determine whether an accessory to the Bair Hugger warming unit (BHWU), a piece of equipment intrinsic to the forward surgical team, could be designed and used to warm and to maintain large volumes of intravenous fluids at an optimal infusion temperature in an austere environment. METHODS: The X-1 is a simple, collapsible, 5-gallon nylon cooler with handles, modified with a port for the BHWU hose and a one-way flutter valve vent. RESULTS: The warming of intravenous fluids to the optimal infusion temperature was accomplished with the BHWU and X-1. The warming time was influenced by the ambient temperature, the starting temperature of the fluids, and the number of bags being warmed. The warmed fluid could be stored and maintained in the X-1. The heat retention of the fluids was influenced by the ambient temperature, the number of bags warmed, and the insulating properties of the X-1. CONCLUSIONS: The BHWU can be used with the compact X-1 to warm and to store large volumes of intravenous fluids at the optimal infusion temperature in the field environment and was successfully used by a forward surgical team in Afghanistan, during Operation Enduring Freedom, for the treatment of combat-wounded soldiers.

Afghanistan↗
PubMed1990

Medicare and Medicaid programs, freedom of information (FOI) guidelines--HCFA. Notice.

In accordance with the settlement agreement reached in the case of Home Health Line v. HCFA, District Court of District of Columbia, Civil Action (D.D.C., C.A.) No. 90-1006 LFO, HCFA is publishing in the Federal Register a notice describing and clarifying HCFA's guidelines concerning expedited processing of Freedom of Information (FOI) requests.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Medicaid program; freedom of choice waiver; conforming changes--HCFA. Interim final rule with comment period.

This interim final rule amends existing Medicaid regulations on freedom of choice waivers granted under section 1915(b) of the Social Security Act (the Act) to conform them to the amendments made to the Act by sections 4604 and 4742 of the Omnibus Budget Reconciliation Act of 1990. This rule: Specifies that the Secretary may not waive the requirement that the State plan provide for adjustments in payment for inpatient hospital services furnished to infants under one year of age, or to children under 6 years of age who receive these services in disproportionate share hospitals. Extends to any provider participating under a section 1915(b)(4) waiver the same prompt payment standards that apply to all other health care practitioners furnishing Medicaid services. This rule also makes technical changes in the regulations relating to a recipient's free choice of providers of family planning services and cost-sharing requirements under waivers.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

A feminist case against euthanasia. Women should be especially wary of arguments for "the freedom to die".

Feminists, among others, should not be too quick to hail assisted suicide and euthanasia as extensions of human freedom. Indeed, there are good reasons why women should be especially suspicious of such "reforms." First, it is not clear that a person has a moral right to end his or her existence. Feminists understand that suicide and murder are irretrievably linked, and that a person is not a monad. We often hear of suicide attempts in which the person's body--by vomiting up poison, for instance--overrules his or her mind. If there can be such miscommunication between a mind and a body, how are we to trust the communication between a person and the physician ready to assist his or her suicide? Ambivalent motivation and ambiguous meanings have always characterized human relations. In the past, however, an absolute taboo against suicide or euthanasia cemented a patient's right to expect the care of his or her physician, family, and community. If we were to discard that taboo, we would subtly alter these relationships and make each other more vulnerable. History suggests that women, minorities, the ill, the old, and the handicapped would be most at risk. Finally, the assisted-suicide debate has even larger social implications. Unconditional respect for the gift of life is eroding in the United States. The suicide rate is already climbing at all levels of society, especially among teenagers. Wouldn't the acceptance of suicide and euthanasia make it even more acceptable for people to check out of all kinds of uncomfortable situations--marriages or life?

Aged↗
PubMed1997

On creativity and cookbooks, discipline and freedom.

Is cookbook medicine a major threat to patients and physicians alike? Should this management tool be condemned as yet another disdainful and questionable aspect of managed care? Presented here are arguments for and against cookbook medicine--with some surprising conclusions. Could it be that cookbook medicine actually fosters creativity, discipline, and freedom?

Algorithms↗
PubMed1998

Electronic Freedom of Information Act; implementation--USIA. Proposed rule.

This rule establishes requirements and conditions necessary for the implementation of the new Electronic Freedom of Information Act (FOIA) Amendments of 1996, 5 U.S.C. 552, as amended by Pub. L. 104-231. This addition to the present regulation will establish criteria that will enable FOIA requesters to better understand how documents of the Agency are maintained and handled electronically.

Consumer Advocacy↗