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Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 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 3, Summer 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 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF ABSTRACT OF PAGES RESPONSIBLE PERSON a. REPORT b. ABSTRACT c. THIS PAGE Same as 136 unclassified unclassified unclassified Report (SAR) Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Journal of Special Operations Medicine EXECUTIVEEDITOR MANAGING EDITOR Deal, Virgil T. MD, FACS Landers, Michelle DuGuay, RN, BSN, MBA [email protected] [email protected] ASSISTANTEDITOR MEDICALEDITOR CONTRIBUTINGEDITOR Parsons, Deborah A., RN, BSN McDowell, Doug, APA-C Schissel, Daniel J., MD [email protected] (“Picture This” Med Quiz) PEER-REVIEW BOARD Ackerman, Bret T., DO Hammesfahr, Rick, MD Anders, Frank A., MD Hesse, Robert W., RN, CFRN, FP-C Antonacci, Mark A., MD Holcomb, John B., MD Arne', Bruce C., DDS Kane Shawn F., MD FAAFP Baer David G., PhD Kauvar, David S., MD Baskin, Toney W., MD, FACS Kersch, Thomas J., MD Black, Ian H., MD Keenan, Kevin N., MD Bower, Eric A., MD, PhD, FACP Kirby, Thomas R., OD Bruno, Eric C., MD Kleiner Douglas M., PhD Butler, Frank, K., MD LaPointe, Robert L., SMSgt (Ret) Cloonan, Clifford C., MD Lephart, Scott M. PhD Coldwell, Douglas M., PhD, MD Lutz, Robert H., MD Davis, William J., COL (Ret) Mason, Thomas J. MD Deuster Patricia A., PhD, MPH McManus, John G., MD Diebold, Carroll J. , MD Mouri, Michael P., MD, DDS Doherty, Michael C., BA, MEPC, MSS Murray Clinton K., MD, FACP Flinn, Scott D., MD Ong, Richardo C., MD Forsten, Robert D., DO, FS Ostergaard, Cary A., MD Fudge, James M., DVM, MPVM Pennardt, Andre M., MD Gandy, John J., MD Peterson, Robert D., MD Gephart, William, PA-S Riley, Kevin F., PhD 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 Yevich, Steven J., MD TEXT EDITORS Ackermann, Bret T. DO, FACEP Hesse, Robert W., RN, CFRN, FP-C Boysen, Hans Kleiner, Douglas M. , PhD Doherty, Michael C., BA, MEPC, MSS Parsons, Deborah A., RN, BSN Forsten, Robert D., DO, FS Peterson, Robert D., MD Gephart, William J., PA-S VanWagner, William, PA-C Godbee, Dan C., MD, FS, DMO Journal of Special Operations Medicine Volume 10, Edition 3 / Summer 10 CCCC OOOONNNNTTTTEEEENNNNTTTTSSSS Summer 10 Volume 10, Edition 3 Dedications 1 Previously Published 55 Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes Medic Recognitions 3 Liangyou Chen, PhD; Andrew T. Reisner, MD; Andrei Gribok, PhD; Jaques Reifman, PhD FEATURE ARTICLES BookReview 63 U.S. Special Forces Medics in Afghanistan Look to 5 ● War Partner with NGOs on Rural Health Review by LTC Craig A. Myatt Matt Pueschel Fromthe USSOCOM CommandSurgeon 65 Time for a Change: Recommended MTOE Rank 10 Adjustment for Army Special Operations Physician COLTomDeal Assistants MAJ John F. Detro, PA-C ComponentSurgeons 66 Suspected Dietary Supplement Injuries in Special 14 COLPeterBenson USASOC Operations Soldiers BrigGenBartIddins AFSOC MAJ John Hughes, MD; SSG Byron Shelton, 18D; CAPTAnthonyGriffay MARSOC Maj Teresa Hughes, BSC TSOCSurgeons 71 The Use of Fresh Whole Blood Transfusions by the SOF 25 Medic for Hemostatic Resuscitation in the Austere COLFrankNewton SOCPAC Environment LTC Ricardo Ong SOCAFRICA SGM F Bowling, 18Z; COL Andre Pennardt, MD Management of Urinary Retention in an Austere 36 USASFC Surgeon 74 Environment: Suprapubic Catheter Placement LTC Christopher P. Smith, MD; SFC Andrew Sorrells, 18D; LTC Andrew Landers Michael Coburn, MD USSOCOM Psychologist 75 Zoonotic and Infectious Disease Surveillance in Central 41 America: Honduran Feral Cats Positive for LTC Craig Myatt, PhD Toxoplasma, Trypanosoma, Leishmania, Rickettsia, and Lyme disease TCCC Updates 77 MAJ Michael McCown, DVM; SFC Benjamin Grzeszak, 18D Frank Butler, MD CAPT (Ret) Hurlburt Dental Team Aids, Trains West African 44 Countries Need to Know 118 SrA Ryan Whitney Bogus Tourniquets Could Endanger Lives in Combat Steve Elliott Case Review 46 A Case of Tapeworm Infestation Expedient Medic 120 SSG Jared Kacoroski, SOCM; SPC Cody Bonk, SOCM; MAJ Scott Gilpatrick, APA-C, DMO Dr. Bruce C. Arne' Editorial Review 49 Educational Resources 126 The Time to Field Freeze Dried Plasma Is Now (Upcoming Conferences) COL Andre' Pennardt, MD, FACEP, FAWM Abstracts from Current Literature 50 Meet theJSOM Staff 127 Corrections 54 SubmissionCriteria 128 TableofContents I This cover is a collage of TCCC related photos from previous JSOM ar- ticles, as well as photos courtesy of CAPT Frank Butler (Ret), Chair- man, Committee on Tactical Combat Casualty Care, Defense Health ISSN 1553-9768 Board and MAJ John Paul, APA-C. FROMTHEEDITOR TheJournalofSpecialOperationsMedicine’s(JSOM)missionistopromotetheprofessionaldevelopmentof SpecialOperationsmedicalpersonnelbyprovidingaforumfortheexaminationofthelatestadvancementsinmedi- cineandthehistoryofunconventionalwarfaremedicine. JSOM DISCLAIMERSTATEMENT:The Journal of Special Operations Medicine (JSOM)presents both medical and nonmedical professional information to expand the knowledge of SOF military medical issues and promote col- laborative partnerships among services, components, corps, and specialties. It conveys medical service support information and provides a peer-reviewed, quality print medium to encourage dialogue concerning SOF 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 JSOMdo not hold themselves responsible for statements or products discussed in the articles. Unless so stated, material in the JSOMdoes not reflect the en- dorsement, official attitude, or position of the USSOCOM-SG or of the Editorial Board. CONTENT:Allscientificarticlesarepeer-reviewedpriortopublication. TheJournalofSpecialOperationsMedicine reservestherighttoeditallsubmittedmaterial. Contentofthispublicationisnotcopyrighted. Publishedworksmay bereprintedprovidedcreditisgiventotheJSOMandtheauthors. Articles,photos,artwork,andlettersareinvited, asarecommentsandcriticism,andshouldbeaddressedtoEditor,JSOM,USSOCOM,SOC-SG,7701TampaPoint Blvd, MacDillAFB, FL 33621-5323. Telephone: DSN 299-5442, commercial: (813) 826-5442, fax: -2568; e-mail [email protected]. TheJSOMisserialindexed(ISSN)withtheLibraryofCongress. (cid:2)(cid:2)(cid:2)(cid:2) Articles published in the peer-reviewed Journal of Special Operations Medicine are indexed in MEDLINE®, the National Library of Medicine’s (NLM) bibliographic database of life sciences and biomedical information. In- clusion in the MEDLINE database ensures that citations to the JSOMwill be identified to researchers during searches for relevant information using any of several bibliographic search tools, including the NLM’s DISTRIBUTION:This publication is targeted to SOF medical personnel. There are several ways for you to obtain the Journal of Special Operations Medicine (JSOM). 1) SOMAmembers receive the JSOMas part of membership. Please note, if you are a SOMA member and are not receiving the subscription, you can contact SOMA through (http://www.trueresearch.org/soma) or contact Jean Bor- das at [email protected]. SOMA provides a very valuable means of obtaining SOF related CME, as well as an annual gathering of SOF medical folks to share current issues. 2) The JSOMis available through paid subscription from the Superintendent of Documents, U.S. Government Print- ing Office (GPO), for only $30 a year. Using the subscription form on the next page, send mail orders to: U.S. Government Printing Office, P.O. Box 979050, St. Louis, MO 63197-9000. Or contact the GPO order desk: tele- phone: (202) 512-1800; fax: (202) 512-2104 (M–F 7:00 am – 6:00 pm EST); email: [email protected]; or visit (http://bookstore.gpo.gov) and type in Journal of Special Operations Medicineinto the search engine in the top right corner. All orders require prepayment by check, American Express, VISA, MasterCard, Discover/NOVUS, or SOD Deposit Account. 3)Online:The JSOM is available online through the USSOCOM public portal at (http://www.socom.mil/JSOM/Pages/default.aspx); the Joint Special Operations University at (https://jsoupublic.socom.mil/publications/index.php#jsom); and to SOMA members at (http://www.truersearch.org/soma). The Journal of Special Operations Medicine Training Supplement, “2010 Edition” is available for purchase through GPO. It can be purchased as a (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). It can be ordered online, via phone, fax, email, or postal mail as above. Lt Col Michelle DuGuay Landers II JournalofSpecialOperationsMedicine Volume10,Edition3/Summer10 III From the Editor FOLD ALONG THIS LINE -------------------------------------------------------------------------------------------------------------------------------- U.S. Government Printing Office P.O. Box 979050 St. Louis, MO 63197-9000 -------------------------------------------------------------------------------------------------------------------------------- FOLD ALONG THIS LINE IV Journal of Special Operations Medicine Volume 10, Edition 3 / Summer 10 SGM Bradly D. Conner Sergeant Major Bradly D. Conner was born 5 March 1966, in Tacoma, WA. He was a Special ForcescompanysergeantmajorassignedtoCompanyC,2ndBattalion,1stSpecialForcesGroup(Airborne). Connerdied9May2007fromwoundssustainedwhileconductingacombatpatroloutsideofAl- Hillah,Iraq. HedeployedinsupportofOperationIraqiFreedominMarch2007. Itwashisfourthdeployment toIraqsince2003. Anative of Tacoma, WAand raised in Coeur d’Alene, ID, Conner enlisted in theArmy 24 June 1987, as an ammunition specialist. After completing basic training at Fort McClellan,AL, and advanced individualtrainingatRedstoneArsenal,hewasassignedtothe515thOrdinanceCompany,RedstoneArse- nalashisfirstassignment. In1992,ConnervolunteeredforSpecialForcestraininganduponcompletion of the Special Forces Qualification Course in 1993, he was assigned to 10th SFG (A) as a Special Forces medicalsergeant. Hefilledseveralpositionsin10th SFG(A)toinclude2nd BattalionS3OperationsNCO, teamsergeant,andfirstsergeantforHHC. Conner’sawardsanddecorationsincludetheBronzeStarMedalSecondOakLeafCluster,Purple Heart,MeritoriousServiceMedal-SecondOakLeafCluster,JointServiceCommendationMedal- Sec- ondOakLeafCluster,ArmyCommendationMedal-FifthOakLeafCluster,ArmyAchievementMedal- Sixth Oak Leaf Cluster, Joint Meritorious UnitAward, Good Conduct Medal - FifthAward, National De- fenseServiceMedal-SecondAward,ArmedForcesExpeditionaryMedal,SouthwestAsiaServiceMedal, KosovoCampaignMedal,GlobalWaronTerrorismExpeditionaryMedal,GlobalWaronTerrorismServ- iceMedal,ArmedForcesServiceMedal,MilitaryOutstandingVolunteerServiceMedal,Noncommissioned OfficerProfessionalDevelopmentRibbon,OverseasServiceRibbon,ArmyServiceRibbon,KuwaitLib- eration Medal, NATO Medal, Combat Infantryman Badge, Master Parachutist Badge, Military Freefall ParachutistBadgeandtheSpecialForcesTab. Connerissurvivedbyhiswife,ason,andtwodaughters. Heisalsosurvivedbyhisparents,two brothers,andasister. -DEOPPRESSOLIBER- Dedication 1 SSG Marc J. Small StaffSergeantMarcJ.Small,29,diedofwoundssustainedfromenemyfireduringacombatre- connaissancepatrolon13February2009. HewasaSpecialForcesOperationalDetachment-Alphateam medicalsergeantassignedtoCompanyB,1stBattalion,3rdSpecialForcesGroup(Airborne). HedeployedinsupportofOperationEnduringFreedominJanuary2009asamemberoftheCom- binedJointSpecialOperationsTaskForce–Afghanistan. Thiswashisfirstdeploymentinsupportofthe GlobalWaronTerror. MarcwasagraduateofMethactonHighSchool,classof1997. HeattendedtheCitadelaswell as Millersville University. Small, a native of Collegeville, PA, volunteered for military service and en- teredtheArmyinDecember2004asaSpecialForcestrainee. Afterbasicandadvancedindividualtrain- ingatFortBenning,GA,hewasassignedtotheJohnF.KennedySpecialWarfareCenterandSchoolat FortBragg,NC,inMay2005forSpecialForcestraining. HismedicaltrainingwaswithJohnF.Kennedy SpecialWarfareCenterandSchoolatJointSpecialOperationMedicalTrainingCenter. Heearnedthecov- eted“GreenBeret”in2007andwasassignedto1stBn,3rdSFG(A)atFortBragg,NC,asaSpecialForces medicalsergeant. Small’smilitaryeducationincludestheSurvival,Evasion,Resistance,andEscapeCourse,Sniper Course, BasicAirborne Course, Basic Noncommissioned Officer Course, Warrior Leaders Course, and SpecialForcesQualificationCourse. HisawardsanddecorationsincludetheArmyCommendationMedal,ArmyAchievementMedal, GoodConductMedal,NationalDefenseServiceMedal,AfghanistanCampaignMedal,GlobalWaronTer- rorismServiceMedal,NoncommissionedOfficerProfessionalDevelopmentRibbon,ArmyServiceRib- bon,OverseasServiceMedal,NATOMedal,ParachutistBadge,CombatInfantryBadge,andtheSpecial ForcesTab. HewasposthumouslyawardedtheBronzeStarMedal,PurpleHeart,andMeritoriousServ- iceMedal. Smallissurvivedbyhismotherandstepfather,fatherandstepmother,fivesiblings,andhisfiancé. -DEOPPRESSOLIBER- 2 JournalofSpecialOperationsMedicine Volume10,Edition3/Summer10 CPT Andrew D. Fisher RRRRAAAANNNNGGGGEEEERRRR NNNNAAAAMMMMEEEEDDDD TTTTOOOOPPPP PPPPAAAA Captain Andrew D. Fisher of 1st Battalion, 75th Ranger Regiment has been selected for the Surgeon General’s Physician Assistant Recognition Award. While deployed to Afghanistan in 2009, Fisher trained the regiment’s medics and provided exceptional daily care, as well as treating combat casualties during several intense firefights. On 30 September, Fisher treated six injured Rangers, four of them classified urgent, during a combat mission. When the platoon medic’s weapon malfunctioned, Fisher joined the assault force and helped overrun the target despite in- tense machinegun fire. He also recovered casualties and coordinated evacuation and care en route. On 25 October, Fisher responded when two Marine attack helicopters supporting an operation crashed. Despite rounds cooking off, burning wreckage, and hot debris, he establisheda casualty collection pointand treated the two Marines whosurvived until they were evacuated. He then helped secure the site andrecover remains of those killed inthe crash. 3 MedicRecognition 3