Charles W. Beadling

Comparison of 10 hemostatic dressings in a groin transection model in swine.

BACKGROUND Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. To test the relative efficacy of different formulations in bleeding control, recently manufactured products need to be compared using a severe injury model. METHODS Ten hemostatic dressings and the standard gauze bandage were tested in anesthetized Yorkshire pigs hemorrhaged by full transection of the femoral vasculature at the level of the groin. Application of these dressings with a 5-minute compression period (at approximately 200 mm Hg) was followed with a subsequent infusion of colloid for a period of 30 minutes. Primary outcomes were survival and amount and incidence of bleeding after dressing application. Vital signs and wound temperature were continuously recorded throughout the 3-hour experimental observation. RESULTS These findings indicated that four dressings were effective in improving bleeding control and superior to the standard gauze bandage. This also correlated with increased survival rates. Absorbent property, flexibility, and the hemostatic agent itself were identified as the critical factors in controlling bleeding on a noncompressible transected vascular and tissue injury. CONCLUSIONS Celox, QuikClot ACS, WoundStat, and X-Sponge ranked superior in terms of low incidence of rebleeding, volume of blood loss, maintenance of mean arterial pressure >40 mm Hg, and survival.

A New Paradigm for Military Humanitarian Medical Operations: Mission-Generic Metrics

OBJECTIVE We report the history of military humanitarian medical operations, define the current science of process and outcome evaluation, and propose a set of generic metrics for monitoring and evaluation in military humanitarian operations. METHODS We comprehensively reviewed the unclassified literature and used our own experiences in military humanitarian activities. RESULTS Our literature review shows that efforts to evaluate the relative quality or cost-effectiveness of military humanitarian missions have been largely unsuccessful. In response to this finding, the authors propose a monitoring and evaluation checklist system with generic metrics, which are broadly applicable but also can be customized specifically for the user. CONCLUSIONS Military humanitarian operations can provide substantial security value to their many different stakeholders. Refinement of our proposed mission-generic metrics list is one method to measure performance and relative quality. Better assessment of outcomes can clarify decisions about the utilization of limited military medical humanitarian funds and personnel.

Conflict and catastrophe medicine

Electronic reproduction. Palo Alto, Calif. : ebrary, 2014. Available via World Wide Web. Access may be limited to ebrary affiliated libraries.

The 2015 Hyogo Framework for Action: Cautious Optimism

Worried concentration mingled with cautious optimism on the faces and in the work of delegates who attended the International Symposium on Disaster Medical and Public Health Management, held May 21-22, 2014, in Washington, DC. This conference was one of several international thematic workshops to prepare for the second Hyogo Framework for Action (HFA-2), entitled “Building the Resilience of Nations and Communities to Disasters,” which will take place in Sendai, Japan, in 2015. Specifically, this conference was designed to produce and shape themes to introduce medical and health into an anticipated rewrite of the original 2005 Hyogo Framework for Action (HFA-1).

International Symposium on Disaster Medicine and Public Health Management: review of the Hyogo framework for action.

The World Conference on Disaster Risk Reduction was held on January 18-22, 2005 in Kobe, Hyogo, Japan. This conference was sponsored by the International Strategy for Disaster Reduction (ISDR) division of the United Nations. At the conclusion of this meeting, 168 countries signed a document titled “Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters.” The most recent Typhoon in the Philippines and the Great East Japan Earthquake and Tsunami of 2011 have served to highlight the need for improved medical and health management in response to large-scale disasters around an “all-hazards approach.” This need is consistent with the concepts of disaster preparedness and resilient communities called for in the Hyogo Framework for Action (HFA). At the Third World Conference on Disaster Risk Reduction to be held in Sendai, Miyagi, Japan in March of 2015, modifications and suggestions will be introduced to improve the existing framework as the world has learned many lessons over the past ten years.

The West Africa Disaster Preparedness Initiative: Strengthening National Capacities for All-Hazards Disaster Preparedness

OBJECTIVE The Ebola outbreak demonstrated the need for improved disaster response throughout West Africa. The West Africa Disaster Preparedness Initiative was a training and assessment effort led by US Africa Command and partners to strengthen capacities among 12 West African partner nations (PNs). METHODS Series of 3-week training sessions with representatives from each PN were held from 13 July through 20 November 2015 at the Kofi Annan International Peacekeeping Training Centre in Accra, Ghana. A team conducted Disaster Management Capabilities Assessments (DMCAs) for each PN, including a review of key data, a survey for leaders, and in-person interviews of key informants. RESULTS All 12 PNs generated a national Ebola Preparedness and Response Plan and Emergency Operations Center standard operating procedures. DMCA metrics were generated for each PN. Top performers included Ghana, with a plan rated good/excellent, and Benin and Burkina Faso, which both achieved a satisfactory rating for their plans. More than 800 people from 12 nations were trained. CONCLUSION PNs have improved disaster management capabilities and awareness of their strengths and weaknesses. The Economic Community of West African States has increased its lead role in this and future planned initiatives. (Disaster Med Public Health Preparedness. 2017;11:431-438).

A review of the role of the u.s. Military in nonemergency health engagement

In recent decades, the U.S. Department of Defense has become increasingly committed to involvement in nonemergency medical humanitarian and civic assistance. This health policy report reviews the legal and doctrinal justifications behind the U.S. militarys participation in nonemergency health engagement, explores whether the aid provided is achieving stated objectives, and provides recommendations on how the militarys role could be improved. Legal and doctrinal foundations are threefold: to provide benefit to the recipients, training to the personnel involved, and enhance security for the United States and host nation. A review of the literature reveals serious questions concerning the measurement of the benefit to recipients from the militarys short-term health engagement missions. A robust and systematic monitoring and evaluation capability is necessary before the militarys success at meeting strategic objectives with HCA can be understood. Regulations should be modified to minimize local capacity displacement. Some of the suggestions in the literature have been adopted and implemented in recent missions. In addition, Department of Defense involvement in disease surveillance appears to be a constructive way for the military to engage with host nations and improve their capacity to detect and respond to outbreaks.

Liberia national disaster preparedness coordination exercise: Implementing lessons learned from the West African disaster preparedness initiative

OBJECTIVE In light of the recent Ebola outbreak, there is a critical need for effective disaster management systems in Liberia and other West African nations. To this end, the West Africa Disaster Preparedness Initiative held a disaster management exercise in conjunction with the Liberian national government on November 24-25, 2015. DESIGN During this tabletop exercise (TTX), interactions within and between the 15 counties and the Liberian national government were conducted and observed to refine and validate the county and national standard operating procedures (SOPs). SETTING The exercise took place in three regional locations throughout Liberia: Monrovia, Buchanan, and Bong. The TTX format allowed counties to collaborate utilizing open-source software platforms including Ushahidi, Sahana, QGIS, and KoBoCollect. PARTICIPANTS Four hundred sixty-seven individuals (representing all 15 counties of Liberia) identified as key actors involved with emergency operations and disaster preparedness participated in the exercise. MAIN OUTCOME MEASURES A qualitative survey with open-ended questions was administered to exercise participants to determine needed improvements in the disaster management system in Liberia. RESULTS Key findings from the exercise and survey include the need for emergency management infrastructure to extend to the community level, establishment of a national disaster management agency and emergency operations center, customized local SOPs, ongoing surveillance, a disaster exercise program, and the need for effective data sharing and hazard maps. CONCLUSIONS These regional exercises initiated the process of validating and refining Liberias national and county-level SOPs. Liberias participation in this exercise has provided a foundation for advancing its preparedness, response, and recovery capacities and could provide a template for other countries to use.

Medical Support of Special Operations

“Special operations” as applied to the US military describe a variety of missions carried out by highly select units from the Army, Navy, and Air Force. Individuals in these units are subjected to notably rigorous selection and training in preparation for missions which are often extremely physically demanding and carried out with limited support from larger conventional forces. Special operations units are required to operate under environmental extremes, in isolated, austere locations and with very limited supplies. Providing optimal medical support to these units requires a detailed understanding of the organizational structure of Special Operations Forces, the nature of the missions, the medical administrative tasks which must be addressed, acute and primary medical care, preventive medicine and the management of combat trauma in this special environment. These issues have not been previously addressed in a single comprehensive document. This chapter will meet that need; it draws substantially from a chapter published previously in the Textbook of Military Medicine.

New Paradigms: The World in the Twenty-First Century – A US Perspective

The US approach to both domestic and foreign disaster preparedness and response has undergone significant change over the past few decades. Regarding domestic disasters, a National Response Framework replaced the National Response Plan. The NRF is intended to allow flexible and adaptable response across all levels of government, local, tribal, state and federal.