Treating Active Duty Service Members Outside of the Military Health System
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Providing front-line medical care in a combat theater can be one of the most rewarding experiences available to a medical provider at any level of training. There is a unity of purpose among the members of any military unit and the opportunity to utilize one's training to support and provide aid to those brothers and sisters in arms tends to be a very gratifying endeavor. However, it can also be a difficult one with a unique set of challenges and hardships to overcome in order to provide the best care possible in the far forward setting. A few of these include balancing the sometimes competing interests of mission goals versus individual patient needs, limited supplies, professional isolation, and presence of increased threats. This chapter reviews the medical capabilities available to provide medical treatment to the forward-deployed service member (SM), as well as the means by which certain topically relevant issues are addressed by the forward provider (i.e. mild traumatic brain injury and post-traumatic brain injury).
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ABSTRACT Active duty military service members (ADSMs) suffer disproportionately from chronic pain. In the USA, military pain physicians serve an important role in the treatment of pain conditions in addition to the maintenance of the fighting force. Expanding roles for pain physicians, including novel therapies, consulting roles for opioid policy, and usefulness in a deployed setting create enormous value for military pain physicians. Ongoing force structure changes, including proposed reduction in the U.S. Military’s healthcare workforce may significantly impact pain care and the health of the fighting forces. Military pain physicians support a variety of different roles in the military healthcare system. Ultimately, maintaining a robust faculty of pain physicians allows for both preservation of the fighting forces and a ready medical force.
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Military orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% plan on staying in the military until retirement. Most surgeons entered into the military due to a desire to serve their country, while most people leave service due to higher pay as a civilian. A minority of military orthopaedic surgeons achieve military retirement; however, increased pay, increased control over practice, and decreased frequency of deployments are factors that could improve retention rates. (Journal of Surgical Orthopaedic Advances 30(2):116-119, 2021).
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Previously, researchers investigated the career accomplishments of USU medical graduates using the data from a USU alumni survey. To better understand if such accomplishments are related to military retention, the current study investigates the relationship between accomplishments (such as military career milestones and academic achievement) and military retention.Utilizing the responses to the alumni survey sent to USU graduates in the Classes of 1980 to 2017, the researchers investigated the relationship between a series of survey items (e.g., military rank, medical specialties, and operation experiences) and military retention.Among the respondents who had a deployment history in support of an operational mission, 206 (67.1%) stayed longer than their initial active duty service or planned on staying longer than their current active duty service commitment. Fellowship directors (n = 65, 72.3%) showed a higher retention rate than other positions. The PHS alumni had the highest retention rate (n = 39, 69%) of the military branches, whereas physicians in medical specialties with higher demand (e.g., otolaryngology and psychiatry) showed less promising retention.By conducting future research on underlying reasons as to why full-time clinicians, junior physicians, and physicians in medical specialties with higher demand showed less promising retention, stakeholders will be able to identify what needs to be addressed to retain highly skilled physicians in the military.
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United States military medical planning must reevaluate the practices of combat casualty resuscitation, transportation, and triage to secondary echelon care. Analysis of the experiences of other medical commands, such as that of the Israeli Defense Force, offers insight into improvements in equipment and training that are achievable with minimal cost. Training programs must involve formal instruction in Advanced Trauma Life Support for the combat corpsman, and ongoing experience in trauma surgery for personnel who are placed in the role of military surgeons. Today in military medicine there exists a major deficiency of expertise in trauma care, arising through a near total lack of involvement in active trauma surgery on the part of military medical training facilities. Civilian trauma centers offer an abundance of opportunity for military-like casualty management, and successful efforts at our command have integrated active duty personnel into this experience.
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We studied a group of active duty military personnel with well-defined, lumbar discogenic, radicular pain syndromes. Our study group included 29 patients, 12 of whom required surgery during the study period. Three of the 29 patients had to be medically retired from active military service. Two patients required permanent limited-duty assignment and 10 others required prolonged (6 months or more) periods of limited duty. These findings highlight the significant adverse impact of lumbar disk disease on fitness for full active duty in military personnel.
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