The Efficacy of Analgesic Subdissociative Dose Ketamine in Trauma Casualties Treated by U.S. Military Special Operations Medical Professionals in a Prehospital Environment

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty data collection tool. Quantitative study inclusion criteria were adult casualties treated by U.S. military medical professionals with ketamine in a prehospital environment, had documented injury data, and had both pre- and post-ketamine pain scores. Descriptive statistics, followed by inferential statistical analyses using Shapiro-Wilkes, Wilcoxon Signed Rank, Spearman rho, and Kruskal Wallis tests were used. Additionally, phenomenology guided the analysis of two (n = 2) case studies. In vivo coding was used to develop themes and subthemes. Case studies collected from U.S. military medical professionals provided qualitative insight that reinforced the quantitative data and provided clinical validity to the study. Research Results/Findings. The study showed safe, efficacious use of analgesic sub-disociative ketamine use in prehospital trauma casualties relative to the 0–10 NRS for pain. The median reported pre-ketamine pain scale for casualties was 9.0 (IQR 2). The median post-ketamine pain scale was 0.0 (IQR 3). The mean total dosage of ketamine administered was 98.19 mg (SE = 9.545). There were 6 (12.8%) casualties who experienced side effects from ketamine that were neither permanent nor life-threatening. The case studies provided the human aspect of the study, reinforced the quantitative data, and provided clinical validity. Post-ketamine pain scores were better than pre-ketamine pain scores. Higher dosages of ketamine provided greater pain relief. No life threatening nor adverse drug reactions were found in this study. Conclusions From Research. This study demonstrated a safe, efficacious analgesic ketamine use in prehospital trauma casualties used by U.S. military special operations medical professionals relative to the 0–10 NRS for pain. The results of this study may inform medical practitioners and policymakers regarding the efficacy of analgesic ketamine in a prehospital environment, aid in making informed treatment decisions regarding trauma casualties, and provide facts for updating and improving clinical practice guidelines and policies focused on the U.S. military. Advancing the understanding to promote better prehospital pain management guidelines, procedures, and practices is essential. Education efforts will make medical professionals aware of the importance of analgesic ketamine for trauma casualties in a prehospital environment. @font-face {font-family: Cambria Math ; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;}@font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-536859905 -1073732485 9 0 511 0;}@font-face {font-family: Calibri $Headings$ ; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-alt:Calibri; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:auto; mso-font-signature:0 0 0 0 0 0;}p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent: ; margin:0in; mso-pagination:widow-orphan; font-size:11.0pt; font-family: Calibri ,sans-serif; mso-fareast-font-family:Arial; mso-bidi-font-family: Calibri $Headings$ ; color:black; mso-themecolor:text1;}.MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:11.0pt; mso-ansi-font-size:11.0pt; mso-bidi-font-size:11.0pt; font-family: Calibri ,sans-serif; mso-ascii-font-family:Calibri; mso-fareast-font-family:Arial; mso-hansi-font-family:Calibri; mso-bidi-font-family: Calibri $Headings$ ; color:black; mso-themecolor:text1; mso-font-kerning:0pt; mso-ligatures:none;}div.WordSection1 {page:WordSection1;

U.S. Counterinsurgency Malpractice?

The U.S. miscalculated the balance between soft and hard power for employment in counterinsurgency operations in Afghanistan

2017 Working Papers

The Next Decade: Amplifying the Women, Peace and Security Agendahttps://digital-commons.usnwc.edu/wps/1000/thumbnail.jp

Strategic Latency Unleashed: The Role of Technology in a Revisionist Global Order and the Implications for Special Operations Forces

The article of record may be found at https://cgsr.llnl.govThis work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory in part under Contract W-7405-Eng-48 and in part under Contract DE-AC52-07NA27344. The views and opinions of the author expressed herein do not necessarily state or reflect those of the United States government or Lawrence Livermore National Security, LLC. ISBN-978-1-952565-07-6 LCCN-2021901137 LLNL-BOOK-818513 TID-59693This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory in part under Contract W-7405-Eng-48 and in part under Contract DE-AC52-07NA27344. The views and opinions of the author expressed herein do not necessarily state or reflect those of the United States government or Lawrence Livermore National Security, LLC. ISBN-978-1-952565-07-6 LCCN-2021901137 LLNL-BOOK-818513 TID-5969

Predicting Maritime Pilot Selection with Personality Traits

Maritime pilots provide a vital service in facilitating the safe and efficient passage of vessels into and out of ports and waterways worldwide. Lack of effective selection of maritime pilots can jeopardize the welfare of people, property, and marine ecosystems. Based on Edwards\u27 conceptualization of person-job fit theory, this quantitative, ex post facto study was an examination of whether personality traits, as measured by the Personality Research Form E (PRF-E), could predict maritime pilot selection. The research questions were: (a) Is there a significant relationship between respondents\u27 PRF-E scale ratings and selection for a maritime pilot job and (b) How significant is the relationship between each of the 22 PRF-E scale ratings and selection for a maritime pilot job. Using a sample of 328 maritime pilot applicants, binary logistic regression was conducted to determine if any of the PRF-E variables were significant predictors of pilot selection. The results of the logistic regression analysis illustrated a significant predictive relationship between 9 of the 22 PRF-E scales and maritime pilot selection, specifically the traits of abasement, achievement, change, cognitive structure, dominance, harmavoidance, sentience, desirability, and infrequency. Future research should examine the relationship between selected maritime pilots\u27 personality traits and job performance. Potential contributions to positive social change include improving the capability of maritime pilot commissions and associations to make more informed and effective selection decisions. The continued assessment of maritime pilot candidates\u27 personality traits could support the prevention of future vessel accidents, ecological damage, human injuries, and fatalities

Information technology and military performance

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Political Science, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 519-544).Militaries have long been eager to adopt the latest technology (IT) in a quest to improve knowledge of and control over the battlefield. At the same time, uncertainty and confusion have remained prominent in actual experience of war. IT usage sometimes improves knowledge, but it sometimes contributes to tactical blunders and misplaced hubris. As militaries invest intensively in IT, they also tend to develop larger headquarters staffs, depend more heavily on planning and intelligence, and employ a larger percentage of personnel in knowledge work rather than physical combat. Both optimists and pessimists about the so-called "revolution in military affairs" have tended to overlook the ways in which IT is profoundly and ambiguously embedded in everyday organizational life. Technocrats embrace IT to "lift the fog of war," but IT often becomes a source of breakdowns, misperception, and politicization. To describe the conditions under which IT usage improves or degrades organizational performance, this dissertation develops the notion of information friction, an aggregate measure of the intensity of organizational struggle to coordinate IT with the operational environment. It articulates hypotheses about how the structure of the external battlefield, internal bureaucratic politics, and patterns of human-computer interaction can either exacerbate or relieve friction, which thus degrades or improves performance. Technological determinism alone cannot account for the increasing complexity and variable performances of information phenomena. Information friction theory is empirically grounded in a participant-observation study of U.S. special operations in Iraq from 2007 to 2008. To test the external validity of insights gained through fieldwork in Iraq, an historical study of the 1940 Battle of Britain examines IT usage in a totally different structural, organizational, and technological context.(cont.) These paired cases show that high information friction, and thus degraded performance, can arise with sophisticated IT, while lower friction and impressive performance can occur with far less sophisticated networks. The social context, not just the quality of technology, makes all the difference. Many shorter examples from recent military history are included to illustrate concepts. This project should be of broad interest to students of organizational knowledge, IT, and military effectiveness.by Jon Randall Lindsay.Ph.D

Standardization Roadmap for Unmanned Aircraft Systems, Version 2.0

This Standardization Roadmap for Unmanned Aircraft Systems, Version 2.0 (“roadmap”) is an update to version 1.0 of this document published in December 2018. It identifies existing standards and standards in development, assesses gaps, and makes recommendations for priority areas where there is a perceived need for additional standardization and/or pre-standardization R&D. The roadmap has examined 78 issue areas, identified a total of 71 open gaps and corresponding recommendations across the topical areas of airworthiness; flight operations (both general concerns and application-specific ones including critical infrastructure inspections, commercial services, and public safety operations); and personnel training, qualifications, and certification. Of that total, 47 gaps/recommendations have been identified as high priority, 21 as medium priority, and 3 as low priority. A “gap” means no published standard or specification exists that covers the particular issue in question. In 53 cases, additional R&D is needed. As with the earlier version of this document, the hope is that the roadmap will be broadly adopted by the standards community and that it will facilitate a more coherent and coordinated approach to the future development of standards for UAS. To that end, it is envisioned that the roadmap will continue to be promoted in the coming year. It is also envisioned that a mechanism may be established to assess progress on its implementation

Ambulance Service 2030: the Future of Paramedics

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy