The Madigan Army Medical Center, located on Joint Base Lewis-McChord just outside Lakewood, Washington, is a key component of the Madigan Healthcare System and one of the largest military hospitals on the West Coast of the United States.The hospital was named in honor of Colonel Patrick S. Madigan, an assistant to the U.S. Army Surgeon General from 1940 to 1943 who was also known as "The Father of Army Neuropsychiatry." On September 22, 1944, Madigan General Hospital was named in his honor.The hospital today is a 205-bed, Joint Commission-accredited facility, expandable to 318 beds in the event of a disaster. Major services include general medical and surgical care, adult and pediatric primary care clinics, 24-hour Emergency department, specialty clinics, clinical services, wellness and prevention services, veterinary care, and environmental health services.Madigan Army Medical Center received designation as a level 2 trauma center by the Washington State Department of Health in 1995, and has maintained level 2 status to the present day. The Madigan Army Medical Center is one of three designated trauma centers in the United States Army Medical Department (AMEDD). In 1999, Madigan became the second military hospital to ever receive a perfect score of "100" from the Joint Commission.Construction of the current facility was completed in the early 1990s. Prior to the opening of the building, the hospital consisted of a network of connected single-story buildings that are still utilized by Madigan Army Medical Center.S.S.
Chronic pain affects approximately one-third of active-duty service members (ADSMs), yet effective treatment remains challenging. Salivary cortisol and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) are established non-invasive biomarkers of stress and oxidative DNA damage and may provide reliable unbiased indicators of treatment efficacy in chronic pain. However, their associations with pain outcomes and potential sex differences remain unclear. It was hypothesized that interdisciplinary pain treatment would result in decreased levels of stress and oxidative DNA damage biomarkers, as well as decreased pain intensity, and that the magnitude of challenge might vary by sex. Our objective was to compare longitudinal changes in salivary cortisol and urinary 8-OHdG in relation to pain outcomes and sex. A total of 190 ADSMs who referred for chronic pain treatment completed data collection on the Patient-Reported Outcomes Measurement Information System (PROMIS) measures and urine and saliva samples at baseline and post-treatment. Multivariable regression models were used to predict changes in PROMIS scores relative to changes in cortisol and 8-OHdG, while adjusting for baseline levels. Interaction terms between participants' sex and changes in biomarkers were added to each model. Given the study's exploratory nature, a significance threshold of p < .10 was used for all analyses. Five statistically significant sex-by-cortisol interactions were identified for pain measures (pain impact, pain interference, physical functioning, sleep impairment, and social functioning), but none for 8-OHdG. Future work is needed to replicate these findings in larger samples. The research protocol was registered in ClinicalTrials.gov (NCT03297905; https://clinicaltrials.gov/study/NCT03297905).
OBJECTIVE:Pediatric mortality from conflict-related injuries exceeds that of adults. Understanding pediatric injury patterns and outcomes is critical for guiding resource allocation and training. This study characterizes pediatric injuries in conflict zones and examines relationships between injury patterns, resource allocation, and survival. METHODS:A retrospective cohort analysis of the Department of Defense Trauma Registry from 2001 to 2022 was conducted for children younger than 18 years treated at deployed military treatment facilities in conflict zones with documented injuries and discharge status. The primary outcome was survival to hospital discharge. RESULTS:A total of 5695 children met inclusion criteria with an overall mortality rate of 9.4%. Nonsurvivors had higher injury severity scores (25 vs 9, P < .001), were younger, and sustained burn injuries (18.1% vs 9.4%, P < .001). They experienced greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, P < .001) and required more transfusions (47.9% vs 29.4% P < .001). Neither group received balanced transfusion, with packed red blood cell-to-platelet ratios of 4:1 in nonsurvivors and 6.5:1 in survivors. CONCLUSION:This large epidemiologic study highlights age-specific injury patterns and resuscitation needs contributing to pediatric mortality in conflict zones. Higher blood loss and resuscitation volumes in nonsurvivors underscore the need for early hemorrhage control. Findings support strategies that include standardized pediatric equipment and targeted training in early recognition and management of hemorrhagic shock with balanced transfusion. These results emphasize the need for tailored resources and protocols for pediatric patients in austere, conflict-related settings.
INTRODUCTION:Effective contraception is essential for U.S. Army Women (USAW), most of whom are of reproductive age and at risk for unintended pregnancy. In this study, we use the Periodic Health Assessment (PHA) to identify contraception needs and electronic health records (EHR) to identify pregnancy events within the Military Health System (MHS). MATERIALS AND METHODS:This was retrospective cohort from August 31, 2021, to August 31, 2023 of PHAs, electronic health records, and pharmacy records obtained from the Armed Forces Surveillance division. The population was USAW who completed 2 PHAs during the study period (n = 23,015). Inclusion criteria were being female sex, 18-45 years, and need for contraception (n = 10,679). Need for contraception was defined as sexually active women with a uterus, who do not plan to conceive over the following 12 months. This was further divided into a "met" or "unmet" need. A met need was defined as use of sterilization, long and short-acting reversible contraceptives, or barrier methods. An unmet need was defined as those not desiring pregnancy and not using contraception. The prevalence of reproductive-aged USAW with need for contraception who are on (needs meet) or not on (needs unmet) contraception along with rate of pregnancy was obtained. RESULTS:Overall prevalence of unmet need for contraception was 18.3%. Junior Officers were 2.24 times (95% CI, 1.89-2.64) more likely than junior enlisted to have contraception needs met after adjusting for other factors. Black/African U.S. U.S. Army Women had significantly lower odds (0.57; 95% CI, 0.50-0.65) of having their needs met compared to their non-Hispanic White counterparts. An unmet need was associated with increased risk of unintended pregnancy (adjusted OR = 2.46, 95% CI, 2.10-2.88). CONCLUSIONS:Twenty percent of USAW with a need for contraception potentially had that need unmet over 12 months, which resulted in twice the rate unintended pregnancy compared to those with a met need. The military may consider using the PHA and other proactive strategies to address this issue.
INTRODUCTION:Cricothyroidotomy is a rarely performed, but lifesaving procedure. It is imperative that surgeons and the medical teams they work with can execute the steps required to successfully perform a cricothyroidotomy. As a procedure that is dependent on tactile feedback and expeditious execution, surgical teams require training models that can meet these needs for successful performance of a cricothyroidotomy when met with a patient who cannot intubate and cannot ventilate. Cadaveric, animal, and adequate synthetic training models are preferred but are not commonly available in deployed environments. Herein, we present a simple, inexpensive, and reproducible cricothyroidotomy training model built using supplies available in any hospital, including deployed medical facilities. MATERIALS AND METHODS:Cricothyroidotomy models were built using spirometer tubing, rolls of tape, and latex roll bandaging. A voluntary training session was held at a deployed military medical facility and was open to all hospital personnel and coalition force members. Participating members completed an anonymous survey detailing their level of experience performing cricothyroidotomy as well as their self-assessment of knowledge of steps, instruments, and overall confidence performing cricothyroidotomy on a 5-point Likert scale. A brief didactic session was held reviewing steps of the cricothyroidotomy, then each participant performed a timed cricothyroidotomy on the model and completed a post-training survey documenting level of confidence with the procedure post-training and an overall assessment of the model using a 5-point Likert scale. Participants repeated a timed cricothyroidotomy on the same model 4 weeks later. Pre and post-training confidence levels were compared using the Wilcoxon signed-rank test; time to cannulation between first and second attempts 4 weeks later were compared using the paired samples t test. This study underwent formal IRB review and was granted exempt status, as it did not involve patients and collected anonymous survey data from voluntary participants. RESULTS:Thirty-two soldiers, including American healthcare professionals and coalition force medics, completed the training. Self-assessment of confidence in performing cricothyroidotomy on a 5-point Likert scale improved from a mean of 2.78 to 3.63 pre and post-training, respectively (P < .005). Mean time to cannulation improved from a mean of 101.6 ± 60.7 seconds on first attempt to 62.6 ± 24.8 seconds on second attempt 4 weeks later. Mean overall rating of usefulness of the model by participants was 4.77 on a 5-point Likert scale, indicating a perception that the model was overall very useful for training. CONCLUSION:A simple, portable, and inexpensive cricothyroidotomy training model can be built with common hospital supplies available even in austere deployed environments. This model is suitable for hands-on practice and can increase level of confidence as well as speed in performing cricothyroidotomy. The realism of the model is limited by the simplicity of the materials, however, it is adequate in instances where cadaver and animal tissue are unavailable. Future study could evaluate equally portable and inexpensive training options for deployed soldiers, including 3D models.
INTRODUCTION:Traumatic brain injury (TBI) is a significant U.S. military health concern. Although emerging evidence suggests that nutrition may contribute to TBI outcomes, research on clinical nutrition interventions, especially within military populations, is limited because of a lack of data repositories that integrate the Nutrition Care Process, lifestyle factors, and clinical outcomes. MATERIALS AND METHODS:We established a novel Nutrition and TBI Data Repository, integrating TBI and nutrition care data from military health records spanning from January 1, 2017, to December 31, 2024. Our data repository leverages 12 distinct data sources and includes clinical encounter, laboratory, radiology, and pharmacy data, among others. RESULTS:Our repository contains clinical data for 431,673 patients with TBI and a 1:1 age- and sex-matched control cohort. The patient population is predominantly male (56.2%) and aged 17-41 years (39.5%). Most first-recorded TBIs are classified as mild (72.5%), and for 67.0% of the TBI cohort, mild represents the highest recorded severity. Active component service members make up 19.8% (n = 170,888) of the repository. We report patient counts across 23 health condition categories: 9 chronic health, 4 nutrition-related, 4 lifestyle factors, 3 sleep disorders, and 4 mental health disorders and 10 procedural code categories, including nutrition procedural codes. Overall, the TBI cohort has higher rates of health conditions, lifestyle codes, and nutrition counseling than controls. CONCLUSIONS:Our Nutrition and TBI Data Repository is the first of its kind, integrating longitudinal patient-level nutrition care data with TBI outcomes sourced directly from the Military Health System to enable researchers to identify critical knowledge gaps in TBI and nutrition care and explore the role of nutrition in TBI recovery.
