Abstract Introduction Military first aid is a critical intervention in life-threatening situations in combat environments. As a substantial proportion of potentially survivable deaths occur before advanced medical care is available, effective first aid at the point of injury is essential. In situations where medical resources are delayed, degraded, or inaccessible, soldiers may become the primary providers of care. This study aimed to explore how Swedish soldiers perceive first aid in military settings following international deployment. Materials and Methods We conducted a qualitative empirical study with a phenomenographic approach. Using purposive sampling, we recruited 20 Swedish soldiers with experience from international deployment. Individual semi-structured interviews were conducted and analyzed to identify the different ways in which first aid was perceived in military contexts. Results Five qualitatively distinct descriptive categories were identified, representing variations in perceptions of military first aid: structured basic measures, automatic skills, mental readiness, a coordinated effort, and emotional proximity in care. The results demonstrate that military first aid is perceived as extending beyond the application of technical procedures; it encompasses cognitive, interpersonal, organizational, and emotional dimensions of care in operational environments. Conclusions Military first aid should be understood as a context-dependent capacity for action rather than solely adherence to predefined procedures. Effective performance depends not only on technical competence but also on how personnel perceive, interpret, and act in complex and dynamic situations. In contemporary conflicts, qualified medical personnel cannot always be expected to be available soon after injuries. These results emphasize the importance of preparing soldiers for the practical, cognitive, and emotional challenges of providing first aid and may inform the development of future military first aid training programs.
Abstract Artificial intelligence (AI) is moving from pilot programs into the routine delivery of military mental health care. Predictive models already scan Veterans Health Administration records to flag veterans at high risk of suicide; models trained on Army Study to Assess Risk and Resilience in Servicemembers data can now stratify suicide risk up to a decade after soldiers leave active service, and generative AI models are being positioned to deliver triage, peer support, and low-intensity psychological interventions. The frameworks that govern responsible military AI have not kept up. The Department of Defense Responsible Artificial Intelligence Strategy and Implementation Pathway, NATO’s principles of responsible use, and allied instruments such as the United Kingdom’s JSP 936 provide lifecycle assurance for AI-enabled capability, but none of them makes specific provision for the therapeutic encounter. That omission exposes service members to what this commentary terms a recognition-action gap. Systems trained predominantly on civilian data can transcribe the words of military distress accurately while misreading their clinical meaning: moral injury classified as fear-based trauma, minimized suicidality scored as low risk, routine operational vernacular flagged as threat. The risk is compounded because the boundary between clinical care and occupational capability is porous in the armed forces. The military command exception to the Health Insurance Portability and Accountability Act Privacy Rule and command notification under Department of Defense Instruction 6490.08 mean that outputs generated for care could lawfully reach deployability, security clearance, and administrative decisions, with predictable consequences for help-seeking. This commentary proposes behavioral validity, the demonstrated capability to safely manage the behavioral presentations of the population a system will actually serve, as a core governance requirement for mental health AI in defense settings. It specifies 4 conditions of use: clinically supervised pre-fielding assessment, therapeutic firewalling, moral injury and cultural competency, and meaningful human control. Defense health systems should not wait for civilian regulators to notice the gap. They are well placed to define the standard.
Introduction: Sleep restriction can impair shooting performance by 10%-40%, thereby diminishing operational effectiveness. Emerging evidence suggests that exogenous ketones may counteract the physical and cognitive declines associated with sleep loss; however, specific effects on shooting performance during sleep deprivation have not yet been evaluated. Materials and Methods: Using a crossover, double-blind, placebo-controlled design, 32 healthy volunteers (16 women) underwent four consecutive nights of 50% sleep restriction in two sequences. Participants received a 25 g dose of either bis-octanoyl (R)-1,3-butanediol (BO-BD) or an isocaloric flavor-matched placebo before, twice daily during, and once after sleep restriction (9 doses per sequence). Capillary ketones were measured using a point-of-care device. Sleep duration/ architecture were monitored using a wearable infrared skin monitor device. Accuracy, precision, decision-making, and reaction time were evaluated using a reliable virtual reality simulator. The reaction time task, Steel Plates, required participants to engage six targets from left to right as quickly as possible, with Hit Factor [(hits-misses)/ time] serving as the primary metric. Results: Time in bed decreased from 7 hours 51 minutes at baseline to 4 hours 15 minutes during sleep restriction (-46%; P < .001). The BO-BD elevated capillary ketones (>1.0 mM) and augmented the time spent in deep sleep 13% relative to the placebo (P = .042). Independent of sleep and relative to placebo, BO-BD elicited an 8% greater Hit Factor (P < .001), 7% faster completion time (P < .001), 1% higher accuracy (P = .023), and 7% greater throughput (P < .001). Marksmanship and decision-making were overall preserved; however, loss of vertical rifle steadiness was associated with sleep loss (P = .052). Conclusion: A transient state of nutritional ketosis enhanced virtual reality shooting performance both before and after shortterm sleep restriction. Acute and twice-daily BO-BD supplementation during sleep restriction may augment shooting speed and efficiency without affecting marksmanship or decision-making under sleep constraints.
Introduction Self-warming chemical blankets are widely deployed in military, prehospital, and hospital settings as a power-independent warming solution. Despite widespread use, no harmonized safety standard governing surface temperature limits for this device class is known to exist, and independent bench-testing data are sparse. This study aimed to characterize the thermal performance and safety profiles of commercially available self-warming chemical blankets and evaluate their suitability for use in military, prehospital, and perioperative contexts.Materials and Methods Four self-warming chemical blanket devices were subjected to standardized laboratory bench testing following the IEC 60601-2-35:2021 framework as an analogical reference standard. Twelve-channel K-type thermocouple arrays and infrared thermography recorded surface temperature distribution over time. Key outcomes included time to 40 degrees C, maximum recorded surface temperature, surface temperature uniformity, and sustained high-temperature exposure duration.Results The Hypothermia Prevention and Management Kit (HPMK) Full Body and HPMK-I Full Body Self-Heating Blankets reached maximum recorded temperatures of 69.1 degrees C and 69.0 degrees C, respectively, and the Ready-Heat Full Body Self-Heating Blanket reached 68.7 degrees C, all substantially and persistently exceeding established burn thresholds for more than 12 hours. The M & ouml;lnlycke Barrier EasyWarm required over 81 minutes to reach peak temperature, did not achieve 40 degrees C within clinically relevant timeframes, and also exceeded burn thresholds under prolonged contact. No device demonstrated simultaneous rapid attainment of therapeutic temperature and maintenance of safe surface temperatures.Conclusions Commercially available self-warming chemical blankets exhibit a dual failure: they are too slow to provide therapeutic warming within the acute treatment window and generate surface temperatures consistent with serious burn risk under prolonged contact, particularly in patients with impaired peripheral circulation or reduced consciousness. The absence of a dedicated safety standard for this device class means that devices generating temperatures far above recognized burn thresholds are fully compliant with current regulatory requirements. The evidence base supporting clinical use of these devices is thin, and these findings are corroborated by burns reported to national device-safety databases. Urgent development of fit-for-purpose safety and performance standards is warranted, alongside review of the guideline endorsement and procurement that sustain the use of these devices.
Introduction Maintaining clinical readiness of military surgeons is essential for optimal combat casualty care, yet limited exposure to high-acuity trauma in military treatment facilities (MTFs) contributes to skill degradation during peacetime. Military-civilian partnerships (MCPs) have emerged as a key strategy to address this gap by embedding military surgeons within high volume civilian trauma centers. However, objectively measuring whether clinical experience translates into readiness remains challenging because of the disconnect between civilian billing-based documentation using current procedural terminology (CPT) codes and military readiness frameworks such as the United States (U.S.) Army General Surgeon Individual Critical Task List (ICTL). This study aimed to develop a CPT-to-ICTL mapping framework to quantify U.S. Army surgeon readiness within a long established MCP.Materials and Methods A retrospective observational study was conducted at a single urban academic Level I trauma center MCP from May 2020 through September 2024. CPT codes from the CPT 2024 Professional Edition were categorized as definitively or potentially satisfying an individual critical task (ICT), with the latter requiring operative or procedural documentation review for confirmation. Billing logs for 2 MCP embedded U.S. Army surgeons (Surgeons A and B) were analyzed, excluding non-procedural and non-critical care codes. During the study period, Surgeon A contributed 48 months of clinical time while Surgeon B contributed 42 months because of periods of deployment and offsite military training. CPT codes were grouped by encounter, mapped to ICTs, and counted once per encounter to avoid duplication. Descriptive statistics were used to summarize ICT frequency. The study was approved by the local Institutional Review Board with a waiver of informed consent.Results The CPT-to-ICTL mapping framework identified 1,239 CPT codes corresponding to 1,772 CPT-to-ICT associations. Open abdominal and thoracic procedures accounted for the largest proportion of mapped codes. Surgeon A and Surgeon B completed 2,020 and 1,358 ICTs, respectively. The most frequently performed ICT was the Focused Assessment with Sonography in Trauma (FAST) examination, with laparotomy as the most common operative task. Additional commonly performed ICTs included tube thoracostomy, trauma resuscitation, and critical care management.Conclusions This novel approach to quantifying military surgical readiness links administrative billing data to readiness-defined tasks. The findings support MCPs as effective environments for generating exposure to combat-relevant clinical activities while highlighting the feasibility of using CPT-based frameworks for objective readiness assessment. This framework has important implications for readiness reporting, program evaluation, and policy development within the Military Health System. Future work should validate this approach across diverse settings, incorporate non-procedural aspects of care, and align readiness metrics with clinical outcomes and deployment performance.
