The Unofficial Newsletter Recognizing the Efforts of the Joint Trauma System to Improve Trauma Care.

3rd Quarter 2015, Volume 8 Issue 1

What is a Trauma System? The notion of a trauma system is new to most cadets in medical training. This is because they are primarily trained to manage the care of an individual patient. The subject of trauma system is not introduced until students attend courses such as Advanced Trauma Life Support and Emergency War Surgery. The US Army Medical Department Center and School defines a trauma system as “an organized, coordinated effort in a defined geographic area that delivers the full range of care to all injured patients and is integrated with the local public health system. The true value of a trauma system is the ability to provide the appropriate level of care to injured patients, integrating existing resources to achieve improved patient outcomes.”

To ensure improved patient out-come, it is imperative providers step-ping into leadership roles understand the in’s and out’s of a trauma system. Healthcare providers are aware patients travel to their locations, and are then transported to another facil-ity for another phase of care. That is the trauma system, right? What is the big deal? One way to communicate the im-portance of “systems” to trauma is to apply the concept of “systems” to everyday concepts such as the trans-portation system. Air transportation hubs are located at air carriers around the nation. Local transportation companies set up shop at airports to make the services available to travelers so they can con-tinue their journeys. Taxis, shuttles, public buses, commuter trains and subways represent different systems, yet together they make up the na-tional public transportation system. Another example of a system comprised of multiple systems — integral components — is anatomy and physiology. Take the cardiovas-cular and respiratory systems for ex-ample. Each component of the sys-tem interconnects with other system components. Then, each system in-teracts with other systems. It is this level of consanguinity which builds an effective trauma system. To learn about trauma systems, refer to the Battlefield Trauma Systems.

DIRECTOR’S NOTES

COL Kirby Gross, USA , MC. JTS Director

Major Emily Wolfe and Captain Samantha Wild, of the Military Ortho-paedic Trauma Registry (MOTR), are the latest JTS members to be deployed in support of Operation Enduring Freedom and Freedom’s Sentinel. Maj Wolfe and Capt Wild are Flight Nurse Officers for the 433rd Aeromed-ical Evacuation Squadron, Lackland Air Force Base, Texas. The two were deployed to the 10th Expeditionary Aeromedical Evacua-tion Squadron, Ramstein, AB, Germa-ny, from September 2014 through January 2015. While there, Capt Wild served as the Officer in Charge (OIC) of the Aero-

medical Evacuation (AE) Operations Team. She launched and recovered over 200 AE missions, ensuring the safe transport of 175 patients. Maj Wolfe served as the OIC of a seven-man AE crew consist-ing of three flight nurs-es and four AE techni-cians. Maj Wolfe and

her crew safely trans-ported over 150 patients to Germany, most of

whom were flown out of Afghanistan. The Major’s crew also flew patients requiring higher levels of care to Andrews Air Force Base, Maryland. Despite the fact that Maj Wolfe and Capt Wild were away from family dur-ing the holidays, they did enjoy some “down time” and take part in the Ger-man holiday festivities. The two took a Rhine River Cruise together, seeing historical castles and wineries, as well as perusing the local Christmas markets. Both remain active reservists with the 433rd AES and continue to train to en-sure they are “ready” to deploy and answer the nation’s call when needed.

Bird’s eye view of Major Emily Wolfe caring for patients during transport.

MOTR FLIGHT NURSES SAFELY

TRANSPORT OVER 325 PATIENTS

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Everyone knows prolonged sitting is bad for you, but did you know it’s now considered a disease by the Mayo Clinic? It is quickly becoming a pervasive disease in a culture where 50 to 70 percent of people spend six or more hours sit-ting a day and 20 to 35 percent spend four or more hours a day watching TV.

If two hours of sedentary behavior can be just as harmful as 20 minutes of exercise is beneficial, just think of what havoc eight hours a day is causing. This finding, published in the Mayo Clinic Proceedings, is based on data from 2,223 partici-pants in the National Health and Nutrition Exami-nation Survey. Cardiologists at the University of Texas Southwestern Medical Center examined the association between fitness levels, daily exercise and sedentary behavior.

Previous studies have shown a sedentary lifestyle is associated with increased risk for type 2 diabetes, heart disease and cancers (breast and colon). If Americans would cut their sitting time in half, their life expectancy would increase.

The best way to reduce low back fatigue and discomfort from sitting is to limit prolonged exposure to sitting to one hour—an impossible feat for those of us confined to the computer for most of the day.

Ta k e B a c k Ye a r s L o s t t o t h e S i t t i n g d i s e a s e : Ta k e B a c k Ye a r s L o s t t o t h e S i t t i n g d i s e a s e : D o Th e D e s k t o p B o o g i eD o Th e D e s k t o p B o o g i e

So what can you do to limit the damage caused by prolonged sitting?

Choose a chair that allows you to change your sitting posture frequently throughout the day.

Use an adjustable height sit-to-stand desk.

Decrease the duration of static posturing.

Vary postures throughout the day.

Minimize awkward and extreme postures.

Sit or stand, depending on the task at hand.

Take short rest breaks during the work day.

The best defense is to increase tissue toleranc-es through exercise and adequate rest. If you have any symptoms of pain/discomfort prompt-ly have them evaluated by a licensed health care provider.

As part of the Army’s mission to help Soldiers and Army families live healthier, active lives, the

Army launched the Performance Triad website. The Performance Triad pro-vides information and resources to help you improve your sleep, activity and nutrition. Staying active during the day may be easier than you think. Look for ways to build activity into everyday routines. Park further away from your office than you normally would. Take the stairs instead of the elevator. Try some simple exercises like squats or standing leg curls at your desk. Getting some daily physical activity is always better than getting none at all.

Find Performance Triad resources here. http://phc.amedd.army.mil/topics/campaigns/perftriad/Pages/PerformanceTriadInformationforDACivilians.aspx

By Maria Dominguez, USAISR Occupational Health Nurse

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Fitness trackers or activity monitors such as Fitbit, Apple Watch, Jawbone UP and Google Glass potentially violate Health Information Portability Accountability Act (HIPAA). The way these devices capture data pose priva-cy and security concerns for individual-ly identifiable health information. The way companies store personal data in the “cloud” is also worrisome. Federal Trade Commission (FTC) Com-missioner Julie Brill has expressed concern over the risks of health data collected by wearables and mobile apps which lie outside the purview of HIPAA and other medical regulations. The FTC has urged Congress to pass legislation to highlight practices of data brokers to better protect consumer sensitive data. Device owners can opt out of sharing information with the community by

The Committee on Tactical Combat Casu-alty Care (CoTCCC) has recommended Zofran (ondansetron) as the preferred anti-emetic medication in TCCC over Phenergan (promethazine). The original selection of promethazine over ondansetron for the TCCC Guidelines was made when ondansetron was being sold under patent. Generic forms of the Zofran were not available, making it pro-hibitively expensive for use as a battle-field anti-emetic. Ondansetron is no longer under patent and available at a lower cost. Ondansetron is increasingly being used as the medication of choice for the treat-

ZOFRAN REPLACES PHENERGAN AS BATTLEFIELD ANTI-EMETIC TCCC Update

specifying data remain private, but opting out of sharing personal data with the manufacturers is not an op-tion at this time, despite requests by privacy advocate groups and the FTC. Additionally, Terms of Sale and Service grant the manufacturer the right to reproduce, modify, publicly distribute, and generally use the data to promote and enhance existing product and create new ones. While not explicitly relinquishing ownership

of intellectual property rights, owners are giving up a substantial control over their data. Not all personal data is equal in the eyes of the law. HIPAA limits health information used in assessments of physician and hospital performance. Patients can request their data not be shared with third parties. HIPAA re-quires patient consent before a pro-vider may use health information for advertising purposes.

“In a medical context that means: mining individually-identifiable health information could constitute a breach of patient privacy if the analysis falls outside of the scope of HIPAA,” Julie Anderson, a former senior policy official at the Department of Vet-erans Affairs. “It is not clear whether using patient data to improve products, as opposed to health outcomes, is allowed under this law. And an even more concerning scenario could take shape if health information were com-bined with other personal, non-medical data for the purposes of user profiling.” Wearable device manufacturers must align Terms of Service and privacy poli-cies with HIPAA privacy and security requirements. To read more, go to : http://www.govhealthit.com/news/are-wearables-violating-hipaa

By Mary Jo Glunz-Bartz, JTS Information Manager

ment of nausea and vomiting in the Emergency Department (ED) and the pre-hospital environment, as well as in inpatient, obstetrical and post-surgical settings. Ondansetron is FDA-approved for the treatment of nausea and vomiting in cancer patients being treated with chemotherapy or ionizing radiation. It is also FDA-approved for post-operative nausea and vomiting. There is, however, an extensive body of liter-ature describing its successful use in many other settings, including undiffer-entiated nausea and vomiting in the ED. It has a well-established record of

efficacy and safety. Its mild side effect profile is more favorable for use on the battlefield and tactical care envi-ronment than promethazine’s. How to use Ondansetron in Tactical Field Care and Tactical Evacuation Care:

13k. Ondansetron, 4 mg ODT/IV/IO/IM, every eight hours as needed for nausea or vomiting. Each 8-hour dose can be repeated once at 15 minutes if nausea and vomiting are not improved. Do not give more than 8 mg in any 8-hour interval. Oral ondansetron is NOT an ac-

ceptable alternative to the ODT for-mulation.

The position paper that supports this change has been approved for release will soon be published in the Journal of Special Operations Medicine. The change will be incorporated into the updated 2015 TCCC curriculum available this summer. Thanks to Lieutenant Commander Dana Onifer, Marine Corps Special Opera-tions Command, and his co-authors for preparing this change to the TCCC Guidelines.

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JTS RJTS RJTS RECOGNIZESECOGNIZESECOGNIZES JJJESSEESSEESSE MMMORALESORALESORALES

FORFORFOR HISHISHIS VVV ITALITALITAL RRROLEOLEOLE INININ THETHETHE

EEEVOLUTIONVOLUTIONVOLUTION OFOFOF THETHETHE DDDOOODTRDTRDTR

Meet Jesus A. Morales (aka Jesse). Jesse has been with JTS since its infancy in 2007, back when staff could park next to the building. Jesse joined the JTS team as an Application Develop-er for the IT Automation Branch after leaving his position as Database Administrator for ISR’s Information Management Office. During his tenure, Jesse has worked with Digital In-novation, JTS’ third-party software developer, to load and test the standalone client-server Store & Forward (S&F) version of JTTS and its Report Writer. He helped transform the S&F JTTS into a robust, real time, web-accessible system, Department of De-fense Trauma Registry (DoDTR). On top of that, he stood up the DoDTR Portal. The website took over 18 months to launch – from equipment setup to test-ing. Jesse was instrumental in database and systems integration, networking and testing. Jesse recalls the day JTTR (DoDTR) went live in October 2010 as a great moment in JTS history.

J T S P a c e s e t t e r H o n o r s E x e m p l a r y P e r f o r m a n c e

Jesus A. Morales Database Administrator

In 2012, he helped develop modules for Orthopae-dic, Infectious Disease, Ophthalmology, Traumatic Brain Injury and Acoustics. In 2013, he moved the Windows servers to a virtual system. More recent-ly, he helped setup a reporting system for Special Projects. “The JTS would be crippled without Jesse. His lon-gevity and knowledge of the DoDTR makes him invaluable,” said Mary Jo Glunz-Bartz, JTS Infor-mation Manager. “Without Jesse's dedication and diligence in maintaining the functionality of the JTS systems, the data acquisition teams and data analysis would be severely degraded. He is my go-to guy.” Jesse continues to work on the forefront of JTS’ initiatives. A new module, Outcomes, is close to completion. He is tasked with the formidable mis-sion of moving the Linux database servers to a vir-tual system by mid-August. This assignment illus-

trates JTS’ manage-ment’s high level of confidence in him. Of all his accomplish-ments, Jesse says his greatest is the standing up of the DoDTR as a web application. Launching DoDTR was vital to the register’s international acceptance and its overall success. Jesse recognizes and appreci-ates the important role he plays in the JTS mission. “The most rewarding part of my job is knowing our system helps save lives and grants better lifestyles because of the information we gather and share,” said Jesse.

About Pacesetter

The Pacesetter program recognizes and honors JTS staff members who set the pace for the organization’s standard of excellence. Pacesetters lead by example, demonstrate a positive attitude when faced with chal-lenges, and are known for their collaborative spirit. They take pride in

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their work and it shows in the product. Each quarter, JTS leadership selects professionals whose behaviors and work ethics support or fur-ther the mission, goals, values and initiatives of JTS.

Cases of ocular trauma caused by munitions and improvised explo-sive devices1 has risen in recent military conflicts, accounting for an increasing proportion of com-bat-related injuries. Approximate-ly 15 percent of open globe inju-ries in Operation Enduring Free-dom and Operation Iraqi Free-dom resulted in enucleation.2 Penetrating ocular injuries from explosive projectiles comprise a

significant proportion of all ocular injuries.3 An irreparable penetrating injury to the globe may require the surgical removal of the eye, most often by enuclea-tion or evisceration.4 Psychological distress and the potential for facial disfig-urement accompany the traumatic loss of an eye; these effects can be mitigat-ed with an ocular prosthesis.5 Today’s realistic prosthesis conceals the absence of the eye thereby improving the defective facial appearance and preventing embarrassment or other psychological distress. The use of ocular prosthesis is an essential to the rehabilitation process.

Ocular prosthetics can be traced to ancient Egypt where burial preparations included replacing the eyes with wax and precious stones.6 The fabrication of ocular prosthetics using heavy metals was evident by the 16th century, when Ambroise Paré, a French barber surgeon, described an ocular prosthesis constructed of gold and enamel built to fit behind the eyelids. Although the evolution of the first glass eye is uncertain, Lorenz Heister, a German anatomist, surgeon and botanist, recommended the use of glass over metal for ocular prosthetics in 1752, citing better aesthetic qualities and orbital tolerance.7 By the 19th century, France was considered the premier producer of stock glass eyes.8 Unfortunately, glass prosthetics were heavy and required frequent replace-ment. Then, in 1835, a glassblower named Ludwig Müller-Uri developed a lighter cryolite glass for prosthetic eyes. Glass was the material of choice up until World War II when a glass shortage occurred. Dental acrylic methyl methacry-late was identified as a better prosthesis fabrication, and alternatives emerged soon after.

The Vision Center of Excellence

OCULAR PROSTHESIS PLAYS H ISTORICAL ROLE IN HELPING

TRAUMA PATIENTS SUCCESSFULLY RECOVER Following surgical removal of an eye, a spherical orbital implant is placed in the socket. The implant is typically constructed from nonporous silicone, hy-droxyapatite, or porous polyethylene.9 The oculoplastic surgeon often sutures the extraocular muscles directly to the implant or to materials surrounding the implant. At the end of the procedure the conjunctiva and Tenon’s fascia are sutured over the implant. A plastic conformer is placed between the conjuncti-va and the eyelids to maintain socket size and contour until a final ocular pros-thesis is placed. After four to eight weeks, patients are referred to an ocularist for placement of a stock or fabrication of custom-designed prosthesis. For a custom designed prosthesis, the ocularist makes an impression of the eye cav-ity using a soft alginate casting mate-rial.7 A wax model of the socket is then created from the alginate cast-ing and placed into the eye for adjust-ment and shaping. The adjusted wax model is used to make a methyl meth-acrylate cast and the final acrylic prosthesis is developed. An artist paints the iris, pupil and other eye details. The prosthesis is then cov-ered with clear acrylic resin, cured, cooled and polished. A final “fitting” ensures the patient can wear the prosthesis securely and comfortably.

Prosthesis fabrication is time consum-ing and requires considerable artistic skill, patience and technical knowledge, making it costly. Insur-ance policies differ in their coverage for prosthetic devices; out-of-pocket costs can range from $2000-$8000. But a well-made ocular prosthesis is a worthy investment. It can make all the difference in the successful rehabilita-tion and societal reintegration of an individual with severe disfiguring injuries.

(Continued on page 10) Page 6

The JTS is constantly evolving to meet the needs of our DoD trauma community. We are proud to recognize nine additional abstraction sites for the DoD Trauma Registry (DoDTR). In the process of the Pacific Command (PACOM) developing its command’s Joint Theater Trauma System (JTTS), the system has designated sites and personnel to lead the initial push for trauma data acquisition in the Pacific Theater. Sites include:

US Naval Hospital, Okinawa, Japan US Naval Hospital, Yokosuka, Japan US Naval Hospital, Guam US Air Force Hospital, Yokota, Japan US Air Force Hospital, Misawa, Japan US Air Force Hospital, Osan, Japan US Army Hospital Tripler AMC, Hawaii Joint Base Hospital in Elmendorf, Alaska (NORTHCOM) US Army Hospital Brian Allgood Army Community Hospital, South Korea

A four-day DoDTR training course was developed for the above sites by the JTS Data Acquisition Branch. Using distance learning resources, including the US Army Medical Information Technology Center audio bridge and Direct Connect Online, JTS hosted two four-day training sessions. These sessions allowed for simultane-ous training to multiple sites across a 19-hour time zone window. The training entailed developing a skill set in medical record abstraction, including trauma diagnoses coding using the Abbreviated Injury Scale coding system. Education focused on utilizing the DoDTR data dictionary and supporting guidelines to ensure consistency in registry data entry. We would like to thank PACOM JTTS leadership and dedicated site personnel for their efforts during training and launching of the new sites. The data generated by the additional acquisition facilities will mark an exponential increase in the footprint of the PACOM JTTS and strengthen JTS’ ability to evaluate and impact trauma care across the globe.

A Word from Data Acquisition

PACOM ADDS DATA ABSTRACTION S ITES TO EXPAND DODTR

For the first time since its inception in 1973, an active duty Army Medicine doctor will be a Fellow at the Robert Wood Johnson Foundation Health Policy Fellows program. LTC (P) Dr. Robert L. Mabry, the JTS Director for Trauma Care Delivery at the U.S. Army Institute of Surgical Research will begin his year-long fellowship in September as a member of the 2015-2016 RWJF Health Policy Fellows Program. For more than 40 years the RWJF has worked to improve health and health care. The Foundation strives to build a national culture of health that will enable all to live longer, healthier lives now and for generations to come. “The reason I wanted to do this was to improve my capacity as an AMEDD leader by seeing first-hand how things work at the political and strategic level, and to see how senior leaders deal with tough challenges,” said Mabry. With an illustrious 31-year Army career thus far, Mabry believes his experience as an enlisted Soldier and a commissioned officer on the Colonel’s promotion list gives him a unique perspective on trying to improve combat casualty care. Mabry believes the fellowship at RWJF will help him to continue to make a difference in Army Medicine and combat casualty care. “We are organizationally focused on hospital-based care. Once a casualty reaches the hospital, most survive,” Mabry said. “But our data shows the vast majority of combat deaths that are potentially salvageable die before reaching the hospital. We need more focus on pre-hospital care. That’s where I believe that I can continue making a difference for our Soldiers.”

LTC (P) MABRY LEAVES FOR PRESTIGIOUS FELLOWSHIP

LTC (P) Dr. Robert L. Mabry, JTS Director for Trauma Care Delivery, USAISR

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Summer 2015 bring changes in uniformed personnel at JTS. Col Jeff Bailey has taken over as Chief of Surgery at Walter Reed National Military Medical Center Bethesda. LTC(P) Robert Mabry is out processing JBSA. LTC (P) Mabry was selected to serve as a Rob-ert Wood Johnson Health Policy Fellow with Congress. He will interact with legislative leadership on health policy issues, including combat casualty care. Col Bailey and LTC (P) Mabry will be taking to their next leadership positions knowledge gained from their experience at JTS. Assignment at JTS permits uniform personnel to gain an understand-ing of how the entire casualty care system fits together. These lessons are tremendous-ly valuable in shaping policy and the next generation of combat casualty care leaders. Stacy Shackelford Col USAF joined JTS in July. Col Shackelford is a trauma surgeon stationed at the Center for the Sustainment of Surgical and Readiness Skills at Baltimore Shock Trauma at the University of Maryland. Col Shackelford was previously deployed in 2012 as the Joint Theater Trauma System Director. Col Shackelford will be serving in the role of Chief of Trauma Care Delivery. Samual Sauer COL US Army will be assigned to JTS in late August. COL Sauer is a physi-cian with training in internal medicine, occupational medicine and aerospace medicine. He serves as Dean of the School of Aerospace Medicine in Pensacola Florida. COL Sauer’s operational experience has primarily been in the special operations community. COL Sauer deployed with the JTTS in 2013 as the Pre-Hospital Director. COL Sauer will be leading the interaction of JTS and the pre-hospital community of providers. COL Sauer will be contributing to JTS remotely as he will remain in Pensacola. Jason Montgomery MAJ US Army joins JTS as a critical care nurse who has had multiple

HAILS AND FAREWELLS

deployments as an en route critical care nurse. He works in Trauma Care Delivery on pre-hospital topics. COL(R) Kotwal will continue with as a contractor and focus on strategic projects. Harold Montgomery Master Sergeant (R) US Army will join JTS as a remote contrac-tor. MSG (R) Montgomery served as Senior Medic of US Special Operations Command. Data Analysis Branch said farewell to Rebecca (Becca) Zeiset on June 26 as she relocat-ed to Maryland. She just found out she is expecting a girl in November. She will be missed! Newcomers are listed in the above table.

Letters

Karissa Holm

JTS staff participated in the May 20th National Trauma Survivors Day campaign by sharing inspirational messages to show support for survivors of traumatic injuries and their caregivers. The messages were posted on social media sites with messages from other AMEDD agencies to create one strong voice for recovery.

COL Kirby Gross Linda Martinez

CAPT Zsolt Stockinger

Love

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NAME Job Title/Position

Teri Graham Trauma Registry HIM Specialist (Coder)

Kathrine Malachi Trauma Nurse Research Analyst

Emily Wolfe Trauma Nurse Research Analyst

Cynthia Kurkowski Senior Technical Writer

Samantha Wild (Returned after theatre) Trauma Nurse Abstractor

Dr. Stephen Giebner (Remote) Physician Writer

Kristie Harnisch Performance Improvement Nurse Analyst

Brianna Premdas Administrative Assistant

Mack Joyce Database Manager

James Mason Automation Branch Chief

Raquel Mencke Abstractor

Vintage Medical Forms for C l inical Data Col lect ion

Did You Know? As a basic workaround, surgeons

wrote brief narratives directly on patient dressings

in order to pass along clinical information.

Images are property of the Office of Medical

History, U.S. Army Medical Department. Page 9

ARTICLES SUBMISSION

JTS Newsletter Editor

Cynthia R. Kurkowski

Data Automation Branch

(210) 539-7756

Cynthia.R.Kurkowski.Ctr@mail.mil

3698 Chambers Pass

Building 3611 - BHT1

JBSA Fort Sam Houston

TX 78234-6315

A b o u t T h e J o i n t T r a u m a S y s t e m M I S S I O N : O P T I M I Z I N G C O M B A T C A S U A L T Y C A R E

The mission of the Joint Trauma System (JTS) is to improve trauma care delivery and patient outcomes across the continuum of care utilizing continuous performance improvement (PI) and evidence-based medicine driven by the concurrent collection and analysis of data maintained in the Department of Defense Trauma Registry (DoDTR). The JTS is a division of the U.S. Army Institute of Surgical Research (USAISR) which is part of the U.S. Army Medical Research and Materiel Command and is collocated with Brooke Army Medical Center. The USAISR is dedicated to both laboratory and clinical trauma research. Its mission is optimizing combat casualty care by providing requirements-driven combat casualty care medical solutions and products for injured soldiers, from self-aid through definitive care across the full spectrum of military operations; provide state-of-the-art trauma, burn, and critical care to DoD beneficiaries around the world and civilians in our trauma region; and provide a Burn Flight Team.

On AKO/DKO: https://www.us.army.mil/suite/page/131956 On the Internet: http://www.usaisr.amedd.army.mil

Battlefield trauma care is constantly evolving; the dissemination of information in a timely fashion is critical to stay up to date on trends, Clinical Practice Guidelines, and performance indicators which are vital for en-suring optimal treatment of casualties in remote areas. The JTS offers clinicians, nurses, and medics the opportunity to acquire Continu-ing Education credits on a weekly basis. The telemedicine conference was developed to increase the knowledge-base of clinicians, nurses, medics, and other non-healthcare providers while deployed. The dual technical platforms of land line telephones and Defense Collaboration Services are used to connect far forward providers throughout the continuum of care. If you would like to join the conference, please contact the JTS Education Branch Chief Dallas Burelison at dallas.r.burelison.ctr@mail.mil

COMING SOON to the JTS Combat Casualty Care Curriculum Conference

The JTS Combat Casualty Care Curriculum Fourth Quarter CME Objectives 23-Jul-15: Public Health: Value of the Trauma Registries

30-Jul-15: Pre-MTF Trauma Systems (Navy, Army)

06-Aug-15: Blunt Abdominal Trauma Clinical Practice Guideline

13-Aug-15: International (NATO) Capabilities

20-Aug-15: Damage Control Resuscitation

27-Aug-15: Historical Vignette

3-Sep-15: JTS Development Process

10-Sep-15:MHSRS update

17-Sep-15:MERT

24-Sep-15 Implementation of Advances to Combat Casualty Care

1. Weichel, E. D., Colyer, M. H., Ludlow, S. E., Bower, K. S., & Eiseman, A. S. (2008). Combat ocu-lar trauma visual outcomes during operations Iraqi and enduring freedom. Ophthalmology, 115(12), 2235-2245.

2. Cho, R.I. (2014). Ocular trauma in the Global War on Terrorism. Ophthalmology Management, 18, 48-50.

3. Wong, T. Y., Seet, M. B., & Ang, C. L. (1997). Eye injuries in twentieth century warfare: a histori-cal perspective. Survey of Ophthalmology, 41(6), 433-459.

4. Perman, K. I., & Baylis, H. I. (1988). Evisceration, enucleation, and exenteration. Otolaryngo-logic Clinics of North America, 21(1), 171-182.

(Continued from page 6)

5. Newton, J. T., Fiske, J., Foote, O., Frances, C., Loh, I. M., & Radford, D. R. (1999). Preliminary study of the impact of loss of part of the face and its prosthetic restoration. The Journal of Prosthetic Dentistry, 82(5), 585-590.

6. Martin, O., & Clodius, L. (1979). The history of the artificial eye. Annals of Plastic Surgery, 3(2), 168-171.

7. Danz W., Sr. (1990). Ancient and contemporary history of artificial eyes. Adv Ophthalmic Plast Reconstr Surg. 8, 1-10.

8. Raizada, K., & Rani, D. (2007). Ocular prosthesis. Cont Lens Anterior Eye, 30(3),152-162. 9. Moshfeghi D.M., Moshfeghi A.A., & Finger P.T. (2000). Enucleation. Surv Ophthalmol, 44(4),

277-301.

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