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- [00:11]
A
Welcome to the Journal of Special Operations Medicine. I'm your co host, Jessica Rodriguez.
- [00:16]
B
I'm Sydney Duke.
- [00:18]
C
And I'm Matthew Farinella.
- [00:20]
A
And this is where evidence based medicine meets unconventional warfare. This is Sophia Leishman, Director of Marketing and Social Media Communications for the Journal of Special Operations Medicine. You can find us on Instagram, Facebook, X LinkedIn, and ThreadsaseOnline. Subscribe to our biweekly newsletter@jsomonline.org and don't forget to subscribe Review and rate this podcast on Spotify
- [00:48]
D
hello again. This is Dan Godby, Medical Editor of the Journal of Special Operations Medicine. Thank you for joining us for the summer edition of the JSON Podcast. For this introduction I will point out other articles worth reading in addition to those articles being highlighted in the podcast, the Dive Medical Officer and still currently diving Public Safety Diver that are in me are coming out in this introduction with the choice of the first two articles I'm going to highlight. The first article I'd like to recommend is Undersea and Hyperbaric Medicine Case Studies and Review. The authors of this manuscript provide a useful review of the range of conditions that may be associated with diving or hyperbaric injuries. The subject is an interesting one and also important for providers or medical technicians who do not frequently encounter these sorts of conditions. Second is Maritime Applications of Prolonged Casualty Care, Drowning and Hypothermia on an Amphibious Warship. This article is both relevant and timely and given the current focus on prolonged casualty care and the potential reliance on maritime operations, particularly in the Pacific theater, the public safety official that I still am is very happy to see the article Injuries in Specialist Police Officers A Scoping Review as one of the topics chosen for this podcast. This is a well written and substantive essay that is well researched. The data discussed presents insight into diverse injuries and populations. As always, we at the JSOM really do want to hear from our readership, particularly those of you in the front level positions. I will always take this opportunity to reiterate our mentoring program specifically created to help medics get through the publishing process. A select group of our editors are dedicated to concentrate on articles submitted by medics and aid in getting them published. Now here's our team with the podcast.
- [02:53]
A
Hello everyone. Welcome back to the Jason Podcast. We are so excited to be back with another episode for this summer. We hope you have all been enjoying your summer just as we have. Us three have had quite a few new things happening in our medical journeys. Sydney and Matt are both rising third year so they are about to begin their new rotations. Clinical Rotations. Where do y' all guys start at?
- [03:17]
B
I start in obstetrics and gynecology, so I'm, I'm excited for that. My first shift, I have to be on call and I've never done that before, so hopefully we'll see some exciting things.
- [03:31]
C
And I'm starting on Monday in family medicine here in Auburn, so looking forward to getting to see the full gambit of things during the rotation.
- [03:42]
A
I'm really excited for y'. All. Family medicine will be really fun because of the breadth of knowledge that you'll get to experience and apply to all different aspects of the rest of your rotations. And OB gyn was super fun for me as well. So I'm really excited. Y' all have a super great year. I start at Wright Patterson tomorrow. Actually, I fly out to Wright Patterson. I'm doing my first audition rotation, so. So we are about to be in the thick of it as a rising fourth year. And then once match happens in December, it will all calm back down. But I'll be doing a bunch of general surgery rotations back to back to back. But I'm excited. I'm really, really excited.
- [04:18]
B
You're on the home stretch.
- [04:22]
A
So we have some really cool articles that we are going to talk to you about today. Sydney is going to go ahead and go first and tell us a little bit about her article.
- [04:32]
B
All right, guys, so this article was kind of near and dear to my heart. The title is Law Enforcement and Tactical Medicine Injuries and Specialist Police Officers A Scoping Review. Both my parents are retired law enforcement, so that's kind of played in part. It's why I wanted to review this article. So this article is by Kate Lyons, Rodney Pope, Ben Schram, Kelly, Karen Kelly, Excuse me. And Robin Orr. So essentially the purpose of this review was to identify and synthesize available research on musculoskeletal injuries within the special specialist police officers world. Specialist police officers are like SWAT police tactical groups, kind of just police officers and law enforcement that go above the general duties of a normal police officer. Again, kind of like they're akin to the military special forces, but within the obviously domestic law enforcement. And so essentially they wanted to compare these injury rates, types and mechanisms of these injuries with general duties of law enforcement officers as well as military special forces. So again, a little bit of background for you. Specialist police officers tend to have a bit of a higher occupational demand than the general duties of a law enforcement officer. They engage in high risk tasks such as, you know, counterterrorism, riots, high risk warrant service, Hostage situations. And they also do this while carrying heavier loads, meaning that the gear in which they wear can range anywhere from 22 to 40 kg, when usually a normal, not normal, like a general police officer or law enforcement officer will have about 10 kg of weight that they're carrying on them in gear. So again, these specialist police officers tend to have a little bit carrying heavier or carrying heavier loads. So because of this, these job requirements do increase the likelihood of musculoskeletal injuries, which already are already more common in police officers in most other professions. And then what was interesting that they found in this article is that the research was really scarce on specialist police officers. There's a lot of available data on general law enforcement officers as well as military special forces, but specifically within these specialist police sectors, there's really hardly any research. Um, so what they did was they kind of scanned for academic databases, you know, including PubMed, Embase, Ovid, Medline, and kind of had certain keywords that they would pull. Specialist police, swat, police tactical group, and they would combine that with injury and injuries. And then so they kind of grabbed all of their articles. And from their initial record, they found about 3,000 articles. And then after screening the eligibility for their study, they only were able to use two studies. So that's what they were talking about when they meant like the research was scarce. These two studies, one was on SWAT operators and then the other one was on Australian special police specialist police units. And the first study on the US SWAT operators basically had a sample of 72 SWAT operators. All of them were male and they ranged from age from 26 to 35 years old. And they all reported injury locations, but not the mechanism of their injuries. And so kind of what stood out was they all had lower back, not all, but about 24.6% had a lower back injuries and about 12% of the SWAT officers, shoulders and then the knee injuries were 10%. So most of these injuries were coming from low back. And then with the Australian specialist police unit, they had about 138 officers with 95% of them being male. And they had a reported injury incident incidence of 1347 per 1000 personnel per year. And most common injuries for them were sprains and strains, with about 61%, with those top locations being hand and wrist, back, head and neck, and head and neck and the back both being at 16% with hand and wrist being about 21%. And the Australians did also mention their top mechanisms were non compliant offenders, routine duties and then operational training. So again that those kind of conflicts that they were having with the non compliant offenders was the bulk of the mechanisms for their injuries. What was also interesting was the Australian specialist police unit article also mentioned the fact that they have about a thousand shifts loss and which equates to 487,000 Australian dollars in injury related costs over a four year period of time. So these injuries again proving a very specific financial burden. So this article, this review kind of had, you know, it had to have limitations. The limitations being that there were only two studies that they could use for, for this as well as they didn't really have any consistent injury definitions. There was limited detail on each of these injuries. Like for example the SWAT officers injuries didn't really specify how they got these injuries. It more just specified the injuries that they had. But what is really important about this article is that they're, you know this has great utility in the law enforcement community. I mean it definitely shows us that there, you know, that there are implications of these injuries. You know, musculoskeletal injuries, they're frequent, they're costly and they're disruptive in specialist police. So definitely what they were seeking was they wanted to see an improved injury reporting system and definitions, you know, targeting injury prevention programs and as well as injection, you know, organizational changes to, to help with this. And so basically after their, their review and what they've deciphered and what kind of like I've gone through and seen is that essentially the injury rates compared to general law enforcement officers as well as military special forces spec police specialists sustained far more injuries than all the other groups according to these two articles. They kind of stand out alone in having the most groups with the most common injuries being sprains and strains and those locations occurring in the hands, the wrist and low back injuries. And again the one thing that stood out the most was the non compliant offenders as well as their operational training for mechanism of injuries. And again this, police specialists carry a load that's two to four times more than general law enforcement officers which they believe contributes to increased musculoskeletal injuries, especially in the low back and the extremity. So again that key takeaway is specialist police officers do face higher injury rates than military special forces and most other occupations. And this is really largely due to that heavy load carriage, the unpredictable high risk task. And you know, I think we really need better data collection and prevention strategies to really address this problem because this, this is a problem where preventing these are really critical to reduce, you know, injury burden on our law enforcement officers as well. As, you know, costs and a multitude of other things. So I'm really hoping to see that, you know, agencies should maybe start incorporating to track these injuries systematically. I think the authors of this article did a great job of showing the need and utility for that. And as well as that, maybe we should have training programs that address these. The, you know, the increase in load carriage, the physical conditioning, the injury prevention, and just kind of, you know, where do medical teams fit in law enforcement as well? Right. I know we have medical teams within our military, special forces within the military as a whole. But at least from, you know, my knowledge of my parents being in law enforcement, I don't remember any medical teams, you know, police specific. I always just remembered firefighters, paramedics, and, you know, just civilian medical care. So, you know, is that, is there utility in that for law enforcement? But anywho, I thought this interest, this article was super interesting and very informative and really does show us that there is a need for research in the law enforcement community and more specifically in the specialist police officers community as well.
- [13:43]
A
Super interesting. I'm actually curious about what kind of injury prevention programs the article would be referring to as far as maybe implementation, just because if a lot of these injuries are happening during training and stuff like that, like, we need these law enforcement people to be able to adequately train, but at the same time we want to keep them safe. So I wonder what that actually looks like when we talk about preventing injuries.
- [14:07]
B
Yeah, And I, I think what they were kind of getting at was the strengthening and conditioning to manage like the sprains, the strange and the back injuries.
- [14:17]
A
Right.
- [14:17]
B
Like we learned in medical school that, you know, there's things that we can do to strengthen those areas in our body in order to help prevent injuries. And I think that they were kind of getting at that. One of the authors was a, a doctor to physical therapy. I'm sure that's something that was, could be considered as well, you know, and just more so than I know that law enforcement does a ton of conditioning.
- [14:42]
A
Right.
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B
But are they doing the stretching, the strengthening those programs to kind of help prevent those? So I think maybe just even, I mean, look at what athletes do and see if we could implement that within the community.
- [15:02]
C
Yeah. And you know, something else I thought you said that was interesting was comparing, you know, the special operations detachments of, of the police forces versus, you know, special operations in the military and the, the rate of injuries being higher and those of the, the police forces. You know, I wonder, my curiosity is like, are they, you know, lending themselves the time to, to recover from their training events and what they're doing. You know, you look at military and it's, it's, you know, the training calendar is built in a cycle and it, and it allows for the, the, the people to have time to recover and, and, and take care of their bodies and do what they need to. But when you look at something like the police, you know those guys are always on. So those people are always having to go to work and you know, they don't really get, I don't think the, the training breaks that you might see in the military. So that could be a reason why their injuries are so much higher. And then also just wanted to touch on. I've got, actually got a family friend who is a physician and he attaches himself to his local SWAT team when they get calls. And I think that there's a rotating schedule of physicians that do. So I think they do have some medical oversight when they get high risk calls. I don't know if it's for every call, but for high risk calls I think that there's going to be some oversight of some medical asset.
- [16:30]
B
Oh yeah, that's, that's super interesting. I haven't heard of that before, but that, that's what's interesting and I'm glad to hear and I think again, what you were saying, it all just points to the fact that we kind of just need to pay attention more in our research and our development for these communities. But yeah, I agree, it's all super interesting.
- [16:52]
A
Thank you very, very much, Sydney for a great synopsis and for picking a great article. We're gonna, we're gonna go ahead and move on to Matt and his article right now.
- [17:03]
C
All right, so the article that I'm going to be reviewing, it's a proof of concept of Is small scale production of diethyl ether for anesthetic use possible by Dr. Sandeep Danhall, Caitlin Kitzinger, Dennis Jerema and Jeffrey Johnson. So kind of what this article is looking at is the again going into Lisco and near peer adversaries the use and ability of alternative anesthetics due to supply chain issues. So a lot of kind of what we're seeing, you know, we're using the Russia Ukraine war as kind of a model. And I think that this is kind of lending itself to, to looking at that and the ability to push supplies forward, especially medical supplies. So this article took in that into account the lack of, the lack of the ability to bring those supplies forward and then an alternative to that being Diethyl ether. Now I'll say that diethyl ether was regularly used until the 1950s before it was replaced by halogenated agents, largely due to safety concerns. So we'll kind of touch on the safety concerns and what's going on with it as I go further through. So the methods that they were looking at, you know, they, they performed an acid promoted dehydration of ethanol. That was carried out twice. I'm not going to get into the organic chemistry of what reactions took place, but kind of the gist of it was that it was not an easy process. It was kind of, you know, you had to have equipment that you could get tentatively off of the environment, but was kind of niche to performing the distillations. It occurred twice over a four hour period. And so the length of time was quite considerable. And then the two experiments that they conducted collected volumes of 2.6 and 1.5 ML, respectively. Now I don't know how long of an anesthetic that amount of liquid would provide, but that is what they were able to collect in their four hour period that they conducted the distillation. So they analyzed the results with proton nuclear magnetic resonance spectroscopy, you know, in layman's term, that provides lines on a spectrum that provide an identifying signature of the clarity of the impurity of the element that they tried to distill being diethyl ether. In this case, there was a little bit of ethanol still within the solution, but it was 97% that Diethyl Ethereum providing a good proof. So this proof of concept demonstrated that diethyl ether was safe for clinical use in inhaled anesthetic, which we again already knew from before the 50s, and can be produced with sufficient purity through acid catalyzed dehydration of ethanol followed by fractional distillation. So the, like I said earlier, the fractional fraction of ethanol was of little clinical consequence when considering a small amount and the inhalation technique. And then some of the limitations that they found were obviously the standard laboratory equipment with ACS grade reagents and then the materials not being available. I think that that's going to be your, your biggest limitation moving forward from this in a forward setting is like, where are you going to find this? Again, very specific, limited equipment to be able to perform, you know, these distillations. It also does not allow for stable storage during the time it forms peroxides when exposed to air and moisture and light. So it also provides diff is, creates some difficulty in, you know, storage of it after you distill it. So it's basically making use of concept that they're using here. The biggest kind of limitation that I think that you see outside of the actual equipment is that both ethanol and diethyl ether are highly flammable. This is one of the main reasons that we've moved away from them and moved to the halogenated agents is that, you know, they're extremely flammable. And the off chance that there's a spark of any sort of, can kind of create damage based off of the location of where it's at. So the solvent can also cause dangerous splashing if it's carried out too rapidly, which is kind of just perfecting the technique. So not only would you have to have the equipment and have the knowledge of how to do it, but you really gotta be on your P's and Q's and how you're performing a distillation to make sure that you're doing it safely in that limited environment, you know. But bottom line is that it can be used, it can be done. How likely we are to continue to push for something like that, you know, I'm not really sure of some of the limitations I also saw were like limited training. So obviously if you're going to implement this in a forward environment with near peer threats, you have to have individuals who are trained on this that know what they're doing. And then some of the benefits to using it is it does not require an advanced delivery system like some of the modern halogenated agents. And then there's less monitoring involved in this. So you can just kind of give them the anesthetic and then monitor vitals, but you're less worried about that respiratory suppression and you know, long term effects of the medication. And that's all I had.
- [23:19]
A
This is actually super interesting because I have never truly thought about when you're going into a setting where you might not have access to anesthetics, like what do we use in these cases? And I've never really thought about like the limitations that come with it. And I think this article was really cool because they saw a gap and they said let's try to figure out how to potentially solve this gap and if it's even possible. And what we find is that it is possible. But is it like the safest? I guess we could say with all the training that would need to be done. We can't just throw just anybody in there to help make this happen. So this is a really cool, this is a really cool article.
- [23:56]
C
Yeah. And I think that, you know, we are in this setting are applying it to anesthetic use. But I think it can be said with any medication across the board, when you're looking at, you know, near peer threats and supply chain issues, you know, how are we going to give analgesics and stuff like that, you know, these medics are out there carrying ketamine and hydromorphone and things like, of that nature. Like how are they going to continue, you know, as they push further and further away from, you know, supply chains, how are they going to get resupplied or how are they going to be able to effectively perform their duties as medics or physicians, you know, moving forward with maybe short resources or lack of resources. So I think this article presented a very good idea, not just in anesthetics, but in analgesics or any medication moving forward.
- [24:56]
B
I mean, I thought that was super interesting. Back in, I believe it was February was the SAM Ops conference. One of the speakers, I forget her name, but they were talking about how in like austere environments where it wasn't even easy to resupply our medics and, and get the supplies in that they need, they were making like these little unarmed or unmanned, they almost look like little boats that would, you know, go from the water to the land to see if they could deliver supplies. And I thought this would be something that kind of coincides with that and goes along with that, like what can we do, you know, to get our medics to get our teams the stuff that they need and you know, the lightest possible capacity, like how we can't just, you know, carry anything and everything. So I thought that was super interesting because I remember, you know, hearing about it just back in February at the same ops conference.
- [25:53]
C
Yeah, that's super interesting. And you know, it again goes all back into our expectations. Moving forward with peer to peer threats is, you know, our ability to have air superiority and if we're going to be able to do resupplies that way, that has been, our current convention has been with speedballs being pushed out of aircraft or in exchange with your medevac pilots. When we're handing off casualties is like, you know, before we would go out, you pre stage the equipment that you know, that you use readily and then when you are exchanging that casualty, you get back, you know, your resupply so that you're able to, to be able to sustain your ability to be operational out on the battlefield. But you know, if we're not having air superiority, we got to look at other means to be able to push supplies forward. And I think, you know, that's super interesting about boats being able to go on to the, go onto land and be able to travel, you know, distance. But how are we going to just push that stuff forward as covertly as possible to not make those people that are transporting that equipment or supplies, or just the supplies in general, if it's from drones or however, to be a target? Because, you know, that's the other problem that's going to come up from it is eventually that stuff's going to be targeted, knowing that it's our supply chain and our means to medically treat casualties.
- [27:21]
A
Yeah, absolutely. That was a great article. That was a great synopsis. Thank you, Matt. Next, we're going to move on to our next article which is titled Ultrasound Use by Special Operations Combat Medics A Narrative Review limited to the JSOM. It is by Dr. Jonathan Curley. This is a narrative review whose aim is to provide an overview of special operations combat medics use of ultrasounds in clinical practice and explore proposed future applications. This was done by a wide spread PubMed search. They looked for special operations medicine and ultrasound use and they were able to find 120 articles and in the initial search, but they were only 20 actually met the inclusion criteria. And there were two large articles that specifically talked about special operations medicine and ultrasound use that directly related to what we were studying and those were both published by jsom. The inclusion criteria was it included articles describing ultrasound use or advocating for ultrasound use in special operations combat medics in clinical practice. With the growing popularity of point of care ultrasounds, the military and tactical environment implementation of ultrasonography might have a huge impact given the potential limitations on timely evacuations and the necessity for possible prolonged field resuscitation. Access to ultrasound machines, because they used to be on the carts in the hospitals, might have attributed to the slow adoption of PoCUS. But now that we have these handheld portable ultrasounds, little butterflies, they're readily accessible and this problem is becoming, we're overcoming it. And so they're not only cost effective, but some of them also offer telemedicine capabilities, enabling guidance and interpretation assistance, which is something that can directly impact and relates to the missions of the special operations combat medics community. So much so that now this is included and being implemented in the scope of practice of these medics. Despite POCUS being implemented in the scope of practice, we still see that its usage and its impact is not very well documented in medical literature, which is why this whole publication came about. So out of the 20 articles, only two truly went into the usage in special operations forces. The others were more body part based. We had some that were talking about detecting elevated intracranial pressures by measuring optic nerve sheath diameters. We had some that were talking about ultrasound's ability to detect pneumothorax in pigs and in cadavers. And then we had some that were talking about pericardial effusion detection. We also had some talking about detection of hemorrhage controls, especially like ensuring adequate placement of a tourniquet and placements of riboas is where we largely saw them. But the two articles that outlined its usage, the ultrasound usage in special operations forces, discovered that while these medics undergo significant EFAS training, EFAS being the extended focused assessment with sonography for trauma, only 34 out of the 109 exams that we were able to look at used the ultrasound for efast. So although these medics are being heavily trained and ready to use these ultrasounds for efast, it's actually a smaller proportion of what the ultrasounds are actually being used for. The other 69 out of the 109 were actually shown that the medics were using the ultrasound for sick call related exams. So that includes like MSK related stuff, superficial assessments like wound care and then others called special exams such as like fetal viability, retinal detachments, kidney stones, stuff like that. So it is noted that the special operations combat medics in these articles that the abdominal ultrasounds were just actually not that common and EFAS was like only merely mentioned. So ultimately there's a lack of literature supporting the notion that the EFAS examination significantly alters the management of abdominal pathology in current practice because there are already protocols for how evacuations would occur with the medevac team. So even if our medics were using this for the EFAs, it doesn't really change what these patients are going to go through because there's still a medevac protocol. So we actually see that it might not be as, as relevant for the EFAST as they had initially thought. This study is really important because we can see just how little research is actually out there on this subject. There really was not that many articles that included this and then two were truly the only ones that really, really went into special operations forces. It shows us too that maybe where we had training for our special operations combat medics, maybe we can alter it to more so benefit the, the mission that they're serving. And if that mission is, if the ultrasounds are being used in sick call over there, then Maybe we need to make sure that these medics are adequately trained to handle these type of calls because it was noted that most of them did not have enough training for what they were actually using it for in sick call. So I thought it was really interesting and definitely more research needs to be done to see how this can be implemented out there because that ultrasound, the point of care ultrasounds are so, so, so accessible nowadays that this can be really helpful in an Osteo environment. They're so little, these. We could definitely use these more.
- [33:11]
C
Yeah, that is a super interesting article. And I think there's definitely a lot of application to point of care ultrasound, especially like we've been talking about moving to near peer threats, you know, something that when I was in Ranger battalion, they put on the Ranger prolonged casualty care course is a two week course. And part of that was that we were extensively trained in point of care ultrasound and using it, you know, in that prolonged care setting. I do see it kind of lends into what Sydney was talking about in her article with, you know, the weight of these guys going out is kind of the same thing with our special operations guys is, you know, ounces make pounds going out the door. And so, you know, are guys willing to carry even if it is just a probe, that probe, you know, somewhere that's readily available for them to be able to use it. And then kind of what you were talking about, Jessica, is like, where how does that drive treatment or change our treatment as we move forward? A lot of the argument that I saw in when we're talking, you know, doing coin operations and previous stuff that we were doing is, well, you know, I can do an EFAS exam and it's still, my treatment's still going to be the same. It's incompressible abdominal hemorrhage that I may not have the ability to fix as a sock a medic or, you know, on the field if I don't have surgical capabilities. My vitals and patient presentation are going to drive my treatment in that case. So, you know, there's definitely something to be said. But moving into a prolonged casualty care, you know, we need to think about evacuation, how that, you know, using point of care ultrasound can kind of change, you know, our evac status of our casualties and maybe move people higher up in the list to get out if we do have any medevac capabilities at that time. And something else that's cool. So a lot of these guys, especially the medics for battlefield tracking, are carrying something called an atac, which is you know, a phone that allows for battlefield tracking. And now with the addition of like the butterfly app, you can just attach your probe right into that phone with that app and be able to do the fast and you have it on you. So it really is just a marginal amount of weight. If these guys are willing to, you know, train with it and get really good at EFAS exams and these other exams to be able to do maybe a little bit more complex procedures under the direction of their medical guidance, it could really lend to saving a lot of patients in the future.
- [35:55]
A
I absolutely agree. Do you think that from your personal experience that y' all were trained in using these ultrasounds for more sit call stuff? Because it might not have been published, but maybe there is some training on there about like just like superficial wounds and fetal viability and like MSK related, like, like a. I think the article mentioned like pectoralis tear, stuff like that. Do you feel like y' all were trained and stuff like that?
- [36:25]
C
I feel like it was more one off chances if that stuff happened. Like if there was an opportunity to ultrasound MSK injury or something of that nature, then it was used there. You know, we trained pretty extensively on ultrasound guided IVs, so that was, you know, done it in clinic a lot and then, you know, ultrasound guided injections for MSK stuff as far as, you know, fetal viability and stuff like that. We were mainly working on male population, so we didn't see really any of that, but the other opportunities, you know, it was just as it was presented that we would be able to work on it.
- [37:04]
B
I always love the experience you bring to this group, Matt. Um, it's. It's always so interesting to hear your, your side of things and, and your point of view. I just think, you know, the theme of the day has been how can we do the most with the least, right? Like, how can we do the best that we can, you know, and give exemplary care and, and you know, and maintain this, this high bar while doing it with the least amount of equipment. And I, I kind of feel like just with the research that's been out there and you know, some of the guest speakers I've heard at conferences and things like that, that that's kind of the direction military medicine is going. So I thought that was super interesting and kind of like how all three of these article kind of went together in that regard.
- [37:52]
C
Yeah, definitely. Doing the most in a resource limited environment is going to be the name of the game. And how do we mitigate supplies and mitigate casualties and movement as much as possible is going to be what everyone's going to be looking towards in this near peer threat. So it's, it's really cool. And I do, I agree with you, Sidney. This, these three articles, you know, I didn't superficially think that they all went hand in hand, but they really did.
- [38:19]
A
Yeah, this was a great session, everyone. These are great articles. We're really looking forward to seeing the catalog of all the new journal articles that are coming out for this summer's edition. And with that, that about wraps up up the summer edition to this JSON podcast. We hope you enjoyed listening as much as we have had hosting. As always, please reach out and give us feedback. We're always eager to find out how we can make a better product to assist your practice out in the operational environment. Thanks and we will see you next time.
- [38:52]
C
As a reminder, the views and opinions are the speaker's own, and nothing contained herein is to be considered the official opinion of the Journal of Special Operations Medicine or the US Government, including the Defense Health Agency, Department of Defense, Department of the Army, Navy or Air Force.