'Through and Through' History: The Management of Gunshot Wounds From the 14th Century to the Present.

Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. 'Through and Through History' explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.

U.S. Army Medical Corps Recruitment, Job Satisfaction, and Retention: Historical Perspectives and Current Issues.

INTRODUCTION: This study was conducted to identify and understand the current factors affecting recruitment, job satisfaction, and retention of U.S. Army Medical Corps officers and provide historical background to understand if the current factors are dissimilar. MATERIALS AND METHODS: An anonymous, voluntary questionnaire was sent to U.S. Army Medical Corps officers, and responses were tabulated and analyzed. Historical research was conducted and historical analysis applied. RESULTS: Recruiting, job satisfaction, and retention among Army Medical Corps Officers have been problematic throughout the 50-year history of the all-volunteer force. Recruiting has largely been of medical students, with very limited numbers of direct accessions. At times, satisfactory overall numbers have camouflaged shortages in key go-to-war specialties. Also, satisfactory numbers in a specialty have sometimes camouflaged problems in depth of experience. Satisfaction has been seen as a problem but apparently only studied informally and/or episodically. Retention has largely been addressed through service obligations, followed by monetary bonuses, although these have to be across the Department of Defense, limiting service flexibility. There has never been consistent, longitudinal sampling of opinion among Medical Corps Officers to allow senior leaders to influence the Department of Defense policy. A recent (2016) study provides substantial data but should be repeated rather than being isolated. CONCLUSION: As the situation in the Department of Defense and Army Medical Department changes, with more focus on go-to-war specialties, the Army needs to better measure opinion among Medical Corps Officers to inform policy. These studies should be conducted regularly to generate reliable information on trends and allow prioritization of effort to areas that hamper recruiting, undermine satisfaction, and prevent retention.

A history of US Army PAs.

The US military has a long tradition of using physician assistants (PAs). The Army began using PAs in 1971 in an effort to supplement the physicians and surgeons in the medical corps. As their numbers grew, PAs gradually replaced general medical officers assigned to battalions. Later, specialty positions developed in aviation medicine, orthopedics, and emergency medicine. The need for a PA serving as an adviser in the major commands slowly developed at all levels of leadership. In 2015, the Army removed limitations on female PAs assigned to combat units. PAs lead in tactical and clinical settings, filling command roles, senior clinical positions, and administrative leadership roles.