Review of EmPATH Units for Behavioral Health Casualties in Prolonged Field Care Environments.

INTRODUCTION: Psychiatric conditions are one of the leading non-battle injury diseases resulting in medical evacuation (MEDEVAC) from combat environments. The challenge of limited MEDEVAC capability necessitating prolonged field care in future large-scale combat operations must be addressed. Therefore, a robust program is needed to address frontline care of behavioral health (BH), maximizing service members returning to duty and minimizing MEDEVAC. This review summarizes the literature on the impacts of the Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) Unit program as a solution to the challenges of treating behavioral health in future wars. MATERIALS AND METHODS: We conducted a systematic literature search and review, and a non-systematic literature critique. We then used the Johns Hopkins evidence appraisal tool to appraise the strength and quality of the evidence. The following electronic databases were utilized for the search: Google Scholar, Embase, CINAHL, and PubMed. Search terms included: included "EmPATH," "prolonged field care," and "operational," alone and combined. RESULTS: The literature review found that the EmPATH unit, a recently developed civilian hospital-based program, can work with higher acuity psychiatric crisis patients who would otherwise be admitted to an inpatient unit, showing promising results in avoiding the need for inpatient hospitalization. EmPATH units help decrease hospitalization rates, reduce restraints and violence, and shorten the patients' boarding time in a holding area. Such findings support the use of the EmPATH unit as a tactic for prolonged field care of psychiatric patients in a combat operational environment. CONCLUSIONS: This is the first literature review to consider EmPATH units for psychiatric prolonged field care based on its advantages demonstrated in the civilian sector. Studies have yet to be done on EmPATH units' usefulness in the military, showing a knowledge gap in current evidence supporting its suitability. Thus, this review recommends further studies of EmPATH units in military settings, especially prolonged field care environments.

Hypnotherapy for the Treatment of Persistent Pain: A Literature Review.

BACKGROUND: Persistent pain causes a significant decrease in quality of life and increases overall disability more than any other condition. Hypnotherapy is emerging as a treatment option for pain management; examination of this treatment modality and its effectiveness is needed. AIM(S): To examine evidence for effectiveness of hypnotherapy to treat persistent pain in adults. METHOD: A consolidated review was completed through searching biomedical and life sciences literature databases. RESULTS: Results were obtained through appraisal of six identified studies meeting inclusion criteria. Hypnotherapy decreases pain and improves pain-related function and quality of life outcomes to a greater extent than other psychological interventions or usual treatments. Furthermore, it has been shown to be effective in a variety of chronic pain conditions. CONCLUSIONS: Current treatment practices fail to alleviate pain adequately; there is sufficient evidence to suggest hypnotherapy as a viable treatment modality for persistent pain. However, more definitive studies are needed for it to be a first-line intervention.

Long-term lower extremity prosthetic costs in children with traumatic lawnmower amputations.

OBJECTIVES: To evaluate prosthetic costs of pediatric lawnmower amputations; to see if reducing the incidence of pediatric lawnmower amputations could result in significant cost savings; and to consider if a cost analysis could be useful to implement more safety features (voluntarily or legislatively). DESIGN: Pediatric lawnmower amputees from 1980 to 2000 were reviewed to determine age at time of injury, level of amputation, number of prostheses, and lifetime per prosthesis. A standard prosthetic program beginning at amputation and ending at age 18 years was constructed. An aggregate cost was calculated according to the proportion of amputation levels. The cost burden for prosthetic care was estimated from the statistics of US pediatric lawnmower injuries. SETTING: Referral pediatric orthopedic center. PATIENTS: Fifty-three lower extremity amputees with 58 lower extremity amputations at a mean +/- SD age of 4.7 +/- 2.5 years were reviewed. RESULTS: The percentage of amputee children injured by riding lawnmowers was 80%; the percentage injured by riding lawnmowers engaged in reverse was 39%. Prosthetic costs from the time of injury to the age of 18 years range from 73,140 dollars to 116,040 dollars per single lower extremity amputation. With 600 to 650 new childhood amputations per year due to lawnmowers, the new annual burden for prosthetic costs thus ranges from 43.88 to 75.42 million dollars, or (600)(73,140 dollars) to (650)(116,040 dollars). CONCLUSIONS: Further encouragement of lawnmower manufacturers to install improved safety devices (such as those to disengage power while in reverse mode of operation), new research on improved safety measures, and continued promotion of educational campaigns regarding the dangers of children being around and/or operating riding lawnmowers and garden tractors should be pursued. This will result in significant cost savings as well as incalculable health savings.