Derek Licina, DrPH

An update on Bleeding Control in Emergency Department; In the United States, trauma claims the lives of over 150,000 civilians each year. In military settings, trauma and exsanguination result in 50% of combat related deaths. The majority of these deaths result from uncontrolled non-compressible hemorrhage. Non-compressible hemorrhage often results from deep vascular injuries within the torso, however can also occur secondary to penetrating injuries that involve the extremities. Given the high mortality rates for non-compressible hemorrhage, rapid and effective management of patients suffering from hemorrhage is essential to good patient outcomes. Consequently, there has been increasing interest in solutions for point-of-injury hemorrhage control in trauma and military medicine. Undoubtedly there is a great need for prehospital hemostatic interventions that can be deployed by trained and untrained personnel. Since 2001, various hemostatic agents have been developed, each with its advantages based upon the type and severity of injury, wound size, wound location, accessibility to injury site, and the coagulation status of the patient. These agents are often used in the military setting as a temporizing measure prior to definitive therapy and include techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and bioengineered agents including ResQFoam, RevMedx’s XSTAT, Tranexamic acid (TXA), and QuikClot Combat Gauze (QCG). Ann Transl Med. 2021 Jul; 9(14): 1192. doi: 10.21037/atm-20-5452 https://lnkd.in/gqgzeuuh

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National Security News and Commentary https://conta.cc/3ZOuRU4 1. Special Operations Chief Details Irregular Warfare Place in Defense Strategy 2. Special ops leaders eye alarming levels of adversary collaboration 3. How Memoirs by American Officials Leave the CIA Out of U.S. Policy in Burma 4. 2024 China Military Power Report 5. What the Pentagon’s New Report on Chinese Military Power Reveals About Capabilities, Context, and Consequences 6. Regional Basing of Security Force Assistance Brigades (SFABs) 7. Army will trim 5% of general-officer jobs in coming years, chief’s spokesman says 8. What’s at risk if Congress doesn’t fund the government by Friday night 9. Countering Chinese Deception in Modern Military Operations 10. The US defence industrial base can no longer reliably supply Europe 11. Trump Signals Jones Act Policy Will Stay the Course 12. State Department 'censor' office finds lifeline 13. Congress demands answers on low testosterone issues among special operators 14. China’s Mosaic Warfare 15. The US military is sending counter-drone systems to New Jersey bases. Here's how the Dronebuster works. 16. Imagining a US Army Drone Corps 17. The Long Range Desert Group and the birth of special operations around the world

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Interesting article about what could be the next pandemic and our lack of preparedness for such an event. In this interview with Epidemiologist Michael Osterholm, he discusses what's keeping the United States from closing public health gaps in preparing for this potentially next public health crisis. The H5N1 virus has been circulating in the avian population and on farms for months and may have just taken the next step towards becoming a pandemic, achieving human-to-human transmission. https://lnkd.in/eD_drMWG

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As a veteran living with Constrictive Bronchiolitis (CB) and having tirelessly advocated in this space - this news hits close to home. The VA has released a Supplemental Notice of Proposed Rulemaking (SNPRM), proposing a new diagnostic code for CB, a severe respiratory condition affecting Post 9/11 veterans exposed to toxic inhalation, including burn pits. While CB is recognized under the PACT Act, this diagnostic code won’t provide the full support we need because the VA continues to rely on outdated testing methods like pulmonary function tests (PFTs), which often come back normal—even in cases like mine, where lung biopsies confirm extensive damage. The VA’s refusal to adopt expert recommendations from its own Delphi Study forces many of us into a frustrating cycle of missed diagnoses, delayed care, and unfair disability compensation. Key Points: 1. Non-invasive tests fail: Veterans with CB often show normal results on non-invasive tests, despite lung biopsy-proven severe damage. 2. Ignoring Delphi criteria: The VA's decision to disregard expert guidance undermines veterans' access to proper disability ratings and essential benefits. 3. Policy change is urgent: The VA must update its evaluation criteria to include biopsy-confirmed CB cases, aligning with the PACT Act’s goal of comprehensive care for veterans. As someone living this reality, I know firsthand how crucial it is for the VA to act now, ensuring veterans receive fair, evidence-based evaluations and the care they’ve earned. To read Burn Pits 360s full Press Release attached below. Rosie Lopez-Torres Le Roy Torres #Veterans #ConstrictiveBronchiolitis #BurnPits #PACTAct #VeteranCare #LungHealth #Advocacy #VeteranVoice

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Santa wears combat boots… Operation Christmas Drop 2024: U.S. Air Force, Allies and Partners Integrating to Deliver Donated Supplies JOINT BASE PEARL HARBOR-HICKAM, Hawaii -- The U.S. Air Force, Allies and partner nations are making final preparations for Operation Christmas Drop 2024. This annual humanitarian activity brings essential supplies to remote communities in the Pacific starting Dec. 4 at Andersen Air Force Base, Guam. Operation Christmas Drop displays the shared capabilities of Indo-Pacific Air Forces and is a testament to the U.S. Air Force's enduring support of humanitarian assistance. The airdropped bundles of food, supplies, and other hard to source items are expected to reach nearly 60 remote islands across the Pacific, including locations in the Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands. The success of this humanitarian activity is made possible through the collaborative efforts of multiple organizations, including the Japan Air Self-Defense Force, Philippine Air Force, Royal Australian Air Force, Royal Canadian Air Force, Republic of Korea Air Force, and the U.S. Air Force. The multinational operation, led by the 374th Airlift Wing from Yokota Air Base, Japan, improves interoperability and communication for future real-world humanitarian assistance and disaster relief requirements. The tradition underscores the commitment to regional security and humanitarian cooperation in the Indo-Pacific. Alongside Airmen from the 36th Wing at Andersen AFB and the 515th Air Mobility Operations Wing at Joint Base Pearl Harbor-Hickam, they plan and execute low-cost, low-altitude airdrops for these missions. For more information, to include the airdrop flyover schedule, visit https://lnkd.in/eFs24bti or direct any questions to the OCD24 Combined Joint Information Bureau at [email protected]. Taken from the link @ https://lnkd.in/eWwBsQeV

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5/15/24 National Security News and Commentary https://conta.cc/4arndSW 1. US special ops teams must cut 5,000 troops over next 5 years amid push to recruit technical experts 2. Evaluating the Strategic Expansion of Pentagon Special Ops Training for Allies Amid Global Tensions 3. The power of relationships and partnerships forged by special ops by Michael K. Nagata 4. US Commander Suggests UK Special Forces Are Active in Ukraine 5. The US is still falling behind on electronic warfare, special operators warn 6. UN Admits Hamas Lied on Casualty Numbers; But the Damage Is Done 7. Army Officer Resigns in Protest of ‘Unqualified’ U.S. Support to Israel 8. The arsenal of democracy is running low on gunpowder 9. How Cobra Gold Helps the US Strengthen Its Indo-Pacific Partnerships 10. Must-Pass Defense Bill Includes 4.5% Military Pay Raise on Top of 15% Increase for Junior Enlisted Troops 11. Putin begins defense ministry purge amid nuclear secrets leak rumor 12. Biden's Latest Policy Failure: West Africa 13. An Army drone branch? Idea advances in House subcommittee 14. GA-ASI and USSOCOM collaborate on ABAD Pod for MQ-9A resilience 15. Putin to meet Xi in Beijing as world convulses from global conflicts 16. America needs to lead in drone warfare 17. Should Taiwan Attempt to Replicate the Zelensky Playbook? 18. Why Iran and Israel Stepped Back From the Brink 19. A UN Trusteeship for Palestine 20. Russian Offensive Campaign Assessment, May 14, 2024 21. Israel–Hamas War (Iran) Update, May 14, 2024

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5/7/24 National Security News and Commentary https://conta.cc/3JOyvG7 1. Ghosts in the Machine: Irregular recruitment for an irregular force 2. Special Ops a Steady Presence in Chaotic World 3. Air Force Special Operators Developing Drone-Launched Swarms 4. GOVERNMENT PERSPECTIVE: Pathfinding, Transforming to Deter, Defeat Special Ops’ Evolving Enemies 5. Main Street on a Flattop aka Operation Flattop 6. HOPE, DELUSION, AND REALITY Joint Force Campaigning 7. Divisions in the Dirt: The Army’s plan for the next big war 8. US Troop Levels in Pacific Take Center Stage as Defense Secretary Huddles with Allied Defense Leaders 9. American troops return to strategic islands near Taiwan for air-assault practice 10. Will DOD need to start producing some medicines to protect troops? 11. Russian Offensive Campaign Assessment, May 6, 2024 12. Israel–Hamas War (Iran) Update, May 6, 2024 13. U.S. Soldier Detained in Russia 14. Secure at Home, Putin Builds on the Alliances He Needs to Prevail in Ukraine 15. How DC became obsessed with a potential 2027 Chinese invasion of Taiwan 16. One defense strategy, two drastically different budgets 17. Soldier Shot During Special Forces Training Event After Live Ammo Mixed in with Blanks 18. Demonstration will bring simulated gunfire, helicopters to Florida during Special Operations Forces Week 19. The Drone Dilemma and the U.S. Air Force 20. America’s China Strategy Has a Credibility Problem 21. The Secret to Japanese and South Korean Innovation

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Teaching Tuesday! What is a CACI? (Pronounced khaki) C.A.C.I. is an acronym and stands for a CONDITION an AME CAN ISSUE. If the applicant/pilot meets all parameters of the CACI condition worksheet and the applicant is otherwise qualified, the AME (Aviation Medical Examiner) may issue the FAA medical certificate. If the CACI requirements are not met, the AME must defer the exam and send supporting documents to the FAA. The following are CACI Conditions as of Nov 2024: Arthritis Asthma Bladder Cancer Breast Cancer C-ITP Chronic Immune Thrombocytopenia Chronic Kidney Disease CLL (Chronic lymphoblastic Leukemia)/SLL (Small lymphocytic Lymphoma) Colitis Colon Cancer/Colorectal Cancer Essential Tremor Glaucoma Hepatitis C – Chronic Hypertension Hypothyroidism Low Testosterone (Low T) Hypogonadism Migraine and Chronic Headache Mitral Valve Repair Polycystic Ovarian Syndrome (PCOS) Prediabetes Primary Hemochromatosis Prostate Cancer Retained Kidney Stone Testicular Cancer Weight Loss Management Call to schedule your FAA medical or a confidential consultation with Dr. Albers about a CACI condition or another medical issue today. https://lnkd.in/eUda8EkN #drsarahalbers #aviation #aviationmedicine #aviationmedicalexaminer #caci

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9/27/24 National Security News and Commentary https://conta.cc/3TKShYg 1. Japan Gets a New Leader Who Wants to Remake the U.S. Military Alliance 2. China’s Newest Nuclear Submarine Sank, Setting Back Its Military Modernization 3. Ukraine Defends Kharkiv by Going on Offense 4. On the Front Lines With Ukraine’s Killer Drone Pilot 5. How Israel’s Spies Got Blindsided by Hamas but Still Hit Hezbollah Hard 6. DoJ Notified of Suspected Faulty Welds on Subs, Aircraft Carriers at Newport News Shipbuilding 7. Exclusive/Australian and New Zealand warships entered the Taiwan Strait today. The People's Liberation Army sent five warships to monitor the entire process. 8. Japan joins patrols through Taiwan Strait - reports 9. Fears of Weakness in Water Cybersecurity Grow After Kansas Attack 10. U.S. Intelligence Stresses Risks in Allowing Long-Range Strikes by Ukraine 11. Xi Jinping Is Prioritizing Political Survival Over Economic Prosperity 12. War Books: The Operational Level of War 13. The Fight for a New Israel 14. Zelensky makes urgent in-person plea to Biden and Harris who highlights her contrasting approach to Trump 15. The Big Five - 27 September edition by Mick Ryan 16. Special operations forces face hurdles to DOD program for civilian transition, report says 17. A Crisis of Competence 18. China-Taiwan Weekly Update, September 27, 2024 19. Strategic Options to De-escalate the Israel-Hezbollah Conflict 20. How Defense Experts Got Ukraine Wrong By Eliot A. Cohen and Phillips Payson O’Brien 21. Has the Third Lebanon War Begun? 22. Stanley McChrystal: Why Kamala Harris Has Won Me Over

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Cost vs Care. Providing our forces with educated, trained, and experienced trauma surgeons is an ethical imperative. Failure to do so violates our values. Outsourcing medical treatment to civilian doctors degrades the ability to care for the wounded. Trauma care is an essential readiness and combat function. https://lnkd.in/efEVvfSa

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12/15/24 National Security News and Commentary https://conta.cc/41uF8Y9 1. Irregular Warfare Lessons From the Cold War 2. Privatizing Veteran Health Care is a Betrayal, Not A Solution 3. How Israel Turned the Mideast Around 4. Trump Courts Xi Jinping, Slaps Japan 5. US starts relocating Marines from Japan's Okinawa 6. The Army is too top-heavy 7. Russian Offensive Campaign Assessment, December 14, 2024 8. Iran Update, December 14, 2024 9. Key US agency that fights foreign influence in jeopardy after funding snub 10. Has World War III Already Begun? 11. The Hunt for the Assad Dynasty’s Missing Billions Begins 12. CEOs Want Trump to Change Course on Tariffs. He Isn’t Budging. 13. Archduke Ferdinand, blah, blah, blah…What Really Started WWI? 14. Macroscope | Trade protectionist measures by the US and others put world on path to war 15. Assad’s Enemies Are Not Our Friends 16. Dark Eagle: US bares hypersonic claws at China, Russia 17. Commentary: Chinese security companies are putting boots on the ground in Myanmar. It could go disastrously wrong

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ACCOUNTABILITY AND REALITY Coast Guard leadership is finally showing signs of throwing in the towel and recognizing reality. The last straw, an abrupt imposition of flight hour restrictions upon the Coast Guard’s workhorse MH-60T “Jayhawk” medium-range recovery helicopters is finally forcing the Coast Guard to forge a new set of strategic goals and refresh an operational template that hasn’t changed much since the bad old days of the failed Deepwater procurement effort. The crisis in the Coast Guard’s rotary wing community not going away. As of early December, almost 18 percent of the Coast Guard’s 45-strong MH-60T “Jayhawk” medium range recovery fleet is out of service. Eight helicopters with over 19,000 flight hours are, as of now, permanently grounded. As the Coast Guard’s rotary wing fleet crumbles, other warts are starting to pop up. In retrospect, the Coast Guard’s aviation planning was saddled with optimistic assumptions about Coast Guard base capabilities, base consolidation expectations and rosy operational cost projections. These savings didn’t pan out. Coast Guard leaders, overly committed to their ideas. Years of emphasizing short-term availability over hammering out long-term, realistic solutions has decimated Coast Guard aviation. In aviation, Coast Guard Admirals haven’t done a particularly great job of setting their junior leaders up for success. Flight crews—that are neither growing nor getting the support they need to take on their ever-increasing maintenance load—are voting with their feet. Frustrated Coast Guard aviation ratings are walking away from retention bonuses of between $35,000 to $50,000 a year. The Coast Guard leadership failures extend to other critical issues. Refusal to answer with any action and/or respond to the many Congressional hearings about the rapes in the Coast Guard and, especially, at the Academy is an absolute further disgrace and stain upon the service. Taking active Coast Guard ships out of service while claiming crew number problems  was another recent Leadership failure and no clear answer was provided to a Congressional hearing about it. There are other serious issues with the Coast Guard leadership in dealing with the NMC and the DOT. All kept silent, except for the realities.

This is a good article describing the plans for MTFs to increase their capacity. It’s important to get patients back into the military hospitals. Busy MTFs = ready medical force of physicians, nurses and corpsmen /medics.

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https://lnkd.in/esJAFdcv "A NPR analysis reveals that half of active duty U.S. military bases are within federally designated Healthcare Professional Shortage Areas (HPSA). These HPSAS, also known as “health care deserts,” are geographic areas, populations, or facilities lacking primary, dental, or mental health care providers, according to the Health Resources and Services Administration. Excluding National Guard installations, NPR found that half the bases are within at least one healthcare desert. Three out of four bases in primary care deserts are also in mental health care deserts, maternal care deserts, or both. By population, 1 in 3 U.S. troops and their families live in a health care desert, NPR found. The analysis also found that 202 military bases are in primary care, mental health care, or maternity care shortage areas, while 35 are in areas designated as all three types. [...] However, the DOD admitted that downsizing was potentially harming military readiness and recruitment. An Inspector General’s report documented issues with access to care and medical staff shortages on base. [...] The DOD now wants to bring Tricare beneficiaries back to the military health system. In a memo obtained by Military.com, Deputy Defense Secretary Kathleen Hicks outlined an effort to “re-attract” beneficiaries to military hospitals and clinics."

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The weaponization of state certificate of need laws (CON) for anti-competitive purposes. North Carolina and Novant are again exhibit A. Novant, now owner of the only acute care #hospital in Wilmington, NC, applied to the CON board to add "one unit of fixed cardiac catheterization equipment". Another application came from an ASC owned by Wilmington Health, a "physician-owned primary care and multi-specialty medical practice" per its website. The NC CON plan allows for only one additional cardiac cath unit in the fast growing Wilmington metro region. Novant also filed an official objection to Wilmington Health's application. The cost of an additional cath unit is just over the CON threshold of $5 million. I certainly don't know if current or projected utilization of cath procedures is appropriate. Neither applicant has much expected Medicaid utilization, and that seems concerning. If you step back and ask how much confidence should we have in the CON Board's estimate of projected "need", and whether adding two as opposed to just one cath lab in a fast growing market is going to drive costs higher than adding just one that we know will be priced higher and be hiked higher because of its monopoly status, you have to question the purpose and use of this whole "need" process. One other factor (not considered by CON board)--Wilmington Health is physician-led and active and successful in value-based care ACO programs and that should make us more confident that its utilization will be appropriate. Novant? Not so much. In any case, it's not a criteria used by the NC CON process. For those of us concerned about the role of private equity in physician practices and health care broadly, you can understand why a group like Wilmington Health might feel they need the support of PE given the forces working against them as they seek to remain independent. Jeff Charles Goldsmith Deborah Williams Ge Bai Chris Deacon Jon Rankin Peter Hayes Victoria Veltri Ann Lewandowski Shawn Gremminger Paul Hattis Dan Ross Stacey Richter Robert L. Nevin, Jr., MPH, MBA, RHIT, CRCR Christopher Whaley Christopher M. Shoffner Benjamin Schachtman Michael F. Cannon Farzad Mostashari https://lnkd.in/dqAY5Pi8

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Today the ISR Task Force partnered with WTOP News, the Federal News Network, U.S. Indo-Pacific Command, United States Space Force, and Planet Federal to discuss the critical topic of Broad Area Management and its impact on the safety and security of our nation. In the round table discussion, we touched on the imperative of #teamwork in Integrated Deterrence while also discussing some of the more tangible ways the services are investing in solutions to deliver enhanced situational understanding around the world. The US Army Intelligence enterprise, under the direction of Lieutenant General Tony Hale, is working hard to deliver horizontally integrated capabilities at a pace and scale that matches the tempo of the modern operational environment. To optimize these systems, we’ve been directed to develop strategies for wide-adoption and implementation of Artificial Intelligence capabilities into human-centric workflows. Soon the world currency will be measured in TPUs and GPUs. #Data centricity is a thing, and embracing it is what separates visionary leaders from everyone else. We wrap up this week with a conversation with Congressman Ken Calvert (R-CA) - a partner on Capitol Hill who is “all in” on AI investments.

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