These Army docs are revolutionizing pain management - especially for burns - We Are The Mighty
MIGHTY TRENDING

These Army docs are revolutionizing pain management – especially for burns

Doctors at the U.S. Army Institute of Surgical Research Burn Center at Joint Base San Antonio-Fort Sam Houston are utilizing a novel method of administering pain medication to burn patients in the burn intensive care unit in hopes to mitigate opioid addiction and other complications associated with burn care.


“It’s something different,” said Dr. Clayne Benson, assigned to Brooke Army Medical Center, collocated with the USAISR Burn Center. “But the promise and benefits are huge.”

The pain medication is managed with the placement of an intrathecal catheter and infusion of preservative-free morphine. The concept is similar to epidural anesthesia used during labor for pain relief, except the catheter resides in the intrathecal space where the cerebrospinal fluid resides instead of the epidural space.

The catheter used is exactly like an epidural catheter used for laboring women.

“It’s an FDA-cleared device for a procedure that a lot of anesthesiologists have done for other reasons,” Benson said. “It had never been done on burn patients and we presented the idea of the study to the burn center leadership [Drs. Booker King, Lee Cancio, Jennifer Gurney, Kevin Chung and Craig Ainsworth] and they agreed to try this initiative.”

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Benson, an Air Force Reserve lieutenant colonel, got the idea of using this technique in the intensive care unit while taking care of polytrauma soldiers at Landstuhl Regional Medical Center in Germany from 2009-2012. Benson said he is excited about the potential of this new pain management for burn patients.

“The results are amazing,” he said. “The best thing about it is that it only uses one-one hundredth of the amount of pain medication used with the traditional [intravenous] method.”

Intrathecal medication is delivered straight to where it is effective, the spinal cord, thereby minimizing systemic complications of IV medications.

Intravenous medication disperses pain medication throughout the entire body and only a tiny percentage of it gets to where it is needed.  This is especially beneficial for burn patients who require numerous painful operations and traditionally require being placed on a ventilator, with one of the reasons being pain control.

Longer ventilator times lead to complications like deconditioning, delirium, and pneumonia, which all impact quality of life and time in the Burn Intensive Care Unit.

These Army docs are revolutionizing pain management – especially for burns
Dr. Richard Erff, chief of the Carl R. Darnall Army Medical Center Pain Clinic, administers cervical epidural steroid injections to a Soldier who suffers from chronic neck and back injuries stemming from his deployment to Iraq. (Army Photo by Patricia Deal)

“Also, the majority of patients who are mechanically ventilated are diagnosed with delirium and are likely to have increased length of hospitalization, increased ventilator days, and higher rates of long-term cognitive dysfunction,” Benson said.

Delirium is another complication burn patients experience with exposure to sedatives and pain medications.

“Delirium is when a patient’s awareness changes and they become confused, agitated, or they completely shut down,” said Sarah Shingleton, chief wound care nurse and clinical nurse specialist at the USAISR Burn Center Intensive Care Unit. “It can come and go, and is caused by a number of things to include different pain medications, pain, infections, a disturbed sleep cycle, or an unfamiliar environment.”

Members of the USAISR Burn Center Intensive Care Unit will present the data of the initiative at the 2018 American Burn Association meeting in April 2018. The presentation will describe a patient who sustained 45 percent burns to her body and had her pain and sedation managed with the placement of the intrathecal catheter.

The abstract prepared for the ABA meeting states, “During intrathecal administration of morphine, IV infusions of ketamine, propofol, and dexmedetomidine were discontinued. The patient was awake and responsive, reporting adequate pain control without systemic opioid administration. Following removal of the intrathecal morphine infusion, the patient’s opioid requirement remained lower than prior to catheter placement despite repeated surgical interventions.”

Also Read: This is why wounded troops don’t spend entire wars in field hospitals anymore

“This novel way of achieving pain control helped us get our patients off mechanical ventilation faster and shorten the time they needed to be in the [intensive care unit],” said Maj. (Dr.) Craig Ainsworth, Burn Intensive Care Unit medical director. “We are excited to share this treatment option with other members of the burn care community so that we can better care for our patients.”

Benson’s goal is to someday apply this type of pain management to patients with polytrauma to reduce pain and the amount of pain medication which could potentially lessen addictions to pain medication.

“It’s a new approach and I hope that eventually it becomes the main mode of pain control for burn and polytrauma patients,” Benson said. “It has been a good team effort with the burn staff and their ‘can do’ attitude. I’m looking forward to where this leads. I believe it will change pain management as well as help to prevent opioid addiction in patients who have suffered from polytrauma and burns.”

MIGHTY TRENDING

US officials blame Iran for using child soldiers

U.S. Ambassador to the U.N. Nikki Haley strongly condemned Iran for its alleged recruitment and use of child soldiers in battlefields across the Middle East.

“The use of child soldiers is a moral outrage that every civilized nation rejects while Iran celebrates it,” Haley said Oct. 18, 2018, during a U.N. Security Council meeting.

Haley’s remarks came two days after the U.S.Treasury Department’s Office of Foreign Assets Control announced new sanctions targeting businesses that provide financial support to the Basij Resistance Force, a paramilitary force under the command of Iran’s Islamic Revolutionary Guard Corps (IRGC).


“Iran’s economy is increasingly devoted to funding Iranian repression at home and aggression abroad,” she said. “In this case, Iranian big business and finance are funding the war crime of using child soldiers. This is crony terrorism.”

The latest sanctions are part of the U.S. efforts to pressure Iran economically for what the Trump administration has described as Iran’s destabilizing role in the Middle East and its sponsorship of terrorism in the region.

The U.S. Treasury Department has listed a network of some 20 companies and economic entities that are believed to be funding the recruitment and training of child soldiers for the IRGC.

“Any company or individual that does business with this Iranian network is complicit in sending children to die on the battlefields of Syria and elsewhere,” Haley said.

The network providing financial support to the Basij is known as Bonyad Taavon Basij.

These Army docs are revolutionizing pain management – especially for burns

Treasury Secretary Steven Mnuchin

“This vast network provides financial infrastructure to the Basij’s efforts to recruit, train and indoctrinate child soldiers who are coerced into combat under the IRGC’s direction,” U.S. Treasury Secretary Steven Mnuchin said in a statement.

“The international community must understand that business entanglements with the Bonyad Taavon Basij network and IRGC front companies have real-world humanitarian consequences, and help fuel the Iranian regime’s violent ambitions across the Middle East,” Mnuchin added.

Iran’s reaction

Tehran called the U.S. sanctions a violation of international law.

Iranian Foreign Minister Mohammad Javad Zarif wrote in a tweet on Oct. 17, 2018, that the latest U.S. sanctions violated two orders by the International Court of Justice (ICJ).

“Utter disregard for rule of law human rights of an entire people. U.S. outlaw regime’s hostility toward Iranians heightened by addiction to sanctions,” Zarif said in a tweet.

Bahram Qassemi, a spokesperson for Iran’s Ministry of Foreign Affairs, said on Oct. 18, 2018, it’s part of a psychological war waged by the U.S. against Iran.

“Such actions show the spitefulness of the U.S. government towards the Iranian people and are a clear insult to legal and international mechanisms,” the state-run IRNA news agency quoted Qassemi as saying.

Measures welcomed

Some Iranian rights activists have welcomed the U.S. move, however, and described it as a positive step to discipline the Iranian government for its actions in the region.

“Any action focused on children’s rights is important because it highlights the importance of protecting children’s rights and puts the issue of child soldiers under the spotlight,” Hamed Farmand, a Virginia-based children’s rights activist, told VOA. “Any international action with the purpose of condemning child soldiers is widely appreciated but it needs more action than just financial sanctions on some institutes involved in it.”

A 2017 Human Rights Watch report accused Iran of committing war crimes by recruiting and sending Afghan refugee children “as young as 14” to fight in Syria. The New York-based organization also has documented how the IRGC has recruited Afghan immigrant children living in Iran to fight in Syria along Syrian regime troops.

Maryam Nayeb Yazdi, also an Iranian human rights activist, said there should be an effective mechanism to force Iran to improve its human rights record.

“To change the behavior of the Iranian government, the international community needs a human rights-focused approach and must take multiple actions simultaneously,” she said during a recent Geneva Summit on Human Rights and Democracy.

Effects of sanctions

But Sadegh Hosseini, a Tehran-based analyst, said U.S. sanctions on the Basij force actually are indirect punishment inflicted on the Iranian people.

“Sanctioning the Basij could affect many Iranians who have voluntarily become members of it or have joined it in the past,” he said.

He told VOA “the purpose of this embargo is unclear but many Iranians who have bank accounts with those financial institutes could be affected, since many of them receive their employment salaries only through accounts at those targeted banks.”

Other experts say that following the U.S. withdrawal from the 2015 nuclear deal with Iran, the U.S. Treasury Department has stepped up its efforts on this front because it is the main pillar that can block Iran’s sale of oil and impose banking restrictions on the country.

“The latest move by the [U.S.] Treasury to sanction Iran’s Basij Resistance Force is an important part of that campaign,” said Farhang Jahanpour, a professor of international law at Oxford University.

“So far, other signatories to the [nuclear deal] have refused to go along with American sanctions on Iran, but many major European companies have cut back or have completely ended their dealings with Iran in fear of U.S. retaliation,” Jahanpour added.

Behnam Ben Taleblou, a researcher at the Washington-based Foundation for Defense of Democracies, said the recent designations were different from previous measures “because they focused on the role of select financial institutions in generating revenue that was ultimately used to benefit the Basij.”

“The [U.S.] Treasury Department’s willingness to go after the entities in the Basij financial support network highlights the challenge of doing due diligence in Iran, as well as signals to the international community that the U.S. is serious about putting the squeeze on all elements of the Iranian economy tied to the IRGC,” Taleblou added.

This article originally appeared on The Voice of America. Follow @VOANews on Twitter.

MIGHTY TRENDING

US Army offering recruits up to $40,000 to join the infantry

U.S. Army recruiters are offering bonuses worth up to $40,000 to new recruits who sign up for the infantry by Sept. 30, 2019, as part of an effort to reverse a shortage of grunts for fiscal 2019.

The drastic increase in bonus amounts for recruits in 11X, the infantry military occupational specialty, went into effect in mid-May 2019, according to U.S. Army Recruiting Command officials, who said that the service still needs to fill about 3,300 infantry training seats by Sept. 30, 2019.

“We saw this coming in May; we immediately went to the senior leadership and said, ‘look, we need to max out the bonuses for 11Xs,'” Maj. Gen. Frank Muth, commander of Army Recruiting Command, told Military.com.


“If you sign up to be 11X and you sign a six-year commitment — ,000.”

Before May 2019, the maximum bonus amount for infantry recruits was ,000 for a six-year commitment.

These Army docs are revolutionizing pain management – especially for burns

A U.S. Army Ranger from 3rd Battalion, 75th Ranger Regiment speaks with a Soldier-in-training during a 12-mile ruck march at infantry One-Station Unit Training, Fort Benning, Ga., April 18, 2019.

(U.S. Army)

Last summer, the Army ran a pilot at Fort Benning, Georgia that resulted in the service extending infantry one station unit training (OSUT) from 14 weeks to 22 weeks. The extended infantry training is designed to give soldiers more time to practice key infantry skills such as land navigation, marksmanship, hand-to-hand combat, fire and maneuver and first aid training.

The bonus increase is just a small step in the Army’s effort to meet its recruiting goal for the active force of 68,000 soldiers by Sept. 30, 2019. The Army launched a multi-faceted recruiting strategy October 2018 after the service missed its 2018 recruiting goal by 6,500 soldiers.

These Army docs are revolutionizing pain management – especially for burns

U.S. Army recruits practice patrol tactics while marching during U.S. Army basic training.

(U.S. Air Force photo by Staff Sgt. Shawn Weismiller)

New recruits signing up for the infantry can also get ,000 for a three-year enlistment, ,000 for a four-year enlistment and ,000 for a five-year enlistment, Recruiting Command officials said.

But these new bonuses won’t last long, Muth said.

“You’ve got to ship in August and September,” Muth said, explaining that infantry recruits must enter OSUT at Benning by the end of this fiscal year.

“If you ship in October, you don’t get the bonus.”

This article originally appeared on Military.com. Follow @militarydotcom on Twitter.

Articles

This big ol’ plane is getting a big ol’ stand-down order

Air Mobility Command has grounded the C-5 Galaxy cargo planes operating at Dover Air Force Base in Delaware after a nose landing-gear unit malfunctioned for the second time in 60 days.


The stand-down order, issued July 17, affects all 18 C-5s stationed at Dover — 12 of them are primary and six are backup aircraft, according to a release.

The Air Force has 56 C-5s in service.

“Aircrew safety is always my top priority and is taken very seriously,” Air Mobility Command’s chief, Gen. Carlton D. Everhart II, said in a release. “We are taking the appropriate measures to properly diagnose the issue and implement a solution.”

These Army docs are revolutionizing pain management – especially for burns
USAF photo by Airman 1st Class Elizabeth Baker

An Air Mobility Command spokesman told Military.com that both malfunctions involved C-5M Super Galaxy aircraft. On May 22 and again July 15, the planes’ “nose landing gear could not extend all the way,” the spokesman said. The C-5M was introduced in 2009 and is the latest model of the C-5.

Air Force personnel will perform inspections “to ensure proper extension and retraction of the C-5 nose landing gear,” Air Mobility Command said. The halt applies only to C-5s at Dover, and Air Mobility Command said it would work to minimize the effect on worldwide operations.

Also read: Behold, the largest plane in the US Air Force

The C-5 is the Air Force’s largest airlifter. It has a 65-foot-tall tail and is 247 feet long with a 223-foot wingspan. The first version, the C-5A, entered service in 1970, and several models have joined the fleet since then.

The C-5M was given more powerful engines, allowing it to carry more cargo and take off over a shorter distance. It can haul 120,000 pounds of cargo more than 5,500 miles — the distance from Dover to Incirlik Air Base in Turkey — without refueling. Without cargo, its range is more than 8,000 miles.

These Army docs are revolutionizing pain management – especially for burns
USAF Airmen load an M1A1 Abrams Tank into an Air Force C-5M Super Galaxy cargo aircraft. (USAF photo by Roland Balik)

In recent years, budgets cuts and sequestration compelled Air Force leadership to begin taking C-5Ms out of service.

Everhart, the Air Mobility Command chief, said in March that total C-5 inventory had fallen to 56 from 112 a few years ago.

But the Air Force has made moves to reverse that deactivation, saying it plans to move at least eight mothballed C-5Ms back into service, using newly allocated funds, over the next four years.

That return to service would partially overlap with an upgrade project for the active fleet of airlifters that is slated to wrap up in 2018.

“I need them back because there’s real-world things that we’ve got to move, and they give me that … added assurance capability,” Everhart told lawmakers at the end of March.

MIGHTY TACTICAL

The last camouflage is up to the scientists

A camouflaged soldier almost invisible to the naked eye may light up like a Christmas tree on a high-end thermal imaging device, which is why advanced thermal detection capabilities are among the greatest threats to the concealed warfighter.

Thermal imaging systems have the ability to detect a soldier’s infrared heat signature, light or electromagnetic radiation outside the visible spectrum emitted by a warm body. These sensors can distinguish between a person’s body heat and the ambient temperature of their surroundings.

“Defeating a thermal signature is probably the hardest thing,” an Army sniper previously told Business Insider, adding that “emerging technology by our near-peer enemies” is making it increasingly difficult for soldiers to hide.


Thermal detection “is dangerous to a sniper because you can’t hide from that,” he explained.

Agreeing with the sniper’s assessment, two masters of modern camouflage explained to BI why this particular threat is so difficult to defeat.

These Army docs are revolutionizing pain management – especially for burns

How a human being appears to the naked eye vs how they appear to a thermal sensor.

(Youtube Screenshot)

“The big thing here is physics,” retired Army Lt. Col. Timothy O’Neill, a consultant for HyperStealth Biotechnology Corp. and the inventor of digital camouflage, said. “For a thermal signature, you are talking about energy at one end of the electromagnetic spectrum. It’s energy. Energy, we recall, cannot be created or destroyed.”

This principle, known as the First Law of Thermodynamics, complicates everything.

“You can put a soldier inside a suit that traps the heat inside so that he can’t be seen, but he gets roasted inside,” O’Neill, who did his doctoral dissertation on camouflage, added. “The heat’s there.” The problem is figuring out what to do with the heat energy.

“It has to go somewhere somehow,” Guy Cramer, president and CEO of HyperStealth, told BI. “You either need to vent it or convert it to a non-detectable signal.” There are certain fabrics that will actually cool the body down, but it doesn’t eliminate the person’s heat signature altogether.

“It’s not an easy thing to do,” he said.

“You get outside the visible spectrum, and you do have problems,” O’Neill added. “Right now, almost all of the threats that we face have late-generation image intensification and thermal detection. It’s not an easy fix.”

These Army docs are revolutionizing pain management – especially for burns

How a human being appears to the naked eye vs how they appear to a thermal sensor.

(YouTube Screenshot)

“There are things you can do, but you are still up against physics,” the father of digital camouflage said. “So, almost anything you do to reduce a thermal signature is going to be high-tech and a little difficult for the soldier.” He said that there are some strides being made in this area, but it’s difficult to know what, if anything, will be a game-changer.

US Army scientists, for example, are researching new infrared obscurants, aerosol particles that block infrared light to obscure the warfighter on the battlefield. The service also put in a multi-million dollar order for Fibrotex’s Ultra-Light Camouflage Netting System (ULCANS), a new kind of advanced camouflage specifically designed to conceal troops from night vision, thermal imaging, radar, and more.

Cramer told BI that he is currently patenting an idea known as “quantum stealth,” a light-bending camouflage material able to bend the electromagnetic spectrum around a target to achieve multi-spectral invisibility. This technology has not yet been publicly demonstrated.

These Army docs are revolutionizing pain management – especially for burns

How a human being appears to the naked eye vs how they appear to a thermal sensor.

(YouTube Screenshot)

The Army’s top general revealed earlier this month that the service is pursuing new camouflage systems to better protect soldiers waging war on future battlefields, and thermal is a priority.

“Advanced camouflage technologies are critical,” Army Chief of Staff Gen. Mark Milley explained to lawmakers. “We are putting a fair amount of money into advanced camouflage systems, both individual, unit, vehicle, etc.”

“We know that adversary [target] acquisition systems are very capable in that, if you can see a target, with precision munitions, you can hit a target, so camouflage systems that break up electronic signatures and break up heat signatures are critical.”

This article originally appeared on Business Insider. Follow @BusinessInsider on Twitter.

MIGHTY HISTORY

7 awesome posters that motivated your grandfather in World War II

Not everyone joins the military right after hearing a news report about Pearl Harbor attacks, after seeing the Twin Towers fall, or after hearing a speech by President Polk talking about “American blood” shed “on American soil.” No, most troops who will join a war make the decision slowly, over time. These are the posters from World War II that might have helped your (great) grandpa or grandmother decide to contribute to the fights in Europe, the Pacific, and Asia.


These Army docs are revolutionizing pain management – especially for burns

(U.S. Naval History and Heritage Command)

This iconic poster from 1942, “Man the Guns,” encouraged men to join the Navy and do their bit for victory on the open ocean.

These Army docs are revolutionizing pain management – especially for burns

(U.S. Army Military History Institute)

World War II saw the first use of paratroopers and other airborne commandos in combat. Germany kicked off airborne combat history during its invasions of Western Europe, but all of the major Allied and Axis powers fielded some sort of airborne force.

These Army docs are revolutionizing pain management – especially for burns

(Flickr/Marines)

“The Marines have landed” was a World War II recruiting poster that capitalized on the expeditionary nature of the Marine Corps. It was first completed in 1941 but was aimed at 1942 recruiting goals. The Marines focused on the Pacific Theater in the war, chipping away at Japan’s control of Pacific islands until the Army Air Forces were in range of the home islands.

These Army docs are revolutionizing pain management – especially for burns

(United States Army Air Forces)

The air forces of the world saw huge expansions in World War I and then the inter-war years. By the time World War II was in full swing, thousands of planes were clashing over places like the English Channel and the Battle of Kursk. American air forces launched from bases in the Pacific, England, Africa, and more in order to take the ultimate high ground against the Axis forces.

These Army docs are revolutionizing pain management – especially for burns

(U.K. National Archives)

This poster from England referenced a Winston Churchill speech in 1941 that reminded the English people of their great successes in late 1940 and early 1941. Hitler’s planned invasion of the British Isles had been prevented, and Churchill was hopeful that continued English resistance would pull America into the war. He finished the speech with this passage:

We shall not fail or falter; we shall not weaken or tire. Neither the sudden shock of battle, nor the long-drawn trials of vigilance and exertion will wear us down. Give us the tools, and we will finish the job.
These Army docs are revolutionizing pain management – especially for burns

(U.S. National Archives and Records Administration)

American men who joined the Army started at a bare a month, equivalent to about 0 today. Joining the Airborne forces could more than double that pay, but it was still clear that fighting the Nazis or the Japanese empire had to be done for patriotism, not the insane pay.

These Army docs are revolutionizing pain management – especially for burns

(U.S. National Archives and Records Administration)

This poster by J. Howard Miller became an iconic image of wartime production and is thought to be the prototype that led to the “Rosie the Riveter” campaign and the accompanying image by Norman Rockwell on The Saturday Evening Post. Women entered the workforce in record numbers in World War II to help the country keep up with wartime demand while a large portion of the male workforce was sent overseas.

These Army docs are revolutionizing pain management – especially for burns

(Flickr/Boston Public Library)

Not everyone could serve on the front lines. Whether restricted because of age, health, or some other factor, people who wanted to serve their country’s defense in the states could join the U.S. Office of Civilian Defense. If it sounds like busy work to you, understand that America’s coasts were being regularly attacked by submarines while the occasional raid by planes or balloons was an ever-present threat.

These Army docs are revolutionizing pain management – especially for burns

(U.K. National Archives)

England took some of the worst hits from Germany in World War II, so British propagandists found it important to remind a scared English public that they’d been here before, that they’d survived before, and that Germany had been turned back before. It might have been cold comfort after France fell so quickly in World War II after holding out for all of World War I, but even cold comfort is preferable to none.

Articles

The 7 most important military decisions the next president will make in 2017

With ISIS continuing to fight, Russia and China throwing their weight around, and budget shortfalls becoming bigger and bigger problems, the Department of Defense will definitely need strong leadership in the form of a commander-in-chief and his political appointees in the months immediately following the inauguration next year.


Here are 7 important decisions he or she will have to tackle:

1. Will the U.S. pressure China to get off of contested islands, force them off with war, or let China have its way?

These Army docs are revolutionizing pain management – especially for burns
The Littoral Combat Ship USS Fort Worth conducts a patrol through international waters near the Spratly Islands. (Photo: US Navy Mass Communication Specialist 2nd Class Conor Minto)

America has a vested interest in navigational freedoms in the South China Sea. Many allies transport their oil, other energy supplies, and manufactured goods through the South China Sea and the U.S. Navy uses routes there to get between the Pacific and Indian oceans.

Currently, a few sets of islands in the area are contested, most importantly the Spratly Islands. In addition to controlling important sea routes, the area may hold vast supplies of oil and natural gas. The most optimistic estimates put it second to only Saudi Arabia in terms of total oil reserves

China is deep in a campaign to control the South China Sea by claiming historical precedent and by building new bases and infrastructure on them. An international tribunal ruling on the issue will likely side against China shortly, but China probably won’t accept the decision.

That leaves a big decision for the next president. Does America recognize Chinese claims, back up U.S. allies in the area through diplomatic pressure, or begin a military confrontation that could trigger a major war?

2. How dedicated is the U.S. to the NATO alliance and deterring Russian aggression?

These Army docs are revolutionizing pain management – especially for burns
173rd Airborne Brigade Combat Team soldiers conduct exercises in partnership with NATO forces. (Photo: US Army Pfc. Randy Wren)

For decades, America’s presence in NATO was unquestionable. Candidates might argue about specific NATO policies, but membership was a given. Now, a debate exists about whether NATO might need to be adjusted or a new, anti-terror coalition built in its place.

America pays more than its fair share for the alliance. Every member is supposed to spend 2 percent or more of its GDP on defense, but only America and four other countries did so in 2015. Even among the five who hit their spending goals, America outspends everyone else both in terms of GDP and real expenses. The U.S. is responsible for about 75 percent of NATO spending.

And NATO was designed to defeat Russia expansion. Though members assisted in the wars in Iraq and Afghanistan, they’ve struggled with what the alliance’s responsibilities are when addressing ISIS. For those who think ISIS should be the top priority, there’s a question about why the U.S. is spending so much time and energy on a European alliance.

So the question before the next president is, should America continue to dedicate diplomatic and military resources to a Europe-focused alliance when ISIS continues to inspire attacks in America and Europe while threatening governments in the Middle East?

3. What part of the world is the real priority?

These Army docs are revolutionizing pain management – especially for burns
(Photo: US Air National Guard Staff Sgt. Christopher S. Muncy)

To use the cliche, “If everything is a priority, nothing is.” The American military does not have the necessary size and resources to contain both Russia and China while fighting ISIS and other terrorist organizations. The next U.S. president will have to decide what is and isn’t most important.

Alliances can help the U.S. overcome some of the shortfalls, but each “priority” requires sacrifices somewhere else. The next president will have to decide if protecting Ukranian sovereignty is worth the damage to negotiations in Syria. They’ll have to decide if the best use of military equipment is to park it in eastern Europe to deter Rusia or to send it to exercises in Asia to deter China.

Obama spent most of his administration trying to pivot to Asia while Middle Eastern and European crises kept forcing America back into those regions. Where the next president decides to focus will decide whether Russia is contained, China is pushed off the manmade islands, and/or if ISIS and its affiliates are smothered.

4. What is America’s role in the ongoing fight against ISIS and is there a need for more ground troops?

These Army docs are revolutionizing pain management – especially for burns
U.S. Marines fire artillery to break up ISIS fighters attacking Kurdish and Peshmerga forces. (Photo: US Marine Corps Cpl. Andre Dakis)

On the note of transferring forces, those vehicles that could be redirected from supporting NATO or conducting exercises could be set to Iraq, Syria, and other countries to fight ISIS, but is that America’s job?

Though America’s invasion destabilized the region, Iraq’s rulers asked U.S. troops to leave before putting up a half-hearted and strategically insufficient response to ISIS. So the next president will have to decide whether America owes a moral debt to prop up the Iraqi government and Syrian rebels and whether it is in America’s best interest to do so.

The answer to those two questions will fuel the biggest one, should America deploy additional ground forces (something generals are asking for), risking becoming mired in another long war, to stop the rise of ISIS and other terrorist groups in the region?

5. How long will the Air Force keep the A-10?

These Army docs are revolutionizing pain management – especially for burns
(Photo: US Air Force Senior Airman Chris Drzazgowski)

The struggle between A-10 supporters and detractors continues to rage. Air Force officials and A-10 detractors say the plane has to be retired due to budget constraints and the limited ability to use the plane in a contested environment. Proponents of the A-10 insist that it’s the cheapest and most effective close-air support platform.

The battle has nearly come to a head a few times. The Air Force was forced by Congress to keep the A-10 flying and finally agreed to a showdown between the A-10 and F-35 for some time in 2016. The critical analysis of the results will almost certainly come while Obama is still in office, but the A-10 decision will likely wait until the next president takes office.

The decision will officially be made by the Air Force, but the president can appoint senior officers sympathetic to one camp or the other. Also, the president’s role as the head of their political party will give them some control when Congress decides which platforms to dedicate money to supporting.

So the new president will have to decide in 2017 what close air support looks like for the next few years. Will it be the low, slow, cheap, and effective A-10 beloved by ground troops? Or the fast-flying, expensive, but technologically advanced and survivable F-35?

6. How much is readiness worth and where does the money come from?

These Army docs are revolutionizing pain management – especially for burns
US Marines conduct underwater training. (Photo: US Marine Corps Lance Cpl. Jered T. Stone)

Sequestration, the mandatory reduction of military and domestic budgets under the Budget Control Act of 2011, puts a cap on U.S. military spending. The service chiefs sound the alarm bell every year that mandatory budget cuts hurt readiness and force the branches into limbo every year.

The next president, along with the next Congress, will have to decide how much military readiness they want to buy and where the money comes from. To increase the percentage of the force that is deployed or ready to deploy at any one time without sacrificing new weapons and technology programs, money would need to be raised by cutting other parts of the federal budget or raising taxes.

So, what size conflict should the military always be ready for? And where does the money for training, equipment, and logistics come from to keep that force ready?

7. How many generals and admirals should the U.S. have?

These Army docs are revolutionizing pain management – especially for burns
Generals and admirals are on the chopping block, though service chiefs like Marine Corps Gen. Robert Neller, seen here speaking to a group of Marines, are likely too valuable to cut. (Photo: US Marine Corps Cpl. Shawn Valosin)

As the number of U.S. troops has decreased in the past 30 years, the number of U.S. general officers has rarely dropped and was actually raised by over 100 since Sep. 11, 2001, causing a 65 percent increase in the number of four-star officers to total number of service members. This has led to questions about whether it’s time to ax some generals and admirals.

Former Secretaries of Defense Chuck Hagel and Robert Gates both proposed serious cuts, and the Senate Armed Services Committee has recently floated a 25 percent reduction in the total number of general officers.

Not only would this significantly cut personnel costs since each general and their staff costs over an estimated $1 million per year, but it would reduce the bureaucracy that field commanders have to go through when getting decisions and requests approved.

MIGHTY SURVIVAL

As military planners, we strategized for a pandemic—here’s what we learned

James Ruvalcaba was the lead operational planner and Joe Plenzler was the public affairs officer for III Marine Expeditionary Force in Okinawa, Japan. They were responsible for authoring the III MEF CONPLAN 5003 to protect all U.S. forces, their families, and Defense Department personnel in Japan. They are both retired Marine lieutenant colonels.

As former lead operational planners for the Biohazard Defense Contingency Plan for all military service members, their families and Defense Department employees in Japan, we noticed the strong possibility of a COVID-19 pandemic in early February of this year.

There are lessons to be learned from an earlier viral outbreak.


In response to the H5N1 or “bird flu” outbreak in 2005, President George W. Bush issued a National Strategy for Pandemic Influenza (PI) that November.

Thirteen days later, Chairman of the Joint Chiefs Gen. Peter Pace issued a planning order (PLANORD) directing all combatant commanders to conduct execution-level planning for a DoD response to pandemic influenza.

The guidance was clear and broad: Develop a contingency plan that specifically addressed the three major missions of force health protection, defense support for civil authorities, and humanitarian assistance and disaster relief.

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As leaders of the planning efforts, we recruited medical experts and researched preventive health materials from the World Health Organization, Centers for Disease Control, National Institute of Health, and disease exposure control studies from the Center for Strategic and International Studies.

This 18-month planning effort included tabletop exercises with State Department officials and local government officials and resulted in a 650-page biohazard response plan for all Marine Corps forces in Japan.

The plan also involved the additional major mission of continuity of operations to ensure that local governments and military installations continued to provide essential and emergency services during a pandemic.

The plan required all units and critical support agencies and businesses to classify their employees or service members as nonessential, essential or emergency-essential personnel.

The lessons we learned in this comprehensive 2005 planning effort are extensive, but they have not been fully implemented in response to COVID-19.

So what can policymakers, emergency medical responders and today’s planners learn from our plan?

Expect a “new normal” until a proven vaccine is developed. Social distancing measures and restrictions on mass gatherings must continue until the population has been vaccinated and the current COVID-19 virus is no longer a threat.

Just like we adapted to the post-9/11 terrorist attacks by instituting new security measures, we must also adapt to the pandemic by continuing social distancing measures until a proven vaccine has been developed, tested and administered to the entire global community. We must do this to avoid subsequent pandemic waves.

Our plan operated under the advice from health experts that a vaccine may take about a year to develop and that it will take months more for it to be readily available to the entire population. We recommend that the vaccine be prioritized and allocated first to medical responders and other personnel designated as emergency-essential responders. Local public health experts should draft immunization plans, to include the prioritization of immunizations to emergency-essential personnel.

The public should expect to experience additional shortages of medical equipment. We’ve seen the shortages of N95 masks, ventilators and ICU beds in hospitals; however, when restrictive measures are eased or lifted, our planning revealed that there will be a huge demand for infrared thermal detection systems (IR thermometers) in order to conduct public health febrile surveillance — especially prior to boarding flights or mass transportation. The post-pandemic environment will most likely involve febrile screenings to ensure viral threats are contained.

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Ongoing surveillance and contact tracing are extremely critical after the first pandemic wave is contained to a manageable level, in order to prevent a second wave or spreading it to another region. We should leverage technology in our smartphones to self-report if we have been in contact with infected people. China successfully implemented these protocols in Wuhan province through a phone app.

The demand for mortuary services may exceed available capacity. Additionally, new protocols must be established for conducting funerals.

Public Service Announcements are critical to shape public action to comply with evolving restrictive measures implemented by public health officials. Additionally, PSAs alleviate fear and anxiety by providing reassurance and critical educational material to assist the public in helping to contain and reduce the pandemic. Simply stated, PSAs help to reset the expectations of the evolving crisis and the associated escalatory or de-escalatory restrictive measures.

A pandemic may produce a second wave after the first outbreak, and sometimes even a second cycle outbreak after a few seasons. This is due to previously undetected pockets of viral outbreaks, a lapse in compliance to restrictive measures, the reintroduction of the virus from an external source, or the possibility of the virus mutating gradually by antigenic drift, or abruptly by antigenic shift. It is important for medical responders, public officials and the public to understand that we must not let our guard down when we start seeing a reduction in the transmissibility of the COVID virus or a reduction in the number of people infected.

We cannot lean on unfounded messages of hope; rather, we should look to science and condition-based assessments to decide when to ease or lift restrictive measures. The message to policymakers and high-ranking preventive health officials is clear: Demand science-based justifications for lifting restrictive measures.

For all that have closely tracked the evolution of this COVID-19 virus from its initial outbreak to a pandemic, the writing on the wall is obvious: National leaders made grave mistakes by not taking the threat seriously.

The lack of early mitigation has now cost us more than 427,000 sick Americans, more than 14,000 deaths and more than .3 trillion.

Our nation is paying a terrible cost for not taking this pandemic seriously enough, early enough. We must act in earnest to implement these lessons to help contain the viral spread so we can safely ease the restrictive measures while preventing a second pandemic wave or subsequent pandemic cycle.

This article originally appeared on Military.com. Follow @militarydotcom on Twitter.

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Army declares war on head injuries with motorcycle-style ballistic helmet

Three years from now, soldiers could be wearing a new ballistic head protection that resembles a motorcycle helmet as part of the Soldier Protection System under development at Program Executive Office Soldier.


The Integrated Head Protection System features a base helmet with add-ons such as a visor, a “mandible” portion that protects the lower jaw, and a “ballistic applique” that is much like a protective layer that attaches over the base helmet.

Related: SOCOM plans to test Iron Man suit by 2018

The base helmet on the IHPS will be similar to the polyethylene Enhanced Combat Helmet that some soldiers are already wearing. Eventually all deploying soldiers will get the IHPS with the base helmet, which is the standard configuration. Other soldiers, vehicle gunners in particular, will also get the mandible portion and the ballistic applique as well, known as the turret configuration, Lt. Col. Kathy Brown, the product manager for Personal Protective Equipment at PEO Soldier, in an Army press release.

These Army docs are revolutionizing pain management – especially for burns
The Integrated Head Protection System is part of the Soldier Protection System. | US Army photo

The visor portion on the IHPS provides ballistic protection to a soldier’s face but doesn’t provide any protection against the sun. So soldiers wearing it will need to wear darkened sunglasses underneath the visor if they are in bright environments.

PEO Soldier has authorized soldiers to wear a special type of sunglasses the can transition from clear to shaded lens with a press of a button.

Brown said the goggles will be available for units to be able to requisition as part of the Soldier Protection System.

“If we are able to drive the price down, the Army could eventually make a decision to include that on the list of items that we carry for deploying soldiers,” Brown said.

Brown said the IHPS will likely be available to deploying Soldiers sometime between 2020 and 2021.

MIGHTY TACTICAL

US F-35 fighter jets are all still ‘below service expectations’

Even though the F-35 program is making strides, each of the Joint Strike Fighter variants is still coming up short on combat readiness goals, according to the Pentagon’s top weapons tester.

Based on collected data for fiscal 2019, the Air Force, Marine Corps and Navy variants all remain “below service expectations” for aircraft availability, Robert Behler, director of the Pentagon’s Operational Test and Evaluation Office, said Nov. 13, 2019.

“Operational suitability of the F-35 fleet remains below service expectations,” he said before the House Subcommittee on Readiness and Tactical Air and Land Forces. “In particular, no F-35 variant meets the specified reliability or maintainability metrics.”


One reason for falling short of the 65% availability rate goal is that “the aircraft are breaking more often and taking longer to fix,” Behler added.

Lawmakers requested that Behler; Ellen Lord, Under Secretary of Defense for Acquisition and Sustainment; Lt. Gen. Eric Fick, Program Executive Officer for the F-35 Joint Program Office; and Diana Maurer, director of Defense Capabilities and Management for the Government Accountability Office testify on sustainment, supply and production challenges affecting the program.

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Crew chiefs with the 421st Aircraft Maintenance Unit work on an F-35A Lightning II at Hill Air Force Base in Utah, July 31, 2019.

(US Air Force photo by R. Nial Bradshaw)

Results improved marginally from 2018 to 2019 but were still below the benchmark, and well below the 80% mission-capable rate goal set by Defense Secretary Jim Mattis in 2018.

Mattis ordered the services to raise mission-capable rates for four key tactical aircraft: the F-16 Fighting Falcon, the Navy’s F/A-18 Hornet, the F-22 Raptor and the F-35. The objective was to achieve an 80% or higher mission-capable rate for each fleet by the end of fiscal 2019.

Units that deployed for overseas missions had better luck, Behler said.

“Individual units were able to achieve the 80% target for short periods during deployed operations,” he said in his prepared testimony.

Fick backed up that claim. For example, he said, the 388th Fighter Wing from Hill Air Force Base, Utah, deployed to the Middle East as part of the F-35A’s first rotation to the region. As a unit, the mission-capable rate for the jet fighters increased from 72% in April to 92% by the time they returned last month, he said.

Later in the hearing, Fick mentioned that a substantial contributor to the degraded mission capability rate — the ability to perform a core mission function — is a deteriorated stealth coating on F-35 canopies.

In July 2019, Defense Secretary Mark Esper told lawmakers the F-35 would fall short of the 80% mission-capable rate target over parts supply shortages to fix the crumbling coating that allows the plane to evade radar.

“[Canopy] supply shortages continue to be the main obstacle to achieving this,” Esper said in written responses to the Senate Armed Services Committee prior to his confirmation. “We are seeking additional sources to fix unserviceable canopies.”

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33rd Fighter Wing F-35As taxi down the flight line at Volk Field during Northern Lightning Aug. 22, 2016.

(US Air Force photo by Senior Airman Stormy Archer)

Nov. 13, 2019’s hearing comes on the heels of a new Government Accountability Office report that once again urges the Defense Department to outline new policies to deal with the F-35’s challenges.

“DoD’s costs to purchase the F-35 are expected to exceed 6 billion, and the department expects to spend more than id=”listicle-2641354570″ trillion to sustain its F-35 fleet,” the Nov. 13, 2019 report states. “Thus, DoD must continue to grapple with affordability as it takes actions to increase the readiness of the F-35 fleet and improve its sustainment efforts to deliver an aircraft that the military services and partner nations can successfully operate and maintain over the long term within their budgetary realities.”

The 22-page report largely reiterated what the GAO found in April 2019: that a lapse in supply chain management is one reason the F-35 stealth jet fleet, operated across three services, is falling short of its performance and operational requirements.

It’s something the Pentagon and manufacturer Lockheed Martin need to work through as they gear up for another large endeavor. The DoD last month finalized a billion agreement with the company for the next three batches of Joint Strike Fighters, firming up its largest stealth fighter jet deal to date.

The agreement includes 291 fifth-generation fighters for the US, 127 for international partners in the program, and 60 for foreign military sale customers.

This article originally appeared on Military.com. Follow @militarydotcom on Twitter.

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MIGHTY TRENDING

Military prepared to counter Russia and China

Russia and China are near-peer competitors and the United States must benchmark military capabilities against these possible threats, Marine Corps Gen. Joe Dunford said at Duke University on Nov. 5, 2018.

The chairman of the Joint Chiefs of Staff told a standing room only audience that the two-plus-three strategy gives civilian and military leaders the framework they need to prioritize personnel and resources.

The rise of China and Russia represent the return of great power competition and the American military must respond to this challenge. But the United States still is concerned about North Korea, Iran and violent extremism, he said.


This does not limit officials, he said. The best guess is that these threats are most likely, but there could be other threats that rise and must be addressed.

Preparing against challenges

“Our assumption is if we prepare against one or some combination of those challenges, then we’ll have the right inventory of capabilities to deal with the unexpected,” the general said. “But clearly, as we do our planning we think of the unexpected in addition to these five challenges.”

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Marine Corps Gen. Joe Dunford, chairman of the Joint Chiefs of Staff, speaks with Peter Feaver, a professor of political science and public policy at Duke University, during a discussion with students in Duke’s Program in American Grand Strategy in Durham, N.C., Nov. 5, 2018.

(DOD photo by Navy Petty Officer 1st Class Dominique A. Pineiro)

He said ensuring overmatch against these threats is not easy and the sources of strength for the U.S. military is what nations concentrate their capabilities on. In the U.S. case, one source of strength is the network of allies and friends around the world. This helps another source of strength and that is the ability to deploy forces and capabilities anywhere in the world and then sustain that effort.

Both Russia and China have developed capabilities that would negate some of these advantages, the chairman said. Russia is doing its level best to chip away at the North Atlantic alliance. China is trying to separate the United States from allies in the Pacific region, like Japan, South Korea, Thailand, and the Philippines.

What complicates this is two new domains of defense: space and cyberspace. Russia and China are developing combat capabilities in both domains and the United States has to defend these areas, the general said.

This is not a return to the Cold War, Dunford told Peter Feaver, a professor of political science and the founder of the Duke Program on American Grand Strategy. “Competition doesn’t have to be conflict,” the general said, “but we now have two states that actually … can challenge our ability to project power and challenge us in all domains.”

This does not mean that Russia or China are enemies of the United States, Dunford said, and he stressed that American diplomats need to continue engaging the countries. But, as a military leader, the chairman said he has to deal with capabilities, not intents.

These Army docs are revolutionizing pain management – especially for burns

Marine Corps Gen. Joe Dunford, chairman of the Joint Chiefs of Staff at Duke University, during a discussion with students in Duke’s Program in American Grand Strategy in Durham, N.C., Nov. 5, 2018.

(DOD photo by Navy Petty Officer 1st Class Dominique A. Pineiro)

In Europe he tells his Russian counterpart that “what you’re seeing in our posture, what you’re seeing the increased forces that we have put in Europe, what you’re seeing in the path of capability development that we are on is in order to deter a conflict, not to fight,” the general said.

These developments are “largely reacting to what we have seen over the last 10 years, which is a significant increase in the development of [Russian] maritime capability, modernizing their nuclear enterprise, cyberspace, and space capabilities and in the land domain,” he said.

Dunford added, “Over all domains, Russia has made a concerted effort to increase their capabilities, and we are responding to them.”

The challenges are different in the Indo-Pacific region, he said. The U.S. goal is to follow the rule of law that has benefitted the region since the end of World War II. The U.S. government would like to see China acquiescing to these rules and not trying to replace them.

“In order for us to have a free and open Indo-Pacific, in order to have China comply with international law and standards as they exist or seek to change them in a legitimate venue, what it will take is a collected multilateral response,” Dunford said. “One of the things we work on very hard is to develop a group of like-minded nations that will seek to have a coherent, collective response to violations of international law.”

He added, “To the extent that we are able to do that, we will be able to manage the situation in the Pacific peacefully.”

This article originally appeared on the United States Department of Defense. Follow @DeptofDefense on Twitter.

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The 13 funniest military memes this week – battle buddy edition

This week’s meme roundup is dedicated to the friends you go to war with: Your battle buddies. These friends would do anything for you, even take a bullet, or in the case of Medal of Honor recipient Kyle Carpenter, jump on a grenade. The bond between battle buddies is second to none, and most people will never experience friendship on this level. Although it’s difficult to capture the bromance in 13 memes, here’s our attempt:


1. Battle buddies depend on each other.

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When the leadership fails, your buddy won’t.

2. Battle buddies aren’t always human.

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Man’s best friend is just as dedicated.

3. War is intense, so jokes and pranks are also elevated to the same level.

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This is their version of “kick me.”

4. You get in trouble together.

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No worries, it’s a just a mouth lashing.

5. You find creative ways to entertain each other.

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This would make a great, “shut the fu– up Carl” meme.

6. Their idea of going to the movies is a little different.

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Their camaraderie makes up for the lack of screen size.

7. They fight together, they watch movies together, and they also drink together …

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… because sometimes you need someone to stagger home with.

8. Buddies look after each other, they don’t report each other.

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Seriously, how do those dixie cup hats stay on?!

9. They settle things differently.

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The quickest way to getting over a disagreement. (from Military Memes Facebook fan page)

10. Your pain is the butt of their jokes.

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They brandish bumps and scars like badges of honor, but more importantly, to show you how much tougher they are.

11. Despite all the shenanigans, buddies will always have your back.

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They’ll follow each other to the gates of hell. (from Military Memes Facebook fan page)

12. They’ll look after each other like their life depends on it.

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There’s no worse feeling than the feeling of letting your buddy down.

13. Battle buddies forever.

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Battle buddies keep their promises. If they said they’ll be there, they’ll be there.

NOW: 10 tips for dating on a forward operating base

AND: 9 Military terms that will make you sound crazy around civilians

OR WATCH: 13 Signs you’re in the infantry:

Humor

7 of the top surprises veterans face going to school

It’s time to go home. You’ve honorably separated or retired from service, you’ve got your DD214 in hand, and you’re likely itching to get on with the next chapter of your life.


Chances are, you’ve already got some school under your belt, but you likely need to get a little bit more to make the career move you see for yourself.

Yup, you are heading full-speed ahead, right for the thing you probably joined the service to avoid: college. Below are 7 of the top surprises every veteran faces going back to college.

Also Read: 5 things we wish we had while we were deployed

7. Homework? Yes, that’s a thing

No doubt you knew homework was involved in the school process, but the amount and the frequency might just surprise you.

No way you expected Mrs. Robinson to assign an essay the first day of basket-weaving class…

These Army docs are revolutionizing pain management – especially for burns
When the professor tells you on Thursday that there’s a quiz on Friday. (Image from Comedy Central)

6. Think high school drama stays in high school? Nope

The drama that you left behind to serve Uncle Sam and this great nation didn’t go anywhere while you were gone.

It is waiting right where you left it, ready to infuriate your overly mature sensibilities.

These Army docs are revolutionizing pain management – especially for burns
The Drama Continues. (Image from Disney’s High School Musical)

5. Lack of structure

College does have structure, obviously, but it can’t begin to compete with the structure we grew accustomed to in the military.

Sure, you’re an adult with lots of life experience and you’re fully capable of completing tasks without supervision, but having the structure suddenly go missing is jarring for many of us.

These Army docs are revolutionizing pain management – especially for burns
When you realize you miss the structure. (Image courtesy of Military.com)

4. Irritability… also a thing

By being in the military, you to get used to dealing with competent individuals. This is because, typically, an incompetent individual doesn’t make it very long — if at all.

Furthermore, if individuals begin to show incompetence, especially if you outrank them, it is perfectly fine and expected that you correct them. That type of behavior is frowned upon in most collegiate settings. It’s something that takes some getting used to.

The adjustment curve is typically worse for those with more time in service.

These Army docs are revolutionizing pain management – especially for burns

3. Yes, you’re the old guy/gal

This is a just a fact of life. The armed forces, as a whole, only make up about a half of one percent of the total population. This means that most of your classmates are civilians who probably came right from high school.

Truth be told, there’s a good chance that you’re older than at least one of your professors.

2. Your military experience may or may not apply

Depending on how different your scholastic endeavor is from your military service, what you did in uniform may or may not matter. This is a bitter pill to swallow for many of us, as we are extremely proud of our service and accomplishments.

This leaves us with a decision. We can become that guy/girl that always brings up their service, or try to find a new place to fit in. Good news though, a lot of schools will take your service and give you scholastic credit for it.

These Army docs are revolutionizing pain management – especially for burns
That look you give when you’re told your years of service don’t apply. (Image from STX Entertainment’s The Foreigner)

Related: 5 reasons MPs hate on firefighters

1. The Billy Madison effect

This is a bit different than just being older. Even if you went to school while in service, those studies often mirror your military duty. Breaking away from that causes you to have to learn and relearn the basics of whatever you’re studying.

This makes you Billy.

Not only are you older, but the subject matter is super entry-level.

Yup, you’re definitely Billy.

These Army docs are revolutionizing pain management – especially for burns
Trying to understand something brand new with your new classmates. (Image from Universal Pictures’ Billy Madison)