All posts by SSD

Arete 12.8.22


After two years, the FBI is still seeking answers about the death of Delta Force operator who killed a fellow operator in 2018, Military News
David is a Real American Hero, Real Clear Defense
Beware Putin: Russia is Surprisingly Vulnerable to Bombardment from Ukraine, Real Clear Defense
Were Russian Air Bases Hit in Drone Strikes by Ukraine?, 1945
AK-12: Russia’s Best Assault Rifle Ever?, 1945
New Court Ruling Slams Air Force’s Limited Approval of Religious Exemptions for COVID-19 Vaccine, Military Times
‘Alarming’: Two More Horses Die in Army’s Premier Ceremonial Unit, Marking Four Since February, Military Times
Convicted Oath Keeper Leader Preyed on Veterans Looking for Meaning After Service, Military Times
Five 10th Mountain Soldiers Arrested on Rape Charges, Military Times
Congress considering repeal of military’s coronavirus vaccine mandate, Axios
Keep COVID Military Vaccine Mandate, Defense Chief Says,
British Army tests GPS-denied navigation outcomes, Digital Battlespace
Systematic battle management software supports major European exercise, Digital Battlespace
U.S. Carrier Fire Injures 9: Navy’s Fire Prevention Efforts Face Scrutiny, Forbes
Marine veteran chugs beer from her prosthetic leg during Lakers game, Military News
Navy investigating ships’ near-miss caught on San Diego Bay’s webcam, Military News
Two women arrested in connection with $1 million stolen from USAA customers’ bank accounts, Military News
Army sergeant charged with stealing machine gun parts after his entire brigade was recalled over a long weekend, Military News
US Dismisses China Objections to South China Sea Mission, Military News
Russia strikes Ukraine’s infrastructure facilities for 8th time, Pravda Report
LEADERSHIP: Mobilizing Madness, Misery, Mayhem And Mutiny, Strategy Page
Combat medic ‘voluntold’ to attend Army Best Squad competition ends up dominating the range, Task & Purpose
Four sailors have committed suicide at a Navy maintenance center since October, Task & Purpose
Why modern technology hasn’t rendered trench warfare useless in Ukraine, Task & Purpose
No, a former Marine general is not working for an infamous Russian mercenary group, Task & Purpose
In Photos: Life in the Bakhmut ‘Vortex’ as Savage Fighting Continues, Moscow Times
3 Killed, Nuclear-Capable Bombers Likely Damaged in Russian Airfield Explosions,Moscow Times
Retrograde: The gritty, true story of the US departure from Afghanistan, We are the Mighty

National Defense, Foreign Policy

Nuclear Hunting Licenses, Real Clear Defense
Staying On Target: Containing Al-Shabaab Through Drone Strikes, Real Clear Defense
China has doubled its nuclear stockpile in the last 2 years, DoD report finds, Task & Purpose
China’s Emerging Subsurface Presence in the Indian Ocean, The Diplomat
Our Military Insiders’ Views of the New National Defense Strategy, Atlantic Council
Russian Military Strategy, Real Clear Defense
To Deter China, the U.S. Must Have the Political Courage to Retaliate Against Russia, Real Clear Defense
Should Sweden Forget About Joining NATO?, 1945
Army Awards Lockheed Martin $430.9 Million To Help Replenish HIMARS Stockpiles, Defense Daily
DARPA Soliciting For Long Endurance VTOL UAS For Navy And Marine Corps, Defense Daily
Arms Sales By World’s Biggest Defense Companies Rise To Almost $600 Billion, Forbes
Don’t Use the War in Ukraine As An Excuse To Permanently Expand the Weapons Industry, Forbes
In Five Years, Russian Agents Blew Up 210,000 Tons Of Ukrainian Ammo—And Nearly Silenced Kyiv’s Artillery, Forbes
Europeans Have Weapons—But Aren’t Warriors, Foreign Policy
Did Iran Actually Abolish Its Morality Police?, Foreign Policy
Scotland’s Independence Dream Hits a Dead End, Foreign Policy
A Dangerous Game Over Taiwan, Hoover Inst.
U.S. designates Al Qaeda, Pakistani Taliban leaders based in Afghanistan, Long War Journal
Islamic State announces death of its caliph, appoints successor, Long War Journal
Another long hotel siege ends in Mogadishu, Long War Journal
3 Months After Fat Leonard Escaped, Feds Remain Mum on Details, Military News
Rise of Israel’s Anti-Arab Party Jeopardizes Regional Normalization, New Lines Institute
China Stems Wave of Protest, but Ripples of Resistance Remain, NY Times
What to Know About Iran’s Morality Police, NY Times
USA achieves many of its goals in proxy war with Russia, Pravda Report
Putin explains reasons behind Russia’s missile attacks on Ukraine’s infrastructure, Pravda Report
Kremlin: Joe Biden’s terms on talks with Putin impossible, Pravda Report
The Way Ahead for Northern European Defense: Shaping the Future with Sweden and Finland as NATO Members, 2nd Line of Defense
Nimitz Carrier Strike Group Departs San Diego for Pacific Deployment, USNI
Japan considering buying 500 U.S.-made Tomahawk cruise missiles, War is Boring
Key facts about China’s declining population, Pew Research
A Plan to Push Back Against China’s Fishing Practices, War on the Rocks

First Responder / Law Enforcement / Wildland Fire/ Homeland Security, Wilderness Professional

Mystery surrounds arrest of alleged Russian spy couple in Sweden,
Wounded Officers Sue Sig Sauer, Say Gun Goes Off by Itself, Military News
FBI joins investigation into attack on North Carolina power grid, The Guardian
What Is Seditious Conspiracy?, HSN
Smart Inverters’ Vulnerability to Cyberattacks Needs to Be Identified and Countered, HSN
Vermilion (OH) Fire Marshal Crashes Vehicle into Fire Station, FFCC
Video: FDNY Tackles Five-Alarm Fire in Manhattan Apartment Building, FFN
Pittsburgh (PA) Pilots Program to let Medics Carry Blood for Trauma Cases, FFN
Video: Truck Topples Off Highway Overpass Onto Accident Scene in Santa Clara (CA), FFN
2 sentenced to prison in overdose death of CAL FIRE firefighter, FR1
Maine FFs wear SCBA to avoid getting high while fighting fire at marijuana growing facility, FR1
Baltimore Fire Chief Niles Ford resigns following release of internal report about LODD fire, FR1
Fla. police chief resigns after internal review into golf cart traffic stop, Police 1
Man lures Calif. LEOs out of station, throws Molotov cocktail at them, Police 1
Fla. deputy, 23, dies after officer roommate ‘jokingly’ fires gun he thought was unloaded, Police 1
Suspect tries to steal from Walmart, finds store filled with deputies, Police 1
State your case: Should police be permitted to use robots to deliver lethal force?, Police 1
Developing a respect-based police survival attitude, Police 1
Bill passes to allow injured firefighters to remain in enhanced retirement system, Wildfire Today
Judge dismisses felony charges against 48 CHP officers in OT scheme, Police 1
Mysterious Attacks on North Carolina Energy Grid Cut Power to Thousands, Gizmodo
A ‘Skills-Based’ Immigration Plan Arguably Incorporates the Worst of All Worlds, Real Clear Markets

Mountain / Outside

Chris Sharma Confirms He’s Still Working on Siurana Mega-Proj, Sends 5.14d, GearJunkie
Polartec Presents 12 ‘Apex Awards’ to Standout Gear Including Polartec Fabrics, GearJunkie
These 20 Pieces Of Gear Changed Backpacking Forever, Outside
Dial in the Elusive Perfect Ski Boot Fit, Outside
Visualizing the Backcountry as a Splitboarder: Minimizing the Challenges of Movement by Anticipating Terrain, BC Ski Touring Blog
Be Prepared — Avalanche Rescue Practice Tips, BC Ski Touring Blog
This 11-Year-Old Completed Two 5.14b Climbs in One Day, Outside
Five Story Lines to Follow with the U.S. Ski and Snowboard Team, Outside
Climbing and Outdoor News from Here and Abroad – 12/1/2022, AAI
[MUST WATCH] Cole Richardson puts it all out there in ‘Yours Truly,’ presented by Arc’teryx, Freeskier
Meet Osprey Ambassador and Artist: Brooke Ruble, Osprey
The Making of Arc’teryx’s New Film: ‘Creation Theory’, Outside
Patagonia Sues Gap Over “Iconic” Fleece Design, Outside
​Griffin Post Puts on An Alaskan Clinic in Magic Hour, TGR
What Climate People Can Learn from Conservation, Patagonia
Lift Line Hurls Snowballs At Skiers For Not Filling Chair (Funny Video), Unofficial Networks
WATCH: The 10 Most Expensive Lift Tickets In The United States, Unofficial Networks
The Best Ice Spikes & Traction For Shoes To Wear All Winter, Wide Open Spaces
Caribou Hunting 101: When and Where to Do It , Wide Open Spaces
The Mystery of Alaska’s Disappearing Whales, Wired

Health / Fitness / Nutrition

Worst flu outbreak in more than a decade spikes hospitalizations, Axios
What Have We Learned from COVID-19? Apparently Not Much, HSN
Activities and Results from U.S. Coast Guard Project Evergreen V, RAND
Video: Extreme Electric Bikes – Eicma 2022, Electric Bike Action
You Should Be Using More Lube, Gear Latest
Danny MacAskill Can Ride A Bike Across A Tennis Net 🎾, Redbull
Why Conjugate is King for Auto-Regulation, Andy Baker
People are pinning their hopes for their weight loss goals on this diabetes drug, The Manual
Scientists discover secret to waking up alert and refreshed, Science Daily
Fitness levels can be accurately predicted using wearable devices — no exercise required, Science Daily
Believe it or ‘nut’, almonds can help you cut calories, study finds, Science Daily
Adolescents Are Ditching Alcohol for Cannabis at a High Rate, Healthline
Five Ways to Get Out Of Back Pain, Men’s Health
The 9 Best Protein Powders For Weight Gain Available In 2022, Muscle & Fitness
Why Should (or Shouldn’t) We Eat a Macrobiotic Diet?
The Most Damaging Exercise Myth, Real Clear Health
The Most Effective Arm Workout You’ll Ever Do, T-Nation
What Most People Get Wrong About Singles and 6 Messages You Might Need, Tiny Buddha
How to Use Data Science for Analyzing Endurance Athletes, Training Peaks
A Sneak Peek At 5 Shoes Triathletes Will Be Lusting After in 2023, Triathlete
Shingles Ups Odds of Stroke, Heart Attack By Almost 30%, WebMD
How Money Buys Happiness: Buy Experiences, Spend on Others, and More Tips, WebMD
Gifts for the Guy Who Loves to Suffer with Michael Easter, Huckberry
Holiday Gear Lab: Top 10 Thoughtful Gifts for Her 2022, Huckberry
Cannabis Is No Better Than a Placebo for Pain Relief, Real Clear Science
Beyond beliefs: does religious faith lead to a happier, healthier life?, Guardian
China’s Xi Jinping ‘unwilling’ to accept western Covid vaccines says US intelligence chief, Guardian
Why does the US keep running out of medicine?, Vox
The Era of One-Shot, Multimillion-Dollar Genetic Cures Is Here, Wired


Minimizing Injury Risk with Load Carriage in Tactical Athletes through Strength and Conditioning: A Critical Review of the Literature

By Tammy Kovaluk, MTI Contributor

Tactical athletes need to perform high level tasks while carrying additional load. Law enforcement personnel, search and rescue, and firefighters all carry loads that are typically 20kg, typically as high as 40kg (5). Military soldiers bear the highest loads, well over 45kg (100+ pounds), a likely cause of the increased injury rates (2, 5). 

There is considerable data on load carriage related injury rates, particularly in military soldiers, perhaps partially because of the cost associated. The average cost of musculoskeletal injury amongst military soldiers is $2.5 billion per year, with estimates as high as $3.6 billion per year (9). This amount includes all cost-associated injuries, however, research indicates a large percentage of these injuries are from load carriage, accounting for 45% of injuries amongst US combat forces during a 12-month deployment (7). According to Szivak, load carriage is the largest contributor to musculoskeletal injury, exceeding injuries due to enemy contact (10). 

Military soldiers undergo load carriage for extended periods of time, along with intensive anaerobic periods, as they do not have the relatively close support networks as with the police or fire service (5). This is likely another reason the injury rates are relatively higher. It also affects combat capability. During WW2 for example, significant numbers of American troops deaths occurred in the water during landing at Omaha Beach due to carrying high loads (5). In 1983 in Grenada, large numbers of US soldiers were so overloaded they were unable to continue fighting, left on the roadside (5).  

I would argue that both search and rescue and wildland firefighters often undergo extended load carriages. However, research is lacking in these areas and is largely focused within military soldiers. 

This purpose of this article is to:

a) Share some common research findings for load-carriage related injuries and risk factors.

b) Share a critical analysis of some literature for minimizing risk of load-carriage related injury through strength and conditioning. This is an area of specialist interest of mine, as I personally know many veterans who suffer long term load carriage related injuries, have heard amongst recruiters that injury rates are increasing in boot camp, and sustained a back injury myself, attributing this largely due to training errors.

Summary: Load Carriage Common Injuries and Injury Risk

Common Injuries

Research indicates the leading causes of load-carriage injuries include the lower extremity (knee, ankle, and foot, at 40.3%) and the spine (at 39.0%) of all injuries, with 82.3% of all injury types being “overuse injuries” (1, 5). These injuries are the number one reason both male and female soldiers have not been able to complete a march (5). Females experience twice the rate of foot injuries and suffer significantly more severe back injury (5). 

Fatigue increases injury risk. 

Commonly reported in research, fatigue associated with load carriage leads to increased energy cost, and biomechanical alternations. Gait patterns, ground impact forces, and spinal load alterations are all factors that increase risk of injury, especially during prolonged and/or high intensity load carriage. (1,2,5). Walking with a backpack load increases forward lean, generating vertebrae stresses, intervertebral discs, muscles, and other spinal structures (1,5). Both heavier loads and time on feet are related to increased fatigue and risk of injury. Research has not indicated the difference in intensity (ie walking vs running) with load carriage and injury rates. I would think this would be important factor consider, as running alone increases compressive forces. 

Sufficient physical fitness is important. 

All research found indicates that underlying fitness, in terms of both aerobic and strength, is important. For example, a study observed musculoskeletal injury rates amongst 67,525 recruits between 2012 and 2014 during Basic Training at San Antonio (1). They concluded that lower levels of fitness amongst the arriving recruits, particularly aerobic fitness, correlated to increased injury rates and severity (1).

Prior injury increases risk of future load carriage injuries. 

It appears a previous load carriage-related injury increases future injuries by approximately 50%. In a study by Orr et al., for example, 34% of 338 military soldier respondents reported at least one load carriage-related injury, and 52% of those experienced repeated load carriage injury after suffering a previous load-carriage injury (7).

Other reported factors 

  • BMI (body mass index). Molloy and colleagues found that a lower BMI had increased risk of injury, as the load is relatively high compared to body weight, as well as those with a combination of a higher BMI and low physical fitness (1). 
  • Muscular deficiencies. Certain muscular deficiencies – particularly decreased trunk flexion strength, decreased trunk extension strength, and decreased knee extension strength – have been correlated with increased injury amongst load carriage of lower extremities and spinal injury (1).  

A critical analysis of some literature related to minimizing risk of load-carriage related injury through strength and conditioning.

Since TSAC (Tactical Strength and Conditioning Facilitator) has become a specialist branch within the NSCA (National Strength and Conditioning Association), strength and conditioning considerations for tactical athletes have been of greater interest. The NSCA now has a “TSAC” report, with primary and secondary articles, TSAC conferences, and a specialized certification available. 

However, despite finding ample research on load-carriage injury rates with promising article titles, the literature on strength and conditioning approaches for minimizing risk of injury was extremely limited. According to Orr, what is lacking are practical guidelines on how to effectively condition military personnel for load carriage tasks: A translation of research findings into practice (2). 

That said, the following is a critical review of three literature papers I was able to find. 


Soldier Load Carriage, Injuries, Rehabilitation and Physical Conditioning: An International Approach: 2021 (5) 

Type: Secondary source article in a peer-reviewed publication.


  • Load carriage sessions should be performed once every 10-14 days. This recommendation is based upon prior researching suggesting load carriage training be performed every 7-14 days. And secondly, neuromuscular function in the trunk and limbs takes 48-72 hours to recover following a load carriage bout.
  • Training programs should include manipulation of load weight, speed, distance, and grade and type of terrain. 
  • Resistance training should be included within the training program, as well as overall aerobic fitness. Increases in musculoskeletal and aerobic fitness are essential in injury resilience, as lower levels are associated with an increased risk of load-carriage related injury.
  • Upper body strength is perhaps more important, as improvements in load carriage performance is more correlated to upper body strength than lower body strength. This recommended is based on a study by Robinson et al: “Aerobic Fitness is of Greater Importance than Strength and Power in the Load Carriage Performance of Specialist Police” (8). The Robinson et al study tested 5km time trials amongst police officers, with 25kg packs. They found the greatest correlation of 5km performance with aerobic conditioning. In terms of strength training, the highest correlations were between 1RM pullups and 1RM bench press, greater than 1RM squat and deadlift (8). 1RM pullups had the greatest correlation, with the authors suggesting that posture maintenance may increase load carriage efficiency (8). 
  • Immediately following injury, emphasis should be in diagnosis and treatment, with a return to function.

Positive Take Aways and Limitations: 


  • The paper did go through the background of load-carriage related injuries, including common factors increasing injury risk and injury rates. 


  • Despite the title of the paper, it did not provide any specific recommended strategies in term of injury prevention, nor rehabilitation. Rehabilitation protocols, for example, simply stated early diagnosis and treatment, as well as a sound return to function. These things are obvious to me. 
  • Simply recommending aerobic and resistance training is completely generalized, with little benefit to a strength and conditioning professional or tactical athlete. In addition, stating that upper body strength is more important did not mention the specific exercises of the Robinson study, I found those from looking at the Robinson study itself. Just stating ‘upper body strength’ could be taken out of context, with athletes doing useless ‘beach body’ exercises, wasting their time. These blanket statements are first, in my opinion, obvious to any competent strength and conditioning coach. And second, could steer practitioners and tactical athletes in the wrong direction, programming useless exercises and rep sequences. 
  • I was surprised and disappointed that, despite the title of this paper, it is of no real practical value. Reading this, I thought “is that all they have to contribute?” It was as if part of the paper was missing. 


Load carriage: minimizing soldier injuries through physical conditioning – a narrative review (6). 

Type: Secondary source article in a peer-reviewed publication. This paper summarized research papers and articles, following key search terms related to training and conditioning for load carriage gathered from numerous sources. The sources included original research papers, conference papers, and secondary source articles (journal articles, relevant subject reviews and military reports).

Recommendations (6): 

  • Combination of resistance training and aerobic training (concurrent training). Studies by Kraemer et al (2001, 2004) suggested that load carriage performance and injury resilience can be improved with concurrent training. Those with lower levels of fitness and exercise will likely make greater initial gains regardless of the type of training, after which specific training is needed to improve performance for a specific task. 
  • Specificity. The conditioning program must consider the task intensity and requirements. Shorter duration, high intensity to adequately condition the athlete to move under direct fire, for example, and longer durations to adequately develop physical and mental stamina during dismounted patrols, for example.
  • Training frequency. Two to four evenly spaced load carriage per month (~7-14 days). However, the authors cautioned that frequency should vary depending upon training intensity (load and speed) and volume (time or distance). They suggest beginning with lighter loads, then progress in weight to match what is required for occupational tasks. 
  • Recovery.  To allow the body to adapt from training stimulus, as well as prevent overload and injury. Inadequate programming of recovery within the training program has been identified as a causal factor in high injury rates among military personnel. This can be achieved by reducing volume throughout long term load carriage training programs. Periodically reducing volume has been shown to drastically reduce injury rates amongst recruits, without negatively affecting fitness. Coined ‘orthopedic holidays,’ strategically placed recovery periods should be long enough for some musculoskeletal recovery, yet short enough to avoid detraining. 
  • Detraining. Be cautious when prescribing recovery periods to avoid detraining. Lengthy breaks in load carriage conditioning have been shown to increase injury and reduce performance when soldiers resume heavy load carriage training and tasks.
  • Conclusion. “A structured and progressive conditioning program with built in recovery periods is recommended.” 


  • The paper did go through the background of load-carriage related injuries, including common factors increasing injury risk and injury rates. 
  • They at least made some recommendations, addressing the main training factors. 


  • Again, less generalized than “Solider Load Carriages” paper but was still quite generalized. 
  • Zero specifics in terms of resistance training.


Resistance Exercise Considerations for Load Carriage (10)

Type: Secondary source. 


  • Resistance Training must address three main areas: strength and power development, work tolerance and fatigue resistance, and injury risk mitigation via dynamic trunk stability. Fatigue will set in more quickly without adequate training in these areas, increasing risk of injury.
  • Dynamic Trunk Stability. Load carriage results in biomechanical and kinematic changes – increased forward trunk lean, increased hip flexion, and forward positioning of the head and neck – all of which increases injury risk, especially back related injuries. With this in mind, traditional trunk stabilization exercises, such as planks and side bridges, are still valuable, particularly during rehabilitative or when pain is present . However, trunk stability should be focused on dynamic movements. Olympic lifts, squats, and farmer’s walks are some examples by the authors. 
  • Resistance training at higher load intensities will result in the highest activation of higher threshold motor units, greatest hormonal stimulus, and greatest translation of forces onto the associated muscles, connective tissue, and bone. Higher load training should be in combination of resistance training with moderate loads and shorter rest periods to improve fatigue resistance. 


  • Although recommendations were still more generalized, there was greater specificity, providing useful information that has some practical value.
  • The purpose of recommendations was addressed, based on prior research and took into account biomechanics, kinematics, and exercise physiology. This relates to “dynamic correspondence exercises,” exercises that transfer to the tasks, rather than wasting time and energy performing useless exercises. 
  • The dynamic trunk stability recommendation was solid, in my opinion. As the authors noted, these exercises transfer to a greater ability in handling the load versus doing isolated movements. They did not use the term “core bracing” – but that is commonly how I think of these exercises. 


  • A few exercises were mentioned. But again, this article does not provide any specifics (ie reps, sets, sample program). They could have included a sample program for one week, and simply provided a caveat. 



There appears to be ample research discussing injury rates amongst tactical athletes. However, practical recommendations are lacking, much greater than expected. Further, almost all studies are specific to military soldiers. I have found more studies than the ones mentioned above, but they all essentially say the same thing, providing similar generalized conclusions. 

Besides the frequency of load carriage, everything is generalized. The papers did not provide any examples in terms of rehabilitation or resistance training exercises, for example. This was surprising, as you will typically see an example program with other sports such as hockey or football. When I write for the NSCA for example, they always ask for a sample ‘Day 1’ or a sample week program, including specific exercises, reps, sets, rest periods etc. When doing so, I simply include a caveat of it being a sample program only, and that the athlete specific needs, strengths and weaknesses, history, training status etc be addressed. It is like nobody is willing to put their neck out and is simply stating the obvious, using base principles. 

That said, anecdotally, I am aware that competent and comprehensive strength and conditioning programs are being implemented, at least amongst the special forces have worked with when preparing for the selection process. This is based upon athletes sharing some of the training they undergo. It is just not being shared amongst the research literature, or even at the TSAC branch of NSCA, at least from what I could find.

As well, physical fitness tests amongst military, firefighters, and police officers are typically based off standard pushups, situps, a run test, and sometimes pullups. Much of this is not specific enough to the actual field, especially when carrying loads under intensive situations. The U.S. Army Physical Fitness Test has shown progress, recently being replaced by the ACFT, with many movements being more applicable to the actual physiological demands. That said, going down this road is a different topic for another article. 


Tammy is a professional strength and conditioning coach currently coaching in Arizona as well as an accomplish endurance, obstacle race and fitness athlete. 

Want to be a paid, MTI contributor? Email a current resume and three topic ideas.




  1. Fox, B., Judge, L., Dickin, D., and Wang, H. Biomechanics of military load carriage and resulting musculoskeletal injury: A review. Journal of Orthopedics & Orthopedic Surgeons, 1(1): 6-11, 2020. 
  2. Hauschild, V. Foot marching, load carriage, and injury risk. Technical Information Paper (Army Public Health Center), 12-954-0616. 2016. DOI:10.13140/RG.2.2.25160.52483
  3. Mala, J., Szivak, T., and Kraemer, W. Improving performance of heavy load carriage during high-intensity combat related tasks. Strength and Conditioning Journal, 37(4): 43-52, 2015.
  4. Nindl, B. Physical Training Strategies for Military Women’s Performance Optimization in Combat-Centric Occupations. Journal of Strength and Conditioning Research, 29: S101-S106, 2015.
  5. Orr, R., Pope, R., Lopes, T., Leyk D., Blacker, S., Bustillo-Aguirre, B., and Knapik, J. Soldier load carriages, injuries, rehabilitation and physical conditioning: An international approach. International Journal of Environmental Research and Public Health, 18(8): 4010, 2021.
  6. Orr, R., Coyle, J., Johnston, V., and Pope R. Load carriage: Minimizing soldier injuries through physical conditioning – a narrative review. Journal of Military and Veterans’ Health, 18(3): 31-38, 2010.
  7. Orr, R., Coyle, J., Johnston, V., and Pope R. Self-reported load carriage injuries of military soldiers. International Journal of Injury Control and Safety Promotion, 24(2): 1-9. 2016
  8. Robinson, J., Robers, A., Irving, S., and Orr, R. Aerobic fitness is of greater importance than strength and power in the load carriage performance of specialist police. International Journal of Exercise Science, 1(11): 987-988, 2018. 
  9. Shumway, J. Injury prevention for tactical personnel – Compiling the evidence and lessons learned. TSAC Report, (52)1, 2019. 
  10. Szivak, T. Resistance exercise considerations for load carriage. TSAC Report, (56)1, 2020. 

Suicide Shaped my EMS Career; Why I Dread Responding to Another Suicide

Dedication: Eric Pracht; End of Watch: July 23, 2016

By Joe Poulton, MTI Contributor

After my Uncle Jim’s Suicide in his backyard with a gun, my Aunt joined Out of The Darkness Walks through the American Foundation for Suicide Prevention (AFSP). When I saw the community of support being built through those walks, and noticed the AFSP expanding; I jumped at the opportunity to help build the Portland Chapter. That commitment lasted from December 2008 to March 2009; then AFSP consolidated the PNW Chapters with the Seattle Chapter and moved meetings north. Looking for another way to help those with depression and suicidal thoughts; inspired by my wife Ariel and her work as an RN, my path shifted towards EMS.

In 2010 I tackled an EMT Basic course in Vancouver, WA. It was difficult learning the required aspects of patient care; where to take pulses, how to take blood pressure, how to splint fractures, CPR, and the list goes on for how to manage the patient. There were no skills for the EMT to manage the psychological effect of the work.

After my EMT course, work began with Denver AMR operations and transitioned from there to AMR’s Boulder 911 system. This was when memories of death ramped up, my first suicide call was a hanging in an Open Space Park. When my Medic partner and I went up trail to the tree I remember being more curious than anything. I saw the face and wondered how many dead people Hollywood artists had to see to get it so right.  Suicide calls compounded, but none were similar to my uncle’s. All were overdoses and hangings.  

When we had our son, we moved back to the PNW and I began working for Clackamas AMR. While I worked through the Reach and Treat (RAT) Academy with AMR; a high school friend after years of trying to manage a TBI and physical challenges died by suicide, but he also took his daughter’s life with him. That was May of 2014 two days before my 35th birthday. I completed the RAT Academy the following October.

A couple years later Eric Pracht, a Denver EMS Brother; became a Paramedic for South Park Ambulance in the years following my move west. He went missing in 2016 and was found in 2020 by hikers within an Open Space Park, a gun nearby. He was 25 years old.

Summer of 2018 was busy with Reach and Treat shifts between fire deployments. One night, a call dropped; knelt on the ground and checked for a pulse, even though there would be none, just cold. A women shot herself the same way my uncle Jim did, there was family and friends experiencing their pain of loss on scene. I remembered my Aunt recalling how grateful she was for the EMS crew talking with her, staying for hours. I wanted to help this family in a similar way. The husband was in heavy grief, unable to talk; I walked over to the friend. Put my hand on his shoulder and in a strange calm spoke, “If you or the family need a network of support, connect with the American Foundation for Suicide Prevention—remember the AFSP if you’re able, just A—F—S—P.” But I didn’t stay for hours, the county has a different crew that comes to assist with grief.  Another suicide—this one—a mirror reflection of my uncle’s.  Different than all the other suicide calls—no family or friends were present experiencing their grief on previous ones.

Even after the Summer of 2018, I didn’t accept the reality of the damage fully. Engaged in sporadic counseling that was not effective. I’ve seen this before—suicides—not understanding the significant difference at the time. This led me down a road of complacency that maintained a disconnect from myself.

Responded to a call in October of 2019 for a suicidal ideation patient, as I stumbled with my questions the patient responded with aggressive irritability. I was unable to have a conversation and shut down, my partner on the rig took the call and I drove. After we transported and got the patient into an ER bed, I had a full panic attack sitting in the driver’s seat of the rig. This was the first intervention that occurred, a Critical Incident Stress Management co-worker from Multnomah County was at the ER. We sat in the EMS breakroom of Mount Hood Medical Center for some time. That was my last RAT shift call. The patient, an off-duty firefighter.

I was late to the game in understanding this challenge, thankfully I’m here. I’m still learning. Not having a significant relationship with other forms of traumatic death in my personal life; lessened the impact of other traumatic calls. I did maintain RAT status with monthly training for Wildland Fire Deployments. However, anxiety remains over the idea of responding to another suicide. 

There is a mechanism of overlap between PTSD and Anxiety, but as noted in the Neuroevolutionary Time-depth Principle article in a segment focused on combat “PTSD may be partly due to it being an overconsolidational fear circuitry overactivity superimposed on a premorbid suboptimal dosage of harm-avoidance-related genes.” 

My accumulation of stress specific to suicides through my EMS work; my lost family and friends, has increased my anticipation anxiety.  In a perceived protection mechanism through the avoidance of working another suicide call; fearing that it could be similar to the previous, has kept me from a 911 shift. Curiously, on the call itself; I did all I could do.

Joe Poulton has worked in EMS for 12 years with the last 8 being on the Reach and Treat team in Clackamas County OR.

Want to be a paid, MTI Contributor? Email a current resume and three specific topic ideas to Writing topics can include fitness, nutrition, quiet professionalism, leadership, and all areas of safety and professionalism in the mountain and tactical worlds. 



Critical Incident Stress Management (CISM) is an “umbrella” term for a variety of psychological modalities that encompass preventative care, intervention, and postvention used in a variety of tools to manage psychological stress before, during, and after traumatic events of all shapes and sizes. 

How does this compare to our old friend epinephrine?

pastedGraphic.png       comes in a number of concentrations

pastedGraphic.png       Has many delivery routes

pastedGraphic.png       Can be used in a miriad of scenarios

pastedGraphic.png       It’s effectiveness in certain scenarios are often in question

pastedGraphic.png      If used incorrectly by poorly trained personelle, outcomes can be poor

pastedGraphic.png       If used correctly by well trained personelle, it can (and has) saved lives 

We’ll go into a deeper dive of CISM/ CISD/ PEER SUPPORT soon. But for my medical providers out there: before you lean all the way in into the LOVE IT or HATE IT camp. Ask yourself how well epi works for anaphylaxis and how we still have a ton of research to do to determine it’s efficacy in cardiac arrests.

Also, to my mental health providers out there:. If the first time you’re meeting a team is to perform a CISD you’re doing it wrong. This failure may be yours, it may be the failure of the providers agency, but if it all possible you should meet the teams you will be asked to care for BEFORE you’re expected to care for the. [sic]

DanSun Photo Art


PTSD and Anxiety

Human brain evolution and the “Neuroevolutionary Time-depth Principle:” Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder


Based on the first 10 episodes of the Resiliency 1st Podcast I’ve learned some simple techniques.


4×8 inhale 4 exhale 8 seconds


Continuous 7+ hours, naps 20-30 minutes or greater than 90 minutes to avoid waking in a sleep inertia cycle. If you continuously wake with an alarm you are not getting enough sleep.

Positive Activity

After a difficult call, do some form of activity. Run or walk fast, even right after the call before you finish the chart. 5 minutes in the ER bay or longer at post if possible. Do it before you nap or go to sleep that is important. Remember to go play when not at work. 

Leveraging a Packraft To Access Hard-to-Get-To Places

Inflating an Alpaca Mule to float 95 river miles down the Red River in Garland City, AR

By Brandon Sanders, MTI Contributor

As I kissed my wife goodbye and pulled my Alpacka Mule into the river, my buddy looked over at me with an eyebrow raised. “How far have you gone in that thing?” he asked, insinuating that my tried and true packraft wasn’t up for floating the lazy 95 miles down to Shreveport. He was a dyed-in-the-wool kayak fisherman who seriously doubted anything you had to inflate. To him, I was an idiot for trusting anything other than roto-molded plastic from a big box retail store. 

He was in for an education.

What is a packraft?

Before we get going, you need to understand what a packraft is. A packraft is an inflatable raft made of highly durable material. Don’t confuse this raft with something you would buy at your local retail store and inflate with a tire pump. This isn’t a pool inflatable. 

The packraft was initially invented by a British naval officer, Peter Halkett. He needed a small craft that he could use to explore the Canadian Arctic. Though it worked for him, it was a dismal failure commercially. 

However, one hundred years later, they would be included in survival kits for pilots in World War Two.  Though they rarely saw any use, this produced a relatively large surplus of them after the war ended. People didn’t take long to start using them in the wild.

Somewhere on the Red River in southern Arkansas on an Alpaca Mule.

Dick Griffith, a godfather of the pack raft community, famously used one in 1982 to cross rivers in the Alaskan Wilderness Classic. An adventure race that traverses some of the most challenging terrains of the 49th state. Seeing his success inspired many to explore what could be done with these small boats. 

Today, packrafts are routinely used in the Alaskan wilderness to solve access issues. You can inflate or deflate them with ease. They pack up small enough to be tucked into a compression sack or strapped over the handlebars of a bike. Packrafts are often the key to unlocking otherwise inaccessible parts of the wild. 

An “inflation bag” is used to blow them up. An inflation bag consists of a nozzle that screws into your inflation valve attached to a cloth windproof bag that is open on one end. On the open end of the bag are two metal rods that provide some structure for you to grab onto. You pull the bag open, twist the handles, so they close the bag, then squeeze the trapped air into the packraft. 

It may seem odd, but it is highly effective at inflating a raft comparable in size to a kayak in a few moments. A quick search online will yield videos of people inflating packrafts in under three minutes. Once the packraft is inflated, you can further “temper” it with a small valve attached to the side of the boat.  

First saltwater fishing trip in an Alpacka Classic in 2013
How I Found It

Years ago, I bought a dirt bike to help me get into public land hunting and fishing locations. As I accessed them, I noticed lakes, rivers, and creeks inviting fishing spots too deep to wade. I immediately began to scheme ways to get a kayak, canoe, or pirogue into the mountains to exploit these spots.  

The issue was trying to get them up the side of a mountain. My only option was to use a dirt bike or to hike them in. Neither was conducive to success. However, the pristine mountain lakes and large pools of rivers were calling my name. 

One evening, I was watching an Alaskan moose hunt on YouTube. As I sat wondering how they would get the horrendous amount of freshly killed meat back to their boat, they pulled out a little raft. The show star inflated the vessel in under five minutes using an inflation bag. He loaded up his meat and floated down the tributary he was hunting. I knew I had found the answer to my problem.

I had to have one. 

How I’ve Used Packrafts

That was in 2011. These days, I use mine all the time. I generally keep one in the back of my truck so it is ready to go at a moment’s notice. The smaller one of the two can be compressed to the size of a football, so it is never in the way. It is perfect for getting to places that seem inaccessible. Here are a few examples of how I have used mine over the past decade.

Fishing Marshes: The Alabama Gulf 

One of the unsung advantages of the packraft is the ability to take it anywhere. When I had to go to the Gulf but couldn’t take a boat, I took my packraft. That allowed me to drive a rental car to the marsh, inflate it, and go fishing. Had I not had the packraft, I would have been forced to rent a boat, kayak, or get a charter. Then I would have paid more and been on someone else schedule and forced into a location. With the packraft, I was in charge.