Bmj Military Health最新文献

{"title":"Regional anaesthesia in combat settings: a position paper from military physicians.","authors":"Philippe Laitselart, S Hellander, F Josse, G Nordmann, N Ribaud, N Carbonnel, P Pasquier","doi":"10.1136/military-2025-002988","DOIUrl":"https://doi.org/10.1136/military-2025-002988","url":null,"abstract":"<p><p>Regional anaesthesia (RA) is a powerful tool in combat casualty care. As contemporary warfare evolves towards major engagements and delayed evacuations, the need for effective, durable and logistically feasible pain management has become critical. RA offers significant clinical and tactical advantages by providing sustained analgesia without impairing consciousness. Despite this, its use remains largely restricted to anaesthetists due to training gaps and institutional inertia. This position paper supports the integration of RA into the standard combat medical toolkit and the training of non-specialist military physicians in its use. Drawing on data from recent military studies and field experience, we explore the benefits of RA in austere settings, the current barriers to its widespread adoption, and the required steps to institutionalise its practice-including doctrinal changes, structured training and strategic support tools such as telemedicine and artificial intelligence. Implementing this position could contribute to improving pain control on the battlefield and preserving operational capacity.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing combat casualty care in military medicine: the potential of early warning systems and wearable biosensors in large-scale warfare.","authors":"Quentin Mathais, H De Malleray, C Nguyen, L-L Weghel, S Boussen, J Bordes","doi":"10.1136/military-2025-002977","DOIUrl":"https://doi.org/10.1136/military-2025-002977","url":null,"abstract":"<p><p>The management of war casualties has evolved significantly. Tactical tourniquets, early surgical haemostasis and massive transfusion protocols have all contributed to a significant decrease in war casualties' mortality. Large scale combat scenarios pose new and major challenges, as the volume of casualties is predicted to exceed available resources. Combat Medical Early Warning Systems (CMEWS) and wearable biosensors could present promising solutions in this context. An Early Warning System consists of three key components: data collection of vital signs, analysis through an Early Warning Score and a corresponding medical response. Biosensors, on the other hand, enable continuous monitoring of physiological parameters. Their miniaturisation, connectivity and reliability make them promising tools, though challenges such as accuracy, cost and data integration remain. Integrated CMEWS, combining biosensors with automated decision-making algorithms, could revolutionise the management of war casualties. These systems would assist in the early identification of severe war casualties and triage, assisting health services in casualty flow management. They have the potential for providing a shared, real-time overview of casualties' status for all healthcare providers. Additionally, the integration of these systems into the battlefield would facilitate improved coordination across medical and command structures, enhancing patient management even in remote or high-risk environments. However, the adoption of integrated CMEWS and biosensors faces challenges, including data security concerns, infrastructure limitations and the need for significant investment and training. Despite these hurdles, their potential to enhance casualty care, particularly in high-intensity conflict settings, is evident and could transform both military and civilian emergency medical care.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle, liver and kidney biomarkers in military training: a 37-week comparative study of dropouts and finalists.","authors":"Thalita Ponce, A Carneiro, C V Lucena, F R Aquino Neto, J B Pesquero, D Viana-Gomes","doi":"10.1136/military-2025-003016","DOIUrl":"https://doi.org/10.1136/military-2025-003016","url":null,"abstract":"<p><strong>Introduction: </strong>Military operational training soldiers are subjected to extreme physical and environmental stress, increasing the risk of exertional rhabdomyolysis (ER) and acute kidney injury (AKI). This study analysed muscle, liver and kidney biomarkers in Brazilian Navy marines undergoing 259 days of high-intensity training across diverse biomes, comparing biomarker behaviour between those who completed the course (finalists) and those who withdrew (dropouts).</p><p><strong>Methods: </strong>This observational study followed 35 male marines (five finalists, 30 dropouts) during six operational missions, each lasting 7-12 days, involving intense physical exertion, controlled feeding, sleep deprivation and free hydration. Blood samples were collected at baseline and post-mission to measure creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), albumin, creatinine, urea, estimated glomerular filtration rate (eGFR) and electrolytes. Statistical analyses included analysis of variance, Friedman tests and area-under-the-curve comparisons.</p><p><strong>Results: </strong>CK, LDH and AST levels remained elevated throughout training, with peak CK values in the 'tropical mission' (3,156 (2,397; 4,804) U/L) and the 'high-altitude mission' post-100km march (9,720 (7,956; 8,3969) U/L), indicating subclinical ER. ALT increased significantly in the 'high-altitude mission' (1,431 (902; 7,099) U/L), while GGT and albumin remained stable. Creatinine showed significant variation, decreasing after the survival phase of the 'high-altitude mission' (0.7 (0.7; 0.8) mg/dL), with eGFR reductions in the 'semi-arid mission' (92 (82; 118) mL/min/1.73 m²). No significant differences in CK, creatinine or eGFR were found between finalists and dropouts, suggesting non-physiological factors influenced dropout rates.</p><p><strong>Conclusion: </strong>The 'tropical mission' and 'high-altitude mission' posed the highest risk for ER and AKI due to extreme CK elevations and creatinine fluctuations. Enhanced hydration protocols and CK reference value adjustments may be necessary to mitigate health risks in military training.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UKAF performance tool: a structured tool for management of common mental health disorders in defence primary healthcare.","authors":"Adrian M Hucks","doi":"10.1136/military-2025-002996","DOIUrl":"https://doi.org/10.1136/military-2025-002996","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dispatches from the new Editor-in-Chief: a new dawn.","authors":"Jason E Smith","doi":"10.1136/military-2025-003025","DOIUrl":"https://doi.org/10.1136/military-2025-003025","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending water fluoridation will threaten warfighter health.","authors":"Adejare Jay Atanda","doi":"10.1136/military-2025-002961","DOIUrl":"https://doi.org/10.1136/military-2025-002961","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment and evaluation of a smoking cessation programme on the prevalence and intensity of smoking during a 6-month military deployment.","authors":"Kirsten A L Morris, A Munns, M R Riley, H Taylor","doi":"10.1136/military-2025-002957","DOIUrl":"https://doi.org/10.1136/military-2025-002957","url":null,"abstract":"<p><strong>Introduction: </strong>Military personnel smoke more frequently and intensely than civilians, with deployments often destabilising smoking behaviours and influencing long-term tobacco use. This study evaluated smoking prevalence and intensity at the start and end of a deployment among personnel with access to a smoking cessation service, identifying factors affecting cessation using the capability, opportunity, motivation, behaviour (COM-B) model.</p><p><strong>Methods: </strong>During a 6-month deployment (January-June 2019), a smoking cessation programme was established and evaluated through a prospective longitudinal service evaluation. Two British Army medical officers, certified by the National Centre for Smoking Cessation and Training, delivered the programme to approximately 120 UK Armed Forces personnel. At both the start and end of the deployment, participants voluntarily and anonymously completed a questionnaire recording age, rank, sex, smoking status and smoking intensity.</p><p><strong>Results: </strong>Surveys were completed by 112 (95%) personnel at the start and 87 (77.7%) at the end. Initially, 44 personnel (39.3%) identified as smokers, compared with 38 (43.7%) at the end. The relative risk of smoking at the end versus the 2019 British Army trained strength was 1.9 (95% CI 1.5 to 2.41; p<0.0001). Smoking prevalence was higher among men and other ranks, with 44.6% of junior and 63.6% of senior other ranks smoking by the tour's end. Median daily cigarette consumption increased, though not significantly. Provider-level factors in the COM-B model were the primary facilitators, while system-level factors were the main barriers to smoking cessation.</p><p><strong>Conclusions: </strong>This is a novel prospective evaluation of a smoking cessation programme in the context of a deployed military setting. It contributes to the existing literature by detailing the unique barriers and facilitators that can influence smoking behaviours in such settings, as well as identifying leverage points for intervention. The findings highlight the importance of tailored smoking cessation interventions that account for the unique challenges and opportunities present during military deployments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulated activation of emergency donor panels.","authors":"Simon William James Grant, Ed Scanlon","doi":"10.1136/military-2025-003001","DOIUrl":"https://doi.org/10.1136/military-2025-003001","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitisation patterns and burden of uncontrolled respiratory allergy symptoms in military personnel.","authors":"Senne Gorris, I Baron, J De Brouwer, A Vanden Daele, J Verstraelen, D Loeckx, J Bousquet, L Van Gerven, S F Seys","doi":"10.1136/military-2025-003006","DOIUrl":"https://doi.org/10.1136/military-2025-003006","url":null,"abstract":"<p><strong>Introduction: </strong>Military personnel is often deployed in environmentally distinct areas across the globe and thereby exposed to a multitude of new plants, weeds or trees. Sensitisation to inhalant allergens occurs upon exposure in predisposed individuals. This causes frequent problems that may affect the readiness of the personnel.</p><p><strong>Methods: </strong>Study participants were recruited among the military personnel of the Belgian Army and invited to receive an allergy test by the skin prick automated test (SPAT) device for a panel of 22 inhalant allergens. A questionnaire was completed to retrieve information on demographics, lifestyle, history of allergy, rhinitis and asthma symptoms, as well as treatment and history of deployment.</p><p><strong>Results: </strong>In total, 160 subjects were included with varying histories of deployment to the Middle East (n=68), Western Africa (n=53), Eastern Europe (n=50), Central Africa (n=47), the USA (n=20) or no international deployment (n=31). A majority of military personnel (79.9%) did not take allergy medication. Applying Allergic Rhinitis and its Impact on Asthma criteria, 26% and 27.9% of untreated soldiers were identified with, respectively, uncontrolled and partly controlled rhinoconjunctivitis. Sensitisation to house dust mite (<i>Dermatophagoides farinae</i>: 29.5%, <i>Dermatophagoides pteronyssinus</i>: 27.5%), timothy grass (28.8%), birch (20.9%), hazel (17.9%) and cat (16.3%) was commonly detected. Also, sensitisation to allergens that are less common in Belgium were detected: <i>Cynodon dactylon</i> (13.1%), <i>Chenopodium alba</i> (6.9%), <i>Phoenix dactylifera</i> (6.2%), <i>Blattella germanica</i> (3.9%), <i>Blomia tropicalis</i> (3.1%) and <i>Salsola kali</i> (1.5%).</p><p><strong>Conclusions: </strong>Over one-quarter of military personnel not treated with allergy medication were identified with uncontrolled rhinoconjunctivitis. Timely allergy diagnosis and treatment are crucial for optimal performance of military personnel during international deployment and avoid an 'unfit-for-duty'. Allergy testing of an extended allergen panel by SPAT can be efficiently implemented in medical screening programmes for military candidates.</p><p><strong>Trial registration number: </strong>NCT05807958.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the all-hazards approach to include extreme cold weather: optimising emergency medical care.","authors":"Jonathon Lowe, M Warner, K Heil, S Todd","doi":"10.1136/military-2025-003051","DOIUrl":"https://doi.org/10.1136/military-2025-003051","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}