Bmj Military Health最新文献

{"title":"Selective non-operative management for abdominal trauma in the deployed military setting: a review of evidence and considerations for large-scale combat operations (LSCO).","authors":"Gerard McKnight, Philip Spreadborough, Anna Sharrock, Tim Stansfield, David O'Reilly, Nigel Tai, Adam Stannard, Douglas M Bowley, David N Naumann","doi":"10.1136/military-2026-003281","DOIUrl":"https://doi.org/10.1136/military-2026-003281","url":null,"abstract":"<p><p>In recent decades, there has been a recognition that selective non-operative management (SNOM) is both safe and feasible for selected patients following blunt and penetrating abdominal trauma. SNOM has been shown to reduce the rate of non-therapeutic laparotomy in the civilian context, even in the management of some patients with gunshot wounds (GSW). SNOM in the military context is both more controversial and challenging, given the different patterns of injury, resource constraints and extended evacuation chain. A review of the available literature was undertaken to help inform the development of best practices in military decision-making for deployed personnel. In anticipation of minimal military data regarding SNOM, attention was paid to translational evidence from the combined civilian-military literature. Within these limitations, SNOM may be appropriate in a highly selected subgroup of military patients in favourable circumstances. Suitable patients must be haemodynamically stable, without evidence of peritonitis, evisceration, bleeding or injury to hollow viscera and without associated significant head, spinal cord or other major extra-abdominal injuries. SNOM in the deployed setting may help to avoid the morbidity associated with non-therapeutic laparotomy and conserve limited resources. However, caution is advised when translating civilian data to the military setting, and future investigations should focus on military-specific injury patterns and resource limitations. Furthermore, the application of SNOM guidelines to the context of large-scale combat operations is more complex, and close monitoring of patient outcome data must be undertaken to evaluate the impact of SNOM in this context.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406443","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":"A systematic review on the role of high-dose vitamin C in trauma patients.","authors":"Nandesh Chandrakant Patel, Charles Coombs, Tim Bage, Arul Ramasamy","doi":"10.1136/military-2026-003285","DOIUrl":"https://doi.org/10.1136/military-2026-003285","url":null,"abstract":"<p><strong>Background: </strong>Major trauma and polytrauma are leading causes of mortality, driven by haemorrhagic shock and a dysregulated inflammatory response. Vitamin C, which has a role in vasopressor synthesis, endothelial function and antioxidant defence, is rapidly depleted in critical illness. Vitamin C has been highlighted as a promising therapeutic opportunity in trauma patients. This systematic review evaluates the evidence of vitamin C use in adult trauma patients.</p><p><strong>Methods: </strong>The systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) and is reported according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Embase, Medline, CINAHL, SCOPUS, ClinicalTrials.gov, and Cochrane Central were searched up to December 2025. Studies evaluating intravenous vitamin C in adult trauma patients were included, with studies screened and quality assessed in duplicate by two blinded authors. Meta-analysis was not possible due to heterogeneous outcome reporting.</p><p><strong>Results: </strong>Six studies, including three randomised controlled trials (RCTs) and three cohort studies, met the inclusion criteria. The included studies suggest patients receiving high-dose vitamin C may have a significantly lower mortality with significantly reduced intensive care unit and hospital stays. There were also lower rates of sepsis and organ failure in the vitamin C cohorts. These findings derive from a small number of methodologically heterogeneous studies, resulting in a limited certainty of evidence.</p><p><strong>Conclusions: </strong>This review identifies the potential benefit of intravenous high-dose vitamin C in trauma patients, supported by a strong biological rationale. The studies included are heterogeneous, which limits their strength and results in low certainty of our presented evidence. High-quality, adequately powered RCTs with standardised protocols, including dosing regimen and timing, are needed before routine clinical use can be recommended.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363052","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":"Analysis of brain injuries in 268 ejection seat aircraft ejections: the prevalence of loss of consciousness and helmet design implications.","authors":"Alasdair Iain Mackay, Xiancheng Yu, Matthew Elfed Lewis","doi":"10.1136/military-2025-003229","DOIUrl":"https://doi.org/10.1136/military-2025-003229","url":null,"abstract":"<p><strong>Introduction: </strong>Ejections from combat aircraft pose a significant risk of head injury, and the primary protective measure against such injuries is the aircrew helmet. Internationally, aircrew helmets are typically certified against motorcycle or motorcycle-derived helmet standards, which may not reflect the injury mechanisms experienced during aircraft ejections.</p><p><strong>Methods: </strong>The objective of this study was to identify the historical risk of head injury associated with combat aircraft ejections. All UK combat aircraft ejections from 1972 to 2025 were analysed to determine common brain pathologies, head injury mechanisms and helmet damage characteristics.</p><p><strong>Results: </strong>In total, 268 aircraft ejections were recorded, with 12% resulting in a head injury. Two primary head injury mechanisms were identified: headbox impact (58%) and parachute landing (27%). The findings indicate that aircrew helmets provide protection against skull fracture as no cases were recorded following in-envelope ejections. This outcome is likely attributable to existing aircrew helmet standards, which assess helmet performance based on peak translational acceleration, a parameter closely linked to skull fracture. A key finding is that loss of consciousness associated with head rotation was the most prevalent pathology, comprising 76% of all head injuries.</p><p><strong>Conclusions: </strong>These results inform potential improvements in aircrew helmet standards. Even a brief incapacitation, such as a loss of consciousness, can impair aircrew escape and evasion capabilities, thereby affecting survivability. Consequently, this study recommends that future aircrew helmet standards expand their test methods to include assessments of rotational injury, with the aim of mitigating the risk of loss of consciousness.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354458","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":"Prehospital tourniquet use and associated outcomes in a low-resource conflict setting: prospective observational casualty data and tourniquet classification system from the Sahel.","authors":"Yves Aziz R Nacanabo, Abdelaziz Faouzi Traoré, S Yves G Sanou, Séraphin Dakissé Nikiema, Jonathan Y Bassinga, Sido Mamadou Konate, Youssouf Bagayogo, John B Holcomb, Hannah B Wild","doi":"10.1136/military-2026-003332","DOIUrl":"10.1136/military-2026-003332","url":null,"abstract":"<p><strong>Introduction: </strong>Tourniquet (TQ) application is a key component of extremity haemorrhage control in high-resource military and civilian trauma systems. In settings with prolonged evacuation times, TQs can cause complications including limb loss, rhabdomyolysis, or death, yet limited data exist on the scope and impact of this problem.</p><p><strong>Methods: </strong>We conducted a single-centre prospective observational analysis at the largest military hospital in Burkina Faso to describe injury epidemiology, TQ application practices and early outcomes among casualties with conflict-related injuries who underwent prehospital TQ application from January to July 2025.</p><p><strong>Results: </strong>100 casualties (N) were included in the analysis. Mean prehospital time was 11.9 hours. The most common mechanism of injury was gunshot wound (64.0%, n=64) followed by explosion (36.0%, n=36). 114 TQs were placed. 5.3% (n=6) of TQs were both medically necessary and appropriately placed. Of 24 amputations, 54.2% (n=13) were performed at an anatomical level more proximal than otherwise indicated due to TQ application and 50.0% (n=12) were associated with TQs that were not medically necessary. Mortality was 5.0% (n=5), three of which were attributable to TQ-associated complications (eg, rhabdomyolysis, cardiac arrest).</p><p><strong>Conclusions: </strong>TQs can reduce preventable death from extremity haemorrhage but can also have harmful consequences in settings with prolonged evacuation times. In our sample from the Sahel, a low proportion of prehospital TQs were medically necessary and appropriately placed, with substantial TQ-associated morbidity and mortality. Context-appropriate clinical algorithms and training programmes are needed to reduce these complications while upholding the role of appropriate TQ use for haemorrhage control in conflict.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice-based small group learning: sustaining and advancing defence general practice.","authors":"Antony Sean Willman, Toby James Holland, Kate King","doi":"10.1136/military-2026-003392","DOIUrl":"https://doi.org/10.1136/military-2026-003392","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333787","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":"Addressing a training gap: high-fidelity simulation to facilitate prehospital emergency medicine education in UK military foundation doctors.","authors":"Charlie Nash, Emily Browne","doi":"10.1136/military-2026-003364","DOIUrl":"https://doi.org/10.1136/military-2026-003364","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284588","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":"Exploring the relationship between moral injury and ICD-11 PTSD/complex PTSD: a comparative study of Danish and UK veteran populations.","authors":"Phoebe Howlett, Anni Brit Sternhagen Nielsen, Mia Sadowa Vedtofte, Sofie Folke, Dominic Murphy","doi":"10.1136/military-2025-003220","DOIUrl":"https://doi.org/10.1136/military-2025-003220","url":null,"abstract":"<p><strong>Introduction: </strong>Moral injury is an important construct in veteran mental health and is associated with adverse psychological outcomes yet cross-national data are limited. Moral injury in Danish veterans remains underexplored. This study aims to provide the first descriptive data on moral injury among Danish veterans and provides a descriptive comparison of moral injury, demographic and health-related outcomes with those of UK veterans. Second, it explores the associations between Moral Injury Outcome Scale (MIOS) scores and ICD-11 post-traumatic stress disorder (PTSD)/complex PTSD in both samples.</p><p><strong>Methods: </strong>Data were extracted from 742 treatment-seeking veterans who self-referred for psychological treatment (the UK: n=428, August 2020-October 2020; Denmark: n=314, July 2024-June 2025). Comparisons were made across demographic (eg, age, gender, relationship status), military (branch, rank) and health measures (adverse childhood experiences, PTSD and complex PTSD, alcohol misuse, sleep difficulties, drug use and moral injury).</p><p><strong>Results: </strong>UK and Danish veterans reported similar exposure to potentially morally injurious events (57.0% vs 52.5%) and MIOS scores (33.5 vs 26.9), with modest cohort differences. Compared with Danish veterans, UK veterans reported higher levels of any PTSD (68.7% vs 46.5%), and complex PTSD was more common in both cohorts (the UK: 62.5% complex PTSD vs 6.2% PTSD; Denmark: 29.0% complex PTSD vs 17.5% PTSD). Non-alcohol drug use was similar (the UK: 10.3%; Denmark: 11.1%), but UK veterans showed higher weekly alcohol consumption (32.0 g vs 24.0 g) and more sleep difficulties (70.1% vs 55.3%). Across cohorts, higher PTSD/disturbances in self-organisation (DSO) symptom scores were associated with greater moral injury across regression models.</p><p><strong>Conclusions: </strong>Although modest cross-national differences were observed, the consistent associations between PTSD/DSO symptoms and moral injury underscore important similarities in clinical presentation. These findings highlight the value of international collaboration in veteran mental health research.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260359","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":"Carrying medication in extreme cold weather: a real-world exposure study.","authors":"James Eatock, Joshua Mackey, Antonia Hazlerigg","doi":"10.1136/military-2026-003348","DOIUrl":"https://doi.org/10.1136/military-2026-003348","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260364","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":"Understanding the problem of transfusion transmitted malaria in the deployed military environment.","authors":"Seth Makin, George Dennis Shanks, John Francis McNamara","doi":"10.1136/military-2026-003303","DOIUrl":"https://doi.org/10.1136/military-2026-003303","url":null,"abstract":"<p><p>Haemorrhage is a leading cause of preventable trauma death in the deployed military environment. Access to whole blood transfusion in military environments with constrained logistics has driven renewed operational interest in emergency blood donor panels. When activated in malaria-endemic environments, emergency donor systems pose unique risks for transfusion-transmitted malaria. In military contexts, where transfusion capability is a force-enabler, risk management must reflect operational realities. Conventional civilian donor deferral criteria may be impractical or overly restrictive, requiring context-specific approaches to infectious risk management. This review aims to examine the risk of transfusion-transmitted malaria from emergency donor panels in military environments, explore the operational role of walking blood banks and evaluate risk mitigation strategies that ensure transfusion safety while preserving operational capability.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260302","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":"EpiDARC-an epidemiological study of British Defence Primary Healthcare (DPHC) demand by the Defence Audit and Research Collaborative (DARC).","authors":"Adrian Mark Hucks, Jacob Henry Matthews, Isobel Folkes, Kirsten A L Morris, Ruth Guest, Peter Bird, Jodie Blackadder-Weinstein, Antony Willman, Kate King","doi":"10.1136/military-2026-003272","DOIUrl":"https://doi.org/10.1136/military-2026-003272","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the workload in military primary care is essential to inform policy making, resource allocation and training for the general practitioners of tomorrow. Due to well-recognised limitations with coding in primary care and additional barriers within UK Armed Forces (UKAF) Defence Primary Healthcare (DPHC), the understanding of reasons for visit (RFV) is difficult to ascertain from a top-down perspective.</p><p><strong>Methods: </strong>A multicentre, cross-sectional study to describe the frequency of patient RFV over a 2 week period in general practices across the DPHC network was undertaken. RFV was documented using the International Classification of Diseases 11 (ICD-11) tier one codes, with specific conditions highlighted based on published literature and Defence needs.</p><p><strong>Results: </strong>18 medical centres, representing all DPHC regions and 26% of the Defence population, were included. A total of 6693 RFV were recorded, which differed from the published literature for primary care in developed countries, cementing the function of DPHC as an occupationally focused service with musculoskeletal injuries and mental health presentations being most common.</p><p><strong>Conclusions: </strong>DPHC can better understand the RFV across its service and intelligently target service delivery, pathway development and managed clinical networks based on this study, which differs from some previous evidence.This study also is a proof of concept for a network of researchers, collaborating with a Defence-wide perspective, allowing grassroots data collection outside of overburdened centralised systems and developing interest and engagement in research, audit and collaboration among our clinicians.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260367","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}