Bmj Military Health最新文献

{"title":"'Golden day' is a myth: rethinking medical timelines and risk in large scale combat operations.","authors":"Joshua Dilday, S Webster, J Holcomb, E Barnard, T Hodgetts","doi":"10.1136/military-2024-002835","DOIUrl":"https://doi.org/10.1136/military-2024-002835","url":null,"abstract":"<p><p>The evolving landscape of battlefield medicine forces medical planners to prepare for large-scale combat operations (LSCO) against peer adversaries, requiring reassessment of recent medical strategies. Despite lacking medical backing, the term 'golden day' has been used by senior military leaders to link the resuscitative benefits of the 'golden hour' to prolonged medical care through similar nomenclature. Pseudomedical terminology can easily enter the lexicon of commanders as attractive soundbites. However, articulating the evidence-based factors influencing mortality on the battlefield is critical to effectively articulate risk to commanders. The challenges of LSCO will be significant with increased casualty numbers and treatment constraints. Realistic medical and operational planning is critical to maximising survival, with a clear understanding of what can and cannot be achieved. Recent improvements in trauma care, such as early haemorrhage control, advanced prehospital care and rapid evacuation to surgical care, have significantly reduced mortality rates. Given the predictability of when casualties die from significant injuries, the absence of timely clinical interventions will increase avoidable battlefield deaths. If evacuation to surgical care is extended to 24 hours, many more casualties will die from potentially survivable injuries. Medical planners must recognise the potential challenges associated with LSCO including contested, delayed evacuation which predicts a tripling of mortality rates from 10% to 30%. Leaders must appreciate the unchanging human physiologic response to injury and historical combat casualty statistics when preparing commanders and politicians for the excess in mortality during LSCO. Without candour, plans will be unrealistic, causing non-medical leaders and the public to be unprepared.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693673","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":"Development of a novel 'In-Water Mass Casualty Triage Tool'.","authors":"Colin A Barton, P Morgan, M J Tipton","doi":"10.1136/military-2024-002855","DOIUrl":"https://doi.org/10.1136/military-2024-002855","url":null,"abstract":"<p><p>The number of in-water mass casualty incidents has increased in recent years and provides significant challenges to rescuers. Existing triage systems require the rescue of immersed (in water) casualties before triage is undertaken. A tool that enables triage to be undertaken <i>before</i> rescue, and therefore the prioritisation of that rescue, should improve the efficiency, efficacy and survival rate associated with the management of such incidents.In this paper, we describe the rationale and development of a proposed novel 'in-water mass casualty triage tool (IWMCTT)' to assist in the swift and effective triage of those in the water in mass casualty situations <i>before</i> they are rescued, based upon the likelihood of survival <i>after</i> immersion. The tool is based on a review of the literature related to the hazards associated with immersion, most notably drowning.The IWMCTT employs a sequential approach to streamline the identification and prioritisation for rescue of immersed individuals; it considers factors such as hazards, visibility constraints, purposeful swimming, moving or floating, airway position, availability of flotation assistance and flotation device effectiveness. It categorises casualties from W1 (high) to W4 (low) priority for rescue.The proposed IWMCTT offers a potential solution to some of the challenges faced during water-based mass casualty incidents; providing rescue assets (rigid-hulled, inflatable boats, ships and helicopters) with a rapid and effective approach to assess and prioritise individuals for rescue and medical attention, hopefully thereby reducing mortality and morbidity. The IWMCTT requires further evaluation and validation.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683035","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":"Incidence of mental disorders and its predictors among air force personnel exposed to counter-insurgency operations in a West African country: a 6-month follow-up study.","authors":"Motunbi Nelson Akinlose, A C Ndukuba, J U Onu","doi":"10.1136/military-2024-002870","DOIUrl":"https://doi.org/10.1136/military-2024-002870","url":null,"abstract":"<p><strong>Background: </strong>Despite robust reports in the literature concerning the effect of exposure to combat on mental health, there is a paucity of studies in the Nigerian Air Force (NAF) using a longitudinal design. This study was designed to determine the incidence of mental disorders among a cohort of NAF personnel exposed to combat and highlight its association with psychosocio-religious variables.</p><p><strong>Methods: </strong>It was a follow-up study using a total population sampling in which all the 290 deployed personnel participated. Data was collected at two intervals: Baseline and 6 months after with sociodemographic questionnaire, Brief Coping Orientation to Problems Experienced Inventory, the Brief Religious Coping, the Oslo Social Support Scale and the Big Five Inventory, General Health Questionnaire (GHQ-12) and the Mini-International Neuropsychiatric Interview (MINI-Plus). A two-staged process involving screening with the GHQ and a further diagnostic interview using MINI-Plus for participants with a GHQ score of 2 and above.</p><p><strong>Results: </strong>The incidence of any mental disorder was 243.1 per 1000 person-years. The top three priority conditions were: Substance use disorder (94.1 per 1000 person-years), major depressive disorder (43.8 per 1000 person-years) and post-traumatic stress disorder (PTSD) (41.6 per 1000 person-years). Being deployed in early adulthood was a risk factor for developing a mental illness (adjusted OR (AOR), (95% CI): 2.89, (1.28, 6.50), p=0.01) while longer duration in the military service was a protective factor (AOR, (95% CI): 0.95, (0.91, 0.99), p=0.03). Social support, personality traits, religious coping and other coping strategies did not significantly predict mental disorders in this population (p>0.05).</p><p><strong>Conclusion: </strong>The incidence of any mental disorder among NAF personnel exposed to combat was huge. The three top priority conditions were substance use disorder, major depressive disorder and PTSD. These findings are useful in identifying priority conditions for interventions in the NAF population.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683039","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":"Effects of undertaking defence engagement (health): a survey of serving personnel's experiences.","authors":"Harrison Charles Roocroft, S T Horne, Ian Gurney","doi":"10.1136/military-2024-002878","DOIUrl":"https://doi.org/10.1136/military-2024-002878","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683036","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":"Aeromedical evacuation management of 1145 patients during the COVID-19 epidemic: a retrospective descriptive study.","authors":"Martín Gascón Hove, A Simonetti, R Vermeltfoort, H Von Perbandt, M Borsch","doi":"10.1136/military-2024-002900","DOIUrl":"https://doi.org/10.1136/military-2024-002900","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683032","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":"MSKI reduction strategies: evidence-based interventions to reduce musculoskeletal injuries in military service members.","authors":"Hans Christian Tingelstad, E Robitaille, T J O'Leary, M-A Laroche, P Larsen, T Reilly","doi":"10.1136/military-2024-002747","DOIUrl":"10.1136/military-2024-002747","url":null,"abstract":"<p><p>Musculoskeletal injuries (MSKI) are one of the biggest challenges for military services globally, contributing to substantial financial burdens and lost training and working days. Effective evidence-based intervention strategies are essential to reduce MSKI incidence, and research has shown the positive effect of both nutritional interventions and physical training (PT) interventions on reducing MSKI incidence. Levels of vitamin D metabolites have been associated with MSKI and bone stress fracture risk, while calcium and vitamin D supplementation has been shown to reduce the incidence of stress fractures during military training. Protein and carbohydrate supplementation during arduous military training (high volume, high intensity) has also been shown to reduce MSKI risk and the number of limited/missed duty days. PT has played a key role in soldier development to meet the occupational demands of serving in the armed forces. Paradoxically, while PT is fundamental to enhancing soldier readiness, PT can also be a major contributor to MSKI; emerging evidence suggests that the nature of the PT being performed is a risk factor for MSKI. However, strategies like reducing training load and implementing PT programmes using evidence-based training principles can reduce MSKI incidence among military service members by 33-62%, and reduce the financial burdens for military services. This review provides a summary of effective MSKI reduction interventions and provides strategies to enhance the success and adoption of such interventions.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113559","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":"Incidence of cervical spine injury in victims of dismounted blast: a systematic review.","authors":"Will Sargent, R Henson, R Millar, A Ramasamy, I Gibb, A Bull","doi":"10.1136/military-2024-002843","DOIUrl":"https://doi.org/10.1136/military-2024-002843","url":null,"abstract":"<p><strong>Introduction: </strong>Dismounted blast has the potential to cause life-threatening injuries to multiple simultaneous casualties, including injury to the cervical spine (c-spine). Spinal immobilisation can be costly in terms of time and personnel required to apply and sustain it. C-spine 'clearing' tools frequently do not apply to the blast-injured casualty, so clinical judgement must be used to determine those requiring c-spine immobilisation. This will be strongly influenced by the likelihood of such an injury, but currently, the incidence of c-spine injury in dismounted blasts is not known.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE and the Cumulative Index to Nursing and Allied Health for original research reporting the number of patients suffering c-spine injury as a result of the dismounted blast, as well as indices of injury severity such as incidence of limb amputation. Rates were combined to give an overall incidence. The systematic review was preregistered with PROSPERO (CRD42024527592).</p><p><strong>Results: </strong>2775 unique studies were identified, 13 of which were analysed. Reported incidences of c-spine injuries ranged from 0% to 5.85% across all 13 studies, and unstable injuries ranged from 0% to 1.23% in the nine studies in which this could be calculated. After excluding one study due to an overlapping population, in 7889 patients the rate of c-spine injury was 0.89%. In the 4618 patients for which the incidence of unstable c-spine injury could be calculated, the rate was 0.30%. There was no correlation between the rate of amputation and the rate of c-spine injury (Spearman's ρ=0.226, p=0.667).</p><p><strong>Conclusion: </strong>Dismounted blasts result in a very low rate of c-spine injury. The populations sampled included a number of seriously injured casualties with potentially life-threatening wounds, such as limb amputation. We recommend deprioritising c-spine control in dismounted victims of the blast in favour of focusing the limited time and resources on addressing potentially life-threatening injuries.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629920","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":"Likelihood of fitness improvements during a standardised physical fitness programme in US Army trainees of different fitness levels.","authors":"Joseph R Pierce, B S Cohen, K G Hauret, M A Sharp, J E Redmond, S A Foulis, B H Jones","doi":"10.1136/military-2024-002763","DOIUrl":"https://doi.org/10.1136/military-2024-002763","url":null,"abstract":"<p><p>IntroductionUS Army Initial Entry Training (IET) aims to develop general fitness and conditioning among large groups of trainees. Despite group mean improvement in physical fitness during IET, some trainees experience substantial gains and others experience no improvement or even declines in fitness. The purpose of this study was to examine the associations between trainee baseline fitness (Army Physical Fitness Test (APFT), the primary fitness assessment at the time of data collection) or estimated baseline body fat (%BF) and the change in fitness by the end of IET.</p><p><strong>Methods: </strong>Trainee (n=774 men, 195 women) APFT performance data were obtained, and baseline anthropometrics were used to estimate %BF. APFT performance change (final-baseline) was analysed directly (t-tests) or by quartiles of baseline APFT performance or %BF (analysis of variance). Cochran-Armitage χ² for linear trend test and risk ratios allowed for comparison against the lowest initial performance referent quartile (Q1), providing the likelihood of fitness improvements. Significance was set at p≤0.05.</p><p><strong>Results: </strong>Performance improved (p<0.01) on all final APFT events for men and women, respectively (push-ups: +38.4% and +91.8% repetitions; sit-ups: +26.8% and +33.5% repetitions; 2-mile run: -9.6% and -10.4% time). Significant trends in both sexes indicated that moving from low-to-high initial APFT fitness quartiles, trainees were increasingly less likely to improve their fitness. Specifically, men and women in the highest initial fitness quartiles (Q4) were 22%-32% and 25%-34% less likely (p<0.01) to improve, respectively, versus the within-sex lowest initial fitness quartiles (Q1). Only the male trainee's 2-mile run time change was related to the initial %BF.</p><p><strong>Conclusions: </strong>Although most trainees' fitness improved by the end of IET, the likelihood and magnitude of improvement were clearly associated with initial fitness levels. Attention to individualised conditioning and training intensity in the physical readiness training programme of instruction may optimise training strategies across all trainee conditioning levels.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630320","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":"Prevalence and risk factors for Achilles tendon rupture in the military population from 2006 to 2015: a retrospective cohort study.","authors":"John J Fraser, J A Zellers, C K Sullivan, C F Janney","doi":"10.1136/military-2024-002759","DOIUrl":"https://doi.org/10.1136/military-2024-002759","url":null,"abstract":"<p><strong>Introduction: </strong>Achilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the military. The purpose of this retrospective cohort study was to evaluate the prevalence and associated factors of ATR in US military service members.</p><p><strong>Methods: </strong>The Defence Medical Epidemiology Database was used to identify all diagnosed ATR in military personnel from 2006 to 2015. The prevalence of ATR was calculated and compared by year, service branch and military rank. Unadjusted and adjusted assessments of risk were calculated.</p><p><strong>Results: </strong>Officers incurred 15 978 episodes at a prevalence of 7.43/1000 (male: 8.11/1000; female: 3.89/1000). Among enlisted personnel, there were 59 242 episodes of ATR that occurred at a prevalence of 6.23 episodes per 1000 (male enlisted: 6.49/1000; female enlisted: 4.48/1000). Apart from enlisted aviation specialists (where there was no significant difference in risk between men and women), both female officers and enlisted service members had significantly lower risk of ATR compared with their male counterparts in all occupations (prevalence ratio (PR): 0.26-0.73). Aviation and service officers demonstrated significantly lower risk of ATR episodes (PR: 0.87-0.91) and administration, operations, intelligence and logistic officers demonstrated increased risk (PR: 1.16-1.31) compared with ground and naval gunfire officers. Among enlisted specialties, all but mechanised/armour and combat engineers had significantly higher risk of ATR risk compared with infantry (PR: 1.14-2.13), with the highest risk observed in the administration, intelligence and communication fields.</p><p><strong>Conclusions: </strong>ATR was ubiquitous in the US military, with multiple risk factors identified, including male sex, older age, rank, military occupation and service branch. These findings highlight the populations that can most greatly benefit from preventive screening and care.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630325","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":"JHC Basting: the founding father of legal protections for medical personnel in conflict.","authors":"Bart van Herwijnen, J Janse, T Falconer Hall","doi":"10.1136/military-2024-002701","DOIUrl":"https://doi.org/10.1136/military-2024-002701","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630306","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}