Bmj Military Health最新文献

{"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":"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":"2025-02-26","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":"No short-term changes in tendon structure following temporary replacement of running with low-impact exercises in service members with midportion Achilles tendinopathy: a prospective cohort study.","authors":"M A Paantjens, P H Helmhout, M T A W Martens, G W Lentjes, E W P Bakker","doi":"10.1136/military-2024-002918","DOIUrl":"https://doi.org/10.1136/military-2024-002918","url":null,"abstract":"<p><strong>Introduction: </strong>Midportion Achilles tendinopathy (mid-AT) is associated with tendon degeneration that may worsen due to mechanical loading. Contrastingly, load can also improve tendon structure. We aimed to evaluate short-term changes in midportion tendon structure and their associations with symptoms, following temporary replacement of running with low-impact exercises on a stair climber or cross-trainer, in service members with mid-AT.</p><p><strong>Methods: </strong>We recruited 40 service members (40 symptomatic tendons) for this study. Ultrasound tissue characterisation (UTC) was used to quantify aligned fibrillar structure (echo-type I+II) and disorganised structure (echo-type III+IV), in the tendon midportion (2-7 cm) and in the area of maximum degeneration (AoMD) within the midportion. Symptoms were evaluated with the modified Victorian Institute of Sports Assessment - Achilles (VISA-A) questionnaire. All measurements were performed at baseline and after 8 weeks. The Wilcoxon signed-rank test was used to evaluate differences in UTC and VISA-A. Spearman's rho was used to calculate the correlations between UTC and VISA-A change scores.</p><p><strong>Results: </strong>Tendon structure did neither change significantly in the midportion: echo-type I+II from median 64.7% (IQR 19.4) to 68.6% (IQR 25.1) (p=0.793); echo-type III+IV from median 35.3% (IQR 19.4) to 31.5% (IQR 25.1) (p=0.775) nor in the AoMD: echo-type I+II from median 56.3% (IQR 18.0) to 57.9% (IQR 32.0) (p=0.677); echo-type III+IV from median 43.8% (IQR 18.0) to 42.3% (IQR 32.1) (p=0.572).On the other hand, VISA-A improved significantly (p=0.000) from baseline (median 46.5, IQR 16.0) to follow-up (median 56.0, IQR 9.0). Correlations between UTC and VISA-A change scores were consistently graded as low (range: 0.309-0.338).</p><p><strong>Conclusions: </strong>Although the replacement of running with low-impact exercises improved symptoms, no changes in tendon structure were observed after 8 weeks. Changes in midportion structure and symptoms were poorly associated. These findings can support loading advice in patients with mid-AT when aiming to prevent progressive degeneration or tendon rupture.</p><p><strong>Trial registration number: </strong>NL69527.028.19, \"Centrale Commissie Mensgebonden Onderzoek\" (CCMO).</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517109","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":"UK defence rehabilitation review of Achilles and patellar tendinopathy conservative management: a systematic review.","authors":"Alice Judd, K Wild, L Puxley, R Barker-Davies","doi":"10.1136/military-2024-002892","DOIUrl":"https://doi.org/10.1136/military-2024-002892","url":null,"abstract":"<p><strong>Introduction: </strong>Tendinopathy is a common condition affecting physically active populations, such as the military. Diagnosis is clinical, with no gold-standard tests. The role of imaging and functional assessment in subdiagnosis is an active area of research with the hope of delivering more nuanced and clinically effective management. A vast array of injectable and adjunctive therapies have been proposed with varying, and at times, conflicting evidence. Multiple methods for exercise therapy exist, but increasingly tendinopathy is recognised as a heterogeneous condition not suited to a one-size-fits-all approach. The aim was to complete a systematic review, to appraise the recent evidence for conservative management of Achilles and patellar tendinopathy.</p><p><strong>Methods: </strong>A multidisciplinary team from across defence rehabilitation searched PubMed for literature dating from May 2017 to July 2023. Four key areas were searched: diagnosis and outcome measures, medical, exercise and adjuncts.</p><p><strong>Results: </strong>A total of 840 articles were identified. Articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following screening and abstract review, a total of 143 were included for full review. Due to the breadth of literature and large heterogeneity of studies, meta-analysis of results was not feasible. Articles were assessed against the Oxford Centre for Evidence Based Medicine criteria.</p><p><strong>Conclusions: </strong>The literature review found the strongest evidence for exercise-based rehabilitation as first-line treatment, with limited evidence for medical interventions and adjuncts. The primacy of stand-alone loading modalities is challenged by developing literature supporting a progressive tendon loading exercise protocol (PTLE). PTLE represents a framework where various exercise modalities are prescribed based on the individual's capacity and function. Novel interventions should be practised with caution and not conducted as monotherapy.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469442","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":"UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach.","authors":"Alice Judd, K Wild, L Puxley, R Barker-Davies","doi":"10.1136/military-2024-002893","DOIUrl":"10.1136/military-2024-002893","url":null,"abstract":"<p><p>Achilles and patellar tendinopathy are common in military personnel due to the repetitive high loads and challenging extrinsic risk factors associated with the demands of their role. Sports medicine is rapidly evolving. Up-to-date evidence-based research is essential, alongside clinical reasoning, to deliver best-practice treatment to service personnel, underpinned by the duty of care to their long-term career.The aim of this research was to develop recommendations on conservative management of Achilles and patellar tendinopathy in relation to the military population. A systematic review was conducted by a multidisciplinary clinical panel from across Defence Rehabilitation. The panel was split into four subgroups (diagnosis and outcome measures, medical, exercise and adjuncts). Each subgroup proposed recommendations for voting across the wider authorship in a modified Delphi process. 28 recommendations achieved substantial agreement following a chaired meeting attended by all authors. A summary infographic was produced to highlight themes relevant to the military patient population.Diagnosis of Achilles and patellar tendinopathy remains clinical. The consensus panel strongly advocates exercise rehabilitation as the primary management of Achilles and patellar tendinopathy. Medical interventions should respect the long-term occupational needs of the military population. Education is advised, but further adjunctive interventions should only be considered on a case-by-case basis. This consensus agreement provides a framework for the development of local guidelines for the management of Achilles and patellar tendinopathy in the UK military population.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014375","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":"Using the capture-recapture method to ascertain the incidence of musculoskeletal injuries among elite military personnel.","authors":"Mita Lovalekar, K A Keenan, D E Cruz, E J Steele, K Beals, B C Nindl","doi":"10.1136/military-2024-002903","DOIUrl":"https://doi.org/10.1136/military-2024-002903","url":null,"abstract":"<p><strong>Introduction: </strong>Injury epidemiology research traditionally uses a single musculoskeletal injury (MSI) data source, such as injury self-report (ISR) or medical record-review (MRR). MSI data obtained from ISR may be incomplete due to recall issues, and MRR data may be incomplete if medical attention was not sought, which is especially problematic in military populations. The objective of this analysis was to determine the ascertainment-corrected incidence of MSI among Special Forces (SF) military personnel using a novel statistical technique, capture-recapture (CRC).</p><p><strong>Methods: </strong>This descriptive cross-sectional study used two sources of MSI data (ISR and MRR) collected at SF military installations. The CRC analysis, using the Chapman modification of the Lincoln-Petersen estimator, was conducted to assess the completeness of MSI data and to estimate the 1-year ascertainment-corrected cumulative MSI incidence.</p><p><strong>Results: </strong>MSI data were available for 335 SF personnel (age: 28.9±6.2 years). At the time the study was conducted, only men could qualify as SF personnel. The percentage of participants identified as injured were 31.3% in the ISR, 26.6% in the MRR and 14.0% in both sources. The CRC estimate of the number of injured participants was 197.8 (95% CI 169.7, 225.8), with a CRC estimated 1 year cumulative incidence of 59.0% (95% CI 50.7%, 67.4%). Overall ascertainment was good (74.3%), but was relatively lower for spine MSI (49.0%) as compared with lower (73.7%) or upper (72.7%) extremity MSI. Ascertainment was highest for fractures (79.5%) versus strain (60.0%) or sprain (68.3%).</p><p><strong>Conclusions: </strong>This was the first study to apply the CRC technique to estimate MSIs among SF personnel, who are at a very high risk of sustaining MSIs. Completeness of the MSI data varied by the MSI anatomic location and type. Further research into the application of the CRC technique in military populations is warranted, to provide an accurate estimate of the MSI burden.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366363","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":"Qualitative assessment of combat-related injury patterns and injury prevention in Ukraine since the Russian invasion.","authors":"Lynn Lieberman Lawry, V Mani, T E Hamm, M Janvrin, L Juman, J Korona-Bailey, J Maddox, O Berezyuk, A J Schoenfeld, T P Koehlmoos","doi":"10.1136/military-2024-002863","DOIUrl":"https://doi.org/10.1136/military-2024-002863","url":null,"abstract":"<p><strong>Introduction: </strong>The ongoing invasion of Ukraine by the Russian Federation represents one of the largest ongoing conventional military engagements in the last 20 years. Since the start of the war, an estimated 210 000 Ukrainian soldiers have been injured or killed as a result of combat. This experience could help prognosticate the nature of large-scale combat operations for modern militaries. The aim of this study was to assess current patterns of injuries among military combatants in Ukraine and identify prevention and mitigation methods.</p><p><strong>Methods: </strong>We conducted a series of key informant interviews during the ongoing conflict using an expanded version of the global trauma system evaluation tool. We focused the analysis on injury patterns and prevention of combat-related injuries.</p><p><strong>Results: </strong>We interviewed 36 participants from June 2023 to February 2024. Respondents described complex polytrauma as representing the injury norm, with prominent battle injuries, including blast wounds to the extremities, traumatic brain injuries and spinal cord trauma. The primary source of injury prevention on the battlefield remains combat body armour. Military commanders and the Ministry of Defence were identified as principal bodies for the authorising equipment and tactical changes. Most respondents stated there was no formal process for using data to inform injury prevention initiatives.</p><p><strong>Conclusion: </strong>The current conflict in Ukraine is characterised by a high prevalence of devastating combat-related injury, with limited measures for battlefield injury prevention. We believe that the provision of additional protective gear could mitigate the severity of some combat-related injuries, while the creation of a trauma registry would provide greater insight into prevention, wounding patterns, treatment and outcomes.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190959","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":"Burden and risk factors for plantar fasciopathy in the military population from 2006 to 2015: a retrospective cohort study.","authors":"Jennifer Xu, S Saliba, J Fraser","doi":"10.1136/military-2024-002869","DOIUrl":"https://doi.org/10.1136/military-2024-002869","url":null,"abstract":"<p><strong>Introduction: </strong>Ankle and foot injuries are highly prevalent in the US Armed Forces, incurring medical and personnel costs for the Department of Defense. The purpose of this study was to evaluate the burden and risk factors of plantar fasciopathy (PF) in the US Military.</p><p><strong>Methods: </strong>The Defense Medical Epidemiology Database identified all diagnosed PF cases in military service members from 2006 to 2015. A custom spreadsheet calculated incidence of PF and relative risk between sexes, military occupations and ranks. Relative risk of injury per demographic category (sex, age, service branch, rank and year) was also calculated.</p><p><strong>Results: </strong>The overall incidence of PF from 2006 to 2015 was 12.85 per 1000 person-years, affecting 176 601 service members. 37 939 officers incurred PF at a rate of 17.65 per 1000 person-years (male 18.20 per 1000 person-years; female 14.80 per 1000 person-years). There were 116 122 enlisted personnel with PF that occurred at a rate of 12.22 per 1000 person-years (male 12.07 per 1000 person-years; female 13.22 per 1000 person-years). When compared with ground and naval gunfire officers, all officer specialties except for aviation and logistics had significantly higher risk of PF; aviation (relative risk (RR): 0.83, p<0.001) and logistics (RR: 0.94, p<0.001) had significantly lower risk. Regarding enlisted specialties, when compared with infantry, all occupations had significantly increased risk for PF except for Special Operations Forces (RR: 0.94, p=0.13). There were multiple associated factors identified with PF, including female sex, age >30, junior enlisted rank, a variety of military occupations and service in the Army.</p><p><strong>Conclusions: </strong>PF was common in the US military during the study period, with multiple salient risk factors identified. These findings highlight the need for prophylactic interventions for populations with the greatest risk.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190958","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":"Low physical activity levels of military police officers during day and night radio patrolling.","authors":"Gabriele Zampero, I Trevisan, F Monma, J C Tinti, L P Dos Santos, T C P Lima, R Gorjão, S M Hirabara, T C Pithon-Cur, R Curi, F A Santa-Rosa, D R de Souza","doi":"10.1136/military-2024-002897","DOIUrl":"https://doi.org/10.1136/military-2024-002897","url":null,"abstract":"<p><strong>Introduction: </strong>The São Paulo State Military Police officers have a higher mortality rate than the civilian population. The radio patrolling work (RP190) is carried out by pairs of military police officers (MPOs) for 12 hours, using a police vehicle, requiring physical capabilities at any moment. However, whether the activity performed by MPOs during operational work is within the sedentary or the physically active range classification requires investigation. This cross-sectional study measured and compared the number of steps performed by MPOs during night and day shift radio patrolling.</p><p><strong>Methods: </strong>The study participants included 170 MPOs with a median age of 35.0 (IQR: 29.0-43.0) years. All volunteers worked either the day (n=117) or night (n=53) shift and underwent step count analysis during the service shift using a Yamax pedometer (Digi-Walker SW 700, Tokyo, Japan). The data were normalised for pedometer wear time corresponding to the working service period. The MPOs in the radio patrolling programme wore the pedometer for 8.5 hours.</p><p><strong>Results: </strong>The results show that they took an average of 2516 (95% CI 2270 to 2632) and 295.8 (95% CI 278.1 to 313.5) steps during the whole service and per hour of service, respectively. No difference in the number of steps was observed during the day compared with the night shift (2574 (IQR: 1829-3371) vs 2485 (IQR: 1502-2821), p=0.131). However, when normalised for wear time of use, the number of steps was significantly higher in the day compared with the night group (311.7±119.1 vs 260.6±108.6, p=0.009, d=0.44).</p><p><strong>Conclusions: </strong>In conclusion, MPOs working the night shift are less physically active than MPOs working the day shift. Furthermore, MPOs' activity can be classified into the sedentary range independently of their shifts.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123754","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":"Mobile container platforms as an agile solution for military surgical capability in modern warfare?","authors":"Elizabeth O'Mara, H Stewart-Woods, D N Naumann","doi":"10.1136/military-2024-002886","DOIUrl":"https://doi.org/10.1136/military-2024-002886","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123757","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":"Frostbite: a systematic review on freezing cold injuries in a military environment.","authors":"T T C F van Dongen, R R Berendsen, F J M de Jong, E L Endert, R A van Hulst, R Hoencamp","doi":"10.1136/military-2022-002171","DOIUrl":"10.1136/military-2022-002171","url":null,"abstract":"<p><strong>Background: </strong>Military practice or deployment in extreme conditions includes risks, dangers and rare disorders. One of the challenges is frostbite; however, current literature does not provide an overview of this condition in a military context. This review aims to map the incidence, risk factors and outcome of frostbite in military casualties in the armed forces.</p><p><strong>Methods: </strong>A systematic literature search on frostbite (freezing cold injuries) in military settings from 1995 to the present was performed. A critical appraisal of the included articles was conducted. Data on incidence, risk factors, treatment and outcome were extracted.</p><p><strong>Results: </strong>Fourteen studies were included in our systematic review. Most studies of frostbite in a military setting were published nearly half a century ago. Frostbite incidence has declined from 7% to around 1% in armed forces in arctic regions but could be as high as 20% in small-scale arctic manoeuvres. Overall and military-specific risk factors for contracting frostbite were identified.</p><p><strong>Conclusion: </strong>During inevitable arctic manoeuvres, frostbite is a frequently diagnosed injury in service members. Postfreezing symptoms often persist after severe frostbite injury, which decreases employability within the service. Over time, military practice has changed considerably, and modern protective materials have been introduced; therefore, re-evaluation and future study in the military field are appropriate, preferably with other North Atlantic Treaty Organization partners.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"81-85"},"PeriodicalIF":1.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10660583","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}