Disaster and military medicine最新文献

{"title":"The contribution of the socio-demographic characteristics on suicidal ideation among Israeli soldiers.","authors":"Leah Shelef,&nbsp;Evyatar Ayzen,&nbsp;Nirit Yavnai,&nbsp;Eyal Fruchter,&nbsp;Orly Sarid","doi":"10.1186/s40696-016-0014-7","DOIUrl":"https://doi.org/10.1186/s40696-016-0014-7","url":null,"abstract":"<p><strong>Background: </strong>Suicidal ideation is a risk factor for suicide attempt. The aim of the present study is to compare suicidal ideation of different groups with different distress.</p><p><strong>Methods: </strong>100 soldiers, aged 18-21, divided into four research cohorts: soldiers who had carried out a suicide attempt (n = 40); soldiers with a psychiatric diagnosis (n = 20); soldiers having high severity adjustment difficulties (n = 20); and a control group of soldiers, having neither a history of mental health diagnosis, nor adjustment difficulties (n = 20). All completed the suicide ideation scale.</p><p><strong>Results: </strong>Half of the attempters had a psychiatric diagnosis (depression or anxiety) on the day of their enlistment and 37.5 % of them had a specified personality disturbance. The attempters were characterized by previously-attempted suicide (p < .01). The lowest mean values (<i>M</i> = 1.95, <i>SD</i> = .67) were among the attempter (F = 3.173, df = 3, p = .02) in motivation for military service. The variable expressing low motivation for military service was the sole predictor of suicide ideation (p = .032).</p><p><strong>Conclusions: </strong>Early diagnosis facilitated better monitoring by military mental health officers.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0014-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of adding a filter for protection from toxic inhalational compounds to the ventilation circuit of mechanically ventilated patients.","authors":"Eliezer Be'eri,&nbsp;Simon Owen,&nbsp;Mark Shachar,&nbsp;Yaron Barlavie,&nbsp;Arik Eisenkraft","doi":"10.1186/s40696-016-0015-6","DOIUrl":"https://doi.org/10.1186/s40696-016-0015-6","url":null,"abstract":"<p><strong>Background: </strong>Standard-issue Chemical-Biological-Radio-Nuclear (CBRN) gasmasks, as used for protection from non-conventional warfare agents or toxic industrial compounds, cannot be used by ventilated patients, leaving them exposed to toxic agents inhaled via their ventilators. This study was conducted to determine the safety of a CBRN filter added to the patient circuit of a ventilator, as a method for affording inhalational protection to ventilated patients.</p><p><strong>Methods: </strong>A Landrace pig was ventilated sequentially with 3 types of ventilators according to 17 different ventilation protocols, with and without a CBRN filters added in-line to the ventilation tubing for each protocol. For each protocol, physiological parameters, including oxygen saturation, inspired CO₂, end tidal CO₂, inspired oxygen, respiratory rate, and pulse rate, as well as airflow parameters including peak inspiratory pressure, positive end expiratory pressure and tidal volume were measured. The impact on the ventilator's trigger/sensitivity function was evaluated in vitro using a Michigan test lung.</p><p><strong>Results: </strong>On average, the addition of the CBRN filter resulted in a 16 ml (5 %) decrease (range 0-50 ml) in the tidal volume, a 1.7 cm H₂O (10 %) decrease (range 1-3 cm H₂O) in the peak inspiratory pressure, and a 0.1 cm H₂O (3 %) decrease (range 0-1 cm H₂O) in the positive end expiratory pressure delivered to the animal. Some ventilators compensated for these airflow changes while others did not, depending on the design of the ventilator's pressure/flow sensing mechanism. Significant rebreathing occurred when the filter was positioned directly on the animal's endotracheal tube, but not when positioned on the air outflow port of the ventilator. <i>In vitro</i> measurements showed that the addition of the CBRN filter added a mean pressure gradient of 0.45 cm H₂O to the trigger/sensitivity function of the system.</p><p><strong>Conclusions: </strong>In-line addition of a CBRN filter to ventilation tubing is a feasible strategy for affording inhalational protection to ventilated patients.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0015-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective medical leadership in times of emergency: a perspective.","authors":"Oded Hershkovich,&nbsp;David Gilad,&nbsp;Eyal Zimlichman,&nbsp;Yitshak Kreiss","doi":"10.1186/s40696-016-0013-8","DOIUrl":"https://doi.org/10.1186/s40696-016-0013-8","url":null,"abstract":"<p><p>Leadership, and more specifically medical leadership, is an unmeasured potential that has the power to influence every aspect of a person's professional life and its challenges and is more evident in times of emergency. Medical leadership is receiving increasing recognition especially in discussing actions to be taken in times of stress and emergency. We propose a comprehensive conceptual model that examines the elements that build successful medical leadership, especially during emergency scenarios. The model is based on two sets of medical leadership capabilities and skills, while the first set is more relevant to everyday challenges, the second set represents abilities and characteristics that arise mostly during emergencies. The model gathers together the characteristics and abilities of the medical leader based on our unique personal experiences during conflicts, terror, civilian challenges and numerous humanitarian missions. This article suggests a framework for the foundations on which the medical leader's education should be built and describes our perception of how to establish medical leadership, its unique elements and the processes leading to outstanding performance in times of emergency.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2016-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0013-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating emergency preparedness and impact of a hurricane sandy in pediatric patients with diabetes.","authors":"Rubina Heptulla,&nbsp;Rebecca Hashim,&nbsp;Doreen Newell Johnson,&nbsp;Jeniece Trast Ilkowitz,&nbsp;Gina DiNapoli,&nbsp;Venkat Renukuntla,&nbsp;Jennifer Sivitz","doi":"10.1186/s40696-016-0012-9","DOIUrl":"https://doi.org/10.1186/s40696-016-0012-9","url":null,"abstract":"<p><strong>Background: </strong>Natural disasters have always been associated with significant adverse events including medical and mental health problems. Children with chronic disease such has diabetes have also been believed to be affected to a greater extent by any natural disaster. The purpose of this study was to assess and compare emergency preparedness post-disaster and post-traumatic stress effects of Hurricane Sandy in affected and relatively unaffected populations.</p><p><strong>Methods: </strong>The study was conducted between February and July 2013. A total of 142 families caring for children with Type 1 Diabetes Mellitus (T1DM) who attended clinics were recruited from hospitals in Bronx, NY (control) and in NJ (affected) by Hurricane Sandy. Subjects were recruited to participate in a survey 3-6 months after the hurricane. Data on demographics, glycemic control and insulin regimens were collected. Families were surveyed for socio-economic status (SES), using Hollingshead questionnaire, general and diabetes preparedness and the Hurricane Related Traumatic Experiences (HURTE) questionnaire was used to evaluate for symptoms of post-traumatic stress.</p><p><strong>Results: </strong>Ninety-five percent of families reported to be generally well to moderately prepared for the hurricane and 83 % reported to be very well prepared with regards to their child's diabetes during the disaster. There was no difference between the sites for preparedness for the disaster, age or gender. There was a trend toward significance (p < 0.06) in New Jersey subjects as to a greater psychological impact from the hurricane. Poor glycemic control was significantly associated with lower SES (p < 0.008). Most importantly, SES was unrelated to preparedness for diabetes management during the hurricane.</p><p><strong>Conclusions: </strong>Despite low SES, families were generally well to moderately prepared for hurricane. In children with diabetes, interventional studies should be designed and implemented so that glycemic control remains unaffected, following any major disaster.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2016-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0012-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic control of diabetes patients under continuous rocket attacks.","authors":"Varda Soskolne,&nbsp;Rachel Dekel,&nbsp;Shlomo Vinker","doi":"10.1186/s40696-016-0011-x","DOIUrl":"https://doi.org/10.1186/s40696-016-0011-x","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the detrimental effects of exposure to stress on glycemic control among diabetes patients has mainly focused on personal life events or acute trauma. However, the effects of continuous exposure to extreme stress on type 2 diabetes patients have rarely been studied. The aim of the current study was to examine the association of continuous exposure to rocket attacks with glycemic control and with risk factors for diabetes complications among civilian type 2 diabetes patients. We focus on patients residing in the Western Negev in the south of Israel that has been subjected to rocket attacks fired from Gaza since the end of 2001.</p><p><strong>Methods: </strong>A two-arm retrospective cohort study of type 2 diabetes patients, aged 35-70 years, residing in a region with chronic exposure to rocket attacks (N = 1697) and in a non-exposed comparison region in Israel (N = 3000). Data were retrieved from the Health Maintenance Organization (HMO)'s database for four time periods representing exposure: chronic-2008; elevated-2009 (post'Cast Lead' operation); return to chronic-2010, 2011. Data included socio-demographic variables, HbA_1c, BMI, LDL cholesterol, blood pressure. General Linear Models (GLM) were used for analysis.</p><p><strong>Results: </strong>For HbA_1c, the model yielded a significant main effect for time, a borderline significance main effect for region, and a significant time by region interaction: no differences in HbA_1c levels between the regions in 2008 and 2009, followed by significant differences between the regions in 2010 and 2011 when HbA_1c continued to increase in the exposed region but decreased in the comparison region. Regarding risk factors, a significant main effect for time for LDL cholesterol only, and significant main effects for region were found in all factors: BMI and LDL cholesterol were higher in the exposed than in the comparison region, but blood pressure values were lower.</p><p><strong>Conclusions: </strong>Continuous exposure to rocket attacks is associated with glycemic control and risk factors in a complex pattern. These preliminary findings require further studies of diverse types of civilian exposure to continuous extreme stress.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2016-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0011-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to duty/play after exertional heat injury: do we have all the answers? A lesson from two case studies.","authors":"Itay Ketko,&nbsp;Amit Druyan,&nbsp;Ran Yanovich,&nbsp;Yoram Epstein,&nbsp;Yuval Heled","doi":"10.1186/s40696-015-0010-3","DOIUrl":"https://doi.org/10.1186/s40696-015-0010-3","url":null,"abstract":"<p><strong>Background: </strong>The common practice in the Israel defense Forces is that exertional heat related injury patients undergo a heat tolerance test 6-8 weeks post event as part of the \"return to duty\" process. In the case of a positive heat tolerance test the individual is classified as heat intolerant, in some cases however, the thermoregulatory recovery may be longer (several months), and therefore a second heat tolerance test is scheduled 6-8 weeks later. The presented case reports emphasize the possibility of different recovery periods of the thermoregulatory center and the distinction between congenital and acquired physiological heat intolerance.</p><p><strong>Case description: </strong>Two young healthy males (A and B) were diagnosed with exertional heat related injury during a pre-recruitment sorting process. Both underwent a heat tolerance test, and were found heat intolerant. During the next months they repeated the test several times. Patient A was finally diagnosed as heat tolerant and patient B was diagnosed as heat intolerant.</p><p><strong>Conclusion: </strong>Susceptibility to heat is a significant determinant for active young people such as athletes and soldiers. Both cases emphasize the importance of the heat tolerance test (and repeated test when needed) as a criteria for an exertional heat related injury patient to return to duty/play and to perform intense physical activities. These cases also emphasize the effectiveness and sensitivity of the test in identifying a temporary and a permanent state of heat intolerance.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"1 ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-015-0010-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case study of medical evacuation before and after the Fukushima Daiichi nuclear power plant accident in the great east Japan earthquake.","authors":"Tetsu Okumura,&nbsp;Shinichi Tokuno","doi":"10.1186/s40696-015-0009-9","DOIUrl":"https://doi.org/10.1186/s40696-015-0009-9","url":null,"abstract":"<p><strong>Introduction: </strong>In Japan, participants in the disaster-specific medical transportation system have received ongoing training since 2002, incorporating lessons learned from the Great Hanshin Earthquake. The Great East Japan Earthquake occurred on March 11, 2011, and the very first disaster-specific medical transport was performed. This article reviews in detail the central government's control and coordination of the disaster medical transportation process following the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant Accident.</p><p><strong>Case description: </strong>In total, 124 patients were air transported under the coordination of the C5 team in the emergency response headquarter of the Japanese Government. C5 includes experts from the Cabinet Office, Cabinet Secretariat, Fire Defense Agency, Ministry of Health, Labour and Welfare, and Ministry of Defense. In the 20-30 km evacuation zone around the Fukushima Daiichi nuclear power plant, 509 bedridden patients were successfully evacuated without any fatalities during transportation.</p><p><strong>Discussion and evaluation: </strong>Many lessons have been learned in disaster-specific medical transportation. The national government, local government, police, and fire agencies have made significant progress in their mutual communication and collaboration.</p><p><strong>Results: </strong>Fortunately, hospital evacuation from the 20-30 km area was successfully performed with the aid of local emergency physicians and Disaster Medical Assistance Teams (DMATs) who have vast experience in patient transport in the course of day-to-day activities. The emergency procedures that are required during crises are an extension of basic daily procedures that are performed by emergency medical staff and first responders, such as fire fighters, emergency medical technicians, or police officers. Medical facilities including nursing homes should have a plan for long-distance (over 100 km) evacuation, and the plan should be routinely reevaluated with full-scale exercises. In addition, hospital evacuation in disaster settings should be supervised by emergency physicians and be handled by disaster specialists who are accustomed to patient transportation on a daily basis.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"1 ","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2015-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-015-0009-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and psychological impacts from the 2011 Great East Japan Earthquake Disaster: a systematic literature review.","authors":"Nahoko Harada,&nbsp;Jun Shigemura,&nbsp;Masaaki Tanichi,&nbsp;Kyoko Kawaida,&nbsp;Satomi Takahashi,&nbsp;Fumiko Yasukata","doi":"10.1186/s40696-015-0008-x","DOIUrl":"https://doi.org/10.1186/s40696-015-0008-x","url":null,"abstract":"<p><strong>Background: </strong>On March 11, 2011, Japan experienced an unprecedented combination of earthquake/tsunami/nuclear accidents (the Great East Japan Earthquake; GEJE). We sought to identify mental health and psychosocial consequences of this compound disaster.</p><p><strong>Method: </strong>A systematic literature review was conducted of quantitative research articles addressing mental health of survivors and the psychological impact of the GEJE. For articles between March 2011 and December 2014, PubMed, PsychINFO, and EMBASE databases were searched with guidance on literature review method.</p><p><strong>Results: </strong>Forty-nine studies met the inclusion criteria. A substantial proportion of the affected individuals experienced considerable psychological distress. Mental health outcomes included, but were not limited to, posttraumatic stress disorder, depression, and anxiety symptoms. Physical health changes, such as sleeping and eating disturbances, also occurred. In Fukushima, radioactive release induced massive fear and uncertainty in a large number of people, causing massive distress among the affected residents, especially among mothers of young children and nuclear plant workers. Stigma was additional challenge to the Fukushima residents. The review identified several groups with vulnerabilities, such as disaster workers, children, internally displaced people, patients with psychiatric disorders, and the bereaved.</p><p><strong>Conclusions: </strong>Following the GEJE, a considerable proportion of the population was mentally affected to a significant degree. The affected individuals showed a wide array of mental and physical consequences. In Fukushima, the impact of nuclear disaster was immense and complex, leading to fear of radiation, safety issues, and stigma issues.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"1 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2015-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-015-0008-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A military suicide prevention program in the Israeli Defense Force: a review of an important military medical procedure.","authors":"Leah Shelef,&nbsp;Lucian Laur,&nbsp;Gil Raviv,&nbsp;Eyal Fruchter","doi":"10.1186/s40696-015-0007-y","DOIUrl":"https://doi.org/10.1186/s40696-015-0007-y","url":null,"abstract":"<p><p>The phenomenon of suicide during military service is not unique to the Israeli military and other armies. Soldiers' age--adolescence--is a known factor contributing to suicide, in light of psychological processes of identity formation and self-definition, the stresses of military service, and above all, the availability of weapons. The stigma of seeking help deters some soldiers from getting the assistance they need when they need it most, thus contributing to the higher suicide rate. In the previous decade the IDF initiated intensive and structured preventive procedures aimed at reducing suicide rate among soldiers. The IDF's Suicide Prevention Program (SPP) was grounded in professional knowledge and backed by military policy changes, both critical to the implementation and change processes. The SPP includes thorough psycho-education and guidance, supervision, greater accessibility of mental health officers, and lower accessibility of nonessential weapons. The SPP has succeeded in reducing the suicide rate by almost 50 %. The aim of this article is to review the background of the design of the IDF's SPP and its major components, leading to the current success.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"1 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2015-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-015-0007-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.","authors":"Ralph Jay Johnson","doi":"10.1186/s40696-015-0006-z","DOIUrl":"https://doi.org/10.1186/s40696-015-0006-z","url":null,"abstract":"<p><p>Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more \"robust,\" that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of \"force protection\" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"1 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2015-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-015-0006-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}