JournalTOCs

Journal of the Royal Army Medical Corps
Journal Prestige (SJR): 0.303

Citation Impact (citeScore): 1
Number of Followers: 7

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0035-8665 - ISSN (Online) 2052-0468
Published by BMJ Publishing Group

[62 journals]

Why we need to talk about deployed palliative care
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  Authors: McMillan; K.
  Pages: 479 - 481
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002003
  Issue No: Vol. 169, No. 6 (2023)
Battlefield REBOA: Aces High or Journeys End'
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  Authors: Parker, P; Johnston, A. M, Mountain, A, Pynn, H.
  Pages: 482 - 484
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002054
  Issue No: Vol. 169, No. 6 (2023)
UK Field Medical Care 2032: one Military Vision
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  Authors: Parker, P; Pynn, H, Haldane, A. G, Ballard, M, König, T. C, Johnston, A. M.
  Pages: 485 - 487
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002056
  Issue No: Vol. 169, No. 6 (2023)
Management of a large outbreak of COVID-19 at a British Army training
centre: lessons for the future
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  Authors: Routledge, M; Lyon, J, Vincent, C, Gordon Clarke, A, Shawcross, K, Turpin, C, Cormack, H, Robson, S. C, Beckett, A, Glaysher, S, Cook, K, Fearn, C, Goudarzi, S, Hutley, E. J, Ross, D.
  Pages: 488 - 492
  Abstract: IntroductionThe COVID-19 pandemic has posed major challenges for infection control within training centres, both civilian and military. Here we present a narrative review of an outbreak that occurred at the Royal Military Academy Sandhurst (RMAS) in January–March 2021, in the context of the circulating, highly transmissible SARS-CoV-2 variant B.1.1.7.MethodsTesting for SARS-CoV-2 was performed using a combination of reverse transcriptase PCR and Lateral Flow Devices (LFDs). Testing and isolation procedures were conducted in line with a pre-established symptom stratification system. Genomic sequencing was performed on 10 sample isolates.ResultsBy the end of the outbreak, 185 cases (153 Officer Cadets, 32 permanent staff) had contracted confirmed COVID-19. This represented 15% of the total RMAS population. This resulted in 0 deaths and 0 hospitalisations, but due to necessary isolation procedures did represent an estimated 12 959 person-days of lost training. 9 of 10 (90%) of sequenced isolates had a reportable lineage. All of those reported were found to be the Alpha lineage B.1.1.7.ConclusionsWe discuss the key lessons learnt from the after-action review by the Incident Management Team. These include the importance of multidisciplinary working, the utility of sync matrices to monitor outbreaks in real time, issues around Officer Cadets reporting symptoms, timing of high-risk training activities, infrastructure and use of LFDs. COVID-19 represents a vital learning opportunity to minimise the impact of potential future pandemics, which may produce considerably higher morbidity and mortality in military populations.
  Keywords: COVID-19
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001976
  Issue No: Vol. 169, No. 6 (2023)
Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied
both successfully and rapidly by Combat Medical Technicians (CMTs)
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  Authors: Smith, T. N; Beaven, A, Handford, C, Sellon, E, Parker, P. J.
  Pages: 493 - 498
  Abstract: Background‘Non-compressible’ haemorrhage is the leading cause of preventable battlefield death, often requiring surgical or radiological intervention, which is precluded in the pre-hospital environment. One-fifth of such bleeds are junctional and therefore potentially survivable. We examine the use of the Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) among UK Combat Medical Technicians (CMTs) as a device to control junctional haemorrhage with external compression of the abdominal aorta—compression of junctional haemorrhage previously considered ‘non-compressible.’ This follows animal studies showing that the AAJTS achieves control of haemorrhage and improves physiological parameters.MethodsCMTs were selected and applied the AAJTS to each other following a 1-hour training package. A consultant radiologist-operated hand-held ultrasound monitored flow changes in the subjects’ common femoral artery. CMTs were then surveyed for their opinions as to utility and function.Results21 CMTs were screened and 17 CMTs participated with 34 total applications (16 day and 18 low-light). 27/34 (79%) achieved a successful application. The median application time was 75 s in daylight and 57 s in low-light conditions. There was no significant difference in Body Mass Index (p=0.23), median systolic blood pressure (p=0.19), nor class of CMT (p=0.10) between successful and unsuccessful applications. Higher systolic blood pressure was associated with longer application times (p=0.03). Users deemed the device easy to use (median score 4.4 on a 5-point Likert scale).ConclusionCMTs can use AAJTS successfully after a 1-hour training session in the majority of applications. Application was successful in both daylight and low-light conditions. Self-reported usability ratings were high.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001881
  Issue No: Vol. 169, No. 6 (2023)
Sustained positive behaviour change of wounded, injured and sick UK
military following an adaptive adventure sports and health coaching
recovery course
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  Authors: Sutton, R. J; Kay, C. W. P, McKenna, J, Kaiseler, M.
  Pages: 499 - 504
  Abstract: IntroductionA rising trend has occurred in the physical and mental health challenges faced by recovering UK service personnel. To support these individuals, bespoke inclusive multiactivity and adventurous training courses (MAC) have been developed. This study investigated the MAC’s influence on participants’ ability to sustain day-to-day changes that facilitate positive mental health and psychological need satisfaction.MethodsThe 146 UK service personnel who participated in this study attended a five-day MAC 12 months ago. To investigate how the supportive experience influenced participants’ lives, quantitative and qualitative data were collected via an online survey. Open-ended questioning and abductive analysis were conducted to understand mechanisms, influential aspects of the course and positive behaviour change.ResultsPositive behaviour changes were reported by 74% of the respondents. These changes align with positive psychological well-being (98%). Impactful elements of the course experienced by participants mostly aligned with the three basic psychological needs of autonomy (34%), competence (36%) and relatedness (61%).ConclusionsRecovery support programmes that encompass health coaching adventurous activities, such as the MAC, can initiate long-term positive behaviour change for recovering military personnel. In this specific context, the concurrence of the self-determination theory concepts that underpin the course delivery and participant outcomes is a powerful endorsement of implementation fidelity.
  Keywords: Open access
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001784
  Issue No: Vol. 169, No. 6 (2023)
Impact of war on veteran life span: natural experiment involving combat
versus non-combat exposed military personnel
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  Authors: Wilson, N; Clement, C, Summers, J. A, Thomson, G, Harper, G.
  Pages: 505 - 509
  Abstract: IntroductionThere is still uncertainty around the impact of combat exposure on the life span of war veterans. Therefore we made use of a natural experiment to study the impact on veteran life span of combat versus non-combat exposure in World War II (WW2).MethodsThe combat-exposed military personnel were derived from a random (10%) sample of the military roll of the 28th (Māori) Battalion from New Zealand. One non-combat cohort was the 15th Reinforcements of this same Battalion, since the war ended before they reached the front line. The other non-combat cohort were Māori personnel who were only involved in Jayforce, which occupied Japan at the end of the WW2. Data on life span were mainly derived from an official repository of birth and death records, but supplemented with other sources, including military files.ResultsWhen comparing life spans of service veterans, there was no statistically significant reduction for the average life span of the 234 combat-exposed veterans in our sample from the 28th (Māori) Battalion (66.7 years), relative to the Māori veterans from two non-combat cohorts: the 132 personnel in the 15th Reinforcements (67.2 years) and the 147 personnel in Jayforce (66.9 years).ConclusionsDespite a very high level of wounding in the combat-exposed group (48%), there were no statistically significant reductions in life span between this group and comparable non-combat exposed veterans. This finding contrasts to life span reductions found in a similar study of New Zealand veterans of WW1.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001991
  Issue No: Vol. 169, No. 6 (2023)
Ten-year reduction in thoracic injury-related mortality among Israel
Defense Forces soldiers
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  Authors: Chen, J; Tsur, A. M, Nadler, R, Beit Ner, E, Sorkin, A, Radomislensky, I, Peleg, K, Ben Avi, R, Shushan, G, Glassberg, E, Benov, A.
  Pages: 510 - 516
  Abstract: IntroductionThis study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation of the 2012 IDF-Military Corps ‘My Brother’s Keeper’ plan which included the publication of clinical practice guidelines (CPGs) for thoracic injuries, emphasis on adequate torso protection, introduction of modern life-saving procedures and encouragement of rapid evacuation.MethodsThe IDF prehospital trauma registry was reviewed to identify all patients who sustained thoracic injuries from January 2006 to December 2017. IDF soldiers who were injured, died of wounds or killed in action (KIA) were included. These were cross-referenced with the Israel National Trauma Registry. The periods before and after the plan were compared.Results458 (12.3%) of 3733 IDF soldiers wounded on the battlefield sustained combat-related thoracic injuries. The overall mortality was 44.3% before the CPG and 17.3% after (p
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001986
  Issue No: Vol. 169, No. 6 (2023)
Musculoskeletal injuries in UK Service Personnel and the impact of
in-theatre rehabilitation during Cold Weather Warfare training: Exercise
CETUS 2020
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  Authors: Ferraby, D. H; Hayhurst, D, Strachan, R, Knapman, H, Wood, S, Fallowfield, J. L.
  Pages: 517 - 522
  Abstract: IntroductionThe Royal Marines provide the lead Service for UK Defence Mountain and Cold Weather Warfare capability. This is the first prospective study addressing musculoskeletal injury rates sustained during Cold Weather Warfare training, with the aim of informing injury mitigation interventions and assist military medical planning with respect to delivering primary care rehabilitation in theatre.MethodsAll musculoskeletal injuries were surveyed by the Forward Rehabilitation Team (Nov 2019–Mar 2020) during a Cold Weather Deployment to Norway (Ex CETUS 2019/20). The frequency, nature of injury (new or recurrent), onset (sudden or gradual), cause, location and exercise/treatment outcome were recorded.ResultsEleven per cent (n=136 cases) of the deployed population (n=1179) reported a musculoskeletal injury, which were mainly ‘new’ (62%), and with a ‘sudden’ onset (64%). Injury rate was 17.8 injuries per 10 000 personnel days. The majority of injuries occurred due to military training (88%), specifically during ski-related (61%) and load carriage (10%) activities.The average Service Person treated by the Forward Rehabilitation Team improved from ‘injured with restricted duties’ to ‘fully fit’, and with an improvement in their self-reported Musculoskeletal Health Questionnaire from 33 to 45 over an average of two rehabilitation sessions. One hundred and seventeen Service Personnel were able to continue on Ex CETUS with rehabilitation in theatre, thus negating the requirement for aeromedical evacuation for continuation of rehabilitation in the UK. Nineteen patients were unable to continue their Cold Weather Deployment due to the nature of their musculoskeletal injury and returned to the UK for continued care in firm base rehabilitation centres.ConclusionThis study identifies the nature, causation and injury location. It demonstrates the effectiveness of in-theatre rehabilitation and the ability to treat patients when deployed. Recommendations are presented to support strategies to mitigate musculoskeletal injury risk during future Cold Weather Warfare deployments to Norway.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-001972
  Issue No: Vol. 169, No. 6 (2023)
Prevalence of common mental health disorders in military veterans: using
primary healthcare data
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  Authors: Finnegan, A; Randles, R.
  Pages: 523 - 528
  Abstract: IntroductionServing military personnel and military veterans have been identified as having a high prevalence of mental disorders. Since 1985, UK patients’ primary healthcare (PHC) medical records contain Read Codes (now being replaced by Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) codes) that mark characteristics such as diagnosis, ethnicity and therapeutic interventions. This English study accesses a cohort profile of British Armed Forces veterans to examine the diagnosed common mental disorders by using PHC records.MethodsThis analysis has been drawn from initiatives with PHC practices in the Northwest of England to increase veteran registration in general practice. Demographic data were collected including gender, age and marital status. Data were also collected on common mental health disorders associated with the Armed Forces.Result2449 veteran PHC records were analysed. 38% (N=938) of veterans in this cohort had a code on their medical record for common mental health disorders. The highest disorder prevalence was depression (17.8%, N=437), followed by alcohol misuse (17.3%, N=423) and anxiety (15.0%, N=367). Lower disorder prevalence was seen across post-traumatic stress disorder (PTSD) (3.4%, N=83), dementia (1.8%, N=45) and substance misuse (0.8%, N=19). Female veterans had a higher prevalence of mental disorders than their male counterparts, while men a higher prevalence of PTSD; however, the gender difference in the latter was not significant (p>0.05).ConclusionThe SNOMED searches do not detail why certain groups had higher recordings of certain disorders. A future study that accesses the PHC written medical notes would prove enlightening to specifically identify what situational factors are having the most impact on the veteran population. The results from a sizeable English veteran population provide information that should be considered in developing veteran-specific clinical provision, educational syllabus and policy.
  Keywords: Open access
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002045
  Issue No: Vol. 169, No. 6 (2023)
Longitudinal survey of UK veterans with pre-existing mental health
difficulties: mental health during the COVID-19 pandemic
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  Authors: Murphy, D; Hendrikx, L. J, Williamson, C, Baumann, J.
  Pages: 529 - 534
  Abstract: IntroductionAt the start of the COVID-19 pandemic, individuals with pre-existing mental health difficulties were thought to be vulnerable to mental health deterioration due to the emerging threat and the actions taken to control infection rates. Yet, there remained a paucity of research investigating changes in veteran well-being, a population facing higher rates of mental health difficulties compared with the general public. This longitudinal study aimed to investigate the mental health and well-being of UK veterans with pre-existing mental health difficulties at two time points during the COVID-19 pandemic.MethodsUK treatment-seeking veterans (N=121) completed an online survey administered towards the end of the first UK lockdown in June 2020 and 1 year later. Data were gathered on sociodemographic characteristics as well as psychometric measures of post-traumatic stress disorder (PTSD), common mental disorders (CMDs), anger difficulties and alcohol misuse.ResultsThe proportion of veterans meeting criteria of PTSD, anger and alcohol misuse remained similar across the two time points, while significantly fewer veterans met criteria for CMDs 1 year later. A notable proportion of the sample reported challenges in attending mental and physical health appointments, which was positively associated with not working and negatively associated with more COVID-19-related stressors.ConclusionsThese findings suggest that, to date, veterans with pre-existing mental health difficulties appear to demonstrate resilience as the COVID-19 pandemic progressed. However, as the pandemic continued, veterans faced significantly more COVID-19-related stressors, less social support, as well as difficulties attending health appointments.
  Keywords: COVID-19
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002046
  Issue No: Vol. 169, No. 6 (2023)
Sex, military occupation and rank are associated with risk of anterior
cruciate ligament injury in tactical-athletes
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  Authors: Aguero, A. D; Irrgang, J. J, MacGregor, A. J, Rothenberger, S. D, Hart, J. M, Fraser, J. J.
  Pages: 535 - 541
  Abstract: IntroductionAnterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. The aim of this retrospective cohort study was to evaluate military occupation, sex, rank and branch of service on ACL injury risk in the US military from 2006 to 2018.MethodsThe Defense Medical Epidemiology Database was queried for the number of US tactical athletes with International Classification of Diseases diagnosis codes 717.83 (old disruption of ACL), 844.2 (sprain of knee cruciate ligament), M23.61 (other spontaneous disruption of ACL) and S83.51 (sprain of ACL of knee) on their initial encounter. Relative risk and 2 statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service and rank.ResultsThe study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p
  Keywords: Open access
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002059
  Issue No: Vol. 169, No. 6 (2023)
Vitamin D levels in Portuguese military personnel
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  Authors: Henriques, M; Soares, P, Sacadura-Leite, E.
  Pages: 542 - 547
  Abstract: IntroductionIn Portugal, most adults have inadequate levels of vitamin D. Active duty military personnel need to be always ready for duty, perform tasks in specific contexts and overcome high physical and mental demands, which raises the relevance of knowing their vitamin D levels. This study aims to characterise vitamin D levels of Portuguese active duty military personnel and evaluate the effect of military status on the prevalence of vitamin D sufficiency, adjusted for season of the year, age and gender.MethodsA retrospective cross-sectional study, based on vitamin D measurements carried out at the Armed Forces Hospital between 2014 and 2020, was fulfilled including the variables age, gender, vitamin D level and dosing date for military personnel and civilians. Comparison of proportions test and the generalised linear regression model were used for data analysis with a significance level of 5%.ResultsOut of 2782 subjects, 62.7% were military personnel. Mean±SD level of vitamin D was 24.5±10.6 ng/mL and 23.7±11.5 ng/mL in military personnel and civilians, respectively. In the military personnel, the prevalence of vitamin D sufficiency, insufficiency and deficiency was, respectively, 25.2%, 40.1% and 34.6%. Prevalence of vitamin D sufficiency was similar in the civilians cohort and, also, between Armed Forces branches. Military status had no effect on the prevalence of vitamin D sufficiency, especially after adjustments.ConclusionsWe present data on vitamin D levels of Portuguese active duty military personnel. Our results found that military personnel are no more at risk of vitamin D inadequacy than civilians, but only a quarter of active duty military personnel had vitamin D sufficiency. Therefore, they can benefit from vitamin D levels assessment towards vitamin D levels optimisation. Further studies are still needed, especially among military personnel with higher risk of vitamin D deficiency.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002021
  Issue No: Vol. 169, No. 6 (2023)
Risk factors for reflex syncope in the British Army
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  Authors: Parsons, I. T; Ellwood, J, Stacey, M. J, Gall, N, Chowienczyk, P, Woods, D. R.
  Pages: 548 - 553
  Abstract: IntroductionReflex syncope in the UK Armed Forces is reportedly higher than comparable militaries and civilian populations and is significantly more common in soldiers who take part in State Ceremonial and Public Duties (SCPD) compared with other British Army service personnel (SP). This study aimed to investigate individual susceptibility factors for syncope in soldiers who regularly take part in SCPD.MethodsA retrospective cohort study was performed in 200 soldiers who perform SCPD. A questionnaire was undertaken reviewing soldiers’ medical history and circumstances of any fainting episodes. A consented review of participants’ electronic primary healthcare medical record was also performed. Participants were divided into two groups (syncope, n=80; control, n=120) based on whether they had previously fainted.ResultsIn the syncope group orthostasis (61%) and heat (35%) were the most common precipitating factors. The most common interventions used by soldiers were to maintain hydration (59%) and purposeful movements (predominantly ‘toe wiggling’; 55%). 30% of participants who had previously fainted did not seek definitive medical attention. A history of migraines/headaches was found to increase the risk of reflex syncope (OR 8.880, 1.214–218.8), while a history of antihistamine prescription (OR 0.07144, 0.003671–0.4236), non-white ethnicity (OR 0.03401, 0.0007419–0.3972) and male sex (OR 0.2640, 0.08891–0.6915) were protective.ConclusionThis is the first study, in the British Army, to describe, categorise and establish potential risk factors for reflex syncope. Orthostatic-mediated reflex syncope is the most common cause in soldiers who regularly perform SCPD and this is further exacerbated by heat exposure. Soldiers do not use evidence-based methods to avoid reflex syncope. These data could be used to target interventions for SP who have previously fainted or to prevent fainting during SCPD.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002040
  Issue No: Vol. 169, No. 6 (2023)
Emotional intelligence in military medical officers in the Defence Medical
Services
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  Authors: MacEwan, D; Gibson, A.
  Pages: 554 - 558
  Abstract: BackgroundEmotional intelligence (EI) is a concept describing an individual’s ability to understand, process and act accordingly on others’ and one’s own emotions. It is a desirable quality for people working in teams and is beneficial to the individual in many ways. It is increasingly recognised that understanding and developing EI are important to working in the healthcare environment. It becomes especially pertinent in the deployed Defence Medical Services (DMS), where clinicians often fulfil a significant leadership role in a small team.MethodsThis study was performed with the aim of exploring the role of EI in military doctors in the UK DMS. EI was measured in a cohort of 64 military doctors by way of a validated self-assessment questionnaire. Results were tested for differences in EI between different services and career stages.ResultsThe survey had an 83% return rate. There was roughly equal distribution between service, career groups and ages across the study population. There were more men than women. The population showed consistently high EI scores compared with control data. There were no statistical differences in EI scores between services or genders. Foundation doctors showed the highest EI scores and consultants the lowest (6.05 vs 5.3).ConclusionIt was demonstrated that military doctors have consistently high EI score, especially at the most junior level. This suggests that traits deemed desirable by the single service selection processes also pertain to high EI without it being specifically measured for. The dangers of having too high EI and the benefits of having a range of EI within a team were discussed. There were limitations of being unable to obtain qualitative data and not including primary healthcare staff. Several recommendations were set out as to how the DMS may use or further investigate EI with regard to training and recruitment.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002068
  Issue No: Vol. 169, No. 6 (2023)
Are young military personnel at a disproportional risk of heat
illness'
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  Authors: Ogden, H. B; Rawcliffe, A. J, Delves, S. K, Roberts, A.
  Pages: 559 - 564
  Abstract: Heat illnesses (HI) define a continuum of conditions where patients become incapacitated due to uncompensable heat stress. In the military, HI has a significant health, financial and operational burden that requires vigilant management. Military training and operations regularly expose personnel to known HI risk factors, meaning that prevalence remains high despite stringent attempts to reduce risk to as low as reasonably practicable. While prepubertal children and elderly adults are widely demonstrated to be at greater risk of classic HI than young adults due to impaired physiological and/or behavioural thermoregulation, in military personnel, it is young recruit-age individuals (16–19 years) who consistently experience the highest prevalence of exertional HI. Mechanistically, controlled laboratory studies have never directly compared thermoregulation between young recruit-age individuals and other groups of adults, though research highlighting impaired thermoregulation in prepubertal children potentially has some relevance to late-developing young recruit-age personnel. Aside from potential age-related differences in thermoregulation, a major consideration must also be given to the increased prevalence of organisational risk factors for HI in younger military personnel (eg, education, physical load, rank, job roles), which is likely to be the primary explanation behind age-related trends in HI prevalence, at least in the military. The aims of this article are to review: (i) the epidemiology of HI between young recruit-age individuals and older military personnel; (ii) the theoretical basis for age-associated differences in thermoregulatory function and (iii) pertinent areas for future research.
  Keywords: Open access
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002053
  Issue No: Vol. 169, No. 6 (2023)
Injury modelling for strategic planning in protecting the national
infrastructure from terrorist explosive events
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  Authors: Breeze, J; Fryer, R. N, Nguyen, T.-T. N, Ramasamy, A, Pope, D, Masouros, S. D.
  Pages: 565 - 569
  Abstract: Terrorist events in the form of explosive devices have occurred and remain a threat currently to the population and the infrastructure of many nations worldwide. Injuries occur from a combination of a blast wave, energised fragments, blunt trauma and burns. The relative preponderance of each injury mechanism is dependent on the type of device, distance to targets, population density and the surrounding environment, such as an enclosed space, to name but a few. One method of primary prevention of such injuries is by modification of the environment in which the explosion occurs, such as modifying population density and the design of enclosed spaces. The Human Injury Predictor (HIP) tool is a computational model which was developed to predict the pattern of injuries following an explosion with the goal to inform national injury prevention strategies from terrorist attacks. HIP currently uses algorithms to predict the effects from primary and secondary blast and allows the geometry of buildings to be incorporated. It has been validated using clinical data from the ‘7/7’ terrorist attacks in London and the 2017 Manchester Arena terrorist event. Although the tool can be used readily, it will benefit from further development to refine injury representation, validate injury scoring and enable the prediction of triage states. The tool can assist both in the design of future buildings and methods of transport, as well as the situation of critical emergency services required in the response following a terrorist explosive event. The aim of this paper is to describe the HIP tool in its current version and provide a roadmap for optimising its utility in the future for the protection of national infrastructure and the population.
  Keywords: Editor''s choice
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002052
  Issue No: Vol. 169, No. 6 (2023)
Fellowships and defence engagement: from clinical niches to strategic
impact
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  Authors: Lowe, J; Potter, D, Warner, M, Horne, S.
  Pages: 570 - 572
  Abstract: Medical fellowships have traditionally developed the individual rather than furthering military or national strategic objectives. This paper describes a medical fellowship with the British Antarctic Survey to illustrate the benefits to the individual, to the military and to wider international defence engagement efforts.By rebranding such fellowships as Defence Healthcare Engagement and by treating international organisations on a par with partner nations, the humble fellowship can facilitate enduring, mutually beneficial healthcare engagement at low cost and with minimal additional resources.
  PubDate: 2023-11-22T00:45:23-08:00
  DOI: 10.1136/bmjmilitary-2021-002009
  Issue No: Vol. 169, No. 6 (2023)