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- The DMS must rapidly reshape its systems to cultivate and sustain
innovation and the implementation of new digital technologies-
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Authors:
Buckley, A; Tai, N.
Pages: 385 - 387
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001924
Issue No: Vol. 169, No. 5 (2023)
- Navigating the ethical maze of genomics in Canadas military
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Authors:
Beauvais, M. J. S; Knoppers, B. M, Boscarino, C.
Pages: 388 - 390
Keywords: Open access
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001954
Issue No: Vol. 169, No. 5 (2023)
- Effects of 12-week full body resistance exercise on vertical jumping with
and without military equipment in Slovenian Armed Forces-
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Authors:
Kozinc, Z; Sarabon, N, Kovcan, B, Simenko, J, Pori, P, Vodicar, J, Hadzic, V.
Pages: 391 - 396
Abstract: IntroductionJumping ability is one of the most important physical qualities in military personnel. Previous training intervention studies have shown equivocal effects on jumping ability. In this study, we assessed the effect of a 12-week resistance exercise programme on countermovement jump (CMJ) performance with and without military equipment.MethodsNinety-six members of the Slovenian Armed Forces (age range 20–47 years) were allocated to the intervention (n=65) and the control (n=32) group. The intervention group performed 2 sessions of full body resistance exercise per week for 12 weeks, while the control group continued with their regular training routine. Before and after the intervention, CMJ assessment using force plates was conducted with and without military equipment.ResultsCMJ testing with and without equipment both exhibited high to excellent relative and absolute reliability. The intervention elicited statistically significant (p=0.011–0.026; 2=0.05–0.06), but small improvements in CMJ height when performed without equipment (from 28.2±3.8 cm to 29.5±3.3 cm) and with equipment (from 25.3±3.7 cm to 27.1±6.1). Other variables showed even smaller or trivial changes.ConclusionsThis study suggests that CMJ with equipment could be a reliable tool to assess jumping performance specific to requirements of military work, which would increase the ecological validity of the testing. The present structured full-body training intervention showed modest improvements in jumping ability in both testing conditions.Trial registration number NCT0341546.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001899
Issue No: Vol. 169, No. 5 (2023)
- Sexual harassment at work within Belgian Defence: a prevalence study
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Authors:
Buyse, K; Goorts, K, Peeters, D, Dhondt, E, Portzky, G.
Pages: 397 - 402
Abstract: IntroductionSexual harassment (SH) at work can have an impact on the general health and well-being and on the productivity of the employee. To date, the Belgian Armed Forces do not have any accurate data about SH. Therefore, this study assessed the prevalence of SH within Belgian Defence.MethodsThe prevalence of SH and staff mental well-being was investigated in a sample of 399 female soldiers. Using quantitative analysis, we measured the impact on mental well-being and the relation to demographic characteristics. Using a qualitative analysis in a subsample of eight female soldiers, we investigated barriers to reporting SH and the impact on professional performance and psychosocial well-being.ResultsThe prevalence of non-physical SH is 36.1% over the last 12 months and 64.4% over the course of a career. Physical SH has a prevalence of 16.1% and 43.4%, respectively. Rape prevalence was reported to be 1.4% over the past 12 months, 9% over the course of their career.One in three female soldiers suffer from reduced mental well-being, which was significantly associated with SH. In the interviews, female employees report an impact of SH on professional and personal performance. The willingness to report is low due to misunderstanding, disinformation and psychosocial insecurity.ConclusionHigh prevalence numbers were found suggesting an important impact on the professional performance and mental well-being of female military personnel. Organisational changes may create more willingness among victims to report incidents to the designated services.
Keywords: Open access
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001855
Issue No: Vol. 169, No. 5 (2023)
- Military families: the impacts of having a first child during service on
military mothers-
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Authors:
Williamson, C; Baumann, J, Murphy, D.
Pages: 403 - 407
Abstract: IntroductionThe rights, roles and responsibilities of servicewomen in the UK Armed Forces has changed dramatically over time. Previously, service personnel were automatically discharged from the military if they became pregnant. As the percentage of servicewomen in the UK Armed Forces increases, having children during service is becoming more common and maternity policies are now in place. Having children during military service can impact on the health and well-being of servicewomen, including a greater risk of illness when returning to work.MethodsA cross-sectional, self-report survey was used for data collection. The response rate was approximately 45%. Female Army veterans were recruited via a female military association. The survey collected data on parental status, the timing of their first child (during or after service), and several current mental and physical health and well-being outcomes.ResultsOf the 750 female Army veterans who completed the survey, 406 reported having children. Of those with children, 14.5% had their first child during service compared with 85.5% after service. The most frequently endorsed health outcomes were low social support, loneliness and common mental health difficulties. Participants who had their first child during military service were more likely to have left the service non-voluntarily.ConclusionsThis study provided insight into the impacts of having a first child during military service on servicewomen. Overall, female Army veterans who had their first child during service had poorer outcomes, including leaving service non-voluntarily. However, none of the health or well-being outcomes remained significant after adjusting the results. This study explored a widely under researched population and field of research. Future research should seek to expand on our findings and continue to explore the impacts of having a first child during military service for military mothers.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001928
Issue No: Vol. 169, No. 5 (2023)
- Reflex syncope in the UK Armed Forces
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Authors:
Parsons, I; Ellwood, J, Stacey, M. J, Gall, N, Grundy-Bowers, M, Chowienczyk, P, Woods, D.
Pages: 408 - 412
Abstract: IntroductionReflex syncope is the most common subtype of syncope and, despite not being associated with increased mortality, often results in significant morbidity and costly diagnostics. Reflex syncope can be of concern for certain occupational groups and may be exacerbated by some occupations. Reflex syncope in the military is anecdotally common but the extent in the UK Armed Forces (UKAF) is unknown. The aim of this study was to assess the incidence and prevalence of reflex syncope in the UKAF.MethodsA retrospective search of the Defence Medical Information Capability Programme using prespecified read-codes was performed at defence primary healthcare centres over the period of 1 January 2019 to 1 January 2020. Data were obtained on 76 103 service personnel (SP) (53% of the UKAF).ResultsThe overall syncope case rate for the UKAF was 10.5 per 1000 person-years (p-yrs). In comparing services there was a significantly increased risk of syncope in the British Army (10.7 per 1000 p-yrs) compared with the Royal Air Force (8.6 per 1000 p-yrs) (p=0.0365), SP who served overseas (16.7 per 1000 p-yrs) in comparison with UK medical centres (10.3 per 1000 p-yrs) (p
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001945
Issue No: Vol. 169, No. 5 (2023)
- Social and economic costs of gambling problems and related harm among UK
military veterans-
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Authors:
Harris, S; Pockett, R. D, Dighton, G, Wood, K, Armour, C, Fossey, M, Hogan, L, Kitchiner, N, Larcombe, J, Rogers, R. D, Dymond, S.
Pages: 413 - 418
Abstract: IntroductionMilitary veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans’ Health and Gambling Study.MethodsAn online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint.ResultsVeterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI –£1016 to –£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status.ConclusionsOur sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.
Keywords: Press releases
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001892
Issue No: Vol. 169, No. 5 (2023)
- Adversity during military service: the impact of military sexual trauma,
emotional bullying and physical assault on the mental health and
well-being of women veterans-
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Authors:
Hendrikx, L. J; Williamson, V, Murphy, D.
Pages: 419 - 424
Abstract: IntroductionDespite making up about 11% of the UK military, there remains limited investigation on the impact of adversity women experience during their service in the UK military. Military adversity can result in a range of well-being difficulties that may persist following transition out of military. The present study therefore examined the prevalence and correlates of different types of military adversity (defined as sexual harassment, sexual assault, emotional bullying and physical assault) within a community sample of UK women veterans.MethodsParticipants were recruited from a UK charity supporting women veterans. 750 women veterans completed an online survey collecting information on sociodemographic and military factors, military adversity, as well as mental health and well-being difficulties. Associations between variables were explored using multivariate logistic regressions.ResultsThe findings indicate a high prevalence of military adversity (22.5% sexual harassment, 5.1% sexual assault, 22.7% emotional bullying and 3.3% physical assault). Younger women, those who held an officer rank during service and those who reported having a combat or combat support role during service were most at risk of military adversity. All types of adversity were significantly associated with probable post-traumatic stress disorder. Sexual harassment was additionally significantly associated with physical somatisation; sexual assault with alcohol difficulties; and emotional bullying with common mental health difficulties, low social support and loneliness.ConclusionsThis study indicates that UK women veterans are at risk of a range of adverse experiences during military service and provides evidence of the impact of such adversities on mental health and well-being. Further research is required to better understand these relationships.
Keywords: Editor''s choice, Press releases
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001948
Issue No: Vol. 169, No. 5 (2023)
- Evaluating the psychometric properties of the Grit scale in Marine
recruits using Rasch analysis-
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Authors:
Dijksma, I; Stuiver, M, Lucas, C, Lindeboom, R.
Pages: 425 - 429
Abstract: IntroductionSuccessful completion of initial military training has been suggested to be predicted by physical abilities, cognitive abilities and non-cognitive abilities such as hardiness and grit. This study aimed to assess the psychometric properties of a Dutch version of a grit measurement scale: the NL-Grit scale.MethodsWe assessed the factor structure, unidimensionality of the subscales, discriminative quality of the rating scale and investigated to what extend the items together can reliably measure the entire range of grit levels in Dutch Marine recruits. We used data of Marine recruit training platoons of the Royal Netherlands Marine Corps.ResultsPrincipal component analysis reflected two subscales: ‘consistency of interests’ and ‘perseverance of effort’. Rasch analysis confirmed the unidimensionality of the intended subscales. Rasch rating scale analysis indicated that the five-point response scale was not used as intended by respondents. Disordered rating scale categories were collapsed to obtain ordered rating categories. The item and person parameters (grit levels) largely overlapped, indicating that the item spread was sufficient for measuring the entire range of grit trait levels. However, larger gaps between item location parameters suggested a low discriminative capacity of the NL-Grit scale for respondents with trait levels within the gaps.ConclusionOur evaluation of the NL-Grit scale suggests sound psychometric quality of the NL-Grit in Dutch Marine recruits. Reliability could be improved by adding items to fill the observed gaps in item content.
Keywords: Open access
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001813
Issue No: Vol. 169, No. 5 (2023)
- Sex-specific differences in physical health and health services use among
Canadian Veterans: a retrospective cohort study using healthcare
administrative data-
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Authors:
St Cyr, K; Aiken, A. B, Cramm, H, Whitehead, M, Kurdyak, P, Mahar, A. L.
Pages: 430 - 435
Abstract: IntroductionMilitary occupations have historically been, and continue to be, male dominated. As such, female military Veteran populations tend to be understudied, and comparisons of the physical health status and patterns of health services use between male and female Veterans are limited outside of US samples. This study aimed to compare the physical health and health services use between male and female Veterans residing in Ontario, Canada.MethodsA retrospective cohort of 27 058 male and 4701 female Veterans residing in Ontario whose military service ended between 1990 and 2019 was identified using routinely collected administrative healthcare data. Logistic and Poisson regression models were used to assess sex-specific differences in the prevalence of select physical health conditions and rates of health services use, after multivariable adjustment for age, region of residence, rurality, neighbourhood median income quintile, length of service in years and number of comorbidities.ResultsThe risk of rheumatoid arthritis and asthma was higher for female Veterans compared with male Veterans. Female Veterans had a lower risk of myocardial infarction, hypertension and diabetes. No sex-specific differences were noted for chronic obstructive pulmonary disease. Female Veterans were also more likely to access all types of health services than male Veterans. Further, female Veterans accessed primary, specialist and emergency department care at greater rates than male Veterans. No significant differences were found in the sex-specific rates of hospitalisations or home care use.ConclusionsFemale Veterans residing in Ontario, Canada have different chronic health risks and engage in health services use more frequently than their male counterparts. These findings have important healthcare policy and programme planning implications, in order to ensure female Veterans have access to appropriate health services.
Keywords: Open access
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001915
Issue No: Vol. 169, No. 5 (2023)
- Human pelvis injury risk curves from underbody blast impact
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Authors:
Yoganandan, N; Moore, J, Humm, J. R, Baisden, J. L, Banerjee, A, Pintar, F. A, Barnes, D. R, Loftis, K. L.
Pages: 436 - 442
Abstract: IntroductionUnderbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis.MethodsTwenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings.ResultsAt the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities.ConclusionsThis is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001863
Issue No: Vol. 169, No. 5 (2023)
- Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in
a military tactical plane: a retrospective descriptive study-
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Authors:
Martinez, T; Simon, K, Lely, L, Nguyen Dac, C, Lefevre, M, Aloird, P, Leschiera, J, Strehaiano, S, Nespoulous, O, Boutonnet, M, Raynaud, L.
Pages: 443 - 447
Abstract: After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.
Keywords: COVID-19
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001876
Issue No: Vol. 169, No. 5 (2023)
- Balloons on the battlefield: REBOA implementation in the UK Defence
Medical Services-
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Authors:
Marsden, M. E. R; Buckley, A. M, Park, C, Tai, N, Rees, P.
Pages: 448 - 451
Abstract: Established in 2018, the Defence Endovascular Resuscitation (DefER) group recognised that resuscitative endovascular balloon occlusion of the aorta (REBOA) offered an option to improve survival in battle casualties dying from haemorrhage, particularly in remote and austere surgical settings. Following a successful jHub opportunity assessment, DefER purchased training and operational kit at pace. By 1 April 2019, the first forward surgical group undertook a bespoke endovascular training and assessment package. Results of the pilot were presented back to a jHub 4* Innovation Board, which initially awarded £500 000 to fund the project to full implementation. Med Op Cap provided a solution to establish REBOA as a core capability on to the 370 modules. REBOA catheters and arterial access kit are now available to deployed Role 2 facilities across defence as an adjunct to damage control resuscitation in specific circumstances. REBOA has, from a standing start, gained pan-Defence Medical Services (DMS) endorsement and has been integrated into deployed damage control resuscitation. To establish a new resuscitation capability across all Role 2 platforms within 15 months of inception represents implementation at pace. This agility was unlocked by empowering clinicians to develop the platform in conjunction with commercial procurement. This article describes how this innovative pathway facilitated the rapid introduction of a lifesaving haemorrhage control technique to equip DMS clinicians.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001925
Issue No: Vol. 169, No. 5 (2023)
- Defence Medical Services REBOA training course
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Authors:
Marsden, M. E. R; Park, C, Barratt, J, Tai, N, Rees, P.
Pages: 452 - 455
Abstract: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors’ perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001926
Issue No: Vol. 169, No. 5 (2023)
- Remote ultrasound diagnostics disrupting traditional military frontline
healthcare delivery-
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Authors:
Blenkinsop, G; Heller, R. A, Carter, N. J, Burkett, A, Ballard, M, Tai, N.
Pages: 456 - 458
Abstract: Accurate and reliable diagnostic capability is essential in deployed healthcare to aid decision-making and mitigate risk. This is important for both the patient and the deployed healthcare system, especially when considering the prioritisation of scarce aeromedical evacuation assets and frontline resources. Novel ultrasound tele-guidance technology presents a valuable diagnostic solution for remotely deployed military clinicians. This report discusses the first use of a consultant radiologist guiding a clinician, untrained in ultrasound, to perform an ultrasound scan via a live tele-guidance feed in the deployed environment using the Butterfly iQ+ tele-guidance system. Distance scanning provided a diagnostic quality report when compared with locally performed imaging to improve patient care and maintain operational output. This example demonstrates feasibility of remote point-of-care imaging systems in provision of location-agnostic high-quality diagnostic capability. Future opportunities to develop care pathways using bedside tele-diagnostics will democratise access, drive efficiency and improve patient care experience and outcomes.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001821
Issue No: Vol. 169, No. 5 (2023)
- Can Defence be assured that future civilian specialty training programmes
will produce suitably qualified and experienced military doctors'-
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Authors:
McPhail; S.
Pages: 459 - 462
Abstract: UK Defence’s doctors receive the majority of their pre-accreditation clinical training within the National Health Service’s (NHS) specialty training programmes. These are designed primarily to serve the needs of a civilian patient population and are undergoing changes. Examination of these changes in relation to the training requirements of Defence’s doctors, suggests that future NHS training programmes present both opportunity and threat to the provision of competent military consultants and general practitioners (GPs). Opportunity to more easily integrate military-specific courses, experience and modules will be present in the form of curricula that are more receptive to change and more flexible with respect to time out of programme. This offers definite advantage in terms of ability to robustly equip military doctors with the skills required to serve their future patients. Narrowing scopes of practice and a reduction in acute care exposure for GPs are potential future threats.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001963
Issue No: Vol. 169, No. 5 (2023)
- Parenteral medications at Role 1: do doctors in the British Army require
improved training and experience'-
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Authors:
Turner, L. J; Martin-Bates, A. J.
Pages: 463 - 468
Abstract: Role 1 doctors in the British Army work predominantly in primary healthcare, but also provide prehospital emergency care and administer potent parenteral medications in the field. Role 1 doctors have theoretical training in the use of these medications on short courses but then have little refresher training and use them infrequently in their routine practice, introducing the risk of skill fade. This may lead to higher rates of medication errors in an environment where the consequences may be significant. This article explores the current training of Role 1 doctors, the threat of skill fade and how the safety of drug administration can be improved. This includes recommendations for the development of training competencies, bespoke courses and clinical placements, e-learning and the use of new technology. Application of these recommendations has the potential to improve patient safety and the confidence of doctors in the use of parenteral analgesia.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001841
Issue No: Vol. 169, No. 5 (2023)
- Developing the military GP using immersive simulation in specialty
training-
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Authors:
King, K; Smith, M.
Pages: 469 - 473
Abstract: Military general practice requires wider knowledge and more diverse skillset than that defined by the Royal College of General Practitioners curriculum. Following completion of specialty training, military general practitioners (GPs) were returning from mostly civilian training environments feeling deskilled and ill-prepared for their military role. The Academic Department of Military General Practice defined the training gap and used co-creative curriculum development to incorporate military topics throughout the GP specialty training programme. Simulation was identified as a key teaching method employed throughout undergraduate and postgraduate health professional education, which could be used to improve the trainee’s learning. The resulting operational preparedness training week used layered teaching methods and feedback to build trainees’ knowledge and skills before a final major immersive simulation exercise. This article describes the educational design process in terms of the ‘10 goal conditions’ described by Issenberg for high-fidelity medical simulations leading to effective learning.
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001964
Issue No: Vol. 169, No. 5 (2023)
- COVID-19: responding to a pandemic on Operation TORAL
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Authors:
Webster, S; Gough, A, Riley, M. R, Makin, S.
Pages: 475 - 478
Abstract: Operation TORAL was the UK’s contribution to NATO’s Operation RESOLUTE SUPPORT in Kabul, Afghanistan. Approximately 1000 British troops were deployed in Kabul when the arrival of the COVID-19 pandemic in Afghanistan was declared. This article will describe the challenges faced due to COVID-19 in Kabul.Medical planning considerations, occupational health issues, implementation of behaviour change and operating as part of a multinational organisation are all discussed, with challenges encountered detailed and potential solutions offered. The use of a suggested framework for ensuring the medical estimate process covered all areas relevant to an emerging viral pandemic —the 4Ds and 4Cs approach—proved particularly useful in the early stages of the pandemic in Afghanistan.
Keywords: COVID-19
PubDate: 2023-09-22T04:14:25-07:00
DOI: 10.1136/bmjmilitary-2021-001911
Issue No: Vol. 169, No. 5 (2023)
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Hybrid journal (It can contain Open Access articles)
