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- Medical support in Space Commands, the next frontier
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Frassini, J; Kral, P, Toth, Z. Pages: 105 - 108 PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2021-001780 Issue No: Vol. 168, No. 2 (2022)
- Endotracheal tube fixation time: a comparison of three fixation methods in
a military field scenario-
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Epstein, D; Strashewsky, R, Furer, A, Tsur, A. M, Chen, J, Lehavi, A. Pages: 109 - 111 Abstract: IntroductionEndotracheal intubation is required in many emergency, trauma and prehospital scenarios. Endotracheal tube (ETT) fixation must be stable and quick to apply to enable rapid evacuation and patient transport. This study compares performance times of three common ETT securement techniques which are practical for out-of-hospital and combat scenarios.MethodsWe compared the time required by military medics to complete ETT fixation in three techniques—fixation of a wide gauze roll wrapped twice around the head and tied twice around the ETT (GR), using a Thomas Tube Holder (TH) and using a pre-tied non-adhesive tape (PT). 300 military medics were randomised to apply one technique each on a manikin, and time to completion was recorded.Results300 ETTs were successfully fixated by 300 military medics. Median times to complete ETT fixation by PT and TH techniques were 24 s (IQR (19 to 31) and (IQR 20 to 33), respectively). Both were significantly shorter to apply than the GR technique, with a median time of 57 s (IQR 47 to 81), p PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001402 Issue No: Vol. 168, No. 2 (2022)
- Determining the psychophysiological responses of military aircrew when
exposed to acute disorientation stimuli-
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Tornero Aguilera, J. F; Gil-Cabrera, J, Clemente-Suarez, V. J. Pages: 112 - 116 Abstract: IntroductionExposure to enviromental flight conditions may impair performance and physical integrity, thus training in simulated environments it is a key factor. This research aimed to study the psychophysiological response, cortical arousal and autonomic modulation of pilots and medical aircrew personnel during disorientation exposure, considering gender, experience, flying hours and body mass index (BMI) as influencial variables.MethodsA total of 47 soldiers (37 men and 10 women, 22 medical aircrew personnel and 25 fighter pilots) of Spanish Air Forces faced 25 min of vestibular, proprioceptive and visual disorientation.ResultsDisorientation exposure elicited an increased psychophysiological response, significant increases in isometric hand strength, cortical arousal, autonomic modulation, perceived stress and effort in both groups while a significant decrease in respiratory muscle capacity and blood oxygen saturation in the medical aircrew group were found. Cross-sectional analysis showed gender differences, males presented greater parasympathetic activity and strength. Larger BMI was associated with greater levels and perception of stress as well as lower cardiovascular performance and sympathetic modulation. Furthermore, experience, previous training and larger flying hours correlated with greater parasympathetic modulation.ConclusionDisorientation exposure produces an increase in cortical arousal and decrease in the parasympathetic nervous system either in pilots and medical aircrew personnel. In addition, medical aircrew personnel are less adapted to disorientation stimulus presenting significantly higher psychophysiological stress response, thus complementary physical training should be mandatory. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001417 Issue No: Vol. 168, No. 2 (2022)
- Vitamin C supplementation reduces the odds of developing a common cold in
Republic of Korea Army recruits: randomised controlled trial-
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Kim, T. K; Lim, H. R, Byun, J. S. Pages: 117 - 123 Abstract: IntroductionThe Republic of Korea (ROK) military has a high incidence of respiratory diseases at training centres. Vitamin C has been reported to reduce the incidence of colds. For the purpose of preventing soldiers' respiratory diseases, this study aimed to investigate whether vitamin C intake can prevent common colds in the ROK Army soldiers.MethodsThis was a randomised, placebo-controlled, and double-blind trial of soldiers who enlisted in the Korea Army Training Centre for 30 days from 12 February to 13 March 2018. The study participants were divided into groups (vitamin C vs placebo). The military medical records were searched to determine whether the participants had a common cold. Multiple logistic regression analysis was performed to identify the association between vitamin C intake and diagnosis of common colds. In addition, subgroup analysis on the relationship between vitamin C intake and common cold according to smoking status, training camp and physical rank was conducted.ResultsA total of 1444 participants were included in our study. Of these participants, 695 received vitamin C (6000 mg/day, vitamin C group), while 749 participants received placebo (0 mg/day, placebo group). The vitamin C group had a 0.80-fold lower risk of getting a common cold than did the placebo group. Subgroup analyses showed that this effect was stronger among subjects in camp A, among never smokers and among those in physical rank 3.ConclusionVitamin C intake provides evidence to suggest that reducing the common colds in Korean Army soldiers. Our results may serve as a basis for introducing military healthcare policies that can provide vitamin C supplementation for military personnel in basic military training. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2019-001384 Issue No: Vol. 168, No. 2 (2022)
- Ballistic gelatin calibration standardisation
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Pullen, A; Kieser, D. C, Hooper, G. Pages: 124 - 127 Abstract: IntroductionA review of ballistic gelatin calibration standards has highlighted that data used from studies with different calibrations methods may not be able to be compared. Calibration of ballistic gelatin did not occur until the mid-1980s when Fackler recognised the deficiencies of uncalibrated gelatin. He determined that the calibration standard should be 85±5 mm of ball bearing penetration for a 180 m/s impact velocity. This study looks to improve on and optimise current ballistic gelatin calibration standardsMethodsNine 0.177 cal (4.5 mm) spheres were fired using a Daisy Powerline air rifle at velocities between 134 m/s and 224 m/s at 25 gelatin blocks (n=225). Velocities were measured using an Oehler Model 36 Chronograph with three Model 57 screens. Depth of penetration (DoP) was measured from the entry surface to the back end of the sphere via a Mitutoyo Absolute vernier calliper.ResultsThe R-squared regression model showed that all batches had a close fit to the regression line. Using the R-squared regression model, the equation y=0.584x – 20.02 (where x is the velocity) returned a DoP of 84.918 mm for a 180 m/s impact and therefore needed minimal adjustment to align with Fackler’s 85 mm DoP. The equation can be adjusted to y=0.584x – 20.12 to return a DoP of 85 mm for 180 m/s.ConclusionsWe propose that the calibration standard of ballistic gelatin with 4.5 mm spheres is DoP=0.584x – 20.12 where DoP is the depth of penetration (mm) and x is the impact velocity (m/s), The measured DoP should be within 5% of the calculated DoP. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001430 Issue No: Vol. 168, No. 2 (2022)
- Irish Defence Forces combat medical technician training: experience of a
novel university medical school-based programme-
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Loughman, S; Berry, C, Hickey, P, Kerr, G. M, Bury, G. Pages: 128 - 131 Abstract: AimsThis study explores the opinions and experiences of Irish Defences Forces’ (IDF) graduates from University College Dublin’s Diploma in Military Medicine Care (DMMC). It aims to identify which aspects of medical education are relevant for the development of military graduates in the role of Combat Medical Technician (CMT) in future.MethodsA validated Clinical Learning Environment Score tool was adapted and incorporated into an online survey. This was sent electronically to 71 graduates. Responses were anonymous.Results38 (54%) graduates responded. Student feedback was positive regarding teaching and clinical placements in the DMMC. In total 16 (42%) students reported use of their new skills in their daily work. Of the 9 (24%) deployed overseas, all used their new skills. Emergency and occupational health skills were used more frequently, while advanced skills were used rarely.ConclusionAn increased emphasis on frequently used skills should be considered. Links to healthcare services would be of benefit to graduates in skills maintenance. Key advanced skills, such as intravenous cannulation and advanced airway management are rarely used but mechanisms to maintain them will improve the relevance of the programme to the CMT role. A change in how the IDF acknowledges qualifications may support more graduates in advancing and maintaining their career in the military medical workforce. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001429 Issue No: Vol. 168, No. 2 (2022)
- Prevalence and severity of periodontal disease among Spanish military
personnel-
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Barcena Garcia, M; Cobo Plana, J. M, Arcos Gonzalez, P. I. Pages: 132 - 135 Abstract: IntroductionPeriodontal disease ranges from simple gums inflammation to major damage to the periodontal tissues, even losing teeth. Severe periodontitis has a world overall prevalence of 11.2%. These are evaluated with periodontal probes and oral epidemiological indices. Our aim is to estimate the prevalence and severity of periodontal disease of a Spanish military population according to the 2013 WHO criteria.MethodsObservational study of prevalence carried out in a representative random sample of 221 military staff from the Spanish Army base ‘Conde de Gazola’. Prevalence was estimated by calculating the Community Periodontal Index modified, loss of attachment, Plaque Index and Gingival Bleeding Index measured with a third-generation electronic ‘Pa-on’ periodontal probe.ResultsAverages of probing depth, recession and clinical attachment level were 2.17, 0.19 and 2.36 mm. Plaque and gingival bleeding indices were 71% and 40.3%. All subjects bled in some tooth after probing. 3.6% of subjects had no periodontal pockets, 58.8% mild periodontal pockets and 37.1% severe periodontal pockets. All had some loss of attachment, 52% mild loss of attachment and 47.5% severe loss of attachment. Teeth present with and without bleeding were 24.4 (86.5%) and 3.6 (13.1%). 28% of teeth had periodontal pockets and 40.4% loss of attachment. Sextant averages with periodontal pockets and loss of attachment were 2.79 and 3.56.ConclusionsOur plaque and gingival bleeding indices were high and we found a higher prevalence and severity of periodontal disease than other Spanish and foreign military populations. This could be related to differences in context, life habits and insufficient dental hygiene. Keywords: Open access PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001419 Issue No: Vol. 168, No. 2 (2022)
- One out of four recruits drops out from elite military training due to
musculoskeletal injuries in the Netherlands Armed Forces-
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Dijksma, I; Zimmermann, W, Hertenberg, E.-J, Lucas, C, Stuiver, M. Pages: 136 - 140 Abstract: IntroductionMusculoskeletal injuries (MSIs) are among the main causes of dropout from military training. The main purpose of this study was to provide an overview of dropout rates and MSI incidence rates during elite military training. Second, this study aimed to explore restricted training days due to MSIs and to describe MSI-care by military physicians.MethodsIn a retrospective observational study, we collected dropout rates and injury surveillance data from the electronic patient records of two elite units of the Netherlands Armed Forces (NAF): the Royal Netherlands Marine Corps (RNLMC) and the Airmobile Brigade (AMB), from 1 January 2015 until 31 December 2017.ResultsIn the RNLMC, total dropout rate was 53.9% and dropout due to MSIs was 23%. The most frequently affected locations were foot, knee and leg. In the AMB total dropout rate was 52.6% and dropout due to MSIs was 25%. In the AMB, the most frequently affected locations were back, knee and leg. Average restricted training days due to MSIs ranged between 8.3 and 20.8 days/injury. MSI-care by military physicians consisted mostly of the provision of injury-specific information and (self-)management options, imposing a specific activity restriction and referral to physiotherapy.ConclusionOur study findings showed that one out of four recruits who dropout from elite military training in the NAF, do so due to MSIs. Redesigning training programmes with the objective to reduce MSIs should be given high priority, as this may reduce dropout substantially. Keywords: Open access PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001420 Issue No: Vol. 168, No. 2 (2022)
- Regular strength training and baseline fitness in overweight infantry
members of Slovenian Armed Forces-
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Vodicar, M; Kovcan, B, Pori, P, Vodicar, J, Simenko, J, Karpljuk, D, Markovic, G, Hadzic, V. Pages: 141 - 145 Abstract: IntroductionThe prevalence of overweight subjects in military cohorts increases despite the obligatory army physical fitness test (APFT) requirements and the negative consequences of possible test failure due to the increased body mass index (BMI). Studies that have examined the association of BMI with baseline fitness in the military are showing conflicting evidence. The primary aim of the study is to examine BMI effects on baseline fitness that was measured by APFT and additional functional performance tests (FT) (vertical countermovement jump with and without load, loaded prone plank, single-leg hamstring bridge test and pull-ups). Our secondary goal is to explore if regular strength training modifies the BMI effect on baseline fitness.MethodsA cross-sectional study on a sample of 118 male infantry soldiers that have performed APFT and FT was carried out. Body mass and body height measurements were used to calculate BMI, and to categorise participants into BMI ranks. Two independent categorical variables (BMI rank and strength training) were used to evaluate their influence on dependent variables of physical performance acquired from APFT and FT.ResultsA significantly large size effect of BMI rank (F=1.69, p=0.037; effect size (ES)=0.15) and regular strength training (F=2.66, p=0.006; ES=0.21) on physical performance was found. It was shown that strength training had a medium ES on push-up and pull-up performance, as well as on the overall APFT score and loaded plank.ConclusionsThe importance of regular strength training and normal BMI for better overall baseline fitness in infantry members was highlighted. Most importantly, it was shown that performance is not affected in overweight soldiers who are performing regular strength training in addition to their daily physical training.Trial registration number NCT03415464 PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001451 Issue No: Vol. 168, No. 2 (2022)
- Understanding sexual offences in UK military and veteran populations:
delineating the offences and setting research priorities-
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Authors: Morgan L. Pages: 146 - 148 Abstract: Recent publications have highlighted the need to address inappropriate behaviours, including discrimination, bullying and sexual harassment, within the British Armed Forces; however, no UK work to date pays sufficient attention to sexual offences as defined by the Sexual Offences Act (2003). In trying to ascertain prevalence, nature and consequences of sexual offences in military and veteran populations, one is faced with majority United States (US) research with different definitions of offences, different populations and different research methods. These and UK publications use various terminology, often ill-defined and used interchangeably (eg, harassment, abuse, violence, assault, trauma), meaning it is not always clear what is being discussed, and the criminal acts of sexual offences have become lost, oversimplified and blurred by their incorporation into wider discussions of sexual harassment and inappropriate behaviour. As a result, there is lack of clarity around the topic, and insufficient recognition and weight is given to the nature and complexity involved in understanding sexual offences and their consequences. It is important to distinguish between different types of unlawful behaviour: each are associated with different physical and psychological health outcomes for victims, and management of perpetrators will differ. Some behaviours will be managed through education and awareness programmes; other behaviours necessitate a prison sentence. This article highlights that understanding sexual offences in military and veteran populations is more complex than existing UK publications have acknowledged, and sets out some of the issues that research needs to consider if we are to develop prevention and management strategies. Keywords: Editor''s choice PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001453 Issue No: Vol. 168, No. 2 (2022)
- The UK defence anaesthesia experience with the Zambia Anaesthesia
Development Programme-
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Davies, R. L; Boyd, M, Lewin, I. J, Duffield, C, Woolley, T. G, Hall, D. P, Coley, E. Pages: 149 - 152 Abstract: For 18 months UK military anaesthetic trainees have been travelling to Zambia for a 3-month fellowship under the auspices of the Zambia Anaesthesia Development Programme. In this article we will discuss the history, current state and future intent of the fellowship in order to better inform the anaesthetic cadre and wider UK Defence Medical Services. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001464 Issue No: Vol. 168, No. 2 (2022)
- Caring for the carers: a COVID-19 psychological support programme
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Lamb, D; Simms, A, Greenberg, N, Withnall, R. D. J. Pages: 153 - 159 Abstract: The outbreak of COVID-19 and the subsequent pandemic brought unprecedented worldwide challenges born out of a rapidly escalating health and economic crisis. From emergency planners to healthcare workers on the front line, and everyone in between, the pandemic, and the uncertainty surrounding it, was likely to become a significant stressor, one with no immediate solution but with the potential to cause enduring distress beyond its conclusion. The UK Defence Medical Services recognised the need to provide an evidence-based programme of care intended to support personnel transitioning from assisting the national response back to normal duties. This was informed by a narrative review that targeted literature exploring strategies for supporting the mental health and well-being of healthcare workers during 21st-century infectious disease outbreaks. The literature identified the experiences most likely to cause enduring distress, which comprised morally challenging decisions, vulnerability, death and suffering, professional and personal challenges, and expectations. The opportunity to find meaning in these experiences, by discussing them with peers who share a contextual understanding, is important to limit the longer-term psychosocial impact of such events. This paper will discuss the design considerations and planned implementation strategy of the Recovery, Readjustment and Reintegration Programme to limit the incidence of distress or longer-term mental ill health among military personnel. Keywords: COVID-19 PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2021-001854 Issue No: Vol. 168, No. 2 (2022)
- Establishing communicable disease surveillance systems
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Falconer Hall, T; Ross, D. A. Pages: 160 - 165 Abstract: Humanitarian emergencies can result in an increase of communicable diseases, leading to a rise in mortality and/or morbidity in vulnerable populations. This requires a public health approach to re-establish control of communicable disease. Communicable disease surveillance systems play a key role, providing the information required for disease control measures, through systematic data collection, analysis, interpretation and dissemination. In humanitarian emergencies, they use the principles, practices and processes of wider surveillance systems, while being more focused on urgent priorities. However, communicable disease surveillance systems in humanitarian emergencies are constrained by multiple environmental, epidemiological and sociopolitical factors. Basic data collection, the bedrock of surveillance systems, can be extremely challenging and may require additional methods to estimate population size and prioritise diseases. Surveillance systems may be operating in conditions of weak state capacity with little physical or institutional infrastructure to support their operation. However, there are examples of successful self-sustaining disease surveillance systems in these circumstances, such as the deployment of WHO’s Early Warning Alert and Response System in a Box. Individuals and organisations charged with establishing communicable disease surveillance systems in emergencies would be well advised to learn from recent examples of success, use the sources of planning guidance outlined in this article and seek advice from organisations with recent experience. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2021-001803 Issue No: Vol. 168, No. 2 (2022)
- Risk factors for mental ill health in UK Army personnel: an overview
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Ross, D; Mackay, D. F, Bergman, B. P. Pages: 166 - 172 Abstract: Women in the UK military are more commonly diagnosed with a mental health disorder than men, but the reasons for this difference are not fully understood. This literature review identifies the risk factors for mental ill health in military personnel before serving, during service and as a veteran. The interaction of risk factors is complex and, in some cases, may be synergistic, such as experiencing adverse events in childhood and exposure to combat. Identification of risk factors allows further research to better understand differences between men and women, and the impact of these risk factors on army personnel. In turn this will inform better preventive strategies, which could be targeted at the primary, secondary or tertiary levels. PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2020-001679 Issue No: Vol. 168, No. 2 (2022)
- Efficacy of mirror therapy and virtual reality therapy in alleviating
phantom limb pain: a meta-analysis and systematic review-
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Rajendram, C; Ken-Dror, G, Han, T, Sharma, P. Pages: 173 - 177 Abstract: IntroductionAmputations result from trauma, war, conflict, vascular diseases and cancer. Phantom limb pain (PLP) is a potentially debilitating form of chronic pain affecting around 100 million amputees across the world. Mirror therapy and virtual reality (VR) are two commonly used treatments, and we evaluated their respective success rates.MethodsA meta-analysis and systematic review was undertaken to investigate mirror therapy and VR in their ability to reduce pain levels. A mean difference (MD) model to compare group pain levels pretreatment and post-treatment via aggregating these results from numerous similar studies was employed. Meta-analysis was conducted using RevMan (V.5.4) and expressed in MD for visual analogue scale (VAS) score.ResultsA total of 15 studies met our search criteria; they consisted of eight mirror therapy with 214 participants and seven VR including 86 participants, totalling 300 participants. Mean age ranged from 36 to 63 years, 77% male, of which 61% were lower body amputees. Both led to a VAS reduction (mirror therapy mean reduction VAS score was 2.54, 95% CI 1.42 to 3.66; p PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2021-002018 Issue No: Vol. 168, No. 2 (2022)
- First German aeromedical evacuations in Mesopotamia during the Great War
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Schwarzkopf, K; Schwarzkopf, C. Pages: 178 - 178 PubDate: 2022-03-25T07:59:08-07:00 DOI: 10.1136/bmjmilitary-2021-001858 Issue No: Vol. 168, No. 2 (2022)
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