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Journal of the Royal Army Medical Corps
Journal Prestige (SJR): 0.303
Citation Impact (citeScore): 1
Number of Followers: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0035-8665 - ISSN (Online) 2052-0468
Published by BMJ Publishing Group Homepage  [62 journals]
  • Preface to special issue of BMJ Military Health on humanitarian and
           disaster relief operations

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      Authors: Sandhu, A; Breeze, J.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002298
      Issue No: Vol. 168, No. 6 (2022)
       
  • Foreword to the Humanitarian and Disaster Relief Operations special issue
           of BMJ Military Health

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      Authors: Ross D.
      Pages: 405 - 405
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002254
      Issue No: Vol. 168, No. 6 (2022)
       
  • Why humanitarian standards have implications for military support to
           civilians on operations

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      Authors: Horne, S; Court, M.
      Pages: 406 - 407
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001614
      Issue No: Vol. 168, No. 6 (2022)
       
  • Understanding medical civil-military relationships within the
           humanitarian-development-peace 'triple nexus: a typology to enable
           effective discourse

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      Authors: Horne, S; Boland, S.
      Pages: 408 - 416
      Abstract: The interface between humanitarianism, development and peacebuilding is increasingly congested. Western foreign policies have shifted towards pro-active stabilisation agendae and so Civil-Military Relationships (CMRel) will inevitably be more frequent. Debate is hampered by lack of a common language or clear, mutually understood operational contexts to define such relationships. Often it may be easier to simply assume that military co-operation attempts are solely to ‘win hearts and minds’, rather than attempt to navigate the morass of different acronyms. In healthcare, such relationships are common and more complex - partly as health is seen as both an easy entry point for diplomacy and so is a priority for militaries, and because health is so critical to apolitical humanitarian responses. This paper identifies the characteristics of commonly described kinds of CMRel, and then derives a typology that describe them in functional groups as they apply to healthcare-related contexts (although it is likely to be far more widely applicable). Three broad classifications are described, and then mapped against 6 axes; the underlying military and civilian motivations, the level of the engagement (strategic to tactical), the relative stability of the geographical area, and finally the alignment between the civilian and military interests. A visual representation shows where different types may co-exist, and where they are likely to be more problematic. The model predicts two key areas where friction is likely; tactical interactions in highly unstable areas and in lower threat areas where independent military activity may undermine ongoing civilian programmes. The former is well described, supporting the typology. The latter is not and represents an ideal area for future study. In short, we describe an in-depth typology mapping the Civil-Military space in humanitarian and development contexts with a focus on healthcare, defining operational spaces and the identifying of areas of synergy and friction.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/jramc-2019-001382
      Issue No: Vol. 168, No. 6 (2022)
       
  • Comparison between Defence Healthcare Engagement and humanitarian
           assistance

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      Authors: Falconer Hall, T; Horne, S, Ross, D.
      Pages: 417 - 419
      Abstract: Humanitarian assistance and Defence Healthcare Engagement have traditionally both been taught on the Medical Humanitarian Stabilisation Operations Course. However, the two activities are distinct. This paper outlines the critical differences between them, focusing on their specific purposes, scope, timescales and ethics. Humanitarian assistance will remain a distinct activity with a focus on the relief of suffering, guided by international norms, while Defence Healthcare Engagement will encompass a broader range of activities, less constrained by internationally agreed principles. This presents an opportunity for the Defence Medical Services to directly contribute to projecting UK influence, preventing conflict and building stability. However, it requires the Defence Medical Services to take responsibility for the ethical issues that Defence Healthcare Engagement raises. This paper recommends the development of an ethical framework that reconciles the strategic aims of Defence Healthcare Engagement with maximising patient welfare at the tactical level. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      Keywords: Open access
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001437
      Issue No: Vol. 168, No. 6 (2022)
       
  • Protecting the health of responders: Team Health

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      Authors: Ross D.
      Pages: 420 - 422
      Abstract: The rise in humanitarian disasters has led to more volunteers responding to deploy with humanitarian organisations. Those organisations that use these volunteers have a responsibility for the health of these teams of workers. This personal view outlines the three phases of ‘Team Health’—prepare, sustain and recover. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001498
      Issue No: Vol. 168, No. 6 (2022)
       
  • CBRNE3 medicine in the austere environment: the challenges

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      Authors: Smith, M; Weir, A.
      Pages: 423 - 425
      Abstract: Chemical, Biological, Radiological, Nuclear and Explosive/Environmental/Endemic Disease (CBRNE3) incidents encompass a wide spectrum of events from natural events/disasters to industrial accidents through to deliberate military release and nuclear war. The UK military operates globally and in environments that are often austere. The very nature of these environments means that CBRNE3 incidents are a very real risk, and a CBRNE3 incident in a well-developed society could ultimately create an austere environment. Responding to such an event in an austere environment poses challenges.The very nature of the environment may be problematic. It may be very remote with limited or no access by road and/or air. It may have limited resources such as water and infrastructure required to manage the event. Extremes of temperature and weather may pose a risk to casualties and responders alike. Specialist teams and equipment may be required, but the host or partner nations may not have suitable capability and these resources may take time to mobilise from the home base. The volume of equipment and material needed in the response may overwhelm logistical chains which may not be robust enough to withstand the initial incident.Proper planning and preparedness is crucial to operating in and managing a CBRNE3 incident in an austere environment. Recognition of the potential threat by intelligence gathering and recognition by personnel on the ground are essential. This requires an appropriate awareness at all levels of command and appropriate prior training, including interoperability training with partner forces. Ultimately, robust planning and training is key to managing CBRNE3 incidents in an austere environment.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002259
      Issue No: Vol. 168, No. 6 (2022)
       
  • Beyond A to E: addressing the unfamiliar issues arising in the acute and
           immediate phase post-catastrophe

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      Authors: Reckless, A; McPhail, S, Lillington, C, Kingsley-Smith, B.
      Pages: 426 - 430
      Abstract: During a time in which there is increased focus on level 5 and 6 prehospital emergency care provision and utilisation in the deployed military space, it is important to consider the range of care that more junior medical practitioners may be exposed to. The initial response to a catastrophe at a level pertaining to General Duties Medical Officers or similar forward-deployed tri-service personnel comprises acute care and triage skills, which are widely taught through prehospital courses and Foundation training. However, beyond that, the necessary workload becomes less clear. To provide comprehensive care in-theatre, there is the need to consider more nuanced and unfamiliar issues such as components in the immediate postcatastrophe landscape. These include aspects such as care of human remains, mental health, chronic conditions in the acute phase and the scope of military medical assistance within the wider relief effort. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2021-002050
      Issue No: Vol. 168, No. 6 (2022)
       
  • Prehospital emergency care in a humanitarian environment: an overview of
           the ethical considerations

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      Authors: Prescott, T; May, S, Horne, S, Barnard, E.
      Pages: 431 - 434
      Abstract: Recent history has demonstrated that UK Defence personnel can be used, potentially with little notice, in humanitarian disaster zones. The provision of prehospital emergency care (PHEC) in a humanitarian environment requires an innovative approach to overcome the technical challenges of a resource-limited setting. In addition to technical challenges, prehospital practitioners working in a humanitarian environment can expect to be faced with ethically testing situations that they are not familiar with in their usual practice. The organisational and individual ethical decision-making burden can result in significant harms. Therefore, the aim of this paper is to discuss the ethical considerations relevant to providing PHEC during a humanitarian disaster in order that personnel can be more prepared to optimally deliver care. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002201
      Issue No: Vol. 168, No. 6 (2022)
       
  • Health economic evaluation: cost-effective strategies in humanitarian and
           disaster relief medicine

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      Authors: Stewart, T; Bird, P.
      Pages: 435 - 440
      Abstract: The health economic evaluation is a tool used in disaster relief medicine to generate a cost–benefit analysis. Like all areas of healthcare, disaster relief operations must use finite financial resources, much of which comes from charitable donations and foreign aid. Interventions can be assessed using cost-effectiveness tools and equity assessments. Through these tools, interventions that maximise benefit for a given cost are highlighted in the immediate rapid response phase where food, clean water and shelter are prioritised, often with military support. Beyond this, applications of technology and pre-response training are discussed as cost-effective investments made in anticipation of a disaster. In particular, novel technology-based approaches are being explored to deliver medical advice remotely through telemedicine and remote consulting. This strategy allows medical specialists to operate remotely without the logistical and financial challenges of forward basing at the disaster site. Interventions in disaster relief medicine are often expensive. A specific and regularly reviewed health economic assessment ensures that healthcare interventions yield a maximal impact while limiting waste and working within the budgetary constraints of a disaster medicine response. This is a paper commissioned as part of the humanitarian and disaster relief operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2021-001859
      Issue No: Vol. 168, No. 6 (2022)
       
  • Is the continued existence of diseases of poverty an indictment of our
           current humanitarian ethos'

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      Authors: Aldridge R.
      Pages: 441 - 443
      Abstract: The continued existence of diseases of poverty is one of the great medical moral dilemmas of the 21st century. That this group of largely either preventable or treatable diseases still plagues a great many of the world’s poorest citizens is a challenging problem to address. This paper examines diseases of poverty not by looking at the pathogenic diseases themselves but by looking at the ‘diseases’ of society that lead to the prevalence of such morbidity. ‘Diseases’ such as lack of infrastructure, lack of nutrition, lack of education, lack of funding and lack of socioeconomic stability. By addressing each of these, in turn, this paper looks to stimulate thought on how society can approach and prevent diseases of poverty in the future.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001413
      Issue No: Vol. 168, No. 6 (2022)
       
  • Priorities of primary care in disaster medicine

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      Authors: Makin, S; Ross, D.
      Pages: 444 - 448
      Abstract: The role of primary care in a disaster has too often been poorly defined and poorly understood. Due to its relative low-cost adaptability and closeness to the community, primary care can treat across multiple medical domains. By interacting with stakeholders from international data collection, state health bodies and secondary care to community groups, primary care can generate effect. Minimal standards are defined by Sphere guidelines to work within international, national and local frameworks. Evolution of the understanding of primary care in disaster medicine has resulted in a greater emphasis on maintaining outputs. In a disaster, effect is maximised by using strong local and wider resiliency frameworks to enable adaptation to new inputs and outputs while continuing continuity of care while moving through the disaster cycle. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2022-002115
      Issue No: Vol. 168, No. 6 (2022)
       
  • Bioethics in humanitarian disaster relief operations: a military
           perspective

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      Authors: Davies, J; Brockie, A, Breeze, J.
      Pages: 449 - 452
      Abstract: The ethical dilemmas faced every day by military personnel working within the NHS will potentially be very different to ones that will be faced in the wake of a humanitarian disaster. Allied to this the potentially differing objectives from military personnel when compared with other healthcare workers in these scenarios and a conflict of ethics could arise.Within this paper, the fundamentals of this conflict will be explored and how working within the military framework can affect clinical decisions. This is a paper commissioned as a part of the humanitarian and disaster relief operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2021-001927
      Issue No: Vol. 168, No. 6 (2022)
       
  • Specialist infantry and defence engagement

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      Authors: Herron, J. B. T; Heil, K. M, Reid, D.
      Pages: 453 - 456
      Abstract: In 2015, the UK government published the National Strategic Defence and Security Review (SDSR) 2015, which laid out their vision for the future roles and structure of the UK Armed Forces. SDSR 2015 envisaged making broader use of the Armed Forces to support missions other than warfighting. One element of this would be to increase the scale and scope of defence engagement (DE) activities that the UK conducts overseas. DE activities traditionally involve the use of personnel and assets to help prevent conflict, build stability and gain influence with partner nations as part of a short-term training teams. This paper aimed to give an overview of the Specialist Infantry Group and its role in UK DE. It will explore the reasons why the SDSR 2015 recommended their formation as well as an insight into future tasks.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001455
      Issue No: Vol. 168, No. 6 (2022)
       
  • Communicable diseases in humanitarian operations and disasters

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      Authors: Murphy R. J.
      Pages: 457 - 461
      Abstract: Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose—the UK Defence Medical Services have become familiar with tools such as multiplex PCR and mass spectrometry. These have the potential to accurately identify organisms and sensitivity patterns in austere environments. Management of communicable diseases depends on accurate diagnosis and has a largely well-established evidence base but can be limited by a lack of resources and skills in an austere setting, therefore telemedicine can assist diagnosis and treatment of infections by projecting specialist skill. Systems such as EpiNATO2 are useful in monitoring diseases and identifying trends in order to establish control measures. Many of these tools and techniques are effective in austere environments and offer learning opportunities for those providing care in similar settings. Further research is ongoing into diagnostic tools as well as remote management.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001415
      Issue No: Vol. 168, No. 6 (2022)
       
  • Complications with hot, cold and altitude environments in disaster
           management

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      Authors: Bainbridge, A; Wolfe, A, Hartley, M.
      Pages: 462 - 466
      Abstract: IntroductionDisaster management is the process of preparing, responding and recovering to an emergency whether that be natural or man-made. It is a time-consuming, resource-heavy process with the aim of reducing the risk of certain events and, where not possible, reducing the impact of said disaster, ensuring that the risks have been identified and appropriate rescue and recovery plan is in place.MethodsWe carried out a thorough literature search on the complications of hot, cold and altitude environments in disaster management and distilled the learnings into this article.ResultsThe incidence of disasters of natural, man-made and complex origin is likely to continue increasing as global temperatures continue to rise.ConclusionDisaster management in the extreme environments of hot, cold and high altitude is fraught with unique challenges, especially around the physiological response of rescuers, resource constraints and logistics. Recognising these challenges is an important aspect of planning and preparation for disaster management in these environments.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002131
      Issue No: Vol. 168, No. 6 (2022)
       
  • Burns management in the military and humanitarian setting

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      Authors: Sandhu, A; Herron, J. B. T, Martin, N. A.
      Pages: 467 - 472
      Abstract: Burns are an unpredictable element of the modern battlespace and humanitarian operations. Most military burns are small and may not be a significant challenge for deployed healthcare assets but usually render the individual combat ineffective until healed. However, larger burns represent a more significant challenge because of the demand for fluid resuscitation therapy, early surgical intervention and regular wound management that can rapidly deplete surgical capabilities. Beyond the initial injury, longer-term consequences, such as psychological morbidity and loss of functional independence, are rarely considered as part of an ongoing care plan. Globally, most of the morbidity and mortality associated with burns are seen in less economically developed countries and are frequently associated with conflicts and natural disasters, but with simple interventions and resources, outcomes in these environments can be markedly improved. Prehospital providers should be confident to manage the initial assessment of a burn, including triaging for evacuation and packaging for safe transfer. This article provides an overview for prehospital providers on the management of thermal burns in military and humanitarian settings, with additional considerations for the management of chemical and electrical injuries.
      Keywords: Editor''s choice
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001672
      Issue No: Vol. 168, No. 6 (2022)
       
  • Children in a disaster: health protection and intervention

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      Authors: Reid, C; Hillman, C.
      Pages: 473 - 477
      Abstract: Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2021-002010
      Issue No: Vol. 168, No. 6 (2022)
       
  • Emergency first responder management of combat injuries to the torso in
           the military, remote and austere settings

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      Authors: Sandhu, A; Claireaux, H. A, Downes, G, Grundy, N, Naumann, D. N.
      Pages: 478 - 482
      Abstract: Traumatic injuries to the torso account for almost a quarter of all injuries seen in combat and are typically secondary to blast or gunshot wounds. Injuries due to road traffic collisions or violence are also relatively common during humanitarian and disaster relief efforts. There may also be multiple injured patients in these settings, and surgical care may be limited by a lack of facilities and resources in such a non-permissive environment. The first responder in these scenarios should be prepared to manage patients with severe injuries to the torso. We aim to describe the management of these injuries in the military and austere environment, within the scope of practice of a level 5 registered prehospital practitioner.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001460
      Issue No: Vol. 168, No. 6 (2022)
       
  • Foreign intervention following a humanitarian crisis: help versus harm

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      Authors: Betney D. T.
      Pages: 483 - 486
      Abstract: Recent experience of humanitarian and disaster relief efforts have demonstrated the critical importance of the local health infrastructure and its response to a disaster in both the short and long term. With increasing involvement of Foreign Medical Teams (FMT), both military and civilian, in these relief efforts, there is a necessity to review how best a FMT can involve and develop the local response; it is no longer valid to design an intervention insular from the local population. Key themes found in interventions that have damaged the local infrastructure and response include: bypassing, undermining and overstretching local capacities; poaching local staff; aid-fuelled inflation; lack of accountability; developing an intervention that the local population is incapable of providing once the FMT has gone and using the local infrastructure for service delivery for the FMT. Principles written by the Organisation for Economic Co-operation and Development summarise concepts that can be used when designing an intervention so as to avoid damaging the local response and their infrastructure. They focus on involving the local population, understanding the complexities and history of the area and the requirement to develop and instil resilience to future crises.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2020-001423
      Issue No: Vol. 168, No. 6 (2022)
       
  • The History of the Post-Graduate Medical and Nursing Officers (PGMNO)
           course in the British Army

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      Authors: Matthews, J. H; Makin, S, Booker, R. J, Holland, A, K Bhabutta, R, Vassallo, D, Woodhouse, J, Ross, D.
      Pages: 487 - 491
      Abstract: Military medicine has been evolving for over 5000 years of recorded civilisation and conflict. The Army Medical Services performed poorly during the Crimean War and the British Army introduced a professional training course for medical officers in 1860. The Army Medical School and the predecessor of today’s Post-Graduate Medical and Nursing Officers (PGMNO) course have had to adapt to changes in British foreign policy and military requirements. The Army Medical School instigated a rigorous scientific medical training which led to major advances in the study of tropical diseases and trauma medicine. These advances were quickly included in the training of future cohorts. Although the Army Medical School has now closed, the PGMNO course thrives at its new location at the Defence Medical Academy, Whittington. Modern general duties medical officers (GDMOs) must be able to provide medical care in a range of austere environments, including humanitarian relief and conflict zones. New clinicians complete their basic military training before completing the PGMNO course and the Diploma in the Medical Care of Catastrophes. This programme ensures that GDMOs and military nurse practitioners gain a wide knowledge of the latest military and humanitarian medicine. The current era will require clinicians who are competent generalists, who can perform in small teams in dispersed locations. This article summarises the development of the British Army’s PGMNO course and the evolution of its syllabus as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/military-2022-002093
      Issue No: Vol. 168, No. 6 (2022)
       
  • Military provision of maternal care in humanitarian and disaster relief
           operations

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      Authors: Bishop, A; Dewhurst, H.
      Pages: 492 - 497
      Abstract: With three-quarters of the 80 million people in need of humanitarian assistance being women or children in 2014, maternal care makes up a significant burden of medical care in humanitarian assistance and disaster relief operations. Due to lack of infrastructure and up to 80% of these displaced people being located in developing countries, mothers are often extremely vulnerable to disease, abuse and malnutrition. This can lead to late presentations of severe disease and birthing complications that would usually be easily manageable, but are far more complex due to the physical condition of the mother and lack of available resources. The British Armed Forces are often involved in humanitarian assistance and disaster relief either intentionally or due to the nature of the operations they carry out. However, it is not always possible to predict the requirement of maternal care. This humanitarian special edition article focuses on the factors impacting the maternal patient in a humanitarian environment, also looking at common pathologies and ways of managing these in a Role 1 facility. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2021-001993
      Issue No: Vol. 168, No. 6 (2022)
       
  • Review of enteral nutrition practices in critically ill adults in
           resource-limited environments

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      Authors: Carter, C; Senior Lecturer, Notter, J.
      Pages: 499 - 502
      Abstract: Enteral nutrition in critical care is a complex area of practice. A resource-limited environment includes countries that are identified as low income and low/middle income. This review describes three themes for its successful implementation of enteral nutrition in a resource-limited environment. These include identification of patients at risk of malnutrition, using non-commercial feeds and the urgent need to develop practice. Malnutrition is a serious complication of critical illness and remains a crucial aspect of patient care in order to prevent complications. Further evidence to develop sustainable enteral nutrition strategies for critically ill patients is urgently required. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
      PubDate: 2022-11-22T03:30:08-08:00
      DOI: 10.1136/bmjmilitary-2022-002102
      Issue No: Vol. 168, No. 6 (2022)
       
 
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