Journal of the Royal Army Medical Corps最新文献

The Defence Medical Services aims to provide gold standard care to ill and injured personnel in the deployed environment and its prehospital emergency care (PHEC) systems have been proven to save lives. The authors have set out to demonstrate, using existing literature, consensus and doctrine that the NHS Skills for Health framework can be reflected in military prehospital care and provides an existing model for defining the levels of care our providers can offer. In addition, we have demonstrated how these levels of care support the Operational Patient Care Pathway and add to the body of evidence for the use of specialist PHEC teams to allow the right patient to be transported on the right platform, with the right medical team, to the right place. These formalised levels allow military planners to consider the scope of practice, amount of training and appropriate equipment required to support deployed operations.

Hepatitis A virus (HAV) is a major cause of acute viral hepatitis, which can lead to severe cases and acute liver failure. A 41-year-old Chinese military officer of the United Nations peacekeeping forces in South Sudan manifested fever, jaundice and coagulation dysfunction. The patient initially had a negative anti-HAV IgM antibody test result but a positive anti-HAV-IgM antibody test result five days after his alanine aminotransferase (ALT) levels peaked. He was given telemedicine consultation and was transferred to a Chinese military hospital specialising in infectious diseases for treatment of severe acute HAV infection. The peak ALT, aspartate aminotransferase, total bilirubin and international standard ratio were 5410 U/L, 3475 U/L, 225.1 µmol/L and 2.12 during hospitalisation, respectively. Military personnel undergoing missions in areas with high prevalence of HAV should be tested for previous HAV infection before departure if they have not been previously vaccinated. If negative results are obtained, they should be vaccinated. Anti-HAV-IgM examination should be repeated after the first negative test result is obtained to eliminate the effects of a window period if a clinical suspicion exists. If a life-threatening case of HAV infection is present, the patient should be transported to a base military hospital specialising in infectious diseases for treatment.

Background: Having served more than 4000 personnel including the peacekeeping troops, UN police and civilian staff, the Chinese Peacekeeping Level 2 Military Hospital has accumulated 1235 inpatient medical records in 4 years. Assessment of the records stored in the CHN L2 identified that the data collected by different teams were incoherent and highlighted the need for implementation of a hospital-based combat injury registry and the establishment of a combat injury surveillance system.

Methods: A one-page, 21-item registry form was designed to collect general information about the injuries, including such data as demographics, injury event, severity, diagnosis and treatment, and outcome. All relevant personnel was required to undergo a 2-day training in order to master the use of the registry form. The new registry form was used to collect the data on all of the cases recorded in the CHN L2 between 26 April 2014 and 31 March 2017.

Results: Analysis of the collected data identified improvised explosive device as the most common (44.95%) mechanism of combat injury in Sector East of MINUSMA. Anefis, the centre of the UN logistic transit, was identified as the location where most of the combat injuries (42.20%) occurred. Based on these results, certain suggestions that addressed this threat were given to the Operation department in Sector East of MINUSMA.

Conclusion: A hospital-based combat injury registry was successfully developed and implemented in the Chinese Peacekeeping Level 2 Hospital. It can provide data to support the policy changes to minimise the impact of combat injuries on peacekeeping troops. The designed registry form provides more accurate estimates of the magnitude of the morbidity due to different causes in the battlefield and lays a foundation for an injury surveillance system.

Objectives: To record the activation and use of the Eastern Sovereign Base Area (ESBA) emergency ambulance service of British Forces Cyprus between 1 September 2013 and 31 August 2016. To reflect on these findings in light of data from 1995 to 1998 to identify current treads and areas of development.

Method: Retrospective epidemiological study of all activations of the ESBA emergency ambulance service within the study period.

Results: 812 patients were treated over 3 years, an 80% increase in workload, of which 41% were entitled personnel. Forty-two per cent of activations were for medical complaints compared with 41% for trauma. The number of deaths remained static (n=15). Road traffic incidents (RTI) remain the top activation by type, but accounting for a smaller proportion of workload. RTI mortality has declined by 50%.

Conclusion: The ESBA emergency ambulance service responded to double the activations, when compared with 18 years ago, with a significant shift to medical cases over trauma. This ESBA emergency ambulance provides a varied and vital service for the local community that also benefits Defence Medical Services personnel interested in the Pre-Hospital Emergency Medicine environment in order to maintain clinical skills and currency for the benefit of future deployments, both humanitarian and kinetic in nature.

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations.

Methods: During the EVTM workshop (September 2017, Örebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test.

Results: Consultants had significantly better overall technical skills in comparison with residents (p=0.005), while understanding of surgical anatomy showed no difference. Procedure times differed significantly (p<0.01), with residents having a median procedure time of 3 min and 24 s, consultants 2:33 and instructors 1:09.

Conclusion: This comprehensive training model using a live tissue-simulator hybrid porcine model can be used for femoral access and REBOA placement training in medical personnel with different prior training levels. Higher levels of training are associated with faster procedure times. Further research in open and percutaneous access training is necessary to simulate real-life situations. This training method can be used in a multistep training programme, in combination with realistic moulage and perfused cadaver models.

Background: Operation of infantry combat vehicle (ICV) influences the cardiorespiratory responses as well as the risk of vibration exposure on the crew members which adversely affect their performance and health.

Aim: To assess the effect of stress factors, that is, ICV's compartmental temperature, relative humidity (RH) and vehicular vibration on the physiological parameters (heart rate (HR), respiratory frequency (RF), estimated core body temperature (ECT)) of the crew members during the ICV operation.

Methods: A 1 hour run trial of the ICV operation was conducted with its crew members at their respective positions. Compartmental temperature and RH were monitored at an interval of every 15 min during the run trial. Physiological parameters were monitored continuously during the run trial. Whole body vibration (WBV) and hand-arm vibration (HAV) of the crew members were also measured during the run trial time.

Results: The findings showed a strong positive correlation (p<0.05) between the increasing compartmental temperature and RH with its run trial time. Significant changes were observed in the physiological parameters (p<0.05) along with the increasing run trial time. Additionally, the physiological parameters showed a strong positive correlation with compartmental temperature and RH, respectively (p<0.05). Also, a significant increase (p<0.05) in the muscle strength was recorded after their exposure to ICV operation. The study also confirmed high level of WBV exposure of the crew members during the ICV operation.

Conclusion: Increase in HR, RF and ECT along with increase in temperature and RH is a predictive indicator of physiological stress. Moreover, high levels of vibration exposure of various operations may bring deleterious effect on soldiers' health as well as their performance. Proper ergonomic intervention can reduce exposure to vibration, physiological stress and increase comfort which may ultimately ensure an optimum performance of soldiers and successful completion of mission.

Introduction: Primary blast lung injury (PBLI) is a prominent feature in casualties following exposure to blast. PBLI carries high morbidity and mortality, but remains difficult to diagnose and quantify. Radiographic diagnosis of PBLI was historically made with the aid of plain radiographs; more recently, qualitative review of CT images has assisted diagnosis.

Methods: We report a novel way of measuring post-traumatic acute lung injury using CT lung density analysis in two casualties. One casualty presented following blast exposure with confirmed blast lung injury and the other presented following extremity injury without blast exposure. Three-dimensional lung maps of each casualty were produced from their original trauma CT scan. Analysis of the lung maps allowed quantitative radiological comparison exposing areas of reduced aeration of the patient's lungs.

Results: 45% of the blast-exposed lungs were non-aerated compared with 10% in the non-blast-exposed lungs.

Discussion: In these example cases quantitative CT lung density analysis allowed blast-injured lungs to be distinguished from non-blast-exposed lungs.

Introduction: UK Ministry of Defence (MOD) policy and strategy recommend the use of a 'Defence MODified' version of the Health and Safety Executive Management Standards Indicator Tool to help managers identify risks of work-related stress among Defence personnel. The Defence MODified Tool ('Stress Indicator Survey') asks personnel to rate their perceptions of eight working conditions known to be significantly associated with work-related stress. MOD psychologists are developing a Defence norm group against which future survey scores can be compared. This article describes the use of the Stress Indicator Survey in MOD and gives an overview of findings from 2016 to 2018.

Method: MOD psychologists conducted 27 Stress Indicator Surveys in 2016-2018. Data were collated from 6227 personnel for the Defence norm group and comparisons were conducted between Service personnel and MOD civil servants, and between Services (Royal Navy/Royal Marines (RN/RM), Army and Royal Air Force (RAF)).

Results: Service personnel had significantly more favourable perceptions than MOD civil servants of most working conditions. The RN/RM had significantly more favourable perceptions than either the Army or the RAF of all working conditions. These findings indicate differential risks of work-related stress in different groups of personnel.

Discussion: Possible explanations for the observed differences in risk of work-related stress are discussed, including the nature of military life and planned changes to Defence civilian headcount. Examples of managerial actions to improve working conditions based on individual survey findings are given.

The Department of Communication and Applied Behavioural Science is one of the three departments in the academic faculty at the Royal Military Academy Sandhurst. The aim of the Department is to equip officer cadets with the skills, knowledge and personal qualities in order for them to develop their own potential, as both individuals and leaders in the British Army. The members of the Department have a range of backgrounds, with most having served in various capacities across UK Defence, both in uniformed and/or civilian crown servant contexts. Several members of the faculty are qualified psychologists, while others have related academic and professional backgrounds. The academic and applied discipline of psychology is the fundamental thread that runs through the various courses and projects delivered by the Department. This paper provides a brief overview of the activities undertaken by the Department, with a specific focus on the psychology components of the academic and applied activities. Although mainly serving in academic teaching roles, this paper illustrates the work of the psychologists outside the classroom, such as via field exercises and deployments overseas. It also touches on the importance of the outreach undertaken by the psychologists in the Department, which supports their ongoing research.