Journal of the Royal Army Medical Corps最新文献

In September 2017, the British Government called on the military to deliver aid and provide assistance to British Overseas Territories in the Caribbean affected by the devastating category 5 Hurricane, Irma.1 The military and humanitarian operation, named Op RUMAN, saw British military personnel from all services deploy at short notice to assess damage, reinstate vital infrastructure and help islanders get back on their feet as quickly as possible. Members of the Deployed Aeromedical Response Team Squadron (DARTS) were among the first troops deployed to the region. The aim of this paper is to describe the role of DARTS within this Op.

Operation RUMAN was the British government's combined military and humanitarian operations to provide relief to the British Overseas Territories in the Caribbean. This paper provides a short summary of the role played by environmental health during the operation and the importance of environmental health considerations at all stages of disaster management.

The management of focal radiation burns after prolonged exposure to ionising radiation remains a relatively rare but significant therapeutic challenge. This narrative aims to highlight certain aspects of management that can be overlooked and mitigation strategies in the management of these potentially fatal injuries.

Increases in the number of women in critical positions on military missions place new demands for specialised healthcare services to promote performance. The main health problems servicewomen facing are musculoskeletal injuries, reproductive diseases, iron deficiency and mental health problems. Herein, we propose several suggestions based on the rich experiences of our hospital. First is to offer preventive measures for servicewomen health. Second is to equip servicewomen with portable medicine packet to treat common diseases. Third is to provide people-centred integrated care.

Introduction: Intense military operations during deployment or training are associated with elevations in inflammatory cytokine markers. However, the influence of an inflammatory response on military-specific skills is unclear. This study examined the association between brain-derived neurotrophic factor (BDNF), glial fibrillar acidic protein, markers of inflammation, marksmanship and cognitive function following a week of intense military field training.

Methods: Twenty male soldiers (20.1±0.6 years; 1.78±0.05m; 74.1±7.9kg) from the same elite combat unit of the Israel Defense Forces volunteered to participate in this study. Soldiers completed a five-day period of intense field training including navigation of 27.8km/day with load carriages of ~50% of their body mass. Soldiers slept approximately fivehours per day and were provided with military field rations. Following the final navigational exercise, soldiers returned to their base and provided a blood sample. In addition, cognitive function assessment and both dynamic and static shooting (15 shots each) were performed following a 200 m gauntlet, in which soldiers had to use hand-to-hand combat skills to reach the shooting range.

Results: Results revealed that tumour necrosis factor-α (TNF-α) concentrations were inversely correlated with dynamic shooting (r=-0.646, p=0.005). In addition, a trend (r=0.415, p=0.098) was noted between TNF-α concentrations and target engagement speed (ie, time to complete the shooting protocol). BDNF concentrations were significantly correlated with the Serial Sevens Test performance (r=0.672, p=0.012).

Conclusion: The results of this investigation indicate that elevated TNF-α concentrations and lower BDNF concentrations in soldiers following intense military training were associated with decreases in marksmanship and cognitive function, respectively.

We present a case of a fit and well British Army officer with sudden-onset chest pain following a viral illness, on a background of arduous skiing over an 8-week period. This resulted in a 6-month downgrade with no clearly defined plan for return to full fitness and deployability. The diagnosis and differentiation of myopericarditis from other causes of chest pain is reviewed. The treatment and management of myopericarditis is summarised and commentary is made on the paucity of evidence underpinning the return to fitness guidelines. The impact of this condition primarily affecting young fit individuals, commonly exacerbated by viral illness and arduous activity, is discussed in the context of individual employability and operational capability in a military setting.

Introduction: Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice.

Methods: A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use.

Results: Based on interpretation of the limited available evidence, five key recommendations are made: pulse oximetry should be continuous and initiated as early as possible; oxygen should be available to all trauma and medical patients in the forward operating environment; if peripheral oxygen saturations (SpO₂) are greater than or equal to 92%, supplemental oxygen is not routinely required; if SpO₂ is less than 92%, supplemental oxygen should be titrated to achieve an SpO₂ of greater than 92%; and if flow rates of greater than 5 L/min are required, then urgent evacuation and critical care support should be requested.

Conclusion: Oxygen is not universally required for all patients. Current guidelines aim to prevent hypoxia but with potentially conservative limits. Oxygen should be administered to maintain SpO₂ at 92% or above. New areas for research, highlighted in this review, may provide a future approach for oxygen use from point of injury to definitive care.