Bmj Military Health最新文献

Background: The role of a Defence General Practitioner (DGP) is beyond the scope of an NHS GP due to their extended role that includes clinical leadership, pre-hospital emergency medicine, occupationally focussed primary care, operational medicine and force health protection.

Aim: To develop a Defence-specific mental health (MH) curriculum for DGPs.

Methods: This study is a two-step process using DGPs and Defence psychiatrists: step one developed a draft curriculum based on Royal College of General Practitioners (RCGP) guidance with supplemental material from the literature and internal Defence policy. Step two used a Delphi process to reach a consensus on the final curriculum.

Results: A 43-point curriculum comprising seven learning objectives (LOs), each with explanatory training objectives (TOs), was produced. One proposed objective was removed in the last round of the Delphi. Round one had 87 responses, with 23 objectives agreed. Round two had 25 responses and 10 objectives agreed. Round three saw the remaining 10 objectives agreed by 16 responses. These objectives represent a consensus of what is expected of DGPs in the management of MH problems.

Conclusion: The defined DGP MH curriculum differs from the core RCGP curriculum. It will aid the development and delivery of DGP education, supporting the MH treatment options within Defence.

Introduction: Emergency donor panels (EDPs) provide a source of prescreened whole blood donors when there is a requirement for transfusion with no other sources of blood available. Transfusion of group O blood with a low titre of anti-A and anti-B haemolysins (OLO) reduces the risk of haemolytic transfusion reactions. There has been no large-scale investigation of UK service persons (SPs) with OLO blood. The aim of the current study was to investigate the proportion of UK SPs with OLO blood available for donation over a 5-year period and to identify proportion and reasons for deferral of donors at screening.

Methods: A retrospective observational study was undertaken reviewing the UK Centre of Defence Pathology EDP screening database between May 2019 and April 2024. Potential donors completed a questionnaire to determine suitability for donation, and if unsuitable, were deferred. Data obtained included EDP date, ABO group, rhesus status, antibody screen results, infectious disease serology and donor questionnaire outcomes (if deferred, the reason for this).

Results: There were 121 EDP screening sessions, including 3329 donor screening episodes. There were 582/3329 donors (17.5%) deferred. The most common donor cause was recent tattoos (n=113). After all exclusions, there were 2372 potential donors and 1265 (53.3%) were group O. 14 were excluded because there were no anti-A/anti-B haemolysin titres recorded. 869/1251 (69.5%) of the remaining group O participants had low titres, that is, OLO blood (36.6% of all potential donors). Only 143/1251 (11.4%) of group O participants were both OLO and rhesus negative (6% of all potential donors). There were two activations of EDPs on operations.

Conclusions: 17.5% of all potential donors were deferred after screening. Of those eligible for donation, 36.6% were OLO but only 6% were OLO and rhesus negative. These data may be used to inform future medical planning for operations.

Introduction: There are unique ethical challenges faced by evaluators of military health engagement (MHE) activities. Existing ethical frameworks provide important evaluation considerations but are either (1) not applicable to the breadth of activities that MHEs may involve or 2) do not adequately address ethical considerations necessary in a military setting.

Methods: The article examines the shortcomings of literature pertaining to existing ethical frameworks and presents a survey of principles that evaluators supporting MHEs may find germane to their work. These principles-accountability and integrity, beneficence, respect, systematic inquiry and competence and undue influence-are drawn from multiple frameworks and were selected for their relevance to evaluation in the context of MHE.

Results: When considered in tandem, the five selected principles provide a provisional framework that accommodates the specific needs of evaluators while also addressing the distinct ethical considerations required of the military. Alongside each principle, practical guidance is offered to assist military personnel in navigating ethical dilemmas they may encounter in theatre and ensure their evaluations are rigorous, accurate and unbiased.

Conclusions: No single ethical framework sufficiently captures the needs of evaluators supporting an MHE; however, select principles from multiple frameworks will capably aid an evaluator in such a setting. Going forward, those charged with evaluating MHEs should consider the proposed principles when conducting research to make certain that evaluations are both ethically and empirically sound.

In response to Ukrainian-identified training gaps in the Ukrainian Armed Forces Special Operations Forces (UAF SOF) medical evacuation chain, NATO SOF medical elements developed the Prolonged Evacuation Transport Team (PETT) training programme. The PETT programme provides critical knowledge and skills to Ukrainian SOF medical personnel to increase survivability and decrease morbidity during contested or prolonged evacuation. The bespoke 3-week curriculum uses components of existing US Joint Trauma System products. Medical professionals, such as paramedics, feldshers and nurses, excelled in the full curriculum, resulting in requests for serial iterations of the programme. However, those with limited medical training (1-3 weeks) faced a steeper learning curve. This finding revealed a requirement for the development of a truncated version of PETT, termed Prolonged Critical Lifesaving Skills. The PETT programme successfully advanced UAF SOF's medical capabilities and established a model for future standardised training in contested environments with prolonged evacuation timelines.

Introduction: Lower limb musculoskeletal injuries (MSKIs) are a leading cause of reduced operational capability and medical discharge in UK military personnel. Late-stage rehabilitation (LSR) is critical for restoring function and readiness for return to duty (RTD) yet remains under-represented in research and clinical guidelines. This service evaluation examines current practices, perspectives and challenges among UK Defence rehabilitation practitioners and physical training instructors (PTIs) in delivering LSR and facilitating RTD for lower limb MSKIs.

Methods: A cross-sectional survey was distributed to UK Defence rehabilitation practitioners and Army PTIs. The survey collected demographic, quantitative and qualitative data on LSR exercises, outcome measures, RTD criteria and perceived challenges. Quantitative data were analysed descriptively; qualitative responses were examined using inductive content analysis.

Results: 157 responses were received across all services and levels of care, with respondents averaging 8 years of clinical experience. LSR commonly included resistance training, plyometrics, running and load carriage. PTIs most frequently reported low cardiovascular fitness as a deficit persisting after rehabilitation. A range of outcome measures was used to guide progression and RTD; however, there was inconsistency regarding their relevance and application across all branches of the UK military. Only 48% of rehabilitation practitioners reported using a formal RTD criteria, while 78% used structured handover tools. Common challenges included time constraints, limited access to resources and low patient compliance and confidence.

Conclusion: LSR and RTD practices for lower limb MSKIs are variable across military rehabilitation settings. There is a clear need to balance standardisation with individualised care based on patient needs and occupational roles. Clear role delineation and communication between rehabilitation practitioners and PTIs are essential during the transition phase. Addressing persistent challenges such as limited time, resources, deconditioning, rehabilitation compliance and psychological readiness may improve LSR effectiveness.

Introduction: Overuse musculoskeletal injuries (MSKIs), including tendinopathies, are the most common types of MSKIs experienced by US active-duty military service members (ADSMs). There are limited granular tendinopathy prevalence data in military populations. Thus, we describe tendinopathy prevalence among ADSM and quantitatively compare tendinopathy prevalence by military and demographic factors.

Methods: A retrospective cohort study using the Medical Assessment and Readiness System database to identify tendinopathies among newly entering service members between January 2016 and December 2020 (n=2,456,739). All study procedures were exempted from institutional review board oversight. Prevalence ratios and 95% CIs not containing 1.00 were considered statistically significant.

Results: A total of 37,434 service members were diagnosed with tendinopathy, representing a crude prevalence of 1.52%. The lower extremity was the most common site of tendinopathy, accounting for 80.33% of all cases, with the majority of diagnoses in the Army and Marines. Prevalence varied most by age, military career and service, with junior enlisted having higher rates of lower extremity tendinopathies. As military careers progressed from enlisted to officer, we noted proportionally more upper extremity diagnoses.

Conclusions: Tendinopathy remains a significant burden on the US military population. The lower extremity is the most commonly affected region, particularly in junior enlisted roles. The data highlight key trends related to age, military career and service branch, providing essential information to guide targeted prevention efforts and clinical interventions aimed at reducing the impact of these injuries.

Scorpions are venomous arthropods with a wide geographical footprint and are endemic throughout all UK Armed Forces operational areas outside of Northern Europe. Scorpion stings are common on military exercises and operations. Here, we present a narrative review summarising epidemiological data pertaining to scorpions in geographical areas of contemporary operational relevance to the UK Armed Forces and suggest evidence-based treatment recommendations suitable for use in a military environment, providing an update to the last detailed review in 2008. The overwhelming majority of stings will result only in local pain and can be managed with analgesia at Role 1 medical treatment facilities. The risk of severe envenoming is greatest in the Middle East. Children and pregnant women are at increased risk of severe envenoming which most commonly manifests as hypertensive crisis. These patients should be evacuated to hospital care and managed supportively in a critical care environment.

Introduction: Carrying heavy loads and body armour may alter posture and increase the risk of low back pain in military personnel. This observational study aimed to assess how two designs of body armour affect posture and pain in German soldiers following loaded marches.

Methods: In this prospective observational study, 20 soldiers (male healthy volunteers) completed three 12-km marches under three conditions: without body armour (control), with old-design armour and with new-design armour featuring a hip belt. Spinal posture (forward trunk lean as primary outcome) and pain were assessed using video rasterstereography and visual analogue scales before and after each march.

Results: Significant differences in forward trunk lean were observed with new-design armour compared with control (mean difference 6.1 mm, p=0.006) and old-design armour (mean difference 5.4 mm, p=0.046). Pain increased significantly after marching with old-design armour (lumbar pain: p<0.01; thoracic pain: p=0.01), but not with the new-design armour.

Conclusion: Body armour design notably affects spinal posture and pain. Although the new design increased forward trunk lean, it did not significantly increase pain, suggesting potential ergonomic advantages.