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The 2014 West Africa Ebola crisis: lessons from UK Defence Healthcare Engagement in Sierra Leone. 2014 年西非埃博拉危机:英国国防医疗在塞拉利昂参与的经验教训。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2023-002665
Mohammed Boie Jalloh, J A Round

The 2014 West Africa Ebola virus disease outbreak prompted the deployment to Sierra Leone of non-governmental organisations and the UK Joint Inter-Agency Taskforce including personnel from the UK Defence Medical Services (DMS). Some of these military personnel partnered with the Republic of Sierra Leone Armed Forces (RSLAF) as an example of Defence Healthcare Engagement (DHE).UK DMS mentors assisted RSLAF to plan and upscale Ebola treatment units. Use of military analysis and planning tools facilitated robust and flexible plans to be produced while under significant time and resource constraints. Macrosimulation exercises enabled large numbers to be trained and standard operating procedures to be developed.Fundamental to success was a mutual respect between the DHE partners while maintaining host nation primacy throughout. DHE in this example offered advantages over non-governmental organisations. Transferable lessons for future DHE from the RSLAF-UK DMS partnership are described in this paper.

2014 年西非爆发埃博拉病毒疾病,促使非政府组织和英国机构间联合工作队(包括英国国防医疗服务局(DMS)人员)部署到塞拉利昂。其中一些军事人员与塞拉利昂共和国武装部队(RSLAF)建立了伙伴关系,这是国防医疗参与(DHE)的一个范例。使用军事分析和规划工具有助于在时间和资源严重紧张的情况下制定稳健而灵活的计划。成功的关键在于 DHE 合作伙伴之间的相互尊重,同时始终保持东道国的主导地位。这个例子中的 DHE 比非政府组织更具优势。本文介绍了从塞拉利昂共和国武装部队-英国 DMS 伙伴关系中获得的可供未来 DHE 借鉴的经验。
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引用次数: 0
Ethical tensions in delivering Defence Engagement (Health). 国防参与(健康)中的伦理矛盾。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2022-002318
Martin Bricknell, J Kelly

This paper considers the potential ethical tensions in the conduct of Defence Engagement (Health) (DE(H)) activities. Multiple academic papers have described the ethical dimensions of topics such as 'medical rules of eligibility', cultural differences in clinical behaviour when providing mentoring support to military health professions, MEDCAPS (non-emergency primary care clinics by international military medical personnel direct to the indigenous civilian population) and military medical collaboration with the civilian public health system and humanitarian organisations. After a short summary of principles and perspectives in military healthcare ethics (MHE), this paper considers the ethical risks of DE(H) activities at the strategic, operational and tactical level. The paper closes by discussing how to prepare military healthcare personnel for ethical challenges during DE(H) tasks. This includes considering the wider legal, professional, societal and public health perspectives alongside clinical perspectives in the analysis of an MHE issue. In conclusion, potential MHE issues during DE(H) activities are predictable and personnel should be trained to identify and address them. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Healthcare Engagement.

本文探讨了在开展国防参与(卫生)(DE(H))活动中可能存在的伦理紧张关系。多篇学术论文阐述了 "医疗资格规则"、为军事卫生专业提供指导支持时临床行为的文化差异、MEDCAPS(国际军事医务人员直接为当地平民提供的非紧急初级保健诊所)以及与民用公共卫生系统和人道主义组织的军事医疗合作等主题的伦理层面。在简要概述了军事医疗伦理(MHE)的原则和观点之后,本文从战略、行动和战术层面探讨了 DE(H)活动的伦理风险。最后,本文讨论了如何让军事医疗保健人员做好准备,以应对在执行 DE(H)任务过程中遇到的伦理挑战。这包括在分析 MHE 问题时,在考虑临床观点的同时,还要考虑更广泛的法律、专业、社会和公共卫生观点。总之,在医疗救护(DE)活动中,潜在的 MHE 问题是可以预见的,应培训人员识别和解决这些问题。本文是《BMJ 军事健康》专刊 "国防医疗参与 "的一部分。
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引用次数: 0
Role of nutrition in human performance in military populations. 营养对军事人员表现的作用。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2022-002311
Jonathan M Scott, P A Deuster

The role of nutrition and performance is well established. Service members' physical and cognitive performance, sleep and mood are impacted by nutritional choices. Although many eating patterns have emerged, consensus among experts recommend a dietary pattern focused on predominantly whole plant-based foods. Adequate intakes of fruits, vegetables, whole grains, beans, legumes, nuts and seeds should be prioritised. Implementation of strategic and intentional fuelling strategies around times of activity maintain adequate energy stores, enhance recovery and protect against training injuries. Carbohydrates are prioritised before, during and after activity or a mission, although the type and amount will vary based on duration and intensity of activity. Protein is generally the focus after activity or a mission and may be included before activity depending on individual tolerance. There are no specific recommendations for fat consumption before, during and after exercise that will improve performance. That said, Service members generally tolerate low-fat meals/snacks prior to exercise, limit fat intake during exercise, may include fat as part of the post exercise meal/snack, and generally consume most fat during the maintenance and growth phase. Careful consideration and planning for food and fluid requirements should be made when Service members are exposed to heat, cold and/or altitude. Operational rations are formulated to meet the nutritional needs of all Service members across a variety of diverse climates, environments and altitudes. Service members may use dietary supplements to improve their performance and need to be aware of available resources to help them make informed decisions.

营养和工作表现的作用已得到公认。军人的体能和认知能力、睡眠和情绪都会受到营养选择的影响。尽管已经出现了许多饮食模式,但专家们一致建议以全植物性食物为主的饮食模式。应优先摄入充足的水果、蔬菜、全谷物、豆类、豆类、坚果和种子。在活动前后实施有策略、有目的的补充燃料策略,以保持充足的能量储备,促进恢复并防止训练受伤。碳水化合物在活动前、活动中和活动后或执行任务时都是优先考虑的,但种类和数量会根据活动时间和强度而有所不同。蛋白质通常是活动或任务后的重点,也可根据个人的耐受性在活动前摄入。对于运动前、运动中和运动后如何摄入脂肪以提高运动表现,目前还没有具体的建议。尽管如此,军人在运动前一般都能耐受低脂餐/点心,在运动中限制脂肪摄入,可在运动后的餐/点心中加入脂肪,一般在维持和生长阶段摄入的脂肪最多。当军人暴露在高温、寒冷和/或高海拔环境中时,应仔细考虑和规划食物和液体需求。作战口粮的配方可满足所有军人在不同气候、环境和海拔条件下的营养需求。服役人员可能会使用膳食补充剂来改善其表现,因此需要了解可用的资源,以帮助他们做出明智的决定。
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引用次数: 0
Delivering effective Defence Engagement (Health): lessons from Operation TRENTON (South Sudan). 提供有效的国防参与(卫生):从 TRENTON 行动(南苏丹)中汲取的经验教训。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2022-002319
Martin Bricknell, T Rowland

This paper describes the Defence Engagement (Health) (DE(H)) component of the medical mission within the UK deployment to South Sudan under Op TRENTON, the UK troop contribution to the United Nations Mission in South Sudan (UNMISS). The DE(H) activities provided advice and mentoring to the Vietnamese military medical services to support the predeployment preparation and training of their medical contingent that would undertake a relief in place of the UK personnel providing a Level 2 hospital in Bentiu, South Sudan. The paper describes these UK DE(H) activities at the strategic, operational and tactical levels to show the integration across these levels from January 2017 until the handover of command in South Sudan on 26 October 2018. The UK worked alongside personnel from the US and Australian military medical services to deliver a Field Training Exercise and other capability-building events for personnel from the Vietnamese 175 Military Hospital. The paper shows how a DE(H) programme can have strategic effects by bringing another nation into a United Nations mission, increasing UK diplomatic activity with a partner country, and by ensuring continuity of medical cover to a key UNMISS location after the withdrawal of the UK medical contingent. This paper forms part of a special issue of BMJ Military Health dedicated to DE(H).

本文介绍了在英国向联合国南苏丹特派团(UNMISS)派遣的部队 "特伦顿行动 "中,英国向南苏丹部署的医疗任务中的 "国防参与(卫生)"(DE(H))部分。DE(H)活动为越南军事医疗服务提供建议和指导,以支持其医疗特遣队的部署前准备和培训,该医疗特遣队将代替英国人员在南苏丹本提乌提供二级医院。本文从战略、行动和战术层面介绍了英国 DE(H)的这些活动,以展示从 2017 年 1 月到 2018 年 10 月 26 日在南苏丹移交指挥权期间这些层面的整合情况。英国与美国和澳大利亚军事医疗服务人员合作,为越南 175 军事医院的人员提供了野战训练演习和其他能力建设活动。本文展示了 DE(H)计划如何通过将另一个国家引入联合国特派团、增加英国与伙伴国的外交活动以及确保英国医疗特遣队撤离后南苏丹特派团关键地点医疗保障的连续性而产生战略效果。本文是《英国医学杂志》军事健康专刊 DE(H) 的一部分。
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引用次数: 0
Exploring the global health and defence engagement interface. 探索全球卫生与国防参与的界面。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2023-002497
John Whitaker, R Rickard, A Leather, J Davies

Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. While the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. While there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.

军队在全球卫生方面发挥着重要且不可避免的作用,并将在部署中与现有的卫生系统对接。虽然军队的主要关切不是全球卫生,但全球卫生活动与国防利益一致的情况显而易见,而且日益频繁。认识到全球卫生与安全之间的这种联系,就需要在影响两者的关切相互交叉时进行深思熟虑并采取行动。除了在行动中为军事人员提供医疗支持外,作为国防参与的一部分,军事医疗活动也可直接产生有利影响。虽然军队在全球卫生领域的作用存在局限性和伦理界限,但仍有必要开展进一步的培训、研究和概念开发,以优化安全与全球卫生交叉领域的军事医学活动,从而产生有利影响。本文是《英国医学杂志》(BMJ)军事卫生专刊 "国防参与 "的一部分。
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引用次数: 0
Operational patient care pathway: building pragmatic medical interoperability through health engagements. 病人护理操作路径:通过卫生参与建立务实的医疗互操作性。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2024-002702
Thomas Falconer Hall, R Wilson, C Chacksfield, S T Horne

The future operational demand for medical support in Western militaries will likely outstrip available resources, necessitating burden-sharing through medical interoperability with allies and partners. However, the current North Atlantic Treaty Organization (NATO) model of interoperability through standardisation, while achieving high levels of commonality and integration along the operational patient care pathway (OPCP), is high-cost and resource-intensive. We have termed this model assured interoperability. Assured interoperability, while applicable to well-established partnerships with high-resource nations, is unlikely to be feasible when working with resource-limited partners or, potentially, when in a sustained conflict with a near-peer adversary. In these circumstances, there will be a requirement to develop a far less resource-intensive model of medical interoperability with lower levels of commonality, assurance and standardisation than assured interoperability, but that provides a 'good enough' OPCP for the operational context. We have termed this pragmatic interoperability. By considering these two types of interoperability, the complete continuum of medical interoperability can be mapped with the full spectrum of partners demonstrating increasing levels of interoperability from pragmatic through to assured interoperability, integrateability and interchangeability, reducing the gap between demand and provision of medical support for operations, increasing operational resilience. This is a paper commissioned as a part of the Defence Engagement special issue of BMJ Military Health.

西方国家军队未来对医疗支持的作战需求很可能会超过现有资源,这就需要通过与盟国和合作伙伴的医疗互操作性来分担负担。然而,目前北大西洋公约组织(NATO)通过标准化实现互操作性的模式,虽然在病人护理操作路径(OPCP)上实现了高度的共通性和一体化,但成本高且资源密集。我们将这种模式称为有保障的互操作性。有保障的互操作性虽然适用于与资源丰富的国家建立的良好合作关系,但在与资源有限的合作伙伴合作时,或者在与近邻对手发生持续冲突时,有保障的互操作性不太可行。在这种情况下,就需要开发一种资源消耗少得多的医疗互操作性模式,其通用性、保证和标准化程度要低于有保证的互操作性,但能为作战环境提供 "足够好 "的 OPCP。我们称之为实用互操作性。通过考虑这两种类型的互操作性,可以绘制出医疗互操作性的完整连续体,从实用互操作性到有保障的互操作性、可集成性和可互换性,所有合作伙伴都能展示出不断提高的互操作性水平,从而缩小行动医疗支持的需求与提供之间的差距,提高行动的应变能力。本文是《英国医学杂志》军事健康版 "国防参与 "特刊委托撰写的一篇论文。
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引用次数: 0
One Health: opportunities for Defence Engagement (Health). 一个健康:国防参与的机会(健康)。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2024-002708
Rebecca L Graves, J Whitaker, K Clay

The One Health concept continues to gain traction as a necessary approach to tackle emerging threats to human, animal and environmental health but has not yet been adopted within Defence Engagement (Health). The health of humans, animals and ecosystems are closely interlinked. The One Health concept recognises this interdependence and seeks to balance and optimise the health of all three through an integrated and unifying approach. With a focus on zoonoses, vectorborne disease, antimicrobial resistance and food safety it encourages collaboration, communication, coordination and capacity building. The UK has made commitments to the One Health approach in the Global Health and Security Agenda, and the Integrated Review. This article explores how the One Health approach could and should be adopted within Defence Engagement (Health) activity to offer the potential for high-impact, low-risk activity while facilitating long-term relationship building.

作为应对人类、动物和环境健康面临的新威胁的必要方法,"一个健康 "概念继续受到重视,但尚未在国防参与(卫生)中采用。人类、动物和生态系统的健康密切相关。统一健康 "概念承认这种相互依存关系,并寻求通过综合统一的方法来平衡和优化三者的健康。它重点关注人畜共患病、病媒传播疾病、抗菌药耐药性和食品安全,鼓励合作、沟通、协调和能力建设。英国已在《全球健康与安全议程》和《综合审查》中对 "一体健康 "方法做出承诺。本文探讨了 "一个卫生 "方法如何能够并应该在国防参与(卫生)活动中采用,以提供高影响、低风险活动的潜力,同时促进长期关系的建立。
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引用次数: 0
Defence Engagement (Health): a historical perspective. 国防参与(卫生):历史视角。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2023-002412
Thomas Falconer Hall, K Attridge

Defence Engagement (DE) (Health) themes are reviewed in this paper through two historical perspectives set in very different contexts. The first-person narrative in Guerrilla Surgeon by Lindsay Rogers outlines the experience of a medical officer building capacity with Tito's Partisans behind enemy lines in Second World War Yugoslavia. This is contrasted with a more academic evaluation of strategic and medical benefits of DE (Health) delivered by the US military during the Vietnam War in Robert Wilensky's Military Medicine to Win Hearts and Minds: Aid to Civilians in the Vietnam War Both texts infer that clear objectives, supported by effective strategic communication, are required for the impact of DE (Health) to be fully realised. Wilensky, in particular, noted that the US military medical effort in Vietnam had no measurable impact on health or political goals in the conflict. Rogers' experience on a more individual level speaks to the promise of DE (Health) delivery contrasted against the lack of regional objectives and cites the loss of British influence when Soviet propaganda was more cohesive and coordinated, resulting in the shift in Partisan loyalty despite British efforts in supplying the bulk of military and medical material. While neither author offers a definitive guide on DE (Health), they offer clear examples of themes that should be considered and demonstrate the importance of evaluating activity and maintaining the historical record to provide an evidence base for future work. This is an article commissioned for the Defence Engagement special issue of BMJ Military Health.

本文通过两个背景截然不同的历史视角,对国防参与(DE)(健康)主题进行了回顾。林赛-罗杰斯(Lindsay Rogers)在《游击外科医生》(Guerrilla Surgeon)一书中以第一人称的叙述方式,概述了第二次世界大战期间南斯拉夫敌后铁托游击队中一名医务官员的能力建设经历。罗伯特-威伦斯基(Robert Wilensky)的《赢得人心的军事医学》(Military Medicine to Win Hearts and Minds)对美军在越战期间提供的医疗保健服务的战略和医疗效益进行了更具学术性的评估:这两本书都推断,要想充分发挥发展(健康)教育的影响,就必须有明确的目标,并辅以有效的战略沟通。威伦斯基特别指出,美军在越南的医疗工作对冲突中的健康或政治目标没有产生可衡量的影响。罗杰斯(Rogers)在个人层面上的经验则表明,尽管英国为越南提供了大量的军事和医疗物资,但在缺乏地区目标的情况下,DE(健康)的交付前景却不容乐观,他还提到,当苏联的宣传更具凝聚力和协调性时,英国的影响力也随之丧失,导致游击队的忠诚度发生变化。虽然两位作者都没有提供关于 DE(卫生)的权威指南,但他们提供了应考虑的主题的明确例子,并证明了评估活动和保留历史记录的重要性,从而为未来工作提供证据基础。本文是受委托为《BMJ 军事健康》国防参与特刊撰写的文章。
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引用次数: 0
Medics as influencers: a historical analysis of British Army military medical exercises in Kenya over two decades. 作为影响者的医务人员:二十年来英国军队在肯尼亚军事医疗演习的历史分析。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2023-002442
Patricia Falconer Hall, T Falconer Hall, Z Bailey, S T Horne

Introduction: Annual British Army medical training exercises have run in Kenya since the early 1990s, initially with a dual purpose-to deliver the Kenyan Extended Programme of Immunisation (in remote locations) and to undertake austere training. This provided a specific response to a capability gap request from the partner nation, but as this gap closed, the exercise changed in various ways. This study aimed to qualitatively explore the impact of these exercises on the Kenyan healthcare system and the influence and relationships between the nations.

Methods: Semistructured interviews were conducted for 10 former senior commanders and medical officers who had deployed in key command and clinical positions from 1993 to 2019. Three researchers conducted thematic content analysis on the key-informant interviews.

Results: Five domains with 18 subdomains formed the study's analysis framework. 16 recurring themes were identified and placed into four categories that denote if they were of benefit to the engagement, enabled success, had the potential to cause harm or were a barrier to successful engagement. Three distinct phases of the exercise were identified: supporting Kenyan vaccinations, direct clinical care, training and education.

Conclusions: This is the first qualitative analysis of the impact of a British Defence Engagement (Health) on the partner nation and UK influence gained through it. It has identified factors which may improve outcomes, namely, ensuring sustainability and continuity between iterations; maintaining enduring stakeholder relationships; responding to a capability gap request; intelligence-led planning with incorporated assessment, monitoring and evaluation; adapting to changes in needs or contextual settings; while ensuring mutual benefit in objective setting. These may be used as the basis for a conceptual framework supporting the planning and execution of high-quality, mutually beneficial Defence Engagement (Health) activities in future. This framework and future research would also benefit from gaining perspectives from the partner nation.

导言:自 20 世纪 90 年代初以来,英国陆军每年都在肯尼亚进行医疗培训演习,最初有两个目的--(在偏远地区)实施肯尼亚扩大免疫计划和进行艰苦训练。这是对伙伴国提出的能力差距要求的具体回应,但随着差距的缩小,演习也发生了各种变化。本研究旨在从定性角度探讨这些演习对肯尼亚医疗保健系统的影响以及两国之间的影响和关系:对 1993 年至 2019 年期间曾在重要指挥和临床岗位上工作的 10 名前高级指挥官和医务官员进行了半结构化访谈。三位研究人员对关键信息访谈进行了主题内容分析:五个领域和 18 个子领域构成了本研究的分析框架。确定了 16 个重复出现的主题,并将其分为四类,分别表示这些主题是否有利于参与、促成成功、有可能造成危害或成为成功参与的障碍。确定了活动的三个不同阶段:支持肯尼亚疫苗接种、直接临床护理、培训和教育:这是首次定性分析英国国防参与(卫生)对伙伴国的影响以及英国通过参与获得的影响力。它确定了可改善结果的因素,即确保迭代之间的可持续性和连续性;保持持久的利益相关者关系;响应能力差距请求;以情报为主导的规划,并纳入评估、监测和评价;适应需求或背景环境的变化;同时确保目标设定的互利性。这些可作为概念框架的基础,支持今后规划和执行高质量、互利的防务参与(卫生)活动。这一框架和未来的研究还将受益于伙伴国的观点。
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引用次数: 0
Defence Engagement (Health) between the UK and Ireland since the Good Friday Agreement in 1998. 自 1998 年《耶稣受难日协议》签署以来,英国与爱尔兰之间的防务接触(卫生)。
IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-19 DOI: 10.1136/military-2023-002657
A J L Moore, B McCrory, A Corcoran, N Guckian, S Bergin, C McCloskey, M Bricknell, J Kelly

This paper describes the range of Defence Engagement (Health) (DE(H)) activities between Northern Ireland and Ireland following the Good Friday Agreement in April 1998. Although the Agreement made provision for cross-border cooperation in health, the Omagh bombing of August 1998 energised the discussion to provide greater co-ordination of future responses to mass casualty events. The paper describes these DE(H) activities at the Strategic, Operational and Tactical levels to show the integration across these levels and between the agencies of both governments. The paper shows how a DE(H) programme can have a successful strategic effect by finding topics of mutual interest that can bring together two countries in order to provide an effective health and social care provision. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement (.

本文介绍了 1998 年 4 月《耶稣受难日协议》签署后,北爱尔兰和爱尔兰之间开展的一系列防卫参与(卫生)(DE(H))活动。尽管《协定》对跨境卫生合作做出了规定,但 1998 年 8 月的奥马爆炸事件激发了对未来应对大规模伤亡事件进行更多协调的讨论。本文件从战略、行动和战术三个层面介绍了 DE(H)活动,以展示这些层面之间以及两国政府机构之间的整合情况。本文展示了 DE(H)计划如何通过寻找共同感兴趣的主题,使两国携手提供有效的医疗和社会保健服务,从而产生成功的战略效果。本文是《英国医学杂志》(BMJ)军事卫生专刊 "国防参与"(defence Engagement)的一部分。
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引用次数: 0
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Bmj Military Health
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