The largest epidemic of Ebola Virus Disease in recorded human history occurred in West Africa in 2014 and resulted in significant morbidity and mortality. The causative pathogen, Ebola virus, is readily transmitted through contact with the body fluids of infected individuals and from the bodies of those who have died from the disease. In its early stages, the illness is characterised by non-specific symptoms that mimic many other endemic infectious diseases in countries with limited healthcare resources. These factors contributed to the rapid spread of the outbreak, which required an international response in which the UK Armed Forces played an important role. This review describes the clinical presentation, lessons learned from managing the West African outbreak, and potential future treatments.
{"title":"Ebola Virus Disease - clinical manifestations, management and future therapies","authors":"D. O'Brien, M. O’Shea, T. Fletcher","doi":"10.1136/jrnms-105-113","DOIUrl":"https://doi.org/10.1136/jrnms-105-113","url":null,"abstract":"The largest epidemic of Ebola Virus Disease in recorded human history occurred in West Africa in 2014 and resulted in significant morbidity and mortality. The causative pathogen, Ebola virus, is readily transmitted through contact with the body fluids of infected individuals and from the bodies of those who have died from the disease. In its early stages, the illness is characterised by non-specific symptoms that mimic many other endemic infectious diseases in countries with limited healthcare resources. These factors contributed to the rapid spread of the outbreak, which required an international response in which the UK Armed Forces played an important role. This review describes the clinical presentation, lessons learned from managing the West African outbreak, and potential future treatments.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64206909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper highlights the key lessons learned in the care of a critically unwell patient during a contingency operation in a resource-limited environment. These include dealing with vulnerabilities in the re-supply of medications and equipment, treating pathology that is not often seen in young, fit UK military personnel and force protection issues to ensure the maintenance of operational capability. It also highlights the rapid United Nations (UN) response to aeromedical evacuation and some of the challenges of performing a critical care transfer in this environment.
{"title":"Medicine and critical care in contingency operations in the\u0000 resource-limited environment: a case study","authors":"D. O'Brien, J. Jeyanathan, R. Berry, K. Houlberg","doi":"10.1136/jrnms-105-12","DOIUrl":"https://doi.org/10.1136/jrnms-105-12","url":null,"abstract":"This paper highlights the key lessons learned in the care of a critically unwell patient during a contingency operation in a resource-limited environment. These include dealing with vulnerabilities in the re-supply of medications and equipment, treating pathology that is not often seen in young, fit UK military personnel and force protection issues to ensure the maintenance of operational capability. It also highlights the rapid United Nations (UN) response to aeromedical evacuation and some of the challenges of performing a critical care transfer in this environment.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64206910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"“The most humane attention”: patient care and treatment at Haslar,\u0000 1753-1855","authors":"J. Wickenden","doi":"10.1136/jrnms-105-207","DOIUrl":"https://doi.org/10.1136/jrnms-105-207","url":null,"abstract":"","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64207286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is need of a better understanding of body composition profiles in multi-national Navy personnel and their relationship with health and fitness. The aim of this review was to produce a critical assessment of original research addressing body composition in this military branch. Electronic databases PubMed and SPORTDiscus were searched to identify surveys and randomised clinical trials from journal articles and technical reports investigating body composition profiles on Navy populations. Twenty-two studies were selected on the basis of stated inclusion criteria for military surveys and randomised clinical trials. Excepting Navy personnel in special operation force units, data indicated that body composition profiles, as determined by Body Mass Index (BMI) and body fat percentage for Navy personnel, were lower compared to respective Army profiles. BMI values increase from shore to ship deployment, with body composition profiles showing less healthy trends for personnel serving on vessels with limited space, whilst special operation forces do not conform to this pattern, constituting a mission-oriented body composition profile. Body composition profiles in multi-national Navy personnel vary in relation to other military branches, geographical locations, specialty and deployment status. There is a need to validate new body composition techniques so recruitment is based on more representative profiles. Finally, the development of fitness interventions for personnel serving on vessels is deemed absolutely necessary in order to counterbalance health and fitness negative adaptations.
{"title":"A structured review of literature on body composition profiles in Navy\u0000 personnel: current practices and considerations for the future","authors":"K. Havenetidis, A. Bissas","doi":"10.1136/jrnms-105-40","DOIUrl":"https://doi.org/10.1136/jrnms-105-40","url":null,"abstract":"There is need of a better understanding of body composition profiles in multi-national Navy personnel and their relationship with health and fitness. The aim of this review was to produce a critical assessment of original research addressing body composition in this military branch. Electronic databases PubMed and SPORTDiscus were searched to identify surveys and randomised clinical trials from journal articles and technical reports investigating body composition profiles on Navy populations. Twenty-two studies were selected on the basis of stated inclusion criteria for military surveys and randomised clinical trials. Excepting Navy personnel in special operation force units, data indicated that body composition profiles, as determined by Body Mass Index (BMI) and body fat percentage for Navy personnel, were lower compared to respective Army profiles. BMI values increase from shore to ship deployment, with body composition profiles showing less healthy trends for personnel serving on vessels with limited space, whilst special operation forces do not conform to this pattern, constituting a mission-oriented body composition profile. Body composition profiles in multi-national Navy personnel vary in relation to other military branches, geographical locations, specialty and deployment status. There is a need to validate new body composition techniques so recruitment is based on more representative profiles. Finally, the development of fitness interventions for personnel serving on vessels is deemed absolutely necessary in order to counterbalance health and fitness negative adaptations.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64207648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The maiden deployment of HMS QUEEN ELIZABETH (WESTLANT 18) was supported by a Role 2 Afloat (R2A) team. This deployment enabled the first of class fixed wing flying trials for the F35-B Lightning and gave the deployed team the opportunity to establish the R2A capability within the Carrier Strike Group. During the deployment the team engaged in continuous medical education and training. This paper describes the experience of the team utilising in-situ simulation techniques, which had not been used before on a R2A deployment. In particular, a high fidelity in-situ simulation exercise (Ex POSEIDON) was enabled with the support of the US Navy, and the lessons identified from this are described.
{"title":"In-situ simulation: a review of Role 2 Afloat team training in HMS QUEEN ELIZABETH during WESTLANT 18","authors":"G. Bott, J. Matthews","doi":"10.1136/jrnms-105-108","DOIUrl":"https://doi.org/10.1136/jrnms-105-108","url":null,"abstract":"The maiden deployment of HMS QUEEN ELIZABETH (WESTLANT 18) was supported by a Role 2 Afloat (R2A) team. This deployment enabled the first of class fixed wing flying trials for the F35-B Lightning and gave the deployed team the opportunity to establish the R2A capability within the Carrier Strike Group. During the deployment the team engaged in continuous medical education and training. This paper describes the experience of the team utilising in-situ simulation techniques, which had not been used before on a R2A deployment. In particular, a high fidelity in-situ simulation exercise (Ex POSEIDON) was enabled with the support of the US Navy, and the lessons identified from this are described.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64206907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent development of Unmanned Aerial Vehicles (UAVs) and their potential use for casualty evacuation (CASEVAC) has exciting implications for the United Kingdom Defence Medical Services (DMS). When compared to existing technology, the unique attributes of small size, increased manoeuvrability and lack of a human pilot would be extremely useful in congested and hazardous settings. There are ethical and practical considerations to be taken into account, but harnessing the full potential of this technology may improve the chances of survival from some battlefield injuries. UAVs could be of most benefit in a congested and complex battlespace, allowing evacuation of casualties from high risk environments. In addition to CASEVAC, a UAV could be used for critical care transfers, Search and Rescue (SAR) and Humanitarian And Disaster Relief (HADR) operations. Given the vast array of potential applications and a lower risk profile compared with current CASEVAC platforms, the DMS should actively monitor the development of UAV technology and plan ahead for integration within current doctrine.
{"title":"The use of Unmanned Aerial Vehicles for CASEVAC in the future urban and\u0000 littoral environments","authors":"G. McKnight, M. Palmer, M. Khan","doi":"10.1136/jrnms-105-29","DOIUrl":"https://doi.org/10.1136/jrnms-105-29","url":null,"abstract":"The recent development of Unmanned Aerial Vehicles (UAVs) and their potential use for casualty evacuation (CASEVAC) has exciting implications for the United Kingdom Defence Medical Services (DMS). When compared to existing technology, the unique attributes of small size, increased manoeuvrability and lack of a human pilot would be extremely useful in congested and hazardous settings. There are ethical and practical considerations to be taken into account, but harnessing the full potential of this technology may improve the chances of survival from some battlefield injuries. UAVs could be of most benefit in a congested and complex battlespace, allowing evacuation of casualties from high risk environments. In addition to CASEVAC, a UAV could be used for critical care transfers, Search and Rescue (SAR) and Humanitarian And Disaster Relief (HADR) operations. Given the vast array of potential applications and a lower risk profile compared with current CASEVAC platforms, the DMS should actively monitor the development of UAV technology and plan ahead for integration within current doctrine.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64207437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Haywood Club Tri-Service Medical Society: a model for decentralised,\u0000 collaborative education and fun for uniformed healthcare\u0000 professionals","authors":"M. Stacey, M. Thompson, J. Keogh","doi":"10.1136/jrnms-105-65","DOIUrl":"https://doi.org/10.1136/jrnms-105-65","url":null,"abstract":"","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64209020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The increased movement of migrants across the Mediterranean to the European Union intensified in 2015. This paper will focus on the complex experiences and lessons learnt by three Medical Officers (MOs) involved in one year of maritime rescue operations in the Mediterranean (August 2016 to July 2017). During this period a total of 7930 people were rescued by the Royal Navy (RN), with the largest single rescue involving 712 people. The medical teams involved delivered sustained care for periods of up to 80 hours, often with no immediate casualty evacuation available. The scope of clinical practice was wide and challenging, from the birth of infants, to the delivery of care to those with burns, gunshot wounds, sepsis and drowning. The teams were often confronted with mass casualty events, a challenge for any deployed unit.
{"title":"Operation LITTEN: a year delivering medical care during the peak of the Mediterranean migrant crisis, 2016-2017","authors":"W. Sharp, W. J. Tanzer, B. Castledine","doi":"10.1136/jrnms-105-80","DOIUrl":"https://doi.org/10.1136/jrnms-105-80","url":null,"abstract":"The increased movement of migrants across the Mediterranean to the European Union intensified in 2015. This paper will focus on the complex experiences and lessons learnt by three Medical Officers (MOs) involved in one year of maritime rescue operations in the Mediterranean (August 2016 to July 2017). During this period a total of 7930 people were rescued by the Royal Navy (RN), with the largest single rescue involving 712 people. The medical teams involved delivered sustained care for periods of up to 80 hours, often with no immediate casualty evacuation available. The scope of clinical practice was wide and challenging, from the birth of infants, to the delivery of care to those with burns, gunshot wounds, sepsis and drowning. The teams were often confronted with mass casualty events, a challenge for any deployed unit.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64209596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Battle of the River Plate: excerpts from the diary of Surgeon\u0000 Commander Jack Cussen RN, PMO of HMS EXETER","authors":"S. G. Bennett","doi":"10.1136/jrnms-105-53","DOIUrl":"https://doi.org/10.1136/jrnms-105-53","url":null,"abstract":"","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64208134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As a naval hero Vice-Admiral Lord Horatio Nelson holds a special place in the affections of the British people. Any expectation that his country would provide for Lady Emma Hamilton and his daughter, Horatia, was almost forgotten when he died. However, following Emma’s death, Nelson’s family shaped Horatia’s destiny, which resulted in a happy marriage and a large family. Her second son, Marmaduke, was influenced by an uncle, a surgeon, who trained and guided him towards a surgical qualification and a life at sea as a surgeon in the Royal Navy. Despite a paucity of documentary evidence, it has been possible to trace his progress by analysing his Admiralty service record and abstracting information from an extensive biography of his mother. As another piece in the Nelson narrative, this account adds a medical perspective.
{"title":"Marmaduke Philip Smyth Ward (1825-1885): Nelson’s grandson and naval surgeon","authors":"I. Fraser","doi":"10.1136/jrnms-105-145","DOIUrl":"https://doi.org/10.1136/jrnms-105-145","url":null,"abstract":"As a naval hero Vice-Admiral Lord Horatio Nelson holds a special place in the affections of the British people. Any expectation that his country would provide for Lady Emma Hamilton and his daughter, Horatia, was almost forgotten when he died. However, following Emma’s death, Nelson’s family shaped Horatia’s destiny, which resulted in a happy marriage and a large family. Her second son, Marmaduke, was influenced by an uncle, a surgeon, who trained and guided him towards a surgical qualification and a life at sea as a surgeon in the Royal Navy. Despite a paucity of documentary evidence, it has been possible to trace his progress by analysing his Admiralty service record and abstracting information from an extensive biography of his mother. As another piece in the Nelson narrative, this account adds a medical perspective.","PeriodicalId":76059,"journal":{"name":"Journal of the Royal Naval Medical Service","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64206943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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