Introduction: Previous research in the UK civilian sector indicates that advanced practitioner (AP) roles could significantly enhance the Defence workforce by addressing increasing healthcare demands in austere and remote environments. Defence Medical Services (DMS) could deploy APs to deliver pre-hospital emergency care (PHEC) on operations, potentially improving patient outcomes in resource-limited settings. While the DMS has trained a few APs, limited research defines their operational role. This study assesses whether military APs can contribute to the deployed pre-hospital workforce. Methods: Qualitative, semi-structured interviews were conducted with 10 military APs and 12 non-AP healthcare professionals (paramedics, nurses and doctors) purposively sampled from the DMS PHEC subspecialty board. The study explored the roles, experiences and challenges of military APs and examined non-APs' perceptions of their employability and integration within DMS. Data were thematically analysed, focusing on role clarity, collaboration and the operational impact of APs. Results: There were three main themes: 'Understanding the gaps, training and career challenges for military APs'; 'Building trust and managing boundaries in multi-professional teams'; and 'Exploring future roles and employment of military APs'. Participants recognised the potential of military APs to operate autonomously in remote locations. Trust fostered through mentorship and collaborative relationships emerged as essential for APs' autonomy and professional growth. However, hierarchical structures within military and medical systems presented challenges, highlighting the need for clearer career management and role identification for APs. Participants advocated for standardising AP roles, aligned with civilian practices, to ensure consistency in roles and expectations. Participants suggested that military APs could enhance care delivery in prolonged field care and critical care retrieval, particularly in PHEC Level 8 teams. APs perceived their role offered enhanced flexibility to the PHEC workforce. Conclusion: To maximise AP potential, the DMS must continue fully developing an AP strategy with workforce implementation. APs offer opportunities to bridge gaps in operational care, improve patient outcomes and support clinical career progression for nurses and paramedics.
Black measles (Rubeola nigra) was understood to be an infrequent, severe subtype of measles defined by very dark, nearly confluent rash in the 19th century. During the US Civil War (1861-65), measles epidemics killed many military recruits on both sides, with a case-fatality rate of 2%. Medical officers described black measles as appearing in the second week of illness and often leading to death. Black measles disappeared the 20th century, and what clinical entity existed during the US Civil War is unclear. If one dismisses a faulty clinical diagnosis, the most likely explanation is a defect in cellular immunity due to nutritional deficiency epidemiological isolation. Measles infections of rhesus monkeys show severe rash when CD8+ lymphocytes are suppressed. Rather than a historical footnote, black measles could be seen as a severe aspect of measles infection in an immunocompromised host.
Future armed conflict in the Indo-Pacific region may see small detachments of soldiers deployed on isolated Pacific Islands for extended periods. Historical experiences with such deployments, particularly during World War II, are reviewed to give insight into possible medical problems and their countermeasures. The 8th Division of the Second Australian Imperial Force (2 AIF) is infamous for its experiences on the Thai-Burma railway. However, it also contained three separate one-thousand-soldier detachments which Imperial Japanese Forces destroyed on New Britain, Timor and Ambon. Crisis mortality (2%/month) was associated with cholera epidemics and forced labour periods under conditions with little food and many tropical infections, such as malaria. Many POW deaths were due to ship sinkings by Allied submarines. Some isolated garrisons, such as a Japanese Naval Battalion on Nauru, survived well until post-war repatriation exposed them to epidemic malaria. Medical preparations for isolated island garrisons need to focus on supplies of fresh water and rations, pre-deployment immunisation and chemoprophylaxis against scrub typhus and malaria. Lack of medical evacuation may present significant practical and psychological challenges for isolated island deployments in a future conflict.
In Canada, military-to-civilian transition (MCT) involves transitioning from military to civilian primary care. This is an important but underexplored aspect of MCT. We investigated releasing military members' perspectives on the transition from military to civilian primary care by analysing previously collected interview data from 69 Canadian military members. We found that participants were apprehensive about accessing primary care after release, felt more support from the military was needed, and made recommendations for improving support. Our findings help explain the high proportions of difficult adjustment to MCT among veterans and highlight the need for more robust support for releasing military members.
Background: Working conditions have a significant impact on job-related performance, and in the military context, this can affect the outcome of exercises and missions. Therefore, the scientific recording and consequentialist improvement of soldiers' conditions of service is important. Purpose: This study aims to contribute to a deeper understanding and potentially improve the wellbeing and performance of NATO soldiers in 1GNC. Material and methods: This study is conceived as an anonymised, observational cohort study. During the command-post exercises STJU23, LOLE24 and AVTR24, the soldiers of the 1GNC were interviewed before and after each exercise. The adapted 'Culture of Care Barometer' was used as a measuring instrument to investigate the workplace-related strengths and weaknesses of 1GNC. Results: The response rates were 34.8% (STJU23), 21.6% (LOLE24) and 24.8% (AVTR24). On average, the overall result for STJU23, LOLE24 and AVTR24 was a mean of 3.84/3.81 (pre/post STJU23), 3.89/3.81 (pre/ post LOLE24), 3.75/3.69 (pre/post AVTR24) and a median of 3.87/3.87 (pre/post STJU23), 3.93/3.81 (pre/ post LOLE24), 3.87/3.77 (pre/post AVTR24). The factor analysis detects a positive correlation for all factors. The highest values were achieved in factor 3 (relationships with colleagues). Conclusion: Our study conclusively demonstrated that potentially stressful working conditions can be detected by using the aCoCB. Professional medical advice can support military leaders in fulfilling their duty to take care of the mental health of their soldiers. Furthermore, psychological factors have a significant influence on military tactical considerations.
Introduction: US Army Reserve personnel are expected to meet the same fitness and readiness standards as their Active Duty counterparts, but little is known about health factors among Reservists. This investigation presents data on injuries, fitness and body mass index (BMI) for Reservists participating in a new health and fitness program. Methods: Twenty-one US Army Reserve units were selected to participate. Electronic surveys were administered in 2021 to collect baseline data on recent injuries, fitness and demographics. Demographics and injury details were summarised. Differences in injury prevalence by BMI and aerobic fitness (Army Combat Fitness Test (ACFT) 2-mile run time) were reported. Results: Among the 2095 baseline survey respondents, most were male (72%), white (60%) and 30 +/- 10 years old on average. More than a quarter of men (28%) and over one-third of women (35%) reported at least one injury in the previous 12 months. Commonly reported injuries included strains (19%) and sprains (12%), often involving the lower back (21%) or knees (19%), and were frequently attributed to running (22%) or weightlifting (18%). Over half of respondents (57%) passed the ACFT. About one-quarter of men (24%) and 16% of women were classified as obese. Men and women classified as obese had an injury prevalence 1.6 times higher than those with normal BMI (p<0.001). Likewise, injury prevalence among women with slower 2-mile run times was 1.6 times higher than the fastest runners (p<0.05). Conclusion: Injuries in this sample of Reservists were similar to those reported in other military populations despite differing exposures and demographic distributions. Maintenance of a healthy weight status should be emphasised for Reservists, along with appropriate physical training resources for military duties. These results should inform future public health programming in the US Army Reserve.
This paper aims to provide some initial thinking on determining the basis for assessment of the existence, severity, and nature of a Spiritual Wound and Injury (SW&I) within an individual. The conditions, behaviours, and Red-Actions (serious, life-threatening, harmful) actions of an SW&I discussed in an earlier paper in this journal1 require a thorough and rigorous assessment if they are to be managed effectively. The first step in developing this tool will be to review existing MI and spiritual assessment tools against the SW&I concepts discussed to date. Several existing assessment tools will be considered. While each has value and presents opportunities for greater understanding, none of them addresses the entire scope of a SW&I. Following this, the SW&I Assessment Tool-Provisional (SW&IAT-P) will be proposed, and its potential uses will be described. The proposed SW&IAT-P is a purpose-built and multidisciplinary tool that medical, psychological and spiritual practitioners can use. The SW&IAT-P is classed as provisional, as it will require further development that is outside the scope of this paper and the research conducted to date. The author seeks comments from all sectors on this paper.
'I am trying to arrange transport for two or three thousand "B" class men; they are absolutely unfit for service. Many of them do not disclose any organic disease upon a carefully conducted clinical examination, but are in and out of hospital, and are quite useless for front line, and practically useless for Home Service....Far better no reinforcements be sent from Australia as they do no duty, and only cause congestion in our hospitals and Command Depots. The class of reinforcements you are sending are not up to the old standard. Headquarters AIF Depots report that 20 per cent are unfit for the front line.'
Psychological assessments for selecting military personnel have played a crucial role in enhancing training effectiveness, ensuring job success and, where possible, reducing mental health casualties in war zones. This article traces the development of psychological assessment for military selection through the World Wars to modern-day procedures. Two main themes emerge from this analysis: firstly, military psychological assessment methods evolve swiftly during war due to the need for mass personnel processing. Secondly, the foundational structures and considerations from these periods of development remain relevant today. However, the theories and tools underpinning psychological assessment for military selection have evolved. Those involved in military psychological selection, therefore, require both an appreciation of its history and an understanding of current theories and tools to succeed in the field, particularly during the rapid development of new procedures. A stepped framework is proposed to guide the implementation and evaluation of psychological assessment processes for military selection. The framework is used to consider the future of psychological assessment for military selection, including in areas such as data aggregation and personality testing that may be targeted for greater effect and efficiency.
This study examines the impact of lighting conditions (darkness, rotational light and continuous light) on war fighters' psychophysiological responses and fine motor skills in close-quarter combat (CQC) simulations. The study assessed the rate of perceived exertion, blood lactate concentration, cortical arousal, isometric lumbar and leg strength, and the time required to reload a pistol magazine in 50 male military personnel experienced in international missions. Findings revealed distinct psychophysiological responses correlated with lighting conditions, with significant responses under rotational and no-light scenarios. Notable correlations included the critical flicker fusion threshold with magazine reload time (r =-0.547, p <0.000) and isometric strength post-CQC with the rate of perceived exertion (r = 0.319, p < 0.009). The study suggests that manipulating lighting conditions can enhance training and performance in high-stress environments, applicable to warfighters, police officers and firefighters.
While there has long been an extensive range of medical, pharmaceutical, psychological, physiological, spiritual and physical programs available to ADF personnel seeking health assistance, allied health practices- particularly creative arts interventions-are still relatively new in the wellbeing context. The Australian Defence Force Arts for Recovery, Resilience, Teamwork and Skills Program (hereafter, ADF ARRTS) is an immersive, non-clinical residential program of creative engagement, funded and delivered by the ADF. It has been held biannually at the University of Canberra's ACT campus since 2015, delving into the disciplines of creative writing, music and rhythm, and visual arts and, for a time, drama. The Defence Science and Technology Group assessed early programs for any improvements in the psychological wellbeing and recovery of Australian military personnel with service-related injuries, finding that, compared to baseline levels, there were significant improvements in self-reported self-esteem, social functioning, physical functioning and general positive affect, and significant reductions in psychological distress, insomnia and post-traumatic levels. There was no significant change in negative affect levels.1 With very encouraging short-term results, as a people-focused program, it remained incumbent on qualitative research into the longer-term effectiveness of program attendance, and on how creative engagement modalities may act to offer improved outcomes for uniformed personnel and veterans. The subsequent qualitative case study, reported here, clarifies the impacts, benefits, challenges and outputs of how engaging with creativity can shape identity and future directions for wounded, injured and ill personnel.
Background: This qualitative study investigates the coping strategies utilised by military physicians facing the dual demands of military service and healthcare provision. Recognising the unique stressors within this professional context, the study aims to identify both adaptive and maladaptive coping mechanisms employed by military physicians. Methods: A purposive sample of 18 military physicians from diverse branches of the armed forces was recruited. Participants, ranging in ranks from junior officers to senior medical officers, were selected based on experience levels, deployment history and demographic characteristics to ensure a comprehensive representation. Semi-structured interviews, guided by an interview guide developed through an extensive literature review, were conducted to explore participants' experiences, specific stressors encountered, coping mechanisms employed and the perceived effectiveness of these strategies. Results: Thematic analysis revealed a spectrum of coping strategies among military physicians. Adaptive strategies included reliance on social support networks, engagement in self-care practices, proactive problem solving, effective time management and seeking professional support. Maladaptive strategies encompassed avoidance behaviours, substance use patterns, isolation tendencies, denial or minimisation and emotional suppression. Conclusion: The findings offer a nuanced understanding of the coping landscape of military physicians, highlighting both strengths and vulnerabilities within this professional community. Identifying adaptive and maladaptive coping mechanisms provides a foundation for targeted interventions and support initiatives. The study's implications extend to organisational practices, policy considerations and avenues for future research, emphasising the importance of prioritising the mental health and wellbeing of military physicians facing the multifaceted challenges of their roles.
Introduction: Cognitive processing therapy (CPT) is a first-line psychotherapy for veterans with post-traumatic stress disorder (PTSD). Comorbid obstructive sleep apnoea (OSA) poses challenges to treatment with continuous positive airway pressure (CPAP) associated with improved PTSD symptoms. CPAP adherence, particularly in those with PTSD, remains a concern. This study explored whether CPAP adherence was associated with CPT efficacy in United States veterans with comorbid PTSD and OSA. Materials and methods: From September 2015 through July 2020, 25 veterans received CPT for their PTSD and were also issued a CPAP machine to treat their OSA. Outcomes included PTSD and depression symptoms measured by the PCL-5 and PHQ-9, respectively. Following guidance from the Centers for Medicare and Medicaid Services, CPAP adherence was defined as >= 4 hours of wear time at night on >= 70% of days between CPT sessions. Linear mixed-effects models were estimated to evaluate whether change in PTSD and/or depression symptoms was moderated by CPAP adherence. Results: Veterans received a median of 12 CPT sessions (range: 4-13) across a median of 77 days of follow-up (range: 7-549). PCL-5 and PHQ-9 scores improved significantly (both p < 0.001), with benefit observed at day 125 and day 50, respectively. However, these improvements were not moderated by CPAP adherence (interaction p = 0.668 and 0.124 for PTSD and depression symptoms, respectively). CPAP use, the apnea-hypopnea index (AHI), and mask leak also did not moderate symptom improvement. Conclusions: Despite that OSA has been suggested to reduce PTSD treatment efficacy, our study demonstrated both PTSD and depression symptom improvement irrespective of CPAP adherence. Although the small sample size and retrospective design require additional research, the overall improvement in PTSD symptoms, regardless of CPAP adherence, supports continued use of CPT by mental health practitioners for veterans with comorbid PTSD and OSA.
Background: Military occupations are widely diverse, requiring specific skill sets and physical demand levels to accomplish their objectives. Purpose: To describe musculoskeletal injury and physical fitness across US Army military occupational specialties (MOS). Methods: Demographics, health behaviours and physical training data were obtained by electronic survey. Musculoskeletal injuries and Army Combat Fitness Test (ACFT) data were obtained from Department of Defense medical and training systems. A multivariable logistic regression model was performed to assess the role of injury risk and MOS while controlling for known military injury risk factors. Results: Participants were 2124 male and 433 female enlisted US Army Soldiers. Injury incidence by MOS ranged from 29% to 62% for males and 49% to 71% for females. MOS contributed to injury risk for males, with the exception of Support and Administration. All other MOSs had between 2.0 to 5.3 times greater injury risk than Field and Air Defense. Military Police had a 3.8 times higher injury risk for females compared to Military Intelligence. Considering physical fitness, ACFT performance by MOS ranged from 425 to 491 points for males and 310 to 364 points for females (maximum score of 600 points). Males in Infantry and females in Military Police MOSs had the highest ACFT scores of 491 and 364 points, respectively. In addition, health behaviours and physical training varied by MOS. Conclusion: Surveillance of injury incidence and physical fitness, along with health behaviours and physical training by MOS, may be used to focus injury prevention strategies.
The mauling that some veterans suffer as a result of issues such as shame, anger, self-abuse and depression are very real, lasting and painful aspects of their lives. For a Religious/Spiritual Practitioner (RSP), or indeed any treating practitioner, to make a meaningful contribution towards treating a Spiritual Wound and Injury (SW&I) they must determine how this condition presents. The paper follows previous arguments by the author that a SW&I starts with a break in an individual's relationship with their concept of God. The manifestation of the SW&I may then follow a pathway such as the Principal Conditions, Behaviours and Red Actions Model (PCB&RA Model). This paper acknowledges that, in some respects, the behaviours of a SW&I may seem very similar to many mental health or general wellbeing issues. Indeed, in many cases, the treatment of SW&I may utilise similar treatments and management approaches to moral injury (MI) or mental illnesses. However, the elements discussed in the PCB&RA Model are all predicated on seeing these conditions, behaviours and actions through a spiritual lens.
Acute schistosomiasis is rarely of military concern, but epidemics have disrupted tropical operations. Acute schistosomiasis is particularly challenging to diagnose because it presents as a non-specific febrile disease, often with an urticarial rash before parasites appear in the stool. US Army combat engineers were infected during bridge construction on Leyte in the invasion of the Philippines, requiring mass evacuation to the USA (n=1300) in 1945. An entire RAAF airfield construction squadron became ineffective, with a 40% infection rate from 16 days of exposure around the Bislig River on Leyte. The Chinese People's Liberation Army's planned invasion of Taiwan was indefinitely delayed when 38% of the infantry assault force became acutely infected with Schistosoma japonica following amphibious training in the Yangtze River delta. In febrile epidemic situations, great diagnostic efforts are often required to determine the prevention and prognosis for affected units to reassure soldiers against rumour and disinformation.
With a rapid and significant rise in psychological screening within the Australian Defence Force (ADF) over the past 20 years, ambiguity has developed between a psychological screen and a psychological assessment used for pre-employment and pre-deployment selection purposes. Additionally, confusion persists around what constitutes a mental health or psychology screen and when it should be used. To provide greater clarification, the origins and purpose of screening for selection for pre-employment and pre-deployment in the ADF and its current uses are explored in this article. A review of contemporary and historical literature examined the use of screening for military selection. It was concluded that screening for selection is useful when estimating traits such as intelligence in pre-employment selection and identifying current mental illness for pre-employment and pre-deployment selection. However, screening is not-and has never been-successful in identifying those who may be predisposed to developing mental distress in the future. The review, therefore, suggests a more nuanced approach to psychological screening for selection in the ADF. Recommendations are made to better understand and standardise the purpose of screening and to consider using different screening tools in a selection versus a mental health support context.
