Cerebrospinal fever was rare in the British Army prior to World War I. An outbreak of the disease on Salisbury Plain in late 1914 posed new challenges. The War Office established the Central Cerebrospinal Fever Laboratory at the Royal Army Medical (RAM) College early in 1915 to conduct research, develop diagnostic tests and coordinate the military response. The Royal Army Medical Corps (RAMC) set up dedicated cerebrospinal wards for the hospitalisation and treatment of patients. The new Medical Research Committee (MRC) supported bacteriological studies of epidemic strains of the meningococcus responsible for the outbreak. The Lister Institute of Preventive Medicine, an independent research institution, acted as a key supplier of antimeningococcus serum. The mortality of military patients during 1915 was poor because the testing infrastructure was still developing, the RAMC had limited experience of treating cases, and the therapeutic serums available at the time seemed ineffective. The survival rate of home troops improved during the war-through the concerted efforts of the RAMC, MRC and Lister Institute-due to timely diagnosis, and early, intensive and prolonged treatment with improved serums. The Official History of the War highlights subsequent trials undertaken with strain-specific MRC serums in late 1918 and 1919 but fails to acknowledge that in late 1917/early 1918 the Lister Institute supplied the RAM College with large quantities of an efficacious multivalent serum and corresponding monovalent serums that were not included in a formal trial.
INTRODUCTION:On military operations, ballistic impact damage is possible to lithium ion (Li-ion) batteries worn on the body by military personnel and the potential for exothermic reactions may result in injury. This paper investigated the effect of impact on batteries that might be worn in front or behind body armour.METHODS:Li-ion batteries were subjected to ballistic impact both without and in combination with body armour using 7.62×39 mm ammunition (mean velocity=769 m/s) at charge levels up to 40%. The effect of penetrating impacts on charged batteries was also investigated using an outdoor range.RESULTS:The backface signature due to ballistic impact was reduced by including a battery pack between fabric body armour and an armour plate, however the batteries were crushed and mechanically disrupted. Ballistic impacts on batteries mounted in front of an armour plate resulted in perforation of the batteries. Increases in temperature, fire and toxic gas emission were noted when batteries were penetrated by an impact.CONCLUSIONS:Batteries provided limited ballistic protection disproving the hypothesis that batteries could replace or enhance existing body armour solutions. Ballistic impact of charged batteries could lead to injury due to heat/flame and toxic discharge. It is recommended that batteries need to be carried in a position from which they can be rapidly removed from contact with the body.
BACKGROUND AND OBJECTIVE Few studies have examined the relationship between dietary patterns and antioxidant status. We aimed to explore the association between major dietary patterns and oxidative stress biomarkers including serum protein carbonyl (PC), ceruloplasmin and total antioxidant capacity (TAC). METHOD In this cross-sectional study, we randomly selected 320 female nurses aged 20-45 years. General information of participants was collected by trained interviewers. Their weight and height were measured and dietary intakes were determined by the 147-food-item semiquantitative food frequency questionnaire. Dietary patterns were derived by principal component analysis of yielding 25 food groups. In this study, 90 subjects were randomly selected from all participants with serum levels of PC, ceruloplasmin and TAC measured further. To determine the association between dietary patterns' score and oxidative stress biomarkers, multiple linear regression analysis was conducted. RESULTS Three dietary patterns were derived: healthy, unhealthy and traditional. After adjusting for several confounding factors, the unhealthy dietary pattern was inversely related to the serum concentration of ceruloplasmin and PC (p<0.05). The relationship between other dietary patterns and antioxidant biomarkers was not significant. CONCLUSIONS According to the results of this study, unhealthy dietary patterns may have an adverse effect on serum ceruloplasmin.
Introduction In April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability. Method The Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading. Results A total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%). Several factors that slowed an individual's recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management. Conclusions MSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units. The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.
INTRODUCTION Parametric survival models are used to develop injury risk curves (IRCs) from impact tests using postmortem human surrogates (PMHS). Through the consideration of different output variables, input parameters and censoring, different IRCs could be created. The purpose of this study was to demonstrate the feasibility of the Brier Score Metric (BSM) to determine the optimal IRCs and derive them from lower leg impact tests. METHODS Two series of tests of axial impacts to PMHS foot-ankle complex were used in the study. The first series used the metrics of force, time and rate, and covariates of age, posture, stature, device and presence of a boot. Also demonstrated were different censoring schemes: right and exact/uncensored (RC-UC) or right and uncensored/left (RC-UC-LC). The second series involved only one metric, force, and covariates age, sex and weight. It contained interval censored (IC) data demonstrating different censoring schemes: RC-IC-UC, RC-IC-LC and RC-IC-UC-LC. RESULTS For each test set combination, optimal IRCs were chosen based on metric-covariate combination that had the lowest BSM value. These optimal IRCs are shown along with 95% CIs and other measures of interval quality. Forces were greater for UC than LC data sets, at the same risk levels (10% used in North Atlantic Treaty Organisation (NATO)). All data and IRCs are presented. CONCLUSIONS This study demonstrates a novel approach to examining which metrics and covariates create the best parametric survival analysis-based IRCs to describe human tolerance, the first step in describing lower leg injury criteria under axial loading to the plantar surface of the foot.
Part I provides the historiographical context and examines the causes which led to the creation of the first independent research ethics committee (REC) at Porton Down, Britain's biological and chemical warfare establishment, in operation since the First World War. The papers in part I and part II argue that the introduction of RECs in the UK stemmed from concerns about legal liability and research ethics among scientists responsible for human experiments, and from the desire of the UK military medical establishment to create an external organisation which would function both as an ' internal space ' for ethical debate and as an ' external body ' to share moral and legal responsibility. The paper asks: What factors were responsible for causing military scientists and government officials to contemplate the introduction of formalised structures for ethical review within the UK military? It argues that Porton may have been exempt from public scrutiny, but it was not above the law of the land. By the mid-1960s evidence of serious ill effects among staff members and service personnel involved in tests could no longer be ignored. Whereas the security of the British realm had previously trumped almost any other argument in contentious debates about chemical warfare, the role of medical ethics suddenly moved to the forefront of Porton's deliberations, so much so that tests with incapacitants were temporarily suspended in 1965. It was this crisis, examined in detail in part II, which functioned as a catalyst for the creation of the Applied Biology Committee as the responsible body, and first point of call, for authorising human experiments at Porton Down.
The UK military commitment to United Nations operations has led to a new challenge in identifying and developing skill sets required for humanitarian operations. The last two decades have concentrated on kinetic operations, with haemorrhage control being the main driver. The austere location and prolonged evacuation timelines have led to identifying management strategies of conditions that would previously have been evacuated to higher echelons of care. The Defence Medical Services have a multifaceted approach to training military personnel for operations, varying from regular exposure to high-acuity trauma and general surgery within their host NHS Trust, to validated training platforms that evolve continually to address the training needs demanded by differing fields of conflict.
When militaries mention loyalty as a value they mean loyalty to colleagues and the organisation. Loyalty to principle, the type of loyalty that has a wider scope, plays hardly a role in the ethics of most armed forces. Where military codes, oaths and values are about the organisation and colleagues, medical ethics is about providing patient care impartially. Being subject to two diverging professional ethics can leave military medical personnel torn between the wish to act loyally towards colleagues, and the demands of a more outward looking ethic. This tension constitutes a test of integrity, not a moral dilemma.
Introduction Haemorrhage is one of the leading causes of battlefield and prehospital death. Haemostatic dressings are an effective method of limiting the extent of bleeding and are used by military forces extensively. A systematic review was conducted with the aim of collating the evidence on current haemostatic products and to assess whether one product was more effective than others. Methods A systematic search and assessment of the literature was conducted using 13 health research databases including MEDLINE and CINAHL, and a grey literature search. Two assessors independently screened the studies for eligibility and quality. English language studies using current-generation haemostatic dressings were included. Surgical studies, studies that did not include survival, initial haemostasis or rebleeding and those investigating products without prehospital potential were excluded. Results 232 studies were initially found and, after applying exclusion criteria, 42 were included in the review. These studies included 31 animal studies and 11 clinical studies. The outcomes assessed were subject survival, initial haemostasis and rebleeding. A number of products were shown to be effective in stopping haemorrhage, with Celox, QuikClot Combat Gauze and HemCon being the most commonly used, and with no demonstrable difference in effectiveness. Conclusions There was a lack of high-quality clinical evidence with the majority of studies being conducted using a swine haemorrhage model. Iterations of three haemostatic dressings, Celox, HemCon and QuikClot, dominated the studies, probably because of their use by international military forces and all were shown to be effective in the arrest of haemorrhage.
This paper considers the manifestation and treatment of psychological trauma in the military. The article describes how military psychologists conceptualise psychological trauma within the culture of the Armed Forces (AF), which is reflected in the process of acquiring what has been referred to as cultural competency. Psychologists in this context acquire an understanding of the manner in which the psychological and organisational systems and culture of the military affect the presentation of psychological trauma, including post-traumatic stress disorder (PTSD). The paper outlines core psychological features of military life, including some of the ways in which the AF functions effectively as an adaptable fighting force. This highlights, for example, the potential for stigma within and between military personnel who experience mental health difficulties. The article proceeds to examine aspects of help-seeking in military mental healthcare, how symptoms can present at different stages in a deployment process, and the consequences that such problems can cause for military conduct and performance. Psychological care in the military is structured within an occupational mental health ethos, in which psychologists fulfil a range of clinical, organisational and leadership roles. These dynamics are explored with examples of care pathways and clarity on evidence-based interventions for trauma and PTSD in those experiencing military-related psychological injuries. Two vignettes are then offered to illustrate how some of these interventions can be used psychotherapeutically in addressing symptoms pertaining to hyperarousal, hypervigilance, guilt and shame.
> The term ‘ immersion foot ’ was coined during the present war ( World War II ) to describe a syndrome occurring in extremities exposed to the effects of cold sea water. It is a disorder characterized by chilling as opposed to freezing of tissues and is distinct from frost-bite. The term is
Missile injuries of the sciatic nerve are frequently encountered in military practice.[1 2][1] As part of a Reconstructive Surgery Project established in Amman, Jordan, 116 civilian war casualties of Middle East conflicts have been referred for secondary repair of sciatic nerve missile injuries
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.
Blast injury is not a new phenomenon, but the nature of warfare has changed; explosive weapons are now the most common mode of battlefield trauma.[1][1] In this issue, McGuire et al demonstrate the incidence of explosive injury in both recent UK operations and those from decades before.[2][2] The
By virtue of its function as a biological pressure transducer, the ear is inherently vulnerable to the effects of noise and blast. While considerable effort has been made to avoid and mitigate the effects of excess noise, the nature of military service currently makes complete amelioration
Reading the paper by Howard et al ,[1][1] I reflected on my experience of the British Services Dhaulagiri Medical Research Expedition, which involved similar power planning, although on a much, much smaller scale. Our study involved collecting the continuous glucose monitoring (CGM) (Dexcom G4, San
‘Medical ethics in times of armed conflict is identical to medical ethics in times of peace’. So states the first line of the World Medical Association’s (WMA) Regulations in Times of Armed Conflict and Other Situations of Violence,[1][1] which can also be found in the WMA International Code
The medical care of those injured during conflict has measurably improved over the last 50 years.[1][1] Within recent UN-mandated conflicts in Iraq and Afghanistan, the early adoption of research-driven innovations in the delivery of trauma care led to year-on-year improvements in survival rates
INTRODUCTION:In response to the Syrian Civil War, the Turkish Armed Forces has focused its attention on internal security and border operations, thereby cushioning against both the threat of terrorist activities and supporting international peace efforts. This study was performed to evaluate the level of knowledge, skills and any behavioural changes after the combat medic course to enhance future courses.METHODS:A cross-sectional descriptive study was conducted between 25 December 2017 and 22 March 2018 using 40 combatant personnel undertaking the combat medic training course. Attendants' perception of self- sufficiency was assessed using a specifically designed questionnaire using a 5-point Likert-type scale. RESULTS : Trainee perception of self-confidence had the highest mean increase post course (4.1±0.7). Trainee academic self-perception demonstrated the lowest mean post course score in the domain of "using of the tactical emergency medications and liquids" (3.80±1.02). The highest mean was in the domain of bleeding control (4.63±0.49).CONCLUSIONS:Improvements to specific components of the course have been identified and implemented to ensure greater success in the operational field environment. In particular, the total course hours will be increased and simulation encouraged using the most recent equipment used in the field.
