Can a projectile-based riot control method ever be truly non-lethal?
(Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Dhar, S. A., Dar, T. A. Tags: Letter to the editor Source Type: research

Subacute cutaneous lupus erythematosus
A 31-year-old female soldier developed subacute cutaneous lupus erythematosus, which remained undiagnosed for 4 years. Referral to dermatology and a punch biopsy confirmed the diagnosis and effective treatment was instituted. The presence of an unresolving annular rash in light-exposed areas, especially in a young woman, should prompt thorough investigation and referral if necessary. The prognosis for this condition is generally good, although a small proportion of patients will go on to develop systemic lupus erythematosus. The occupational implications of this condition require thoughtful management in the military ...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Furzeland, J., Malcolm, P. Tags: Immunology (including allergy), Radiology, Connective tissue disease, Systemic lupus erythematosus, Dermatology, Surgical diagnostic tests, General surgery Case report Source Type: research

Pulmonary embolism in a British soldier: could this have been prevented?
A 31-year-old soldier presented to the medical centre with acute onset pleuritic chest pain and shortness of breath. He had previously presented to combat medical technicians (CMTs) on two occasions over 2 weeks with right calf pain following a long-distance drive. On both occasions, he was managed as a musculoskeletal disorder without referral to a medical officer (MO). Following this presentation, he presented 4 days later to an MO who referred to secondary care where he was diagnosed with a pulmonary embolism (PE) and deep vein thrombosis (DVT). The CMT treatment protocol does not include the differential diag...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Saveker, R. Tags: Immunology (including allergy), Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Pain (neurology), Venous thromboembolism, Pulmonary embolism, Guidelines Case report Source Type: research

Post-traumatic growth among the UK veterans following treatment for post-traumatic stress disorder
Conclusions This study observed the presence of PTG following exposure to traumatic events within a sample of the UK veterans following their treatment for PTSD. PTG scores were moderately low in comparison to similar studies in the USA. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Murphy, D., Palmer, E., Lock, R., Busuttil, W. Tags: Original article Source Type: research

Challenges encountered and lessons learnt from venous injuries at Sri Lankan combat theatres
The objective of this study was to characterise the spectrum of peripheral venous injury in the Sri Lankan war theatres, including categorisation of anatomic patterns, mechanism and management of casualties, including short-term results of surgical repair of traumatic venous injuries versus ligation. In addition, the effects and outcome of combined arterial and venous injuries versus arterial injury alone are compared. Methods All adults with extremity vascular injuries admitted to a military base hospital during an 8-month period were prospectively recorded and those with a venous injury were analysed. Result A total of...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Ratnayake, A. S., Samarasinghe, B., Bala, M. Tags: Original article Source Type: research

Medical causes of temporary or definitive leaves from a French counterterrorist unit pre-internship
Discussion The high prevalence of minor traumatology that we observed is similar to the ones observed in other cohorts describing initial training for military personnel in the conventional forces. However, the presence of other pathologies in our study, such as cranial trauma or medical causes, is due to the specificity of this internship selection granting access to an elite unit. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Thabouillot, O., Roffi, R., Bertho, K., Ramon, F., Commeau, D., Fressancourt, Y., Quemeneur, E., Roche, N.-C., Dubourg, O. Tags: General practice / family medicine, Trauma, Injury Original article Source Type: research

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine
This article aims to document advances made, lessons learned, encourage debate and identify priorities for future research for military complex trauma rehabilitation. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Pope, S., Vickerstaff, A. L., Wareham, A. P. Tags: Patients, Drugs: CNS (not psychiatric), Pain (neurology), Hospice Original article Source Type: research

General practitioners' approach to malingering in basic military training centres
Conclusions In countries where the military service is compulsory, prevalence of malingering is estimated to be higher (approximately 5–25%). The problem of malingering is often underestimated due to the fact it is usually overlooked. Malingering remains a problem for the entire military healthcare system, due to the difficulties in exact diagnosis. Therefore, it can be useful to take some practical administrative measures for the soldiers who are prone to malingering, in order to discourage the behaviour. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Kokcu, A. T., Kurt, E. Tags: General practice / family medicine, Informed consent, Legal and forensic medicine Original article Source Type: research

What are the best and worst things about having a father in UK Armed Forces? Analysis of free text responses
Conclusions Adolescents take a great deal of pride in their father's jobs in the military, and they enjoy the financial benefits. A majority, however, feel a lack of contact with their father is the most negative factor. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Jain, V., Stevelink, S. A. M., Fear, N. T. Tags: Original article Source Type: research

Appendicitis in a deployed military setting: diagnosis, management and impact on the fighting force
Conclusions Diagnostic imaging will be limited in future conflicts and reliance on clinical judgement will be necessary. Military clinicians may need to accept higher rates of NA, as prolonged observation may not be possible. CT scanning should be used to a greater extent when available. A conservative management strategy for appendicitis with appropriate antibiotics should be considered in the event of delayed transfer to a surgical facility. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Howes, R., Webster, C., Garner, J. Tags: Drugs: gastrointestinal system, Epidemiologic studies, Drugs: CNS (not psychiatric), Pain (neurology), Radiology, Clinical diagnostic tests, Gastrointestinal surgery, Radiology (diagnostics) Original article Source Type: research

The influence of sexual harassment on mental health among female military personnel of the Republic of Korea Armed Forces
This study aimed to analyse the impact of sexual harassment on mental health among female military personnel of the ROK Armed Forces. Methods Data from the 2014 Military Health Survey were used. Instances of sexual harassment were recorded as ‘yes’ or ‘no’. Analysis of variance (ANOVA) was carried out to compare Kessler Psychological Distress Scale 10 (K-10) scores. Multiple logistic regression analysis was performed to identify associations between sexual harassment and K-10 scores. Results Among 228 female military personnel, 13 (5.7%) individuals experienced sexual harassment. Multiple logistic...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Kim, T. K., Lee, H.-C., Lee, S. G., Han, K.-T., Park, E.-C. Tags: Health policy, Open access, Health service research Original article Source Type: research

Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces
This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Zimmermann, W. O., Helmhout, P. H., Beutler, A. Tags: Editor''s choice Review Source Type: research

Formation of Defence Primary Healthcare: a new way of delivering firm base primary healthcare
Following the Strategic Defence and Security Review of 2010, the UK Surgeon General was directed to merge the delivery of primary healthcare from the three single Service organisations to a unified Defence Primary Healthcare. Although front line clinical staff were to be preserved, considerable savings were to be made in headquarters staff. This was one of the largest UK military medicine changes in delivery for a generation. The changes were completed on time with the transfer of UK and overseas general practice, specialist community services and dentistry, with a later requirement to add healthcare for the Reserves. The ...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Burgess, J. E., Gall, M., Orr, S., Kilbey, S. Tags: General practice / family medicine, Dentistry and oral medicine Review Source Type: research

Modelling primary blast lung injury: current capability and future direction
This article briefly reviews the modelling work undertaken in this field until now and describes the rationale behind the generation of an in silico physiological model. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Scott, T., Hulse, E., Haque, M., Kirkman, E., Hardman, J., Mahoney, P. Tags: Personal view Source Type: research

Human factors in contingency operations
This article describes the importance of human factors on Role 2 Afloat, one of the Royal Navy's maritime contingency capabilities, and illustrates how they are vital to ensuring that correct decisions are made for patient care in a timely manner. Teamwork and communication are particularly important to ensure that limited resources such as blood products and other consumables are best used and that patients are evacuated promptly, allowing the facility to accept further casualties and therefore maintain operational capability. These ideas may be transferred to any small specialist team given a particular role to perform. ...
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Mercer, S. J., Khan, M., Scott, T., Matthews, J., Henning, D., Stapley, S. Tags: Patients Personal view Source Type: research

Highlights of this edition
(Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - March 28, 2017 Category: Journals (General) Authors: Breeze, J., Garner, J. Tags: From the editor Source Type: research

Training for damage control resuscitation using a rapid infuser
(Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Seal, G., Stables, A., Mercer, S. Tags: Journalology, Drugs: cardiovascular system, Competing interests (ethics), Resuscitation, Metabolic disorders PostScript Source Type: research

Use of multiplex PCR to rapidly diagnose febrile patients during a gastroenteritis outbreak among Ebola virus treatment unit workers
Multiplex PCR can provide rapid diagnosis for patients presenting with an acute undifferentiated febrile illness. Such technology is useful in deployed settings, where access to conventional microbiological diagnosis is limited. It was used in Sierra Leone to guide management of febrile healthcare workers, in whom Ebola virus disease was a possible cause. In particular, it informed appropriate antibiotic treatment while minimising the risk to clinicians of exposure to the causative organism. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Evans, T. O., Fominyam, T., Matthews, S. W., Bailey, M. S., Hutley, E. J. Tags: Drugs: gastrointestinal system, Infection (gastroenterology), Infectious diseases Case report Source Type: research

The use of breathing techniques for the management of Eustachian tube dysfunction
Discussion The breathing technique offers a series of methods that can be used to treat patients who are refractory to conventional treatments and can add to the range of non-surgical treatments for this common condition. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Herron, J. B. Tags: General practice / family medicine, Airway biology Case report Source Type: research

Two cases of cutaneous leishmaniasis in Dutch military personnel treated with oral miltefosine
Conclusions Miltefosine proved to be a convenient, effective and well-tolerated treatment option in the treatment of cutaneous leishmaniasis in Dutch military personnel. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: van der Snoek, E. M., Couwenberg, S., Stijnis, C., Kortbeek, L., Schadd, E. Tags: Infectious diseases, Dermatology Case report Source Type: research

Malaria in British military personnel deployed to Sierra Leone: a case series
From December 2014 to April 2015, seven cases of malaria were seen in 1530 military personnel deployed to Sierra Leone on Operation GRITROCK in response to the West African Ebola outbreak, despite predeployment briefings, prescription of chemoprophylactic agents and bite prevention measures. The cases have prompted discussion regarding the efficacy of current measures and how to prevent future cases in deployed military personnel or more widely, those working in malaria-risk environments. All of the cases have made a full recovery and returned to work. We discuss what can be learnt concerning the choice of chemoprophylacti...
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Quantick, O., Howlett-Shipley, R., Roughton, S., Ross, D. Tags: Infectious diseases Original article Source Type: research

Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling
This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Staruch, R. M. T., Beverly, A., Lewis, D., Wilson, Y., Martin, N. Tags: Orthopaedic and trauma surgery, Resuscitation, IT Original article Source Type: research

Tuberculosis in Scottish military veterans: evidence from a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans
Conclusions Scottish veterans born before 1950 are at moderately increased risk of tuberculosis compared with age, sex and geographically matched civilians with no record of service, although the difference is not statistically significant. Scottish veterans born from 1950 show a reduction in risk compared with civilians. Tuberculosis should be considered in the differential diagnosis of respiratory disease in the older veteran. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Bergman, B. P., Mackay, D., Pell, J. Tags: Drugs: gastrointestinal system, Liver disease, Infectious diseases, Epidemiologic studies, Editor''s choice Original article Source Type: research

Psychological aptitude evaluation of the special forces candidate
Discussion Prospective studies in subsequent recruitment courses candidates with high scores were classified as not qualified to enter the course, and those with intermediate scores were subject to additional in-depth interviews with a psychologist or psychiatrist to determine their suitability. In the following courses a correlation was established between the questionnaire score and week of discharge for those discharged. Application of this method during subsequent recruitment courses has reduced early dismissal from Swiss SF recruitment schools. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Genoni, L., Jelmini, F., Lang, M., Muggli, F. Tags: Original article Source Type: research

Is baseline aerobic fitness associated with illness and attrition rate in military training?
This study aimed to investigate the effects of baseline aerobic fitness on haematological, salivary and mood variables, and simultaneously, in a novel approach, to identify factors precipitating illness and attrition rate in recruits during military training. Methods Thirty-five healthy male recruits from an Army Training Regiment undertaking 12 weeks of training were prospectively investigated. Their 2.4 km run time (RT) was used as a surrogate of baseline aerobic fitness. Saliva and venous blood samples were analysed for secretory IgA, full blood counts and cell cytokine production (interleukin (IL) 6 and IL-8...
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Dimitriou, L., Lockey, J., Castell, L. Tags: Infectious diseases, Epidemiologic studies, Immunology (including allergy), Drugs: endocrine system Original article Source Type: research

Angled shots onto body armour using 9 mm ammunition: the effect on potential blunt injury
Conclusions Understanding the deformation of bullets may assist with recreating a shooting incident and interpreting forensic evidence. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Lyall, A., Carr, D. J., Lankester, C., Malbon, C. Tags: Trauma, Injury Original article Source Type: research

Functional test measures as risk indicators for low back pain among fixed-wing military pilots
Discussion Our findings show that LBP among military pilots is a common problem but it is also associated with tasks other than flying. The functional test results were not associated with flight-related LBP but adequate isometric back endurance may have protective role in LBP caused in physical activities. When trying to find the pilots with increased risk of flight-related LBP, a more sensitive set of tests should be considered. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Honkanen, T., Kyröläinen, H., Avela, J., Mäntysaari, M. Tags: Drugs: CNS (not psychiatric), Pain (neurology) Original article Source Type: research

Skin disease in United Nations peacekeepers in Lebanon
Conclusions Environment, group living, occupational activities and work-related stress act as initiating and/or aggravating factors in the development and/or spread of some conditions. The knowledge of disease profile empowers doctors to enforce preventive measures and prepare for treatment modalities. In particular, the underlying psychological component in lichen simplex chronicus and alopecia areata should be addressed appropriately. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Zhou, Z., Liu, T., Zhang, Z. Tags: Infectious diseases, Dermatology Original article Source Type: research

Audit of annual medical appraisal and revalidation activity across the UK Defence Medical Services 2013-2014
Discussion To assist DMS compliance with GMC quality assurance requirements, HQ Surgeon General now maintains a central database of appraisal and revalidation data across the five DMS DBs. Appropriately targeted appraiser training and ‘revalidation ready top-up’ training should be provided to ensure the demand for military appraisers is met, and that DMS appraisers appropriately maintain their skills. MOD now maintains a central live database for ongoing appraisal and revalidation monitoring. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Morris, L. E., Withnall, R. Tags: Original article Source Type: research

The prevalence of causative organisms of community-acquired urethritis in an age group at high risk for sexually transmitted infections in Korean Soldiers
Conclusions CT was the most prevalent STI pathogen and coinfections of NG with non-NG appeared less frequently. The young male soldiers with urethritis should be administered suitable antibiotics for STI pathogens that were found by mPCR results, rather than an experimental combination of antibiotics for coinfections. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Kim, H. J., Park, J. K., Park, S. C., Kim, Y. G., Choi, H., Ko, J. I., Kim, M. K., Jeong, Y. B., Shin, Y. S. Tags: Infectious diseases, Urology, Ophthalmology, Sexual health, Urological surgery Original article Source Type: research

A systematic review of military head injuries
Conclusions The description of body segment varies among articles and this makes comparisons among datasets difficult. There is a lack of detail regarding the precise position and severity of injuries, and long-term outcome for casualties. It is demonstrated that wearing military helmets reduces fatalities on and off the battlefield. The risk of BHBT injuries is widely referred to, but evidence of their occurrence is not provided by the authors that describe the risk of BHBT occurring. Further research into the causes and severity of head injuries would be useful for designers of military helmets and other associated perso...
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Carr, D. J., Lewis, E., Horsfall, I. Tags: Drugs: CNS (not psychiatric), Neurological injury, Trauma CNS / PNS, Trauma, Injury Review Source Type: research

An outbreak inside an epidemic: managing an infectious disease outbreak while treating Ebola
Even in the middle of an epidemic of a very serious illness, outbreaks of other infectious diseases will continue. Clinicians need to be able to make rapid decisions about the nature of the outbreak and how to manage it. A balance needs to be struck between managing all patients as if they have the worst-case scenario illness and the resultant risks to themselves, their colleagues and the mission. This paper reviews basic epidemiological tools that inform robust decision-making in the management of such outbreaks. It then describes how a pragmatic approach, combined with effective use of these techniques, rapid diagnostics...
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Horne, S., Forbes, K., Burns, D., Tuck, J. Tags: Drugs: gastrointestinal system, Infection (gastroenterology), Infectious diseases Review Source Type: research

Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit
This article outlines the main hazards perceived at the outset of the operation and the methods used to mitigate the risk to the healthcare workers at the EVD TU. The article examines the mechanisms that enabled the hospital to respond positively to challenges that emerged during the deployment, while simultaneously reducing the risk to the healthcare workers involved in care delivery. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Lamb, L. E., Cox, A., Fletcher, T., McCourt, A. Tags: Infectious diseases Personal view Source Type: research

Highlights of this edition
(Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - January 26, 2017 Category: Journals (General) Authors: Breeze, J., Garner, J. Tags: From the editor Source Type: research

Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment
We present two paediatric cases where this approach was used to preserve the lower limb despite extensive explosive trauma. In the first case, an 11 cm tibial defect was managed with an ipsilateral fibular graft. The graft was placed in an intercalary position proximally, with medial displacement of the ankle and fixation of the fibula as a strut graft. In the second case, a 10 cm tibial defect was managed with an ipsilateral fibular graft, using intercalary placement proximally and distally. Both children returned to weight bearing with crutches within several months of surgery. For large tibial defects, ipsilat...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Keenan, A. J., Keenan, O. J. F., Tubb, C., M Wood, A., Rowlands, T., Christensen, S. E. Tags: Orthopaedic and trauma surgery Case report Source Type: research

Leptospirosis in a British soldier after travel to Borneo
Undifferentiated febrile illness in a returning soldier is a common problem encountered by serving medical officers. A 32-year-old soldier presented to Birmingham Heartlands Hospital with fever and acute kidney injury after return from Borneo. Leptospirosis was suspected and empirical antibiotics were started before subsequent confirmation by serology and PCR. Leptospirosis is common in South-East Asia, and troops exercising in jungle areas, and in the UK, are at risk. Advice, including inpatient management when appropriate, is available from the UK Role 4 Military Infectious Diseases and Tropical Medicine Service. (Source...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Burns, D. S., Clay, K. A., Bailey, M. S. Tags: Infectious diseases Case report Source Type: research

Sudden onset hemiplegia at high altitude
This report describes a case of posterior circulation infarct thought to be due to a paradoxical embolus through a patent foramen ovale. The relationship between high-altitude physiology, increased incidence of thromboembolism and the significance of patent foramen are discussed in the report. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Chandler, H. C., Mellor, A. Tags: Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Venous thromboembolism Case report Source Type: research

Incidence of acute mountain sickness in UK Military Personnel on Mount Kenya
Conclusions This represents the first informative dataset for Mount Kenya ascents and altitude. The incidence of AMS during AT on Mount Kenya using this ascent profile is high. Adapting the current ascent profile, planning the ascent after time in country and reducing perceived exertion during the trek may reduce the incidence of AMS. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Hazlerigg, A., Woods, D., Mellor, A. Tags: Sports and exercise medicine Original article Source Type: research

The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective
Background The insertion of a surgical airway in the presence of severe airway compromise is an uncommon occurrence in everyday civilian practice. In conflict, the requirement for insertion of a surgical airway is more common. Recent military operations in Afghanistan resulted in large numbers of severely injured patients, and a significant proportion required definitive airway management through the insertion of a surgical airway. Objective To examine the procedural success and survival rate to discharge from a military hospital over an 8-year period. Methods A retrospective database and chart review was conducted, usin...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Kyle, T., le Clerc, S., Thomas, A., Greaves, I., Whittaker, V., Smith, J. E. Tags: Original article Source Type: research

Ultrasound-assisted external fixation: a technique for austere environments
Conclusions The current study results suggest that with minimal training, orthopaedic surgeons can use portable ultrasound to diagnose femur fractures, decide the appropriate external fixator configuration, and safely insert Schanz pins outside the zone of injury. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Talbot, M., Harvey, E. J., Reindl, R., Martineau, P., Schneider, P. Tags: Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma, Injury Original article Source Type: research

Combat casualties from two current conflicts with the Seventh French Forward Surgical Team in Mali and Central African Republic in 2014
Objectives The Seventh Airborne Forward Surgical Team (FST) has been deployed in Gao, Mali, and in Bangui, Central African Republic (CAR), for two 3-month periods in 2014. The initial role of the FST was to provide emergent care to French and coalition soldiers but it was expanded to include humanitarian assistance. The aim of the present study was to describe and compare injuries and surgical activity of the Seventh Airborne FST during these two conflicts. Methods All surgical patients treated by the FST between January and December 2014 have been included. Patient demographics, mechanisms of injury, surgical management ...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Dubost, C., Goudard, Y., Soucanye de Landevoisin, E., Contargyris, C., Evans, D., Pauleau, G. Tags: Haematology (incl blood transfusion), Trauma, Injury Original article Source Type: research

Pressure effects on the nose by an in-flight oxygen mask during simulated flight conditions
Conclusions The exerted pressure by the oxygen mask changes during different flight conditions. Exposure to changing pressures and to shear forces probably contributes to mask-inflicted nasal trauma. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Schreinemakers, J. R. C., Boer, C., van Amerongen, P. C. G. M., Kon, M. Tags: Drugs: CNS (not psychiatric), Pain (neurology), Trauma, Injury Original article Source Type: research

Transfusion support by a UK Role 1 medical team: a 2-year experience from Afghanistan
Conclusions An isolated Role 1 medical team can safely deliver blood transfusion on vehicle, helicopter or foot patrols. The transport and storage of blood created a large logistical burden for a relatively small clinical output. However, with further developments, this capability may have utility in contingency operations especially for isolated teams. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Aye Maung, N., Doughty, H., MacDonald, S., Parker, P. Tags: Haematology (incl blood transfusion) Original article Source Type: research

Risk factors for heat illness among British soldiers in the hot Collective Training Environment
Conclusions Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of ‘marginal gains’ is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Moore, A. C., Stacey, M. J., Bailey, K. G. H., Bunn, R. J., Woods, D. R., Haworth, K. J., Brett, S. J., Folkes, S. E. F. Tags: Open access Original article Source Type: research

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009-2013
Conclusions The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Stacey, M. J., Brett, S., Woods, D., Jackson, S., Ross, D. Tags: Open access Original article Source Type: research

Tactical damage control resuscitation in austere military environments
Conclusions In tactical situations, in association with haemostatic procedures (tourniquet, suture, etc), tranexamic acid should be the first medication used according to the current guidelines. The use of fibrinogen concentrate should also be considered for patients in haemorrhagic shock, especially if point-of-care (POC) testing of haemostasis or shock severity is available. If POC evaluation is not available, it seems reasonable to still administer this treatment after clinical assessment, particularly if the evacuation is delayed. In this situation, lyophilised plasma may also be given as a resuscitation fluid while re...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Daniel, Y., Habas, S., Malan, L., Escarment, J., David, J.-S., Peyrefitte, S. Tags: Haematology (incl blood transfusion), Drugs: cardiovascular system, Resuscitation Review Source Type: research

British Military freezing cold injuries: a 13-year review
Conclusions A lack of supporting climatic and activity data meant that it was difficult to draw additional conclusions from the data collected. In future, a greater emphasis should be placed on collection of climatic and additional data when FCIs are diagnosed. These data should be collated at the end of each deployment and published as was regularly done historically. It is hoped that these data could then be used as the starting point for an annual climatic study day, where issues related to FCIs could be discussed in a Tri-Service environment and lessons learned disseminated around all British Forces personnel. (Source:...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Heil, K. M., Oakley, E. H. N., Wood, A. M. Tags: Trauma, Injury Review Source Type: research

The prehospital management of avalanche victims
Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in ...
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Kornhall, D. K., Martens-Nielsen, J. Tags: Epidemiologic studies, Editor''s choice Review Source Type: research

Returning to contingency: the forward trauma team
This article shares the experiences of this Role 1 and its unusual context, and discusses the relevance with regard to future medical planning. The focus is on the human element; a fundamental of all military operations yet one that is often overlooked. We consider the team construct and the team members of Role 1 and suggest how this team and its leaders can be optimally prepared, supported and maintained, and then safely disassembled. We also consider how best this team can be placed within the battle group formation in order to provide the highest standard of care. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Dickinson, A., Dalal, S., Beales, L. Tags: Personal view Source Type: research

Highlights of this edition
(Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 27, 2016 Category: Journals (General) Authors: Breeze, J., Garner, J. Tags: Infectious diseases, Journalology, Drugs: CNS (not psychiatric), Competing interests (ethics) From the editor Source Type: research