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Review of enteral nutrition practices in critically ill adults in resource-limited environments
Enteral nutrition in critical care is a complex area of practice. A resource-limited environment includes countries that are identified as low income and low/middle income. This review describes three themes for its successful implementation of enteral nutrition in a resource-limited environment. These include identification of patients at risk of malnutrition, using non-commercial feeds and the urgent need to develop practice. Malnutrition is a serious complication of critical illness and remains a crucial aspect of patient care in order to prevent complications. Further evidence to develop sustainable enteral nutrition s...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Carter, C., Senior Lecturer, Notter, J. Tags: Invited review Source Type: research

Military provision of maternal care in humanitarian and disaster relief operations
With three-quarters of the 80 million people in need of humanitarian assistance being women or children in 2014, maternal care makes up a significant burden of medical care in humanitarian assistance and disaster relief operations. Due to lack of infrastructure and up to 80% of these displaced people being located in developing countries, mothers are often extremely vulnerable to disease, abuse and malnutrition. This can lead to late presentations of severe disease and birthing complications that would usually be easily manageable, but are far more complex due to the physical condition of the mother and lack of available r...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Bishop, A., Dewhurst, H. Tags: Invited review Source Type: research

The History of the Post-Graduate Medical and Nursing Officers (PGMNO) course in the British Army
This article summarises the development of the British Army’s PGMNO course and the evolution of its syllabus as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Matthews, J. H., Makin, S., Booker, R. J., Holland, A., K Bhabutta, R., Vassallo, D., Woodhouse, J., Ross, D. Tags: Invited review Source Type: research

Foreign intervention following a humanitarian crisis: help versus harm
Recent experience of humanitarian and disaster relief efforts have demonstrated the critical importance of the local health infrastructure and its response to a disaster in both the short and long term. With increasing involvement of Foreign Medical Teams (FMT), both military and civilian, in these relief efforts, there is a necessity to review how best a FMT can involve and develop the local response; it is no longer valid to design an intervention insular from the local population. Key themes found in interventions that have damaged the local infrastructure and response include: bypassing, undermining and overstretching ...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Betney, D. T. Tags: Invited review Source Type: research

Emergency first responder management of combat injuries to the torso in the military, remote and austere settings
Traumatic injuries to the torso account for almost a quarter of all injuries seen in combat and are typically secondary to blast or gunshot wounds. Injuries due to road traffic collisions or violence are also relatively common during humanitarian and disaster relief efforts. There may also be multiple injured patients in these settings, and surgical care may be limited by a lack of facilities and resources in such a non-permissive environment. The first responder in these scenarios should be prepared to manage patients with severe injuries to the torso. We aim to describe the management of these injuries in the military an...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Sandhu, A., Claireaux, H. A., Downes, G., Grundy, N., Naumann, D. N. Tags: Invited review Source Type: research

Children in a disaster: health protection and intervention
This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for ch...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Reid, C., Hillman, C. Tags: Invited review Source Type: research

Burns management in the military and humanitarian setting
This article provides an overview for prehospital providers on the management of thermal burns in military and humanitarian settings, with additional considerations for the management of chemical and electrical injuries. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Sandhu, A., Herron, J. B. T., Martin, N. A. Tags: Editor''s choice Invited review Source Type: research

Complications with hot, cold and altitude environments in disaster management
Conclusion Disaster management in the extreme environments of hot, cold and high altitude is fraught with unique challenges, especially around the physiological response of rescuers, resource constraints and logistics. Recognising these challenges is an important aspect of planning and preparation for disaster management in these environments. (Source: Journal of the Royal Army Medical Corps)
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Bainbridge, A., Wolfe, A., Hartley, M. Tags: Invited review Source Type: research

Communicable diseases in humanitarian operations and disasters
Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose—the UK Defence Medica...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Murphy, R. J. Tags: Invited review Source Type: research

Specialist infantry and defence engagement
In 2015, the UK government published the National Strategic Defence and Security Review (SDSR) 2015, which laid out their vision for the future roles and structure of the UK Armed Forces. SDSR 2015 envisaged making broader use of the Armed Forces to support missions other than warfighting. One element of this would be to increase the scale and scope of defence engagement (DE) activities that the UK conducts overseas. DE activities traditionally involve the use of personnel and assets to help prevent conflict, build stability and gain influence with partner nations as part of a short-term training teams. This paper aimed to...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Herron, J. B. T., Heil, K. M., Reid, D. Tags: Invited review Source Type: research

Bioethics in humanitarian disaster relief operations: a military perspective
The ethical dilemmas faced every day by military personnel working within the NHS will potentially be very different to ones that will be faced in the wake of a humanitarian disaster. Allied to this the potentially differing objectives from military personnel when compared with other healthcare workers in these scenarios and a conflict of ethics could arise. Within this paper, the fundamentals of this conflict will be explored and how working within the military framework can affect clinical decisions. This is a paper commissioned as a part of the humanitarian and disaster relief operations special issue of BMJ Military He...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Davies, J., Brockie, A., Breeze, J. Tags: Invited review Source Type: research

Priorities of primary care in disaster medicine
The role of primary care in a disaster has too often been poorly defined and poorly understood. Due to its relative low-cost adaptability and closeness to the community, primary care can treat across multiple medical domains. By interacting with stakeholders from international data collection, state health bodies and secondary care to community groups, primary care can generate effect. Minimal standards are defined by Sphere guidelines to work within international, national and local frameworks. Evolution of the understanding of primary care in disaster medicine has resulted in a greater emphasis on maintaining outputs. In...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Makin, S., Ross, D. Tags: Invited review Source Type: research

Is the continued existence of diseases of poverty an indictment of our current humanitarian ethos?
The continued existence of diseases of poverty is one of the great medical moral dilemmas of the 21st century. That this group of largely either preventable or treatable diseases still plagues a great many of the world’s poorest citizens is a challenging problem to address. This paper examines diseases of poverty not by looking at the pathogenic diseases themselves but by looking at the ‘diseases’ of society that lead to the prevalence of such morbidity. ‘Diseases’ such as lack of infrastructure, lack of nutrition, lack of education, lack of funding and lack of socioeconomic stability. By addr...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Aldridge, R. Tags: Invited review Source Type: research

Health economic evaluation: cost-effective strategies in humanitarian and disaster relief medicine
The health economic evaluation is a tool used in disaster relief medicine to generate a cost–benefit analysis. Like all areas of healthcare, disaster relief operations must use finite financial resources, much of which comes from charitable donations and foreign aid. Interventions can be assessed using cost-effectiveness tools and equity assessments. Through these tools, interventions that maximise benefit for a given cost are highlighted in the immediate rapid response phase where food, clean water and shelter are prioritised, often with military support. Beyond this, applications of technology and pre-response trai...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Stewart, T., Bird, P. Tags: Invited review Source Type: research

Prehospital emergency care in a humanitarian environment: an overview of the ethical considerations
Recent history has demonstrated that UK Defence personnel can be used, potentially with little notice, in humanitarian disaster zones. The provision of prehospital emergency care (PHEC) in a humanitarian environment requires an innovative approach to overcome the technical challenges of a resource-limited setting. In addition to technical challenges, prehospital practitioners working in a humanitarian environment can expect to be faced with ethically testing situations that they are not familiar with in their usual practice. The organisational and individual ethical decision-making burden can result in significant harms. T...
Source: Journal of the Royal Army Medical Corps - November 22, 2022 Category: General Medicine Authors: Prescott, T., May, S., Horne, S., Barnard, E. Tags: Invited review Source Type: research