bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical experience with recombinant activated factor VII in a series of 45 trauma patients
Authors: Felfernig Michael 
Published: March 2013

AimHaemorrhage control is a major priority in the care of trauma patients in military as in the civilian setting. About 50% of combat deaths are due to fatal bleeding. The aim of this analysis was to assess the efficacy and safety of recombinant activated factor VII (rFVIIa; NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark) when used to treat trauma-related blood loss.Patients and methodsForty-five patients aged 5–81 years (mean age 30.5 years) received rFVIIa (mean dose 73.6 μg/kg) for the management of trauma-related bleeding. Trauma was classified as blunt (n = 42) or penetrating (n = 3). The primary outcome measure was reduction of transfusion requirements; improvements in coagulation status post-rFVIIa were also noted.ResultsHaemostatic efficacy was achieved in 43/45 (95.6%) patients following rFVIIa administration, and transfusion requirements (defined as median units of packed red blood cells administered in the 24-hour period following rFVIIa administration) were reduced from 10 to 3 units (P < 0.001). Coagulation status also showed improvement (median values for activated partial thromboplastin time and prothrombin time decreased from 43 to 37 s [P < 0.001] and from 19 to 12 s [P = 0.026], respectively). No safety concerns were raised by the available data.ConclusionsAs this analysis has several limitations that are unavoidable when using global registries to collect and analyse data, our findings are not conclusive. However, these preliminary observations especially in those patients who underwent very early rFVIIa treatment offer further support for the use of rFVIIa in trauma.
Primary Blast Injuries to the Eye: A Review of the Evidence
Authors: Abbotts R , Harrison SE , Cooper GL 
Published: March 2013

ObjectivesEye injuries are relatively common following detonations. The majority of these are caused by secondary fragments. Primary blast injury to the eye (from the air-blast alone) has been described historically, but the differentiation of air-blast and fragment aetiologies in the reports is not clear. The aim of this review is to consider the evidence in the literature for true primary blast injury to the eye.MethodsA literature review using Medline, Pub-med and Web of Knowledge databases.ConclusionsOverall, there is little conclusive evidence that primary ocular blast injury occurs in survivors of explosions. However, some case reports do surmise its occurrence and it cannot be unequivocally ruled out. If it does occur, it is more likely to be at high overpressures that will produce life-threatening injuries. The development of enhanced blast weapons may result in an increased incidence. At present however, the most severe and damaging threat to the eyes from blast remains the impact of fragments and debris.
The Operational Emergency Department Attendance Register (OPEDAR): A New Epidemiological Tool
Authors: Russell R , Hodgetts T , Ollerton J , Massetti P , Skeet J , Bray I , Harrison K 
Published: March 2013

AimTo determine the number, status and nature of emergency department attendances to deployed field hospitals.PopulationAll attendances to the emergency department (ED) of deployed field hospitals in support of Operation TELIC (Iraq) from initial entry war fighting to enduring operations.MethodsAnalysis of hand written and electronic registers ED attendance registers and validation with four other data sources.ResultsValidation of data held on OpEDAR against 4 other data sources shows that OpEDAR is accurate, but that accuracy can be further improved. 26,746 ED attendances recorded on OP TELIC from 19 March 2003 to 11 November 2006. 21,112 (78.9%) were UK military. Overall, 43.5% were admitted from ED. Attendances peaked during TELIC phases 2 (422.9 per 1,000 troops deployed), but have settled to around 200 per 1,000 troops deployed in the more recent phases. Ophthalmology rates peaked in TELIC 2 to 20.72 per 1,000 and have since reduced to a consistent 10 to 15 per 1,000. This suggests that preventative measures introduced for eye injury are incompletely effective or incompletely utilised.ConclusionsOpEDAR is a clinical tool to inform manning, equipment and training requirements for enduring and new operations, focused on the requirements of the emergency department. Multivariate quality control models applied in industry could be applied to OpEDAR to produce a dynamic epidemiological tool that identifies emerging case clusters and facilitates deployed commanders to take preventative action.
Tourniquet Use in Combat Trauma: UK Military Experience
Authors: Brodie S , Hodgetts Timothy J , Ollerton Jo , McLeod Judith , Lambert Paul , Mahoney Peter 
Published: March 2013

AimTo determine the prevalence of tourniquet use in combat trauma, the contribution to lives saved and the complications of their use in this environment.PopulationAll casualties treated at UK field hospital facilities in Iraq and Afghanistan and meeting criteria for entry into UK Joint Theatre Trauma Registry (JTTR) from 04 Feb 03 to 30 Sep 07.MethodsCases were identified from UK JTTR. Casualties from Permanent Joint Overseas Bases (PJOBs) were excluded. ISS, NISS, TRISS and ASCOT were calculated automatically within JTTR from AIS 2005 (Military) codes.Results1375 patients met UK JTTR entry criteria for the period specified (excluding PJOBs). 70/1375 patients (5.1%) were treated with one or more tourniquets (total 107 tourniquet applications). 61/70 (87%) survived their injuries. 17/70 (24%) patients had 2 or more tourniquets applied. 64/70 patients received a tourniquet after April 2006, when tourniquets were introduced as an individual first aid item. 43/70 (61%) patients were UK military.ConclusionsISS and TRISS are poorly representative of injury severity and outcome for combat trauma involving isolated multiple limb injuries and cannot be used to discriminate whether a tourniquet is life-saving. The presence of severe isolated limb injuries, profound hypovolaemic shock and the requirement for massive transfusion reasonably identifies a cohort where the use of one or more tourniquets pre-hospital to control external bleeding can be said to be life-saving.
Combat-Related Disorders: A Persistent Chimera
Authors: Alexander David A , Klein S 
Published: March 2013

Whilst there may be some individuals who genuinely enjoy combat, for most troops it represents many emotional challenges, such as, overcoming fear and being witness to death, suffering and mutilation, as well as having to tolerate extremes of physical discomfort.At present we lack sufficiently valid and reliable methods of screening out those personnel particularly vulnerable to adverse reactions to these challenges. The authorities should aim to provide good training, an appreciative milieu, and a working climate in which those with genuine psychopathology feel confident to admit this, without censure and stigma, and to have access to evidence-based treatments.We should also remember that military life offers much to many men and women, and that surviving physically and psychologically the unavoidable brutalities of combat can often leave a legacy of positive outcomes. We must avoid becoming preoccupied with risk and psychopathology.
Retrospective Analysis of the Ethnic Origins of Male British Army Soldiers with Peripheral Cold Weather Injury
Authors: Burgess John E , Macfarlane F 
Published: March 2013

ObjectivesTo determine if African Americans, Pacific Islanders and Gurkhas have a different incidence and severity of peripheral cold injury when compared to Caucasians in the British Army.MethodThe design was a retrospective analysis of those British male army personnel aged over 18 assessed at the Institute of Naval Medicine Cold Injury Clinic. The participants were 311 patients assessed on first attendance at the UK Institute of Naval Medicine.ResultsAfter excluding those classed as normal, African Americans had a relative incidence of 30.36 (95% CI 25.82 – 35.70) when compared to Caucasians; Pacific Islanders a relative incidence of 2.58 (CI 1.24 – 5.38), again against Caucasians. Being of Gurkha ethnicity proved protective, with no abnormal cases found on assessment. The African Americans were more severely affected than Caucasians, with mean scores of 5.39 (SD 1.767) against 4.24 (SD 1.994) for Caucasians. The severity of Pacific Islanders were similar to Caucasians. The ages of African Americans, Pacific Islander and Caucasians had similar means of 26.05, 26.30 and 26.68 respectively, but with a broader age range for Caucasians; SDs 3.428, 2.958 and 7.735.ConclusionYoung male African Americans in the British Army are at 30 times greater chance of developing peripheral cold injury and are more severely affected than their Caucasian counterparts following similar climatic exposure, using similar clothing and equipment. Pacific Islanders are at a 2.6 times increased risk, while being a Gurkha is protective.
UK Armed Forces Unintentional Firearm Injuries
Authors: Stansfield Tim , Rushforth G 
Published: March 2013

ObjectivesTo report on the incidence of unintentional firearm discharge and injury across the UK Armed Forces and present several cases of this wounding phenomenon.MethodMunitions Incidents and Defects (MID) Cell data on UK Military Negligent Discharges and unintentional firearm injuries from 01 Jan 03 to 31 Dec 07 was categorised according to cause of injury, wound, service affiliation, incident context and weapon type. The injuries of three patients are described.ResultsOver the 5 year period there were 1158 Unintentional firearm discharges, forty three (4%) of which resulted in injury. Fifty five military personnel sustained unintentional firearm injuries during the review period, more than half of which were gunshot wounds and this included one fatality. The Regular Army suffers an average of 7.7 unintentional firearm injuries per 100 000 Regular Army person years.ConclusionUnintentional firearm injury is well recognised across the civilian and police sectors worldwide. Despite the recent tempo of high grade training and operations that currently engage UK Armed Forces this form of injury remains uncommon. We hope to facilitate discussion with the chain of command to manage the risk of these injuries.
Preliminary Results of the ‘Surgiligtm’ Synthetic Ligament in the Management of Chronic Acromioclavicular Joint Disruption
Authors: Wood TA , Rosell PAE , Clasper JC 
Published: March 2013

BackgroundChronic instability of the acromioclavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial ligament is often required in service personnel, and a number of methods to augment this repair have been used. Many of these operative methods require a second operation to remove the metalwork, and in addition can be associated with a failure rate of up to 30%. The ‘Surgilig™’ was originally designed for use in the revision of failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation, reinforcing the autologous graft, in an attempt to reduce the failure rate.Data Collection And AnalysisWe prospectively followed up the Modified Weaver Dunn procedures using Surgilig™. The post-operative x-rays were reviewed at six weeks, three months and then six months to assess the radiological success of the procedure. Our patients were discharged at six months.ResultsWe have performed this procedure in 11 patients. One of the 11 patients was excluded from the study as the Surgilig™ graft was used in addition to a hook plate. The remaining ten patients have all reached the six-month post-operative time with no incidence of radiological failure of the graft. After six months they were discharged from clinic follow-up as the coracoacromial graft had sufficient strength to no longer rely on the augment for mechanical stability of the joint. All 10 patients had a good clinical and radiological result. One patient even had inadvertent stress/ weight-bearing x-rays taken at six weeks, with no discernable detrimental effect to outcome.ConclusionAlthough a small study, these initial results for primary fixation of acromioclavicular joint disruption with Surgilig™ are extremely encouraging. The results suggest that Surgilig™ should continue to be used in its current role. As patient numbers increase, a follow-up study to evaluate these preliminary findings should be conducted.
Training Tomorrow’ Military Surgeons: Lessons from the Past and Challenges for the Future
Authors: Eardley WGP , Taylor DM , Parker PJ 
Published: March 2013

The nature of conflict is evolving, with current warfare being associated with an initial “shock and awe” phase followed by protracted periods of counter-insurgency and peace support missions. As conflict has changed, so have the munitions deployed and the resulting patterns of injury. Improvised Explosive Devices have become the preferred weapon of the insurgent and the resultant explosive and fragmentation injuries are the hallmark of modern military wounding. These injuries pose a significant challenge to deployed medical forces, requiring a well-defined, seamless approach from injury to rehabilitation.Traditionally, military medical services demonstrate a poor ‘institutional memory’ in the maintenance of combat surgical skills. Numerous publications detail the re-learning of key tenets of war surgery by generations of surgeons deploying onto the field of battle. While the maintenance of military surgical capability in trained surgeons may be addressed through combat surgical courses, concern exists as to the generic competency of those currently in training and their ability to deal with the burden of injury associated with modern conflict.The training of junior doctors in the United Kingdom and further afield is in a state of flux. New curriculum development, streamlined and run-through training programmes have combined with the legal requirements of the European Working Time Directive to produce a training landscape almost unrecognisable with that of previous years.This article investigates the development of current military wounding patterns and modern surgical training programmes. It describes processes already in place to address the unique training needs of military surgeons and proposes a framework for enabling appropriate training opportunities in the future.
Blast Mines: Physics, Injury Mechanisms And Vehicle Protection
Authors: Ramasamy Arul , Hill AM , Hepper AE , Bull AMJ , Clasper JC 
Published: March 2013

Since World War II, more vehicles have been lost to land mines than all other threats combined. Anti-vehicular (AV) mines are capable of disabling a heavy vehicle, or completely destroying a lighter vehicle. The most common form of AV mine is the blast mine, which uses a large amount of explosive to directly damage the target. In a conventional military setting, landmines are used as a defensive force-multiplier and to restrict the movements of the opposing force. They are relatively cheap to purchase and easy to acquire, hence landmines are also potent weapons in the insurgents’ armamentarium. The stand-off nature of its design has allowed insurgents to cause significant injuries to security forces in current conflicts with little personal risk. As a result, AV mines and improvised explosive devices (IEDs) have become the most common cause of death and injury to Coalition and local security forces operating in Iraq and Afghanistan.Detonation of an AV mine causes an explosive, exothermic reaction which results in the formation of a shockwave followed by a rapid expansion of gases. The shockwave is mainly reflected by the soil/air interface and fractures the soil cap over the mine. The detonation products then vent through the voids in the soil, resulting in a hollow inverse cone which consists of the detonation gases surrounded by the soil ejecta. It is the combination of the detonation products and soil ejecta that interact with the target vehicle and cause injury to the vehicle occupants.A number of different strategies are required to mitigate the blast effects of an explosion. Primary blast effects can be reduced by increasing the standoff distance between the seat of the explosion and the crew compartment. Enhancement of armour on the base of the vehicle, as well as improvements in personal protection can prevent penetration of fragments. Mitigating tertiary effects can be achieved by altering the vehicle geometry and structure, increasing vehicle mass, as well as developing new strategies to reduce the transfer of the impulse through the vehicle to the occupants. Protection from thermal injury can be provided by incorporating fire resistant materials into the vehicle and in personal clothing. The challenge for the vehicle designer is the incorporation of these protective measures within an operationally effective platform.
Self-Administration of Exercise and Dietary Supplements in Deployed British Military Personnel During Operation TELIC 13
Authors: Boos Christopher , Wheble GAC , Campbell MJ , Tabner KC , Woods DR 
Published: March 2013

ObjectivesRecent operational experience has led to the identification of several potentially serious adverse events related to the use of dietary and exercise supplements among British Army personnel. This study aimed to establish the point prevalence of dietary and exercise supplement usage in British soldiers on Op TELIC during January 2009.MethodsA cross-sectional questionnaire-based study of British military personnel located at the Contingency Operating Base (COB), in Basra, was performed during the sixth week of Op TELIC 13.ResultsFrom 1544 questionnaires (target population) issued, a total of 1017 (65.9%) completed questionnaires were evaluated. The mean population age was 29.5 years (range 18-58) of which 87.4% were male. 417/1017 persons (41.0%) admitted to a history of supplement use of which 32.0% were current users and 9.4% were previous users. Of these current users, 66.0% started taking them on their current deployment. The most commonly taken supplements were whey protein (18.8%), amino acids (17.9%), and creatine (13.2%). There were 14 persons (1.4%) who admitted to current use of anabolic steroids. The most-frequently given reasons for taking supplements were either to ‘increase muscle bulk’ (40.4%) or to aid training and recovery (20.8%).ConclusionsThis is the first study to investigate the use of exogenous nutritional supplements within the British Military and has identified their widespread use during operational deployment. The use of anabolic steroids is particularly worrying, given both their illegality and their well-recognised and deleterious health effects. There is a need for greater awareness and education regarding potential benefits and dangers of supplement use in order to maximise any potential benefits and minimise clinical risk.
Current Epidural Practice – Results of a Survey of Military Anaesthetists
Authors: Woods KL , Aldington Lt Col 
Published: March 2013

ObjectivesAs epidurals are now used for pain relief on deployment a survey was conducted to look at the current epidural practice of UK military anaesthetists. The aim was to identify any potential issues with regard to equipment and training to allow future development of pre-deployment training.MethodsAn internet based survey was carried out. All military anaesthetists were sent an e-mail containing a link to the survey and the results of those who responded were analysed.ResultsA total of 49 surveys were completed. 78% of respondents carried out epidurals more than once a month, in a wide range of specialities. There was considerable variation in methods of securing epidurals and in drug choice amongst respondents.ConclusionsThe results of this survey show that whilst epidurals are commonly carried out amongst military anaesthetists during their UK practice, there is significant variation within the practice. Areas have been identified for development of educational courses, for example methods of securing epidurals, and these have already been acted upon.
High Altitude Pulmonary Oedema
Authors: Hall DP , Duncan K , Baillie J Kenneth 
Published: March 2013

High altitude pulmonary oedema (HAPE) is an important and preventable cause of death at high altitudes. However, little is known about the global incidence of HAPE, in part because most cases occur in remote environments where no records are kept. Furthermore, despite international efforts to achieve consensus, there is wide disparity in the diagnostic criteria in clinical and research use. We have reviewed the literature on the incidence and epidemiology of HAPE.There is broad agreement between studies that HAPE incidence at 2500m is around 0.01%, and increases to 1.9% at 3600m and 2.5-5% at 4300m. Risk factors for HAPE include rate of ascent, intensity of exercise and absolute altitude attained, although an individual pre-disposition to developing the condition is also well described and suggests an underlying genetic susceptibility. It is increasingly recognised that clinically-detectable HAPE is an extreme of a continuous spectrum of excess pulmonary fluid accumulation, which has been demonstrated in asymptomatic individuals.There is a continued need to ensure awareness of the diagnosis and treatment of HAPE among visitors to high altitude. It is likely that HAPE is preventable in all cases by progressive acclimatisation, and we advocate a pragmatic “golden rules” approach. Our understanding of the epidemiology and underlying genetic susceptibility to HAPE may be advanced if susceptible individuals register with the International HAPE Database:http://www.altitude.org/hape.php.HAPE has direct relevance to military training and operations and is likely to be the leading cause of death at high altitude.
Changes to Colour Vision on Exposure to High Altitude
Authors: Davies Andrew J. , Morris DS , Kalson NS , Wright AD , Imray CHE , Hogg CR 
Published: March 2013

ObjectivesSeveral studies have shown deterioration in colour vision at altitudes above 3,000m. These studies have been conducted in photopic (bright daylight) conditions, whereas many military operations take place in mesopic (dim light) conditions. Data suggests that the tritan colour vision axis (blue cones, TA) are more susceptible to hypoxic insult than protan axis (red cones, PA). The objective of this study was to examine colour vision at high altitude, in mesopic conditions, and using a novel method of assessment to discriminate between the tritan and protan axis.MethodsWe examined 42 eyes (21 subjects, mean age 44, range 22-71), at sea level and within 12-36 hours of exposure to 3300m. This was done in a darkened room, with refractive error correction. Colour vision was studied using Chroma Test™, a software programme that analyzes colour contrast threshold (CCT) of both TA and PA. We planned to repeat CCT measurement at 4,392m, but technology failure prevented this. Non-parametric paired data was examined using the Wilcoxon signed rank test.ResultsThere was found to be no change to either the PA (p=0.409) or the TA (p=0.871) upon ascent. Within the PA 16 eyes had a lower CCT at high altitude, whilst 26 were higher. In the TA 20 eyes had a lower CCT and 22 were higher. At sea level, mean CCT for PA was 4.21 (SD 2.29) TA was 7.06 (SD 1.77). At 3,300m mean CCT for PA was 4.36 (SD 2.86) and TA was 6.93 (SD 2.39).ConclusionsThis experiment revealed no changes to colour vision with exposure to 3,300m. This may be below the threshold altitude for cone dysfunction, alternatively colour vision deterioration may be less significant in mesopic conditions.