bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burns and Military Clothing
Authors: McLean A D 
Published: March 2013

Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury.Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulderlaunched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict.The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns.Clothing can be a barrier to some types of burn - both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials.Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered - face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under high heat loads in the laboratory, combat clothing can ignite, but there is little evidence that clothing ignition is a common occurrence in military burn casualties.Thermoplastic materials have many benefits in civil and military clothing. There is little objective evidence that they exacerbate burns, or complicate burn management. Their use in military clothing must be based on objective evidence, not hearsay.
Malaria remains a military medical problem
Authors: World MJ 
Published: March 2013

ObjectiveTo bring military medical problems concerning malaria to the attention of the Defence Medical Services.MethodSeven military medical problems related to malaria are illustrated by cases referred for secondary assessment over the past five years. Each is discussed in relation to published data.ResultsThe cases of failure of various kinds of chemoprophylaxis, diagnosis and treatment of malaria may represent just a fraction of the magnitude of the overall problem but in the absence of reliable published military medical statistics concerning malaria cases, the situation is unclear.ConclusionPresent experience suggests there are a number of persisting problems affecting the military population in relation to malaria. Only publication of reliable statistics will define their magnitude. Interim remedies are proposed whose cost-effectiveness remains to be established.
Prospective Evaluation of Handheld Ultrasound in the Diagnosis of Blunt Abdominal Trauma
Authors: Brooks A , Davies B , Connolly J 
Published: March 2013

ObjectivesTo evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma.MethodsTrauma ultrasound using the Focused Assessment with Sonar for Trauma (FAST) technique was performed using the Sonosite 180 handheld ultrasound during the primary survey of adult patients triaged to the resuscitation room with multiple trauma or suspected abdominal injury. The ultrasound findings were compared against the investigation of choice of the attending surgeon/accident & emergency physician - CT, DPL, laparotomy or clinical observation.Results50 patients who had sustained blunt abdominal trauma were evaluated using FAST. Satisfactory images were obtained in 96%. There were 5 true positive scans confirmed by CT, DPL or laparotomy. There were no false negative or false investigations. The sensitivity and specificity of handheld FAST was 100%.ConclusionsHandheld ultrasound using the Sonosite 180 system can be successfully used by appropriately trained doctors as the primary investigation in the acute evaluation of blunt abdominal trauma.
A Two Year Review Of The Treatment And Complications Of Mandibular Angle Fractures
Authors: Dhariwal D K , Gibbons A J , Murphy M , Llewelyn J , Gregory M C 
Published: March 2013

A review of all patients with treated mandibular angle fractures at a district general hospital, over a two year period, was undertaken. Forty one consecutive patients with 43 mandibular angle fractures were identified. Thirty eight fractures were treated by open reduction and internal fixation with miniplates and 5 by intermaxillary fixation (IMF).Fractures treated with miniplates were reduced under direct vision to give an anatomical reduction without using temporary intermaxillary fixation. The shortened operative time together with the prompt administration of intravenous antibiotics following injury and rapid treatment of fractures after admission resulted in a low complication rate of 7.3% of patients requiring a subsequent surgical procedure. Although IMF has an important role to play in the general treatment of facial fractures, we suggest that there is a place for single miniplate fracture fixation without the use of temporary IMF when treating simple angle fractures. As this technique is quick and has a low complication rate its use in military situations should be considered.
Musculoskeletal Injuries In Female Soldiers: Analysis Of Cause And Type Of Injury
Authors: Strowbridge N F 
Published: March 2013

ObjectivesTo record and analyse those injuries and conditions requiring referral to a military sports injury and rehabilitation centre over a three year period, with special reference to gender, type and site of injury, and the cause of the injury.MethodsA prospective study in which data on the gender, diagnosis, and cause of injury, of all patients referred to the Colchester Garrison Sports Injury and Rehabilitation Centre was recorded. All subjects were trained, serving soldiers in the British Army referred via their General Practitioner.ResultsLow back pain (OR 2.71, p<0.0001) and injuries to the hip, thigh and lower leg (OR 2.33, p<0.0001) were more frequent in female soldiers. Military training (OR 4.62, p<0.0001), work (OR 2.53, p<0.0001), recreation (OR 2.39, p<0.0001), and pre-existing conditions (OR 4.2, p<0.0001) were the causes most commonly cited by female rather than male soldiers. There was no statistical gender difference for sport related or road traffic accident injuries.ConclusionsFemale soldiers are more likely to sustain an injury than their male counterparts. Specific injuries account for the majority of this difference. Military training, work, and recreation are more likely to be the cause of injury in the female soldier. Conditions existing prior to military service were also more common. There was no gender difference in the injuries caused by sport or road traffic accidents. These results may act as a basis for targeted intervention in order to reduce inequality without reducing overall training standards.
The Pipe Bomb: A Modern Terrorist Weapon
Authors: Gibbons A J , Farrier J N , Key S J 
Published: March 2013

The use of pipe bombs by terrorist organisations around the world has risen dramatically. The pipe bomb is simple and easy to make and details of bomb construction are freely available from the Internet. Components can be found in most hardware stores and thus give little forensic information.Despite the increasing use of pipe bombs, clinicians may be unfamiliar with the type of injuries they cause. This paper describes two incidents of pipe bomb explosions and illustrates the type of injuries sustained by both terrorists and victims.
A Lesson Not Yet Learned
Authors: Becker GW , Laundy TJ 
Published: March 2013

ObjectivesAccounts of numerous military campaigns throughout history have shown that casualties from medical illness usually greatly outnumber combat injuries. We aimed to see whether this remained the case in a modern campaign where predominantly surgical facilities were deployed.MethodsWe examined 1511 hospital records of inpatients in the Oman theatre during the last three months of Exercise Saif Sareea II and the initial period of Operation Veritas.ResultsOf the 1399 records included, 1033 (74%) required care from a physician, whereas 366 (26%) were treated by surgeons. However, of patients returning to duty in theatre (total 985), 884 (90%) had been treated by physicians and 101 had been treated by surgeons. Notably, only 23 (2%) of these had undergone a surgical procedure.ConclusionsExperience in Oman suggests that the lessons of history in respect of casualties in times of conflict are both unlearned and being repeated. The role of the medical specialities in military secondary care should be recognised and deployed facilities should not be defined by surgical capability alone.
Impact Of Deployment Of Personnel With Chronic Conditions To Forward Areas
Authors: Hodgetts TJ , Greasley LA 
Published: March 2013

AimTo identify reasons for inappropriate deployment of soldiers with chronic conditions to an operational environment.SettingTwo British Army field hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop concentration prior to war-fighting (Operation Telic).PopulationAll British military personnel on land during the concentration phase, rising to an estimated 28,000 troops.MethodsReal-time electronic record maintained of all cases presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed.Results50 sequential cases were analysed. 34% were downgraded prior to deployment. Of those who were P2 FE, 85% were judged to have required protection from deployment by downgrading. 20% of all cases had a history of chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of all cases were deployed while waiting for secondary care investigation or review that should have ensured protection from deployment. No patient had an existing “FT” (forward temperate) or “LT” (lines of communication temperate) grading: but in four cases it was predictable that the patient’s underlying condition would be adversely affected by deployment to a desert environment. In 5 cases it was identified that the inappropriate deployment could be attributed to clinical management within the civilian sector, with a consequent failure to institute the necessary downgrading process.ConclusionsReview of the medical grading process is needed to protect those soldiers who are awaiting outpatient opinion or definitive diagnosis from investigation, and to provide an employability grading that matches a soldier’s fitness for operational role.
Organisation For The Relief Of Concentration Camps
Authors: Engel HO 
Published: March 2013

ObjectiveTo review the essential principles involved in rescue missions for natural and man-made disasters.MethodA description of the relief of a concentration camp in 1945 as an example of the logistics required in any major disaster or rescue.ResultsThe arrival of trained Army rescue teams on the first day and dealing systematically with priorities in salvage, treatment and nursing saved many lives, even of desperately ill patients.ConclusionsA centralised administration and organisation of supplies is the first priority. Suitable intravenous and very light nutrients, and the prevention and combating of infections are more urgent than the provision of shelter and clothing.
A Field Mental Health Team In The General Support Medical Setting
Authors: McAllister PD , Blair S P R , Philpott Steven 
Published: March 2013

The recent conflict in the Gulf saw the large-scale deployment of Field Mental Health Teams (FMHT), in support of 1 UK Division and its constituent brigades. This article describes the activities and findings from a FMHT deployed alongside a General Support Medical Regiment covering the divisional rear area.The rate of psychiatric casualties was much lower than anticipated, but the expected bias towards less experienced personnel and reservists was noted.The article covers all stages of the operation from pre-deployment training, reception, staging and onward integration, operations, redeployment and homecoming, describing the core activities of the FMHT at each stage.
Extremity Injuries Remain A High Surgical Workload In A Conflict Zone: Experiences Of A British Field Hospital In Iraq, 2003
Authors: Ramalingam T 
Published: March 2013

BackgroundDuring this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle injured extremities.MethodA retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict.ResultsSixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87).ConclusionThe experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.
The Incidence And Occupational Outcome Of Overuse Anterior Knee Pain During Army Recruit Training
Authors: Wills A K , Ramasamy A , Ewins D J , Etherington J 
Published: March 2013

ObjectivesTo determine the incidence and occupational outcome of overuse anterior knee pain (AKP) in Army recruits undergoing basic training.MethodsA prospective cohort study of 1008 Army recruits. Recruits underwent the 12-week phase 1 training program. Cases of AKP were captured through self-presentation of pain at a primary care medical centre. All recruits medical records were reviewed on leaving training and any other lower limb injuries were recorded for comparison with the AKP group. Training outcomes in terms of medical discharges (MD) and discharges as of right (DAOR) i.e, voluntary discharge, were recorded along with training days lost (TDL) and whether a recruit had been held back in training (BS).Results8.75% (95%CI: 6.93 – 10.57) of recruits reported to the medical centre with AKP. Of these more than half were referred to see a GP and the majority were from patients with no previous history of AKP (91%, 95% CI: 85.2 – 97.5). The median TDL per AKP case was 3 days (IQR: 3-5 days). The AKP group had a significantly higher (p<0.01) MD rate (12.5%) than the lower limb injury group (3.3%; 95% CI diff: 1.1 – 17.2% ) and the baseline rate of all other recruits (2.5%; 95% CI diff: 2.3 – 17.7%). The majority of AKP cases occurred by week 4 (median) of training (IQR: 2.2 – 6.4).ConclusionsThere was a high incidence of AKP, and while the short term prognosis appears relatively good in the majority of cases as reflected in the median TDL, a large minority were medically discharged and held back in training. Further work should examine methods of reducing the disease burden of AKP in the Army, addressing areas such as aetiology, prevention and treatment.
An Observational Study On The Spectrum Of Heat-Related Illness, With A Proposal On Classification
Authors: Day T K , Grimshaw D 
Published: March 2013

During operations in subtropical areas over the summer months of 2001 and 2003 the authors audited 80 patients with heat-related illness, with the intention of defining the nature and distribution of the underlying pathophysiology. Haematological, biochemical and clinical data were gathered prospectively and patients allocated to diagnostic categories on the basis of the combination of clinical findings and investigations. Four basic types of heatrelated illness could be distinguished: (1) excessive salt loss with hyponatraemic dehydration, (2) hypokalaemic alkalosis with low serum bicarbonate, (3) haemodilution associated with excessive water intake in stressed individuals, and (4) loss of normal thermoregulation, characterised by high core temperature and paradoxical cessation of sweating. Most of the patients fell clearly into a single distinct category, but there was a degree of overlap. Reduction of extracellular fluid volume was a common central mechanism. Common provoking factors identified were: gastrointestinal upset, history of previous heat intolerance (35%) environmental temperatures exceeding 45°C, short period of acclimatisation (55%), travel, sleep loss, hard physical work especially if directly preceded by a period of sleep, work in confined humid spaces (45%), and lack of additional salt intake. When several of these factors were present together admission rate over one 24-hour period reached 3% of persons at risk per day. Patients are often more ill than they appear. To reduce the incidence of heat illness during future operations the following measures are proposed:Avoidance of physical exertion during the heat of the day for the first 7-10 days.Progressive gentle exercise in the early morning or late evening over the same period.Increase in daily salt intake to 15-20gm for the first 2-3 weeks.Only sufficient water intake to relieve thirst and to ensure the flow of abundant dilute urine.
A Review Of 10 Years Of Systematic Health Surveillance In The Army
Authors: Tuck JJH , Bricknell MCM 
Published: March 2013

Health and morbidity reporting has been an important feature of the historical assessment of military campaigns from times of antiquity. Most of these reports have concentrated on hospital admission rates and mortality. In 1994 the British Army introduced a primary care health surveillance reporting system called J94. This provided the first opportunity for the systematic capture and analysis of morbidity data that allowed the identification of disease trends and the audit of remedial action. In parallel with the developments made by the military in the field of health surveillance, a number of initiatives in the NHS tried to develop real time surveillance systems with differing degrees of success.This paper reviews the developments made by military and civilian programs, identifies the problems that have been faced, areas where success has been achieved and the issues that will have to be considered as we prepare for the introduction of the next generation of IT based medical information systems into the military.
Management Of Unstable Cervical Spine Injuries In Southern Iraq During OP TELIC
Authors: Bird JH , Luke DP , Ward NJ , Stewart MPM , Templeton PA 
Published: March 2013

IntroductionCervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3.MethodologyThe MND(SE) Hospital databases were used to identify all casualties admitted with either a “Cervical” or “Neck” injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries.ResultsForty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman’s fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation.ConclusionsFive casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK.RecommendationsAll unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from Role 3. Halo Rings and Vests should be available at Role 3 facilities.
The Role of Local Steroid Injections in an Operational Field Hospital Setting
Authors: Ramasamy A , Shah RR , Bhullar TPS , Warnock F , Pitman T 
Published: March 2013

ObjectivesTo assess the safety and effectiveness of administering local steroid injections in an operational field hospital environment.MethodA prospective study of patients presenting to the physiotherapy department at the British Military Hospital (BMH) Shaibah, Iraq was undertaken from July 2006 – September 2006. Patients with a condition amenable to local steroid injection and who had not improved with conservative therapy were considered for the study. They then underwent local injection with steroid and local anaesthetic.ResultsDuring this period 12 patients were identified that fitted the criteria for local steroid injection. This represented 7% (12/179) of patients who were seen by the physiotherapy department in either an in or out-patient setting. All patients were injected with local anaesthetic and steroid injection with a single dose of intravenous antibiotic as antimicrobial cover. 10/12 (83.3%) were able to return to their unitwithin this theatre of operation. The only complication was one case of post injection flare of pain, which settled after 48 hours.ConclusionThe use of local steroid injection, as an adjunct to physical therapy, can enable service personnel to remain in the theatre of operations. These patientsmay have otherwise required aero medical evacuation. We consider the use of a local steroid injection to be a safe and effective intervention in certain patients where conservative measures alone do not work. This study highlights the safety of using steroid injections in an operational field hospital setting. Further large scale studies may help corroborate this conclusion.