|Year : 2017 | Volume
| Issue : 1 | Page : 66-67
Updates on military medicine
Classified Specialist (Marine Med) and PMO, INS Abhimanyu, NAD Karanja, Uran, District Raigad, Maharashtra, India
|Date of Web Publication||17-Aug-2017|
Surg Cdr Rohit Verma
49, Bhagirathi, Near Afghan Church, Colaba, Mumbai - 400 005, Maharashtra
Source of Support: None, Conflict of Interest: None
Updates on Military Medicine including Naval Medicine; Combat and Trauma Medical Care; Military Epidemiology and Military Psychiatry. The summary of the latest scientific publications in the field of Marine Medicine and allied sciences.
Keywords: Chronic wounds, hyperbaric oxygen therapy, standard wound care
|How to cite this article:|
Verma R. Updates on military medicine. J Mar Med Soc 2017;19:66-7
| Naval Medicine|| |
Training of fleet surgical teams
A United States Navy study  to evaluate the efficacy of a training course of fleet surgical teams has determined it to be very successful. The course included classroom didactic hours and hands-on simulation sessions. A pretest was administered before the course, a posttest on completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to the disposition and critical errors made during patient care. Time to disposition improved significantly, and critical errors improved. This demonstrates that while training courses for naval operation, specific scenarios are being conducted; there is simultaneous requirement to continuously evaluate their efficacy as well.
A Royal Netherlands Navy study  has found that the otitis externa (OE) during military diving training is more frequent than previously thought. However, early diagnosis and treatment of OE did not seem to affect completion of diving courses. This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.
| Combat and Trauma Medical Care|| |
Trauma registry in the combat scenarios has been a recurring theme in recent studies. A 8-year retrospective analysis  by Israeli investigators has revealed an integrated military/civilian national trauma network and has positively impacted civilian trauma outcomes through reduced mortality and reduced late interhospital transfers despite having more severe injuries in the recent conflicts. This study is of particular importance in conflicts where a large number of civilian casualties are expected such as in asymmetric warfare. Among other things, the study found early evacuation by helicopter, early interhospital transfers (to a specialized center), and direct evacuations to level 1 centers to have positively impacted outcomes. However, the mortality in combat was similar to noncombat trauma. A combined civil/military trauma registry is thus of importance in evaluating, casualty distribution, patterns of evacuation/triage, hospital length of stay, and mortality. It may lead to an optimum distribution of scant medical resources in combat zones.
Provider care in airborne casualty evacuations
A United States Air Force (USAF) study  on the type of care while undertaking medical evacuation (i.e., helicopter-based casualty evacuation) determined that medical providers with higher-level training were more likely to perform more advanced procedures during en route care, however, there was no significant association between provider type and in-theater or 30-day mortality rates. Therefore, the optimum level of provider skills and care while undertaking airborne casualty evacuations remains to be elucidated.
| Military Epidemiology|| |
Mild traumatic brain injury
Almost 25,000 nonmedically evacuated soldiers returning from Afghanistan or Iraq, to two military bases between 2009 and 2014, were screened for mild traumatic brain injury (mTBI) in a US Department of Veterans Affairs study. mTBI cases were about twice as likely as controls to report receiving rehabilitative services and fair or poor health. Other predictors of postconcussive symptoms included posttraumatic stress, combat exposure, and noncephalic pain. A majority of both cases and controls reported traumatic brain injuries predating this latest deployment. In this nonclinical population of recently deployed soldiers, a substantial proportion of those who had sustained an mTBI were symptomatic 3 months postdeployment. This study reveals of the subclinical manifestations of mTBI sustained in combat.
| Military Psychiatry|| |
Barriers to mental healthcare to armed forces personnel
A USAF study  has assessed the extent to which stigma and barriers to accessing mental health (MH) services as perceived by USAF nursing personnel are associated with resilience, stress, previous deployment, or demographic characteristics. This study found that substantial percentages of USAF nursing personnel have concerns that accessing MH services may adversely affect their careers and how they are viewed by unit leaders and peers. In addition, higher levels of concern about stigma were associated with higher levels of stress and lower levels of resilience. Perhaps, this calls for energetic campaigns to destigmatize MH issues among armed forces personnel in general and among medical personnel in particular.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hoang TN, Kang J, Siriratsivawong K, LaPorta A, Heck A, Ferraro J, et al.
Hyper-realistic, team-centered fleet surgical team training provides sustained improvements in performance. J Surg Educ 2016;73:668-74.
Wingelaar TT, van Ooij PA, van Hulst RA. Otitis externa in military divers: More frequent and less harmful than reported. Diving Hyperb Med 2017;47:4-8.
Kashuk JL, Peleg K, Glassberg E, Givon A, Radomislensky I, Kluger Y. Potential benefits of an integrated military/civilian trauma system: Experiences from two major regional conflicts. Scand J Trauma Resusc Emerg Med 2017;25:17.
Maddry JK, Mora AG, Savell S, Reeves LK, Perez CA, Bebarta VS. Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes. J Trauma Acute Care Surg 2016;81 (5 Suppl 2 Proceedings of the 2015 Health System Research Symposium):S104-10.
Schwab K, Terrio HP, Brenner LA, Pazdan RM, McMillan HP, MacDonald M, et al.
Epidemiology and prognosis of mild traumatic brain injury in returning soldiers: A cohort study. Neurology 2017;88:1571-9.
Hernandez SH, Morgan BJ, Parshall MB. Resilience, stress, stigma, and barriers to mental healthcare in U.S. air force nursing personnel. Nurs Res 2016;65:481-6.