Life- and limb-saving surgery in a level 1 trauma centre can be carried out with almost unlimited resources in western countries. In the austere environment military surgery is well organised up to the level of a role III facility and for allied forces transfer to a role IV facility results in optimal care for the severely injured. However, when local ... more
From the CAF perspective, a stratified risk matrix was formulated by the Directorate of Medical Policy/Medical Standards, which balanced an acceptable level of risk to the health and safety of CAF personnel, whilst taking into consideration the potential unavailability of an appropriate level of medical care required, due to operational situation. The ... more
Report: S. M. Eagan Chamberlin, MPH PhD (United States of America)
Moral Dilemmas, the Physician-Soldier & the Problem of Dual Loyalty
Being a physician-soldier can be an ethically and morally complicated job. While the moral obligations of physicians are usually oriented towards the health and well being of their individual patients, military health professionals may encounter situations in which ethical tensions arise between their responsibilities to individual patients and those ... more
This article will discuss and review the role of the Nurse Practitioner (NP) within a Role One, deployed Defence health facility,build on international evidence whilst supporting the utilisation of NPs in the RAAF Health Service and subsequently more widely in the greater Australian Defence Force (ADF). This article will provide somepractical evidence ... more
Report: H. Frickmann1, D. Sturm2, E.-J. Finke (GERMANY)
As experience from the most recent crisis regions in the Middle East (Gaza, Lebanon, Iraq, Syria), in Central Africa (including the Democratic Republic of the Congo and Mali) or in Afghanistan very clearly prove, asymmetric warfare will determine the nature of military conflicts in future. The Medical Service must be prepared for this development too. In ... more
In the previous NATO Trauma Registry publication of the MCI Forum in 2012, the author summarized the history of the initiative. Now the project has been delivered to the second phase with more involvement of the project participating nations. Allied Command Transformation (ACT) and NATO Centre of Excellence for Military Medicine (MILMED COE) have been ... more
Article: W. HUSSAIN, A. M.KHAN, M. Z. ALI, A. RASHID, A. IKRAM (PAKISTAN)
African Trypanosomiasis is a serious public health problem in certain regions of Africa. Many cases remain undiagnosed due to lack of diagnostic facilities. The disease is curable; fatal if untreated. We report a middle aged African individual with nonspecific symptoms diagnosed as a case of African Trypanosomiasis. ... more
Hypobaric and hyperbaric changes can trigger extreme states of pain in the human body. This article focuses on the phenomenon of barodontalgia, describing its pathophysiology and providing suggestions for preventative measures and approaches to treatment based on patient cases.
The article highlights the issue from a strategic point of view and does not go into details of its operational and tactical aspects. MCIF readers get a short introduction, background and the main requirements for a comprehensive approach to integration of military and civilian medical capabilities, using competence as a driving factor, within one organization, under military management.
The authors intend to generate discussions that can contribute to development of recommendations how to approach integration of civilian and military medical capabilities within one organization. These recommendations will inevitably go beyond national aspects of integration efforts, defining the appropriate level of interaction between the political, ... more
In the MCIF issue 1/2010 an article was published called “Multinational Approach in Medical support to NATO Operations”. In this article the author, Col Dr Fazekas, explains the need for multinational cooperation and the definition of standards for Multinational Medical Units to ensure minimum quality requirements. This need resulted in the development of the AMedP-27, the NATO Medical Evaluation Manual and the promulgation of its covering STANAG 2650 in 2010.
In a following article from the same author, Col Dr Fazekas describes the design and conduct of the pilot Medical Evaluation (MEDEVAL) Course. In the meantime two medical exercises were evaluated, the MEDEVAL course had evolved tremendously and the preparation for four major international evaluation and certification projects were ongoing. The magnitude of ... more
Report: J. PERALBA, J. COUCEIRO DE MIGUEL, V.N. GAVILÁN (SPAIN)
War and combat has served for centuries as an engine for research, progress and as an experimental ground to test theories and hypothesis. Some advances and conclusions were the result of just observations or casual events and others the result of specific scientific research geared for war or just applications of scientific knowledge in other fields of the combat arena. This has also been the case in the medical field.
At the 2002 NATO Summit still under the impression of the terror attacks in the United States, decisive capability gaps were
shown to exist within NATO. Among other issues, warnings were raised about the lack in capability for the near-real-time (NRT)
detection of disease outbreaks and the determination of whether these outbreaks are to be attributed to the use of biological
weaponry or to natural causes. Since 2003, under the lead of NATO Allied Command Transformation (ACT), existing capabilities
and systems of NATO partners have therefore been identified and examined as to their suitability for operational use in NATO
Interventional radiology is a relatively recent development within the field of radiology. It has extended the reach of the technique from use in purely diagnostic procedures to employment as part of minimally invasive treatment approaches.
The main feature of interventional radiology is that it provides imaging guidance during therapeutic intervention, whereby all forms of radiological media can be used (CT, ultrasound, fluoroscopy). Particular successes have been achieved with CT-guided intervention under damage control conditions in Camp Marmal in Mazar-e-Sharif (MES), the base of the ... more
The Central University Military Hospital(CUMH) was founded 83 years ago, on September 26, 1929. Itisone ofthe mostimportantmedicalinstitutionsin Albania for tradition,experiencecreatedduring many years of operation, and contributing notably to the development of Albanian military and civilian medicine. ... more
Trauma Registries are the golden standards in civilian trauma patient care for performance improvement, quality assurance and trauma system development. Few countries have implemented a military counterpart of such a system, collecting combat casualty care in different military operations. Committee of the Chiefs of Military Medical Services in NATO ... more
Report: J. M. MULVEY (Australia), A. A. QADRI, M. A. MAQSOOD (Pakistan)
The October 8, 2005 earthquake in Northern Pakistan had widespread destructive effects throughout the northern subcontinent.
Large numbers of people were killed or severely injured and many medical services destroyed. This report describes the experience of the only standing surgical hospital in the Kashmir region of Bagh District. A total of 149 patients received emergency surgery using ketamine anaesthesia with benzodiazepine premedication. This was found to be safe, effective ... more
As training resources and time become increasingly scarce new training methods and venues must be utilized to ensure mission readiness of Aerovac units to Airlift Wounded Warriors. The 94th Aeromedical Evacuation Squadron of the US Air Force Reserve Command is integrating simulation into initial and continuation training for flight nurses and flight medics. ... more
With rapid evacuation of patients with craniocerebral missile injury (CMI) from the combat zone to neurosurgical centers, early evaluation with computed tomography (CT), improved surgical techniques and post-operative care, there has been an overall improvement in the survival of these patients. Series have reported improved survival even in patients with ... more
Among the multiple problems Military Medical Ethics has to face, the threat to Humanitas in asymmetric conflict appears to be a particular challenge. It is worthwhile to explore such a fundamental phenomenon as the Humanitas in the light of the new wars, as it is of crucial importance for the medical services. ... more
In 2012, 18.63 % of all dental procedures performed during tours of duty of the German Armed Foces (Bundeswehr) were caused by periodontal problems. These 819 treatment sessions represent a not unimportant factor that requires more detailed analysis. The inflammatory periodontal disorders in question were gingivitis and periodontitis. These usually chronic ... more
Article: C. v. SEE, C. KÜHLHORN, F. HELLWIG, N.-C. GELLRICH (GERMANY)
As part of their preparation for active deployment, personnel of the armed forces are required to undergo a medical examination that is appropriate to the proposed theatre of operations. This generally includes a thorough dental examination. In addition to assessing specific absolute criteria, the examining dentists also determine whether problems are ... more
The Article is based on a lecture, delivered during the 40th ICMM World Congress on Military Medicine, 7-12 Dec 2013, Jeddah, Saudi-Arabia.
The use of Improvised Explosive Devices (IEDs) in recent conflict often results in complex orthopedic/neurological trauma, which may include limb loss, spinal cord injuries and traumatic brain injury. Survival rate have increased very much, but unfortunately many warriors sustained limb amputations. The primary rehabilitation goal for these individuals is ... more
Report: K. POLLO, H. BRAHO, L. NIKOLLARI (HUNGARY)
Tracheal injuries are seen in approximately 1%–7% of patients with penetrating neck injuries. Although they are rare, a high suspicion should be maintained because of the potential for life-threatening airway compromise. This case report aims to emphasize this claim.
Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. Factors contributing to these problems are complex anatomy, proximity of vital structures, and potential ... more
A prevention programme for personnel injured in the line of duty − a lifetime concept
In the form of its 'Continuous, interdisciplinary medical care of soldiers injured in the line of duty to restore, retain and improve their psychological and physical capacity' concept, the medical services of the Bundeswehr (German Armed Forces) have evolved a comprehensive medical programme designed for the support of personnel who have been wounded, ... more
Article based on conference presentation at NATO MilMed conference, Budapest, 25 Jun 14
This article is to give an overview of how British Armed Forces mental health care is structured and give some background data for mental disorder in the UK Military; to explain the working model of the Defence Medical Rehabilitation Centre (DMRC) Headley Court and to present some of the work of the mental health team at DMRC. ... more