Saving Life and Limb- - an ethical dilemma
Report: A. B. VAN VUGT (THE NETHERLANDS)

Saving Life and Limb- - an ethical dilemma

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

Article: C. CROSS

CANADIAN ARMED FORCES MEDICAL RISK MATRIX

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)

The Warrior in a White Coat

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

Nurse Practitioner LedHealth Facility (Role 1) on Exercise PrecisionSupport, 2011: A nurse practitioners observational report
Report: D. O’NEILL, M. LUTHER (AUSTRALIA)

Nurse Practitioner LedHealth Facility (Role 1) on Exercise PrecisionSupport, 2011: A nurse practitioners observational report

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

Risks of Infection as a Result of Foreign Tissue Implantation Injuries and Sexual Violence in Asymmetric Conflicts
Report: H. Frickmann1, D. Sturm2, E.-J. Finke (GERMANY)

Risks of Infection as a Result of Foreign Tissue Implantation Injuries and Sexual Violence in Asymmetric Conflicts

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

NATO Trauma Registry Phase 2 – Capability Development
Report: Dr. Robert Balazs

NATO Trauma Registry Phase 2 – Capability Development

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

African Trypanosomiasis: A Unique Experience at United Nation Mission in Liberia - Case Report
Article: W. HUSSAIN, A. M.KHAN, M. Z. ALI, A. RASHID, A. IKRAM (PAKISTAN)

African Trypanosomiasis: A Unique Experience at United Nation Mission in Liberia - Case Report

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

Crisis Event on a Commercial Airline Flight -  Military Medical Simulation Training at APMMC XXII
Article: D.C. HOSTLER, D.S. VINCENT (USA)

Crisis Event on a Commercial Airline Flight - Military Medical Simulation Training at APMMC XXII

"Ladies and gentlemen, if there is a doctor on board, please identify yourself by pushing your call button.”

 ... more

Barodontalgia - Toothache triggered by hypobaric and hyperbaric conditions
Report: Reinke

Barodontalgia - Toothache triggered by hypobaric and hyperbaric conditions

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.

 ... more

Hungarian Experience in Integrating Military and Civilian Medical Capabilities -  Competence as a Driving Factor
Article: Z. VEKERDI, A. GROSZ, L. SVED, P. BAZSO, G. K. SZUGYIEZKI (HUNGARY)

Hungarian Experience in Integrating Military and Civilian Medical Capabilities - Competence as a Driving Factor

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

Recent Developments in Medical Evaluation
Article: R. MEIJERING (RNLAF)

Recent Developments in Medical Evaluation

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

Aeromedical Evacuation Experience - Feedback and Cooperation with Industry for Better Casualty Care
Report: J. PERALBA, J. COUCEIRO DE MIGUEL, V.N. GAVILÁN (SPAIN)

Aeromedical Evacuation Experience - Feedback and Cooperation with Industry for Better Casualty Care

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.

 ... more

Development of a multinational Deployment Health Surveillance Capability (DHSC) for NATO
Report: H.-U. HOLTHERM (GERMANY)

Development of a multinational Deployment Health Surveillance Capability (DHSC) for NATO

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
deployments.

 ... more

The value of interventional radiology in current combat environments
Report: S. WALDECK, E.K. KOLLIG (GERMANY)

The value of interventional radiology in current combat environments

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

83 YEARS MILITARY HOSPITAL IN ALBANIA
Article: L. Nikollari, E. Kukeli (Albania)

83 YEARS MILITARY HOSPITAL IN ALBANIA

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

NATO Trauma Registry – evidence based military medical care for the Alliance
Article: R. BALAZS (HUN)

NATO Trauma Registry – evidence based military medical care for the Alliance

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

Earthquake Injuries and the Use of Ketamine for Surgical Procedures: The Kashmir Experience
Report: J. M. MULVEY (Australia), A. A. QADRI, M. A. MAQSOOD (Pakistan)

Earthquake Injuries and the Use of Ketamine for Surgical Procedures: The Kashmir Experience

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

Aeromedical Evacuation Simulation Training
Article: C. E. CORLISS (UNITED STATES)

Aeromedical Evacuation Simulation Training

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

RETAINED INTRACRANIAL SPLINTERS: A REVIEW
Article: Brig Harjinder S Bhatoe VSM

RETAINED INTRACRANIAL SPLINTERS: A REVIEW

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

The Threat to Humanitas in Asymmetric Conflict
Article: D. FISCHER (GERMANY)

The Threat to Humanitas in Asymmetric Conflict

A Challenge for Military Medical Ethics

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

Periodontal emergency treatment in the field
Article: M. LÜPKE (GERMANY)

Periodontal emergency treatment in the field

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

Preparation for active deployment and combat readiness from the perspective of dental medicine
Article: C. v. SEE, C. KÜHLHORN, F. HELLWIG, N.-C. GELLRICH (GERMANY)

Preparation for active deployment and combat readiness from the perspective of dental medicine

A critical review

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

Developments in Computer Assisted Rehabilitation Environments
Article: R. van der Meer, MD (NL)

Developments in Computer Assisted Rehabilitation Environments

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

Penetrating Neck Injury
Report: K. POLLO, H. BRAHO, L. NIKOLLARI (HUNGARY)

Penetrating Neck Injury

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

Back to life
Report: A.LISON, M.GRUENE (GERMANY)

Back to life

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: Elizabeth Ashton MB ChB,FRCPsych, RAF

From Trauma To Recovery: Treatment at DMRC

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