When Investment for Medical Countermeasures Against Rare, but Dangerous Agents Becomes Cost Effective – The Ebola Case
Report: M.L. JOHNSON (GERMANY), J. BELIN, F. DORANDEU, M. GUILLE (FRANCE)

When Investment for Medical Countermeasures Against Rare, but Dangerous Agents Becomes Cost Effective – The Ebola Case

There are countless chemical, biological, radiological, and nuclear (CBRN) agents that are proficient enough to harm individuals. Examples include viruses (e.g. influenza) and bacteria which are widely distributed by nature, but also some which are far less common, such as the Ebola virus. Cases include chemical (e.g. organophosphorus compounds [OP]) and ... more

Medical Force Protection
Article: O. QUANTICK, D. ROSS (UK)

Medical Force Protection

What have we Learnt from Operation HERRICK in Afghanistan?

Medical Force Protection (Med FP) measures are important in mitigating morbidity and mortality in deployed forces. Historically, Disease Non Battle Injury (DNBI) accounts for significantly more morbidity than traumatic injury. However, how successful have we been in implementing such measures in Afghanistan? The author who conceived and undertook 3 Med FP ... more

Oximes as Nerve Agent Antidotes
Article: Dr. Helmut Priewer and Christoph Bloch

Oximes as Nerve Agent Antidotes

From Hydroxylamine to HI 6-DMS

Organophosphate-type nerve agents (e. g. tabun, sarin, soman, cyclosarin, VX) are among the most toxic synthetic compounds known so far. Organophosphate intoxication causes an excess of the neurotransmitter acetylcholine by inhibition of the acetylcholinesterase that normally reduce the activity of acetylcholine. The following study gives an insight in the ... more

Value-oriented Psychotherapy for Soldiers with Moral Injury and Operational Experience
Article: Peter Zimmermann, Christian Fischer, Thomas Thiel, Christina Alliger-Horn

Value-oriented Psychotherapy for Soldiers with Moral Injury and Operational Experience

From the German Armed Forces Centre for Military Mental Health (Psychotrauma Centre) of the Bundeswehr Hospital Berlin

Participating in a military operation abroad is for many soldiers an experience that will shape their lives. During the months spent outside Germany, soldiers gain many different impressions, for example as a result of the close bonds that form in the camps – not least with soldiers from other nations – but also through contact with the local culture ... more

The Context for Planning Military Health Services Support
Article: MCM Bricknell1, CE Beardmore2

The Context for Planning Military Health Services Support

This article is designed to provide a short summary for medical personnel with limited military experience to understand how the medical staff function works within a military headquarters. It places planning military health services support in the context of wider planning for military operations. It starts by examining the Contemporary Operating ... more

The Influence of Type 2 Diabetes Mellitus on Periodontal Disease
Report: Diana Elisa Gomes Correia, José João Baltazar Mendes

The Influence of Type 2 Diabetes Mellitus on Periodontal Disease

Portuguese Armed Forces Hospital – Dental Service

The epidemiological association between PD and DM results from a direct causal relationship in which the complications of DM act as modifiers of the expression of PD and vice versa. The aim of this study is to investigate the influence of DM2 in the development of PD in a Portuguese
population. Patients are followed in the Armed Forces Hospital by the ... 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