Ambulatory visits, active component, U.S. Armed Forces, 2021

The aggregate numbers and rates of ambulatory care visits by active component service members in 2021 were the highest of the previous ten years. Most disease and injury categories experienced slight increases in both rates and numbers. From 19% of ambulatory care visits in 2020 to less than 15% in 2021, telehealth contacts were used less frequently. The statistics for 2021 demonstrate a return to pre-pandemic levels, notwithstanding the possibility that the response to the COVID-19 pandemic in 2020 was related with declines in the incidence of disease and injury diagnoses in the community of service members seeking ambulatory care. Additionally, the proportions of telehealth-delivered medical encounters have similarly decreased to the lower levels seen before the pandemic. Lessons learned may direct future actions to lower the frequency of disease and harm in the post-pandemic era. This study details the ambulatory health care visits made by active component members of the U.S. Army, Navy, Air Force, and Marine Corps in 2020 in terms of frequency, rates, trends, and other factors. U.S. service members' ambulatory visits to fixed military and nonmilitary medical treatment facilities (reimbursed through the Military Health System [MHS]) are recorded in standardized, computerized records. The Defense Medical Surveillance System (DMSS), the data source for this report, routinely archives these records for health surveillance purposes. This research excludes ambulatory visits that are not frequently and fully recorded using standardized electronic records (for example, during deployments, field training exercises, or at sea). As in previous MSMR reports, the primary (first-listed) diagnostic position of the visit records was used to categorize all records of ambulatory visits of active component service members according to the first four characters of the ICD-10 codes. In this research, a specific query of the DMSS records was carried out to identify ambulatory visits that were completed via "telehealth" encounters rather than in-person meetings (e.g., via telephone or video conferencing). Most data summaries included both types of encounters and did not make a distinction between them, however due to the rise in telehealth encounter usage during the coronavirus 2019 (COVID-19) pandemic, changes in the proportions of telehealth encounters were examined.

Investigation on health awareness, professional awareness and mental health status of medical students in a military school during the outbreak of novel Coronavirus pneumonia

Objective: To understand the health and professional consciousness and mental health of military medical students during coronavirus disease 2019 (COVID-19) epidemic. Methods: From Feb. 17 to Feb. 20, 2020, an electronic questionnaire was used to investigate the attitudes and coping styles of military medical students towards quarantine and delay of school opening, their attitudes towards online teaching, and health and professional consciousness during COVID-19 epidemic;and their mental health status was scored by symptom checklist 90 (SCL-90). Results: A total of 2 736 valid questionnaires were collected. The students basically understood and agreed with the quarantine and delay of school opening during the epidemic, and 70.83% (1 938/2 736) supported online teaching. During the quarantine period, 85.31% (2 334/2 736) of the students chose to listen to music or watch TV series for relaxation, and 64.69% (1 770/2 736) insisted on learning, reading literatures or writing papers. Students could basically form the habits of washing hands frequently and wearing masks, and their consciousness of health protection was higher than that before the epidemic. For military medical students, their professional beliefs and determination have been strengthened during the epidemic, and many students wanted to join in the fight against the epidemic. The survey found that 12.94% (354/2 736) of the students had mental health symptoms, and the top 3 SCL-90 factors were obsessive-compulsive disorder (78.53%, 278/354), interpersonal sensitivity (64.12%, 227/354), and depression (44.07%, 156/354). Conclusion: During the epidemic, military medical students can generally adapt to the difficult environment and improve themselves. The mental health problems of military medical students have their own characteristics, special attention must to be paid, and the humanistic education of medical students should be strengthened.

Retour d'expérience des six évacuations sanitaires aériennes collectives MoRPHEE durant la pandémie de Covid-19

Après son apparition en Chine à la fin de 2019, l'épidémie de coronavirus 2019 (Covid-19) a rapidement provoqué le risque d'une saturation des ressources en soins intensifs dans chaque pays touché. La répartition de la maladie entre les différents territoires est hétérogène. Le transport interhospitalier sur longue distance de patients atteints de Covid-19 dans le but de limiter la pression sur les unités de soins intensifs au niveau national ou international n'a pas encore été décrit. L'objectif de cet article était de fournir des données descriptives des six missions d'évacuation aéromédicale collective (Evasan) de patients atteints de Covid-19 réalisées en Europe et sur le territoire national français les 18, 21, 24, 27, 31 mars et 3 avril 2020 grâce au dispositif MoRPHEE. Trente-six patients souffrant de syndrome de détresse respiratoire aiguë (SDRA) ont été évacués durant six missions d'évacuations sanitaires collectives. Le SDRA était modéré (rapport PaO2/FiO2 > 100 et ≤ 200) chez 24 patients et léger (rapport PaO2/FiO2 > 200 et ≤ 300) chez 12 patients. La durée médiane de la ventilation mécanique en soins intensifs avant le transport était de quatre jours (interquartile [IQ] : 3‒5). Le rapport médian PaO2/FiO2 était de 180 mmHg (IQ : 156‒202). Le débit médian de perfusion de noradrénaline était de 0,08 μg/kg par min. Aucune complication mettant en jeu le pronostic vital n'a été signalée. En conclusion, l'évacuation sanitaire aérienne collective de patients gravement malades de Covid-19 est une solution contribuant à contrôler le niveau de saturation du système de soins au niveau national ou international.Alternate : Since its emergence in China in late 2019, the coronavirus disease 2019 (COVID-19) outbreak has rapidly posed the risk of critical care resources overload in every affected country. The distribution of the disease among the territories is heterogeneous. Long-range inter-hospital transport of critically ill COVID-19 patients as a way to mitigate the localised pressure from overloaded intensive care units at a national or international level has not been reported yet. The aim of this article was to provide descriptive data about the six collective aeromedical evacuation of COVID- 19 patients performed within Europe and French national territory on March 18, 21, 24, 27, 31 and April 3, 2020. Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six aeromedical evacuation missions. ARDS was moderate (PaO2/FiO2 ratio > 100 and ≤ 200) in 24 patients and mild (PaO2/FiO2 ratio > 200 and ≤ 300) in 12 patients. The median duration of mechanical ventilation in ICU before transportation was 4 days [Interquartile (IQ): 3–5]. The median PaO2/FiO2 ratio was 180 mmHg (IQ: 156–202). The median norepinephrine infusion rate was 0.08 μg/kg/min. No life-threatening event was reported. Collective aeromedical evacuation of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease at a national or international level. Future works may evaluate the global safety and effectiveness of aeromedical evacuations in this context.

Role of military medicine in massive immediate threat situations

The COVID-19 pandemic has highlighted the inclusive role of non-health actors in the process of adaptation and response to the threat. In the Republic of Croatia, this is particularly visible in the multiple crises that hit country at the same time – several earthquakes and the pandemic. In the near future, the number of infectious agents capable of causing a new pandemic will increase, as will the possibility of facing other types of disasters. Today, more than ever before, we need pre-prepared and multidisciplinary organized health care. Future disaster preparedness should not imply multiple protocols for risk management, but one single multi-layered protocol involving all actors of government and public services. Due to its historical role and organizational system, the army is fully prepared to become part of a multidisciplinary team that manages mass casualty threats. Key elements required for effective national civil-military health cooperation in planning, detecting, responding to, and recovering from health crises or disasters include (a) establishing a strategic cooperation plan for emergency health interventions;(b) appreciation of the differences between the civilian and military systems;(c) identification of potential areas for cooperation at the national level;(d) standardization and institutionalization of Civil Military Cooperation;and (e) joint training and exercise of civil-military emergency medical preparedness capacities. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Rates of Lapidus Procedures in the US Military Before and After the Advent of and Advocacy for Tri-Plane Lapidus Corrective Surgery.

Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking. We employed official personnel and health records of the total active-duty US military to conduct a retrospective cohort study of Lapidus surgery rates before and after the advent of the tri-plane corrective Lapidus procedure. Least-squares and locally-weighted scatterplot smoother regression functions were used to confirm time trends. Sociodemographic and occupational traits of Lapidus patients were compared using 2-sided t tests and chi square tests. Lapidus surgery rates among hallux valgus patients decreased during 2014 to 2016 and increased during 2017 to 2021. While multiple factors might explain these trends, they coincide with the advent of and advocacy for tri-plane Lapidus surgery. The results support the possibility that its rise influenced overall Lapidus rates in this population. As these findings represent limited evidence of such an influence, further research is required to confirm a causal link. If such a link is found, and if the ongoing research suggests that superior outcomes are associated with tri-plane Lapidus surgery, substantial implications could exist for this population. Benefits might include enhanced medical readiness due to the importance of lower extremity function during military duties. Additional research is needed to confirm the impact of the procedure and to determine whether Lapidus surgery rate patterns in civilian populations mirror these findings.

Military Response to Medical Crises-Consensus Recommendations for Military-Civilian Transitions of Care.

OBJECTIVE: The threat that New York faced in 2020, as the COVID-19 pandemic unfolded, prompted an unprecedented response. The US military deployed active-duty medical professionals and equipment to NYC in a first of its kind response to a "medical" domestic disaster. Transitions of care for patients surfaced as a key challenge. Uniformed Services University and the Icahn School of Medicine at Mount Sinai hosted a consensus conference of civilian and military healthcare professionals to identify care transition best practices for future military-civilian responses. METHODS: We performed individual interviews followed by a modified Delphi technique during a two-day virtual conference. Patient transitions of care emerged as a key theme from pre-conference interviews. Twelve participants attended the two-day virtual conference and generated best practice recommendations from an iterative process. RESULTS: Participants identified 19 recommendations in 10 "sub-themes" related to patient transitions of care: needs assessment and capability analysis; unified command; equipment; patient handoffs; role of in-person facilitation; dynamic updates; patient selection; patient tracking; daily operations; and resource typing. CONCLUSIONS: The COVID-19 pandemic resulted in an unprecedented military response. This study created 19 consensus recommendations for care transitions between military and civilian healthcare assets that may be useful in future military-civilian medical engagements.

SEND IN THE ARMY! MILITARY ROLES IN THE PANDEMIC

While we usually think of the National Institutes of Health as a civilian institution, the US Public Health Service is in fact a uniformed service. Officers of the USPHS are involved at all levels of the "civilian" response of the Department of Health and Human Services, the NIH, and the Biomedical Advanced Research and Development Authority (BARDA). [...]all of our military medical resources are being mobilized to fight the coronavirus.

Military Medical Role in Civilian Disaster.

US military medical units have responded to natural disasters (eg, hurricanes, earthquakes), relieved overwhelmed civilian health care systems (eg, during the COVID-19 pandemic), and provided support to stabilization efforts after civil unrest. The military will continue to assist civilian agencies with future medical response to similar disasters, contagious outbreaks, or even terrorist attacks. The keys to an effective disaster response are unity of effort, prior coordination, and iterative practice during military-civilian exercises to identify strengths and areas of improvement. Critical care advanced practice nurses are likely to work concurrently with military medical colleagues in multiple scenarios in the future; therefore, it is important for these nurses to understand the capacities and limitations of military medical assets. This article describes the capabilities and collaboration needed between civilian and military medical assets during a variety of disaster scenarios.

US Navy Ship-Based Disaster Response: Lessons Learned.

Purpose of Review: The US Navy has a long history of responding to disasters around the globe. US Navy ships have unique characteristics and capabilities that determine their capacity for a disaster response. This paper discusses common considerations and lessons learned from three distinct disaster missions. Recent Findings: The 2010 earthquake in Haiti had a robust response with multiple US Navy ship platforms. It was best assessed in three phases: an initial mass casualty response, a subacute response, and a humanitarian response. The 2017 response to Hurricane Maria had a significant focus on treating patients with acute needs secondary to chronic illnesses to decrease the burden on the local healthcare system. The COVID-19 response brought distinctive challenges as it was the first mission where hospital ships were utilized in an infectious disease deployment. Summary: The first ships to respond to a disaster will need to focus on triage and acute traumatic injury. After this first phase, the ship's medical assets will need to focus on providing care in a disrupted health care system which most often includes acute exacerbations of chronic disease. Surgeons must be ready to be flexible in their responsibilities, be competent with end-of-life care, and negotiate technical and cultural communication challenges.

A Call to Action: Evidence for the Military Integration of Teledermoscopy in a Pandemic Era.

Skin disease remains a common complaint among deployed service members. To mitigate the limited supply of dermatologists in the U.S. Military Health System, teledermatology has been harnessed as a specialist extender platform, allowing for online consultations in remote deployed settings. Operational teledermatology has played a critical role in reductions of medical evacuations with significant cost-savings. When direct in-person lesion visualization is unattainable, teledermoscopy can be harnessed as an effective diagnostic tool to distinguish suspicious skin lesions. Teledermoscopy has the versatile capacity for streamlined incorporation into the existing asynchronous telemedicine platforms utilized worldwide among deployed U.S. military healthcare providers. In terms of clinical utility, teledermoscopy offers a unique and timely opportunity to improve diagnostic accuracy, early detection rates, and prognostic courses for dermatological conditions. Such improvements will further reduce medical evacuations and separations, thereby improving mission readiness and combat effectiveness. As mission goals are safeguarded, associated operational budget costs are also preserved. This innovative, cost-effective technology merits integration into the U.S. Military Health System (MHS).

Results of the work of the military medical academy research institute of novel coronavirus infection problems through 2020-2021

Novel coronavirus infection COVID-19 pandemic has become a serious test for the world's population across the board - from individual to population. Introduced restrictive measures of self-isolation, observation, and quarantine, mostly known before the pandemic only to medical specialists, have become a forced "lifestyle" for most of the people across the globe, their specific adaptation to the new, unusual conditions of the existence and communication. Healthcare has faced off with an unknown infection, while traditional methods of the treatment showed their ineffectiveness at the initial stage. The results of the Research Institute of Problems of New Coronavirus Infection of the Military Medical Academy named after S.M. Kirov from April 2020 to present are listed. Work basis is formed by the scientific and clinical results of the Academy's work during the COVID-19 pandemic. The experience of organizing sanitary, antiepidemic and preventive measures at the permanent disposition and in the field in the regions of Russia and abroad is presented. Developed, improved, and put into the practice methods of diagnosis and treatment of the patients, including the electron microscopic diagnostics of long-term carrier, ultrasound examination of the lungs, glucocorticosteroid therapy, helium-oxygen therapy, risk prediction algorithms and computer-aided evaluation of the degree of lung tissue damage, evaluation of the drug effectiveness are listed. In a separate section study related to the Russian vaccine "Gam-COVID-Vac", the assessment of immunity after the disease, complex disorders, and in postvaccination cases, the use of the immune pathogen-reduced plasma, the mutual influence of various vaccines are presented. Methods of rehabilitation of convalescents, dispensary-dynamic observation, and military medical examination are studied and developed.

Experience of Military Medicine in the Fight against the New Coronavirus Infection.

The results achieved by the medical service of the Armed Forces of the Russian Federation to overcome the new coronavirus infection are presented. The high efficiency of the established unified system of biological safety and strict ranking of the priorities of anti-epidemic measures is shown. The experience of organizing traveling medical and nursing teams, as well as temporary military medical units on the territory of Russia, as well as in foreign countries, is demonstrated. Among the priority scientific results of military doctors, especially noteworthy is the study of the world's first COVID-19 vaccine Sputnik V, its immunogenicity, the effectiveness of its use in previously ill patients and revaccination, as well as the use of immune plasma from those who have been ill and vaccinated. By the examples of organized military groups and the general population, the features of the formation of herd immunity have been studied. Military doctors were the first in the country to show the effectiveness of hormone therapy in the treatment of coronavirus infection and to study its effects. They carried out ultrastructural studies of the life cycle of the virus. It is shown that the system of comprehensive measures implemented by military medicine determined a lower incidence of new coronavirus infection among the personnel of the Ministry of Defense of Russia and a lower mortality among the military.

Utilizing MHS Genesisto Identify and Treat Military Children Exposed to Adverse Childhood Experiences(ACEs)

Purpose/Objectives: Introduction: In 2011, the AAP issued a policy statement directing pediatricians to “actively screen for precipitants of toxic stress that are common in their particular practices.” As a result of expanding evidence, the profound impact of ACEs on childhood development is becoming more widely understood, as is the chance to intervene and change outcomes. However, it is not yet standard screening practice in most pediatric clinics in the Military Health System. This project highlights ACEs screening implementation at a military treatment facility utilizing the new medical record system MHS Genesis (MHSG), thus providing valuable insight for other clinics hoping to do the same. Objective: To comply with the AAP's policy, our pediatric clinic at Madigan Army Medical Center launched a quality improvement project with a goal of screening at least 80% of children ages 3-10 years old with ACEs questionnaires at annual well-child checks. Design/Methods: Methods: Using PlanDo-Study-Act quality improvement methodology, a team including faculty, residents, nursing, and front-desk staff was formed to guide ACEs screening implementation. The project launched in November 2019, where all providers were trained in the background and significance of ACEs, how to do document screening scores in MHSG, and how to respond to positive scores. ACEs questionnaires were then provided at every well child check in 2020 within the target age range and a monthly data query was performed. The team leadership met each month to analyze barriers to screening and documentation in MHSG, eliciting frequent feedback from involved staff and providing relevant training and interventions in response. Results: Results: Since implementation of this process improvement project, our ACEs screening rates increased from 0% to 59%. Of the 1192 children screened in 2020, 286 were deemed at-risk and connected with appropriate resources, though numbers would likely have been higher since many of the target age group were not seen in 2020 due to the COVID-19 pandemic. Identified barriers to ideal MHSG screening implementation include: software updates that alter formatting, provider variation in understanding score documentation, and workflow breakdowns in the setting of staffing shortages. Conclusion/Discussion: Discussion: We successfully implemented ACEs screening into our pediatric clinic with the project being met with strong enthusiasm by providers, nurses and families. It will soon be expanding to military family medicine and the other pediatric clinics on base. Recognizing how MHSG helped and hindered our efforts was a valuable learning experience and one we feel can significantly benefit our comrades at other military treatment facilities. This project provides the necessary foundation for enterprise-wide ACEs implementation utilizing MHSG.

A historical analysis of vaccine mandates in the United States military and its application to the COVID-19 vaccine mandate.

The Department of Defense has implemented a mandate that all military personnel be vaccinated against COVID-19. This article reviews the historical precedent of vaccine mandates for United States military personnel dating back to the formation of the continental army, as well as previous controversies about vaccine mandates such as the first influenza vaccine mandate and the Anthrax Vaccine Immunization Program. The historical review discusses precedent for the current COVID-19 vaccine mandate and the reception of these vaccine mandates by military personnel. The review then discusses how these historical lessons can inform the present COVID-19 vaccine mandate.

Pushing the frontiers of military medical excellence: updates, progress and future needs.

Since its establishment in 2014, Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties, with a special emphasis on topics with military relevance. The field of military medicine may be obscure, and may not be readily encountered by the typical clinician on a day-to-day basis. This journal aims not only to pursue excellence in military research, but also keep current with the latest advancements on general medical topics from each and every specialty. This editorial serves to recap and synthesize the existing progress, updates and future needs of military medical excellence, discussing foremostly the unique traits of literature published in this journal, and subsequently presenting the discourse regarding wartime and peacetime medicine, the role of the military in a public health emergency, as well as wound healing and organ regeneration. Special attention have been devoted to military topics to shed light on the effects of Chemical, Biological, Radiological and Explosive (CBRE) warfare, environmental medicine and military psychiatry, topics which rarely have a chance to be discussed elsewhere. The interconnectedness between military combat and soldier physical and mental well-being is intricate, and has been distorted by pandemics such as coronavirus disease 2019 (COVID-19). This journal has come a long way since its first article was published, steadily contributing to the existing knowledge pool on general medical topics with a military slant. Only with continuous research and sharing, can we build upon the work of the scientific community, with hopes for the betterment of patient care.

Strategy and effects of the areo-medical evacuation team in Mali to prevent and control COVID-19 pneumonia epidemic

This article summarizes the strategy and effects of preventing and controlling the epidemic in the evacuation support of the aero medical evacuation team of the 7th peacekeeping medical contingent of China to Mali, to actively respond to the coronavirus disease-19 (COVID-19)epidemic based on existing medical conditions and further provide scientific evidence for guaranteeing military medical service in public health emergencies.

Understanding the Mechanisms of Blue Light Exposure on Cognitive Performance

Military personnel often face challenging situations, including being sleep deprived, having to remain focused and undistracted for long periods of time and having to respond quickly and precisely in response to different critical situations. Being able to sustain attention, even when one is sleep deprived, remain positive and calm, and being able to respond quickly, are all of crucial importance to mission success. Blue light exposure seems to be a safe and easily implemented tool to improve attention, increase cognitive functioning and enhance mood. However, the exact mechanism that explains these beneficial effects is currently unknown. Lack of knowledge makes it impossible to provide exact recommendations for how to best use blue light exposure. It is also unclear how quickly after blue light onset measurable changes in the brain are present and how they correlate with subjective and objective changes in alertness, cognitive functioning and mood. The results from this study will provide information on the exact mechanisms that underlie the positive effects of blue light exposure. Answers to these crucial questions will make it considerably easier to provide targeted and informed recommendations for how to best use blue light across a wide variety of settings in order to improve cognitive functioning.

Diagnosis and Treatment of TBI and Polytrauma during Ground and High-Altitude Evacuation using Liquid Biopsy and Extracorporeal Life Support

TBI alone and in combination with polytrauma and lung injury caused up to 83 percent of nonsurvivable combat-related deaths. There is no accurate diagnosis method or viable therapeutic intervention for these casualties primarily due to the severity of injury, which can be unrecognized early on. Our proposal will address these unmet needs via utilization of a model of TBI with targeted descriptors of injury severity derived from bedside cell free DNA (cfDNA) testing, and then via addition of polytrauma and lung injury with subsequent testing of therapeutic intervention via extracorporeal life support (ECLS).

Combating an invisible enemy: the American military response to global pandemics

The present moment is not the first time that America has found itself at war with a pathogen during a time of international conflict. Between crowded barracks at home and trenches abroad, wartime conditions helped enable the spread of influenza in the fall of 1918 during World War I such that an estimated 2040% of U.S. military members were infected. While the coronavirus disease 2019 (COVID-19) pandemic is unparalleled for most of todays population, it is essential to not view it as unprecedented lest the lessons of past pandemics and their effect on the American military be forgotten. This article provides a historical perspective on the effect of the most notable antecedent pandemic, the Spanish Influenza epidemic, on American forces with the goal of understanding the interrelationship of global pandemics and the military, highlighting the unique challenges of the current pandemic, and examining how the American military has fought back against pandemics both at home and abroad, both 100 years ago and today.

2020 Annual Report: Defense Advanced Distributed Learning Advisory Committee (DADLAC)

Last year was filled with chaos, but from that crisis came opportunitiesopportunities to reinvent the reputation and purpose of distributed learning, and to reimagine its uses around the world. We faced a sink-or-swim moment, and Im proud to say that this community excelled. Distributed learning emerged as a silver lining to the years hardships. We met last years unprecedented demands, and the value of our DADLAC community was demonstrated time and again as we collectivelyand successfullyaccelerated and expanded defense distributed learning by orders of magnitude. This report highlights our communitys activities, along with important policies and plans impacting our respective programs.