Health risk management matrix -- a medical planning tool.

This paper describes the Health Risk Management Matrix. This is a planning tool, developed at the Defence Medical Services Training Centre, to teach students how to develop and write a Medical Force Protection Plan. The tool covers 5 stages: hazard identification, identification of the population at risk, risk assessment, control measures (divided into information training and policy, medical counter-measures, and treatment) and monitoring activities. The paper provides a worked example using malaria as a hazard.

Roles for international military medical services in stability operations (security sector reform).

This is the second in a series of three papers that examine the role of international military medical services in stability operations in unstable countries. The paper discusses security sector reform in general terms and highlights the interdependency of the armed forces, police, judiciary and penal systems in creating a 'secure environment'. The paper then looks at components of a local military medical system for a counter-insurgency campaign operating on interior lines and the contribution and challenges faced by the international military medical community in supporting the development of this system. Finally the paper highlights the importance of planning the medical support of the international military personnel who will be supporting wider aspects of security sector reform. The paper is based on background research and my personal experience as Medical Director in the Headquarters of the NATO International Stability Assistance Force in Afghanistan in 2006.

Pertussis -- a case finding study amongst returnees from Op Herrick.

We present a case finding study of serologically confirmed Pertussis amongst BFG-based returnees from Op HERRICK. The role of Pertussis in the aetiology of the commonplace "Kabul Cough" is discussed. It is recommended that enhanced health surveillance for Pertussis takes place both during and after future deployments to Afghanistan, to prevent the potential onward transmission of a potentially fatal illness to unimmunised children.

Stability operations and the implications for military health services support.

This paper examines the implications of the new military campaign type--Stability Operations--on military health service support. The paper uses the format of the medical estimate process and shows how the health service support planning factors of Mission Analysis; Ground; Enemy forces; Friendly forces; Time and Space; Security; Casualty Estimate; Medical Command, Control, Communication, Computers and Information (C4I); Medical Capabilities; Medical Force Protection; Medical Logistics; and Medical CBRN are affected by this change. The paper also identifies two new roles for military medical services, assistance to security sector reform and assistance to reconstruction and development. These two new roles will be discussed more fully in later papers.

Reflections on medical aspects of ISAF IX in Afghanistan.

This paper is a personal review of my experience as the Medical Adviser in the NATO Headquarters of International Assistance Force (ISAF) in Afghanistan from August 2006 to February 2007. It is in 5 sections, medical plans and operations, clinical issues, supporting the Afghan Security Forces Medical Services, supporting Health Sector Reconstruction and Development and preventive medicine. It concludes with a short summary of personal lessons.

Roles for international military medical services in stability operations (reconstruction and development).

This is the last in a series of three papers that provide a discussion on the wider roles of military medical forces in stability operations. It examines the framework for civil-military co-operation in humanitarian operations and complex emergencies. It then introduces the non-military components of 'stability' operations and examines the military role in reconstruction and development. The paper examines the potential capabilities of military medical services in providing medical support for non-military populations, Village Medical Outreach Programmes and medical infrastructure projects.

A review of 10 years of systematic health surveillance in the Army.

Health and morbidity reporting has been an important feature of the historical assessment of military campaigns from times of antiquity. Most of these reports have concentrated on hospital admission rates and mortality. In 1994 the British Army introduced a primary care health surveillance reporting system called J94. This provided the first opportunity for the systematic capture and analysis of morbidity data that allowed the identification of disease trends and the audit of remedial action. In parallel with the developments made by the military in the field of health surveillance, a number of initiatives in the NHS tried to develop real time surveillance systems with differing degrees of success. This paper reviews the developments made by military and civilian programs, identifies the problems that have been faced, areas where success has been achieved and the issues that will have to be considered as we prepare for the introduction of the next generation of IT based medical information systems into the military.

EX SAIF SEREEA II--the field hospital clinical report.

This paper places on record the clinical activity of the hospital facilities run by 22 Field Hospital on Exercise SAIF SEREEA II in Oman from August to November 2001. There were 1322 episodes of illness resulting in a hospital admission. The mean rate of admission was 1.96 patients per thousand per day (SD 13.62). The main causes of admission were gastrointestinal illness, conditions related to the heat and injuries. The reporting of health service utilisation data is an important duty of medical personnel during overseas deployments in order to add to the dataset available for the estimation of medical workload for future operations.

The evolution of casualty evacuation in the 20th century (Part 4)--an international perspective.

This is the fourth in a series of papers that review the evolution of the military casualty evacuation during the 20th Century. The previous three papers have looked at the British Army system. This paper looks at the organisation of army medical services from the United States, Israel, Russia and Croatia and compares these with the British Army system reported in the previous papers. All national army medical services have evolved organisations to reduce the time lag between injury and surgery for their wounded. The paper will show that there are some fundamental differences in the organisation of medical units to achieve this aim. Helicopters are almost universally used for the evacuation of seriously ill casualties when this is practicable.

Command in a field hospital.

This paper examines the challenges involved in commanding a field hospital. There are frequent, dynamic tensions between the military culture that is based on a task-focussed, hierarchical structure and the clinical culture that is based on flat, process-focussed, multidisciplinary teams. The paper outlines the cultural environment of the field hospital and then examines the deployment sequence whereby a functioning clinical facility may be created from a group of disparate individuals. There are a number of tools that may assist with this including the personality of the Commanding Officer, individual skills, the creation of an organizational identity and the choice of command structure.

The evolution of casualty evacuation in the British Army in the 20th century (Part 3)--1945 to present.

This is the third in a series of papers describing the evolution of the British casualty evacuation chain during the 20th century. This period was dominated by the threat of war between NATO and the Warsaw Pact in Central Europe. The Suez Crisis in 1956, the Falklands War in 1982, the GulfWar in 1991 and events in the Balkans during the 1990s demonstrated the requirement for a flexible system for medical support to the UK Armed Forces.

The evolution of casualty evacuation in the 20th Century (Part 5)--Into the future.

This is the final part of a series of papers that review the evolution of the military casualty evacuation system in the 20th Century. This paper draws together the themes that have been presented in the previous papers to describe the mandatory functions of such a system. The forward surgical hospital is the key treatment node if wounded soldiers are to have the maximum chance of survival. Suggestions are made for the minimum size, organisation and clinical capability of such a military medical unit. However, the majority of military casualties are likely to be less seriously injured or non-trauma cases. The casualty evacuation system must also have sufficient capacity to accommodate these patients.

The evolution of casualty evacuation in the British Army in the 20th century (Part 2)--1918 to 1945.

This is the second in a series of papers that examine the evolution of the military casualty evacuation chain during the 20th century. The Spanish Civil War demonstrated to the world the revolutionary tactic of 'Blitzkrieg' developed by the Germans. This and the experience of the British Expeditionary Force in 1940 emphasised the need for mobility in forward medical units. The campaign in the Western Desert led to the creation of a number of new units such as the Field Surgical Unit and the Field Transfusion Unit which were introduced across the British Army as a result of the findings of the Hartgill Committee. The aeroplane transformed the evacuation chain from CCSs to base hospitals and beyond.

The evolution of casualty evacuation in the British Army 20th century (Part 1)--Boer War to 1918.

This is the first in a series of papers which describe the evolution of the British casualty evacuation system in the 20th Century. This paper describes the formation of the Field Ambulance after the Boer War and the development of the Casualty Clearing Station during the First World War. It also discusses how the effects of an improved understanding of triage, shock and wound infection contributed to changes in the internal organization of hospitals in the field.

Heat illness--recent developments.

This paper reviews the literature concerning exertional heat illness in soldiers. It focuses on developments since Bricknell's two part paper "Heat Illness--A Review of Military Experience" published in this journal in 1996. Recent advances in the understanding of risk factors, pathophysiology and treatment are discussed with a view to reducing the already low incidence of heat illness within the Armed Forces.

The reconnaissance and siting of field hospitals.

This paper describes the reconnaissance function for the siting of deployable field hospitals. It reports two levels of reconnaissance, theatre/operational and tactical. The paper describes the factors to be considered when conducting the reconnaissance and the format of the reconnaissance report.