The Tägerwilen II report: Recommendations from the NATO Prehospital Care Improvement Initiative Task Force.

BACKGROUND: The Committee of the Chiefs of Military Medical Services (COMEDS) initiated the Prehospital Care Improvement Initiative Task Force (PHCII TF) to advise on how to improve prehospital care within NATO nations. The Task Force consisted of the NATO Military Health Care Working Group and its subordinated expert panels, including the Blood Panel, the Emergency Medicine Panel and the Special Operations Forces Medicine Panel. METHOD: The PHCII TF identified four key prehospital care themes for exploration: 1) Tactical Casualty Care, 2) Blood Far Forward), 3) Forward Surgical Capabilities), and 4) Prolonged Casualty Care. A consensus experimentation workshop explored the four themes, utilizing a modified Delphi technique and Utstein rotations during syndicate work, resulting in 83 consensus statements. The consensus statements were further evaluated on six criteria: actionable, measurable, urgent, interoperability, low risk/threat and impact. RESULTS: The 83 consensus statements, when weighted against the six criteria, resulted in 15 recommendations, focusing on standardization of training, ensuring provision of evidence-based practices and removing legislative barriers to improve prehospital care. CONCLUSION: The recommendations on these four themes reflect the most significant priorities in improving prehospital care, and must be incorporated in the on-going revision of NATO doctrine.

Short-termed changes in quantitative ultrasound estimated bone density among young men in an 18-weeks follow-up during their basic training for the Swiss Armed Forces.

Background: Quantitative Ultrasound (QUS) methods have been widely used to assess estimated bone density. This study aimed to assess changes in estimated bone density in association with changes in body composition, physical activity, and anthropometry. Methods: We examined changes in anthropometry, body composition, and physical activity associated with changes in estimated bone mineral density (measured using quantitative ultrasound with a heel ultrasound device indicating broadband ultrasound attenuation BUA and speed of sound SOS) in a follow-up sample of n = 73 young men at the beginning and again 18 weeks later at the end of basic military training. Results: At the end of the basic training, the subjects were on average significantly heavier (+1.0%), slightly taller (+0.5%) and had a higher fat mass (+6.6%) and grip strength (+8.6%). A significant decrease in mean physical activity (-49.5%) and mean estimated bone density calculated with BUA (-7.5%) was observed in the paired t-test. The results of the multivariable linear regressions (backward selection) show that changes in skeletal muscle mass (delta = 2nd measurement minus 1st measurement) have negative and body weight (delta) have positive association with the speed of sound SOS (delta), while fat mass (delta) and physical activity (delta) had the strongest negative associations with estimated bone mineral density (delta). In particular, we found a negative association between fat mass (delta) and estimated bone mineral density (delta, estimated with BUA). Conclusion: Our study suggests that estimated bone density from the calcaneus can change within a few months even in young and mostly healthy individuals, depending upon physical activity levels and other co-factors. Further studies including other troop types as control groups as well as on women should follow in order to investigate this public health relevant topic in more depth. To what extent the estimated bone density measurement with quantitative ultrasound is clinically relevant needs to be investigated in further studies.

H1N1 outbreak in a Swiss military boot camp--observations and suggestions.

QUESTIONS UNDER STUDY: The A(H1N1)pdm09 influenza virus is a highly contagious pathogen which caused the 2009 influenza pandemic. The virus is known to affect mainly younger people and may be a problem in crowded living conditions. The aim of the study was to describe a major A(H1N1)pdm09 outbreak in a Swiss military boot camp and to develop suggestions for similar future situations. METHODS: Retrospective chart analysis of a A(H1N1)pdm09 outbreak between 14 December and 23 December 2010. Symptoms, signs and lab parameters were documented. RESULTS: 105 of 750 male recruits were affected by the outbreak. All nasopharyngeal swabs of 16 patients with high fever were tested positive. Common clinical symptoms included high fever, myalgia and bronchitis with persistent cough and throat aches. Fever progression typically occurred in two peaks within three days. Median length of stay at the infirmary was 3 days (range: 0.5-9 days). CONCLUSION: A(H1N1)pdm09 has become a ubiquitous seasonal virus in the region. Complications were uncommon and non life threatening. In the event of new influenza outbreaks, hygienic and containment measures must be quickly and correctly implemented, in order to avoid an epidemic. This should also be considered in non-military settings like school camps or in retirement homes.

Outbreak of Query fever among Argentinean special police unit officers during a United Nations mission in Prizren, South Kosovo.

After an outbreak of Query fever (Q fever) in an Argentinean special police unit, 115 officers were investigated to evaluate the risk of infection with Coxiella burnetii after having been exposed to contaminated dust originating from a nearby barn harboring infected sheep. All officers were serologically tested and the medical history of potential risk factors was performed. The percentage of officers showing acute Q-fever seroconversion was found to be 51.3%. Forty-two individuals showed clinical symptoms, among them, 28 patients underwent medical care. No relevant risk factor was found. In areas of an unknown epidemiological situation, patients with unclear respiratory infections should be serologically tested for C. burnetii to offer the correct treatment and avoid possible chronic cases. Attention has to be drawn to choosing the site of a camp so as to protect troops from possible infectious disease. During a U.N. mission in Kosovo, we observed a Q-fever outbreak among the Argentinean special police unit. Our investigation was initiated to evaluate the incidence of C. burnetii infection and Q-fever manifestations in an entire population sharing the same exposure risk and to develop suitable measures to interrupt transmission.