Review of the Naval Health Research Center's development of medical information systems for far-forward echelons of care, 1983 to 1997.

Medical treatment information must be gathered quickly and accurately to ensure continuity of care at far-forward echelons. The manual documentation methods in use during the Vietnam War revealed the need for considerable improvements in medical information documentation, patient tracking, and effective transfer of data throughout each of the first three echelons of care. The U.S. military determined that automation would result in the greatest enhancement of documentation techniques. The Naval Health Research Center (NHRC) has been an integral part of the development of medical information systems for the Navy's far-forward echelons of care. The prototypes designed by NHRC for echelons I and II can successfully raise the standard of treatment while simultaneously reducing the number of individuals needed for administrative duties and increasing the number of medical staff available for patient care. An overview of NHRC's work in medical information systems from 1983 to 1997 is presented.

A virtual reality patient simulation system for teaching emergency response skills to U.S. Navy medical providers.

Rapid and effective medical intervention in response to civil and military-related disasters is crucial for saving lives and limiting long-term disability. Inexperienced providers may suffer in performance when faced with limited supplies and the demands of stabilizing casualties not generally encountered in the comparatively resource-rich hospital setting. Head trauma and multiple injury cases are particularly complex to diagnose and treat, requiring the integration and processing of complex multimodal data. In this project, collaborators adapted and merged existing technologies to produce a flexible, modular patient simulation system with both three-dimensional virtual reality and two-dimensional flat screen user interfaces for teaching cognitive assessment and treatment skills. This experiential, problem-based training approach engages the user in a stress-filled, high fidelity world, providing multiple learning opportunities within a compressed period of time and without risk. The system simulates both the dynamic state of the patient and the results of user intervention, enabling trainees to watch the virtual patient deteriorate or stabilize as a result of their decision-making speed and accuracy. Systems can be deployed to the field enabling trainees to practice repeatedly until their skills are mastered and to maintain those skills once acquired. This paper describes the technologies and the process used to develop the trainers, the clinical algorithms, and the incorporation of teaching points. We also characterize aspects of the actual simulation exercise through the lens of the trainee.

The field hospital at Zagreb: tri-service medical care in a peacekeeping operation.

The objective of this investigation was to provide military medical planners with insights into the specific materiel, skills, and information requirements demanded by humanitarian missions through review of approximately 16,000 records from a tri-service medical patient database used at the field hospital in Zagreb, Croatia, during Operation Provide Promise. This review describes (1) the origin, rationale, structure, and implementation of the database; (2) the patients who used medical services provided by the hospital; (3) the diagnoses encountered in outpatient visits, admissions, and surgical operations; and (4) the distribution of medical services used by various subgroups of interest.

Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel.

The objectives of this study were to (a) describe demographic factors associated with high rates of carpal tunnel syndrome (CTS), cubital tunnel syndrome, and other neuritis of the arm and hand, and (2) identify the high-risk occupations associated with these disorders in the Navy. Computerized records of first hospitalizations of all active-duty Navy-enlisted personnel were searched for all cases of CTS, cubital tunnel syndrome, and other neuritis of the arm and hand (ICD-9 CM codes 354.0-354.9) during 1980-1988. There were 1039 first hospitalizations (including 493 cases of CTS) for all neuritis of the arm and hand in 4095708 person-years in men and 186 first hospitalizations (including 90 cases of CTS) in 365668 person-years in women. Incidence rates of hospitalized cases with CTS rose with age for both sexes. Rates in white women were approximately three times those in white men (p < .0001), but rates in black women were not significantly different from those in black men. Rates of cubital tunnel syndrome also increased with age in both sexes and were higher in white women than white men (p < .05). Occupations with significantly high standardized incidence ratios (p < .05) for CTS in men included aviation-support equipment technician, engineman, hull-maintenance technician, boatswain's mate, and machinist's mate. In women, occupations with significantly high standardized incidence ratios included boatswain's mate, engineman, hospital corpsman, ocean-systems technician, and personnelman. Several occupations for each sex had significantly high standardized incidence ratios for cubital tunnel syndrome, with high rates in hospital corpsmen of both sexes (p < .05). Gender and race differences according to occupation did not account for the occupations at highest risk. Further research is needed to determine the extent to which CTS and related disorders could be prevented by modifying the motions currently performed in occupations with the highest standardized incidence ratios.

Comparisons of casualty presentation and admission rates during various combat operations.

Daily casualty rates were analyzed and compared for four ground operations: Okinawa, Korea, Vietnam, and the Falklands. Daily admission rates of wounded-in-action (WIA) for combat troops ranged from 1.61 to 5.54 per 1,000 strength. The killed-in-action rates of combat troops ranged from 0.2 to 1.35. Support troop WIA admission rates ranged from 0.05 to 0.43 per 1,000 strength per day. Among wounded combat troops, the mean number of sick days before return to duty were 4.3 and 5.1 days for two different operations.

Incidence of insulin-dependent diabetes mellitus in young adults: experience of 1,587,630 US Navy enlisted personnel.

First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a surrogate for insulin-dependent diabetes mellitus incidence among 17-34-year-old US Navy enlisted personnel followed for 6,077,856 person-years. In the 15-year period, the overall incidence of insulin-dependent diabetes mellitus was 21.3 per 100,000 person-years. Incidence did not differ significantly by sex, but was higher for blacks than whites (28.4 vs. 20.2 per 100,000 person-years, respectively; p < 0.05). Incidence increased with age threefold for white men and fivefold for black men (p < 0.05) between the ages of 17-19 and 30-34 years.

Comparisons of wartime and peacetime disease and non-battle injury rates aboard ships of the British Royal Navy.

Disease and non-battle injury rates were computed for ships of the British Royal Navy which were deployed during wartime and peacetime operations. The wartime sick list admission rates were lower aboard carriers, battleships, and cruisers when compared with their counterparts deployed in peacetime; rate differences for battleships and cruisers were statistically significant (p < 0.05). Several categories of disease also yielded significant differences in the wartime/peacetime contrasts. Infections and parasitic disorders aboard carriers, skin diseases aboard battleships, and skin diseases, injuries, and generative system disorders occurring on cruisers were all lower during wartime than on peacetime deployments. Illness rates also varied by ship type, with the lowest rates evidenced aboard carriers.

Upper respiratory disease in deployed U.S. Navy shipboard personnel.

A study was conducted to determine the risk of upper respiratory disease among deployed U.S. Navy shipboard personnel. Between January and June 1989, a Patient Encounter Form was used to collect disease information from 10 U.S. Navy ships. Patients with a diagnosis of upper respiratory infection (URI) on initial sick-call visit were used in this study. Information on time spent in various ports and time at sea for each of the 10 ships was also collected. A classification scheme was developed to permit daily estimates of URI rates and to indicate whether the ship was in port or at sea. Of 967 cases of URI, 64.4% occurred while at sea, with an average daily rate of 0.5/1,000 crew members; 35.4% of the cases occurred while in port, with an average daily rate of 0.4/1,000 crew members. There was an increase in URI rates after 9 days at sea or in port. These data suggest that there are defined periods of increased transmission of upper respiratory infections aboard ships, both at sea and in port.

Prediction of posttreatment effectiveness in Navy alcoholics.

Major predictors of the posttreatment effectiveness of 2195 alcoholics enlisted in the U.S. Navy were, for men 26 and over, abstinence during treatment, years of service and level of pay, and, for younger men, level of pay, not being demoted and not missing promotion to petty officer status.