Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma.

To mitigate medical risks in remote environments, the authors have implemented an innovative integrated medical support solution for bleeding management on board ships since 2013. Fresh whole blood transfusion (FWBT) and lyophilised plasma were put in place to address life threatening haemorrhages in maritime operations in the Arctic and Antarctica. The authors are illustrating the bleeding risks with an actual case occurring in Antarctica prior to the implementation of these procedures. They are presenting the different steps involved in the complex process of FWBT, from blood donors' qualifications to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including the training of health care professionals, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks.

Lessons from managing an injured suspected pirate onboard a Role 1 medical facility.

The embarkation of detainees is complex and medical requirements and ethical considerations can collide with operational requirements. Morally and ethically the correct route of action is always to disembark the patient at the earliest opportunity to a first rate medical facility; however this is not always possible for a variety of geographical, operational, financial and political reasons. It is ultimately a command decision utilising the best advice that the Medical Officer can provide. It is important that Commanding Officers and Medical Officers have a strong working relationship and understand each other's responsibilities and constraints.

Ensuring respect for persons when recruiting junior enlisted personnel for research.

Junior enlisted personnel in the Navy at training commands or recruit depots who are recruited for research can be considered a "captive audience" and therefore require special precautions to ensure that the ethical principle of respect for persons is maintained. Unfortunately, this can be difficult because of the hierarchical structure of the military and closed communities of junior enlisted personnel at training commands and recruit depots. This article provides a theoretical discussion of the ethical issue of autonomy and the essential elements of informed consent that Navy researchers need to address when recruiting subjects from this population. Two relevant policy statements to Navy researchers, Department of Defense Directive 3216.2 and Bureau of Medicine and Surgery Instruction 3900.6B, which provide guidance for protection of human subjects, are reviewed and critiqued, and a suggested plan to ensure the ethical principle of respect for persons is presented.

Body mass penalties in the physical fitness tests of the Army, Air Force, and Navy.

Recent research has empirically documented a consistent penalty against heavier service members for events identical or similar to those in the physical fitness tests of the Army, Air Force, and Navy. These penalties, which are not related to body fatness, are based on biological scaling models and have a physiological basis. Using hypothetical cases, we quantified the penalties for men, with body mass of 60 vs. 90 kg, and women, 45 vs. 75 kg, to be 15% to 20% for the fitness tests of these three services. Such penalties alone can adversely affect awards and promotions for heavier service members. To deal equitably with these penalties in a practical manner, we offer two recommendations, i.e., (1) implementation of revised fitness tests with balanced events, in which the penalties of one event for heavier service members are balanced by an equal and opposite bias against lighter service members, or (2) development of correction factors that can be multiplied by raw scores to yield adjusted scores free of body mass bias.