Non-battle Emergency Department Utilization of the First Modular Army Field Hospital Prototype in Support of Operation INHERENT RESOLVE.

INTRODUCTION: The 2010-2011 withdrawal from Iraq included the closure of all fixed-facility military medical resources. Operation INHERENT RESOLVE, the United States-led counter-terrorism mission in Iraq and Syria, subsequently commenced in 2014. With increasing combat operations, the 28th Combat Support Hospital deployed to Iraq to support that mission as a limited footprint unit prototyped after the new modular Army Field Hospital. We describe the non-battle utilization of the emergency medical treatment section. METHODS: We prospectively collected data for this project as part of a performance improvement initiative to track healthcare utilization to guide emergency medical treatment section staffing. The project took place at a combat support hospital near Baghdad, Iraq from July 2016 through January 2017. RESULTS: During this time, the emergency department (ED) averaged 3.5 visits per day totaling 675 non-battle encounters. Most (84.6%) were U.S. military personnel with a median age of 32 (IQR 26-38). The most common procedure performed was point-of-care ultrasound (n = 33). Most patients (96.9%) underwent discharge from the ED. Of the 21 subjects admitted, 6 were for surgical intervention and the remaining for medical or observational indications. The most common chief complaints were musculoskeletal (31.1%, n = 210), respiratory (15.3%, n = 103), and dermatologic (12.0%, n = 81). CONCLUSIONS: Non-battle injuries and illnesses were the predominant reason for ED utilization. Most subjects were discharged back to duty with relatively low-resource utilization. Few visits required procedural interventions.

Catastrophic Non-Survivable Brain Injury Care-Role 2/3.

A catastrophic brain injury is defined as any brain injury that is expected to result in permanent loss of all brain function above the brain stem level. These clinical recommendations will help stabilize the patient so that they may be safely evacuated from theater. In addition to cardiovascular and hemodynamic goals, special attention must be paid to their endocrine dysfunction and its treatment-specifically steroid, insulin and thyroxin (t4) replacement while evaluating for and treating diabetes insipidus. Determining the futility of care coupled with resource management must also be made at each echelon. Logistical coordination and communication is paramount to expedite these patients to higher levels of care so that there is an increased probability of reuniting them with their family.

[Development of different approaches to classification of medical equipment sets].

The authors provided results of the study on approaches to the classification of medical equipment sets for the medical service of the Armed Forces. A retrospective analysis of the formation and development of classifications of first aid kits, medical bags, sets of medical equipment, medical kits and kits is performed. Basic factors influencing the structure and principles of classification sets of medical equipment are detected. The authors present modern classification of sets of medical equipment and the ways of its improvement.

[Even more critical medicine: a retrospective analysis of casualties admitted to the intensive care unit in the Spanish Military Hospital in Herat (Afghanistan)]. / Medicina aún más crítica: análisis retrospectivo de las bajas atendidas en la UCI del Hospital Militar español de Herat (Afganistán).

OBJECTIVE: To analyze casualties from firearm and explosives injuries who were admitted to the Intensive Care Unit in the Spanish ROLE-2E from December 2005 to December 2008 and to evaluate which damaging agent had produced the highest morbidity-mortality in our series using score indices with anatomical base (ISS and NISS). DESIGN: Observational and retrospective study performed between 2005 and 2008. SETTING: Polyvalent Intensive Care Unit in the Spanish Military Hospital of those deployed in Afghanistan. PATIENTS OR PARTICIPANTS: The inclusion criteria were all patients who had been wounded by firearm or by explosive devices and who had been admitted in ICU in Spanish Military Hospital in Herat (Afghanistan). INTERVENTION: The anatomic scores Injury Severity Score and the New Injury Severity Score (NISS) were applied to all the selected patients to estimate the grade of severity of their injuries. VARIABLES OF INTEREST: Independent: damaging agent, injured anatomical area, protection measures and dependent: mortality, surgical procedure applied, score severity and socio-demographics and control variables. RESULTS: Eighty-six casualties, 30 by firearm and 56 by explosive devices. Applying the NISS, 38% of the casualties had suffered severe injuries. Mean stay in the ICU was 2.8 days and mortality was 10%. Significant differences in admission to the ICU for the damaging agent were not observed (P=.142). CONCLUSIONS: No significant differences were observed in the need for admission and stay in the ICU according to the damaging agent. The importance of the strategy, care and logistics of the intensive care military physician in Intensive Medicine in the Operating Room in Afghanistan is stressed.

Consultoria psiquiatria em Hospital Geral do Exercito: experiencia de um ano / Psychiatric consultation in Army General Hospital: experience of 1 year

Este trabalho visa transmitir a experiencia inedita na literatura mundial de Interconsulta Psiquiatrica em Hospital Militar (Hospital Geral de Campo Grande-HCeGC), no periodo de marco de 1992 a marco de 1993. Pretende, ainda, comparar os dados obtidos quanto ao numero de casos atendidos, idade, sexo, estado civil, categoria e situacao militar atual, Forca Armada a que pertence, escolaridade, unidade solicitante, motivo e autor do pedido, medicacao em uso, exame neurologico, diagnostico e conduta psiquiatrica, com dados da literatura civil, propondo a expansao da Interconsulta a outras Organizacoes Militares de Saude, nao so do Comando Militar do Oeste (CMO), mas tambem de outros Comandos.

What's new in tent hospitals?

There will always be a need for some kind of rapidly deployable, easy to assemble, temporary shelter for use in military conflicts, large-scale military disasters, industrial accidents, major construction projects in remote areas, refugee relocation centers, military hospitals, and any temporary outdoor event requiring cover. The history of tenting is essentially a history of man's ingenuity in creating portable, rapidly erected, temporary shelter. This article will be limited to the stages of development of the latest in military tent hospitals.