A descriptive analysis of patient encounter data from the Fleet Hospital FIVE humanitarian relief mission in Haiti.

Fleet Hospital FIVE personnel treated more than 24,000 patients during a 1997 military operation other than war in Haiti. Sample data were analyzed for 10,215 Haitians who received humanitarian assistance care at field treatment sites and for 353 military, United Nations personnel, and Haitian nationals who were treated at the fleet hospital. Demographic data, type of encounter, diagnoses, and prescriptions were tabulated. Children aged 1 to 10 years accounted for 31% of humanitarian assistance visits. Females outnumbered males; in adults aged 21 to 30 years, the proportion was almost three to one. Most (97%) were initial encounters. Infectious and parasitic diseases, such as worms or scabies, accounted for 25% of diagnoses. At the fleet hospital, more than 80% of patients were males; these were most often older than 21 years. Injuries and aftercare procedures constituted 51.5% of diagnoses. Of 18,100 prescriptions, 57% were for anti-inflammatories, vitamins, or anti-parasitics. Implications for medical planning are described.

Estimating supply requirements for forward medical treatment facilities.

The Naval Health Research Center designed, developed, and used a systematic process to review Marine Corps medical supply requirements. This approach consisted of identifying the medical tasks required to treat patients with specific injuries and illnesses and determining the supplies and equipment required to perform each task. Subject matter experts reviewed treatment briefs, tasks, supplies, and equipment and examined their value to Marine Corps medical providers in forward areas of care. By establishing the clinical requirement for each item pushed forward, the Naval Health Research Center model was able to reduce the logistical burden carried by Marine Corps units and enhance far-forward clinical capability. The result of this effort is a model to estimate supplies and equipment based on a given casualty stream distribution. This approach produces an audit trail for each item and allows current authorized medical allowance list configurations to be revised using information such as type of conflict anticipated, expected duration, and changes in medical doctrine.

MARC ES: a computer program for estimating medical information storage requirements.

During combat, documentation of medical treatment information is critical for maintaining continuity of patient care. However, knowledge of prior status and treatment of patients is limited to the information noted on a paper field medical card. The Multi-technology Automated Reader Card (MARC), a smart card, has been identified as a potential storage mechanism for casualty medical information. Focusing on data capture and storage technology, this effort developed a Windows program, MARC ES, to estimate storage requirements for the MARC. The program calculates storage requirements for a variety of scenarios using medical documentation requirements, casualty rates, and casualty flows and provides the user with a tool to estimate the space required to store medical data at each echelon of care for selected operational theaters. The program can also be used to identify the point at which data must be uploaded from the MARC if size constraints are imposed. Furthermore, this model can be readily extended to other systems that store or transmit medical information.

Users' evaluation of the Navy Computer-Assisted Medical Diagnosis System.

U.S. Navy Independent Duty Corpsmen (IDCs) aboard small ships and submarines are responsible for all clinical and related health care duties while at sea. During deployment, life-threatening illnesses sometimes require evacuation to a shore-based treatment facility. At-sea evacuations are dangerous, expensive, and may compromise the mission of the vessel. Therefore, Group Medical Officers and IDCs were trained to use the Navy Computer-Assisted Medical Diagnosis (NCAMD) system during deployment. They were then surveyed to evaluate the NCAMD system. Their responses show that NCAMD is a cost-efficient, user-friendly package. It is easy to learn, and is especially valuable for training in the diagnosis of chest and abdominal complaints. However, the delivery of patient care at sea would significantly improve if computer hardware were upgraded to current industry standards. Also, adding various computer peripheral devices, structured forms, and reference materials to the at-sea clinician's resources could enhance shipboard patient care.

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.

Casualty rates among naval forces ashore.

Casualty rates for naval forces ashore across varying battle intensities are needed as input to medical and manpower planning models. Casualty data of medical and construction battalions participating in World War II amphibious assaults, Korea, and Vietnam were extracted from archival sources. Casualty rates among naval ashore forces fluctuated with battle intensity. The rate during intense combat was 15 per 1,000 per day among hospital corpsmen organic to infantry units, 7.5 for medical battalion personnel, and 2.1 among construction forces. Casualty rates dropped dramatically with decreasing battle intensity, especially among construction and medical battalions.

The relationship between battle intensity and disease rates among Marine Corps infantry units.

Disease and non-battle injury (DNBI) rates were examined in conjunction with casualty rates across two Marine Corps operational scenarios, the assault on Okinawa and the Korean War. DNBI rates increased significantly with battle intensity among Marine infantry battalions involved in both operations. Highly significant positive correlations (p < 0.001) were evidenced between DNBI rate and wounded-in-action (WIA) rate, DNBI rate and killed-in-action rate, and DNBI rate and the preceding week's WIA rate among infantry units in both Okinawa and Korea. The severity of wounds and DNBI rate were also significantly correlated.

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.