Mastering multicasualty trauma care with the Trauma Non-technical Skills Scale.

BACKGROUND: Multicasualty events present complex medical challenges. This is the first study to investigate the role of nontechnical skills in prehospital multicasualty trauma care. We assessed the feasibility of using the Trauma Nontechnical Skills Scale (T-NOTECHS) instrument, which has not yet been investigated to evaluate these scenarios. METHODS: We conducted an observational study involving military medical teams with Israel Defense Forces Military Trauma Life Support training to assess the T-NOTECHS' utility in predicting prehospital medical team performance during multicasualty event simulations. These teams were selected from a pool of qualified military Advanced Life Support providers. Simulations were conducted in a dedicated facility resembling a field setting, with video recordings to ensure data accuracy. Teams faced a single multicasualty scenario, assessed by two instructors, and were evaluated using a 37-item checklist. The T-NOTECHS scores were analyzed using regression models to predict simulation performance. RESULTS: We included 27 teams for analysis, led by 28% physicians and 72% paramedics. Interrater reliability for simulation performance and T-NOTECHS scores showed good agreement. Overall T-NOTECHS scores were positively correlated with simulation performance scores ( R = 0.546, p < 0.001). Each T-NOTECHS domain correlated with simulation performance. The Communication and Interaction domain explained a unique part of the variance ( ß = 0.406, p = 0.047). Assessment and Decision Making had the highest correlation ( R = 0.535, p < 0.001). These domains significantly predicted specific items on the simulation performance checklist. Cooperation and Resource Management showed the least correlation with checklist items. CONCLUSION: This study confirms the T-NOTECHS' reliability in predicting prehospital trauma team performance during multicasualty scenarios. Key nontechnical skills, especially Communication and Interaction, and Assessment and Decision Making, play vital roles. These findings underscore the importance of training in these skills to enhance trauma care in such scenarios, offering valuable insights for medical team preparation. LEVEL OF EVIDENCE: Diagnostic Tests or Criteria; Level III.

Perceptions of general surgery residents at military treatment facilities: Excellent training with crisis of confidence.

BACKGROUND: The declining operative volume at Military Treatment Facilities (MTFs) has resulted in Program Directors finding alternate civilian sites for resident rotations. The continued shift away from MTFs for surgical training is likely to have unintended negative consequences. METHODS: An anonymous survey was generated and sent to the program directors of military general surgery training programs for distribution to their residents. RESULTS: A total of 42 residents responded (response rate 21%) with adequate representation from all PGY years. Ninety-five percent of residents believed that their programs provided the training needed to be a competent general surgeon. However, when asked about career choices, only 30.9% reported being likely/extremely likely to remain in the military beyond their initial service obligation, while 54.7% reported that it was unlikely/extremely unlikely and 19% reported uncertainty. Eighty-eight percent reported that decreasing MTF surgical volume directly influenced their decision to stay in the military, and half of respondents regretted joining the military. When asked to assess their confidence in the military to provide opportunities for skill sustainment as a staff surgeon, 90.4% were not confident or were neutral. CONCLUSION: Although military surgical residents have a generally positive perception of their surgical training, they also lack confidence in their future military surgical careers. Our findings suggest that declining MTF surgical volume will likely negatively impact long-term retention of military surgeons and may negatively impact force generation for Operational Commander. LEVEL OF EVIDENCE: Prognostic and Epidemiological, Level IV.

Training for a mass casualty incident: Conception, development, and implementation of a crew-resource management course for forward surgical teams.

BACKGROUND: Since 2021, the predeployment training of French FSTs has included a simulation-based curriculum consisting of organizational and human factors. The purpose of this article is to describe the development of a crew-resource management (CRM) training course dedicated for the forward surgical teams (FSTs) of the French Military Health Service. METHODS: The approach was based on three steps: (1) establishment of a conceptual framework of FSTs deployment; (2) development of an aircrew-like CRM training combining lectures, laboratory exercises, and situational training exercises to consider four fundamental "nontechnical" (cognitive and social) skills for effective and safe combat casualty care: (a) leadership, (b) decision-making, (c) coordination, and (d) situational awareness; (3) Implementation of teamwork evaluation tools. RESULTS: A multidisciplinary team designed a conceptual framework for FST preparedness, 24 French FSTs completed a high-quality training that takes into account both technical and nontechnical skills to maintain quality of combat care during mass-casualty incidents, FSTs' CRM skills were assessed using an audio/video recording of a simulated mass-casualty incident.

The Comparative Effectiveness and Provider-induced Demand Collaboration Project: A Pioneering Military-Civilian Academic Partnership to Build Health Services Research Capacity for the Military Health System.

INTRODUCTION: Like civilian health systems, the United States Military Health System (MHS) confronts challenges in achieving the aims of reducing cost, and improving quality, access, and safety, but historically has lacked coordinated health services research (HSR) capabilities that enabled knowledge translation and iterative learning from its wealth of data. A military-civilian academic partnership called the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC), formed in 2011, demonstrated early proof-of-concept in using the MHS claims database for research focused on drivers of variation in health care. This existing partnership was reorganized in 2015 and its topics expanded to meet the need for HSR in support of emerging priorities and to develop current and HSR capacity within the MHS. MATERIALS AND METHODS: A Donabedian framework of structure, process, and outcomes was applied to support the project, through a core of principal investigators, researchers, analysts, and administrators. Within this framework, new researchers and student trainees learn foundations of HSR while performing secondary analysis of claims data from the MHS Data Repository (MDR) focusing on Health and Readiness, Pediatrics, Policy, Surgery, Trauma, and Women's Health. RESULTS: Since 2015, the project has trained 25 faculty, staff, and providers; 51 students and residents; 21 research fellows across multiple disciplines; and as of 2022, produced 107 peer-reviewed publications and 130 conference presentations, across all five themes and six cores. Research results have been incorporated into Federal and professional policy guidelines. Major research areas include opioid usage and prescribing, value-based care, and racial disparities. EPIC researchers provide direct support to MHS leaders and enabling expertise to clinical providers. CONCLUSIONS: EPIC, through its Donabedian framework and utilization of the MHS Data Repository as a research tool, generates actionable findings and builds capacity for continued HSR across the MHS. Eight years after its reorganization in 2015, EPIC continues to provide a platform for capacity building and knowledge translation.

Creative self-beliefs of civilian and military school students / Crenças do self criativo de estudantes de escolas civis e militares / Creencias del self creativo de estudiantes de escuelas civiles y militares

Creative Self-Efficacy (CSE) and Creative Personal Identity (CPI) are creative self-beliefs which act as creative achievement predictors in different contexts, including school. Brazilian theoretical studies suggest that characteristics of military school can inhibit creative expression. The question is raised whether the school environment can influence CSE and CPI. Therefore, the goal was to compare male and female students from military and civilian schools, in terms of CSE and IPC, in addition to verifying the interaction between the variables. Participants were 230 secondary school students, with a mean age of 16.07 years (SD = .92). The Short Scale of Creative Self (SSCS) and a sociodemographic questionnaire were used. No significant differences or interactions were observed, except for the higher IPC in women when compared to men. Thus, it is possible that the typical restrictions of the military model of education do not necessarily imply barriers to creativity.(AU)

Autoeficácia Criativa (AEC) e Identidade Pessoal Criativa (IPC) são crenças do self criativo que atuam como preditoras da realização criativa em diversos contextos, inclusive escolar. Estudos teóricos brasileiros sugerem que as características da escola militar podem inibir a expressão criativa. Questiona-se como AEC e IPC podem ser influenciadas pelo ambiente escolar. Portanto, o objetivo deste estudo foi comparar estudantes de escolas militares e civis, do sexo masculino e feminino, quanto à AEC e IPC, além de verificar possível interação entre as variáveis. Participaram 230 estudantes do ensino médio, com idade média de 16,07 anos (DP = 0,92). Utilizou-se a Escala Breve do Self Criativo (EBSC) e um questionário sociodemográfico. Não foram observadas diferenças ou interações significativas entre os grupos, exceto pela IPC superior nas mulheres, quando comparadas aos homens. Nesse sentido, é possível que as restrições típicas do modelo militar de educação não impliquem necessariamente barreiras à criatividade.(AU)

La Autoeficacia Creativa (AEC) y la Identidad Personal Creativa (IPC) son creencias del self creativo que actúan como predictores del logro creativo en diferentes contextos, incluyendo el escolar. Estudios teóricos brasileños sugieren que las características de las escuelas militares pueden inhibir la expresión creativa. Se cuestiona si el entorno escolar puede influir en la AEC y la IPC. Por lo tanto, el objetivo de este estudio fue comparar alumnos y alumnas de escuelas militares y civiles, en términos de AEC y IPC, además de verificar la interacción entre las variables. Participaron 230 estudiantes de secundaria de escuelas públicas, con una edad promedia de 16,07 años (DS = 0,92). Se utilizó la escala Short Scale of Creative Self (SSCS) y un cuestionario sociodemográfico. No se observaron diferencias o interacciones significativas entre los grupos, excepto por una IPC superior en mujeres en comparación con los hombres. Es posible que las restricciones típicas del modelo educativo militar no necesariamente impliquen barreras para la creatividad.(AU)

Initial report on special operations clinical training at a civilian academic medical center.

BACKGROUND: Military-civilian partnerships for combat casualty care skills training have mostly focused on traditional, combat surgical team training. We sought to better understand US Special Forces (SF) Medics' training at West Virginia University in Morgantown, West Virginia, a Level 1 trauma center, via assessments of medical knowledge, clinical skills confidence, and technical performance. METHODS: Special Forces Medics were evaluated using posttraining medical knowledge tests, procedural skills confidence surveys (using a 5-point Likert scale), and technical skills assessments using fresh perfused cadavers in a simulated combat casualty care environment. Data from these tests, surveys, and assessments were analyzed for 18 consecutive SF medic rotations from the calendar years 2019 through 2021. RESULTS: A total of 108 SF Medics' tests, surveys, and assessments were reviewed. These SF Medics had an average of 5.3 years of active military service; however, deployed experience was minimal (73% never deployed). Review of knowledge testing demonstrated a slight increase in mean test score between the precourse (80% ± 14%; range, 50-100%) when compared with the postcourse (82% ± 14%; range, 50-100%). Skills confidence scores increased between courses, specifically within the point of injury care ( p = 0.09) and prolonged field care ( p < 0.001). Technical skills assessments included cricothyroidotomy, chest tube insertion, and tourniquet placement. CONCLUSION: This study provides preliminary evidence supporting military-civilian partnerships at an academic Level 1 trauma center to provide specialty training to SF Medics as demonstrated by increase in medical knowledge and confidence in procedural skills. Additional opportunities exist for the development technical skills assessments. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Determining the educational impact of virtual patients on trauma team training during a multinational, large-scale civil military simulation exercise.

BACKGROUND: With asymmetrical conflicts ongoing, many countries have an increasing number of major trauma events but limited capacity to cope with these events. Training for such events comprises primarily of simulations requiring significant resources and that are time-consuming and expensive. Virtual patients are defined as computer-based programs presenting authentic cases support training in trauma management. HYPOTHESIS: Assisted learning technologies augment simulated trauma team training and can improve trauma team competencies. The aim was to investigate if virtual patients increased competencies in decision making required and to identify deficiencies in care for the management of trauma patients during a multinational civil military trauma exercise. METHODS: A prospective educational intervention study with mixed methods, measuring the effects of a novel virtual patient model on trauma teams, was performed. The population consisted of surgeons, anesthesiologists, emergency department physicians, nurses, and paramedics (n = 30) and constituted six trauma teams from eight countries; three trauma teams formed the participating group, and three were allocated as control group. The participating group was exposed to virtual patients before, during, and after the live simulation exercise. Data sources were derived from individual preassessments and postassessments, evaluations made by experts in trauma, and video recordings of performance during the live simulation exercise and analyzed by the thematic analysis method. RESULTS: Using virtual patients contributed to improved individual knowledge about the management of major trauma patients and improved teamwork. Virtual patients as support for reasoning in decision making were directly correlated to level of previous knowledge and experience. Two of the three participating trauma teams showed lower levels of existing knowledge and competence in managing major trauma patients and therefore made more efficient use of the virtual patients. CONCLUSION: Results demonstrated advantages using virtual patients during a major civil military trauma live simulation exercise and appear to be supportive especially for teams who are not as experienced. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Aligning Air Force Ground Surgical Team (GST) Training With the Deployment Experience.

INTRODUCTION: The Air Force Ground Surgical Team (GST) Phase 1 course is a two-week pre-deployment training for the Air Force's conventional austere surgical care platform. Since the creation of the GST platform and associated training pipeline in 2017, course adjustments and improvements have relied on expert opinion and anecdote. To gain a more robust understanding of GST deployment clinical and operational activities, we conducted a survey of all surgeons who completed GST Phase 1 training from its inception in April 2017 to September 2020. MATERIALS AND METHODS: 87 surgeons took the course from April 2017 to September 2020. 60 of those surgeons were still on active duty and were candidates to complete the survey sent from the Air Force Survey Office. 31 individuals responded and their identification was kept blinded. An IRB exemption was issued before study initiation. RESULTS: Of the 31 respondents, 9 took the GST Phase 1 course but never deployed, and were excluded. The remaining 22 surgeons deployed at some point from 2017 to 2020. Four surgeons reported providing no surgical care during their deployment. 68% of the surgeons deployed to an actual standalone GST platform, while the rest were retained at larger military treatment facilities (MTFs) or Role III facilities. The median number of surgeries performed was 2 for surgeons at standalone GSTs and 7 for those at larger MTFs/Role IIIs. A holding time of greater than 12 hours was reported for 15% of operative patients and 58% of nonoperative patients at standalone GSTs. 28% (n = 5) of surgeons reported taking care of patients in the Golden Hour of surgery, and 23% of teams reported a patient death. Two surgeons cared for a military working dog, and four surgeons cared for pediatric patients. 50% of surgeons had more than one patient present simultaneously for care. 50% of surgeons' resupply were in the greater than 30 days or never received category. CONCLUSIONS: The GST Phase 1 course has a unique role in preparing students to provide austere surgical care. This includes both preparing to function in the operational military environment as well as applying sound in-garrison trauma surgical care techniques to the austere, resource variable environment. The results of this survey suggest that a broadening of content-specific deployment-related topics, the formalization of documentation education, incorporating formal evidence-based nontechnical skills training, and identifying optimal GST context-specific behaviors will strengthen the effectiveness of the course in preparing students for deployment.

Head Face and Neck Surgeon Deployment in the New French Role 2: The Damage Control Resuscitation and Surgical Team.

INTRODUCTION: High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. MATERIALS AND METHODS: The DCRST is a tactical mobile medico-surgical structure with several configurations depending on the battlefield, mission, and flux of casualties. It represents the new French paradigm for the management of combat casualties, including HFN injuries. RESULTS: The HFN's military surgeon training starts during residency with rotation in the different subspecialties. The HFN surgeon follows a training course called "The French Course for Deployment Surgery" that provides sufficient background to manage polytrauma, including HFN facilities on modern warfare. We have reviewed the main surgical procedures required for an HFN military surgeon. CONCLUSION: The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon's training.Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.

Collaboration between the military and a charity: delivering care to patients, training to defence medical staff and defence engagement overseas.

The Royal College of Anaesthetists Military Anaesthesia higher training module was approved in 2008. The opportunities for trainee deployments to operational environments are limited, and while the need to ensure training and demonstrate the unique military skill set remains, these may not be consistently attainable within NHS posts. This paper proposes a template for the successful integration of military training with a charity mission by describing experiences in Addis Ababa over the two weeks of Project Harar's 2020 Complex Surgery Mission. This model not only benefits patients and military trainees by providing opportunities to gain the skills and attributes required by the Armed Services Consultant Appointment Board, but also by projecting the Defence Medical Services on the global stage.

Construção e validação de instrumento para avaliação das medidas de biossegurança em bioterrorismo pelos bombeiros / Construction and validation of and assessment tool for biosafety measures in bioterrorism for firefighters / Construcción y validación de un instrumento para evaluar las medidas de bioseguridad en el bioterrorismo de los bomberos

Objetivo: Este estudo teve como objetivo desenvolver e validar um instrumento de avaliação das medidas de Biossegurança adotadas pelos bombeiros militares, para a contenção dos agentes biológicos frente a um evento de bioterrorismo. Métodos: Tratou-se de um estudo descritivo de abordagem quantitativa, de desenvolvimento metodológico e do tipo de validação de conteúdo de um instrumento de avaliação. O estudo foi dividido nas fases de desenvolvimento e validação do instrumento. Para o desenvolvimento do instrumento foram feitas revisões da literatura e para a validação do instrumento foi utilizado o método Delphi. Para o estudo foram incluídos 6 juízes que avaliaram o instrumento através da escala numérica tipo Likert. Resultados: Os juízes avaliaram que o instrumento proposto está bem estruturado, possuindo boa clareza e coesão de escrita, com aplicabilidade no campo de estudo e de grande relevância, principalmente em vista a ausência desse tipo de instrumento para a população de bombeiros militares. Para avaliar a concordância entre os juízes foi utilizado o índice de Validade de Conteúdo, que alcançou 98% de concordância e o Índice de Fidedignidade Interavaliadores, que alcançou os conceitos bom e muito bom, mostrando baixa variância das respostas dos juízes, sendo estatisticamente válido. Conclusão: O estudo descreveu o processo de construção e validação do instrumento, provando ser apropriado e confiável para ser utilizado.

Objective: This study aimed to develop and validate an instrument to assess the Biosafety measures adopted by firefighters, for the containment of biological agents in the face of a bioterrorism event. Methods: This is a descriptive study with a quantitative approach, methodological development, and the type of content validation of an assessment instrument. The study was divided into instrument development and validation phases. For the development of the instrument, literature reviews were conducted and for the instrument validation, the Delphi method was used. For the study, 6 judges were included who evaluated the instrument using the Likert-type numerical scale. Results: The judges evaluated that the proposed instrument is well structured, with good clarity and cohesion of writing, with applicability in the field of study and of great relevance, especially considering the absence of this type of instrument for the military firefighter population. To evaluate the agreement between the judges, we used the Content Validity Index which reached 98% of agreement and the Interrate agreement, which reached the concepts good and very good, showing low variance of the judges' answers, being statistically valid. Conclusion: The study described the process of construction and validation of the instrument, proving to be appropriate and reliable to be used.

Objetivo: Este estudio tenía como objetivo desarrollar y validar un instrumento para evaluar las medidas de bioseguridad adoptadas por los bomberos militares para contener los agentes biológicos durante un evento de bioterrorismo. Métodos: Se trata de un estudio descriptivo de abordaje cuantitativo, de desarrollo metodológico y del tipo de validación de contenido de un instrumento de evaluación. El estudio se dividió en las fases de desarrollo y validación del instrumento. Para la elaboración del instrumento se realizaron revisiones bibliográficas y para la validación del mismo se utilizó el método Delphi. Para el estudio se incluyeron 6 jueces que evaluaron el instrumento mediante una escala numérica tipo Likert. Resultados: Los jueces evaluaron que el instrumento propuesto está bien estructurado, poseyendo buena claridad y cohesión de redacción, con aplicabilidad en el campo de estudio y de gran relevancia, especialmente en vista de la ausencia de este tipo de instrumento para la población de bomberos militares. Se utilizó el Índice de Validez de Contenido para evaluar la concordancia entre los jueces, alcanzando un 98% de acuerdo y el Índice de Fiabilidad Inter-registrador, que alcanzó conceptos buenos y muy buenos, mostrando una baja varianza en las respuestas de los jueces, siendo estadísticamente válido. Conclusión: El estudio describió el proceso de construcción y validación del instrumento, demostrando ser apropiado y confiable para ser utilizado.

Simulation-based education improves military trainees' skill performance and self-confidence in tourniquet placement: A randomized controlled trial.

BACKGROUND: Tactical Combat Casualty Care (TCCC) is the standard of care for stabilization and treatment of military trauma patients. The Department of Defense has mandated that all service members receive role-based TCCC training and certification. Simulation education can increase procedural skills by providing opportunities for deliberate practice in safe, controlled environments. We developed and evaluated the effectiveness of a simulation-based TCCC training intervention to improve participants' skill performance and self-confidence in tourniquet placement. METHODS: This study was a single-blinded, randomized trial with waitlist controls. Army Reserve Officers Training Corp cadets from a single training battalion comprised the study population. After randomization and baseline assessment of all participants, group A alone received focused, simulation-based TCCC tourniquet application training. Three months later, all participants underwent repeat testing, and after crossover, the waitlist group B received the same intervention. Two months later, all cadets underwent a third/final assessment. The primary outcome was tourniquet placement proficiency assessed by total score achieved on a standardized eight-item skill checklist. A secondary outcome was self-confidence in tourniquet application skill as judged by participants' Likert scale ratings. RESULTS: Forty-three Army Reserve Officers Training Corp cadets completed the study protocol. Participants in both group A (n = 25) and group B (n = 18) demonstrated significantly higher performance from baseline to final assessment at 5 months and 2 months, respectively, following the intervention. Mean total checklist score of the entire study cohort increased significantly from 5.53 (SD = 2.00) at baseline to 7.56 (SD = 1.08) at time 3, a gain of 36.7% ( p < 0.001). Both groups rated their self-confidence in tourniquet placement significantly higher following the training. CONCLUSION: A simulation-based TCCC curriculum resulted in significant, consistent, and sustained improvement in participants' skill proficiency and self-confidence in tourniquet placement. Participants maintained these gains 2 months to 5 months after initial training. LEVEL OF EVIDENCE: Therapeutic/care management; Level II.

Data-driven readiness: A preliminary report on cataloging best practices in military civilian partnerships.

BACKGROUND: Between conflicts, many of the combat casualty care lessons learned are lost as the nation shifts priorities and providers leave the military. Solutions are needed to bridge the knowledge gap created by interwar periods. One of the foremost solutions is partnerships between civilian trauma centers and the military health system. Over the past two decades, a myriad of military-civilian partnerships (MCPs), which vary in their composition, duration, and focus, was created. The objective of this report is to describe the initial attempt of the Department of Defense to catalog existing MCPs to inform both civilian and military stakeholders. This initial catalog is intended as a reference to aid in future MCP development and facilitate the synchronization of efforts to improve trauma care delivery and readiness. METHODS: Using methodology from the Institute of Defense Analysis, the total number of eligible trauma centers in the United States was determined. The Institute of Defense Analysis determined eligibility-based American College of Surgeons Trauma Center verification or state trauma center designation. Each military service provided their list of MCPs, which were categorized. Military-civilian partnerships were cataloged by various characteristics and program components. Key variables include number and type of personnel trained, duration of training, and focus, for example, team versus individual focused and training versus maintaining proficiency focused. RESULTS: A total of 1,139 hospitals in the United States are potentially eligible for MCPs. There are at least 87 unique partnerships; the majority are part-time sustainment MCPs. The Air Force has the largest number of providers in MCPs. There are many challenges to maintain accurate and up to date data on MCPs. CONCLUSION: With the collated information, the Defense Health Agency, military services, special operations community, and civilian partners will be better empowered to optimize the readiness value of their programs and better prepare our military medical providers for the nation's and military's future needs.

Vitamin C supplementation reduces the odds of developing a common cold in Republic of Korea Army recruits: randomised controlled trial.

INTRODUCTION: The Republic of Korea (ROK) military has a high incidence of respiratory diseases at training centres. Vitamin C has been reported to reduce the incidence of colds. For the purpose of preventing soldiers' respiratory diseases, this study aimed to investigate whether vitamin C intake can prevent common colds in the ROK Army soldiers. METHODS: This was a randomised, placebo-controlled, and double-blind trial of soldiers who enlisted in the Korea Army Training Centre for 30 days from 12 February to 13 March 2018. The study participants were divided into groups (vitamin C vs placebo). The military medical records were searched to determine whether the participants had a common cold. Multiple logistic regression analysis was performed to identify the association between vitamin C intake and diagnosis of common colds. In addition, subgroup analysis on the relationship between vitamin C intake and common cold according to smoking status, training camp and physical rank was conducted. RESULTS: A total of 1444 participants were included in our study. Of these participants, 695 received vitamin C (6000 mg/day, vitamin C group), while 749 participants received placebo (0 mg/day, placebo group). The vitamin C group had a 0.80-fold lower risk of getting a common cold than did the placebo group. Subgroup analyses showed that this effect was stronger among subjects in camp A, among never smokers and among those in physical rank 3. CONCLUSION: Vitamin C intake provides evidence to suggest that reducing the common colds in Korean Army soldiers. Our results may serve as a basis for introducing military healthcare policies that can provide vitamin C supplementation for military personnel in basic military training.

AUDCRED: ferramenta de apoio para auditoria de contas em saúde / AUDCRED: support tool for auditing health accounts

Introdução: Uma das ferramentas de qualidade mais eficientes para monitorar um sistema de gestão é a auditoria, pois, quando bem aplicada, diagnostica não conformidades no serviço avaliado, sendo executada por profissionais capacitados que apresentam, além do conhecimento técnico-científico, atributos pessoais como imparcialidade, prudência e diplomacia. Objetivos: O objetivo geral do estudo foi desenvolver uma ferramenta móvel que possa servir de apoio para o processo de auditoria de contas médicas e os objetivos específicos foram: identificar os requisitos necessários para o desenvolvimento da ferramenta de auditoria; apresentar um protótipo e desenvolver uma ferramenta garantindo os requisitos de segurança necessários à manutenção da informação pessoal, possibilitando sua implementação, distribuição e modificação e avaliar o impacto da ferramenta para a auditoria em saúde no âmbito da Marinha do Brasil. Método: Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa, aplicado à produção tecnológica e destinado a desenvolver uma ferramenta informatizada móvel para apoio ao serviço de auditoria de contas médicas. Para desenvolvimento da ferramenta foi utilizada a metodologia de Pressman, seguindo as seguintes etapas: coleta e refinamento dos requisitos, elaboração de projeto rápido, construção do protótipo, avaliação pelo cliente e posterior refinamento quando há necessidade de ajustes finais do projeto, com o intuito de satisfazer da melhor forma as necessidades dos clientes. Resultados: Foram distribuídos 75 formulários para os auditores da Marinha e, tendo sido respondidos 65 (84,3%), observou-se que 40,9% dos entrevistados eram enfermeiros e 29% não tinham experiência em auditoria. As falas dos entrevistados foram analisadas, emergindo cinco categorias relacionadas a melhorias e uma a crítica, sendo estas respectivamente: ampliar o módulo para controle e previsão de custos; regular os serviços que serão prestados pela contratada; orientar profissionais a executarem a auditoria em saúde; ampliar módulo para que possam ser apresentados indicadores e relatório; disponibilizar mais informações sobre os credenciados e não entender o propósito da ferramenta. Conclusão: Acredita-se que a ferramenta irá contribuir para que os auditores recém-ingressos na Marinha possam executar o processo de auditoria de acordo com a técnica, gerando uniformidade, dando celeridade e, principalmente, evitando perdas para a organização. Dessa forma, favorecendo ao profissional mais habilidade e destreza em todo processo

Introduction: One of the most efficient quality tools to monitor a management system is the audit, because, when properly applied, it diagnoses non-conformities in the service evaluated, being performed by trained professionals who have, in addition to technical-scientific knowledge, personal attributes such as impartiality, prudence and diplomacy. The general objective of the study was to develop a mobile tool that can support the medical bills audit process and the specific. Objectives: The general objective of the study was to develop a mobile tool that can support the medical bill audit process and the specific objectives were: to identify the necessary requirements for the development of the audit tool; present a prototype and develop a tool ensuring the security requirements necessary for the maintenance of personal information, enabling its implementation, distribution and modification, and evaluating the impact of the tool for health auditing within the Brazilian Navy.Method: This is a descriptive, exploratory study with a qualitative approach applied to technological production, aimed at developing a mobile computerized tool to support the medical bill audit service. For development of the tool, Pressman's methodology was used, following the steps: collection and refinement of requirements, rapid design development, prototype construction, customer evaluation and further refinement when there is a need for final design adjustments, in order to satisfy the best way to meet the needs of customers. Results: 75 forms were distributed to the Navy auditors, with 65 (84.3%) answered, it was observed that 40.9% of respondents were nurses, 29.% had no experience in auditing. The speeches of the interviewees were analyzed emerging five categories related to improvements and one the criticism, respectively: expanding the module for cost control and forecasting; regulate the services that will be provided by the contractor; guide professionals to perform the health audit; expand module so that indicators and report can be presented; provide more information about the accredited and do not understand the purpose of the tool. Conclusion: It is believed that the tool will help auditors who have recently joined the Navy to perform the audit process according to the technique, generating uniformity, speeding up and, above all, avoiding losses for the organization. In this way, providing the professional with more skill and dexterity throughout the process

Predeployment training of Army medics assigned to prehospital settings.

BACKGROUND: Medics have numerous responsibilities in the combat theater, which include performing lifesaving interventions, providing basic medical and nursing care, and caring for casualties in a variety of scenarios unique to the battlefield. An evaluation of the medic predeployment training paradigm is important and will help to understand its current state and identify areas for improvement. Therefore, the purpose of this study was to perform a focused assessment of Army medic predeployment training to identify patterns that might inform future medic training. METHODS: A web-based survey was created using the Intelink.gov platform and sent by e-mail to Army medics who deployed since 2001. Medics were asked to reflect upon the predeployment training from their most recent deployment experience. There were multiple choice, Likert-type scale, and free-text response questions. Descriptive statistics were used to analyze the results. RESULTS: There were 254 respondents who met the study inclusion criteria. Most of the respondents had their clinical competency evaluated (68.5%, n = 174). Respondents reported several acute trauma, basic nursing, and battlefield medicine skills as being critical but also felt that many of these same skills would have benefited from additional predeployment training. Most of the respondents felt very or fully confident and prepared to provide combat casualty care (74.8%, n = 190 and 74.8%, n = 190). There were 64 respondents (25.2%) who reported feeling not at all, slightly, or moderately confident, and 54 (84.4%) of these respondents described in a free-text question wanting additional training before deployment. CONCLUSION: Respondents reported many skills as being critical to combat casualty care, but several of these skills would have benefited from additional predeployment training. Respondents with more deployment experience or completion of more predeployment training reported feeling more confident and prepared to provide combat casualty care. A common sentiment was the desire for more training of any form before deployment. LEVEL OF EVIDENCE: Epidemiological, level IV.

Reciprocal Learning Between Military and Civilian Surgeons: Past and Future Paths for Medical Innovation.

Numerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey Fellowship in the History of Medicine, we conducted archival research to shed light on the lessons that civilian surgery has learned from the military system and vice-versa. Several historical case studies highlight the need for immersive programs where surgeons from the military and civilian sectors can gain exposure to the techniques, expertise, and institutional knowledge the other domain provides. Our findings demonstrate the benefits and promise of structured programs to promote reciprocal learning between military and civilian surgery.

Evaluation of a fellowship abroad as part of the initial training of the French military surgeon.

INTRODUCTION: Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS: This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS: Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION: A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.