Contact lens-related complications in austere conditions among military personnel: a systematic review.

INTRODUCTION: Military service personnel are required to deploy to austere environments where they are exposed to harsh conditions. Many service personnel continue to wear contact lenses when deployed as they are an effective alternative to spectacles by affording superior ergonomic functionality, although they are associated with significant complications. We aimed to explore the prevalence and type of contact lens-related complications among deployed service personnel worldwide. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed, Medline, CINAHL and EMBASE databases were searched for relevant articles published between 1950 and 2023. The keywords 'contact lens' and 'military' or 'army' or 'navy' or 'air force' and 'austere' or 'deployed' or 'adverse' were used. RESULTS: Five eligible articles were included. Excluded articles reported contact lens wear in the firm base, were not related to military personnel or did not involve the deployed setting. Major complications associated with contact lens wear included microbial keratitis and contact lens-related discomfort. Excluding case reports, the overall incidence of contact lens-related complications ranged from 0.35% to 25.4%. The three case reports included in this systematic review described Acanthamoeba keratitis, Nocardia keratitis and contact lens-related discomfort as significant complications. These case reports also detailed time to initial presentation and type of contact lens worn when complications were encountered. Types of deployed conditions service personnel were exposed to included desert, temperate and underwater environments. CONCLUSIONS: We highlight a scarcity of recent data regarding contact lens-related complications in the deployed setting. While contact lens-wearing service personnel are at risk of infectious keratitis and contact lens-related discomfort, we recommend good-quality data collection on contact lens wearing schedules and complication rates to steer guidance on contact lens wear in service personnel.

War and disaster are forcing a major rethink around mass casualty management.

Mass casualty events (MASCAL) do not follow the same rules as typical major incidents. In the West at least, the latter often occur in stable, networked trauma systems, whereas MASCAL are characterised by overwhelming numbers of patients, compounded by protracted scene and transport times, decompensated response systems and significant disruption to infrastructure, command and control.This paper describes the 8Ds approach being taken by the UK Defence Medical Services and the North Atlantic Treaty Organization Emergency Medicine Panel framework to approach MASCAL. The eight domains were derived from literature about management of casualties in the World Wars, and also from approaches taken by civilian health systems as they struggle to manage increasing demand. They are: distribute; decompress; delay; delegate; deliver faster and deliver better; dynamic levels of care; and de-escalate These domains will allow a structured approach to research and innovate around MASCAL, informing better guidelines for their management.

Use of supplemental oxygen in emergency patients: a systematic review and recommendations for military clinical practice.

INTRODUCTION: Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice. METHODS: A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use. RESULTS: Based on interpretation of the limited available evidence, five key recommendations are made: pulse oximetry should be continuous and initiated as early as possible; oxygen should be available to all trauma and medical patients in the forward operating environment; if peripheral oxygen saturations (SpO2) are greater than or equal to 92%, supplemental oxygen is not routinely required; if SpO2 is less than 92%, supplemental oxygen should be titrated to achieve an SpO2 of greater than 92%; and if flow rates of greater than 5 L/min are required, then urgent evacuation and critical care support should be requested. CONCLUSION: Oxygen is not universally required for all patients. Current guidelines aim to prevent hypoxia but with potentially conservative limits. Oxygen should be administered to maintain SpO2 at 92% or above. New areas for research, highlighted in this review, may provide a future approach for oxygen use from point of injury to definitive care.

Military Prehospital Emergency Care: defining and professionalising the levels of care provided along the Operational Patient Care Pathway.

The Defence Medical Services aims to provide gold standard care to ill and injured personnel in the deployed environment and its prehospital emergency care (PHEC) systems have been proven to save lives. The authors have set out to demonstrate, using existing literature, consensus and doctrine that the NHS Skills for Health framework can be reflected in military prehospital care and provides an existing model for defining the levels of care our providers can offer. In addition, we have demonstrated how these levels of care support the Operational Patient Care Pathway and add to the body of evidence for the use of specialist PHEC teams to allow the right patient to be transported on the right platform, with the right medical team, to the right place. These formalised levels allow military planners to consider the scope of practice, amount of training and appropriate equipment required to support deployed operations.

General Duties Medical Officer Role 1 remote supervision in the era of Army Contingency Operations.

The return to contingency after Operation HERRICK (2002-2014 Afghanistan conflict) has seen an emerging trend for small-scale rapidly developing expeditionary operations. The associated small, remote medical footprint for such operations, often within a coalition construct, reliant on host nation support is in direct conflict with the General Medical Council (GMC) guidelines for junior doctor supervision in an 'approved practice setting'. If a General Duties Medical Officer (GDMO) is nominated to support future operations, the provision of assured patient care and supervision within GMC guidelines, while ensuring career progression and ongoing education, may prove a challenge. Recently published British Army Policy aims to provide a framework to meet these challenges. The authors' first-hand experience in implementing this policy is explored further. The deployment of a remotely supervised GDMO, in line with British Army Policy, is both suitable and safe. This should assure quality medical care delivery during the era of Army Contingency Operations.

Patient Satisfaction: Receiving a copy of the GP letter following fracture or elective orthopaedic clinic.

Following orthopaedic/fracture clinics at our hospital, patients now receive a copy of the letter summarizing an outpatient consultation that is sent to their General Practitioner. We undertook a patient satisfaction questionnaire to determine if patients found this change in practice beneficial. Of the 83 patients who had received this letter, most patients had read the letter (96%) and understood the content (90%). 13% were worried after having read the content and 86% found it helpful. Of the 40 patients who did not receive a copy, 32 (80%) specified that they would wish to in the future. The results support the new practice although it could be improved by identifying those who do not wish to be included thereby reducing costs.