Maintaining Surgical Readiness While Deployed to Low-Volume Military Treatment Facilities: A Pilot Program for Clinical and Operational Sustainment Training in the Deployed Environment.

INTRODUCTION: Maintaining readiness among Army surgeons is increasingly challenging because of declining operative experience during certain deployments. Novel solutions should be considered. MATERIALS AND METHODS: A pilot program was conducted to rotate surgical teams from a military treatment facility with a low volume of combat casualty care to one with a higher volume. Pre- and postrotation surveys were conducted to measure relative operative experience, trauma experience, and perceived readiness among rotators. RESULTS: Operative volumes and trauma volumes were increased and that perceived readiness among rotators, especially those with the fewest previous deployments, was improved. CONCLUSIONS: Maintaining readiness among Army surgeons is a difficult task, but a combination of increased trauma care while in garrison, as well as increased humanitarian care during deployments, may be helpful. Additionally, rotating providers from facilities caring for few combat casualties to facilities caring for more combat casualties may also be feasible, safe, and helpful.

Balancing Patient Care and Force Protection at Military Medical Treatment Facilities.

OBJECTIVES: This study aimed to identify delays of care due to base access security protocols at a stateside military medical treatment facility (MTF) for patients with a time-sensitive medical condition who are seeking emergency medical care at the MTF. METHODS: We retrospectively analyzed emergency medical services (EMS) run reports from January 1, 2017 to November 12, 2017 to hospital access points to assess patients who were initially denied access to the MTF. Time from EMS activation until patient delivery at the emergency department, number of time-sensitive complaints, number of time-sensitive conditions, and number of unauthorized access attempts are reported. RESULTS: During the 11-month period of review, 42 delays of care related to EMS activation by the sentry at hospital access points were identified. Of the 42, 14 were associated with a time-sensitive complaint, 2 with time-sensitive conditions, and none were unauthorized access attempts. CONCLUSION: We identify the potential for patient harm due to delays in care resulting from the security protocols at our MTF. A review of force protection requirements with consideration for their impact on patient safety, especially in cases of time-sensitive conditions, has been conducted.

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.

A New Approach to Organization and Implementation of Military Medical Treatment in Response to Military Reform and Modern Warfare in the Chinese Army.

BACKGROUND: Recent system reforms within the People's Liberation Army (PLA) have led to establishment of 5 theatre commands and a general joint logistics command. These reforms have presented new challenges to the organization and implementation of medical services. The medical service of the PLA must keep pace with these reforms by applying innovative theories to establish appropriate organizational guidelines and structures. The medical service must also adapt to the modern and future eras of information warfare. METHODS: We review the existing structure and features of the military medical service of the PLA, highlighting issues related to ongoing reform within the PLA and the characteristics of modern and future information warfare. Reflection on current rules for medical evacuation and treatment of war-related injuries were made, and related organizational and structural innovations were proposed. FINDINGS: Recent reforms and the characteristics of modern information warfare have rendered the current medical service and medical evacuation system of the PLA inefficient. The scale of the echelon configuration should be adjusted to establish a more focused, effective, and intelligent medical service. Resource allocation and general joint logistics should be optimized to establish a new well-rounded, three-dimensional medical evacuation system, and the "stabilize before healing" rule should be applied at all levels of the medical service. These changes should help to create a modern, effective, and responsive medical service within the PLA. DISCUSSION: This article explores how the military medical service of the PLA could adapt to system reform in order to implement efficient treatment of war injuries, reduce mortality and morbidity rates, and maintain combat readiness in the modern era of information warfare.

Being Prepared for the Next Conflict: A Case Analysis of a Military Level I Trauma Center.

BACKGROUND: As we transition to an interwar period, combat-related injuries are at their lowest levels in over a decade, yet we must continue to maintain our surgical skills and train new surgeons. During the recent wars, the importance of the treatment and care for amputations and complex extremity injuries became apparent. This study compares the number of these procedures performed during the treatment of civilian and military orthopaedic trauma patients at a Department of Defense Level I trauma center over the past 9 years. The need to evaluate this unique system is further highlighted by the recent recommendation from the National Academies of Sciences, Engineering, and Medicine's to combine civilian and military trauma systems. METHODS: Data derived through a retrospective review of electronic health records were charted and evaluated for statistically unique periods. RESULTS: There were significant fluctuations in the number of procedures performed within the military cohort, with peaks centered around 2007 and 2011-2012, whereas the number of civilian cases remained relatively steady. On average, the civilian cohort also produced a more consistent and greater number of tibia fractures than the military cohort. For the past 3 years, the civilian cohort has produced 22 more tibia fractures per quarter than the military cohort. Furthermore, although type III open tibia fractures were the most common classification within the military cohort, the civilian cohort provided comparable numbers of type III open fractures despite only being the second most common fracture classification in the civilian cohort. In fact, the civilian volume outpaced the military cohort the past 3 years in this metric. More importantly, the military cohort produced 6 type III fractures in 2013, and 3 in 2014, whereas the civilian cohort produced 14 and 25, respectively, during those years. DISCUSSION/IMPACT/RECOMMENDATIONS: Fluctuations in the military cohort's data mirrors surges in operational activity, whereas the civilian cohort demonstrates a higher and more predictable number of tibia fractures; with reliability and numbers being important factors in training new surgeons and maintaining surgical skills. Although this study focused on specific orthopaedic trauma cases deemed essential to combat casualty care, it highlights the universal reality facing U.S. Military Medicine: as combat trauma continues to decline, military medicine as a whole will have to look elsewhere for critical trauma experience. This study confirmed military case volumes fluctuate with operational demands and evaluated one method of supplementing the declining combat trauma volumes with a local civilian trauma mission. This indicates not only the need for a system that is able to quickly adapt to the increased patient load, but also depicts how little reliability there is within the system in terms of perpetuating physician experience when the civilian trauma mission is not considered.

A Tobacco-Free Medical Campus Policy is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation.

INTRODUCTION: Tobacco control is an ongoing concern for the U.S. Army. Although tobacco use is currently prohibited within all military hospitals and clinics, known as military treatment facilities (MTFs), no such facility had implemented a tobacco-free medical campus (TFMC) policy before 2012. This evaluation examined the effects of one Army installation's TFMC policy implementation at its medical facilities. MATERIALS AND METHODS: Online questionnaires were distributed to medical campus employees, including Active Duty Soldiers, civilians, and contractors, before policy implementation (N = 1,210) and 12 months following policy implementation (N = 1,147). Chi-square analyses, independent t tests, and logistic regression models were utilized to examine pretest/post-test changes in employees' secondhand smoke (SHS) exposure; tobacco use, motivation to quit, and cessation; and health outcomes. Twenty-three focus groups, interviews, and informal discussions with 65 employees and patients were conducted 13 months after initial policy implementation to capture both the intended and unintended policy effects. RESULTS: After controlling for demographic characteristics, the study found that employees had more than twice the odds of exposure to SHS in the workplace at baseline than at 12-month follow-up (odds ratio: 2.06, 95% confidence interval: 1.73-2.46, p < 0.001). Employees also reported a lower prevalence of diagnosis with chronic bronchitis (p < 0.05) at follow up compared to baseline. Although the mean number of sick days taken for respiratory illness decreased over time, results were not significant after controlling for demographic factors. No significant differences existed in tobacco-use prevalence or quit rates among tobacco users over time. Employees reported significantly higher levels of satisfaction with a TFMC policy than the original policy (p < 0.001) though this finding was moderated by smoker status such that smokers reported lower levels of satisfaction with the policy over time. Qualitative findings revealed that the most common policy effect was that the policy caused smokers to change the location of where they used tobacco to off campus. Findings further revealed several unintended policy effects, including safety concerns and greater visibility of smokers in front of the MTF. CONCLUSION: The first Army MTF TFMC policy was associated with reported reductions in SHS exposure and improvements in some short-term health outcomes. The policy had no observed association with tobacco-use prevalence, motivation to quit, or cessation at 12-month follow-up. Focus group participants discussed several positive and negative policy effects. These policies should be expanded and studied in more depth across military installations, and policy makers should plan mitigation strategies to reduce unintended effects. This is an important step in military tobacco control, but additional efforts will be necessary to curb tobacco use within this population.

Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

BACKGROUND: Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90. Transfers from role 2 facilities were excluded. Data captured included demographics, admission vital signs, laboratory values, blood products, and mortality. Relationships between admission physiology, blood product utilization, and mortality were developed. Independent associations between variables were determined by logistic regression analysis. RESULTS: 1,703 patients were identified who met our inclusion criteria and composite mortality was 23%. Mortality in those receiving a balanced transfusion ratio was 18% versus 27% (p < 0.0001). Hypotensive casualties who survived were significantly more likely to have a higher presenting Glasgow Coma Score (GCS), temperature, SBP, shock index, and pH. In addition, this group was also more likely to have a lower international normalized ratio, pCO2, and base deficit (p < 0.001). Age, heart rate, and pulse pressure were not significantly different between groups. Independent predictors of mortality included Injury Severity Score, presentation GCS, and initial pH value (p < 0.0001). In contrast, independent predictors of survival included those with above-knee amputation and a balanced transfusion (p < 0.0001). CONCLUSIONS: Combat casualties hypotensive on arrival to surgical facilities have a significant expected mortality. Those receiving balanced transfusions demonstrated improved survival. Of the five independent risk factors, pH, GCS, and the presence of above-knee amputation are typically available during initial evaluation. These factors may be helpful in determining resource allocation and mortality risk, especially in triage or mass casualty settings.

An Orthopedic Performance Improvement Initiative at a Small Military Treatment Facility.

OBJECTIVES: The scientific literature demonstrates a cost-benefit associated with early access to physical therapy. The purpose of this case study is to report the results of an orthopedic performance improvement initiative (OPII) at a small military treatment facility (approximately 4.5K active duty beneficiaries). The OPII was introduced to (1) limit variation by ensuring that all active duty orthopedic consults were audited ensuring proper timing of appropriate services and (2) establish contractual agreement for shared resources with the U.S. Naval Jacksonville Orthopedic Department. METHODS: OPII was accomplished through consensus development and strong leadership support. All orthopedic referrals (n = 260) were audited for 6 months. Appropriate recommendations were provided to either continue with orthopedic care or to redirect to a physical therapy first approach. RESULTS: Orthopedic referrals decreased 27% with concomitant 32% increase in physical therapy referrals producing overall savings of $462K (33%). Meanwhile, surgical throughput improved 45%. Seventy percent of the savings were attributed to improved utilization translating to a relative value unit savings per beneficiary of $17.64 (23.7%). CONCLUSION: Our results support the value of a conservative physical therapy first approach for musculoskeletal conditions and shared mil-to-mil resourcing agreements. Success requires an iterative audit/feedback process balanced with stakeholder consensus.

Establishing a Joint Theater Trauma System During Phase Zero Operations.

OBJECTIVES: Military personnel risk injury due to accidents, disasters, and military threats during Phase Zero "shaping" operations. Medical facilities must be poised to respond. METHODS: The U.S. Pacific Command (PACOM) Area of Responsibility (AOR) covers more than 50% of the earth's surface; relevant Clinical Practice Guidelines must include the maritime setting and extended evacuation periods. Military hospitals in the region are not connected by a defined Trauma System. There is variable adherence to trauma training requirements before assignment in this AOR. Demand for trauma care at any 1 location is low and trauma teams have little opportunity to maintain competency for high-risk/low-volume interventions. There is no documentation of total demand for trauma care in the AOR. Trauma care in PACOM is often deferred to civilian facilities. RESULTS: Core elements of a Joint Theater Trauma System (JTTS) as established during combat operations in U.S. Central Command are applicable during Phase Zero. A PACOM JTTS was established to address the region's readiness to respond to Phase Zero trauma as well as escalation of regional threats. Information technology coordination was a critical hurdle to overcome. CONCLUSION: PACOM lessons learned are applicable to other Geographic Combatant Commands developing a JTTS during Phase Zero operations.

[Medical support of the Armed Forces of the Russian Federation: the results of the activities and the main tasks for 2015].

Presented the directions of activity of the medical service in the past year, including improving the legal framework, the optimization of medical management software, improving combat and mobilization readiness of units of the army, the optimization of therapeutic and preventive activities, implementation of innovative technologies, increasing mobility of units and subunits, their level of equipping with modern samples of property, training of qualified personnel, intensify research and etc. Analyzed and formulated directions of development of military medicine in 2015, including improvement of combat and mobilization readiness of the management body, military and medical organizations and departments, improving the legal framework of the military health care, holding among the troops interventions for the prevention morbidity of personnel by pneumonia and meningitis, work with commanders at all levels to ensure the preservation and strengthening of health of servicemen, improving of the system of early and active detection of diseases in the military, providing a guaranteed level of care to all contingent Ministry of Defense, improving the quality and accessibility of sanatorium treatment, maintaining constant readiness of medical special forces to carry out tasks for the purpose, improvement of professional training of personnel of the medical service, providing qualitative preparation of government medical service to participate in the training of troops, implementation of unexpected problems, equipping of army medical service with modern medical equipment finishing of the construction and renovation of military medical organizations facilities, improvement of social protection of personnel and many others.

Wartime paediatric extremity injuries: experience from the Kabul International Airport Combat support hospital.

Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. Paediatric patients were defined as those younger than 16 years old. Of the 220 injured children operated on, 155 (70%) sustained an extremity injury and were included. The mean age of the children was 9.1 ± 3.8 years. Among these children, 77 sustained combat-related injuries (CRIs) and 78 sustained noncombat-related injuries (NCRIs), with a total of 212 extremities injuries analysed. All CRIs were open injuries, whereas NCRIs were dominated by blunt injuries. Multiple extremities injuries and associated injuries were significantly more frequent in children with CRIs, whose median Injury Severity Score was higher than those with NCRIs. Debridement and irrigation was significantly predominant in the CRIs group, as well as internal fracture fixation in the NCRIs group. There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma.

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis.

Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p < 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p < 0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers.

[The past and future of surgical clinics of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military medical academy].

A brief 140-years history of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military Medical Academy is presented. Today the department of military surgery, integrated into the system of emergency medical care, locates in historical building of the Kirov Military Medical Academy, and considered as part of multi-field regional center for the treatment of severe combined injuries, and is the only one injury care center of the first level in the Ministry of Defence of the Russian Federation. The hospital admits on treatment more that one million of severe injured patients annually; many patients with severe injuries are transferred from other regional hospitals. Every year more than two thousands of surgical interventions are performed in the hospital. Next renovation of the building is planned in the near future; it should provide further development of new medical technologies in the Kirov Military Medical Academy.

[The Russian Armed Forces Military Medical Service: condition and ways of improvement].

In 2013 the main efforts of the Medical Service were aimed at the following tasks: optimization of management system of military medical service, improvement of medical evacuation system, medical service security for military contingents, assigned according to territory principle to military-medical facilities of the Ministry of Defence of the Russian Federation, implementation of innovations at all stages of medical evacuation in peace- and wartime, security of combat and mobilization readiness of regulatory bodies of the Medical Service, medical military units and military medical facilities, medical service of troops battle training, improvement of material and technical resources, security of regular pharmacy and equipment supply, activation of research work in the Medical Service interests. Lines of military medicine development in 2014 are: transfer of treatment facilities that are not used by the Ministry of Defence into the Federal Biomedical Agency till the end of 2014, prevention of pneumonia and meningitis in military personnel, improvement of early diagnosis system, medical service for military contingents according to territory principle, improvement of diagnostic and treatment work in military-medical units and subunits and military-medical facilities by means of development of material and technical resources, monitor the implementation of innovative diagnostic and treatment technologies, completion of construction projects of central military hospitals and etc.

Adherence to published antimicrobial prophylaxis guidelines for wounded service members in the ongoing conflicts in Southwest Asia.

In 2008, a clinical practice guideline (CPG) was developed for the prevention of infections among military personnel with combat-related injuries. Our analysis expands on a prior 6-month evaluation and assesses CPG adherence with respect to antimicrobial prophylaxis for U.S. combat casualties medically evacuated to Landstuhl Regional Medical Center over a 1-year period (June 2009 through May 2010), with an eventual goal of continuously monitoring CPG adherence and measuring outcomes as a function of compliance. We classified adherence to the CPG as receipt of recommended antimicrobials within 48 hours of injury. A total of 1106 military personnel eligible for CPG assessment were identified and 74% received antimicrobial prophylaxis. Overall, CPG compliance within 48 hours of injury was 75%. Lack of antimicrobial prophylaxis contributed 2 to 22% to noncompliance varying by injury category, whereas receipt of antibiotics other than preferred was 11 to 30%. For extremity injuries, antimicrobial prophylaxis adherence was 60 to 83%, whereas it was 80% for closed injuries and 68% for penetrating abdominal injuries. Overall, the results of our analysis suggest an ongoing need to improve adherence, monitor CPG compliance, and assess effectiveness.

Mode of delivery trends by hospital type: an 18-year comparison of a military hospital with university and community hospitals.

OBJECTIVE: To determine the rate of mode of delivery over 18 years in a military teaching hospital as compared to university and community hospitals. METHODS: From January 1992 to December 2009, we retrospectively calculated yearly rates for mode of delivery from a military hospital, two university hospitals, a community hospital in South Carolina and all community hospitals in Arkansas. RESULTS: Over the 18-year period, 803,249 deliveries occurred from all hospitals. Overall the cesarean delivery rates have significantly increased across all practice models (22.7% + 0.9 versus 33.0% + 0.9, p = <0.001). The rate of increase has been greatest in university hospitals (21.8-37%) followed by community hospitals (26.7-32.9%) and the military hospital (19.6-29.2%). The rate of forceps-assisted deliveries has decreased dramatically across all practice models (11.6% + 1.3 versus 1.1% + 0.1, p = <0.001). The decline in forceps use was 6.4 to 1.1% in community hospital, 12.6 to 1.4% in university hospitals, and 15.7 to 0.9% in military hospitals. CONCLUSIONS: The overall cesarean delivery rate has increased in all practice models but less so in the military. Forceps deliveries have dramatically decreased overall especially in the military hospital.

Utility of musculoskeletal ultrasound in a Department of Defense rheumatology practice: a four-year retrospective experience.

OBJECTIVE: To analyze the utility of musculoskeletal ultrasound (MSUS) in a rheumatology department and characterize relevant clinical trends. METHODS: Electronic medical records of all patients (n = 503) requiring MSUS in our department from January 2007 to December 2011 were reviewed. Rheumatologists performed MSUS using MyLab 25 or MyLab 70 systems. Clinical data were collected, including age, sex, symptoms, joint(s) examined, MSUS findings, procedures, further radiologic studies, and additional specialty consults. Results were tabulated from 717 total MSUS encounters and each was categorized as a completed encounter or an incomplete encounter. All magnetic resonance imaging (MRI) reports that followed MSUS were examined for concurrence. Cumulative numbers of MSUS examinations and MRIs were totaled. The Medicare global national average cost for MRIs and potential savings were calculated. RESULTS: A total of 789 joint sites were examined by MSUS. There were 84 US-guided procedures. Overall, 158 specialty consults were generated. After MSUS, 55 additional radiologic studies were ordered. There were 613 (85.5%) primary completed MSUS encounters and 104 cases (14.5%) requiring further imaging studies or an orthopedic consultation. There was an increased use of MSUS and a concurrent decreased use of MRI in our department over 4 consecutive years. We calculated the total potential savings from our rheumatology service to the Department of Defense as approximately $27,937.80 to $38,047.20 over 4 years. CONCLUSION: MSUS has a positive impact in a rheumatology practice. MSUS augments the clinical examination, influences diagnosis and management, decreases reliance on other imaging modalities, and reduces health care costs.

[Development of coloproctology in the Vishnevsky Central Military Clinical Hospital N 3].

The authors show the development of colonoproctology in the Vishnevsky Central Military Clinical Hospital N 3. The authors chose and described diagnostic possibilities of the proctologic center: videoendoscopy, ultrasonic diagnosis, computing technologies, methods of anatomical verification. The authors gave a characteristic of patients and methods of treatment. Almost half of all patients are oncology patients. Over the last decade 6750 patients were treated in the proctologic center, 1484 of them suffered with primary bowel cancer. 56,7% of patients suffered with colon cancer, 43,3%--rectal cancer. Special attention is paid to the patients with combat trauma. During the military conflicts on the North Caucasus 659 servicemen were treated in the hospital, 72 of them--with gunshot wounds of the colon. The majority of patients had bullet wounds, 15%--mine-blast injuries. All patients were operated on during the early stages of evacuation. Depending on character and location of injury patients were operated on properly. 68% of 72 patients suffered colon injuries, 32%--rectal injuries. 6 patients died (8,3%). The authors came to conclusion that organization and results of diagnostic and treatment, scientific and educational activity show the successful functioning of integration production treatment of patients with colonic pathology. The further ways of development are designed.

[Prospective concepts of the military field therapy development].

The authors suggested the main problems solved by the military field therapy: development, scientific rationale, systematic improvement and practical application of the organizational form of first aid for the wounded in conditions of combat actions; research on the etiology, pathogenesis and clinical picture of states caused by effect of weapon of mass destruction (nuclear weapon, chemical weapon, etc); development of methods of diagnosis, prophylaxis and treatment of the abovementioned states; research of the pattern, clinical progression and treatment of somatization disorders in conditions of combat and casual activity of troops, analysis of morbidity among the troops and development of prophylaxis;formulation of military-medical questionnaire and development of the system of rehabilitation for the wounded. Searching for innovative methods for solving the problems of military field therapy is the current problem. Modern warfare changed the concept of delivery of health care, effectiveness of evacuative actions, training of medical personnel and medical maintaining. The authors came to conclusion that qualitative technology breakthrough in development of military medicine and military field therapy would not happen without strategic understanding and learning of prospect technologies.