Surveillance of mental and behavioral health care utilization and use of telehealth, active component, U.S. Armed Forces, 1 January 2019-30 September 2020.

This analysis of population-level health care utilization data evaluates changes in monthly counts and rates of medical encounters for mental and behavioral health (MH/BH) conditions and the proportion of care delivered via telehealth among active component military members of the U.S. Armed Forces during the first 6 months (March-September 2020) of the COVID-19 pandemic. Comparisons are also made to the same time period in the previous year (2019). Telehealth usage increased during the early pandemic and was on average 25% higher during March-September 2020 as compared to the previous year. In contrast, MH/BH outpatient visit rates declined modestly between March and May 2020 before rebounding in June and remaining stable through September 2020. The number of bed days attributable to MH/BH conditions also declined during March and April 2020 and was on average 30% lower during March-September 2020 as compared to the same period in the prior year. Continued surveillance is warranted to track MH/BH health care utilization during the later months of the pandemic to ensure that sufficient resources continue to be directed towards MH/BH care to support the health and readiness of active component service members.

Augmented reality visualization tool for the future of tactical combat casualty care.

ABSTRACT: The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.

Accident prevention activity and accident experience in the Republic of Korea military.

INTRODUCTION: According to data released by the Korea National Statistical Office, the number of accidents has been decreasing since 2012. However, a considerable number of deaths related to safety accidents (23-46 deaths) are still reported annually. This study aimed to observe the correlation between accident prevention activities in the Republic of Korea (ROK) military and the incidence of safety accidents. METHODS: The study used data from the 2014-2015 Military Health Survey and included 13 618 responses (Army: 8414 (61.8%); Navy/Marine: 2262 (16.6%); Air Force: 2942 (21.6%)) from the ROK military personnel. Accident experiences and thoughts on accident prevention activities were self-reported. Multiple logistic regression analysis was used to examine the validity of accident prevention activity and accident experience. RESULTS: Of the 13 618 military personnel who responded, 12.0% reported experiencing safety accidents in the military and 1020 (7.5%) felt that accident prevention activities in the military were insufficient. On logistic regression analysis, we found a significant difference (insufficiency OR=1.56, CI 1.31 to 1.86). In particular, military personnel who belong to the Army and Navy were more likely to think that accident prevention activities were insufficient. In addition, military personnel who experienced falls/slips, crash, and laceration/puncture wound/amputation/penetrating wound accidents were more likely to think accident prevention activities were insufficient. CONCLUSIONS: Our study found that accident prevention activities in the military and accident experiences were related. It is necessary for the ROK Ministry of Defense, Army, Navy and Air Force headquarters to re-evaluate their accident prevention systems.

Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities.

Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.

Historic Firsts: Aeromedical Evacuation and the Transportation Isolation System.

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.

The implications of emerging technology on military human performance research priorities.

OBJECTIVES: To demonstrate the need for the military human performance research community to anticipate and evolve with the emergence of new and disruptive battlefield technologies that are changing the fundamental role of the human combatant. METHODS: An international team of military performance researchers drew on relevant literature and their individual national perspectives and experiences to provide an integrated forecast of research priorities and needs based on current trends. RESULTS: Rapid advances and convergence in fields such as robotics, information technology and artificial intelligence will continue to have a revolutionary impact on the battlefield of the future. The disruption associated with these technologies will most acutely be experienced by the human combatant at the tactical level, with increasing cognitive demands associated with the employment and use of new capabilities. New research priorities may include augmented performance of humans-machine teams, enhanced cognitive and immunological resilience based on exercise neurobiology findings, and psychophysiological stress tolerance developed in realistic but safe synthetic training environments. Solving these challenges will require interdisciplinary research teams that have the capacity to work across the physical, digital and biological boundaries whilst collaborating seamlessly with end-users, human combatants. New research methodologies taking full advantage of sensing technologies will be needed to provide rigorous, evidence-based data in real and near-real world environments. Longer term research goals involving biological manipulation will be shaped by moral, legal and ethical considerations and evolving concepts of what it means to be human. CONCLUSION: This paper outlines key recommendations to assist military human performance researchers to adapt their practice in order to match the increasing pace of military modernisation. By anticipating technological change and forecasting possible emerging technologies the military human performance research community can manoeuvre to prioritise research activities today in line with future needs and requirements.

Burn wound care of civilians in Sahel region by French military surgical teams: ethical challenges and future training requirements.

The primary mission of the French military surgical teams deployed in external operations in the Sahel is to provide support for combatants. However, many of their activities and of the limited human and material resources allocated to them are devoted to providing free medical assistance to the local population. The French military surgical teams are very often expected to take care of serious burns for the benefit of civil populations because of the absence of dedicated civilian medical structures. Surgical teams are faced with a necessary triage of patients to be taken care of because of the discrepancy between the high demand for care and the means at their disposal. But the triage can lead to ethical dilemmas when the values that come into play in the decision contradict each other or when they run up against the quota of available human and material resources, as well as the interests of the military institution. The challenge is then to become aware of these dilemmas in this particular context. A discussion of these ethical dilemmas would help carers to avoid developing fatalistic attitudes or developing chronic pathologies due to unresolved or unconscious predicaments. Solutions are proposed that place ethical reflection at the heart of the practices during external operations by the French surgical teams. The ethics of discussion must bring together all players in care management and also the military authorities, before, during and after the missions. Training programmes for ethical reflection would benefit surgical teams and help them approach and become aware of the dilemmas they will necessarily face.

Fellowship in Immediate Medical Care examination: applicability to the Defence Medical Services.

The Fellowship in Immediate Medical Care (FIMC) is the highest level of formal qualification available for pre-hospital practitioners, aiming to test the knowledge, technical and non-technical skills of those providing specialist Pre-Hospital Emergency Care (PHEC). The FIMC is a multiprofessional examination with the potential to support continuous quality improvement of the PHEC that the Defence Medical Services (DMS) can offer to our patients now and in the future. The aim of this article is to inform the readership about the evolution of the FIMC examination and its applicability to military clinicians (and their civilian counterparts). A secondary aim is to inform those who are preparing for the examination.

Medical services policy in respect of detainees: evolution and outstanding issues.

Alleged and confirmed abuse of civilians arrested or detained by the UK Armed Forces has been the subject of four formal enquiries, and all have used medical evidence and/or addressed medical issues. After the first three, robust policies were put in place to ensure that all those arrested had appropriate medical examinations and that healthcare personnel acted appropriately. However, by the time of the Second Gulf War, the training and medical processes had lapsed and were found to be a contributory factor in not preventing abuse. The fourth enquiry has endorsed most of the lapsed policies but is ambiguous in two areas-on medical certification of fitness for interrogation and the timing to the first medical examination. This article summarises the medical aspects of the four enquiries and discusses the two ambiguous areas, arguing that to diverge from the policies eventually put in place in Northern Ireland is a retrograde step. It also discusses how training put in place to avoid the very events which occurred in the Second Gulf was discontinued.

Norovirus gastroenteritis outbreaks in military units: a systematic review.

INTRODUCTION: Norovirus gastroenteritis is one of the most frequent causes of personnel unavailability in military units, being associated with significant morbidity and degradation of their operational effectiveness. The disease is usually mild but can be severe and life-threatening in young and healthy soldiers, who are prone to dehydration due to intensive daily activity. Despite its impact, the full extent of the norovirus gastroenteritis burden in military forces remains unclear. This systematic review aims to evaluate the impact and ascertain clinical and epidemiological features of norovirus outbreaks that have occurred in the military forces. METHODS: The systematic review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines and used three databases: PubMed, Scopus, and LILACs. Papers published up to 1 September 2019 were included without restrictions if they reported one or more outbreaks in the military forces on active duty, either on national territories or deployed overseas. RESULTS: A total of 343 papers were retrieved from the literature search. After inclusion/exclusion criteria a total of 39 eligible papers were considered. From 1988 (first reported outbreak in the military) to 2018 more than 101 norovirus outbreaks have been reported in the military, accounting for at least 24 332 cases. Secondary transmission was emphasised as the main route of norovirus transmission in the military forces, with eating outside the military setting an important route for the primary cases. CONCLUSIONS: The present review highlights that norovirus gastroenteritis has been a burden to military troops both in combat and on peacekeeping operations. Norovirus disease has been shown to exact a substantial toll on mission readiness and operational effectiveness. It is noteworthy that the impact of norovirus outbreaks among military units is underestimated because the literature review retrieved information from the armed forces from only nine countries.

MIlitary Combat Mental Health Framework.

This paper describes a framework for understanding military combat mental health based on the possible mental ill-health consequences of exposure to 'potential trauma events' for members of the armed forces and after their military service as veterans. It uses a life course approach that maps an individual's mental well-being against four 'states': fit, reacting, injured and ill. It then considers five categories of factors that influence the risk of mental illness from this exposure based on research evidence; prejoining vulnerability, resilience, precipitating, treatment and recovery. This framework offers a structure to debate current knowledge, inform policy and therapeutic interventions, provide education and to guide future research into the subject.

Reflecting on success in trauma research: experiences from the SGCNS and SIR studies.

The inclusion of British Service Personnel (SP) lacking capacity into research studies from the point of injury through to medium-term rehabilitation had not previously been undertaken until work to support operations in Afghanistan (2001-2014). The Surgeon General's Casualty Nutrition Study and the Steroids and Immunity from Injury through to Rehabilitation Study sought to address the nutrition, endocrine and immune responses in a military patient cohort. A fundamental part of research is to feedback to patients, their relatives and ward staff on data collection and outcomes, and how future research may be improved to better support both injured SP and trauma patients in the UK. This paper will provide an experiential view on the delivery, operations and infrastructure requirements that should be considered when developing military research at a role-3 facility, before, during and after a study.

Present and future of Spanish Military Telemedicine / Presente y futuro de la Telemedicina Militar Española. 25 años de la Unidad de Telemedicina en el Hospital Central de la Defensa «Gómez Ulla»

Telemedicine consists of the exchange of health information between healthcare professionals, and between healthcare professionals and patients, through the use of information and communications technologies (ICT). It is already considered an emerging technology in what is commonly called the «Productivity Plateau». It is also probably an exponential growth technology, in which the «trigger» for such growth will be a mixture of new technologies such as portable sensors/ wearables that detect multiple patient data (Blood Pressure, Heart Rate, Respiratory Rate, Glycaemia, Temperature, etc.), better communications (5G), augmented and mixed reality (augmented and virtual), artificial intelligence systems to improve diagnosis, etc. In Spain, Military Telemedicine is a pioneer in the field. The main mission is to provide remote health support to health professionals or military personnel deployed in Operations and remote or difficult-to-access locations. In 2021 the Spanish Telemedicine Unit at Central Defense Hospital «Gómez Ulla» will celebrate its 25Th anniversary. This article discusses the aforementioned aspects of telemedicine as an emerging technology and describes the current mission, organization and capabilities of Spanish military telemedicine, as well as its future

La Telemedicina consiste en el intercambio de información sanitaria entre profesionales sanitarios, o entre profesional sanitario y paciente, mediante el uso de las tecnologías de la información y comunicaciones (TIC). Se considera ya una tecnología emergente en el denominado «Plateau de productividad». Probablemente se trate de una tecnología de crecimiento exponencial, en la cual el «gatillo» para dicho crecimiento será una mezcla de diferentes tecnologías, como nuevos sensores portátiles que detecten múltiples datos de los pacientes (Tensión Arterial, Frecuencia cardiaca, Frecuencia respiratoria, Glucemia, Temperatura, etc), mejores comunicaciones (5G), realidad aumentada y mixta (aumentada y virtual), sistemas de inteligencia artificial para ayuda al diagnóstico, etc. En España, la Telemedicina Militar es pionera en este campo. Su misión fundamental es el apoyo y asesoramiento sanitario a distancia a personal sanitario y también no sanitario, tanto en Zona de Operaciones (ZO) como en situación de aislamiento y/o localización remota. En 2021 el Servicio de Telemedicina del Hospital Central de la Defensa «Gomez Ulla» celebrará su 25 aniversario. En el artículo se tratan los mencionados aspectos acerca de la Telemedicina como tecnología emergente y se describe la misión, organización y capacidades actuales de la Telemedicina Militar Española, así como sus perspectivas de futuro