Devising a training programme and reviewing the lessons identified during contingency operations on board the Role 3 Maritime platform.

The deployment of the Primary Casualty Receiving Facility (PCRF) to Sierra Leone in October 2014 in support of Operation GRITROCK was a contingency operation that required a very specific training programme. This article discusses the training and how it evolved beyond its original remit into a programme used as a management tool to meet the needs of the staff. The result was the implementation of a comprehensive package from which lessons can be drawn and used when planning future operations.

[Medical Service of the Finnish Defence Forces].

Thee article is a brief description of the current state of the Finnish Defence Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Finland, the Finnish Defence Forces, and their medical service is presented. Then some particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical , service personnel income.

[Marine, aviation and space physician, psychologist and physiologist (To the 90th anniversary of the birth of G. M. Zarakovskii)].

In the current paper authors discuss problems of marine and aerospace medicine and psychophysiology, which Georgii Zarakovskii (1925-2014), a prominent domestic experts in the field of military medicine, psychology and ergonomics, solved. Authors focused on methodological approaches and results of the study of psychophysiological characteristics and human capabilities took into account for design of tools and organization of flight crews, astronauts and military experts. Authors marked the contribution to the creation of a system integrating psychophysiological features and characteristics of the person neccessary for development, testing and maintenance of aerospace engineering and organization of its professional activities. The possibilities of using the methodology of psychophysiological activity analysis in order to improve the reliability of psychophysiological military specialists, are shown.

The new NEMOs--changes to initial medical officer training.

It is desirable that a Royal Navy Medical Officer is not only medically competent but also a proficient Naval Officer with an ethos common to all Officers, irrespective of specialty or branch. In 2012 Britannia Royal Naval College (BRNC), in conjunction with the Institute of Naval Medicine (INM), modified the New Entry Medical Officer (NEMO) training course to comprise an initial phase at BRNC (15 weeks) followed by a second phase at INM (16 weeks). This is in contrast to the traditional training delivered at INM and Fort Blockhouse prior to joining BRNC for 7 weeks. The following article is a reflection of this experience.

[The head of the medical service must be the person...(To the 70th anniversary of N.G. Ryzhman)].

The article is devoted to contribution of major general (rear Admiral. - navy) of medical service Nikolay Grigoryevich Ryzhman (1944-2005), the chief of the medical service of the Northern fleet (1991-1999), to development of naval medicine, who would have turn 70 years this September. The constant analysis, and experience generalization of the medical services of the fleet connections and associations and aspiration to provide fighting capacity for the fleet crew - were a keynote of Ryzhman's activity concerned development and deployment of the new forms and methods of medical support and searching of ways to increase crew efficiency. The implemented methods and forms of organization of the medical support and scientific development of the medical support are used even now in the practical activities of the medical service of the Northern fleet.

[Shestov V I--the founder of the Department of Organisation and tactics of the naval medical services].

Vasilii Ivanovich Shestov during the Great Patriotic War performed various tasks concerning the organization of medical support in the Leningrad naval base, consulted on an issue of production and use of hospital and medical transport ships, worked on the organization of medical support in Schliessburg and etc. Shestov performed a considerable amount of research and methodological works concerning the establishment of the discipline "Organisation of naval medical support". He is considered as one of the founders of the theory of naval medical evacuation support.

Lessons from the battlefield: human factors in defence anaesthesia.

Anaesthetists in the Defence Medical Services spend most of their clinical time in the National Health Service and deploy on military operations every 6-18 months. The deployed operational environment has a number of key differences particularly as there is more severe trauma than an average UK hospital and injury patterns are mainly due to blast or ballistics. Equipment may also be unfamiliar and there is an expectation to be conversant with specific standard operating procedures. Anaesthetists must be ready to arrive and work in an established team and effective non-technical skills (or human factors) are important to ensure success. This article looks at some of the ways that the Department of Military Anaesthesia, Pain and Critical Care prepares Defence Anaesthetists to work in the deployed environment and focuses on the importance of human factors. This includes current work in the field hospital in Afghanistan and also preparing to work for the Royal Air Force and Royal Navy. We highlight the importance of human factors with reference to the type of case mix seen in the field hospital. We also detail the current pre-deployment training package, which employs multiple educational tools including high-fidelity simulation.

[Psychopathology service on ships]. / Psychopatologia sluzby na okretach.

The aim of this study was to describe the specific engineering services and suitability of candidates for the psychophysical performance. Navy ships are equipped with equipment and weapons are controlled by electronic devices ship and crew. Advanced technology puts high demands on operator. For the ship's staff are recruited soldiers of the psychophysical characteristics predisposing to this kind of action. The paper uses personal experience to work in military units of the Navy, and data from the literature. Terms of sailing ships off the summer season are defined as difficult. The crew during a combat mission felt the risks associated with movements of the ship in difficult meteorological conditions, and associated with the implementation of the task. The development of ship's technical equipment, working in isolated groups, functioning within a limited space, noise, vibration, electromagnetic waves heighten the emotional burden on crew members. Military service on Navy ships require high psycho-physical predisposition, resistance to stress. The crucial factor is proper selection among the candidates based on psychiatric and psychological counseling for military and medical jurisprudence. Also plays a significant role for training doctors and specialists in psychoprophylaxy of military units in the field of mental hygiene.

"SAR-First-Responder Sea" - backgrounds to a medical education concept in German SAR service.

We present backgrounds to a medical education concept for the full-time rescue men on the vessels of the German Maritime Search and Rescue Service (DGzRS, English: GSRS). In contrast to land-bound emergency services, the daily work spectrum of the GSRS rescue men is mainly characterised by technical assistance for sea-going ships, and searching procedures but not medical emergencies. Nevertheless, severe medical exigencies might occur aboard sea-going ships, with immediate need of professional medical treatment. Thus, a professional medical training course adapted to the needs and costs of maritime search and rescue procedures at German Coasts was set up and has now been unveiled.

[Prophylaxis of chemical poisoning in the Army and Navy].

Prophylaxis of chemical poisoning in the Army and Navy assumes carrying out of a complex of measures, directed on saving of life, health and military professional serviceability of staff in conditions of action of factors of chemical character in peaceful and war time. It requires from the medical staff effectuating special sanitary and preventive measures, including realization of the effective medical control over working conditions of soldiers and civilian personnel on objects, where toxic chemical substances are used, propagation of medical and hygienic knowledge, regular increase of knowledge level and practical skills of military doctors.

Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons.

OBJECTIVE: Newly-graduated military general surgeons often find themselves isolated at sea, solely responsible for all surgical care of several thousand sailors, regardless of the surgical specialty training required for any individual procedure. This educational need assessment explored trends in afloat surgical care over the last 25 years, and assessed trainees' preparedness for their expected role as an isolated surgeon. DESIGN: A sample of deidentified US Navy Ship's Surgeon case logs were reviewed to determine afloat case load trends in 5 common afloat case categories (urologic/gynecologic, anorectal, hernia, appendectomy, and hand/orthopedic/trauma) from 1990s to 2017. Individual procedures were mapped to American College of Surgeons/Military Health System Knowledge, Skills, and Attitudes line items to ensure afloat-relevant skills were identified. Recent military resident case logs were then compared with afloat cases to evaluate relevant trainee experience. SETTING: US Navy ships at sea from 1995 to 2017. PARTICIPANTS: US Navy afloat-deployed surgeons, totaling 1340 cases within the study period. RESULTS: Case log analysis of 1340 surgeries, comprising >200 months at sea, reflected 46 named procedures; 34 of 46 (74%) correlated to an intraoperative knowledge, skills, and attitudes item. The most common surgeries were vasectomy, (304 of 1340, 23%). No difference in case mix was apparent comparing pre- and post-2000 deployments (representing afloat laparoscopic integration) in 4 of 5 categories, while hernias proportionally declined. Case volume per deployment markedly declined overall (p < 0.001) and in each category. Resident case log analysis from 2012 to 2016 showed experience was limited in urologic/gynecologic, orthopedic, and open appendectomy categories. CONCLUSIONS: No formal case repository exists for afloat surgery, making detailed analysis problematic. Current training provides excellent surgical education but minimal exposure to rare-but-real cases expected on deployments, which may not translate to competency for the isolated, afloat surgeon. Military surgical leadership should embrace training for these cases and assertively invest in the development of the military's newest surgeons.

Training needs among maritime professionals: a cross sectional study.

BACKGROUND: Maritime medical practice includes assessment of fitness, management of medical emergencies and healthcare on board and ashore. A better response to seagoing professionals' health requirements can be achieved when all the respective stakeholders have a common understanding. Training is a powerful tool to raise awareness and in particular continuing professional development is very significant in sustaining competencies of these professionals. The objective of the study was to identify maritime professionals' perceived training needs. MATERIALS AND METHODS: A cross-sectional study was conducted among maritime professionals participated in the 14th International Symposium on Maritime Health. Fifty responses with the response rate of 42.7% were received with medical doctors representing 78% of the sample. Descriptive statistics were used to describe the basic characteristics of the data needs using STATA 15.1. RESULTS: Among the 23 themes, the ranking of perceived training needs was highest for fitness evaluation and examination guidelines and working conditions (both with the same percentage 86%), onboard medicine 82%, rules and regulations and health and safety at work (with the same percentage 80%). The lowest was on gender issues 32%. CONCLUSIONS: The finding suggests the planning and effective implementation of further training for the maritime health professionals in a variety of topics including financing and management issues. Highest importance of training was expressed by those over 40 years and by medical doctors with more than 10 years of practice. These findings could usefully be combined with a qualitative study to gain in-depth results and may help the respective authorities to organise relevant training.

Health promotion in the maritime work environment--training of leaders.

The essence of the project of pro-health attitudes promotion is the assumption that they contribute to a successful occupational career and reduce health and life hazards in the maritime work environment. The method chosen was to train students of the Maritime Academy in Gdynia, the future officers and potential health leaders among maritime employees.

A cost analysis of training expenses versus the value of medical care provided during West Africa Training Cruise 2004: Senegal.

A medical civic assistance program (MEDCAP) visit was conducted by naval reservists in eight villages in Senegal, West Africa. More than 6,000 patients were treated by MEDCAP team members. Medical and dental care, eyeglasses, vitamins, medications, educational material, and mass casualty training were provided. Major challenges confronting the mission were to provide care in makeshift clinics in remote villages in an arduous sub-Saharan climate, where more than one-half of the population lacks adequate public health funding to address basic medical and dental needs. To estimate the economic costs and benefits of the mission, as a guide to future planning, we calculated the total costs of the mission and its economic benefits. Total costs were found to be $502,500. We estimated that the monetary value of the medical services provided was $730,090. Additional nonquantifiable value was created through training and development of military and professional partnerships. In a post-September 11 world, the MEDCAP is an important and cost-effective vehicle to advance U.S. foreign policy in a nonthreatening manner. Countless lasting friendships can be won with bandages and medicines.

Exercise Maganga Mercury 23 January-10 February 2006.

It is very likely that Royal Navy doctors will be called upon more and more in the future to work on similar overseas exercises. I found the experience immensely challenging and educational and would have no hesitation in volunteering for further deployments or recommending other RN doctors to do the same.

Might telesonography be a new useful diagnostic tool aboard merchant ships? A pilot study.

BACKGROUND: Developments of new, ultra-light diagnostic ultrasound systems (UTS) and modern satellite telecommunication networks are opening new potential applications for diagnostic sonography. One such area is maritime medicine. It is our belief that ship officers can be trained to use diagnostic ultrasound systems with the aim to generate ultrasound images of sufficient quality to be interpreted by medical professionals qualified to read sonograms. METHODS: To test our thesis we included lectures and hands on scanning practice to the current maritime medicine curriculum at the Faculty of Maritime Studies at the University of Rijeka. Following the didactic and practical training all participating students examined several patients, some with pathology some without. Images obtained by students were then submitted for interpretation to a qualified physician (specialist of general surgery trained in UTS) who was unaware of the patient's pathology. RESULTS: In total, 37 students performed 37 examinations and made 45 ultrasound images, on 3 patients. In this paper, results on this pilot study are presented. CONCLUSION: It is possible to teach ship officers to produce diagnostically usable ultrasound pictures aboard ships at sea. But before reaching final conclusion about applicability of telesonography on board merchant ships, further studies are necessary, that would include studies of economic feasibility, and on validity of introducing such a diagnostic tool to the maritime medical practice.

Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma.

To mitigate medical risks in remote environments, the authors have implemented an innovative integrated medical support solution for bleeding management on board ships since 2013. Fresh whole blood transfusion (FWBT) and lyophilised plasma were put in place to address life threatening haemorrhages in maritime operations in the Arctic and Antarctica. The authors are illustrating the bleeding risks with an actual case occurring in Antarctica prior to the implementation of these procedures. They are presenting the different steps involved in the complex process of FWBT, from blood donors' qualifications to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including the training of health care professionals, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks.

Critical care retrieval revisited.

In 2000, the Journal of the Royal Naval Medical Service published an account of critical care retrieval experience written by Adrian Mellor and based on his time spent with CareFlight in Sydney, Australia. Having recently completed a term with the same organisation, I wanted to reiterate the usefulness of such an attachment. The purpose of this article is therefore to compare my experiences with those of Surgeon Commander Mellor and to provide an update on the work involved in critical care retrieval within New South Wales.