Disaster and Military Medicine

We describe ethical issues arising in the allocation of civilian medical resources during armed conflict. Three features are significant in the context of allocating scarce resources in armed conflicts: the distinction between continuous and binary medical resources; the risks of armed conflict itself, and the impact of cultural differences on cases of armed conflict. We use these factors to elicit a modified principle for allocating medical resources during armed conflict, using hemodialysis for patients with end-stage renal disease as a case study...

BACKGROUND: In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature...

BACKGROUND: Burns from white phosphorus are rare and remain a challenge for clinicians. White phosphorus burns are often associated with smaller surface areas and high morbidity rates. Classed as a chemical burn, white phosphorus is used for military purposes and within industry, for the manufacture of fireworks and agricultural products. CASE PRESENTATION: In this report, we discuss the case of a 40 years old female who sustained 2% Total Body Surface Area partial to full thickness burns from white phosphorus...

BACKGROUND: Disaster relief personnel tend to be exposed to excessive stress, which can be a cause of mental disorders. To prevent from mental disorders, frequent assessment of mental status is important. This pilot study aimed to examine feasibility of stress assessment using vocal affect display (VAD) indices as calculated by our proposed algorithms in a situation of comparison between different durations of stay in stricken area as disaster relief operation, which is an environment highly likely to induce stress...

BACKGROUND: The prevalence of medical symptoms in aviators has not been described in the medical literature. METHODS: An anonymous questionnaire was handed to all Israeli Air Force aviators who went through the routine yearly examination. Because only two women filled the questionnaire, we excluded them. The questionnaire contained a list of 49 symptoms and the aviators were asked to mark symptoms that were present in the last month before the examination as well as age, estimated weekly flying hours, military service status (reserve or career) and type of aircraft (jet-fighter, helicopter or transport)...

This brief update reviews the recent literature available on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the combat casualty care (CCC) environment. A number of changes need to be incorporated in the CCC guidelines: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hetastarch is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain tactical field care settings where this option might be feasible (FSC, GH) is discussed; (4) 1:1:1 damage control resuscitation (DCR) with plasma: packed red blood cells (PRBC): platelets is preferred to 1:1 DCR with plasma: PRBC when platelets are available; and (5) the 30-min wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure has been eliminated...

BACKGROUND: Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages...

BACKGROUND: The exposure to war scenes via screens, despite offering a degree of detachment, can be stressful for the operator. The aim of the current study is to examine the existence of anxiety, depression, and post traumatic stress disorder (PTSD) symptoms among unmanned aerial vehicle (UAV) Israeli operators. METHODS: Participants comprised 41 UAV operators (87.2% male), aged 22-38 (Mage = 26.05, SD = 3.54). Most (78.0%) reported having viewed battlefield scenes...

BACKGROUND: International social networking is eminent in medical practice, mainly in sharing knowledge and mutual inspiring and in social and professional bonding. Since 2006, the International Medical Course is taking place in Commander Branch at the Military Medicine Academy of the Medical Corps, Israeli Defense Forces; in which medical officers from other military forces are participating along with Israeli officers. One of the course's objectives is international networking. The purpose of this study was to assess the level of networking in the International Medical Course compared to others means of networking, and to examine which components in the course are the most important in networking formation...

BACKGROUND: The International Preparedness & Response to Emergencies & Disasters (IPRED) conferences are conducted bi-annually in order to share insights and lessons learned from diverse crises. The aim of the article is to bring the IPRED conferences into better professional attention and to share the main insights that were presented in IPRED IV, which was held in January 2016. MAIN BODY: The major lessons learned included: Planning, regional/global collaboration and public-private cooperation should be implemented in developing novel technologies...

BACKGROUND: This article reports the exploratory development and study efforts regarding the viability of a novel "going-in light" or "Going Light" medical component in support of US Army Pacific (USARPAC) Humanitarian Assistance/Disaster Relief (HA/DR) missions, namely, a BLU-MED® incremental modular equipment package along with a Rapid Deployment Medical Team (RDMT). The study was conducted to uncover a way for the U.S. Army to: (1) better medically support the greater U...

BACKGROUND: The combat role of the twenty-first century infantry soldier has changed and accordingly their boots should evolve to meet these new needs and maximize soldier performance. OBJECTIVE: To evaluate injuries and durability of the hot weather infantry boots (HWIB) in elite infantry training and assess the initial performance of newly designed Israeli infantry boots (NDIB). METHODS: In Phase 1, the durability of the HWIB during elite infantry training was evaluated at weeks 10, 19 and 64 in a cohort of 67 recruits...

Despite the comparatively few cases of Ebola Virus Disease (EVD) that arose outside of Sierra Leone, Guinea, and Liberia in 2014, public health response partners around the world developed a patchwork of plans and policies to monitor thousands of people exposed to EVD, quarantine suspected cases, isolate confirmed cases, and close borders to prevent further spread of the disease. Deeply affected countries such as Sierra Leone, Guinea, and Liberia, as well as less affected countries such as the United States, Canada, and Australia developed special guidance regarding isolation and quarantine measures for EVD...

BACKGROUND: Primary care medical officers (MOs) are expected to maintain self-education while serving in their units in order to maintain professional standards. With the rise of smartphone use in the Israel Defense Forces (IDF), the WhatsApp application can facilitate medical learning. To date, there has been no description of the use of this tool by MOs in a military setting. This paper aims to describe the pattern of use of a WhatsApp application group by IDF's MOs. METHODS: We collected all the information (textual and visual) uploaded to a WhatsApp group called "The Division's Physicians", originally established two years earlier, during a randomly selected sample month...

BACKGROUND: Paraoxonase-1, an organophosphorous-hydrolyzing enzyme, was shown to provide protection against organophosphates poisoning in vivo. In vitro findings suggest that the phytoalexin resveratrol can elevate paraoxonase-1 levels and thus may provide protection against organophosphate poisoning. This study was conducted to evaluate the effect of prolonged resveratrol intake on paraoxonase-1 levels in rats, and its role as a potential prophylactic treatment in organophosphate poisoning...

The following is a case study of the blizzard of October 2014, an Israeli rescue team, the Special Mental Health Team (SMHT) of the Israeli Defense Forces Medical Corps, was sent to the disaster area to rescue Israeli trekkers. The SMHT intervention was provided immediately following the traumatic events with the purpose of lowering stress-related symptoms, shortening recovery time and reducing post-traumatic stress disorder symptoms that could occur in the future. Forty Israeli trekkers were assessed by SMHT: 75 % (n = 30) had mild acute stress reaction (ASR) symptoms and 25 % (n = 10) had severe acute stress disorder (ASD) symptoms...

This article reviews the current epidemiology and clinical presentation of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection and describes the preparedness plan of several countries. The MERS-CoV was first reported in 2012 and has since infected more than 1600 patients in 26 countries, mostly in Saudi Arabia and the Middle East. The epidemiology of the infection is compatible with multiple introductions of the virus into humans from an animal reservoir, probably dromedary camels. The clinical presentation ranges from no symptoms to severe pneumonitis and respiratory failure...

Lassa fever, a zoonotic viral infection, is endemic in West Africa. The disease causes annual wide spread morbidity and mortality in Africa, and can be imported by travelers. Possible importation of Lassa fever and the potential for the use of Lassa virus as an agent of bioterrorism mandate clinicians in Israel and other countries to be vigilant and familiar with the basic characteristics of this disease. The article reviews the basis of this infection and the clinical management of patients with Lassa fever...

Toxins are hazardous biochemical compounds derived from bacteria, fungi, or plants. Some have mechanisms of action and physical properties that make them amenable for use as potential warfare agents. Currently, some toxins are classified as potential biological weapons, although they have several differences from classic living bio-terror pathogens and some similarities to manmade chemical warfare agents. This review focuses on category A and B bio-terror toxins recognized by the Centers for Disease Control and Prevention: Botulinum neurotoxin, staphylococcal enterotoxin B, Clostridium perfringens epsilon toxin, and ricin...

BACKGROUND: Optimizing performance of aviators while minimizing risks arising from the exposure to extreme environment, both external and internal, is one of the principles guiding the Israeli Air Force. Young cadets in particular are considered an "at risk" population due to the fact that they have no experience in flight in the first stages of training and are therefore subjects for investigation. METHODS: In this study, we investigated the cognitive performance of young cadet pilots across different hours of the day...