Deployed ophthalmic workload in support of US and NATO operations in Afghanistan

PurposeThe extent and types of ophthalmic disease and non-battle injury (DNBI) seen by expeditionary ophthalmologists at deployed military medical treatment facilities have not previously been reported. We aim to characterise the extent and type of ophthalmic pathology including DNBI at a US military medical treatment facility in Afghanistan.MethodsWe conducted a retrospective non-interventional cohort study of all patients seen by ophthalmologists at Craig Joint Theater Hospital at Bagram Airfield (BAF), Afghanistan, between 1 October 2018 and 31 August 2019.ResultsThere were 281 patients seen in 540 separate encounters, of which 146 patients seen were active duty military stationed at BAF with DNBI, of a population at risk of 6000 personnel. Diagnoses managed included open and closed globe injury, bacterial and herpetic keratitis and retinal detachment, with the most common being dry eye, corneal abrasion/foreign body, blepharitis, chalazion and uveitis. Thirteen patients (5%) required aeromedical evacuation out of theatre and 39 patients were aeromedically transferred within theatre for assessment. Expert consensus estimated that 89 patients (36%) would be likely to require aeromedical evacuation out of theatre without ophthalmic input.ConclusionsThe rate of ophthalmic DNBI among deployed US, UK and coalition forces at BAF was 2.65% per year, of whom 97% were returned to duty (95% of all patients). We estimate that evacuation and loss to unit would increase from 5% to 36% without an ophthalmologist present. The low number of within-theatre aeromedical transfers suggests that the local presence of an ophthalmologist at a patient’s deployed medical treatment facility affects access to deployed ophthalmic care.

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Retrospective Assessment of the Efficacy of Modified Progressive Tinnitus Management Skills Education in a Military Medical Treatment Facility

Military Medicine ◽

10.1093/milmed/usz024 ◽

2019 ◽

Vol 184 (9-10) ◽

pp. e468-e473 ◽

Cited By ~ 1

Author(s):

LaGuinn P Sherlock ◽

Candice E Ortiz ◽

Georgina P Blasco ◽

Daniel I Brooks

Keyword(s):

Medical Treatment ◽

Outcome Measures ◽

Primary Outcome ◽

Secondary Outcome ◽

Published Data ◽

Treatment Facility ◽

Coping Ability ◽

Medical Treatment Facility ◽

Treatment Facilities ◽

Skills Education

Abstract Introduction The number-one service-connected disability is tinnitus. Tinnitus currently has no cure, but the functional impact of tinnitus has been shown to be mitigated by Progressive Tinnitus Management (PTM), a multi-level management approach. The duration of PTM Level 3 skills education (PTM-SE) and the inclusion of mental health providers have been identified as barriers to implementation of PTM-SE in Department of Defense (DOD) medical treatment facilities. The goal of this study was to determine if a version of PTM-SE modified for use in DOD medical treatment facilities resulted in positive changes in tinnitus-related outcomes. Materials and Methods A retrospective study was conducted by examining the medical records of patients who attended modified PTM-SE appointments. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The study sample included 130 patients who completed modified PTM-SE between January 2015 and June 2016. Primary outcome measures were tinnitus awareness and tinnitus annoyance; secondary outcome measures were effect on life and self-perceived coping ability. Outcome measures were analyzed with nonparametric statistics and logistic regression. Results Modified PTM-SE resulted in clinically significant improvements in the primary outcome measures (awareness, p < 0.0001; annoyance, p < 0.0001). The proportion of patients who indicated an improvement in coping with tinnitus was similar to other published data with similar modifications to PTM-SE. Conclusions The evidence supports the assumption that PTM is a flexible program of tinnitus management that even when modified to be suitable for use in a DOD medical treatment facility provides meaningful reductions in tinnitus awareness and annoyance and improves tinnitus coping ability among military beneficiaries. These findings should encourage audiologists to modify PTM to work within their military medical treatment facility.

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Understanding, Predicting, and Reducing Appointment No-Shows in a Military Medical Treatment Facility

10.21236/ada422554 ◽

2000 ◽

Author(s):

Andrew H. Bertrand

Keyword(s):

Medical Treatment ◽

Treatment Facility ◽

Medical Treatment Facility

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Analysis of Camp Pendleton California Medical Treatment Facility Budget and Execution Process

10.21236/ada493638 ◽

2008 ◽

Author(s):

Jr. Constantino ◽

Dominador D.

Keyword(s):

Medical Treatment ◽

Treatment Facility ◽

Medical Treatment Facility

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Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support

Military Medicine ◽

10.1093/milmed/usaa252 ◽

2020 ◽

Author(s):

John Breeze ◽

William G Gensheimer ◽

Joseph J DuBose

Keyword(s):

Medical Treatment ◽

Emergency Room ◽

Neck Region ◽

Neck Injuries ◽

Treatment Facility ◽

Medical Treatment Facility ◽

Trauma Registries ◽

Neck Wound ◽

Major Injury ◽

High Negative Predictive Value

ABSTRACT Introduction Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. Materials and Methods All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. Results During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Conclusion Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

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Analysis of cases managed by dermatological service in the Chinese peacekeeping level 1+ medical treatment facility in Lebanon, 2018–2019

BMJ Military Health ◽

10.1136/jramc-2019-001315 ◽

2020 ◽

pp. jramc-2019-001315

Author(s):

Xingwang Wang ◽

H Yang ◽

Yuqing Wang ◽

Jin Yuan ◽

Qinghua Yu

Keyword(s):

Medical Treatment ◽

Skin Diseases ◽

Acne Vulgaris ◽

Treatment Facility ◽

Medical Treatment Facility ◽

Common Category ◽

Medical Facilities ◽

Different Types ◽

Level 1 ◽

Basic Medical

IntroductionTo accomplish the peacekeeping mission in Lebanon, China has deployed a level 1+ (CHN L1+) medical treatment facility (MTF) as per the new memorandum. The aim of this study was to review and analyse the skin diseases managed by Chinese dermatological service so as to gain the latest prevalence of different types of skin diseases in this mission area.MethodsAll patients assessed and treated by the dermatological service of CHN L1+ MTF from January 2018 to May 2019 were included. A comparative analysis was made between this study and data published by other peacekeeping medical facilities.ResultsA total of 549 patients were included (87.4% men, with an average age of 35 years old), consisting of 399 military personnel and 150 civilians. Dermatitis and eczema (27.1%) were the most common category of skin diseases, followed by cutaneous mycoses (13.3%) and disorders of skin appendages (10.6%). Among these categories, unspecified dermatitis (9.3%), acne vulgaris (6.6%), tinea corporis (5.3%), folliculitis (5.1%) and tinea pedis (4.7%) were the top five most common reasons for dermatological consultation.ConclusionsTo get a clearer understanding of the disease-type profile in this mission area was beneficial for peacekeeping doctors to make more accurate diagnosis, as well as to prepare more comprehensive medicines during the predeployment period. As dermatological service was lacking in basic medical troops, we would recommend the use of telemedicine to promote dermatological consultations when a specialist was not deployed.

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Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001700 ◽

2021 ◽

pp. e001700

Author(s):

Sarah Godby ◽

R Dierst-Davies ◽

D Kogut ◽

L Degiorgi Winslow ◽

M M Truslow ◽

...

Keyword(s):

Military Personnel ◽

Healthcare Providers ◽

Secondary Analysis ◽

Health Agency ◽

Active Duty ◽

Tobacco Prevention ◽

Cigarette Use ◽

Us Military ◽

Active Duty Military ◽

Health Related

BackgroundElectronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel.MethodsA secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates.ResultsIn 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27).ConclusionThe results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.

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Strategic Orthopedic Evacuations to the Spanish Role 4 During a Decade (2009–2018)

Military Medicine ◽

10.1093/milmed/usz354 ◽

2019 ◽

Vol 185 (5-6) ◽

pp. e734-e741

Author(s):

Rafael García Cañas ◽

Ricardo Navarro Suay ◽

Carlos Rodríguez Moro ◽

Daniel Aedo Martín ◽

Rafael Tamburri Bariaín ◽

...

Keyword(s):

Medical Treatment ◽

Orthopedic Surgery ◽

Armed Forces ◽

Categorical Variables ◽

Medical Support ◽

Treatment Facility ◽

Research Committee ◽

Cross Sectional ◽

Medical Treatment Facility ◽

Lesion Pattern

Abstract Introduction Casualty evacuation is a key point in medical support to military operations, sometimes being necessary to transfer them to National Territory for a definitive diagnosis and treatment. The aim of this work is to analyze the patients evacuated from Areas of Operations to the Orthopedic Surgery and Traumatology Unit of the Spanish Role 4 Medical Treatment Facility in the last 10 years. Material and Methods A cross-sectional, descriptive, and retrospective study carried out in the period between January 1, 2009 and December 31, 2018. The study population was all personnel evacuated from the Area of Operations to Spanish Role 4. For categorical variables, absolute and relative percent frequencies were used. Spanish military authorization was obtained to perform this study. This study has been approved by the Ethics and Clinical Research Committee of the Defense Central Hospital “Gómez Ulla” (code 12/17). Results A total of 520 medical evacuations have been performed on Role 4, of which 227 were on the Orthopedic Surgery and Traumatology Unit. Seven percent of the evacuees were categorized as “combat” casualties. The areas of operations from which more patients have been evacuated were Afghanistan and Lebanon, 30.39% and 19.38%, respectively. The most frequent lesion pattern was the fracture affecting the extremities. Accidents (n = 98, 43.17%) and sport (n = 57; 25.3%) were the main causes of injury. Sixty-seven (29.51%) patients were treated surgically in Role 4. No deaths were recorded among patients in this series. Conclusion Evacuations because of trauma cause more than half of the medical repatriations carried out on the National Territory, of which the majority are due to fractures affecting the limbs, especially the bones of the hand. Sport was the first preventable cause of injury among evacuated patients. Our results are similar to the experience obtained by other allied armed forces. It is a moral imperative and a fundamental necessity for the Spanish military medical services to promote and maintain the Spanish Role 4 Medical Treatment Facility as an indispensable element in medical support for international missions.

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