Current Clinical Concepts: Heat Tolerance Testing

ABSTRACT Heat tolerance testing (HTT) has been developed to assess readiness for work or exercise in the heat based on thermoregulation during exertion. Although the Israeli Defense Force protocol has been the most widely utilized and referenced, other protocols and variables considered in the interpretation of the test are emerging. Therefore, the purpose of this “Current Clinical Concepts” manuscript is to summarize the role of HTT following an exertional heat stroke (EHS), assess the validity of HTT, and to provide a review of best practice recommendations to guide clinicians, coaches and researchers in the performance, interpretation, and future direction of HTT. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.

Study reveals “dark side” of training in Israeli Defense Force that instills conservative values at odds with more progressive organization

Purpose The study was inspired by previous research showing the importance of congruence between declared and actual content. But the authors said there was a dearth of research into incongruence between training content and values of an organization. Design/methodology/approach The study focused on a leadership skills development course in the Israel Defense Forces (IDF). The course was developed and delivered by military clergy. The initial purpose was to investigate the effectiveness of intra-organizational training for developing leadership skills. But qualitative analysis of the data revealed an incongruence between the declared content of the course – to develop leadership skills – and the actual content of the course – instilling conservative values. Findings The authors said that the military clergy in the IDF hold conservative views that are traditional and nationalist, whereas the formal values of the IDF are quite different. They are based on the values of democratic state and military professionalism. The authors say this incongruence “may be harmful and cause a long-term clash of values in the organisation”. Originality/value The authors said the most important contribution was to illuminate the potential “dark side” of training. Exposing the covert side of training can inspire scholars to search for more hidden in organizational HR routines, they said. Awareness of the potential “dark sides” should also lead to improvements in training, making it more effective in the short and long term. An important practical implication was that a “clash of values” might occur between traditional values and the organization’s formal values.

SARS-CoV-2 Epidemic in the Israeli Defense Force—Lessons Learned From Our rt-PCR Screening Policy

ABSTRACT Background During the SARS-CoV-2 pandemic, multiple preventative measures were used to prevent the virus from spreading in the population. The Israeli defense force deployed further means to contain the disease, including putting units in quarantine, physical distancing and using masks, gowns and disinfectants when in contact with suspected patients. Methods We used reverse transcriptase-polymerase chain reaction (rt-PCR) tests to screen for patients among asymptomatic soldiers within units participating in civilian aid or in close contact with known patients, using personal protective equipment. Positive results were repeated and followed with serological testing to verify the nature of results. Results Between April and May 2020, we screened a total of 1,453 soldiers in 13 different units. We found 11 false positive results, leading to unnecessary measures until resolution, and three true positive results (0.2%). All true positive results had unreported symptoms concomitant with SARS-CoV-2 disease. These results led to the resolution of this screening policy. Conclusion Screening asymptomatic army personnel in this setting with rt-PCR test for SARS-CoV-2 is not warranted and leads to unnecessary false positive results. Efforts should be directed at identifying symptomatic patients.

Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data

ABSTRACT Introduction The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command’s (NC) preliminary experience. Materials and Methods We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC). Results The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18–50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units. Conclusions Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.

From civilian service to military service: what led policy-makers to remove nursing care from field units of the Israeli defense force (IDF) and return it later?

Background From the very onset, Israeli military nurses served in supporting positions on the front lines, shoulder to shoulder with men. When the IDF was established in 1948, nurses were sent to serve near areas of conflict and were not included in compulsory military service in field units. Once the military hospitals were closed in 1949, nursing in the Medical Corps lost a clear military purpose, and its main contribution was in the civilian arena. From 1949 until 2000, most recruited military nurses operated their mandatory service mainly in a civilian framework according to the integration agreement between the ministry of defense to the ministry of health. Between 2000 to 2018, military nurses served at home front military clinics and in headquarters jobs at the Medicine Corps. In2018, the Medical Corps decided to integrate military nurses into the Israeli military service in order to cope with the shortage of military physicians, among other things, and ensure appropriate availability of medical and health services for military units.. This study examines, for the first time, the considerations that led to the closure of military hospitals and the transfer of the military service of nurses in the IDF to the Ministry of Health in 1949 and the decision in 2018 to return the military nurses to the field’s military battalions. Methods The study was based on an analysis of documents from the IDF archives, the Israeli parliament archive, the David Ben-Gurion archive, articles from periodical newspapers, and interviews with nurses and partners in the Israeli Medical Corps. Results During almost 70 years, Israeli military nursing’s main contribution was to the civilian hospitals. The return of nursing care to the IDF field units in recent years intended to supplement the medicine corps demands in field units by placing qualified academic nurses. Conclusions The removal of nursing care from the IDF field units was provided as a response to the needs of the health demands of the emerging state. Until 2018 there was no significant need for military nurses except in emergency time. This is in contrast to other military nursing units.

Integrating Israeli Defense Force (IDF) veterans with disabilities into the workforce: characteristics and predictors

Background According to the ICF Model, the central goal of rehabilitation is the returning of persons with disabilities to an active and fruitful life within society. The Israel Ministry of Defense Rehabilitation Department’s occupational rehabilitation program includes assessment, professional guidance, training, and assistance integrating into employment. Aim Examining predictors for the integration of Israel Defense Force veterans with disabilities into the workforce. Methods All 1416 male veterans with disabilities who served in the military, were injured during their service, and were treated by the Israel Ministry of Defense Rehabilitation Department between 2001 and 2006 were included in this study. Data collection was based on computerized administrative data in the Ministry of Defense. The data was collected with no identifying details. Predictive variables were: health condition, personal factors, participation factors, level of functioning and structure, and variables relating to the local environment. Results Compared to a physical disability, mental and mixed (physical and mental) disabilities reduce the odds for integration into the workforce. Higher education at the time of the injury is an additional predictor for integration into the workforce. Participation in a rehabilitation track for further education to acquire a profession is one of the main predictors for integration into the workforce. Conclusion The results may enable developing more accurate intervention plans, with more efficient use of resources, including consolidation of existing information systems and monitoring the processes and outcomes of rehabilitation.

Perceived Stress and Intent to Die in Young Soldiers Who Attempt Suicide

Background: Intent to die is an important component of suicide risk assessment. The authors compared the predictive effect of two forms of stress – military and perceived – in intent to die by suicide among young adult Israeli soldiers with a history of suicide attempts. Depression, suicide ideation, and habituation/acquired capacity for suicidality served as covariates. Methods: Participants were 60 young adult soldiers in the Israeli Defense Force (ISF; aged 18–21 years), who made a suicide attempt during their military service. Study variables were assessed using self-report measures. Results: Intent to die by suicide correlated with suicide ideation, habituation/acquired capacity, depressive symptoms, and perceived stress. In a multiple regression analysis, perceived stress predicted intent to die (b = .44, p = .002) over and above the prediction by suicide ideation (b = .42, p = .013) and acquired capacity/habituation (b = .28, p = .023). Limitations: The cross-sectional design restricts causal inference. In addition, an exclusive reliance on self-report measures might have inflated shared method variance. Conclusions: Perceived stress captures a unique dimension of intent to die by suicide among young suicide attempters.

Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades

Objective: The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide.Methods: Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions.Results: A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers.Conclusion: The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.