Eye emergencies in the deployed setting

Eye emergencies are common on deployed operations. This article aims to describe the common eye presentations and to guide the initial assessment and management of ophthalmic emergencies for a healthcare professional remote from immediate specialist input. Emphasis is placed upon how urgently ophthalmic advice should be sought for certain eye conditions.

Medical leadership and management for military clinicians

The development of medical leadership and management skills is an essential requirement for the progression of Defence Medical Services personnel in both military and medical training. This review will summarise how military experience can contribute to achieving medical leadership and management competencies and will signpost further opportunities and resources available. While it specifically focuses on doctors, this article has relevance to all Defence Healthcare Professionals.

Ebola Virus Disease - clinical manifestations, management and future therapies

The largest epidemic of Ebola Virus Disease in recorded human history occurred in West Africa in 2014 and resulted in significant morbidity and mortality. The causative pathogen, Ebola virus, is readily transmitted through contact with the body fluids of infected individuals and from the bodies of those who have died from the disease. In its early stages, the illness is characterised by non-specific symptoms that mimic many other endemic infectious diseases in countries with limited healthcare resources. These factors contributed to the rapid spread of the outbreak, which required an international response in which the UK Armed Forces played an important role. This review describes the clinical presentation, lessons learned from managing the West African outbreak, and potential future treatments.

Role 2 Afloat support to the QUEEN ELIZABETH (QE) Class – an update from WESTLANT 18

WESTLANT 18 saw a Role 2 Afloat (R2A) team deploy on HMS QUEEN ELIZABETH (QNLZ) to support the First of Class Flying Trials for the F-35 Lightning 2 aircraft. This team established the R2A capability onboard QNLZ and began the process of developing R2A support to Carrier Strike Group (CSG) operations. The deployment was a great success and many lessons were identified. The experience from this deployment is summarised and the current R2A support to CSG is described.

The effects of barotrauma on the ear

Ear barotrauma represents a spectrum of pathology ranging from a mild, self-limiting condition, to significant morbidity with occupational implications. This article describes the anatomy of a normal functioning ear and how this function is disrupted in patients with ear barotrauma. It will discuss the clinical features of the condition, as well as how to investigate and manage a patient presenting with ear barotrauma, including the occupational considerations that should be made.

The use of Unmanned Aerial Vehicles for CASEVAC in the future urban and littoral environments

The recent development of Unmanned Aerial Vehicles (UAVs) and their potential use for casualty evacuation (CASEVAC) has exciting implications for the United Kingdom Defence Medical Services (DMS). When compared to existing technology, the unique attributes of small size, increased manoeuvrability and lack of a human pilot would be extremely useful in congested and hazardous settings. There are ethical and practical considerations to be taken into account, but harnessing the full potential of this technology may improve the chances of survival from some battlefield injuries.UAVs could be of most benefit in a congested and complex battlespace, allowing evacuation of casualties from high risk environments. In addition to CASEVAC, a UAV could be used for critical care transfers, Search and Rescue (SAR) and Humanitarian And Disaster Relief (HADR) operations. Given the vast array of potential applications and a lower risk profile compared with current CASEVAC platforms, the DMS should actively monitor the development of UAV technology and plan ahead for integration within current doctrine.

Military combat movements and exercises: is there a role for adopting sports nutrition carbohydrate recommendations during exercise?

The daily energy requirements for specialist military troops can reach 5000 kcal during training and wartime deployment. Maintaining energy balance is important for health and physical and mental performance in this population, who can effectively be considered as high-performance endurance athletes. In the sporting world, a balanced diet consisting of 50-60% carbohydrate (CHO), 20-25% protein and 25-30% fat is recommended for these athletes. CHO intake is regarded as a key dietary constituent, as this substrate provides the sole fuel source during high-intensity exercise. However, achieving such high CHO intake rates can be challenging for military personnel, especially in the field. In sports nutrition, athletes commonly use dietary CHO supplements to reduce this deficit. There may be lessons and insight from nutrition and metabolism in sport that could provide Royal Marines, Medical Officers and other embedded medical professionals with strategies to increase CHO intake during intense training or combat situations.This review will highlight the exercise demands of infantry soldiering, will suggest supplementary strategies to increase CHO intake, in addition to dietary intake, and will describe the metabolic effects of CHO ingestion during prolonged activity in the context of military exercise.

Lessons identified in delivering an orthopaedic training course in Freetown, Sierra Leone as part of the NIHR Global Health Research Group FIXT trial

AimsThere are many challenges in delivering an orthopaedic training programme in Sierra Leone, West Africa, including human resource and equipment constraints. We provide a reflective analysis of adaptive strategies to overcome these.MethodsAn orthopaedic surgical training course was delivered in preparation for a clinical trial in Connaught Hospital, Freetown, Sierra Leone. The trial examines the implementation of Ilizarov frame fixation for tibia fractures in adults.ResultsWhilst it is possible to deliver a high-quality course in Sierra Leone, a significant amount of prior planning and preparation, including adaptive and contingency strategies, is required to achieve the desired outcome.ConclusionsWith the Royal Navy increasing its global reach, including deployment of new aircraft carriers, there are increasing opportunities to deliver medical training in low and middle-income countries in both the military and civilian sector. We believe this article may be useful for service and civilian practitioners intending to deliver education and training around the world.