Civilian Medical Personnel Research Articles

The prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics in wartime–An observational cross-sectional study six months after outbreak

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder–7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

INTERNATIONAL HUMANITARIAN LAW AND MEDICAL CONFIDENTIALITY

This study focuses on appraising the right of the wounded and sick to medical confidentiality within the context of international armed conflict in International Humanitarian Law. It finds a correlation between the right to medical confidentiality and the general protection accorded to the wounded and sick in IHL. The paper argues that in hostilities, just like in peacetime, the right to medical confidentiality exists to protect the wounded and sick. However, it is the major finding of this paper that as important as the right to medical confidentiality may be, because military medical personnel owe dual loyalty, (one to the medical profession and the other to the Military), they face the dilemma of striking a balance between these responsibilities, which in turn affects their obligation to respect medical confidentiality. To address this challenge, the paper recommends greater commitment and respect by States to their obligations under IHL through the provision of adequate training for their military and civilian medical personnel on what the duty of confidentiality entails; and the stipulation of effective sanctions against the violation of this right through their domestic laws.

Design and Development of a Prototype Heads-Up Display: Supporting Context-Aware, Semi-Automated, Hands-Free Medical Documentation

Military and civilian medical personnel across all echelons of medical care play a critical role in evaluating, caring for, and treating casualties. Accurate medical documentation is critical to effective, coordinated care and positive patient outcomes. We describe our prototype, Context-Aware Procedure Support Tools and User Interfaces for Rapid and Effective Workflows (CAPTURE). Leveraging human factors and usercentered design methods, and advanced artificial intelligence and computer vision capabilities, CAPTURE was designed to enable Tactical Combat Causality Care (TCCC) providers to more efficiently and effectively input critical medical information through hands-free interaction techniques and semiautomated data capture methods. We designed and prototyped a heads-up display that incorporates: multimodal interfaces, including augmented reality-based methods for input and information display to support visual image capture and heads-up interaction; post-care documentation support (e.g., artifacts to support post-care review and documentation); context-aware active and passive data capture methods, specifically natural language interpretation using systemic functional grammars; and computer vision technologies for semi-automated data capture capabilities. During the course of this project we encountered challenges towards effective design which fall into three main categories: (1) challenges related to designing novel multimodal interfaces; (2) technical challenges related to software and hardware development to meet design needs; and (3) challenges as a result of domain characteristics and operational constraints. We discuss how we addressed some of these challenges and provide additional considerations necessary for future research regarding next generation technology design for medical documentation in the field.

International Humanitarian Law and Review of Recurrent Violations Including Chemical Weapons Use

Introduction:The basis of International Humanitarian Law (IHL) is the Theory of Natural Law, which states that the laws of morality and the ability to use reason in the determination of inalienable human rights, are innate to humans, and cannot be taken away by any states or laws. IHL is an agreement among nation-states that applies to situations of conflict to protect civilians and guides conduct in time of war. IHL extends protection to civilian medical personnel. The recent escalation in chemical weapons use by states has violated IHL and the 1997 Chemical Weapons Convention (CWC) treaty, with little repercussion from the international community.Aim:We review the increase in chemical weapons use, international chemical weapon treaty violations, and violations of IHL against medical personnel.Methods:A review was conducted of existing medical and grey literature for sources discussing chemical agents, their history, and violations of laws prohibiting their production, stockpiling, or use. The following publications were reviewed: PubMed, EBSCHost, and Google Scholar.Results:The use of sarin, chlorine, and mustard gas against civilians has been confirmed multiple times in Syria by the United Nations since 2011. Physicians for Human Rights mapped 537 attacks, both violent and chemical, against 348 different medical facilities in Syria from March 2011 to July 2018. Since March 2011, at least 847 civilian medical personnel have reportedly been killed. Many were killed by government forces as part of a war strategy creating further incapacitation. Most recently, Medecins Sans Frontiers concluded its Yemen mission due to repeated attacks, including two in one week in October 2018.Discussion:There must be recognition and emphasis on the health severity of such attacks and the violations of IHL and the CWC. Physicians must use their unique positions for advocacy and call for action in upholding international treaties.

The Central Simulation Committee (CSC): A Model for Centralization and Standardization of Simulation-Based Medical Education in the U.S. Army Healthcare System

In this report, we describe the organizational framework, operations and current status of the Central Simulation Committee (CSC). The CSC was established in 2007 with the goals of standardizing simulation-based training in Army graduate medical education programs, assisting in redeployment training of physicians returning from war, and improving patient safety within the Army Medical Department. Presently, the CSC oversees 10 Simulation Centers, controls over 21,000 sq ft of simulation center space, and provides specialty-specific training in 14 medical specialties. In the past 2 years, CSC Simulation Centers have trained over 50,000 Army medical students, residents, physician assistants, nurses, Soldiers and DoD civilian medical personnel. We hope this report provides simulation educators within the military, and our civilian simulation colleagues, with insight into the workings of our organization and provides an example of centralized support and oversight of simulation-based medical education.

MILITÊRE GENEESKUNDIGE GEDURENDE DIE VROEE JARE (DEEL 2)

When the First World War broke out in August 1914, the Union Defence Force was still without a properly organised medical staff of .its own. Although the Defence Act of 1912 had made provision for a South African Medical Corps, financial difficulties and the importance of establishing fighting units seem to have relegated the importance of providing mil.itary medical services. On 4 August 1914, the personnel of the South African Medical Corps consisted of three men all at Defence Headquarters: a staff officer, a quartermaster and a clerk. As the Union was soon involved in the world conflict the proper establishment of a military medical service became of paramount importance. Initially a great deal was done by a skeleton staff from the Royal Army Medical Corps but South Africa was rich in civilian medical personnel and these people so on offered their services. The South African Medical Corps expanded rap,idly during the campaign in South West Africa and apart from establishing a large number of military hospit als in the Union, was able to staff several institutions in France and in German East Africa, where again the Corps worked in close co-operation with its British counterpart.

Orthopaedic Care Aboard the USNS Mercy During Operation Unified Assistance After the 2004 Asian Tsunami

On December 26, 2004, a 9.0-magnitude earthquake occurred off the northwest coast of Sumatra, Indonesia. The subsequent tsunami caused unprecedented destruction throughout the Indian Ocean basin1. In eleven nations, millions were injured and/or displaced and, although estimates vary, as many as 300,000 lives may have been lost2-4. Within days after this natural disaster, hundreds of humanitarian organizations and thousands of military troops from several countries mobilized to offer assistance5-7. The U.S. military response came in the form of Operation Unified Assistance, a mission of humanitarian aid and disaster relief8. Within days, the U.S. Navy carrier strike group led by the USS Abraham Lincoln and the expeditionary strike group led by the USS Bonhomme Richard were sent to provide aid to heavily damaged areas. Numerous U.S. military aircraft were also dispatched to facilitate the safe movement of personnel, food, medicine, and drinking water9,10. In addition to providing immediate relief services, the U.S. Navy deployed a hospital ship to the region. The USNS Mercy departed San Diego, California, on January 5, 2005, en route to the Aceh province of Sumatra, Indonesia. The mission of the USNS Mercy was to conduct medical humanitarian aid and disaster relief operations in support of the government of Indonesia to reduce suffering and improve public health. The Mercy crew of health-care providers included medical and surgical staff from the U.S. Navy and officers from the U.S. Public Health Service. To augment the Navy Medical Corps, approximately 100 civilian volunteer physicians, nurses, and technologists from the non-governmental organization Project HOPE were included11, making this the first mission in history to utilize civilian medical personnel aboard a U.S. Navy vessel. From February 5 through March 16, 2005, the USNS Mercy provided …

Psychiatrist Answers Plea To Help Tsunami Victims

Psychiatrist Answers Plea To Help Tsunami Victims

National implementation of international humanitarian law: Biannual update on national legislation and case law January – June 2005

Decree No. 138 on implementing the Law on the use of the red cross and red crescent emblem and other emblems protected under the Geneva Conventions and their Additional Protocols was adopted on 25 January 2005 and published in the official gazette on 27 January 2005. The Decree regulates the use of the emblem as a protective device by the medical and religious personnel of the armed and police forces and by civilian medical personnel when so authorized by the Ministry for Social Protection. It provides for disciplinary sanctions in cases of misuse of the emblem and requires that measures be taken by the Ministry of National Defence and the Directorate-General of the National Police to spread knowledge of the rules on the use and protection of the red cross emblem and other distinctive signs, and to incorporate those rules into policy and military doctrine.

Medical Aspects of Harsh Environments

The Office of the Surgeon General of the United States Army has created a remarkable 2-volume set that comprehensively covers the essentials of medical care in extreme environments. Produced by the Borden Institute, the Army's medical publishing division, Medical Aspects of Harsh Environments, Vols 1–2, features contributions from noted authorities, clear photographs and figures, and a thorough list of references at the end of each chapter. Both volumes have been skillfully edited by US Army physicians Dave Ed Lounsbury and Ronald F. Bellamy, and detailed scientific information is presented in a highly readable format. Although the volumes are part of the Textbooks of Military Medicine series, they would make a welcome addition to any medical library. Volume 1 is divided into two sections: Hot Environments and Cold Environments. Hot Environments includes chapters on the physiology of exercise in hot climates, the pathophysiology of heatstroke, and the prevention of heat illness. The chapter on clinical diagnosis, management, and surveillance of exertional heat illness is particularly informative and includes an excellent review of the controversies related to the treatment of heatstroke. Cold Environments includes chapters on physiological responses to cold stress and hypothermia, prevention of cold injuries, cold water immersion, and the treatment of accidental hypothermia. Readers with an interest in research will appreciate the discussions of hypothermia studies from the military literature, many of which are not mentioned in other texts. Volume 2 begins with a section on mountain medicine, including acute mountain sickness and high-altitude cerebral edema, high-altitude pulmonary edema, and human adaptation to altitude. The chapter on high-altitude pulmonary edema is particularly well written, although the effects of beta-agonists such as salmeterol are not mentioned. The authors, however, cannot be faulted for this omission because major studies of beta-agonists and high-altitude pulmonary edema were almost certainly published after the chapter had already gone to press. This volume also reviews topics that are not typically found in most texts of emergency or wilderness medicine. For example, in addition to chapters on diving medicine, the reader will find chapters on shipboard medicine, motion sickness, acceleration effects on fighter pilots, biological and chemical warfare, medical support of special forces, and military spaceflight. A unique feature of the text is the integration of cases from prior military engagements, including those dating to ancient times. The historical perspective provided for mountain medicine, hypothermia related to shipwrecks, freezing cold injury, and other topics makes for fascinating reading and in no way detracts from the scientific merits of the work. On the contrary, these historical cases are used as effective teaching tools and add interest to the material presented. The work is timely, given recent military and political events. At the time of this writing, US and other forces have been deployed to Iraq and continue to be present in Afghanistan. Both of these countries are known for harsh environments with temperature extremes, and Afghanistan has difficult, mountainous terrain. With patient populations in such diverse climates and conditions, these volumes should be a valuable resource for military medical personnel. This work will also appeal to an audience much broader than the military medical community, and the reader will not find an excess of military jargon. Although some sections may be extraneous, civilian medical personnel who care for patients in extreme conditions will find these volumes to be of great clinical value. Furthermore, the merits of this work are not confined to clinical utility. Anyone with an interest in the physiological effects of extreme environments and patient care in the outdoors could enjoy and learn from this text. In summary, this is an outstanding work that contributes greatly to the medical literature. The foreword, written by the Surgeon General of the Army, James B. Peake, promises a third volume with a focus on prevention and further historical perspective. One wonders whether experiences from recent military action in the Middle East will provide additional insight for this coming volume—an insight that could contribute to the further advancement of patient care in harsh environments.

U.S. Army Dietitians Deploy in Support of Cobra Gold: A Humanitarian Mission

Dietitians are multifunctional and play an important role in humanitarian missions as educators, planners, and consultants. Three dietitians deployed to Thailand in support of the 16th Annual Joint and Combined Exercise, Cobra Gold 1997. The goal of the Medical Civic Assistance Program (MEDCAP) was to promote long-term public health improvements in rural Thai villages. The dietitians counseled 140 patients and taught an additional 5,300 individuals during nutrition classes. The primary nutrition-related clinical diagnoses included malnutrition, anemia, diabetes, hypertension, goiter, and poor appetite. The dietitian who deployed as the medical planner and MEDCAP executive officer facilitated coordination and planning for all phases of the MEDCAP operation. The teams were made up of U.S. and Thai military forces and Thai civilian medical personnel. The mission requirements were established with the Royal Thai Supreme Command, Thai governors, Ministry of Public Health officers, military and medical officers, and veterinarians of the three provinces.

Massacre and Rape in Hong Kong: Two Case Studies Involving Medical Personnel and Patients

One continuing challenge to historians of the second world war in the Far East is to attempt to explain the numerous Japanese excursions into brutality, rape and murder. In Hong Kong and elsewhere, a number of these assaults seem to have been directed particularly against medical officers, orderlies, nurses and patients. Was this deliberate or coincidental? Innate brutality as the sole explanation fails on the now general understanding that we all are capable of brutality in certain circumstances. There were several incidents of brutality against groups of individuals at the time of the Japanese capture of Hong Kong, examination of which suggests a variety of explanations. Among these are drunkenness, so-called battle lust or blood lust, perception of offensive military action from within a group purportedly surrendering, confusion because of propinquity of combatant and non-combatant formations, apparently official orders to kill prisoners, and implicit or explicit sanction to celebrate victory and expiate the death of friends by means of theft, brutality, rape and murder. All of these excuses were put forward in Hong Kong, not only at the time of the events, but also at war crimes trials held after the war and in more recent writings. The intent of this paper is to examine and compare two of these brutal assaults in order to try to discover how they came to happen. These events took place on Hong Kong Island on 19 and 25 December 1941. One was the murder of Royal Army Medical Corps and other personnel near the Salesian Mission at Shau Kei Wan, early on the morning of 19 December 1941. The second was the bloody rampage of murder and rape at the temporary hospital in St Stephen's College on 25 December 1941. There were medical establishments overrun by the Japanese where no atrocities occurred. For example, the staff of the Kowloon Hospital were not ill-treated physically in any way, though for a few days they went very hungry. Dr Isaac Newton, the surgeon in charge of all civilian medical personnel on the Kowloon peninsula, recorded in his diary on 13 December 1941 that the

Issues in the protection of the wounded and sick

The Protocols additional to the Geneva Conventions, adopted in 1977, broaden the protection afforded by international law to wounded, sick and shipwrecked members of armed forces and to medical personnel, medical units and military medical transports in certain circumstances. Their main purpose, however, is to extend to civilians, civilian medical personnel etc. the protection which hitherto was enjoyed only by military personnel. Thanks to the Additional Protocols, military personnel and civilians today enjoy equal protection.

Protection and Nurses

The fourth and last session of the Diplomatic Conference on the Reaffirmation and Development of International Humanitarian Law applicable in Armed Conflicts has just opened. The Conference is considering two Protocols additional to the Geneva Conventions of 1949. The first widens the scope of humanitarian law applicable in international armed conflicts, in particular by giving additional protection to civilians even when they are not in the enemy's power, and by extending to civilian medical personnel the protection which until now had been granted only to military medical personnel. The second Protocol develops the law applicable in non-international armed conflicts, which until now was restricted to a few principles contained in common article 3 of the four Conventions of 1949.