Civilian Systems Research Articles

Injury of the musculoskeletal system in civilian casualties as a result of hostilities. Report 1. Age structure

The integration of the military medical supply system into the unified medical space of Ukraine involves the functional combination of forces and means of medical services and the civilian health care system in order to maximize their capabilities for effective medical supply of the troops while preserving organizational independence. The purpose of our study was to determine the clinical and epidemiological characteristics of civilian patients with trauma due to modern hostilities. Materials and methods. To carry out our work, we analyzed skeletal traumas in 137 civilian patients who were injured during modern hostilities in Ukraine and were treated in health care facilities of the frontline zone in 2014–2023. Results. Comparing epidemiological data in two different periods of the war in Ukraine, we concluded that there is some difference in the age structure of victims with traumatic injuries sustained during modern hostilities. Thus, during the high-intensity conflict, the number of children’s injuries increased dramatically. The share of victims under the age of 15 during the full-scale invasion increased 4.5 times. In this period, the percentage of young and middle-aged wounded civilians decreased. If in the period of Anti-Terrorist Operation/Joint Forces Operation the number of people aged 16–60 was 67.6 %, then with the beginning of hostilities their share decreased to 42.0 %. This trend indicates the strengthening of internal and external migration starting from February 2022. Unlike the young and middle-aged, the share of elderly and senile people increased dramatically during the full-scale war. During the period of low-intensity military operations, the number of patients aged 61–91 was 29.4 %, while during high-intensity conflict, it was already 44.8 %. A sharp increase in traumatic injuries among elderly and senile patients is another feature of this conflict. Conclusions. Publicizing the experience of providing medical care to patients with injuries sustained due to military actions in Ukraine is only at the beginning of its existence. That is why, based on the above, we planned to continue scientific research on this problem.

Weakening of the state by occupying more lands: evidence from the Five Dynasties

Can wars truly build states and rationalize their structures? This study focuses on the administrative origin of state-building and finds historical evidence that seems contrary to the idea of "war-making states". As states acquire more territory, they become increasingly vulnerable to setbacks in subsequent military activities, even when facing state failure or demise. Drawing upon geospatial data spanning from 906 to 969 AD during Chinas Five Dynasties and utilizing a difference-in-differences method, our study reveals that (1) states did not progressively expand in size due to continuous warfare, and (2) larger territorial acquisitions were associated with decreased probabilities of state survival, as expanding net territorial areas corresponded to higher likelihoods of state failure in the following years. (3) The relationship between civilian and military systems within a state profoundly impacts the validity of the "war-making states" hypothesis. This study highlights that war makes states more susceptible to collapse if the military system dominates the civilian bureaucracy. Conversely, if the civilian system controls the military and forms a centralized regime, the "war-making states" hypothesis holds true. These findings revise the prevailing hypothesis of "war-making states" in historical sociology, showing that the "war-making states" hypothesis depends on a specific political structure and bureaucratic system.

Critical Care Nursing and Mass Casualty Response During Operation Allies Refuge.

Operation Allies Refuge started in July 2021 with implications for critical care nurses, both military and civilian, serving at the US Army's Landstuhl Regional Medical Center in Landstuhl, Germany. Cultural and logistical concerns and complications were at the forefront of care provided to Afghan evacuees during the operation and were exacerbated by a mass casualty event on August 26, 2021, when a suicide bomber attacked the Abbey Gate of Hamid Karzai International Airport in Kabul, Afghanistan. This article discusses the issues that affected care, including language barriers, supply shortages, cultural differences, mass evacuation during a pandemic, and management of the mass casualty event by the critical care team. The information is compiled into a summary of lessons learned to assist in future management of emergency evacuee care within our military and civilian health care systems.

Detection of cefiderocol and aztreonam/avibactam resistance in epidemic Escherichia coli ST-361 carrying blaNDM-5 and blaKPC-3 from foreign fighters evacuated from Ukraine.

Genomic surveillance detected clonal Escherichia coli sequence type-361 isolates carrying blaNDM-5, blaKPC-3, blaCTX-M-15, and rmtB1 from a patient in Ukraine and four wounded foreign soldiers evacuated to Germany. Isolates were non-susceptible to carbapenems, aminoglycosides, and cefiderocol and aztreonam/avibactam due to a PBP3 YRIN insertion and the blaCMY-145 AmpC β-lactamase. Coordinated surveillance efforts across civilian, military, and veteran healthcare systems are essential to prevent further spread as international volunteers return home after medical evacuation from Ukraine.

Artificial Intelligence in the U.S. Military Health System: Forging a New Frontier for Clinical Care and Efficiency

ABSTRACT The Military Health System (MHS) has historically been at the forefront of innovation in medicine and science, but it has also historically struggled to implement battlefield innovations or civilian technologies for wider domestic use. Artificial intelligence (AI) has emerged as a transformative force in health care with civilian health systems and institutions at the forefront of these innovations. While these tools have the potential to support resolution of military health’s most pressing issues, the MHS is behind its civilian counterparts in advancing AI. Adoption of AI could benefit the MHS in such areas as service member and beneficiary access to care; more precise allocation of medical personnel and resources; improved operations of military treatment facilities; early detection of emerging threats to health; and force multiplication of existing telehealth capabilities. This evolving and highly visible technology also presents challenges in the military context above those in the civilian context, such as additional levels of privacy and security, integration with purpose-built secure systems, and additional regulatory obligations. To address these, the MHS should engage in three lines of effort to advance AI: establishing governance, education and training of medical personnel, and engaging in research, development, testing, and piloting of AI applications. This will require dedicated personnel and resources for a substantial initial outlay to be recouped later through more effective administration and care. By leveraging lessons learned from civilian systems, the MHS can design, adopt, and implement AI solutions to improve care for service members in both domestic and operational contexts, and for their beneficiaries.

Arbitrary low-frequency power-splitting strategy in ferrite/piezoelectric magnetoelectric heterostructures: theory and experimental validation

Exploring low-frequency (LF) arbitrary power-splitting technologies to address the independent excitation issues of LF/VLF mechanical antennas (MA) with random distributions is challenging due to unidentified device construction and operation mechanism. In light of this, a device construction strategy for three-port magnetoelectric (ME) arbitrary power splitter in composite of ferrite/piezoelectric heterostructure, as well as theoretical model was developed. To validate the feasibility and effectiveness of the strategy, three size-tailored ME samples with length ratio of split PZT segments in 1:1, 2:1, and 3:2 were modeled, fabricated and comparatively characterized. Experimental results show that the achievable maximum power conversion efficiencies (PE) reach 52%, 71%, and 59% for three tailored ME samples, respectively, and as expected the power-splitting ratios are directly proportional to the square ratio of ME voltage coefficient (MEVC) from each port of the tailored ME samples, which are in coincidence with theory under desired operation stability and favorable experiment repeatability evaluated by uncertainties of 0.25854 V cm−1 Oe−1 and 0.32979 V cm−1 Oe−1 for each port. Therefore, a prediction of evolutionary tendency for arbitrary power splitter realization was expanded in view of our experimental observations, and a great flexibility for device future design and further optimization was also provided. Therefore, the presented LF power-splitting strategy paves the ways for arbitrary power splitter realization and enriches the multi-functional ME power electronics families, as well as enables potential applications for efficient excitations of MAs in high-permeable military underwater and civilian emergency rescue distribution long-wave communication system for practical scenarios of submarine, underground railways, tunnels and collapsed residential buildings.

Transitioning Military Flight Surgeons: Untapped Leadership Potential

Battalion and brigade flight surgeons represent an often-overlooked yet promising cohort in civilian healthcare leadership. Possessing a skill set cultivated through military service, they offer a deep understanding of population health, adaptability, and resilience. With these attributes, they are well-equipped to spearhead transformative change within civilian healthcare systems, driving innovation, and improving patient-centered outcomes.

DEVELOPMENT OF AN INFORMATION AND LOGIC MODEL FOR PREVENTING EMERGENCIES DUE TO IMPACT ON PROTECTIVE ELEMENTS OF SMALL SHELTER FACILITIES BY SHOCK AND IMPULSE LOAD

The article examines problems of preventing emergencies due to damage to small shelter facilities caused by the impact of unmanned aerial vehicles (UAVs), which, in turn, leads to shock-impulse loading of their upper hemisphere and the following destruction. The development of a civilian protection system against terrorist attacks on civilian infrastructure in the form of an extensive network of small shelter facilities increases the level of individual and collective protection of the population, especially in cities that fall within the area of enemy missile and artillery strikes. Therefore, when designing and building settlements, it is necessary to provide for the possibility of protecting the civilian population from both shrapnel-type damage, which already has a practical implementation in existing projects, and from possible high-precision destruction of the upper hemisphere of small shelter facilities by a UAV warhead of high explosive or thermobaric type. Relevant design solutions should focus on preventing terrorist emergencies due to shock-impulse loading of the upper hemisphere of small shelters, which is formed by considering the information-logic model for preventing local-level emergencies due to shock-impulse loading of small shelter facilities. The information-logic model assumes the existence of two security management loops for a small shelter: external and internal. It is worth noting that the external loop is an integral part of the overall urban (regional) air defence system and includes the block of measures to directly affect the threat (striking UAV) in the form of firearms and electronic warfare. The result of the successful development of management decisions by the external control loop is eliminating the threat of an enemy attack UAV. On the other hand, the experience and individual elements of the UAV are the basis for the formation of initial conditions of the mathematical model for preventing terrorist emergencies due to the shock and impulse load of small shelter facilities. The initial conditions represent the result of the development of two consecutive blocks: a block for collecting UAV characteristics and a block for analysing the shock-impulse load that occurs or is predicted based on the characteristics of the attacking UAV. The basis of the internal control loop is the mitigation design unit, which determines further information exchange within this loop. In particular, it triggers the block for improving the effectiveness of protection, which receives statistical and predictive information on emergencies that have occurred (nature of damage and consequences). It allows for continuous updating of information on the characteristics of construction materials used in the construction of shelter facilities and the effectiveness of design solutions, forming characteristics of a small shelter. The result of the corresponding block is the formation of boundary conditions of the mathematical model for preventing terrorist emergencies due to the shock and impulse loading of small shelters. The basis of the block for forming the coupling equation of the mathematical model for preventing terrorist emergencies due to shock-impulse loading of small shelter facilities is the theoretical and practical achievements of the theory of reliability and its derivative theory of plasticity. An appropriate solution to the problem of preventing terrorist emergencies due to shock and impulse loading of small shelter facilities allows further implementation of management decisions to improve the efficiency of protection. Thus, the study solved an urgent scientific problem, namely, the formation of an information-logical model for the prevention of local-level emergencies due to shock-impulse loading of small shelter facilities, the implementation of which allows to form management decisions to improve the security of small shelters and is the basis for further development of an appropriate mathematical model and methodology. Keywords: information-logic model, shock-impulse load, small shelter facility, emergency.

Type-specific whole blood still has a role in the era of low-titer O universal donor transfusion for severe trauma hemorrhage.

Whole blood can be ABO-type specific (type-specific whole blood (TSWB)) or low-titer O universal donor (low-titer O whole blood (LTOWB)). Having previously used LTOWB, the US Armed Forces Blood Program began using TSWB in 1965 as a method of increasing the donor pool. In contrast to military practice, the Association for the Advancement of Blood and Biotherapies formerly the American association of blood banks (AABB), from its first guidelines in 1958 until 2018, permitted only TSWB. Attempting to reduce time to transfusion, the US military reintroduced LTOWB in the deployed environment in 2015; this practice was endorsed by the AABB in 2018 and is progressively being implemented by military and civilian providers worldwide. Low-titer O whole blood is the only practical solution prehospital. However, there are several reasons to retain the option of TSWB in hospitals with a laboratory. These include (1) as-yet ill-defined risks of immunological complications from ABO-incompatible plasma (even when this has low titers of anti-A and -B), (2) risks of high volumes of LTOWB including published historical advice (based on clinical experience) not to transfuse type-specific blood for 2 to 3 weeks following a substantial LTOWB transfusion, (3) uncertainty as to the optimal definition of "low titer," and (4) expanding the potential donor pool by allowing type-specific transfusion. Several large randomized controlled trials currently underway are comparing LTOWB with component therapy, but none address the question of LTOWB versus TSWB. There are sufficient data to suggest that the additional risks of transfusing LTOWB to non-group O recipients should be avoided by using TSWB as soon as possible. Combined with the advantage of maintaining an adequate supply of blood products in times of high demand, this suggests that retaining TSWB within the civilian and military blood supply system is desirable. TSWB should be preferred when patient blood group is confirmed in facilities with a hematology laboratory, with LTOWB reserved for patients whose blood group is unknown.

CIV-MIL integration in the transformation of the EU healthcare network: a dual-gain strategy

PurposeThis article aims to address the need for a more structured partnership between civilian and military healthcare, particularly in the context of cross-border threats in the EU. While both systems are driven by the same goal of providing high-quality healthcare services and achieving optimal patient outcomes, they operate under different national approaches and resources.Design/methodology/approachTwo recent crises are presented as examples that highlight the necessity of cooperation between civilian and military medical systems. The Covid-19 Pandemic and the Ukrainian Conflict are described based on the experience gathered by the author as a member of the NATO Centre of Excellence for Military Medicine and form the base to shape a broader perspective on the future of civil-military interaction in healthcare at the European Union level.FindingsThe ability to deliver coordinated responses during crises depend on the level of interoperability, preparation and mutual understanding. To improve synergies, a structured partnership should be established, prioritizing common standards of care and shared best practices. Integrating military and civilian healthcare pathways can be especially beneficial in situations where patients are moved from the point of injury or sickness across different military and civilian structures to receive the most appropriate treatment and rehabilitation for their conditions.Originality/valueThe relationship between military and civilian healthcare systems is often discussed at multinational level, but a clear focus is lacking concerning their shared mission, distinct functions and potential for cross-border collaboration.

Civil-military cooperation in the field of additive manufacturing technologies in military logistics

Technological progress opens up opportunities for the development of many areas, including military activities. Industry 4.0 develops technologies that are used in military activities. The potential for supporting military logistics is created by additive manufacturing technology. Development and implementation of innovations should be conducted in a way that ensures interoperability, which means multi-stakeholder and multifaceted cooperation. However, achieving the benefits resulting from this technology requires integrated, systemic, regulated cooperation between the civilian sector - the creator of the technology and the military sector - its beneficiary. This article focuses on issues related to civil-military cooperation in the field of adapting additive manufacturing technologies (3D printing, AMT) to military logistics. The purpose of this paper is to identify the challenges and directions of development of military logistics and presenting the essence and role of AMT, and to define the key factors of civil-military cooperation in the field of implementing AMT in the military logistics system. To solve the research problem, a qualitative research approach was used, referring to the relevant literature and participant observation. Analysis allows to create a proposal of a conceptual model of cooperation between military and civilian systems in the field of implementation and development of AMT in the field of military logistics. The obtained results, discussion and conclusions focus on the conditions for building a civilian-military partnership in the field of targeted development and safe, efficient implementation of AMT in military logistics.

The overview of ecologic military and civilian power systems

Obtaining electrical energy is a substantial challenge for the 21st century. The world is increasingly dominated by pro-ecological tendencies: wind energy, solar radiation and electric energy from the so-called hydrogen batteries and their mutations. In military applications, using these source types is also beneficial since it substantially improves camouflage possibilities, e.g., it enables the reduction of the thermal afterglow and noise intensity. The manuscript’s authors developed the overview of pro-ecological power systems and presented the current state of implementations.

Infrared Small Target Detection Based on Tensor Tree Decomposition and Self-Adaptive Local Prior

Infrared small target detection plays a crucial role in both military and civilian systems. However, current detection methods face significant challenges in complex scenes, such as inaccurate background estimation, inability to distinguish targets from similar non-target points, and poor robustness across various scenes. To address these issues, this study presents a novel spatial–temporal tensor model for infrared small target detection. In our method, we introduce the tensor tree rank to capture global structure in a more balanced strategy, which helps achieve more accurate background estimation. Meanwhile, we design a novel self-adaptive local prior weight by evaluating the level of clutter and noise content in the image. It mitigates the imbalance between target enhancement and background suppression. Then, the spatial–temporal total variation (STTV) is used as a joint regularization term to help better remove noise and obtain better detection performance. Finally, the proposed model is efficiently solved by the alternating direction multiplier method (ADMM). Extensive experiments demonstrate that our method achieves superior detection performance when compared with other state-of-the-art methods in terms of target enhancement, background suppression, and robustness across various complex scenes. Furthermore, we conduct an ablation study to validate the effectiveness of each module in the proposed model.

Global assessment of military and civilian trauma systems integration: a scoping review

Background: The global burden of trauma disproportionately affects low- and middle-income countries (LMIC), with variability in trauma systems between countries. Military and civilian healthcare systems have a shared interest in building trauma capacity for use during peace and war. However, in LMICs it is largely unknown if and how these entities work together. Understanding the successful integration of these systems can inform partnerships that can strengthen trauma care. This scoping review aims to identify examples of military-civilian trauma systems integration and describe the methods, domains, and indicators associated with integration including barriers and facilitators. Methods: A scoping review of all appropriate databases was performed to identify papers with evidence of military and civilian trauma systems integration. After manuscripts were selected for inclusion, relevant data was extracted and coded into methods of integration, domains of integration, and collected information regarding indicators of integration, which were further categorized into facilitators or barriers. Results: 74 studies were included with authors from 18 countries describing experiences in 23 countries. There was a predominance of authorship and experiences from High Income Countries (91.9% and 75.7%, respectively). Five key domains of integration were identified; Academic Integration was the most common (45.9%). Among indicators, the most common facilitator was administrative support and the lack of this was the most common barrier. The most common method of integration was Collaboration (50%). Conclusion: Current evidence demonstrates the existence of military and civilian trauma systems integration in several countries. High-income country data dominates the literature, and thus a more robust understanding of trauma systems integration, inclusive of all geographic locations and income statuses, is necessary prior to development of a framework to guide integration. Nonetheless, the facilitators identified in this study describe the factors and environment in which integration is feasible and highlight optimal indicators of entry.

Specialized Prosecutor’s Office in the field of defense: legal status, role in the system of law enforcement agencies, functions and tasks under martial law

The full-scale invasion of the Russian Federation into the territory of Ukraine has directed the activities of state bodies towards defense and preservation of the integrity and sovereignty of the State. The main role in achieving this goal is played by the Armed Forces of Ukraine and other armed military formations, but due to the growth in the number of defense forces, the number of offenses has increased.
 To combat such offenses, Ukraine established the Specialized Defense Prosecutor’s Office, the legal status, functions and role of which are not sufficiently studied in the scientific environment, since this body in its current form was established only in 2023.
 The article, among other things, examines the retrospective of the formation and development of the military prosecutor’s office in Ukraine, and establishes the fact of continuous reform of the military prosecutor’s office, which over time has led to the leveling and devaluation of the role of military prosecutors in the law enforcement system of Ukraine. The article also substantiates the author’s opinion that the military justice system was unprepared to fulfill its tasks, especially in a full-scale war, and the civilian law enforcement system and civilian courts are not able to fully perform their functions, especially in the combat zone.
 In the course of the work, the author emphasizes the need for a complete restoration of military justice and the difficulties of the work of the specialized prosecutor’s office in modern conditions.
 In general, the article analyzes the issues of transformation of the military prosecution bodies in Ukraine as a component of the military justice system, examines the changes that have occurred in this structure since Ukraine gained independence, and identifies the problematic aspects and prospects for restoring an effective military justice system.
 Based on the results of the article, the author analyzes the legal nature of the body and its formation in historical retrospect, which gave a clear understanding of the legal position of the Specialized Defense Prosecutor’s Office in the system of law enforcement agencies, identifies and studies the functions performed by the body, formulates a list of tasks for which this prosecutor’s office was established, and identifies the shortcomings which require improvement and legal regulation at the legislative level.

Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study

ABSTRACT Background: Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians. Methods: First-time deployed military personnel (N = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (N = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared. Results: Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter. Conclusions: MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP.

Faster Refill in an Urban EMS System Saves Lives: A Prospective Preliminary Evaluation of a Prehospital Advanced Resuscitative Care Bundle.

Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian EMS systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality. This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid (TXA), and PRBCs via a rapid infuser. ARC patients were compared to trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and SBP < 90 mmHg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest. A total of 210 patients (ARC = 61, controls = 149) met criteria. Median age was 32 years, with no difference in demographics, initial SBP or heart rate recorded by EMS, or new injury severity score (NISS) between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls (p < 0.03). Fewer patients in the ARC group required prehospital advanced airway placement (p < 0.001). 24-hour and total in-hospital mortality were lower in the ARC group (p < 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (OR 0.19, 95%CI 0.05-0.68, p = 0.01). Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. ARC closer to the point of injury warrants consideration. Level IV, Prospective.

Investigating insomnia in United States deployed military forces: A topic modeling approach

Study objectivesThis retrospective study analyzed free-text clinical notes from medical encounters for insomnia among a sample of deployed US military personnel. Topic modeling, a natural language processing technique, was used to identify thematic patterns in the clinical notes that were potentially related to insomnia diagnosis. MethodsClinical notes of patient clinical encounters coded for insomnia from the US Department of Defense Military Health System Theater Medical Data Store were analyzed. Following preprocessing of the free text in the clinical notes, topic modeling was employed to identify relevant underlying topics or themes in 32,864 unique patients. The machine-learned topics were validated using human-coded potential insomnia etiological issues. ResultsA 12-topic model was selected based on quantitative metrics, interpretability, and coherence of terms comprising topics. The topics were assigned the following labels: personal/family history, stimulants, stress, family/relationships, other sleep disorders, depression, schedule/environment, anxiety, other medication, headache/concussion, pain, and medication refill. Validation of these topics (excluding the two medication topics) against their corresponding human-coded potential etiological issues showed strong agreement for the assessed topics. ConclusionsAnalysis of free-text clinical notes using topic modeling resulted in the identification of thematic patterns that largely mirrored known correlates of insomnia. These findings reveal multiple potential etiologies for deployment-related insomnia. The identified topics may augment electronic health record diagnostic codes and provide valuable information for sleep researchers and providers. As both civilian and military healthcare systems implement electronic health records, topic modeling may be a valuable tool for analyzing free-text data to investigate health outcomes.

Long Term Cancer Risk of U.S. Service Members Exposed to Burn Pits during Military Deployment to Iraq from 2006-2008: A Retrospective Cohort Study

Introduction: Burn pits have known individual carcinogenic byproducts, including polyaromatic hydrocarbons and volatile organic compounds, which have a presumptive link between deployment exposure and tumorigenesis. However, there are a dearth of epidemiologic data describing the long-term cancer incidence in U.S. service members who were exposed to burn pits during deployment to Iraq. A retrospective cohort study was carried out with the goal of assessing long-term cancer risk in service members who deployed to Iraq and reported exposure to burn pits. Methods: Data were collected from the Armed Forces Health Surveillance Division. Inclusion criteria were any service member who deployed to Iraq (Joint Base Balad or Camp Taji) between January 1st, 2005 to June 30th, 2007, whose deployment lasted at least 180 days, who reported burn pit exposure on their post-deployment health assessment form, who were at least 35 years old at the time of their deployment, who remained in the military for at least 10 years post-deployment, and who had post-deployment serum available in the DoD Serum Repository. Controls were individually matched to the research cohort by age (+/- 3 years), sex, branch of service, rank, and occupation category. To minimize confounding from the “healthy deployer effect”, controls were also required to have deployed to Germany for at least 180 days, and to have been at least 35 years old at the time of their deployment. Controls could not have ever deployed to Southwest Asia or reported burn pit exposure. Cancer incidence was captured via ICD-9 and -10 codes of 140-209 and C00-C96, respectively. Primary endpoint was assessment of serum monoclonal gammopathy in deployed, exposed personnel vs. non- deployed controls. The secondary endpoint was assessment of long-term neoplasia development via ICD-code, which is reported here. A Fisher test was used for comparison of post- deployment malignancies between deployed/exposed service members and controls. This study was exempt from full IRB review and funded by Murtha Cancer Center Research Program. Results: 534 deployed/exposed service members and 534 matched controls met inclusion criteria. Median age at deployment was 37 (range: 35-55). Most service members were white enlisted males in the Army. Mean follow up from the end of deployment was 14 years for deployed/exposed members and 10 years for controls. In each cohort, 39 service members (7%) developed malignancy post-deployment (p=1.0), of which solid tumors were exceedingly more common as shown in Table 1. Only two hematologic malignancies were diagnosed, both in the deployed/exposed cohort, consisting of multiple myeloma and a lymphoid malignancy. There were no differences in the number of service members with multiple primary tumor types between the exposed and unexposed groups. There were also no differences in the number of service members with anemia, hypercalcemia or kidney disease; however, exposed personnel were more likely to develop obesity after their deployment (n=171 vs. 159, p=0.002). Serum monoclonal gammopathy results will be reported separately. Conclusions: Service members who deployed to Iraq between 2006-2008 for at least 180 days, who reported burn pit exposure, and who were followed for an average of 14 years post deployment did not have higher rates of plasma cell disorders or any other malignancy than matched controls who deployed to Germany. Limitations of epidemiologic studies on service members include response bias on post-deployment health assessment forms, inability to capture service members who leave the military, and lack of details on Veterans seeking healthcare through the VA system or civilian healthcare system. It is possible that with a more expansive patient cohort that includes Veterans and longer follow up, that a difference in cancer incidence could emerge. Further research is needed to better understand cancer risk factors in service members. Disclaimer: The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of Uniformed Services University of the Health Sciences (USUHS), The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense (DoD) or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

Respond quickly and effectively! Components of the military health surveillance system in natural disasters: A qualitative study

BACKGROUND: The systematic collection, analysis, and interpretation of health data by health surveillance systems provide timely and comprehensive surveillance of public health, identification health priorities, and, consequently, a quick and timely response to reduce damage during natural disasters. Since military forces appear as first responders at the scene of accidents, the present study aimed to identify the components of the military health care system during natural disasters. MATERIALS AND METHOD: Qualitative data collected through semi-structured interviews were analyzed via the conventional content analysis approach to identify the components of the military health care system in natural disasters. The participants consisted of 13 experts who were experienced in providing health services in the military and the civilian health care system during natural disasters in January 2022 to June 2022. RESULT: The identified components were classified into four main categories, namely, pre-requisite components (comprehensive health care, defined position, and providing information), driving components (system efficiency, effective communication), operational components (contingent performance, effective response), and promotional components (purposeful support, pre-disaster preparation). CONCLUSION: In conclusion, the military health surveillance system is a cooperative service for the national health system in which data is essential for making decisions on health and treatment measures during disasters. This study—by identifying four categories of the important components in the design, implementation, and development of the military health surveillance system—provides a comprehensive view of an appropriate and evidence-based military surveillance system in disasters.