Injured Soldiers Research Articles

Military civilian partnerships: International proposals for bridging the Walker Dip.

The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military, and allied nations have taken creative steps to address the Walker Dip in their own surgical communities. A panel entitled "Military and Civilian Trauma System Integration: Where Have We Come; Where Are We Going and What Can We Learn from Our International Partners" at the 2018 American Association for the Surgery of Trauma meeting brought together a cadre of civilian and military surgeons with experience in this area. The efforts described involved the creation of a new trauma training program in Doha, Qatar, the military civilian partnership in the Netherlands, and the steps taken to address the deficit of penetrating trauma in Sweden. This article focuses on the lessons that can be learned from our allied partners to assure readiness for deployment among military surgeons. LEVEL OF EVIDENCE: Economic and Value Based Evaluations, level V.

Recycling the Disabled: Army, Medicine, and Modernity in WWI Germany by Heather R. Perry

Reviewed by: Recycling the Disabled: Army, Medicine, and Modernity in WWI Germany by Heather R. Perry Lutz Kaelber Recycling the Disabled: Army, Medicine, and Modernity in WWI Germany. By Heather R. Perry. Manchester: Manchester University Press, 2017. Pp. xii + 228. Paper £24.99. ISBN 978-1526106773. Military historians have studied the causes and consequences of World War I in great detail and in ways that often invoke a great deal of controversy, extending their reach into a broad range of topics, including those typically treated by the history of medicine or disability studies. Heather R. Perry's study examines the practice of orthopedic medicine during the years 1914–1918, and elucidates how three processes converged to render war-disabled men fit to return to German society. First, specialization made orthopedic physicians uniquely capable of restoring, as fully as possible, the capacity of disabled soldiers, so that they could continue to contribute to the war effort. To accommodate and compensate for a variety of war-related functional impairments, for example, the development of prosthetics was revolutionized during this time, allowing for the creation of more effective artificial limbs. This skill, now much in demand, advanced orthopedic physicians' standing among fellow healthcare professionals. Second, since militarization put the German economy and society on a war footing, orthopedic physicians spearheaded efforts to establish and then enhance institutional structures for the rehabilitation of wounded soldiers and their reintegration into society; bodies were to be effectively "recycled" so that they might subsequently contribute to the war effort in civilian contexts. Finally, medicalization aimed at transforming individuals formerly considered "permanently crippled" into the "temporarily injured." This involved the reeducation of the population so [End Page 183] that physically disabled soldiers were no longer perceived solely as objects of pity and charity, and also necessitated shaping the expectations of these soldiers in a way that allowed them to conceive of themselves as (potentially) economically self-sufficient and productive instead of dependent on the state due to their disabilities. As Perry shows, using the example of the Siemens corporation in Berlin, companies helped promote these ideas not only by employing individuals with physical disabilities but also by finding that they could be more rather than less productive and efficient than nondisabled workers. She also elucidates the activities of the Supreme War Office (Kriegsamt), newly created in 1916, which assumed control over examination policies and funneled injured soldiers through central hospitals throughout their convalescence, conducting inspections and evaluations on-site, with the mission of classifying as few soldiers as possible as no longer fit for war duty. In an excellent microstudy, Perry considers how these policies played out in Saxony. Apart from a few typographical errors, the scholarship presented in this book is meticulous. Anyone familiar with the disparate nature of topic-related materials dispersed over a variety of archives will appreciate Perry's ability to locate the archival sources and perform a sophisticated, erudite analysis of them. Yet, while the book provides a major contribution to the understanding of the ways in which physical conditions were medicalized and defined as disabilities in Germany during World War I, it is also myopic. For example, occasional exceptions notwithstanding, this book does not venture much beyond Germany during the war for the purpose of comparing and contrasting the developments she describes in the context of other European war powers. Her study ends rather abruptly in 1918: it neither addresses the status of war-induced physical disability in the Weimar Republic nor does it discuss how the policies and innovations she addresses played out in the postwar period. Furthermore, the book does not discuss mental and psychiatric disabilities resulting from the war. A discussion of the similarities and differences of medical approaches to those types of disabilities would have been useful, particularly given extant studies suggesting that many practitioners of military psychiatry during and after World War I were suspicious of claims that the experience of war itself had serious and lasting consequences for mental health. Informed by eugenics and racial hygiene, they tended to blame endogenous factors for the development of psychoses in soldiers. As such, they represented a faction within psychiatry and medicine that began to distinguish between those who...

Historical Trajectory of Men in Nursing in India.

IntroductionDuring 100 BC, the world perceived that the nurses are meant for rendering care to the sick individuals. During 600 to 700 BC, the nurse was considered as the one who attends to the patient, is pleasant in his or her demeanor, does not speak ill of anybody, is attentive to the requirements of the sick, and follows the instructions of the physicians. The men who were wise and passionate to help the sick were trained by a medical teacher for years together who later became a doctor. India is the pioneer country in developing the formal nursing curriculum. With the emergence of British and establishment of East Indian Company and Imperial Government, the nursing education became more formalized. No men came forward to nursing. Only women have opted nursing and were employed as nurses. Very few men were trained as nurses informally and were sent for war field to take care of the injured soldiers. It took several years to elevate the standards of male nurses.MethodsThe data were retrieved from the records of Tamil Nadu Archives and Historical Research, Chennai, Tamil Nadu, India. The written permission was obtained from the commissioner for collecting the data retrospectively. All the collected data were checked for its consistency by matching the data again with the retrieved database.ResultsGreat British Government has brought the reformations in bringing up the working standards of male nurses. The reformation and renaissance of male nurses started in 1938, and it reached a level of recognition in 1950. The male nurses were recruited in 1938, but they reached the position of a head nurse by 1950.ConclusionThe male nurses had a long journey to overcome the hurdles in their practice and professional advancement. In recent years, the male nurses are identified for their extraordinary contribution in the delivery of health care.

Franz Zamecnik Infanterist – Invalide – Feinmechaniker Gesichtsrekonstruktionen während des Ersten Weltkrieges in der k.u.k. Monarchie

In the course of the fighting at the fronts of World War I, the introduction of new projectilesled to an unanticipated number of head injuries, catching the military leadershipand casualty medical support unprepared. Since the military saw the frequency of facialinjuries as an imminent danger to its forces, it determined that specialists were neededto treat facial injuries quickly and effectively.Maxillofacial doctors were confronted with a new situation. On the one hand, due todisfigurements, it became necessary to address psychological issues in treatments, andon the other hand, military leaders demanded treatment methods that would make thelargest number of soldiers fit for battle as quickly as possible. From this point on, medicalactivity was viewed as a quantifiable resource by the military and was actively integratedin warfare.The main question is: How did the injured soldiers deal with disfigurements? A reviewof existing patient files reveals different approaches soldiers took to come to termswith their facial injuries. There were patients whose complete resignation culminated insuicide and others who drafted self-confident designs for living; Franz Zamecnik’s reaction,presented in this essay, is an example of the latter.The soldiers’ and doctors’ perspectives must be assessed against the background ofinstitutional medicine and the military.

Review of massive transfusion protocols in the injured, bleeding patient.

Massive haemorrhage is a significant cause of mortality and morbidity in a variety of clinical settings, although most research has been related to trauma patients. Military studies from recent conflicts found that higher ratios of plasma to red blood cells (RBCs) were associated with increased survival in injured soldiers, and subsequent trials in civilian populations showed similar decreased mortality. Over the last decade, massive transfusion protocols (MTPs) have become an important component in the treatment of the massively bleeding patient. This review is intended to summarize the more recent findings and trends in massive transfusion. There have been several observational studies suggesting that higher ratios of plasma to RBC and platelets to RBC are associated with improved survival but there is a paucity of randomized studies relating to specific ratios, dosages, timing, and guidance. Other studies have developed and assessed scoring systems used to initiate MTPs and specific tests used to guide MTPs. Finally, the specific blood components and adjuncts that constitute a MTP are the subject of further ongoing research. The absence of a universal definition of massive bleeding or massive transfusion, heterogeneity in patients suffering from massive bleeding, and the difficulty in predicting which patients will require a massive transfusion all contribute to the difficulty of studying massive transfusion. However, there is evidence that higher plasma : RBC ratios correlate with improved survival, and that adjuncts to transfusion play a key role. Furthermore, recent validations of massive haemorrhage scoring systems should allow more consistent and appropriate triggering of massive transfusions.

A history of Stoke Mandeville Hospital and the National Spinal Injuries Centre.

Stoke Mandeville Hospital and the National Spinal Injuries Centre (NSIC) are renowned worldwide for the successful treatment of spinal injuries and as the birthplace of the Paralympic movement. The emergence of the spinal centre was a direct result of the setting up of the Emergency Medical Services in the Second World War to treat injured soldiers. This paper documents the history of the hospital as a whole and the influence of the NSIC in particular on the overall facilities leading up to and after the building of the modern NSIC in 1983.

Artificial intelligence, robotics and digitalization in the concept of military surgery of the German medical service

As in other areas, military surgery is being transformed by developments in artificial intelligence, robotics and digitalization. Although the prospect of operating with arobot-assisted surgery system in the country of deployment while the responsible surgeon is in Germany is still along way off, the training of military surgeons and the treatment of injured soldiers on deployment would nowadays be unimaginable without the digitalization of surgery in the armed forces. The structure of the medical environment in German clinics places restrictions on training that is close to operational reality. In the daily routine it is not possible to carry out the necessary numbers of deployment-relevant emergency surgical procedures under the expected conditions. Such procedures thus require the use of appropriate simulators or simulated scenarios that are as close to reality as possible. Although military surgeons are qualified in at least two specialist areas, the availability of telemedicine on deployment is helping to noticeably improve the treatment of injured soldiers. Telemedical consultation with colleagues in Germany makes it possible, for example, to reach joint decisions across different branches and disciplines. Until now it has not been possible to substitute the attending surgeon in the country of deployment with robot-assisted surgery systems or even robots for carrying out life-saving and stabilizing procedures; however, in order to provide surgeons with the necessary tools to successfully operate in situations where there is ashortage of personnel and materials in an inhospitable environment, use is made of the means that are currently available in the German medical services and constant efforts are made to explore the future possibilities of digital simulation. This article shows the reader the current status of digitalization in surgical training and deployments in the German armed forces.

Cliveden: The Canadian Red Cross Hospital, William Osler and the 'Taplow Affair'.

At the start of the First World War, the estate of Cliveden was offered as a hospital to the Canadian Government by its owner William Astor. This article describes its history, Sir William Osler's involvement in the hospital, and the involvement of other doctors and some of their research. The rehabilitation programs to help the injured soldiers are described, including the physical, occupational, sporting and social activities undertaken in order to help them towards their return to civilian life. Political ambitions in Canada and friction between the owner of Cliveden, Nancy Astor, and the medical/military establishment led to turmoil which engulfed Osler and is known as the 'Taplow Affair'. The hospital was dismantled after the war but became re-activated in the Second World War and is now a National Trust property.

STOICISM AND WAR WOUNDS: MUCIUS SCAEVOLA, SERGIUS SILUS AND QUINTUS SERTORIUS

Soldiers sustaining battle wounds was both an historical reality as a popular literary theme in the Late Republic and the Early Empire. Battle scars were often instrumentalised as tokens of bravery on the battlefield and equated with military honours, symbolising true virtus . In this paper we analyse how some ancient authors constructed the behaviour of injured soldiers in their writing based on stoic ideals such as an indifferent attitude towards damaged body parts. We further argue that these literary depictions served as powerful metaphorical exempla that had educative and moral purposes not restricted to a military context but in a broader sense, relevant for all aspects of life. The targeted readership was encouraged for introspection and to discern popular from philosophical views in their own frame of mind on achieving virtus . In addition, a stoic framework was cleverly selectively deployed against boasting soldiers and their ideological allies which proved to be very efficient.

Reading war photographs: the 1971 India–Pakistan war in the Anglo-American press

This article examines photographs of the 1971 India–Pakistan war published in the Anglo-American newspapers: The New York Times and The Times (London) and magazines: Life, Newsweek, Time, and The Economist. The images projected the war as a spectacle and predominantly used photographic conventions associated with non-journalistic images. The photographs showcased a rather frank representation of the 1971 war, displaying images of failed military operations, dead or injured soldiers, POWs, and revenge killings. However, some of these candid documentary war photographs offer archival value in that they challenge and complicate historical amnesia and partial accounts of the war and conflict in India, Pakistan, and Bangladesh.

“Commercial Battles of Self-Support”: Concrete Construction and the Disabled World War I Veteran

As the First World War drew to a close, its demobilization— or the redistribution of labor in the war’s aftermath— became a pressing question across industries in the United States, including the field of reinforced concrete construction. This essay explores an emerging conceptualization of disability in these years as it informed how other forms of work might be understood. A provocation by Albert Kahn (on the possibility of incorporating injured soldiers into the production of reinforced concrete) and the research of Frank and Lillian Gilbreth (on concrete and on the retraining of disabled soldiers and workers) offer starting points in understanding a new economic subjectivity that was entailed in the work of industrial building.

ETIKA PEREMPUAN DI RUANG PUBLIK : PEMAHAMAN TEMATIS-KORELATIF HADIS-HADIS TENTANG PEREMPUAN

In the Islamic point of view, there is no prohibition for women to play a role in the publik scene. Even since the time of Rasulullah SAW, the role of women in the publik scene has occurred. Women at the time of the Prophet were present in the study attended by men, actively participating in spreading the religion of Islam, even women also participated in wars, treated and took care of sick, injured soldiers and provide for their eating and drinking needs. This shows the association of men and women in publik spaces is allowed. However, this does not mean eliminating barriers between men and women, and forgetting the restrictions of sharia prevailing in meetings that men and women participate in. Therefore, it is necessary to know the ethics for women when in the publik scenes, according to the guidance of the Qur'an and Sunnah. This research uses library research method by reviewing the verses and hadis that discuss the issue of women ethics while in publik scenes.

Bonds of Kinship and Care: RAMC Photographic Albums and the Making of ‘Other’ Domestic Lives

Abstract This article critically interrogates the nature of facial wounds themselves, their visceral, dehumanising quality, visibility, and social meaning. Little attention has been paid to the cultural ramifications and difficult questions concerning the futures of facially injured soldiers that Britain had to address in the post-war era. Focusing on photograph albums as socially salient objects, this article challenges medical photographic archives. Building on unexplored family archives, it revises understandings of the difficulties of veterans' homecoming, and how they achieved a level of emotional recovery as they tried to find a place in the post-war social fabric. The article argues that family photographic collections show the less obvious way that the war lived on for veterans and families, its damage and how it was passed on. These private collections offer new revelations on the success or failure of the surgical interventions in their aesthetic aims.

The Life and Work of Nikolai Ivanovich Pirogov (1810-1881): An Outstanding Anatomist and Surgeon.

Nikolai Ivanovich Pirogov is considered one of the most important anatomists and surgeons in the history of medicine. The Russian physician conducted more than 11,000 dissections and meticulously studied human anatomy, discovering important anatomical regions such as Pirogov's triangle. Pirogov developed surgical methods and techniques used by physicians for many decades such as Pirogov's amputation. Pirogov is also known for his contribution to war medicine, given his experience practicing medicine in the Crimean War as a surgeon, where he introduced innovative methods for the treatment of injured soldiers. Pirogov’s most important contribution to the scientific community is his humanistic and democratic mentality—which he maintained until the end of his life—elements necessary for the evolution of every modern physician and scientist.

Machaon: the first trauma surgeon in Western history?

Homer's epics, the Iliad and the Odyssey, written between 800-700 BC, offer valuable information about what medical practice meant at that time. Descriptions of injuries and care given can be found among the 26,000 verses of these poems. During the Trojan War many warriors possessed empirical knowledge of wound care. However, Machaon and his brother Podalirius were the chief medical officers of the Greek army as it besieged Troy. Machaon was acting mainly as a trauma surgeon, while Podalirius was a physician. The original texts of the Iliad and Odyssey, as well as relevant literature and references, were methodically studied for extraction of adequate information about the life and work of Machaon. He provided medical care to injured soldiers and officers, and performed small operations. He treated the wound of King Menelaus of Sparta, the co-chief of the Greek army and many others. He was also a talented warrior, participating in many battles around the walls of Troy. When he was injured, the Greeks rallied around him so that he would not be taken or killed by the enemy. Since he had the knowledge and the ability to save lives, his life was considered equal to that of many men. Future generations would worship him as god protector of surgery. Machaon's techniques and skills can be considered to constitute the origins of modern surgery and trauma management at the dawn of western civilisation.

La Greffe Générale: the voice of French facially injured soldiers

Like the combatants on the frontline, the wounded soldiers of the First World War wrote and published newspapers during the sometimes lengthy periods of time they spent in hospital. La Greffe Générale is the journal written by and for facially injured combatants treated at the Val-de-Grâce military hospital in Paris. Throughout the eight issues released between December 1917 and July 1918, the voices of these men can be heard. While the surgeons’ perspective prevails in most remaining documents to do with French maxillofacial wards, La Greffe Générale gives an insight into the experiences of injury and treatment from the point of view of the wounded and convalescent combatants. The specific challenges faced by facially injured men are reflected in their writings, as this article shows. At the same time, their newspaper is in itself an attempt to respond to some of these issues. Ultimately, the patients’ publication reveals how gueules cassées, as French disfigured veterans came to be known, tried to collectively cope with their changed lives. The ethos reflected in, and fuelled by, La Greffe Générale played, this article argues, a significant part in the later constitution of the facially disfigured men’s organisation, the Association des Gueules Cassées.

An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport.

Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. Historically, evaluations of ERC and patient outcomes have been based on retrospective analyses of incomplete data sets that provide limited insight on ERC practices. Little evidence exists to determine if current training is adequate to care for the most common injuries seen in combat trauma patients. Simulation technology facilitates a standardized patient encounter to enable complete, prospective data collection while studying provider type as the independent variable. Information acquired through skill performance observation can be used to make evidence-based recommendations to improve ERC training. This IRB approved multi-center study funded through a Congressionally Directed Medical Research Program grant from the Combat Casualty Care Intramural Research Joint En Route Care portfolio evaluated Navy ERC providers. The study evaluated 84 SMT, ERC RN, and physician participants in the performance of critical and secondary actions during an immersive, high-fidelity, patient transport simulation scenario focused on the care during an interfacility transfer. Simulation evaluators with military ERC expertise, blinded to participant training and background, graded each participant's performance. Inter-rater reliability was calculated using Cohen's Kappa to evaluate concordance between evaluator assessments. Categorical data were reported as frequencies and percentages. Performance attempt and accuracy rates were compared with likelihood ratio chi-square or Fisher's exact test where appropriate. Tests were two-tailed and we considered results significant, that is, a difference not likely due to chance exists between groups, if p < 0.05. Confidence intervals were used to present overlap in performance between provider types. Critical and secondary actions were assessed. A majority of providers completed at least one of the critical life-saving actions; only one participant completed all critical actions. Evaluation of critical actions demonstrated that a tourniquet was applied by 64% of providers, blood products administered by 46%, needle decompression performed by 51%, and a complete handoff report performed by 48%. Assessment of secondary actions demonstrated analgesic was accurately administered by 24% of all providers, and 44% reinforced the "hemorrhaging amputation site dressing." Over 98% of participants failed to properly perform all critical actions during the interfacility transfer scenario, which in a real-life combat casualty transport scenario could result in a preventable death. Study results demonstrate serious skill deficits among all types of Navy ERC providers. These data can be used to improve the training of Navy ERC providers, ultimately improving care to injured soldiers, sailors, airmen, and marines.

Aeromedical Battlefield Evacuation Under Endogenous Uncertainty in Casualty Delivery Times

We propose a new medical evacuation (MEDEVAC) model with endogenous uncertainty in the casualty delivery times. The goal is to provide timely evacuation and medical treatment to injured soldiers. The model enforces the “Golden Hour” evacuation doctrine, attempts to maximize the expected number of severely injured soldiers evacuated within one hour without delay, and represents the availability of air ambulances as an endogenous source of uncertainty. The MEDEVAC model is a mixed-integer nonlinear programming problem whose continuous relaxation is in general nonconvex and for which we develop an algorithmic method articulated around (i) new bounding techniques obtained through the solution of restriction and relaxation problems and (ii) a spatial branch-and-bound algorithm solving conic mixed-integer programs at each node. The computational study, based on data from Operation Enduring Freedom, reveals that the bounding problems can be quickly solved regardless of problem size, the bounds are tight, and the spatial branch-and-bound dominates the CPLEX and BARON solvers in terms of computational time and robustness. Compared to the MEDEVAC myopic policy, our approach increases the number of casualties treated timely and can contribute to reducing the number of deaths on the battlefield. The benefits increase as the MEDEVAC resources become tighter and the combats intensify. The model can be used at the strategic level to design an efficient MEDEVAC system and at the tactical level for intelligent tasking and dispatching. Data are available at https://doi.org/10.1287/mnsc.2017.2894 . This paper was accepted by Yinyu Ye, optimization.

Ahmed Saadawi’s Frankenstein in Baghdad: A Tale of Biomedical Salvation?

This article examines the Iraqi novel Frankenstein in Baghdad (2013, English translation 2018) by Ahmed Saadawi. It explores Saadawi’s reimagining of the original creature from Mary Shelley’s Frankenstein (1818) in post-2003 Baghdad as a being built out of the corporeal remains of Iraqi civilians killed in waves of political violence. The essay shifts critical attention from the metaphorical significance of this creature to the medical logic of its anatomy, bringing the novel into conversation with US narratives of ‘biomedical salvation’ (Jennifer Terry) that emphasized the medical advances catalyzed through treatment of injured coalition soldiers and from which Iraqi civilian casualties were excluded. I argue that Saadawi’s novel mirrors structural elements of these biomedical salvation narratives while ultimately destabilizing their logic, exposing the disturbing biosocial realities in post-2003 Iraq and their material consequences.

Incorporation of Humanitarian Programs: Ukraine’s Experience

Mr Aeschlimann tells the story of the establishment of the International Committee of the Red Cross and its main activities. He notes that the Committee was founded by Henri Dunant from Switzerland. The symbol of Red Cross was not a coincidence; Henri Dunant associated it with health protection. It is also noteworthy that the symbol resembles the flag of Switzerland. Since the very inception, the primary responsibility of the organisation was taking care of injured soldiers and captives; later on, it started to help abused people. Soon enough, the organisation began to provide food to the people in need. Mr Aeschlimann also emphasises that the International Committee of the Red Cross has worked in line with the principles of international humanitarian law and cooperated with states for its improvement since its foundation and adoption of the First Geneva Convention. The legal aspect is also an important part of the organisation’s work. In general, the Committee has a broad range of activities, totally depending on the state of a conflict or domestic violence. The International Committee of the Red Cross launched aggressive activities in 2014, following the outbreak of the military conflict in the east of Ukraine. The organisation pays much attention to the following aspects related to its operation in Ukraine: the conflict was unleashed between nations with similar mentality and is of highly politicised and polarised character. Representatives of the organisation act not only in the territory under Ukrainian control but also in the occupied territory. Mr Aeschlimann mentions that the most challenging aspect of working in Ukraine is to adjust to the fast pace of drastic changes in the country due to sweeping reforms and transition economy. Moreover, the organisation faced certain difficulties in providing humanitarian assistance, but currently all the subtleties have been settled and the ICRC is operating in favourable conditions. Among the priority tasks of the International Committee of the Red Cross, the following can be singled out: expansion of activities, namely measures on the search for missing persons, expansion of a program of support of psychosocial and psychological health. Special attention is drawn to provision of first aid to people near to the collision line. Mr Aeschlimann also tells how he chose this profession, his free time taking into account a busy working schedule, and his favourite places in Ukraine. Keywords: the International Committee of the Red Cross, the ICRC mission, the First Geneva Convention, humanitarian assistance, conflict.