Medical Corps Research Articles

Jeremy Oliver Neil Lawson

Jeremy Oliver Neil Lawson studied medicine at St Mary’s Hospital Medical School on a Kitchener’s scholarship (1947-53). At medical school he sailed for United Hospitals Sailing Club and played water...

Obituary: Dr Leslie David Payne

Dr Leslie David Payne died on 24 May 2018 from an illness bravely borne. The Royal Army Medical Corps (RAMC), the wider military medical and particularly the security service community...

314 Treatment With Intravenous Fluid Therapy Was Not Associated With Improved Survival Among Patients With Ebola Virus Disease: An International Multisite Cohort Study

To evaluate the association between crystalloid intravenous fluid (IVF) therapies and mortality outcomes among patients with Ebola Virus Disease (EVD). This retrospective cohort study accrued patients with EVD admitted to 5 International Medical Corps run Ebola Treatment Units (ETU) in 2 countries during the 2013-16 epidemic. Standardized treatments with antimicrobials and nutritional supplementation were provided to all patients, however IVF was administered based on clinical indication and resource availability. The outcome of interest was 28-day survival compared between cases exposed to IVF therapies and those not. To control for patient and epidemic specific time varying factors cases were temporally reweighted on their viral load at triage and clinical symptoms based on each day of treatment using inverse probability weighting adjustments for receipt of IVF therapies. Bootstrap sampling techniques were used to derive 95% confidence intervals (CI) and assess for significance between comparison groups. There were 424 cases analyzed, of which 354 (83.5%) received treatments with IVF therapies. The mean age was 30.5 years and 57.0% were female. The most common case symptoms included diarrhea (86%), anorexia (81%), vomiting (77%), fever (77%), and dysphasia (59%). Cases treated with IVF therapies were found to have no significant difference in proportional survival as compared to those not treated with IVF therapies at 0.31 (95% CI: 0.21-0.48) versus 0.38 (95% CI: 0.25-0.64), respectively (p=0.367). Among cases suffering mortality within 28-days mean survival durations were 5.5 (95% CI: 4.8-6.5) days among those who received IVF therapies and 5.7 (95% CI: 5.1-6.7) days for those not treated with IVF therapies (p=0.257). Although mortality was greater among cases that received IVF there were no significant differences in survival outcomes, suggesting minimal utility for a therapy requiring relatively high-resource allocation and greater provider risk in epidemic settings.

Abstract: Tranexamic Acid: Current Practices and Administration Protocols in Aesthetic Plastic Surgery in Israel

PURPOSE: Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a promising agent for reducing perioperative bleeding and subsequent blood transfusion without an increase in complications and adverse events. This accumulating evidence has led to its adoption by the Israeli Defense Forces Medical Corps as well as in a variety of elective surgical procedures in various fields. Despite its great popularity among plastic surgeons in Israel, an optimal dosing regimen has not yet been described. This study presents the current practices of TXA usage in plastic and reconstructive surgery among members of the Israeli Society of Plastic and Aesthetic Surgery towards the establishment of standardized guidelines for optimum administration. METHODS: An online survey was sent to all members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS). The survey was organized into three general parts: (1) demographic data and practice profiles, (2) familiarity, perceptions, and experience with TXA in various aesthetic plastic surgery procedures, and (3) TXA administration protocols including dosage, mode, and time of administration. RESULTS: 103 Israeli plastic surgeons completed the survey. 86% of respondents use TXA routinely in aesthetic surgery. The most common procedures performed under TXA are face-lift (81%), abdominoplasty (71%), rhinoplasty (55%), and liposuction (47%). The most common breast procedures are breast reduction (60%), mastopexy (51%) and breast augmentation (52%). However, 96.5% of responders report the lack of an official TXA protocol in their department or clinic. The majority of respondents give TXA as an IV bolus after/before skin incision (68%). Other modes include a bolus followed by topical TXA (31%), a bolus followed by maintenance infusion (5%), infusion alone (18%), or topical alone (14%). Oral administration and other combination regimens were also fully reported and are described in detail. The majority of respondents use a standard IV bolus dose ranging from 0.5 gr to 10 gr, regardless of weight, with the most popular dose being 1 gr (47%). The most common TXA solution concentration used for topical administration is 1 mg/ml (42%). Respondents who use TXA routinely reported reduced perioperative blood loss (54%), improved surgical field (53%) and precision (29%) and easier postoperative recovery with less ecchymosis and edema and/or faster return to social activity (75%) following TXA administration. No thrombotic events were reported (0%). No correlation was found between respondent characteristics and the dose or mode of administration of TXA in aesthetic procedures (p>0.05). CONCLUSION: This is the first study to provide a broad view of TXA’s utility of use in aesthetic plastic surgery, as well as a contemporary appraisal of administration protocols. The results emphasize the efficacy and well-documented safety profile of TXA and its important role in a variety of aesthetic procedures, in addition to its use in craniofacial and orthognathic surgery. The authors encourage plastic surgeons to report their TXA protocols and emphasize the need for further prospective studies with a large sample size and standardized blood loss measures to establish guidelines for optimum TXA administration in different plastic and reconstructive surgery procedures.

Dispatches from the editor: highlights of the September 2018 issue

Welcome to the September issue of the Journal of the Royal Army Medical Corps , containing 18 original submissions covering the breadth and depth of current military medicine.[1–18][1] Transfusion support...

Douglas Waddell Jolly (1904-1983) - New Zealand pioneer of modern battlefield surgery.

New Zealand-born surgeon Douglas Jolly was studying in London at the outbreak of the Spanish Civil War. He joined a British volunteer medical team and in December 1936 was placed in charge of a mobile medical unit of Spain's Republican Army. For the following two years, he took part in every major battle of the war, operating as close as possible to the front line. In that time he made significant contributions to trauma surgery, especially for abdominal injuries, and developed a 'three-points-forward' triage system. He described these medical innovations in a handbook which became highly influential among Allied medical services in Second World War, Korea and Vietnam. Jolly served with the Royal Army Medical Corps (RAMC) in the Middle East during Second World War and was awarded a military OBE.After the war, he became Chief Medical Officer of Queen Mary's Orthopaedic Hospital, Roehampton. He has been described as 'a pioneer in the field of surgical treatment for trauma and one of the most notable war surgeons of the 20th century.' In belated local recognition of this innovative and dedicated pioneer of trauma surgery, a memorial to Jolly will be unveiled in his home town of Cromwell, New Zealand in 2018.

Richard Emmott Shaw

Richard Emmott Shaw was born in Ravensthorpe in the West Riding of Yorkshire. He came from a family of corn millers. Educated at Mirfield Grammar School, he then studied medicine...

Transnational Exchange in the Nazi New Order: The Spanish Blue Division and its Medical Services

This article uses the case of the Spanish Blue Division to examine the history of transnational exchange and cooperation within the Nazi New Order. In particular, it explores the experiences of the Blue Division's medical services, which were required to engage most closely with the international environment of the Eastern Front. The Blue Division and its medical services shed new light on this topic in a number of different ways. Firstly, they show how the New Order was experienced by those from outside the core Axis states of Germany and Italy, and beyond the minority of ideologically-committed fascist fellow travellers. Secondly, volunteers within the medical corps help to illustrate how the New Order was perceived as a forum for scientific, intellectual and professional exchange, building on the traditional prestige of German science and pre-war practices of international scientific cooperation. Finally, integrating the perspectives of junior officers and rank-and-file troops helps to move beyond the political and cultural elites who dominate the literature on the New Order to show how cooperation and exchange worked on the ground. In particular, it demonstrates where the limits to this cooperation lay, and how individuals dealt with the tensions and conflicts between different national groups.

Structured decision-making for the management of a biological fieldable laboratory during outbreaks: a case for European Union Civil Protection Mechanism (EUCPM)

Fast on-scene deployment of an analytical laboratory capacity to help contain an outbreak of infectious disease requires setting up an appropriate policy framework and a range of operating procedures to ensure efficient support to decision-making, as well as the optimal engagement and use of dedicated resources. This work focuses on fully autonomous deployment when the mobile capacity operators themselves need to make decisions and implement all the operational functions (OFs), from basic needs like provision of equipment, power supply, food and accommodation for the staff, to complicated procedures like logistics of transportation and supply chain. A model of the identity and structure of specific decision-making requirements for a generic deployment of laboratory capacities was built from the real experience during specific deployments of the operators and managers of the Belgian capacity Biological Light Fieldable Laboratory for Emergencies (B-LiFE). Self- and external assessments were conducted and lessons learned successively reviewed after each deployment by B-LiFE laboratory operators and managers and observers in the framework of European demonstration projects and joint exercises. The result was consolidated by integrating the assessment of European Commission-appointed certifiers during the certification procedure of B-LIFE as a self-sufficient module of the European Medical Corps, namely the European modules exercise “Modex” in April 2017 (Revinge, Sweden) followed by the “ModTTX 4” Table-top in May 2017 (Bruges, Belgium). A complete and updated set of Fieldable Laboratory operational functions is presented, including their contents, cross-links, inter-dependencies, information needs for implementation, and related decisions.

Alan Stanley Ogden

Alan Stanley Ogden was a general practitioner in Bournemouth from 1946 until his retirement in 1985. After house jobs, he served five years in the Royal Army Medical Corps, mostly...

Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study

BackgroundTargeted clinical interventions have been associated with a decreased risk of neonatal morbidity and mortality. In conflict-affected countries such as South Sudan, however, implementation of lifesaving interventions face barriers and facilitators that are not well understood. We aimed to describe the factors that influence implementation of a package of facility- and community-based neonatal interventions in four displaced person camps in South Sudan using a health systems framework.MethodsWe used a mixed method case study design to document the implementation of neonatal interventions from June to November 2016 in one hospital, four primary health facilities, and four community health programs operated by International Medical Corps. We collected primary data using focus group discussions among health workers, in-depth interviews among program managers, and observations of health facility readiness. Secondary data were gathered from documents that were associated with the implementation of the intervention during our study period.ResultsKey bottlenecks for implementing interventions in our study sites were leadership and governance for comprehensive neonatal services, health workforce for skilled care, and service delivery for small and sick newborns. Program managers felt national policies failed to promote integration of key newborn interventions in donor funding and clinical training institutions, resulting in deprioritizing newborn health during humanitarian response. Participants confirmed that severe shortage of skilled care at birth was the main bottleneck for implementing quality newborn care. Solutions to this included authorizing the task-shifting of emergency newborn care to mid-level cadre, transitioning facility-based traditional birth attendants to community health workers, and scaling up institutions to upgrade community midwives into professional midwives. Additionally, ongoing supportive supervision, educational materials, and community acceptance of practices enabled community health workers to identify and refer small and sick newborns.ConclusionsImproving integration of newborn interventions into national policies, training institutions, health referral systems, and humanitarian supply chain can expand emergency care provided to women and their newborns in these contexts.

Maurice William Beaver

Maurice William Beaver was brought up in London and Cornwall during the second world war and was educated at Ilford County High School for Boys. In 1949 he went to...

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).

In Memoriam: Robert J. Hall, MD (1926–2018)

In Memoriam: Robert J. Hall, MD (1926–2018)

Sister Soldiers of the Great War: The Nurses of the Canadian Army Medical Corps by Cynthia Toman

<i>Sister Soldiers of the Great War: The Nurses of the Canadian Army Medical Corps</i> by Cynthia Toman

Philip Harker Newman (1911-1994): Dunkirk hero, war psychologist and orthopaedic surgeon to Sir Winston Churchill.

Philip Harker Newman an orthopaedic surgeon and a major in the Royal Army Medical Corps was left behind to man a casualty clearing station during the evacuation of Dunkrik in 1940. Newman was made a Prisoner of War and studied the adverse psychological effects of incarceration on his fellow officers. He escaped from Germany eventually returning to Europe for its liberation in 1944. He was awarded the Distinguished Service Order and Military Cross for his bravery. In 1946, Philip Newman was appointed consultant orthopaedic surgeon to The Middlesex Hospital and The Royal National orthopaedic Hospital, London. He became an internationally recognised authority on the management of spinal conditions including spondylolisthesis. In 1962, he operated with Sir Herbert Seddon (1903-1977) on Sir Winston Churchill who had sustained a fractured neck of femur following a fall in the South of France. Newman became President of The British Orthopaedic Association in 1976 and chairman of the Editorial Board of The Journal of Bone and Joint Surgery. In 1976, he was also awarded a CBE and wrote his wartime memoirs, Safer than a Known Way published in 1983.

Christopher William Grant

After qualifying and starting medical postgraduate training, Christopher William Grant was sent to Kenya for two years as lieutenant and then captain in the Royal Army Medical Corps, attached to...

Nigel B Sprague

Nigel B Sprague entered Durham School in September 1936, where he discovered rowing. This passion remained with him for the rest of his life. In 1940 he became a medical...

Unusual partnerships: The Corfe-McMurdie anaesthetic inhaler of 1918 and the 2nd Australian Casualty Clearing Station.

This World War 1 ether/chloroform vaporiser-inhaler was designed by and made for Captain Anstruther John Corfe by Private Eric Aspinall McMurdie, both of the 2nd Australian Casualty Clearing Station (ACCS), Australian Army Medical Corps (AAMC). It has a plaque attached labelled 25 May 1918. It is a perfect example of the ingenuity forced by the realities of war, and is one of the unique pieces in the Harry Daly Museum at the Australian Society of Anaesthetists (ASA) headquarters in Sydney, Australia. While serving in Blendecques, France, Private McMurdie ingeniously fashioned this vaporiser from discarded items he found on the battlefield. These included Horlick's Malted Milk bottles, on which he etched measurements for ether and chloroform, and a spent brass artillery shell, which made the heating component of the inhaler. The 2nd ACCS triaged and operated on thousands of troops, and this inhaler is a reflection of the skills and innovative expertise of the staff of the 2nd ACCS which included X-rays to localise foreign bodies, and locally made splints and apparatus to treat trench foot.

Major Barbara Stimson: A Historical Perspective on the American Board of Surgery Through the Accomplishments of the First Woman to Achieve Board Certification.

: Dr. Barbara Bartlett Stimson, AB, MD, MedScD, FACS (1898-1986) was a pioneering orthopedic surgeon from a prominent American family who, in 1940, became the first woman certified by the American Board of Surgery (ABS, certificate number 860). It would be another 7 years and approximately 2500 candidates before the next female surgeon would be certified. A member of the third class to admit women to Columbia Medical School and the second female surgical resident to complete training at Columbia-Presbyterian Medical Center, Dr. Stimson was a confident and exceptionally accomplished trailblazer for women in surgery. In this biographical sketch based upon documents from the ABS, and the archives of Vassar College and the College of Physicians and Surgeons at Columbia-Presbyterian Medical Center, Dr. Stimson's motivations, attitudes, and unique accomplishments emerge as testimony to the exceptional career of this driven, self-possessed woman. Stimson was undaunted by the sex-based conventions of her time, and achieved a notable career as a surgeon in the profession she loved; first honing her skills at a busy urban fracture service in New York, then serving with distinction in the Royal Army Medical Corps during World War II, and finally returning to the states to become a respected leader in her field. Her life story and unprecedented ABS certification affirm her conviction that proven skill and ability can be used as a means of overcoming unfounded biases, and helped pave the way for future generations of board certified female surgeons in the United States.