Military Medical Care Research Articles

Addressing Differences in Knowledge and Experience in Trauma Care Capabilities Among an International Team of Military Medical Care Providers in a Deployed Setting.

Military medical personnel are crucial in providing life-saving care at the point of injury (POI) in challenging environments such as combat zones and disaster areas. This article examines the specialized training US Military medical personnel undergo before deployment and the increasing trend of deploying as part of multinational forces in operations like those in Afghanistan with NATO and non-NATO countries. Integrating medical teams from diverse backgrounds poses significant challenges in maintaining a cohesive and efficient team due to varying trauma management training standards and medical practices among the allied forces. Tactical Combat Casualty Care (TCCC) training and the development of clinical practice guidelines (CPG) by the US Joint Trauma Service have been key strategies by the US Military to standardize care. However, the variation in trauma management training among NATO allies and the differences in medical subspecialties and approaches can lead to inefficiencies and reduced effectiveness in a multinational trauma center setting. For instance, the approach to trauma care can significantly differ between the US and European countries, impacting the interoperability and teamwork in multinational medical teams. To address these challenges, the article highlights the importance of standardized medical training programs that include cultural awareness to enhance the effectiveness of multidisciplinary, multinational medical teams. It also underscores the necessity for standardized international trauma training in the face of increasing global conflicts and the potential for large-scale combat operations. The article discusses the "Trauma Tuesday" program implemented in Kabul, Afghanistan, as an example of how intensive training and simulation exercises can improve team dynamics, knowledge, and skills in trauma management among a diverse team from various nations. The need for ongoing education and developing a standard for managing trauma patients in international teams is emphasized to ensure effective communication and coordination. The article suggests that multinational trauma training can significantly improve team cohesion and critical life-saving skills, essential for future battlefields where access to definitive care may be delayed. Further research is recommended to explore the best methods for achieving effective multinational medical team integration and training standardization.

Infection with klebsiella and pseudomonas in mine-blast wounds: frequency of their isolation at the third stage of evacuation; spectrum of their resistance; sensitivity to antimicrobial drugs; general rules of military medical care

Introduction. During the war that has been going on in Ukraine for two years, the number of patients with mine-blast injuries has increased dramatically. The issue of wound colonization by resistant microorganisms and modification of their species spectrum, which increases during the evacuation of victims to various medical facilities, is of great importance. At the third stage of wounded military personnel evacuation 87.7 % of wounds were occupied by gram-negative bacteria in the form of monoculture, including strains of Pseudomonas aeruginosa and Klebsiella pneumoniae with multidrug resistance, which have a high potential for adaptation in hospital conditions. The aim of the study. To investigate the frequency of infection with Klebsiella and Pseudomonas of mine-blast wounds at the third stage of evacuation, to determine the spectrum of their resistance, sensitivity to antimicrobial drugs, and to present general recommendations for military medical care. Materials and methods. The material from purulent wounds was taken from victims with mine-blast injuries who were admitted for inpatient treatment to the surgical department. The sampling was carried out with sterile swabs with transport nutrient medium. The material was inoculated on blood agar, Endo medium, CHROMID® P. Aeruginosa Agar, MPA and incubated at 37°C for 24 hours. Biochemical identification was performed using the Enterotest 24 and Nefermtest 24 test systems (Lachema, Czech Republic). Antimicrobial susceptibility testing was performed using the Kirby-Bauer method and the determination of the minimum inhibitory concentration (MIC) using broth microdilutions according to the recommendations of the European Committee for the Antimicrobial Susceptibility Testing (EUCAST 2023). Healthcare-associated infections (HCAI) among the wounded servicemen were diagnosed according to the updated MoH Order No. 1447. Results. K. pneumoniae and P. aeruginosa were isolated from the wounds of 38 examined mine-blast injured patients. Out of these 17 (44.7 %) patients had P. aeruginosa; in 9 patients both pathogens were in association; in 2 patients P. aeruginosa was isolated in pure culture; in the remaining cases P. aeruginosa was in association with other microorganisms. Quantitatively, the bacteria were isolated in the range of 106-109 colony forming units (CFU/ml) of pathogen in the patient’s wound contents. In wounded servicemen, infectious wound complications appeared later than the 3-rd day of hospital stay, so they were classified as HCAI. 33.3 % and 22.2 % of K. pneumoniae isolates demonstrated susceptibility to amikacin and imipenem, respectively. Moderate susceptibility of P. aeruginosa to amikacin was detected in 29.4 % of isolates, and to ticarcillin-clavulanate – in 23.5 %. 41.2 % of P. aeruginosa isolates demonstrated sensitivity to piperacillin-tazobactam, 23.5 % – to imipenem, and 11.8 % – to ceftazidime. No significant difference was detected between the susceptibility of Pseudomonas and Klebsiella strains to imipenem (p more than 0.05). It was recorded absolute susceptibility of K. pneumoniae and P. aeruginosa strains to colistin. In total 92.3 % of P. aeruginosa and 90.7 % of Klebsiella isolates were represented by multidrug-resistant strains. Timely and thorough primary surgical treatment of the wound and correct antimicrobial treatment reduce the risk of wound infection. Conclusions. K. pneumoniae and P. aeruginosa were isolated from 44.7 % of wounded servicemen with mine-blast trauma at the third stage of evacuation. There was an increase in the frequency of multidrug-resistant strains of K. pneumoniae (90.7 %) and P. aeruginosa (92.3 %). The isolated strains of K. pneumoniae and P. aeruginosa that induced healthcare-associated infections were hospital-acquired. All isolates were susceptible to colistin. High-quality treatment of wound requires complete elimination of microorganisms prior to further rehabilitation stages.

Participation of public organizations and people of the Middle Volga region in the charity movement during the period of the Russo-Turkish war of 1877–1878

The article is devoted to the history of private charity in the Middle Volga region during the Russo-Turkish War of 1877–1878. It analyzes various aspects of the charitable and volunteer movement organized by the population of the provinces of the Middle Volga region. The article shows the role and degree of participation of the population in charitable activities and support for state policy during the war. Special attention is paid to the initiative of ordinary citizens, public organizations and private companies in the formation of the necessary material and technical base, military medical care and gathering donations to the Army.

Establishment ofthe Clinician-Scientist Investigator Opportunity Network to Develop Military Medical Research Leaders.

The ability of military clinicians to conduct military medical research is often limited because of competing priorities and a lack of research mentorship. The Clinician-Scientist Investigator Opportunity Network (CSION) was developed with the intent of training clinicians how to engage in requirements-driven research within the DoD. Three to five academic medical faculties were selected from a pool of applicants each year to participate in a 2-year research fellowship. To be eligible for the CSION program, applicants had to meet the following criteria: (1) Completed residency graduate medical education training, (2) not be currently enrolled as a graduate medical education trainee, and (3) obtained permission from their department leadership to focus 25% of their duty hours on CSION participation to include didactic and research efforts. The remaining 75% of fellows' time was dedicated to clinical duties. Monthly didactics, intensive mentorship, and consistent support were offered to each fellow by the CSION leadership team. Metrics were recorded to include both research and clinical productivity. Between January 2019 and December 2022, 12 CSION fellows graduated from the program (four in the class of 2020, three in 2021, and five in 2022). From 2019 to 2021, the 12 CSION fellows initiated 204 research protocols, generated 489 publications/presentations, and secured 33 research grants. All graduates of the program remain active in clinical research with multiple graduates currently assigned to research positions. The CSION research education program is a 2-year additional duty research fellowship producing clinician-scientists conducting military-relevant medical research and publications and may be considered a low-cost/highly efficient alternative to achieve the reported benefits of the MD-PhD tract. The expansion of the CSION program may improve the quality of military medical research and health care.

Military Medical Training at the Central Institute for the Advanced Medical Education in the Second Half of the 1930s

The paper describes the initial stage in the organization of military medical training at the Central Institutefor Advanced Medical Education (CIAME), now the Russian Medical Academy for Continuous Professional Educationat the Ministry of Health of the Russian Federation, Moscow. The problem statement in this study is the first of itskind in Russian historiography. The research relied on the documents found in the Russian State Archive of Scientificand Technical Documentation and the Archive of the Russian Medical Academy of Continuous Professional Education.The decision to establish a military medical department at the CIAME was made in 1936. The authors identified the main tasks and challenges the new department had to face, as well as solution methods, areas of theoretical and practical training,and curriculum. The article also describes the role of the CIAME in the Battle of Khalkhin Gol in 1939 and the WinterWar of 1939–1940. In the second half of the 1930s, the CIAME medical staff acquired experience in military medicaltraining and medical care in combat conditions, which proved invaluable during the Great Patriotic War of 1941–1945.

Case of gunshot injury to the liver by a hand-made modified sniper bullet: organ-preserving surgical management with damage control tactics and transpapillary biliary decompression

Combat penetrating gunshot injuries are frequently associated with damage to the liver. A bile leak and an external biliary fistula (EBF) are typical complications. Biliary decompression is commonly applied for the management of EBF. Furthermore, there is insufficient data available regarding the characteristics of combat trauma and its management in the context of ongoing hybrid warfare in East Ukraine.
 A 23­year­old male was admitted with a thoracoabdominal penetrating gunshot wound (GSW) that was caused by a high­energy multiple metal projectile (a fragmented sniper bullet). Damage control tactics was applied at all 4 levels of military medical care. Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, and placement of a biliary stent were used for evaluation and biliary decompression. Stent occlusion was treated with stent replacement and scheduled ERCP. Partial EBF was diagnosed based on the primary wound defect of the liver and was closed without surgical intervention on the 34th day after injury. Acute cholecystitis was associated with ERCP and was managed with cholecystostomy.
 The combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective, along with the application of damage control tactics. Scheduled ERCP is effective for the management of EBF, so liver resection can be avoided. The transpapillary intervention with stent placement was successfully used for biliary decompression. Early post­traumatic stent occlusion can be diagnosed and effectively managed by scheduled ERCP as well as stent replacement with a large­diameter stent inserted as close as possible to the site of bile leak.

Five Influential Factors for Clinical Team Performance in Urgent, Emergency Care Contexts.

In deployed contexts, military medical care is provided through the coordinated efforts of multiple interdisciplinary teams that work across and between a continuum of widely distributed role theaters. The forms these teams take, and functional demands, vary by roles of care, location, and mission requirements. Understanding the requirements for optimal performance of these teams to provide emergency, urgent, and trauma care for multiple patients simultaneously is critical. A team's collective ability to function is dependent on the clinical expertise (knowledge and skills), authority, experience, and affective management capabilities of the team members. Identifying the relative impacts of multiple performance factors on the accuracy of care provided by interdisciplinary clinical teams will inform targeted development requirements. A regression study design determined the extent to which factors known to influence team performance impacted the effectiveness of small, six to eight people, interdisciplinary teams tasked with concurrently caring for multiple patients with urgent, emergency care needs. Linear regression analysis was used to distinguish which of the 11 identified predictors individually and collectively contributed to the clinical accuracy of team performance in simulated emergency care contexts. All data met the assumptions for regression analyses. Stepwise linear regression analysis of the 11 predictors on team performance yielded a model of five predictors accounting for 82.30% of the variance. The five predictors of team performance include (1) clinical skills, (2) team size, (3) authority profile, (4) clinical knowledge, and (5) familiarity with team members. The analysis of variance confirmed a significant linear relationship between team performance and the five predictors, F(5, 240) = 218.34, P < .001. The outcomes of this study demonstrate that the collective knowledge, skills, and abilities within an urgent, emergency care team must be developed to the extent that each team member is able to competently perform their role functions and that smaller teams benefit by being composed of clinical authorities who are familiar with each other. Ideally, smaller, forward-deployed military teams will be an expert team of individual experts, with the collective expertise and abilities required for their patients. This expertise and familiarity are advantageous for collective consideration of significant clinical details, potential alternatives for treatment, decision-making, and effective implementation of clinical skills during patient care. Identifying the most influential team performance factors narrows the focus of team development strategies to precisely what is needed for a team to optimally perform.

Activities of the Russian Red Cross society in Buryat-Mongol Autonomous Soviet Socialist Republic in the years of the Axis aggression

The purpose of the study is to identify the features of the functioning of the Russian Red Cross society on the territory of the Buryat-Mongol Autonomous Soviet Socialist Republic in 1941–1945. In the article, the author reveals the main areas of activity of the regional Red Cross society, which included training of personnel for sanitary work (nurses, orderlies, squads); assistance in the deployment and further operation of evacuation hospitals; participation in the organisation of military medical trains and care for the wounded; preparation of donor blood; training the population to provide first aid; assistance to health authorities in carrying out educational and educational work on sanitary defence. In addition, various forms of activity of the population itself in obtaining medical skills, especially the youth of the republic, have been analysed. The scientific novelty lies in the fact that a number of previously unpublished sources are put into circulation, collected directly for this study. This made it possible to highlight some details that previously could not be reflected in other works. As a result of the study, it was determined that the activities of the regional society adhered to the main directions of the work of the Russian Red Cross Society and, despite the difficulties that arose, was quite effective in a difficult wartime.

Imperial Acculturation on Russian’s Southeastern Frontier: An International Survey

This article reviews and summarizes the results of an international survey of experts about Imperial Acculturation Policy and the Problem of Colonialism (based on the materials from the Ural-Volga and Central Asian territories) organized in Orenburg in 2019. The questionnaire asked participants to reply with their thoughts about the characteristic features of the Russian Empires policy of "developing" the nomadic and semi-nomadic peoples of the Kazakh steppe, Bashkiria, Kalmykia on its southeastern frontier from the 18th to the early 20th centuries. Key questions included: The basic terminology (acculturation, imperial acculturation policy); The heuristic value of the acculturation model with respect to the colonial approach. Nomadic and semi-nomadic perceptions of Russian citizenship; The governments efforts to civilize its nomadic and semi-nomadic subjects; The impact of military service, public education and medical care; The role of the Russian Orthodox Church in imperial acculturation policy; The persistence of ethnic identity; General trends in acculturation. The conclusion reflects on using the acculturation model to understand the integration the southeastern nomadic periphery into the Russian Empire.

The Formation of Authorities of the Soviet Socialist Republic of Lithuania and Belarus on the Example of the People’s Commissariat for Health Care at the Beginning of 1919

The article presents an analysis of the formation and activity of the People’s Commissariat for Health Care of the Socialist Soviet Republic of Lithuania and Belarus at the beginning of 1919. The basic structure of the Commissariat was worked out on the basis of various sources. It was found that, due to the outbreak of the 1919–1921 Polish-Soviet war, the efficiency of the Commissariat during its time in Vilnius was limited. The relative stabilisation of the health-care management system was achieved after the Commissariat was evacuated to Minsk, and later to Bobruisk, away from the front line. It has been proven that at the beginning of the Polish-Soviet war, military and civil medical care was combined in a single system, and all medical professionals in the Lithuanian-Belarusian Soviet Republic were required to do military service. The worsening of the military situation for the Red Army in Lithuania and Belarus determined the split of the Health Care Commissariat into two separate divisions: the field division for medical care for Soviet troops near the front line, and the civil division for helping civilians.

Neonatal Thermoregulation: A Golden Hour Protocol Update.

Premature infants are poor regulators of body temperature and are subjected to environmental factors that can lead to rapid heat loss, leaving them vulnerable to an increased risk of morbidity and mortality from hypothermia. Thermoregulation protocols have proven to increase survival in preterm infants. To evaluate a Plan-Do-Study-Act (PDSA) cycle on a previously implemented Golden Hour protocol at a military medical care facility for infants born at less than 32 weeks of gestation and weighing less than1500 g. Specific aims included the use of increased delivery/operating room temperatures and proper use of thermoregulatory devices (polyethylene bags and thermal mattress). Outcomes were analyzed and compared using a pre/postdesign. The data was collected using the neonatal intensive care unit admission worksheet. Although statistical analysis was not significant, clinical significance was illustrated by a decrease in hypothermia rates on admission and at 1 hour of life. There was a 100% compliance rate with increasing delivery room/operating room temperatures and thermal mattress use. Polyethylene bag use compliance was 50%. Golden Hour protocols have proven to be an effective tool. Thermoregulation is a significant component of these protocols, and it is imperative that every step is taken to manage the environmental temperature during the birth and admission process. There is a need for continued research on the impacts of thermoregulatory devices and protocols, with resulting practice and device recommendations.

A Mixed Methods Approach to Define Tactile Requirements for a Part-Task Trainer

In response to the incidence of oculofacial traumas that were observed during the wars in Iraq and Afghanistan, military medical care provider training programs have placed an increased focus on the treatment of ocular traumas. As such, the Lateral Canthotomy and Cantholysis (LCC) Training System was developed to simulate the anatomy of the human eye and to mimic the symptoms of an eye that is afflicted with a retrobulbar hemorrhage. We report a mixed-methods psychophysics study that was conducted during the development of the LCC Training System to determine the appropriate retrobulbar pressure to be simulated by the trainer to provide anatomically accurate sensations of pressure. More than 200 eye inserts with either pre-or post-LCC pressures were evaluated by oculofacial trauma subject matter experts. The captured evaluations enabled the research team to identify and specify the pressure requirements that would be used by manufacturers to produce an anatomically and tactically-accurate trainer.

P027 TRANSITION OF CARE OF ACTIVE DUTY PATIENTS WITH IBD TO THE VETERANS ADMINISTRATION HEALTHCARE SYSTEM: TOOLKIT FOR SUCCESS

The shift from being an active duty military patient with inflammatory bowel disease (IBD) seen in a military treatment facility (MTF) to being a veteran receiving chronic illness care within the Veterans Administration (VA) is a time of increased vulnerability and risk for loss of continuity of care, and poor disease outcomes. A transitional care program must prioritize the psychosocial growth, self-efficacy and disease-specific knowledge of active military patients who are transitioning to VA care as well as enhance collaborative management between military and VA providers. The Department of Defense (DoD) has established the Transition Assistance Program (TAP) to assist military members to civilian life, but limit preparedness in skills to navigate/understand medical care. There is currently no available data on transition readiness from active duty military medical care to VA medical care and our objective is to determine the feasibility and acceptability of a self-management intervention.

P027 TRANSITION OF CARE OF ACTIVE DUTY PATIENTS WITH IBD TO THE VETERANS ADMINISTRATION HEALTHCARE SYSTEM: TOOLKIT FOR SUCCESS

Abstract The shift from being an active duty military patient with inflammatory bowel disease (IBD) seen in a military treatment facility (MTF) to being a veteran receiving chronic illness care within the Veterans Administration (VA) is a time of increased vulnerability and risk for loss of continuity of care, and poor disease outcomes. A transitional care program must prioritize the psychosocial growth, self-efficacy and disease-specific knowledge of active military patients who are transitioning to VA care as well as enhance collaborative management between military and VA providers. The Department of Defense (DoD) has established the Transition Assistance Program (TAP) to assist military members to civilian life, but limit preparedness in skills to navigate/understand medical care. There is currently no available data on transition readiness from active duty military medical care to VA medical care and our objective is to determine the feasibility and acceptability of a self-management intervention. Methods: We prospectively measured readiness with the use of the IBD Self-Efficacy Scale (IBD-SES) and Transition Readiness Assessment Questionnaire (TRAQ). All enrolled patients (50 active duty servicemembers) were in disease remission and underwent TAP and 50% were further randomized to undergo TRAQ-based educational and behavioral interventions via mobile applications and clinical consults. Results: Servicemembers who underwent further TRAQ-based interventions compared to those only undergoing TAP demonstrated significant improvement in medication/appointment management, tracking/managing health issues, and talking with providers (p&amp;lt;0.001). Furthermore, these servicemembers also demonstrated significant improvement in self-efficacy and self-management which was maintained up to 3 months post military discharge (p&amp;lt;0.001). Servicemembers had an average VA primary care wait time of 3.5 months and for Gastroenterology specialist of 5.4 months, resulting in &amp;gt;60% of servicemembers having to discontinue therapy due to lapse in care (50% rate of flares) and unnecessary therapy switch. Conclusion: This is the first and only study to assess transitioning from active duty service to VA medical care for a chronic illness. We demonstrated improved and sustained self-efficacy outcomes with a transition program for IBD along with potential limitations in the VA transition. We have an opportunity to influence the conversation of appropriate DoD transition of medical care and to develop a model of care with wider applicability.

Research on motion pattern recognition of exoskeleton robot based on multimodal machine learning model

Exoskeleton as a real-time interaction with the wearer’s intelligent robot, in recent years, becomes a hot topic mouth class research in the field of robotics. Wearable exoskeleton outside the body, combined with the organic body, plays a role in the protection and support. By wearing an exoskeleton robot, it is possible to expand the wearer’s athletic ability, increase muscle endurance, and enable the wearer to complete tasks that he or she cannot perform under natural conditions. Based on the above advantages, the exoskeleton robot in military medical care and rehabilitation has broad application prospects. This paper describes the multimodal model of machine learning research status and research significance of the text on the exoskeleton robot applications, and on the basis of a detailed study of gait. It mainly involves: analysis and planning and obtaining motion information processing, pattern recognition and analysis of gait and the gait conversion process, and the EEG and joint position, foot pressure, such as different modes of data as input to machine learning models to improve the timeliness, accuracy and safety of gait planning. Since the common movement process involves the transformation process of gait, this paper studies the gait transformation process including squatting, walking on the ground and standing.

Medicalised Battlefields: The Evolution of Military Medical Care and the ‘Medic’ in Japan

Summary During the tumultuous Meiji era (1868–1912), medicine, war and the relationship between them changed significantly in Japan, in reaction to the expansion of western imperialism. During this era of reforms, which coincided with the rise of humanitarianism and the modernisation of international warfare, a new role emerged at the intersection of war and medicine: the medic. Medics were paradoxical figures, serving as soldiers whom the military trained to provide care but forbade to fight. The medic evolved continuously as army leaders and the army’s medical department repeatedly redefined it in light of knowledge obtained from abroad and of accrued wartime experience. This article explores how the role evolved out of discrepancies between learned, planned and encountered realities and argues that the invention and reinvention of the medic mirrored attempts to redefine not only medicine’s role in battle, but also medical care, where it was to be provided and by whom.

‘The lure of war’: reconsidering the motivations of nurses to volunteer in the First World War

ABSTRACTThis article argues that the motivations for British women to volunteer for the First World War were more nuanced and complicated than the formulaic binaries of patriotism versus pacifism. It reads the war-time memoirs of two women in military medical care, May Sinclair’s A Journal of Impressions in Belgium and Olive Dent’s A Volunteer Nurse on the Western Front to demonstrate how understandings of gender roles and nationalist affiliations rendered complexity to the reasons why certain women volunteered for war-work. These two women volunteered very early in the war and published their life-writing during the war (1915 and 1917 respectively). Consequently, they did not have the advantage of hindsight, and their writings were the product of the immediate pressures of the war environment. By reading the memoirs of these women and unpacking their overt motives to volunteer, this article reveals the nuances in the reasons women volunteered to engage in military medical work during the First World War.

Chinese expert consensus on the treatment of modern combat-related spinal injuries

The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

CPR performed in battlefield emergency care

IntroductionDuring military missions medical care is provided to military personnel as well as civilians. Although cardiopulmonary resuscitation (CPR) may not be a common task in a military field hospital, all personnel need to be trained to deal with cardiac arrest.MethodsThis study was a comparative simulation study. Participants (n=36) from the Swedish armed forces performed CPR for 2 minutes at one of three different locations: at ground level, a military bed, or a transportable military stretcher. Compression depth and rate after 2 minutes of CPR and at the time of the participants’ own request to be relieved were measured. Descriptive and inferential analysis was conducted. ResultsThere is a direct correlation between compression depth and working level, concluding that the higher working level, the lower the compression depth. There is in total an overall low percentage of participants within limits for correctly conducted CPR regarding both compression depth and rate. Time to fatigue is related to working level, where increased level results in early fatigue. ConclusionThe quality of CPR is affected by the level at which it is performed. The quality of CPR was satisfactory when working at ground level, but suboptimal when working at hospital bed level or military stretcher level. When working at raised levels, participants appeared to misjudge their own compression depth and rate. This may indicate that changes are needed when CPR is practised in the military hospital setting. Future studies regarding the use footstools are required due to the height of military beds and transportable stretchers.

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People’s Liberation Army (PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level I facilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level II facilities. At Level III facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.