UK Defence Medical Services Research Articles

Caring for the carers: an evaluation of the recovery, readjustment and reintegration programme (R3P)

IntroductionThe challenges faced by healthcare workers, not least during the response to the COVID-19 pandemic, have been extensively studied, and concerns continue to be highlighted in relation to their long-term...

Diamedica Draw-over Vaporiser: bench testing the UK Defence Anaesthesia System in the deployed environment

IntroductionThe Diamedica Draw-over Vaporiser 2 (DDV2) is the sevoflurane vaporiser used by the UK Defence Medical Services to provide deployed volatile general anaesthesia. The Defence Anaesthesia System employs the DDV2...

Secure app-based secondary healthcare clinical decision support to deployed forces in the UK Defence Medical Services

BackgroundModern instant messaging systems facilitate reach-back medical support for Defence Medical Services (DMS) by connecting deployed clinicians to remote specialists. The mobile app Pando (Forward Clinical, UK) has been used...

The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial.

Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034. PRR1-10.2196/49918.

The 2022 monkeypox outbreak: A UK military perspective.

With the emergence of SARS-CoV-2 and now monkeypox, the UK Defence Medical Services have been required to provide rapid advice in the management of patients with airborne high consequence infectious diseases (A-HCID). The Defence Public Health Network (DPHN) cadre, consisting of closely aligned uniformed and civilian public health specialists have worked at pace to provide evidence-based recommendations on the clinical management, public health response and policy for monkeypox, with military medicine and pathology clinicians (primarily infectious disease physicians and medical microbiologists). Military environments can be complicated and nuanced requiring specialist input and advice to non-specialists as well as unit commanders both in the UK and overseas. DPHN and military infection clinicians have close links with the UK National Health Service (NHS) and the UK Health Security Agency (UKHSA), allowing for a dynamic two-way relationship that encompasses patient management, public health response, research and development of both UK military and national guidelines. This is further demonstrated with the Royal Air Force (RAF) Air Transport Isolator (ATI) capability, provided by Defence to support the UK Government and UKHSA. Military infectious disease clinicians are also embedded within NHS A-HCID units. In this manuscript we provide examples of the close interdisciplinary working of the DPHN and Defence clinicians in managing military monkeypox patients, co-ordinating the public health response, advising the Command and developing monkeypox policy for Defence through cross-government partnership. We also highlight the co-operation between civilian and military medical authorities in managing the current outbreak.

Public health and military health.

This paper summarizes the role of Public Health specialists within the UK Defence Medical Services (DMS). The armed forces have a need for expert advice on health improvement, health protection and healthcare public health. The first professor of military hygiene, Dr Edmund Parkes, was a leading pioneer in the public health movement of the late 19th century. Since then, the armed forces have evolved the term 'hygiene', though 'health', to 'well-being'. Military doctors with an interest in medical administration and the health of populations have longstanding links with their civilian peers, through the Society of Medical Officers of Health and its successor the Faculty of Public Health. The specialty of Public Health in the armed forces is multidisciplinary, following the same educational pathway as civilian peers. The speciality has made important contributions during global health emergencies including the Ebola outbreak in 2014 and the recent COVID-19 pandemic. Although a small cadre, within the DMS and in the UK Public Health workforce, they have an important role in keeping our armed forces ready for operations. We celebrate the 50th anniversary of the Faculty of Public Health and expect that the DMS will contribute to the further development of the specialty.

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

IntroductionThe acquisition and retention of militarily relevant surgical knowledge and skills are vital to enable expert management of combat casualties on operations. Opportunities for skill sustainment have reduced due to...

Intraoperative fluid irrigation for traumatic wounds

We present the first systematic review conducted by the UK Defence Medical Services in conjunction with the Cochrane Collaboration. Irrigation fluids are used to remove contamination during the sur...

Defence Healthcare Engagement: A UK Military Perspective to Improve Healthcare Leadership and Quality of Care Overseas.

Defence Healthcare Engagement (DHE) describes the use of military medical capabilities to achieve health effects overseas through enduring partnerships. It forms a key part of a wider strategy of Defence Engagement that utilises defence assets and activities, short of combat operations, to achieve influence. UK Defence Medical Services have significant recent DHE experience from conflict and stabilisation operations (e.g. Iraq and Afghanistan), health crises (e.g. Ebola epidemic in Sierra Leone), and as part of a long-term partnership with the Pakistan Armed Forces. Taking a historical perspective, this article describes the evolution of DHE from ad hoc rural health camps in the 1950s, to a modern integrated, multi-sector approach based on partnerships with local actors and close civil-military cooperation. It explores the evidence from recent UK experiences, highlighting the decisive contributions that military forces can make to healthcare leadership and quality of care overseas, particularly when conflict and health crisis outstrips the capacity of local healthcare providers to respond. Lessons identified include the need for long-term engagement with partners and the requirement for DHE activities to be closely coordinated with humanitarian agencies and local providers to prevent adverse effects on the local health economy and ensure a sustainable transition to civilian oversight.

Combat casualty care: advances in torso trauma and lessons learned from two decades of conflict

AbstractThe last two decades have resulted in rapid developments in the management of torso trauma in injured military personnel. Through international collaboration and targeted research strategies, the UK Defence Medical Services have been at the fore-front of these developments. This review explores the key partnerships and areas of research that have enabled these successful developments to occur.

Nurse education in the British armed forces.

Defence nurses form the largest registered specialty in the UK defence medical services. Once qualified, defence nurses maintain and develop their nursing and clinical skills in appropriate healthcare settings, and can be deployed in operational environments such as Afghanistan. Workforce planning and staffing establishment levels are defined to meet the needs of British armed forces, allies and, potentially, local populations. Since the workforce is geographically dispersed, deployed or undertaking non-clinical duties, there are constraints on nurses' attempts to maintain basic skills and access continuing professional development. This article explores the concept and the developing role of defence nurse lecturers in improving educational support for defence nurses.

Nursing and medical contribution to Defence Healthcare Engagement: initial experiences of the UK Defence Medical Services

IntroductionThe WHO Constitution enshrines ‘…the highest attainable standard of health as a fundamental right of every human being.’ Strengthening delivery of health services confers benefits to individuals, families and communities,...

Military assistance to the civil authority: medical liaison with the Manchester clinicians after the Arena bombing

UK Defence Medical Services’ personnel have experienced an intense exposure to patients injured during war over the last decade and a half. As some bitter lessons of war surgery were...

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

This paper provides the definitive record of the UK Defence Medical Services (DMS) lessons from the organisation of medical services in support of Operation (Op) TELIC (Iraq) and Op HERRICK...

DMS research and MODREC – a guide for potential researchers

AbstractFollowing and during recent conflict, the UK Defence Medical Services (DMS) research programme has resulted in significant advancements in care. There are opportunities to work in medical research with the backing of either MOD funding and/or 3rd sector support. Research may require Ministry of Defence Research Ethics Committee (MODREC) approval, a process that can be daunting and confusing for those new to research. Often researchers have a finite period in which to complete their research; any delay in the process can be frustrating and may decrease the effectiveness of the research period. Here, we use recent experience to describe the development of a research idea and its submission through the MODREC process. We identify considerations and potential pitfalls in order to streamline and inform the process for those considering DMS research in the future.

Audit of annual medical appraisal and revalidation activity across the UK Defence Medical Services 2013–2014

AimTo provide the first annual audit of Defence Medical Services (DMS) medical appraisal and revalidation activity.ContentA questionnaire-based survey of appraisal and revalidation activity within the 2013–2014 appraisal year (1 April...

Nurse-delivered focused echocardiography to determine intravascular volume status in a deployed maritime critical care unit

Focused echocardiography is increasingly used by clinicians to guide fluid resuscitation. The UK Defence Medical Services (DMS) have adopted focused echocardiography as a tool to guide flow assessment and resuscitation in deployed critical care. We aimed to explore whether two focused echo techniques, namely Inferior Vena Cava (IVC) and Left Ventricular Outflow Tract Velocity Time integer (LVOT VTi) respiratory variability could be taught to a group of critical care nurses without previous exposure to ultrasound imaging. After a five-week program of training, validation was carried out on healthy volunteers. The mentor, an accredited focused echo trainer, and six nurses performed a total of forty-eight scans on eleven volunteers. The mentor and students acquired subcostal long axis views of the IVC and apical five chamber views using a high frequency linear ultrasound probe. Mean values from three measurements were obtained for IVC diameter and LVOT VTi. Minimum and maximum values were recorded for both variables across a full respiratory cycle. Echo images were saved and at least two images for each student were reviewed offline by an accredited echo-training supervisor. In all cases students were able to obtain adequate echo windows. There was good correlation between values recorded by the mentor and students for both IVC diameter (r = 0.90, p < 0.001) and LVOT VTi (r = 0.77, p < 0.001). Bland Altman analysis showed good correlation with minimal bias for VTi measurements. There was some increase in bias for IVC measurements below 1.2 cm. In summary, we found that these skills for assessing intravascular volume status could be acquired in a relatively short time by specialist nurses without previous experience, and that results were comparable to those produced by an experienced practitioner.

Introducing ‘The Diverse Nature of Defence Healthcare’ university module for DMS personnel

Over the past 10 years the UK Defence Medical Services has deployed healthcare personnel to a variety of operational areas in support of UK Operations. The unique nature of every...

Operation GRITROCK: the Defence Medical Services’ story and emerging lessons from supporting the UK response to the Ebola crisis

This paper is a record of the UK Defence Medical Services (DMS) contribution to the UK response to the Ebola crisis in West Africa from the start of planning in...

Human factors in complex trauma

### Key points Human factors are now integrated into everyday anaesthetic practice, as a result of the work performed over a decade ago looking at anaesthetists non-technical skills (ANTS).1 Much of this work was performed after key publications in the USA2 and the UK3 highlighting that human error and system design was responsible for patient harm. Subsequent high profile cases relevant to anaesthesia4,5 have brought to light where human factors failures have led to patient death. In 2010, the Royal College of Anaesthetists dedicated the entire Anniversary Meeting to Human Factors and published a supplement to the British Journal of Anaesthesia . Some of the human factors related to the trauma team are listed in Table 1. View this table: Table 1 Typical human factors relevant to the trauma team The 2007 report ‘Trauma: Who Cares?’6 highlighted the deficiencies in the delivery of trauma care in the UK, some of which resulted from failures in decision-making, communication, and team-work. Following on from this report, there has been the development of trauma centre networks around the country and a perceived improvement in trauma care delivery. The UK Defence Medical Services (UK-DMS) have attributed much of the success of their trauma care in Afghanistan to exemplary human factors,7 particularly in the organization, briefing, and co-ordination of the trauma team.8 This article will focus on a typical complex civilian trauma …