Journal of the Royal Naval Medical Service最新文献

Sudden hearing loss can be both an immediately debilitating and long-term career-threatening condition within the militarypopulation. Careful assessment is key, particularly in an environment where heightened occupational risk factors maycontribute to or confound diagnoses, and where access to basic investigation may be limited.This article looks at the patient with a new presentation of sudden hearing loss in a military setting and, by providing keyfeatures and a structured approach to examination and basic investigation, how to consider key diagnoses through clinicalassessment alone.The acute management of sudden sensorineural hearing loss (SNHL) remains a difficult issue, particularly regarding theefficacy of treatment regimes to restore hearing. We have reviewed the evidence to help military medical personnel makewell-informed decisions when treating and making occupational assessment of those they have diagnosed with sudden hearing loss.

RFA ARGUS deployed on Operation (Op) GRITROCK between Oct 2014 and Apr 2015 to provide support to the United Kingdom (UK) response to the Ebola crisis. This article describes the radiology capability on board ARGUS within the Primary Casualty Receiving Facility (PCRF).

Non-Battle Injuries (NBI) represent a significant attritional threat to personnel deployed on operations. Operation (Op) GRITROCK involved personnel deployed across both land and maritime environments and was the first deployment of the Primary Casualty Receiving Facility (PCRF) on contingency operations of this type. This article outlines the incidence, demographics and functional outcome of individuals assessed for NBI by the embarked rehabilitation team. A total of 138 injured individuals were assessed over the period Oct 2014 - Mar 2015. ARGUS personnel made up 83.3% (n=115) of the injured population. Most common presentations were low back pain (LBP) (21%) and soft tissue lower limb injuries (14.5%), primarily occurring through individual sport (42.8%) or normal duty (34.8%). The Force Medical Rehabilitation Team (FMRT) effectively retained troops in theatre; although 22.5% (n=31) were considered urgent cases, only one individual required medical evacuation. 53.6% of presentations were exacerbations of a previous injury. Future work will examine the long-term outcome of these injuries.

British military personnel are frequently exposed to high altitude (HA) (>1500m). Operations in Afghanistan have occurred at altitudes of up to 3000m and there remains the possibility of rapid deployment of non-acclimatised troops to HA areas. British military personnel also deploy to HA frequently on Adventurous Training (AT) and there are numerous expeditions every year to the Greater Ranges. As such, there remains a reasonable likelihood of the development of high altitude illness (HAI) with potentially life-threatening consequences. This article aims to provide an overview of the adaptive (acclimatisation) and pathological (acute HAI) responses to HA exposure, with particular reference to military deployments.

Aims: To identify the prevalence, injury patterns and mortality of penetrating abdominal injury in patients treated at the UK Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan.

Methods: All patients with a penetrating abdominal injury were identified from the UK Joint Theatre Trauma Registry(JTTR). Demographics, predicted survival and observed mortality were compared. Sub-group analyses of UK military patients were conducted, comparing changes in survival as the campaign progressed and identifying the anatomical distribution of abdominal injuries.

Results: Between June 2006 and June 2013, 1331 of the 8558 (16%) patients recorded on the JTTR had a penetratingabdominal injury; 393 were UK military, of whom 175 (45%) survived. 71% of UK military fatalities had the maximum New Injury Severity Score (NISS) of 75 compared to 4.6% of UK military survivors. The survival rate of UK military patients increased in the later stages of the campaign. Fatal injury in UK military patients was associated with significant vascular or hepatic injuries.

Conclusions: This study has defined the epidemiology of penetrating abdominal injury in a modern conflict. Continuedtraining and further research into injury prevention and management will help to ensure that the improved outcomes observed in Afghanistan continue on future operations.

Anaphylaxis is a severe, life-threatening, generalised hypersensitivity reaction. It affects 1 in 1,333 (~0.08%) of the Englishpopulation during their lives, with 1% of cases being fatal. Management, underpinned by guidance from the ResuscitationCouncil (UK), focuses on a thorough clinical assessment and prompt administration of intramuscular adrenaline. Symptomsmay recur, so patients must be observed for a period of no less than six hours. In a deployed environment evacuation mustbe swift and into a safe environment capable of providing critical care support. There are clear occupational implicationsfollowing a case of anaphylaxis, and a confirmed case may affect service personnel’s fitness to deploy. This article willsummarise the management of anaphylaxis in Royal Naval personnel.