Adapting the Swedish Armed Forces medical services to meet new challenges

The land battle today is different from that of 20 years ago. It now occurs over vast areas, the fluid battlefield. Tanks have undergone important changes (cross-country capability, improved armor, and more lethal weapons). The combat units contain armored personnel carriers, providing protection for the soldier. The weapon effects on armored vehicle personnel are well studied and include ballistic, blast, thermal, and toxic injury. However, casualty statistics for armored units are not extensively reported. The public acceptance of casualties, especially in peacekeeping operations, today is much lower than in the past. A study by the Swedish Armed Forces has identified the need for a new organizational structure. Casualties will be picked up on the battlefield by armored medical evacuation vehicles and transported directly to the battalion aid station. The training level of all medical personnel must be increased, using battlefield-related trauma courses and making better use of existing resources in the form of qualified medical practitioners.     

装甲车乘员爆炸伤研究进展

通过对以往战伤资料研究发现,早期装甲兵战伤中烧伤发生率高,四肢骨折、创伤性截肢比例增加,复合伤更多,死亡率更高,与步兵战伤不同。随着新技术、新材料的应用,装甲车正面防护能力不断增强,当受到反装甲武器袭击时有相当一部分未被击穿。由于装甲车被击穿与否,导致乘员损伤的因素及机制不同,装甲兵战伤特点也随之改变,如四肢伤、多发伤、潜在脊髓损伤,伤情较轻,死亡率低;另外,创伤性颅脑损伤发生率高也可能与此有关。笔者就装甲车乘员爆炸伤研究进展进行综述。     

矩阵式太阳辐照模拟实验系统的设计与研制

目的 设计研制矩阵式太阳辐照模拟实验系统,用于开展装甲车辆舱室热舒适性测试、评价与控制技术研究.方法 以氙灯作为光源,设计可升降的矩阵式灯阵,结合计算机自动控制功能,实现整车的太阳辐照模拟.结果 系统可对装甲车辆顶面和左、右侧面进行辐照,辐照度在200~1200 W/m2范围内可连续变化,辐照面积和工作高度可根据车型大小和高低进行调整.结论 该系统可满足不同型号装甲车辆的太阳辐照模拟实验,为开展装甲车辆舱室热环境相关研究奠定了实验基础.     

装甲步兵某部春训期间训练科目与训练伤的分布调查分析

目的探讨装甲步兵在春季共同科目训练期间,训练科目与训练伤之间关系和分布特征。方法由驻军医院骨科医师和部队医务人员组成训练伤调查医疗组,采取逐一询问,以及查阅训练期间营、团卫生部门医疗登记。结果春训期间训练伤共发生78例,占参训人员的5·7%,400m障碍和5km越野发生训练伤占48·7%和39·7%。结论装甲步兵春训期间,在训练科目中400m障碍和5km越野发生训练伤率高,训练伤种类以四肢关节损伤和疲劳性骨折发生率高。     

对坦克内乘员的受伤特点和早期救治进行研究的意义和途径

在现代高技术局部战争中，坦克等装甲兵器既是主要的突击武器，也是攻击的重点，因而其乘员的伤亡与救治日益引起人们的重视。针对这一情况，作者从研究需求性、研究的真实性和结果的指导性三个方面论述了“作战兵器密闭舱室内人员受伤特点与救治原则”研究的意义，并从武器部门与医学单位结合的角度指出了研究途径，其中也特别指出军事合作研究的重要性。     

装甲步兵某部膳食营养状况短期波动的调查

目的在一个月的时间间隔内先后进行两次营养状况调查,以了解某装甲步兵基层连队膳食营养状况短期波动情况,为指导基层官兵合理营养提供实践指导。方法膳食调查采用称重法,体格检查包括测量身高、体质量、皮褶厚度（三头肌、肩胛下、髂嵴上）、腰围和上臂围。结果 与第一次调查结果相比,第二次人均每日摄入的粮食、畜肉、禽蛋、鱼虾、牛奶、大豆、蔬菜、干菜类减少,减少幅度在2.14%~43.25%,禽肉、蔗糖、植物油、食用菌的摄入量增加,增加幅度在4.23%~38.4%;与第一次比较,第二次人均每日摄入量增加的营养素有锌、硒、维生素A和维生素E,增加幅度在2.0%~28.0%,其余的营养素摄入量均减少,减少幅度在2.0%~27.6%。与第一次体格检查结果相比,第二次新兵的肩胛下皮褶厚度显著下降（P〈0.05）,新兵、老兵及合并计算的腰围值均显著降低（P〈0.05）。结论调查的连队膳食结构存在不合理现象。部队官兵的膳食组成、摄入的食物种类和营养素均存在短期波动性。     

Military casualties in Baranja and east Slavonia during the first 9 months of the war in Croatia.

The total number of Croatian Army soldiers killed in the period from the beginning of July 1991 until the end of March 1992 was 487. The number of severely wounded was 1,160, and 1,141 soldiers were slightly wounded. The ratio of the killed to wounded was 1:5, except in the municipality of Osijek, where it was 1:2.5. The number of casualties increased continually and culminated during November 1991, the period of fiercest fighting in this territory, followed by a gradual decrease. The most common mechanism of injury was explosives, which were responsible for almost half of all casualties (47.9%). An equal number of soldiers were killed by explosives and infantry weapons (46.4% and 44.9%, respectively). Casualties caused by motor vehicle crashes are not to be ignored, especially after the cease-fire agreement. Car crashes frequently resulted in death (from 4.5%-12.4%).     

装甲车辆乘员作业姿态测量系统的设计与实现

目的：设计用于装甲车辆乘员作业姿态测量系统。方法采用微机电系统（ MEMS）传感器采集4名乘员头部、颈部、躯干、四肢等重要部位姿态参数，红外追踪辅助测量校准驾驶员双臂姿态参数，利用无线收发器将数据传输至控制单元进行预处理，然后发送至数据采集器进行存储，事后数据传输给后端计算机，利用软件系统进行人体姿态参数处理与显示。结果与结论系统可完成乘员作业姿态参数的测试，为今后开展乘员运动学和动力学的分析提供手段。     

Annual training medical support for a Reserve Separate Infantry Brigade (Mechanized).

The authors have combined their experience of recent changes in the Health Service Support of a separate mechanized infantry brigade during 10-day field training exercises conducted by the same population, in the same geographical area, and in the same season in 4 consecutive years. The development of Health Service Support and the reasons necessitating its evolution are discussed. The impact of MedForce activities on training effectiveness is highlighted. The intensive use of health care providers in the most forward field medical treatment facilities, to include the nursing pool from the training support reserve hospital and Army Medical Department augmentation pool doctors, can alleviate unit medical staff shortfalls and provide exceptional training for unit medics "in house." The deployment of medical assets far forward and the maximization of "in situ" treatment of casualties prevents significant loss of training time and can prevent loss of life in combat. The authors recommend changing the medical care doctrine of Vietnam, from the life-threatening "scoop and run" doctrine to the life-preserving "doc in the box" doctrine presented in this article.     

野战条件下564例血尿调查分析

目的　调查分析野战条件下血尿 (FCH)的发生情况。方法　对直接参加战术合同训练实兵实弹对抗演习的各兵种一线干部战士发生血尿者由一线卫生人员立即进行尿样采集与血压监测 ,并填写血尿调查表。结果　 1 2 5 86例中共发生FCH者 5 64例 ,发生率为 4 48%;以步兵、装甲兵FCH发生率最高 (P <0 0 1 ) ;军龄以 9个月者发生率最高 (P <0 0 1 ) ;性别间FCH发生率比较无显著性差异 (P >0 0 5 ) ;血压升高者FCH发生率明显增加 (P <0 0 1 )。发生脱水者与无脱水者FCH发生率比较差异较显著(P <0 0 1 ) ;以无症状者为主 (P <0 0 1 )。结论　演习中FCH的发生可能与血压升高、脱水等有关     

Training incidents in armored vehicles in the Singapore Armed Forces

Training in armored vehicles presents occupational hazards. Since the inception of armored units in the Singapore Armed Forces in 1969, there has been no scientific study of the demographics of the trauma patterns. A review of existing literature also indicated a paucity of data on this subject. This article qualified and quantified the proportion of trauma during peacetime armored vehicle training during a 5-year period. Most of the 100 documented incidences of injuries occurred on the head and body limbs. Many injuries were caused by minor lacerations, abrasions, and crush injuries. Although fractures accounted for 24%, 65% of the total injury count could be classified as "minor." A diurnal pattern of injuries was noted in the study. The injury patterns could be used to analyze morbidity and mortality trends and facilitate subsequent evaluation of efficacy of affirmative action. New challenges facing further research in training injuries were also discussed.     

Ground crew injuries and fatalities in U.S. commercial aviation, 1983-2004

INTRODUCTION: Ground crew services are an essential part of airport operations. Injury hazards to ground crewmembers who are in close proximity to aircraft have not been well studied. The objective of this paper was to examine airport ground crew injuries and fatalities involving aircraft of commuter air carriers and major airlines. METHODS: Investigation reports for all ground crew injuries involving commuter and major airline aircraft that occurred at United States airports between 1983 and 2004 were obtained from the National Transportation Safety Board (NTSB) and analyzed to describe the immediate cause and pattern of injury occurrence. RESULTS: During the 22-yr study period, the NTSB recorded a total of 80 ground crew accidents involving landing, taxiing, or standing commercial airline aircraft, yielding an overall rate of 0.47 ground crew related accidents per 1 million aircraft departures. These accidents resulted in injuries to 98 ground crewmembers, including 21 fatalities. Two-thirds of the accidents took place as the aircraft was departing. Vehicular collisions with an aircraft made up 43% of accidents, 34% were caused by moving aircraft equipment such as propellers or nose gear, and 11% resulted from jet blasts or fires. CONCLUSIONS: intervention programs for airport ground personnel should emphasize the safe operation of the aircraft equipment and ground vehicles. Some of the injuries to ground crewmembers might be avoided through improved design of commonly used equipment.     

Prevention of psychoemotional disorders on a prolonged space flight by psychological support means

A number of supportive and rehabilitative measures forming so-called psychological support can be used to prevent potential psychoemotional disorders in crewmembers during prolonged space missions. The use of these measures in the Salyut--6--Soyuz 96--185-day space flights has shown their efficiency in terms of expansion of the "psychological living space" and maintenance of a high emotional and working tone of crewmembers.     

Off-duty preparation for overnight work in rotor wing air medical programs

INTRODUCTION: Air medical teams provide around-the-clock critical care, risking performance-altering fatigue from circadian disruption and sleep deprivation. Although safety is an essential issue in the air medical industry, there is little understanding of off-duty preparation for overnight shifts. METHODS: An anonymous survey was distributed to pilots and medical team members at participating programs with variable program, staffing, and shift models. Eighty responses from crewmembers working 12-hour night shifts (12N) were analyzed with appropriate t-tests and nonparametric tests. RESULTS: 12N crewmembers sleep significantly less in off-duty periods than before night shifts: 7.3 +/- 1.2 hours versus 4.8 +/- 1.9 hours (P < 0.01). Preshift sleep does not differ between crewmembers permitted on-duty rest and those for whom it is prohibited. 34.1% of 12N crewmembers permitted on-duty rest say they report to work planning to sleep. The minimum preshift sleep reported by 12N crewmembers before any shift in the past month averaged 2.4 +/- 2.3 hours, with 36.3% having worked overnight in the past month with no sleep before their shift On-duty rest permission was not a significant factor. Fifty-five percent of 12N crewmembers report outside employment (OE) in addition to their flight position. 12N crewmembers with OE averaged significantly less preshift sleep than those without OE: 4.4 +/- 2.1 hours versus 5.3 +/- 1.6 hours (P < 0.05). 54.5% of 12N crewmembers with OE described reporting to a flight shift within 8 hours of leaving their other job at least once within the past month. OE was more common when the flight program permitted on-duty rest (P < 0.01). CONCLUSION: Air medical team members report for 12N shifts with a significant sleep debt that does not differ between crewmembers permitted on-duty rest and those with on-duty rest prohibitions. More than half of flight team members surveyed have OE and many report for flight duty within 8 hours of leaving their other job. 12N shift crewmembers are at a particularly high risk for the consequences of fatigue. This is an important consideration as the industry develops on-duty rest guidelines to optimize safe operations.     

Composition of the water obtained after its sanitary and hygienic use by men and women

The composition of wash water used by men and women was investigated. The results were exposed to multifactorial statistical analysis using the method of principal components. The investigation allowed the following conclusions to be made: 1) wash water used by men and women is comparable in composition; therefore the sex of the crewmembers of space vehicles can be disregarded when designing water reclamation systems; 2) three parameters, viz. oxidizability, electric conductivity and chloride content, can be adequately used to assess the quality of utilized wash water; 3) the composition of wash water is largely dependent on the health status of its users.     

One aspect of training aircraft crews

This paper describes the psychophysical training of crewmembers of flying vehicles who may find it necessary to cross a water boundary or to remain for long in water after emergency splash-down. In order to prevent attacks of fear and panic caused by such frightful things as whirlpools and convulsions the paper presents data on the nature of turbulent processes in running water and the techniques of overcoming them as well as on the origin of convulsions in swimmers and methods of their alleviation. The paper also describes an easy method of how to have a rest when swimming that makes it possible to eliminate the feeling of fatigue by remaining motionless for an infinitely long time.     

Shifts in the mice blood-forming system and energy exchange of erythrocytes due to chronic exposure to chemical agents (acetone, ethanol, acetaldehyde) and radiation in concentrations and doses modeling the conditions in extended orbital mission

The paper presents the results of an investigation with mice subjected to isolated and successive exposure to a blend of chemical agents (acetone, ethanol, acetaldehyde) at MPC levels defined for piloted space vehicles followed by fractionated gamma-irradiation by daily 1 cGy (30 cGy total). The selected chemicals are the primary contributors to total air contamination and present in the prioritized list of compounds to be monitored to ensure air quality on piloted space vehicles. Radiation levels were determined with allowance for mice radiosensitivity to simulate the actual absorbed dose accumulated by crewmembers of orbital mission of up to a year in duration (10 cGy). Based on the findings in the hematopoietic system and erythrocyte biochemistry, energy exchange and redox parameters, pre-irradiation exposure to chemical agents within the MPC limits accentuated radiosensitivity gravely and, therefore, made mouse organism less tolerant to radiation. It was shown that adaptation of the hematopoietic system calls forth activation and significant straining of regulatory mechanisms equally in opposing to a single factor or combination of chemical and radiation exposure. The marked tension of these mechanisms persisted till day 30 of recovery.     

Immune responses and latent herpesvirus reactivation in spaceflight

BACKGROUND: Increased frequency and severity of herpesvirus infections are common in individuals with impaired cellular immunity, a phenomenon observed in both the elderly and astronauts alike. This study investigated immune responses and latent herpesvirus reactivation during a 9-d spaceflight. In addition, adrenocortical and immune responses of an elderly astronaut (payload specialist-2, PS2; age 77) who flew on this mission were compared with that of younger crewmembers. HYPOTHESIS: Spaceflight and associated stresses will decrease cellular immunity and reactivate latent herpesviruses. METHODS: Blood and urine samples, collected from the seven crewmembers who flew on the Space Shuttle Discovery (STS-95), were analyzed for levels of neuroendocrine hormones, leukocyte and lymphocyte subsets, and evidence of herpes-virus reactivation. RESULTS: Prior to flight, increased antibody titers to latent Epstein-Barr virus were found. During flight, acute changes in dehydroepiandrosterone sulfate (DHEAS) and cortisol resulted in a pronounced decrease in the DHEAS/cortisol ratio by the end of the mission for PS2 and a younger crewmember. Shedding of cytomegalovirus (CMV) in urine and increased CMV antibody titers also occurred inflight. At landing, the percent increases in adrenocorticotropic hormone and cortisol were greatest for PS2 as compared with the other six crewmembers. A significant neutrophilia also was observed in all crewmembers. Notably, PS2 had large increases in monocytes and natural killer cells at landing while other crewmembers showed little change or a decrease. CONCLUSIONS: These findings indicate that spaceflight and associated stresses reactivate latent herpesviruses and suggest that acute changes in neuroendocrine hormones mediate these changes in part by downregulating cellular immunity. Moreover, the similarities between aging and spaceflight suggest that the study of the immune system in elderly subjects may be useful as a predictive model for astronauts enduring long-term spaceflights.     

装甲车辆舱内有害气体自动监测与净化装置研究

目的研制适用于装甲车辆舱室环境的有害气体自动监测与净化装置。方法系统设计为传感器组、控制器和空气净化机3个模块,采用集成化和数字化测试技术、物理吸附结合化学催化技术以及耐低温与抗冲击减振技术研制样机,并对样机进行模拟实验和环境适应性实验。结果样机实现了对模拟舱内CO、NO2、SO2、挥发性有机物(VOCs)和烟/粉尘实时监测与自动净化的功能,启动14～16 min后舱内有害气体浓度均符合相关标准规定。结论该装置净化效果明显,满足装甲车辆车载设备环境适应性要求,具备了应用于实车的技术条件。     

装甲车辆舱内有害气体自动监测与净化装置研究

目的研制适用于装甲车辆舱室环境的有害气体自动监测与净化装置。方法系统设计为传感器组、控制器和空气净化机3个模块,采用集成化和数字化测试技术、物理吸附结合化学催化技术以及耐低温与抗冲击减振技术研制样机,并对样机进行模拟实验和环境适应性实验。结果样机实现了对模拟舱内CO、NO2、SO2、挥发性有机物（VOCs）和烟/粉尘实时监测与自动净化的功能,启动14～16 min后舱内有害气体浓度均符合相关标准规定。结论该装置净化效果明显,满足装甲车辆车载设备环境适应性要求,具备了应用于实车的技术条件。