军事训练和军事作业眼外伤流行病学调查

目的 了解我军军事训练和军事作业眼外伤的流行病学特征.方法 将2005年1月1日-2009年12月31日在全军训练伤监测网点11所后送医院住院的军人眼外伤资料填入“部队医院军人眼外伤登记表”.眼外伤患者的流行病学资料包括受伤时间、地点、外伤类型、原因、检查、治疗和康复水平等,所有数据录入数据库进行统计分析.结果 共有军...     

Psychostimulants and military operations

Sleep-deprived individuals appear to have decreased psychological and physical capabilities. Studies have shown how major psychological aspects, such as alertness, complex mental performance, and memory, are strongly affected by sleep deprivation. Military use of psychostimulants dates back many years, especially in units that operate over long hours and deprive soldiers of sleep. During prolonged military operations, pilots are regularly kept awake for hours and days without fulfilling their biological sleep requirements. This consequently affects their natural circadian rhythm. This article deals with both the benefits and the side effects of two kinds of psychostimulants, namely, dextroamphetamine, which is more popular and is most widely used, and modafinil, which is a relatively newer type. There is growing evidence that modafinil has fewer side effects, in comparison with its predecessor dextroamphetamine, while still maintaining all of the latter's beneficial characteristics.     

Use of hearing protection on military operations

Noise Induced Hearing Loss (NIHL) continues to be a significant source of morbidity for UK service personnel. The Personal Interfaced Hearing Protection (PIHP) system was procured as an Urgent Operational Requirement primarily to provide a connection to the Personal Role Radio. Through its custom- mould design it was also expected to act as Personal Protective Equipment (PPE) against NIHL in a method that had not been possible previously. The aim of this paper was to evaluate user opinion of the four current methods of hearing protection including PIHP. 108 service personnel serving in a Forward Operating Base in Afghanistan were questioned anonymously using a paper-based questionnaire. The response rate was 78%, reflecting the difficulties in anonymous data collection in an environment such as this. PIHP was perceived to be more practical for use on the ranges or patrolling than the standard methods of hearing protection. Although only 4% were routinely wearing PIHP on patrol, this was related to understandable reluctance in wearing a new system that had only been issued immediately prior to this deployment. Early design problems highlighted by our study, such as changes in the design of the ear-piece to improve retention, have already been implemented. Compliance will be improved through a dedicated educational programme to explain its relevance. Despite the logistical difficulties in providing custom- made ear moulds, the PIHP system must be delivered to all service personnel early in their career so they are confident in its use long before operational deployment. Future research is required to ascertain the effectiveness of PIHP as a method of PPE in reducing the incidence of NIHL.     

Acute and long-term management of sports-related closed head injuries

Aggressive participation in athletics is rewarded in many ways in our society. As long as there is such strong impetus for participation in athletics, the risks of head injuries for participants will remain. Important strides made in understanding of the pathophysiology of head injuries may lead to improved treatment strategies in the future. In light of the current lack of effective therapies, however, the best options remain injury prevention, early and appropriate recognition, and limitation of subsequent, further injury. Frequently the medical staff is encouraged to allow the athlete to return to play based on the desires of the coach, team, fans, parents, and even the athlete himself. A thorough understanding of the potentially serious risks of repetitive injury, however, mandates that only a proper conservative period of observation and evaluation will best serve the competitor.     

Field evaluation and management of head and neck injuries

This article presents clear, concise guidelines for classification, evaluation, and emergency management of injuries that occur to the head and neck as a result of competitive and recreational sports. There are several principles that must be considered by individuals responsible for an athlete who sustains a serious head or neck injury: a person who "captains" the medical/first-aid team; knowledge of the appropriate emergency management techniques; availability of emergency medical equipment including a spine board, telephone, and ambulance; and a clear understanding of the philosophy that emergency management should "do no further harm."     

Hypothermia: threat to military operations

Hypothermia has altered the course of military history. Military casualties tend to occur in epidemics, associated with cold weather combat or maneuvers, trauma, immobilization, improper clothing, exhaustion, and underlying illness. Symptoms of hypothermia begin subtly with fatigue and loss of concentration, but progress to stupor, coma, and resemble rigor mortis. Treatment of mild hypothermia is with body heat and warm clothes and fluids. Moderate and severe cases require gentle evacuation and active core rewarming method(s). Inhalation of warm (40 degrees C, 104 degrees F) humidified oxygen is safe, effective, and can be begun in the field. Recognition of risk factors and active measures can lessen the menance of cold weather for military personnel.     

Boxing-related head injuries

Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.     

Traumatic injuries: imaging of head injuries

Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for clinical state, MRI is warranted. Follow-up is best done with MRI as it is more sensitive to parenchymal changes. In routine MR protocol gradient-recalled-echo sequences should be included at any other time after a traumatic event since they are very sensitive in detection of hemosiderin as well as former hematoma without hemosiderin. The MR signal intensity varies depending on sequences and time scanning after trauma.     

Risk propensity assessment in military special operations

Risk taking, decision making, and stress factors are strongly associated in military operations. The authors used the Bond and Lader mood and alertness scale and a new scale, Evaluation of Risks (EVAR), to assess risk proneness in a maritime counter-terrorism exercise. EVAR items are distributed among five factors: self-control, danger seeking, energy, impulsiveness, and invincibility. In the study, 10 pilots were submitted to strenuous night flights with limited sleep deprivation. Compared with baseline data, pilots reported an increase in impulsiveness, whereas EVAR factors were consistent in a control group composed of 9 navy crew member. Correlations were observed between mood and alertness and risk factors. These results illustrate how EVAR can be used to evaluate change in risk proneness in individuals submitted to various stressors. But further studies are required to weigh stress factors and environmental conditions in risk propensity with a larger population of various age and personality traits.     

Malaria prophylaxis during military operations in Thailand

Thai soldiers deployed along the Thai-Kampuchean border experience high attack rates of drug-resistant falciparum malaria. Adequate drug prophylaxis has proven difficult with the failure of chloroquine, pyrimethamine/sulfadoxine, and pyrimethamine/dapsone. Under some circumstances, mefloquine, doxycycline, and proguanil/sulfamethoxazole can successfully prevent falciparum malaria in Thailand. Decisions regarding chemoprophylaxis drugs in Thailand depend on a complex interaction of effectiveness, compliance, side effects, and long-term usefulness.     

The effect of sleep deprivation and sustained military operations on near visual performance.

A group of military servicemen were deprived of sleep for 65 h while they carried out a simulated military mission with a high visual workload. Their performance in a series of near vision tests was monitored. In general, the visual system was found to be resilient to the stress of sleep loss, the subjects experiencing mild symptoms of asthenopia (eyestrain). However, after 48 h without sleep there was a reduction in amplitude of convergent fusional reserves and a decrease in contrast sensitivity to a spatial frequency of 6 cycles/degree. A disruption in diurnal rhythms for these parameters was suggested. The results are considered in terms of the maintenance of visual efficiency and comfort with loss of sleep, and have implications for both the military and civilians involved in shift work and long work schedules.     

Laser eye injuries in military occupations

INTRODUCTION: Lasers (light amplification by stimulated emission of radiation) play an important role in our world and their use is increasing. They are powerful tools for good, but can also cause tragedy, especially in an aviation environment. Information about injuries associated with lasers is limited. This study highlights several laser eye injuries in the U.S. military and discusses issues pertaining to them. METHODS: We gathered data from the U.S. Army Safety Center, the U.S. Army Center for Health Promotion and Preventive Medicine, and the Walter Reed Army Institute of Research. This paper describes ten representative cases of laser eye injury that occurred in the U.S. military between 1984 and 2000. RESULTS: Patients suffered retinal damage, though no corneal injury occurred. Most were caused by accidental exposure to a Q-switched, Neodynium:YAG (Nd:YAG) laser at 1064 nm wavelength. The incidents occurred both on and off duty, indoors and outdoors, and from close and long ranges. None of the victims were wearing eye protection. Inadequate training and poor equipment design were major factors in at least six of the nine unintentional cases. The tenth occurred during military operations in the Persian Gulf. All of the victims needed several months medical care and follow up. Two received medical discharges as a result of their injuries. DISCUSSION: As illustrated by these cases, human and societal costs from unintentional laser eye injuries can be reduced by improving operator training, safety procedure compliance, and equipment design. In addition, intentional laser eye injuries are a growing concern and further research is needed to design appropriate protection, treatment and countermeasures.     

美军战救经验对我军颅脑战伤救治的启示

《Emergency War Surgery》总结了2007—2017年美军在历次战争中战创伤的各种类型和治疗经验,为在作战环境下进行医疗救护提供重要参考.本文对其颅脑损伤部分进行归纳分析,从救治理念、伤情判断、救治要点三方面归纳美军的实践经验,以及颅脑穿透伤的伤情判断、检诊要点和预后判定,详细介绍颅脑战创伤救治中的关...     

新兵心理弹性对军事训练疲劳及训练伤的影响

目的 调查分析通信某旅新兵心理弹性水平及影响因素,探索其对军事训练疲劳和训练伤的影响,为官兵疲劳状态的改善及训练伤防治提供参考依据.方法 通过随机整群抽样方法,采用一般情况调查表、心理弹性量表中文版和多维疲劳量表(MFI-20)对通信某旅2020年9月入伍的126名参训新兵进行测评分析.结果 新兵心理弹性评分总分平均分为(75.79±14.09)分,显著高于国内常模,超重、吸烟、身体疲劳、情绪低落、恐惧训练是新兵心理弹性的不利影响因素.集训新兵心理弹性水平与疲劳各维度得分呈显著负相关(P<0.05),可以负向预测新兵疲劳水平.高心理弹性组训练伤的检出率明显低于低心理弹性组(P<0.05).结论 心理弹性对新兵的训练疲劳具有较强的负向预测力,并在一定程度上影响军事训练伤的发生.在新兵入伍时,应注重心理筛选;在训练过程中,开展心理弹性的评估与训练,有效提高新兵入伍集训期间应对不良应激、战胜逆境的能力,对于提高部队战斗力具有重要意义.     

Coordinating medical civil military operations in Multinational Division-North

Medical civil military operations (MCMO) are part of military civil capacity-building efforts within the full spectrum of military operations, from war to military operations other than war. In 2008-2009 during Operation Iraqi Freedom, the Division Surgeon's Section (DSS) of the 25th Infantry Division (25ID) and Multinational Division-North developed an innovative MCMO program in northern Iraq. The program centered on understanding and mapping key relationships, empowering brigade-level programs, and leveraging technology to identify and share best practices. The DSS mapped the critical relationships within and between the three entities affecting MCMO: the government of Iraq (GOI), Department of State (DOS), and the Department of Defense (DOD). A division MCMO working group was then created along with processes to facilitate MCMO project execution and program management. The structure and organization of the 25ID MCMO program lend themselves to other operational environments requiring synchronization of medical capacity-building efforts.     

The relevance of neuropsychologic testing for sports-related head injuries

The utilization of neuropsychologic testing following sports-related concussion has dramatically increased over the past 5 years. The inclusion of neuropsychologic test results in the diagnosis of concussion has resulted in increasing questions into the specific role of these procedures in the return-to-play decision-making process. This article reviews the relevance of neuropsychologic testing for the sports medicine physician.