Biomedical subjects
Publications and source records attributed to M C Bricknell.
The organisation and design of field hospitals within the British Army has been under review since the GulfWar. This paper discusses principles for the organisation and design of field hospitals and makes suggestions for further development. The paper describes the deployment of field hospitals from a 25 bed hospital troop up to a 200 bed field hospital.
This paper considers the occupational health and safety issues that apply within a military field hospital. It considers NHS occupational health and safety activities and examines how these might be applied within an Army Medical Services unit. Areas that are unique to field hospitals are highlighted in comparison with a static NHS hospital. Some issues for future work are also considered.
This paper describes the development of the Army Health Policy (AHP), which is a key component of the Army Human Resources Strategy (AHRS). The work on the AHP provided an opportunity for a fundamental review of the delivery of health support to the Army. The AHP will provide the strategic framework by which the Army will ensure the health of its workforce and, where appropriate, their dependents. The methodology used for this work may be a useful model for the development of a health policy for occupational populations.
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This article is a literature review of the aspects of military parachuting related to occupational medicine and focuses on 'conventional' military static line parachuting using a round parachute. The analysis of injuries resulting from military parachuting provide an excellent example of military occupational medicine practice. The techniques of military parachuting are described in order to illustrate the potential mechanisms of injury, and a number of 'classical' parachuting injuries are described. Finally some recommendations are made for the recording of parachute injuries which would assist in the international comparison of injury rates and anatomical distribution.
Military parachuting is perceived to be a 'high risk' activity. The estimate of risk should be based on a comparison of injury rates between soldiers who are military parachutists and soldiers who are not military parachutists rather than the rate of injury per parachute descent. Since other aspects of military life also have an inherent risk of injury the risk attributable to military parachuting must be assessed in this context. The aim of this paper is to determine whether Parachute Regiment soldiers have a greater risk of injury as compared with non-Parachute Regiment infantry soldiers by comparing rates of hospital admission and medical discharge between the two groups. Records at the Defence Analytical Services Agency were analysed for the 10-year period 1987-96. The mean rate of hospital admission for Parachute Regiment soldiers was 50.1 per 1,000 and for infantry soldiers was 50.8 per 1,000 [relative risk (RR) = 0.98; 95% confidence interval (CI) = 0.92-1.04). The mean rate of medical discharge for Parachute Regiment soldiers was 4.9 per 1,000 and for infantry the mean rate was 2.8 per 1,000 (RR = 1.76; CI = 1.45-2.15). This study has shown a methodology for comparing occupational exposure to risk that could be extended to other groups if they can be separated by appropriate criteria.
Military parachuting has been recognized as a hazardous activity since it was first introduced in World War II. Other risks associated with military service include actual war-fighting, training with weapons and explosives, operating with armoured vehicles or deployment to climatic extremes. These other hazards should be considered in any assessment of the additional risk associated with military parachuting. The aim of this study was to identify the risk attributable to parachuting amongst US Army enlisted soldiers. This study identified a cohort of infantry soldiers who served between 1990-94. They were separated by receipt of parachute hazardous duty pay. There was a total of 329,794 person-years (PY) available for study of which 18% were in the exposed group. The rate of hospitalization was very similar in both groups [123.9 per 1,000 PYs for the exposed group, 127 in the non-exposed group: relative risk (RR) = 0.98, 95% confidence interval (CI) = 0.96-1.00). The exposed group was 1.49 times (CI = 1.42-1.57) more likely to be admitted as a result of an injury as compared with the non-exposed group. Military parachuting was 20 times (CI = 16.6-24.3) more likely to be the cause of an injury. This study has shown that receipt of hazardous duty pay for military parachuting can be used as a marker in identifying significant additional risks to the health of infantry soldiers associated with military parachuting. This was reflected in an increased incidence of admission for acute injury and musculoskeletal trauma (particularly a trauma pattern associated with parachuting) as a result of military parachuting. Other risks, which are associated with parachute pay, are admission for the effects of heat, battle injury and helicopter accidents.
The Defence Medical Services provide to a British population healthcare services that are funded from taxation and are free at the point of delivery. This paper reviews some principles for determining entitlement to healthcare for the population cared for by the Defence Medical Services. The starting point for entitlement uses the principles under which the National Health Service (NHS) was established. These are then extended to acknowledge the limitations of an NHS model when considering occupational health issues and geographical variations in healthcare provision.
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This paper examines the requirement for health surveillance systems for military forces. Military health surveillance is the routine systematic collection, analysis, interpretation, and reporting of standardised, population based data for the purpose of characterising and countering threats to the military population's health, well-being and performance. The components of a health surveillance system should enable concurrent or retrospective analysis of health effects in military personnel using a cohort study design. Military hazards include trauma, infection, toxic effects, radiation, psychological stress and ergonomic stress. Variations in distribution of the hazard, distribution of the population, fragility of the cohort, and the variation in the duration and magnitude of exposure complicate definition of the exposed cohort. The measurement of biological effect is complicated by limits in knowledge about the relationship between exposure to the hazard and effect. A biological model that explains detection, causality, pathological process and health effect should support this knowledge. Lastly the definition of health effect needs to consider the difference between clinical activity rates and true measures of health outcome. The UK has a number of health surveillance systems including sentinel reporting, a population-based primary care reporting system and measures of medical discharge and death. The US Army is developing IT-based surveillance systems to link hazard, personnel and medical databases. The paper suggests a conceptual model for such a system in the UK military.
This paper describes the use of the J97 Health Surveillance System to monitor the effects of exposure to atmospheric pollution on the health of the Army population in Brunei. It shows that the J97 Health Surveillance tool is adaptable and can be used to rapidly set up a population-based health surveillance system.
On the night of May 15/16, 1996, the largest parachute assault of United States (US) and United Kingdom (UK) airborne forces in 52 years occurred at Fort Bragg, North Carolina. This paper describes the injuries sustained in that operation. A total of 4,754 (US, N = 3,066; UK, N = 1,688) aircraft exits were made, causing a total of 137 (US, N = 73; UK, N = 64) injuries in 117 personnel (US = 68; UK = 49). There were 15 hospital admissions (US = 8; UK = 7; p = 0.37) and no fatalities. The combined exit injury incidence was 24.6 injured soldiers per 1,000 exits. The US exit injury rate was 22 injured per 1,000 aircraft exits and the UK rate was 29 injured soldiers per 1,000 aircraft exits. This difference was not statistically significant (p = 0.25). Lower extremity sprains, strains, and fractures accounted for the majority of injuries in US and UK forces. UK soldiers sustained significantly more of these potentially incapacitating injuries than US troops, 16.1 per 1,000 exits versus 9.1 per 1,000 exits, respectively (chi 2 = 4.07; p = 0.043; relative risk [RR] = 1.70; 95% confidence interval [CI] = 1.01, 2.86). The UK forces sustained significantly more closed head injuries than US forces, 7.1 per 1,000 exits versus 2.3 per 1,000 exits, respectively (chi 2 = 6.4; p = 0.011; RR = 3.13; 95% CI = 1.23, 7.93). The UK forces also had significantly more soldiers with multiple injuries than US forces (RR = 9.15; 95% CI = 2.5, 39.7). Factors that may have influenced differences in injury incidence include differences in weight of personal equipment and possible differences between the drop zones.
Compares the methodology of the medical decision-making process with that of the military. The key to both professions is reliable, efficient decision making. Effective decision makers use the hypothetical-deductive approach which utilizes intuition to generate ideas which are tested by the available evidence. Medicine is developing a holistic, conceptual and student-centred education process which compares with the more rigid, external system of military training. The military system has a better methodology for communication both verbally and in writing than medicine. Suggests that both professions may benefit from an examination of each professional culture.
Heat illness is a recognised risk of military training. The Combat Fitness Test (CFT) has been identified as an activity that has been associated with heat casualties. The aim of this study was to establish whether a heat stress limit could be set for acclimatised soldiers performing the CFT by measuring the group mean rises in core temperature whilst performing the CFT at various environmental temperatures. The study showed that CFTs should not be undertaken when the start or expected end Wet Bulb Globe Test (WBGT) is greater than 25 degrees C if the group mean rise in core temperature is not to exceed 0.6 degree C (95% CI 0.2 degree C to 1 degree C).
This study forms part of a research programme to investigate the relationships between the rise in core temperature and the environmental temperature in soldiers exercising at a constant rate. The measurement of core temperature is a fundamental requirement for this research. The aim of this study was to evaluate the use of an infra-red tympanic thermometer (IVAC Corecheck) for use in thermal physiological studies conducted outside the laboratory environment by comparing the right ear temperature by TM thermometer and the left ear external auditory meatus by thermistor. The slope of the regression line between the two measurements was 0.9967 with a correlation coefficient of 0.706 which is reasonable. The TM thermometer in general reads higher than the aural thermometer with a 95% confidence limit for agreement from +0.78 to -0.53 degrees C of the aural temperature. Thus this study demonstrated that the tympanic thermometer (IVAC Corecheck) is sufficiently reliable compared to the aural thermistor to justify field trials.
Heat illness in the British Armed Forces is a significant occupational risk. This paper analyzes reports of heat casualties occurring in Episkopi, Cyprus from January 1990 through December 1994. A total of 96 casualties were reported from 48 separate incidents. On seven occasions, three or more casualties occurred concurrently (maximum 19). There were 20 incidents causing 32 casualties from Cyprus-based units and 28 incidents causing 64 casualties from units visiting Cyprus. There was a clear seasonal variation of reports with the maximum number of reports occurring from May to August. The majority of reported casualties occurred when the Wet Bulb Globe Temperature was between 26 degrees C and 29 degrees C. Cyprus-based units had most casualties occurring as a consequence of forced marching whereas most casualties from visiting units occurred during military field exercise training. Visiting Territorial Army units had the highest incidence of heat casualties for visiting units. The majority of heat casualties were mild; there were only ten severe cases. It was not possible to identify any particular risk factors applicable to individuals except incomplete acclimatization. The study showed that the current guidelines used by the British Armed Forces do not prevent all heat casualties. It is not possible to estimate how many casualties are prevented by the guidelines. All incidents involving a serious casualty or multiple casualties should be investigated to determine whether the guidelines should be further amended.
This is the second part of a two part review of the military experience of heat illness. It presents a synopsis of the literature from the end of the Second World War to the present day. The epidemiological evidence for the factors causing heat injuries are summarised as well as the international developments of preventive measures. Finally the current areas of uncertainty are identified and some proposals for future research will be made.
Asthma is a common condition. General Practitioners in the NHS now receive specific remuneration for running asthma disease management programmes. This paper presents the results of an audit of asthma management in an Army General Practice. The records of all patients were reviewed. In addition a questionnaire survey of patient knowledge and satisfaction was undertaken. The study identified several areas for improvement.