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New blast weapons.

Over the last decade a large number of weapon systems have appeared that use blast as their primary damage mechanism. This is a notable trend; until recently very few warheads relied on blast as their primary output. Most warheads in service use explosives to drive metal such as fragments and shaped charge jets to engage targets. New technologies are now being integrated into warheads that claim to have enhanced blast performance. Blast weapons could have been designed to fill a gap in capability; they are generally used for the attack of 'soft' targets including personnel, both in the open and within protective structures. With the increased number and range of these weapons, it is likely that UK forces will have to face them in future conflicts. This paper briefly describes fuel-air explosive blast weapons and reviews a range of enhanced blast weapons that have been developed recently. The paper concludes with a brief discussion on the reasons why enhanced blast technologies may be proliferating and how this could affect the Defence Medical Services.

Explosions↗

Lessons learned from non-medical industries: the tragedy of the USS Greeneville.

In February 200l the nuclear powered submarine USS Greeneville collided with the Japanese fishing trawler Ehime Maru, killing nine passengers. A series of small failures and hurried actions escalated into tragedy. This incident provides lessons learned that can be used by healthcare organizations to improve patient safety. Expertise, training, equipment, and procedures appeared to be adequate protection, yet the presence of multiple defences obscured their faulty functioning, just as they often do in medical settings. A number of other problems occurred aboard Greeneville which we also see in health care. The problem was the total breakdown of communication. The Greeneville team also failed to move from a rigid hierarchical structure to a more flexible adaptive structure. Communication often breaks down in healthcare settings, which are organized to maximize status and hierarchical differences, thus often impeding information flow needed to make decisions. Redundancy failed aboard Greeneville as it often does in medicine. Finally, the Captain of the Greeneville established an artificially hurried situation. Time constrained situations happen all the time in health care. We recommend strategies to mitigate the development of these kinds of processes.

Accidents, Occupational↗

Army technologists: 29-year follow up for cause of death.

A previous 18-year follow-up study revealed no significant excess of cancer among men who served in the Army during World War II as radiological technologists (n = 6,560) as compared with men who served as medical, laboratory, or pharmacy technologists (n = 6,826). Extension of the follow up by 11 years (1946-1974) revealed that 145 former radiological technologists had died of cancer, as compared with 158 controls. No statistically significant differences were found between these groups for individual sites of cancer or for deaths from other causes.

Follow-Up Studies↗

Stereotaxy, navigation and the temporal concatenation.

Nautical and cerebral navigation share similar elements of functional need and similar developmental pathways. The need for orientation necessitates the development of appropriate concepts, and such concepts are dependent on technology for practical realization. Occasionally, a concept precedes technology in time and requires periods of delay for appropriate development. A temporal concatenation exists where time allows the additive as need, concept and technology ultimately provide an endpoint of elegant solution. Nautical navigation has proceeded through periods of dead reckoning and celestial navigation to satellite orientation with associated refinements of instrumentation and charts for guidance. Cerebral navigation has progressed from craniometric orientation and burr hole mounted guidance systems to simple rectolinear and arc-centered devices based on radiographs to guidance by complex anatomical and functional maps provided as an amalgam of modern imaging modes. These maps are now augmented by complex frame and frameless systems which allow not only precise orientation, but also point and volumetric action. These complex technical modalities required and developed in part from elements of maritime navigation that have been translated to cerebral navigation in a temporal concatenation.

Animals↗

Otolaryngic health service support in the airland battle.

The Blast Injuries of the Ear Seminar was conducted to better define the state of knowledge about the medical care and consequences of blast injuries of the ear in battle. The immediate concern of this discussion was the relative importance of the finding of widespread eardrum ruptures in penetrating attacks by shaped charge munitions against the Bradley Fighting Vehicle and the M113 Armored Personnel Carrier. In order to focus on the care of the soldier with such injuries, a brief description of the current medical care and evacuation chain of the US Army, as well as the proposed future evacuation chain in the Airland Battle scenario, will be discussed. Detailed treatment of patients will be discussed in the descriptions from the Quad Service Clinical Data Base regarding wounds of the tympanic membrane. Most blast injuries of the ear would not be considered as incapacitating casualties by the Army Medical Department, except in severe circumstances.

Blast Injuries↗

Graphical displays.

This paper selectively reviews the field of scientific and medical graphics. Examples are provided using world health statistics and several new methods of presenting multivariate data are introduced.

Computer Graphics↗