Traumatic carotid artery thrombosis is uncommon and it usually results from penetrating injuries and less commonly secondary to blunt trauma. It can lead to delayed clinical presentation, which leads to delay in the diagnosis. Soldiers in combat scenario also can present with such an illness, which results from varied modes of injuries. Our case illustrates an unusual cause of carotid thrombosis.

Increases in the number of women in critical positions on military missions place new demands for specialised healthcare services to promote performance. The main health problems servicewomen facing are musculoskeletal injuries, reproductive diseases, iron deficiency and mental health problems. Herein, we propose several suggestions based on the rich experiences of our hospital. First is to offer preventive measures for servicewomen health. Second is to equip servicewomen with portable medicine packet to treat common diseases. Third is to provide people-centred integrated care.

In September 2017, the British Government called on the military to deliver aid and provide assistance to British Overseas Territories in the Caribbean affected by the devastating category 5 Hurricane, Irma.1 The military and humanitarian operation, named Op RUMAN, saw British military personnel from all services deploy at short notice to assess damage, reinstate vital infrastructure and help islanders get back on their feet as quickly as possible. Members of the Deployed Aeromedical Response Team Squadron (DARTS) were among the first troops deployed to the region. The aim of this paper is to describe the role of DARTS within this Op.

Operation RUMAN was the British government's combined military and humanitarian operations in September 2017 to provide relief to the British Overseas Territories in the Caribbean affected by Hurricane Irma. The Ministry of Defence (MoD), in conjunction with the Department for International Development, produced a tangible effect by the delivery of healthcare and a response to a humanitarian disaster with very little time for planning. The rescue element was accomplished within days but this was followed swiftly by a recovery phase requiring a '', with additional assets from non-governmental organisations and the private sector. The aim of this article is to provide information on the role of the Defence Medical Services on behalf of the MoD, and other departmental organisations in achieving the mission of providing medical and logistical support for these British Overseas Territories.

The 700+ Caribbean islands present a vast area of operations (AO) with challenges providing healthcare to the local population and deployed personnel. Predisaster host nation medical care relied on casevac for basic primary and secondary healthcare, with medivac by air for advanced medical treatment. Disruption to facilities and transport links by Hurricane Irma rendered the native healthcare system on its knees. During Op RUMAN, the Royal Air Force Medical Services (RAFMS) provided expertise in prehospital emergency care and critical care aeromed to enable emergency treatment and access to definitive care for local nationals and our own personnel. The ability to provide independent, safe aeromedical care across a variety of aviation platforms is unique to the RAFMS. The AO did not fit any current doctrine; an adaptable, functional unit concept was adopted to enable care to the walking wounded through to critical care along prolonged timelines.

The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described-but not exclusively trauma-cases with no secondary cerebrospinal fluid leakage encountered.

The () is published with the aim of propagating current knowledge and expertise while also acting as institutional memory for the practice of medicine within the military. This work aimed to examine how the interests of the , and by inference the Army Medical Services, have changed over time as reflected by the articles published in the journal.

Food and catering and its impact on health and life satisfaction of coalition soldiers during their deployment on a military operation in the Middle East area was the aim of our research. Our fundamental research question was how food and catering in the military operational environment affects the life satisfaction and health of deployed soldiers.

The extent of the French forces' territory in the Sahel band generates long medical evacuations. In case of many victims, to respect the golden hour rule, first-line sorting is essential. Through simulation situations, the aim of our study was to assess whether the use of ultrasound was useful to military doctors.

A 34-year-old female soldier presented with fever and behavioural changes while deployed in Kenya and was diagnosed with encephalitis. The patient underwent urgent aeromedical evacuation to the Queen Elizabeth Hospital, Birmingham for further management. Microbiology tests excluded common infectious causes that are endemic in the East Africa region. However, an autoantibody screen was positive for antibodies against the N-methyl-D-aspartate receptor (NMDAR). Full body imaging confirmed the presence of limbic encephalitis and an ovarian mass suggestive of a teratoma. The patient was diagnosed with ovarian teratoma-associated anti-NMDAR encephalitis, a potentially fatal disease. The patient underwent surgery to remove the teratoma and commenced immunotherapy with steroids, plasma exchange and rituximab. This case highlights the diagnostic challenges of fever with behavioural changes in military personnel deployed in a tropical environment.

Part I provides the historiographical context and examines the causes which led to the creation of the first independent research ethics committee (REC) at Porton Down, Britain's biological and chemical warfare establishment, in operation since the First World War. The papers in part I and part II argue that the introduction of RECs in the UK stemmed from concerns about legal liability and research ethics among scientists responsible for human experiments, and from the desire of the UK military medical establishment to create an external organisation which would function both as an for ethical debate and as an to share moral and legal responsibility. The paper asks: What factors were responsible for causing military scientists and government officials to contemplate the introduction of formalised structures for ethical review within the UK military? It argues that Porton may have been exempt from public scrutiny, but it was not above the law of the land. By the mid-1960s evidence of serious ill effects among staff members and service personnel involved in tests could no longer be ignored. Whereas the security of the British realm had previously trumped almost any other argument in contentious debates about chemical warfare, the role of medical ethics suddenly moved to the forefront of Porton's deliberations, so much so that tests with incapacitants were temporarily suspended in 1965. It was this crisis, examined in detail in part II, which functioned as a catalyst for the creation of the Applied Biology Committee as the responsible body, and first point of call, for authorising human experiments at Porton Down.

Using a major ethics crisis as a methodological approach to study secret science environments, part II examines the origins and organisation of the Applied Biology Committee (ABC), the first independent research ethics committee (REC) at Porton Down, Britain's biological and chemical warfare establishment since the First World War. Although working in great secrecy, the UK military, and Porton in particular, did not operate in a social, political and legal vacuum. Paradigm shifts in civilian medical ethics, or public controversy about atomic, chemical and biological weapons, could thus influence Porton's self-perception and the conduct of its research. The paper argues that the creation of the first REC at Porton in 1965, that is, the ABC, as the inside the UK's military research establishment reflected a broader paradigm shift in the field of human research ethics in the mid-1960s.

Biological interventions to improve performance, such as amphetamines, have a long history of military use, and in the future may include more advanced biotechnologies. This article discusses the ethics of using biomedical enhancements in the military. The article begins by describing the distinction between biomedical enhancements and interventions intended to prevent, treat or mitigate disease. It then sets forth three principles to guide the ethical use of bioenhancements-proportionality, paternalism and fairness. The article applies these principles to concerns raised by military bioenhancement: safety, fairness in access to military reward, carryover effects to civilian life, whether service members can be ordered to use bioenhancements and when they may be permitted to do so voluntarily.