David Dagan

Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model

An Israeli medical relief team that usually deploys a freestanding, self-sufficient field hospital found in the Philippines that when a local facility is partly functional, there are important short- and long-term benefits to full integration with the local units.

Apples and oranges: looking forward to the next generation of combat casualty care statistics.

I combat casualty care requires continuous learning through comparing medical outcomes across battlefields. Differences in outcomes may be caused by the combat care rendered as well as weaponry, geography, and numerous other nonmedical factors. A rough understanding of battlefield lethality and medical care quality is obtained through calculation of the case fatality rate (CFR), percentage killed in action (%KIA), and percentage died of wounds (%DOW) (defined later). These standard statistics serve to isolate, at least partially, the medical care aspect of combat because only casualties (i.e., after injury) are considered. Lesswell standardized, however, are the numbers on which these statistics are based, complicating efforts to make quantitative comparisons across forces. We think it is time to identify newmeasures for assessing combat casualty care as we describe later.

Analysis of injury patterns and roles of care in US and Israel militaries during recent conflicts: Two are better than one.

BACKGROUND As new conflicts emerge and enemies evolve, military medical organizations worldwide must adopt the “lessons learned.” In this study, we describe roles of care (ROCs) deployed and injuries sustained by both US and Israeli militaries during recent conflicts. The purpose of this collaborative work is facilitate exchange of medical data among allied forces in order to advance military medicine and facilitate strategic readiness for future military engagements that may involve less predictable situations of evacuation and care, such as prolonged field care. METHODS This retrospective study was conducted for the periods of 2003 to 2014 from data retrieved from the Department of Defense Trauma Registry and the Israel Defense Force (IDF) Trauma Registry. Comparative analyses included ROC capabilities, casualties who died of wounds, as well as mechanism of injury, anatomical wound distribution, and Injury Severity Score of US and IDF casualties during recent conflicts. RESULTS Although concept of ROCs was similar among militaries, the IDF supports increased capabilities at point of injury and Role 1 including the presence of physicians, but with limited deployment of other ROCs; conversely, the US maintains fewer capabilities at Role 1 but utilized the entire spectrum of care, including extensive deployment of Roles 2/2+, during recent conflicts. Casualties from US forces (n = 19,005) and IDF (n = 2,637) exhibited significant differences in patterns of injury with higher proportions of casualties who died of wounds in the US forces (4%) compared with the IDF (0.6%). CONCLUSIONS As these data suggest deployed ROCs and injury patterns of US and Israeli militaries were both conflict and system specific. We envision that identification of discordant factors and common medical strategies of the two militaries will enable strategic readiness for future conflicts as well as foster further collaboration among allied forces with the overarching universal goal of eliminating preventable death on the battlefield.

Military Medicine Publications: What has Happened in the Past Two Decades?

Background Military medical personnel, like all other physician specialists, face the challenge of keeping updated with developments in their field of expertise, in view of the great amount of new medical information published in the literature. The availability of the Internet has triggered tremendous changes in publication characteristics, and in some fields, the number of publications has increased substantially. The emergence of electronic open access journals and the improvement in Web search engines has triggered a significant change in the publication processes and in accessibility of information. Objective The objective of this study was to characterize the temporal trends in the number and types of publications in military medicine in the medical literature. Methods We searched all PubMed-registered publications from January 1, 1990 to December 31, 2010 using the keywords “military” or “army”. We used the publication tag in PubMed to identify and examine major publication types. The trends were tested using the Mann-Kendall test for trend. Results Our search yielded 44,443 publications in military medicine during the evaluation period. Overall, the number of publications showed two distinct phases over time: (1) a moderate increase from 1990 to 2001 with a mean annual increase of 2.78% (r 2=.79, P<.002), and (2) a steeper mean annual increase of 11.20% (r 2=.96, P<.002) from 2002 to 2010. Most of the examined publication types showed a similar pattern. The proportion of high-quality-of-evidence publication types (randomized controlled trials, systematic reviews, and meta-analyses) increased from 2.91% to 8.43% of the overall military medicine publications with a mean annual incremental increase of 14.20%. These publication types demonstrated a similar dual phase pattern of increase (10.01%, r 2=.80, P<.002 for 1990-2001 and 20.66%, r 2=.88, P<.002 for 2002-2010). Conclusions We conclude that over the past twenty years, scholarly work in the field of military medicine has shown a significant increase in volume, particularly among high quality publication types. However, practice guidelines remain rare, and meta-analyses are still limited in number.

Ethical and Surgical Dilemmas in Patients with Neglected Surgical Diseases Visiting a Field Hospital in a Zone of Recent Disaster.

ObjectThe massive typhoon Haiyan (Yolanda) ripped across the central Philippines on November 8, 2013, and damaged infrastructure including hospitals. The Israeli Defense Forces field hospital was directed by the Philippine authorities to Bogo City in the northern part of the island of Cebu, to assist the damaged local hospital. Hundreds of patients with neglected diseases sought for medical treatment which was merely out of reach for them. Our ethical dilemmas were whether to intervene, when the treatment we could offer was not the best possible.MethodsEach patient had an electronic medical record that included diagnosis, management and aftercare instructions. We retrospectively reviewed all charts of patients.ResultsOver 200 patients presented with neglected chronic diseases (tuberculosis, goiter, hypertension and diabetes). We limited our intervention to extreme values of glucose and blood pressure. We had started anti-tuberculosis medications, hoping that the patients will have an option to continue treatment. We examined 85 patients with a presumed diagnosis of malignancy. Without histopathology and advanced imaging modality, we performed palliative operations on three patients. Eighteen patients presented with inguinal hernia. We performed pure tissue repair on seven patients with large symptomatic hernias. We examined 12 children with cleft lip/palate and transferred two of them to Israel. We operated on one child with bilateral club feet. Out of 37 patients with pterygium, our ophthalmologist repaired the nine patients with the most severe vision disturbance.ConclusionMedical delegations to disaster areas should prepare a plan and appropriate measures to deal with non-urgent diseases.

Improvised Neonatal Care-Realizing the Gaps in a Disaster Zone.

The treatment of newborns in a disaster zone can be extremely challenging. The effects of the disaster combine with local health care disparity to give these neonates little chance of survival in the event of even minor complications. Rescue teams arriving at such locations must be prepared to handle and to aid these difficult situations using improvisation and ingenuity to overcome many of the unexpected hurdles. A discussion of the difficulties faced in the Philippines following a typhoon and recommendations for future teams are presented.

Case report: a brain abscess in a disaster zone- beyond the call of duty

We present a case of a child with a suspected brain abscess treated by a military field hospital in post-typhoon Philippines. We review our intervention and decision process both at the field hospital and following his transfer to a referral center. These interventions were critical for his successful outcome.

Preparation of medical personnel for an early response humanitarian mission – lessons learned from the Israeli defense forces field hospital in the Philippines

IntroductionHumanitarian aid provision and early medical response missions to areas ravaged by natural disasters are as essential nowadays as in the past, and medical personnel play a pivotal role in these delegations.Case descriptionIn November 2013, tropical cyclone Haiyan (Yolanda) slammed the Philippines archipelago, leaving more than an estimated 6000 dead in its wake while demolishing vital infrastructure and affecting the life of an estimated 25 million locals. The Israeli Defense Forces (IDF) rapidly constructed and sent a humanitarian aid delegation which included a field hospital deployment with medical capabilities from diverse specialty fields.Discussion and evaluationThe purpose of this article is to summarize our experience in the preparation process of medical personnel before and during deployment. We offer a simple, practical and structured checklist that will assist the medical specialist in preparation for his mission.ConclusionPreparation of medical personnel for humanitarian aid medical missions is a complex and vital task that might be better accomplished with thorough briefing and structured checklists which begin with addressing of personal safety and other daily needs of the staff.