[Healthcare for migrants on the high seas. The case of the operation EUNAVFOR MED "Sophia".]

Since 2015, the Spanish Navy participates in the Operation EUNAVFOR MED Sophia, a naval operation of the European Union against the trafficking of human beings in the Mediterranean in which our ships carry out an important humanitarian work in the rescue and assistance of migrants on the sea. The attention and health care of these migrants lies mainly in the military Health Group and it is based on a series of principles and procedures among which the application of a triage adapted to the special conditions of rescue and assistance on the sea and in the diagnosis and treatment of various pathologies present among migrants. In this context, a series of epidemiological data is provided, especially the most frequent pathologies attended by rescued migrants and emphasizing the importance of adopting a series of measures to prevent the transmission of infectious pathologies that are rare or already eradicated in our country.

The Role 2 Afloat custodian

The Role 2 Afloat (R2A) capability is now firmly established on several maritime platforms using the 370 Module (afloat) equipment. This year has seen the appointment on board ships that support R2A of a new full-time role, the Medical Module Manager (MMM), who is responsible for the equipment on board. This article outlines the new role.

Consideration of the medical care and biomedical support of women and children on Role 2 Afloat maritime contingency operations

The Royal Navy’s Role 2 Afloat (R2A) capability has now been firmly established in support of United Kingdom (UK) troops on contingency operations such as humanitarian aid and disaster relief operations. This article reviews the current capability of R2A to deliver medical care to children and pregnant women, including the challenges facing the deployed Biomedical Scientist (BMS).

Role 1 Enhanced: a new paradigm in humanitarian operations

Operation BUCKTAIL is the UK contribution to migrant surveillance and reconnaissance in the Aegean Sea. This paper describes two different and novel medical configurations which deployed in early 2016 to this Area of Operations (AO). Casualties in this situation would be treated under the Convention of Safety Of Life At Sea, a humanitarian role which may be less familiar to some of the Defence Medical Services. Casualty management is discussed and the composition of medical teams examined.

The Maritime Medical Emergency Response Team: what do we really need?

Since 2006, the Defence Medical Services (DMS) pre-hospital care focus has been the Medical Emergency Response Team (MERT), which has enabled the projection of Damage Control Resuscitation (DCR) to the point of wounding as part of consultant- delivered care. Now in a period of contingency operations, the Royal Navy (RN)’s Role 2 medical capability, Role 2 Afloat (R2A) delivers DCR (including surgery) on a maritime platform. This article will focus on the development of the Maritime MERT component of R2A (termed Maritime In Transit Care (MITC) in Maritime Medical Doctrine) and will discuss the requirements based on experience of and preparation for an operation in 2016. Also discussed are the individual competencies and training required to be part of the Maritime MERT; it is hoped that this will simulate debate around this evolving team.

Establishing and maintaining a robust Role 2 Afloat organisation within the Royal Naval Medical Services

In 2009, the Royal Navy (RN) reconfigured the Role 2 maritime medical treatment capability, the Role 2 Afloat (R2A). This capability is now firmly established on a number of platforms in the fleet and was recently externally validated on RFA MOUNTS BAY prior to completion of an operational deployment supporting contingency operations in the Mediterranean. This article outlines the future challenges for R2A and offers suggestions on how to maintain a robust R2A organisation within the Royal Naval Medical Service (RNMS).

The role of the operating department practitioner on board Role 2 Afloat

The Role 2 Afloat (R2A) is the Royal Navy (RN)’s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners (ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.

[Three centuries with the Fleet (to the 300th anniversary of the Saint-Petersburg naval hospital)]

The authors analysed the history of the Saint-Petersburg naval hospital, founded in October, 1715 by Peter the Great, defined its role in the key historical events during organisation of medical, aid delivery to wounded and patients, discussed current tasks, concerning development of hospital art when forming modern image of the navy of the Russian Federation.

[Marine, aviation and space physician, psychologist and physiologist (To the 90th anniversary of the birth of G. M. Zarakovskii)]

In the current paper authors discuss problems of marine and aerospace medicine and psychophysiology, which Georgii Zarakovskii (1925-2014), a prominent domestic experts in the field of military medicine, psychology and ergonomics, solved. Authors focused on methodological approaches and results of the study of psychophysiological characteristics and human capabilities took into account for design of tools and organization of flight crews, astronauts and military experts. Authors marked the contribution to the creation of a system integrating psychophysiological features and characteristics of the person neccessary for development, testing and maintenance of aerospace engineering and organization of its professional activities. The possibilities of using the methodology of psychophysiological activity analysis in order to improve the reliability of psychophysiological military specialists, are shown.

Platelet apheresis in a deployed maritime environment: experiences from Operation GRITROCK

When the Primary Casualty Receiving Facility (PCRF) on Royal Fleet Auxiliary (RFA) ARGUS deployed to Operation GRITROCK in October 2014, platelet apheresis had yet to be proven as a sustainable and usable capability for improving provision of blood products on a maritime platform. This paper explores the difficulties encountered by nurses tasked with setting up this capability once deployed and the requirements needed to ensure that this capability is maintained for future operations.

PCRF Pathology, OP GRITROCK--A biomedical scientist's perspective

The Primary Casualty Receiving Facility (PCRF) Pathology Department was deployed on Operation GRITROCK from October 2014 to April 2015 to support the medical treatment facility on RFA ARGUS. The department deployed with enhanced microbiology capability and effectively became the microbiology reference laboratory for the Joint Operations Area (JOA). A platelet apheresis capability was delivered in the maritime environment for the first time on an active operation.

[Medical Service of the Finnish Defence Forces]

Thee article is a brief description of the current state of the Finnish Defence Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Finland, the Finnish Defence Forces, and their medical service is presented. Then some particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical , service personnel income.

[Status and development prospects of radiological health in the Navy]

More than 7.5 thousands of people work as military and civilian personnel and have an access to a lot of sources of ionizing radiation on ships and vessels, at coastal units and institutions of the Navy. This fact determines the importance of radiation safety and medical preventive measures on naval fleets. The article analyses the state of radiation-hygienic measures, outlines the conceptual basis for the development of radiation hygiene in the Navy. Substantiated reconstruction tasks effectiveness of health control and state sanitary and epidemiological supervision of radiation safety, provides information about the optimal set of instruments for radiation monitoring equipment radiobiological laboratories and centres of state sanitary and epidemiological supervision at various levels.

[Shestov V I--the founder of the Department of Organisation and tactics of the naval medical services]

Vasilii Ivanovich Shestov during the Great Patriotic War performed various tasks concerning the organization of medical support in the Leningrad naval base, consulted on an issue of production and use of hospital and medical transport ships, worked on the organization of medical support in Schliessburg and etc. Shestov performed a considerable amount of research and methodological works concerning the establishment of the discipline "Organisation of naval medical support". He is considered as one of the founders of the theory of naval medical evacuation support.

[The head of the medical service must be the person...(To the 70th anniversary of N.G. Ryzhman)]

The article is devoted to contribution of major general (rear Admiral. - navy) of medical service Nikolay Grigoryevich Ryzhman (1944-2005), the chief of the medical service of the Northern fleet (1991-1999), to development of naval medicine, who would have turn 70 years this September. The constant analysis, and experience generalization of the medical services of the fleet connections and associations and aspiration to provide fighting capacity for the fleet crew - were a keynote of Ryzhman's activity concerned development and deployment of the new forms and methods of medical support and searching of ways to increase crew efficiency. The implemented methods and forms of organization of the medical support and scientific development of the medical support are used even now in the practical activities of the medical service of the Northern fleet.

[The organization of emergency actions for ocular burns in conditions of military unit (of the ship)]

Prehospital services for ocular burns are delivered by servicemen as self or mutual management and also by paramedic. Every case of ocular burn should be considered as severe one. The patient, shortly after the first aid, should be transported to the medical company or medical unit. Under conditions of medical unit military doctor has to organize an ophthalmological working space (ophthalmological comer) with the necessary equipment. Eye irrigation has to be made for chemical ocular burns. Military doctor should consider any previous irrigation as insufficient. For severe ocular burns during evacuation to the hospital it is necessary to perform a simple blepharorrhaphy or (if the condition of lids allows) to make a hermetic seal with aid of aid-band. Doctor's obligations should also include prophylaxis of ocular burns.

[The experience in organizing the medical support of allied convoys during the Great Patriotic War on the northern maritime theater]

The medical support of allied convoys during the Great Patriotic War had a number of features. The Intensity of power of the fighting, the meteorological conditions, the composition of convoy's forces, the kind of enemy's weapon - had a significant impact on the structure of losses in personnel. The main type of medical care on the ships of 2-3rd rank was predoctor care. On the large and small antisubmarine ships and torpedo boats - it was first aid. The factor which has been affecting the amount of assistance - was a one-time inflow of a significant number of victims. Medical-evacuation provision of the convoys was carried out by the ships medical service without the use of amplification and sanitary ships. The most part of the wounded were taken to the coastal fleet hospitals later than 12 hours after the wound. The war experience has shown that in the distant convoys qualified surgical assistance may be provided in case of organizing it in this convoy and in case of using high-speed vehicles.

[Delivery of surgical care on naval ships: formation, development, and current stage]

Acute surgical diseases were and remain one of the most important problems of the organization of medical care and treatment of patients in the conditions of long distant sea voyage, when there is no possibility for medical evacuation. We analyzed the positive experience of surgical care in the sea, gained by Soviet and then and by Russian Navy physicians. As we haven't registered significant changes in morbidity of Navy crewmembers, we think that studying and creative application of this experience will have the positive effect.

Op Patwin Part 2: HMS illustrious' medical response to typhoon Haiyan

Operation PATWIN was the United Kingdom's (UK) response to the disaster caused by Typhoon Haiyan. The UK deployed a force including HMS DARING and HMS ILLUSTRIOUS and this article describes the medical response including the deployment of a Role 2 medical team and the hosting of a UK civilian medical team UK Med. The deployment followed humanitarian guidelines in UK doctrine and contained in the Oslo guidelines, but demonstrated a unique example of a civilian team supported by the military.

The new NEMOs--changes to initial medical officer training

It is desirable that a Royal Navy Medical Officer is not only medically competent but also a proficient Naval Officer with an ethos common to all Officers, irrespective of specialty or branch. In 2012 Britannia Royal Naval College (BRNC), in conjunction with the Institute of Naval Medicine (INM), modified the New Entry Medical Officer (NEMO) training course to comprise an initial phase at BRNC (15 weeks) followed by a second phase at INM (16 weeks). This is in contrast to the traditional training delivered at INM and Fort Blockhouse prior to joining BRNC for 7 weeks. The following article is a reflection of this experience.

[Main concepts of preventive health care for the air staff of sea-based aviation]

The authors researched the air-stuff and complex of adverse factors uncharacteristic for the air-staff of land-based aircraft. It was determined that adverse factors affect the air-staff foremost in 4-5 months of a blue-water sailing, except cardiovascular system diseases. In a month of a blue-water sailing was registered a hypotonic state. Systolic blood pressure varied from 100-105 mm Hg and lower, dystolic blood pressure varied from 60-65 mm Hg and lower. The lowest ranges of blood pressure were registered in three months after the beginning of the sailing. In the following, the hypotonic state, registered during the monthly medical examinations, remained till the end of the sailing. Normal averages of blood pressure were restored in two weeks after the end of sailing. Low red cell count (for more than 1100 points) was registered in 61.5% of patients, (for more than 550 points) in 38.4% of patients. Low white cell count (for more than 4800 points) was registered in 33.3% of patients, (for more than 3300 points) in 41% of patients, (for more than 1330 points) in 25% of patients. Input data was: red cell count--4250 points, white cell count--7300 points in 1 ml of blood. After the sailing haematological indices were restored. The authors suggested guidelines for primary and secondary disease prevention.

[Aspects of development of surgical service of modem Navy]

The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

[Organization of clinical care of North Fleet hospitals in XVIII century]

Clinical care of national navy hospitals was normed from reception of patients till hospital discharge. After admission to the hospital, patient got competent medical care and corresponding attendance. But the situation changed in XVIII century, period of wars. In conditions of war time hospitals were overcrowded with patients and wounded. The number of patients went beyond the bedspace. Deficit of vacant beds was supplied with the help of additional beds; deficit of medical staff was supplied with the help of participation of another medial staff. Huge number of patients with different diseases, including contagious diseases, conduced communication of contagious diseases inside the hospital. Diagnostics and methods of treatment of these diseases were not enough researched. Taking into account results of statistical analysis of data about the number of fatality cases (peace time--4-10%, war time--20%), we can make a conclusion that clinical care of national navy hospitals was satisfying.

The Royal Naval Medical Services: delivering medical operational capability. the 'black art' of Medical Operational Planning

This article looks to dispel the mysteries of the 'black art' of Medical Operational Planning whilst giving an overview of activity within the Medical Operational Capability area of Medical Division (Med Div) within Navy Command Headquarters (NCHQ) during a period when the Royal Naval Medical Services (RNMS) have been preparing and reconfiguring medical capability for the future contingent battle spaces. The rolling exercise program has been used to illustrate the ongoing preparations taken by the Medical Operational Capability (Med Op Cap) and the Medical Force Elements to deliver medical capability in the littoral and maritime environments.

Pre-hospital, Maritime In-Transit care from a Role 2 Afloat platform

Maritime In-Transit Care (MITC) is a new concept to allow the provision of pre-hospital care in the maritime environment within Role 2 Afloat (R2A) teams. This article describes the experiences of an Emergency Medicine nurse and a Medical Assistant who made up the MITC team on the recent R2A exercise on RFA CARDIGAN BAY. As well as describing their personal experiences, the concept of the MITC team is introduced and their role within R2A outlined.

Laboratory support to Role 2 Afloat

This article outlines the personal experiences of a biomedical scientist who recently deployed as a member of the Role 2 Afloat team on Exercise INTREPID DEFENDER. The laboratory support for the different departments is described and the provision of blood products available to Role 2 Afloat is outlined.

International Mine Countermeasures Exercise 2013: Role 2 Afloat

In May 2013 a Role 2 Afloat team was deployed on board the Bay-class Landing Ship Dock (Auxiliary) RFA CARDIGAN BAY as part of the US-led Task Force involved in the International Mine Countermeasures Exercise 2013 (IMCMEX 13). This article introduces a series of papers from the various departments that make up the Role 2 Afloat team explaining the make-up of the team and also the overall capability of the team to deliver Role 2 care in the maritime environment.

Anaesthesia and critical care aspects of Role 2 Afloat

The equipment and procedures for providing anaesthesia and critical care within the Role 2 Afloat team are described. In particular the lessons learned from a recent exercise onboard RFA CARDIGAN BAY are outlined with emphasis on the constraints of the unique maritime environment and the essential differences between the level of care at Role 2 and Role 3.

Special feature: emergency medicine in Role 2 Afloat

The Emergency Medicine aspects of care are described from recent experience of exercising a Role 2 Afloat team on board RFA CARDIGAN BAY. Lessons learned specific to this platform are outlined, as well as the more general issues of delivering Emergency Medicine in the maritime environment.

[Naval Clinical Hospital in Vladivostok--140 years]

The history of the oldest medical institution of the Far East--Vladivostok Naval Hospital Clinical Pacific Fleet is presented. The history of Hospital, celebrating 140th anniversary in October 2012, is closely associated with the formation of Pacific Fleet, birth and development of medicine in the Far East. Currently, specialized medical care is administrated in 29 medical departments of the hospital with an annual inspection and treatment of 12-13 thousand people.

[Directions of interdepartmental interaction in case of delivery of health care for injured in emergency situations in stationing sites of navy]

In points basing of navy will remain probability of emergence of emergency situations which is connected with existence of the enterprises of the industry and objects of navy. As a result of emergency situations in places of basing of navy discrepancy of prospective sanitary losses to possibilities of forces and means of a health service of fleet that demands interaction with health services of other ministries and departments is probable. Criterion of need of interaction is the ratio of quantity struck and possibilities of a health service of navy. Plans of interaction of a health service of fleet with medical institutions of other departments should provide options of use of available forces and means of medical institutions in garrisons for joint assistance struck in an emergency situation. The questions solved during interaction should become: radiation, chemical, biological survey; allocation of forces and means for rendering of medical care; use of sanitary transport; organization of sanitary processing, etc.

[Expert assessment of commands of naval medical service, incorporated in Service for Disaster Medicine]

Expert assessment of possibilities of naval medical service for delivery of assistance in emergency situations in deployment areas is performed. It is noted that the main menaces are radiation, chemical accidents, and explosiveness of objects. Inconsistency between supposed losses and possibilities of naval medical service is probable in case of emergency. This inconsistency requires improvement of interaction with medical services of other ministries, drill of coordinative actions of naval medical commands with other commands of other ministries in organizational frames of united Service for Disaster Medicine.

[Organization and establishment of naval hospitals in XVIII century]

In XVIII century naval hospitals were medical-prophylactic institutions with fixed number of employees. Number of employees and rate of salary were established in accordance with regular schedules. These schedules could be changed within the limits of restruction of Navy. There was strict division of labour in home hospitals. Each employee was responsible for the task put for him/her. Strict division of official duties excluded parallelism during the work and provides unity of action. Naval hospitals of XVIII century had double subordination. On the one hand hospitals subordinated to Medical office (now Medical board), on the other hand to the Admiralty-board, exactly to its commissariat expedition occupied with provisions and kit supply. Administration of hospitals was based on vertical hierarchy and had centralized character.

Maritime pre-hospital emergency care primary retrieval team--operational considerations

This article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach.

OP deference--Libyan crisis 2011. Non combatant evacuation operations (NEO) --role one medical experience

It is the author's belief that Role 1 GDMO led medical care continues to be a potent and adaptable force, capable of operating efficiently and with a high degree of autonomy in potentially high threat environments. The medical team was able to adapt to the operational demand and retained the full confidence of the command chain, however the MO felt acutely aware of gaps in his New Entry Medical Officer clinical training. Short duration courses such as Advanced Paediatric Life Support, Basic Surgical Skills and MIMMS provide excellent added value for medical officers and increase self confidence. NEMO training in the future may benefit from the inclusion of these. Despite the challenges faced during the NEOs the Role 1 medical team in CUMBERLAND found the experience very rewarding and an example of what they joined the Royal Navy to do.

Skills required for maritime pre-hospital emergency care

Pre-hospital emergency care (PHEC) in the military has undergone major changes during the last 10 years of warfighting in the land environment. Providing this care in the maritime environment presents several unique challenges. This paper examines the clinical capabilities required of a PHEC team in the maritime environment and how this role can be fulfilled as part of Role 2 Afloat. It applies to Pre-hospital emergency care projected from a hospital not to General Duties Medical Officers at Role 1.

[Establishment of national naval hospitals in the XVIII century]

The first naval hospitals were established in St. Petersburg, Revel and Kronstadt, Kazan, Revel, Astrakhan and Archangel. The question when the first hospitals were opened is still controversial because of the lack of many documents of those years. Researchers disagree, probably because of the fact that they take into account different timeframes for the project of a hospital corps. Regardless of whether you will find unequivocal, direct evidence for their discoveries in a given year, the value of the old hospital as medical institutions will not change. Much more important is the fact of their education because of intense activity of the domestic fleet. In the creation of naval hospitals as in anything else to take care of the state of preservation, strengthening and restoring the health of personnel, of which largely depended on the readiness of the fleet.

[Origins of the coat, appearance of physicians of the Russian fleet in the first third of XVIII century]

The article is devoted to the reconstruction of medical uniforms Russian navy first third of the 18th century. It can be assumed that doctors were in varying degrees, the senior officer's dress, but of course without the braid, although there are exceptions, which related to doctors willing to go to a more senior hypostasis. A number of documents of different structures gives rise to speak with a high probability that the doctors of different ranks, serving in the Marine units that had shaped dress that is largely consistent with their position in the hierarchy of ranks and received in the near future, its development.

[Improvement of the supply norms for ships carrying combat missions in peace-time]

The authors developed the projects of norms of supplying of ships of Northern Fleet by medical reinforcement groups. Norms are added by the medicals which are in the log-book of pharmaceuticals and necessary for the sudden problems. The third norm is added by the traumatologic set. Modern diagnostic equipment is also added to the norms. The authors came to conclusion that the forehanded planning of requirement of medical supply for medical reinforcement groups allows to create an adequate norms of supplying of medical reinforcement groups in the Northern Fleet.

Infections onboard ship--analysis of 1290 advice calls to the Radio Medical (RM) doctor in Sweden. Results from 1997, 2002, 2007, and 2009

Results from a descriptive study on Swedish Telemedical Advice Services (TMAS) from 1997, 2002, 2007, and the first six months of 2009 on infectious conditions are presented. These findings concern symptoms, actions taken, number of evacuations, means of communication, and use of digital photos. They show that infectious conditions are a significant contributor to calls to the service and that they can be more frequently treated on board than can other conditions.