Volume 27 Number 4 October 2019 Journal of Military and Veterans’ Health Rehabilitation in the Australian Defence Force RY ME A DI IT C L I Stress and Immune Mediators In The Canadian Armed Forces I N M E A N S A I S O S A C L I A 2019 AMMA Conference Abstracts A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association SAVE the DATE AMMA 2020 Conference 8 – 11 OCTOBER Hotel Grand Chancellor Hobart, Tasmania Table of Contents Letter to the Editor ��������������������������������������������������������������������������������������������������������������������������������������������������������������������6 Original Articles Rehabilitation in the Australian Defence Force ����������������������������������������������������������������������������������������������7 Stress and Immune Mediators In The Canadian Armed Forces: Association Between Basal Levels and Military Physical Performance 15 Case Study Upper Respiratory Tract Infection Symptoms as a Herald Sign of Metamizole-Induced Neutropenia 24 2019 AMMA Conference Abstracts ������������������������������������������������������������������������������������������������������������������������������������������������������������������ 27 2019 Conference Poster Presentations ������������������������������������������������������������������������������������������������������������������������������������������������������������������ 77 Ambulance arriving at 2GHB deployed in the field Courtesy of Colonel Murray Hayes, RAADC Volume 27 Number 4; October 2019 Journal of Military and Veterans’ Health EDITORIAL BOARD CDRE Andy Robertson, CSC, PSM (Editor in Chief) Associate Professor Martin Richardson (Deputy Editor) BRIG Anne Campbell CDRE Michael Dowsett Dr Helen Kelsall COL Prof Peter Leggat, AM Benjamin Mackie David Robertson Tyler C Smith, MS, PhD Dr Darryl Tong Jason Watterson Australasian Military Medicine Association PATRON STATEMENT OF OBJECTIVES MAJGEN Charles New The Australasian Military Medicine Association is Surgeon General Australian Defence Force Reserves an independent, professional scientific organisation of health professionals with the objectives of: COUNCIL • Promoting the study of military medicine • Bringing together those with an interest in President GPCAPT (Retd) military medicine Geoff Robinson, NSC • Disseminating knowledge of military medicine Vice President Dr Nader Abou-Seif • Publishing and distributing a journal in military medicine Secretary Dr Janet Scott • Promoting research in military medicine Treasurer CAPT Ian Young Membership of the Association is open to doctors, Council Members CDRE Andrew Robertson dentists, nurses, pharmacists, paramedics and Dr Peter Hurly anyone with a professional interest in any of the Rachelle Warner disciplines of military medicine The Association is totally independent of the Australian Defence Force Past President Dr Greg Mahoney Public Officer Ms Paula Leishman JMVH is published by the Australasian Military Medicine Association 227 Collins Street Hobart Tas 7000 Australia Ph: +61 3 62347844 Email: [email protected] ISSN No. 1835-1271 Journal of Military and Veterans’ Health Editorial After the war The theme for this year’s AMMA conference is “After The Journal now has a new website - https://jmvhorg/ - the War: Repatriation, recovery and public health” with enhanced search capability and a full coverage The impetus for this theme was the realisation that of all the issues over the last 28 years I would 100 years ago, in 1919, our forebears were just encourage all our readers to visit the website to find coming to terms with the fact that the Great War, the articles of interests Podcasts are likely to be added War to end all Wars, was finally over Repatriation in 2020 The issue themes for 2020 are also listed, of service men and women back to Australia was a and I would encourage authors to submit articles on key focus of the government, as was the recovery Transition to Civilian Life (April 2020), Global Health from the economic and public hardships from the Security (July 2020) and Preparing for Conflict and war Rehabilitation of the 137,000 wounded was also Disaster (October 2020) a key focus To complicate this further, pandemic Our fourth issue of 2019 primarily addresses the influenza had spread around the world in the abstracts of papers presented at the 28th AMMA second half of 1918 and continued in 1919, with an Conference There are also three excellent articles estimated 100 million deaths While initial transport – a timely review of rehabilitation in the ADF, a of the personnel back to Australia, under the control review of stress mediators in military physical of Lieutenant General Monash, proceeded well, with performance and a salient respiratory disease case all troops largely home by September 1919, the other study We continue to get a good range of articles, key elements of the repatriation system were in their but other military and veterans’ health articles are infancy and progressed far more slowly The term always very welcome and we would encourage all our ‘Repat’ quickly acquired pejorative connotations in readers to consider writing on their areas of military some quarters, with soldiers venting their frustration or veterans’ health interest We would particularly in various papers A short story in the Sydney Mirror welcome papers based on the presentations at the observed that if Repat officials ‘had as much silk conference, but welcome any articles across the as they have method they wouldn’t have enough to broader spectrum of military health make a necktie for an ant’1 Given the sheer numbers involved, it is intersting to ponder how Australia Dr Andy Robertson, CSC, PSM would fare under similar circumstances 100 years Commodore, RANR later, even given the support systems that have Editor-in-Chief grown up over that period References: 1 Payton P ‘Repat’: A concise history of repatriation in Australia Department of Veterans’ Affairs; Canberra: 2018 Volume 27 Number 4; October 2019 Page 5 Letter to the Editor In reply to Dr Worswick’s article ‘Medical Officer is made from the Special Projects Office responsible Training – An Infantryman’s Perspective’ JMVH for procurement of the equipment, together with Vol 27, Number 3, as an Army Medical Level 2 CATC and the allocation of unit resources (time and Doctor from a similar Royal Australian Infantry personnel) to ensure bulk numbers of personnel are Corps background with non-regimental experience effectively trained in the new equipment system in Recruit, Officer and overseas training of foreign Concurrently, training institutions are targeted to forces, I can unequivocally say the training of the ensure it incorporates training for future throughput Army’s uniformed health workforce, when compared The Q system is trained in maintenance and repair to how well the Army trains its other members, is In contrast, in Health there is no plan, coordination not good, not average, not adequate… it is just poor or measured outcomes for iSTAT implementation overall The one exception being the Army School The same applies to countless other pieces of medical of Health ADF Medical Technician course currently equipment entering or have entered service – oxylog producing wonderfully trained clinicians to a ventilators, tempus pro, ultrasound, MRX, etc baseline level of competency Overall, the collective organisation, integration and By way of some simple examples, the Army Standing delivery of training to achieve individual competencies Instruction for Personnel (ASIP), Part 8 Chapter and to ensure there is a baseline competency for 9, mandates numerous civilian competencies a ‘how, when and for whom’ an effect is delivered eg deployable (to field or operations) Medical Level 2 understanding a weapon system function, pulling the Treatment Team Medical Officer, a Nursing Officer trigger at the right target and right time, is something in a treatment team and a Medical Technician in the rest of Army generally does exceptionally well… a treatment team must have Currently, there is except Health Other groupings with similar technical no discernible effort or output at Formation level requirements to health that straddle civilian and (17 Brigade) that controls resources to centrally military governance, think aeronautical engineering, supervise, coordinate, fund and deliver these are light years ahead of Health – boards of inquiry competencies to ensure the Army’s health workforce into previous catastrophic failures have forced them meets these mandated civilian competencies The to be net result is that very few, if any, clinicians posted to these roles have achieved the Army specified Doctor Worswick’s article into Army Medical requirements for its deployable health workforce Officer Training should not only prompt action for This is a poor outcome for our treated soldiers remediation of the training shortfalls for medical officers, particularly in the PGY1-4 space, given Furthermore, the iSTAT point of care biochemical a seismic change in the civilian medical PGY 1 test machine (complete with cartridges) has finally and 2 training environment from 20 years ago has made its way into Close Health Units so that post the foundation of the fellowship of emergency our deployable treatment teams can identify medicine, but also prompt organisational reform for reversible causes to inform treatment of cardiac development of a ‘training culture’ within the Army arrest in accordance with the ALS/ALS2 Australian health workforce more