Volume 28 Number 4 October 2020 Journal of Military and Veterans’ Health Emergency Medicine Comes of Age in the ADF RY ME A DI IT C L I Post-Traumatic Stress Disorder and Killing in Combat: A Review of Existing Literature I N M E A N S A I S O S A C L I A 2020 Conference Abstracts A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association C N . I U A N T S O I R T A A L I A C S O I S A S N A M E I N L I I C T I A D R E Y M Y ME AR D T IC I I IL N M E A N S A I S O S A C L I A A T R I T O S N U A IN C. Volume 28 Number 1 January 2020 Journal of Military and Veterans’ Health Volume 28 Number 2 April 2020 Journal of Military and Veterans’ Health Volume 28 Number 3 July 2020 Journal of Military and Veterans’ Health Warfare, Ships and Medicine: Prehistoric Origins RY ME A DI IT C L I Casualty Evacuation in the Australian Defence Force I N M E A N S A I S O S A C L I A Scaffolded Clinical Skills Development for Clinical Managers in the Royal Australian Navy A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association Warfare, Ships and Medicine in Ancient Egypt and Greece RY ME A DI IT C L I Infection Prevention and Control Practices in the Deployed Military Field Hospital I N M E A N S A I S O S A C L I A Adjunct Activities for Mental Health Improvement for Veterans A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association The Navy and the 1918-19 Influenza Pandemic RY ME A DI IT C L I Roman Warfare, Ships and Medicine I N M E A N S A I S O S A C L I A Art, Trauma, and PTSI: An Interview with Dr. Frank Ochberg A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association Do you have an article of interest to our readers? The Journal of Military and Veteran’s Health is a peer reviewed quarterly publication published by the Australasian Military Medicine Association. Authors are invited to submit articles of relevance to the Editor for consideration for publication in the Journal of Military and Veterans’ Health (JMVH). See the JMVH website for Categories include: authors’ instructions and Original Research/Original Articles Biographies submit your article online at www.jmvh.org Short Communication History Review Articles Book Reviews Reprinted Articles Commentary Case Studies View from the Front Abstracts from the Literature Table of Contents Editorial ��������������������������������������������������������������������������������������������������������������������������������������������������������������������5 Original Articles Benefits and Employment and Care For Peer Support Staff in The Veteran Community: A Rapid Narrative Literature Review 6 Viking Warfare, Ships and Medicine ������������������������������������������������������������������������������������������������������������ 16 Emergency Medicine Comes of Age in the ADF �������������������������������������������������������������������������������������������� 28 Psychotropic Polypharmacy in Australian Vietnam War Veterans with Post-Traumatic Stress Disorder: A Descriptive Cohort Study 34 Review Articles Post-Traumatic Stress Disorder and Killing in Combat: A Review of Existing Literature 46 History Innovations From the Battlefield: Tourniquets �������������������������������������������������������������������������������������������� 60 Conference Abstracts ������������������������������������������������������������������������������������������������������������������������������������������������������������������ 65 Cover Photo: The Year of the Nurse SGT Dave Morley, military Reporter Defence News MECC Division. Volume 28 Number 4; October 2020 Journal of Military and Veterans’ Health EDITORIAL BOARD CDRE Andrew Robertson CSC, PSM (Editor in Chief, JMVH) Associate Professor Martin Richardson (Deputy Editor) BRIG Anne Campbell CDRE Michael Dowsett Dr Helen Kelsall COL Prof Peter Leggat, AM Dr David Robertson 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 Geoff Robinson, NSC military medicine Vice President Dr Nader Abou-Seif • Disseminating knowledge of military medicine • Publishing and distributing a journal in military Secretary Dr Janet Scott medicine Treasurer CAPT Ian Young, AM • Promoting research in military medicine Journal Editor Dr Andrew Robertson, CSC, PSM Membership of the Association is open to doctors, dentists, nurses, pharmacists, paramedics and Council Members Dr Peter Hurly anyone with a professional interest in any of the OStJ, DSD, JCD disciplines of military medicine The Association is Rachelle Bonner totally independent of the Australian Defence Force MAJ Brendan Wood CStJ, DSD RNZAMC 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 Whither reality? As we prepare for our first virtual conference, we This issue is traditionally devoted to the AMMA probably face it with some trepidation and some Conference abstracts in the lead up to the meeting anticipation As a consequence of COVID-19, many This will again be a feature; however, we are of us have become denizens of the virtual world, fortunate to have an increasing number of excellent jumping from videoconferences to webinars to Zoom articles available as well The role of emergency family catch-ups Some of these changes have been medicine in the Australian Defence Force, the productive—allowing people to meet quickly and benefits of peer support staff for veterans, and the easily, or undergo a medical consultation without the role of polypharmacy in Post-Traumatic Stress need to travel—and will no doubt remain However, Disorder (PTSD) are all addressed in this issue The the human element remains and we all benefit links between killing in combat and PTSD are also from developing our relationships and networks examined Finally, Viking warfare and medicine, and when we can meet in person This year, that option the military history of tourniquets are both explored hasn’t been possible, but we can still listen to an excellent range of diverse speakers—both local and The Journal continues to welcome articles on a international—discuss their papers and be involved range of military and veterans’ health topics and I in panel deliberations This is also likely to be a would encourage everyone to consider submitting feature of future hybrid conferences, where speakers their papers As people prepare their presentations present from afar and those who can’t attend in for the Conference, I would ask people to consider person can listen in Hopefully, the personal element the next step of turning that well-researched will return and we can enjoy the presentations in presentation into a journal article A great deal of real life and the social interactions that surround excellent research, applied science, reviews, case them Let’s hope that 2021 allow us to build on this studies and historical papers never see the light of virtual foundation with some real face-to-face time day and we always appreciate the contributions that flow from the conference I look forward to seeing you all virtually at the end of November 2020 Dr Andy Robertson, CSC, PSM Commodore, RAN Editor-in-Chief Volume 28 Number 4; October 2020 Page 5 Original Article Benefits and Employment and Care for Peer Support Staff in the Veteran Community: A Rapid Narrative Literature Review C Deans Abstract Background: Veteran services increasingly use peers to support other veterans There are hypothesised benefits for the service users, service system and peers Purpose: This rapid narrative literature review sought recommendations for the employment of veteran peers via related reviews: one on the use of mental health peers, and one on the use of veteran peers irrespective of setting Method: Searches were conducted using PsycINFO and PubMED databases for peer-reviewed articles over the past decade Results: Part A of the search returned 117 articles Article categories were: case studies, single program evaluations, descriptive pieces, literature reviews and employment There were no outcome evaluations with control or comparison groups Part B of the search returned 20 articles Article categories were: case studies, peer, consumer and employment experiences There were no pre-post program evaluations Conclusion: There is limited evidence for the benefits of mental health peers or veteran peers From the current literature, some anticipated benefits and recommendations for the employment of veteran peers can be derived Anticipated benefits include engagement with providers, social support, stigma reduction, client engagement, program completions and peer benefits Considerations for employment include principles, selection, training, staff roles, organisational considerations, consumer access and peer care Key words: veteran, mental health, peer, employment, benefits, care Introduction for homeless or incarcerated veterans, 4 There has also been some use of peers for physical health A peer (‘peer’, also known as a ‘lived-experience