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Background: Figures from the Department of Veterans' Affairs indicate there may be over 30,000 Australian veterans that have or may yet develop some form of service-related mental illness. There is a growing body of evidence that there is a spiritual dimension to soldiers' wounds. Purpose: The purpose of this paper is to understand the causes, symptoms and healing pathways for spiritual wounds, Method and materials: Firstly, exploration of the nature of veteran spirituality, Secondly, how a veteran's spirit can be wounded and what form these wounds take will need to be understood, Finally, approaches to healing these spiritual wounds. Results: There is a strong and growing body of empirical evidence highlighting linkages between diminished spiritual functioning and mental health issues such as post-traumatic stress disorder (PTSD). Properly trained and accredited medical and psychological practitioners are required to deliver treatment in their space. Conclusion: There is limited evidence of any spiritual institution or facility of any nature making a significant contribution in the support of veterans whose Defence service has led to mental health issues with a spiritual or faith basis. Determining what role spiritual institutions or facilities should take will need to be a major area for further study. [ABSTRACT FROM AUTHOR]

More than 2500 trained Australian army nurses served overseas during World War I. Many were called upon to act outside their normal nursing practice and one new area was that of anaesthetics. Due to a lack of medical officers in the latter part of the war, a number of Australian theatre sisters trained and worked as nurse anaesthetists in Casualty Clearing Stations in France. The British Army provided three months' training for Australian, British and New Zealand nurses in the use of chloroform and ether. Australian nurses were enthusiastic volunteers as trained nurses at home had already carved out a small but unofficial place for the profession in this role. In addition, Canadian and American army and civil nurses were already trained and used as nurse anaesthetists. While nurses were successfully used without recorded incident, at the end of the first training course, the Director General of Medical Services, Australian Imperial Force, decreed that the nurses would not be further trained or used. This was out of step with the other countries participating, and this paper examines some possible reasons for the change of heart. [ABSTRACT FROM AUTHOR]

Australian Defence Force Garrison Health Support operate in a complex relationship between a geography-based National Support Area (NSA) health care model, in which most of the medical resources and staff are owned by the single services; deployable capabilities, also owned by the Single services; and a National health care system that provides primary, secondary and tertiary health care both to the NSA and to deployed forces. The Alexander Review, amongst other things, was required to inform the development of a command and technical control structure for health units that optimizes operational efficiency and effectiveness, and clarifies accountability to the Service headquarters and other Groups in the ADF. The RAAAKERS™ (Responsibility, Authority, Accountability, Awareness, Knowledge, Experience, Resources and Systems) framework was used as an analysis tool to assist in understanding the main command and control stress points in the Defence Health Services Division (DHSD). Structured interviews with many of the key staff of DHSD allowed the RAAAKERS™ construct to probe into the alignment of elements related to command capability, such as the Responsibility, Authority and Accountability attributes, and those associated with elements of control, such as the KERS attributes. In particular the paper shows how data from the interviews enabled construction of RAAAKERS™ metrics to highlight problematic areas related to technical control and to a lack of alignment in Responsibility, Authority and Accountability in some areas of DHSD. The Viable Systems Model (VSM), developed by operations research theorist Stafford Beer, is a model of the organisational structure of any viable or autonomous system. As an additional analysis tool for the Alexander Review, VSM techniques were used to study Garrison Health Support and to determine the structure of the five internal systems needed for viability. This preliminary study also indicated stress points in the technical control aspects of Garrison Health Support and provided some support to the findings of the RAAAKERS™ investigation. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of the U.S. Physician Assistants (PA) program in the Australian military. The PA model, which can be a post-military career choice option, has been beneficial in internal military application. The Australian healthcare system has considered the PA model as a means to address medical workforce shortages and maldistribution.

The article discusses the professional development of medical officers in military and clinical progression through the Rank and Competency Level program provided by the Australian Defence Force (ADF) in Australia. Advancement through the required training to clinical Competency Level 3 has been a struggle for the officers. Outcomes significant for immediate clinical environment are compatible with relevant content for ADF Registrar training.

The article discusses the availability of armamentarium for emergency airway rescue through supraglottic airway devices which have simple blind placement technique and high rates of correct positioning in Australia. The accumulation of evidence allows for pre-hospital and emergency airway management with supraglottic devices to be advocated more routinely. Devices can be evaluated, trained, and assessed through low cost airway simulators.

The article discusses the airway management provided by pre hospital personnel and military medics in Australia. Theatre and pre-hospital airway support are operated through video aided laryngoscopy. Far flung deployed medical personnel can afford a lifesaving tool for integration into battlefield care doctrine and algorithms through continued development in ruggedisation and miniaturisation.

An abstract of the article "Delivering quality healthcare in challenging environments" by Mark Parrish is presented.