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ABSTRACTIntroduction: Systemic Autoimmune Diseases (SADs) include systemic lupus erythematosus, antiphospholipid antibody syndrome, rheumatoid arthritis, systemic sclerosis, Sjogren’s syndrome, mixed connective tissue disease, idiopathic inflammatory myopathies and vasculitis. SADs often occur in women of childbearing age and can affect fertility. Both infertility treatments and fertility preservation techniques are thus often indicated.Areas covered: The literature regarding the safety of fertility-related drugs for both fertility preservation and infertility treatment in patients affected by SADs was reviewed. Based on current knowledge, all the options for fertility preservation should be contemplated in patients with SADs who are at risk for fertility loss, including GnRH analogue administration, oocyte/embryo vitrification and ovarian tissue cryopreservation. Similarly, if pregnancy is not contraindicated in a patient with a SAD, neither should be any fertility treatment.Expert opinion: Women with SADs should postpone conception until a stable disease has been achieved for at least 6 months. When infertility treatments are needed, women with antiphospholipid antibodies should receive concomitant anticoagulation. If in vitro fertilization/intra-cytoplasmic sperm injection and embryo transfer is required, ovarian hyperstimulation and the inherent risk of thrombosis should be eliminated by GnRH-agonist trigger and cycle segmentation. Counselling about adherence to anti-rheumatic therapy to prevent disease exacerbations is also critical.

The new millennium challenges the Army Medical Department to provide good care in a variety of circumstances from peacetime to operations other than war to combat. To provide care in this broad variety of missions, the Army Medical Department needs flexible providers. The new 91W health care specialist enlisted medic is designed to meet this need. By coupling skills in emergency care, evacuation, medical force protection, and primary care with certification in emergency medical technology, the 91W initiative will fill the needs of the Army now and into the new millennium.

During battlefield and mass casualty incidents, triage has been traditionally performed by many different personnel, including medics, nurses, dentists, and physicians. The objective of this study was to determine which military medical providers are most knowledgeable in mass casualty triage. The design was a prospective, written, timed, case-based examination of triage knowledge. Participants were volunteers from the active duty medical (physician), dental, nursing, and enlisted corps of the three military services. Subjects completed a 16-minute written examination consisting of seven cases in each of three simulated mass casualty scenarios: combat; nuclear, biological, and chemical; and humanitarian. Tests were taken anonymously, although demographic data on medical specialty, training, and experience were collected. Participants were instructed to classify the cases using the NATO categories of immediate, delayed, minimal, or expectant. Scores were tabulated according to two grading scales: an absolute scale of number correct, and a weighted scale amplifying gross misclassifications. Median scores between groups were tested pairwise using the Kruskal-Wallis one-way analysis of variance with p < or = 0.05. Statistically significant differences were noted between the highest and lowest scoring groups in each scenario. Our conclusion is that among the subject groups tested, physicians were best at mass casualty triage. Dentists, nurses, and medics scored progressively less well on our examination.

As military medicine in general copes with a rapidly changing world environment, so too must the backbone of the medical force, the enlisted medic. To meet these challenges, the training and utilization of military medics must match new and different missions. This paper will explore innovative approaches to training and preparing for combat casualty care and field medicine. The focus will fall on the education, evaluation, operations, patient-care skills, equipment, and telemedicine potential of the military medic. Future directions for study and development will be suggested. Exploration of the following may improve the capability of the military medic: (1) improved training to include advanced-level skills and interventions for combat casualty care and broader exposure to the casualties expected in operations other than war; (2) annual educational and periodic proficiency evaluation requirements; (3) strengthened medical control at all echelons; and (4) carefully selected additional equipment and technologies to enhance medical capabilities.

Safety is a principal concern for everyone in aviation, including those in military and civilian aeromedical programs. The U.S. Army flies thousands of helicopter missions each year, including many aeromedical flights. The comparison between Army general and aeromedical aviation crash data provides a benchmark for establishing patterns in aeromedical safety and may be useful for similar programs examining safety profiles.