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Introduction: The U.S. Naval Ship COMFORT has performed six humanitarian assistance and disaster relief mission since 2007. This paper describes the surgical volume per surgical specialty for five missions spanning 19 countries., Materials and Methods: Raw surgical case logs were analyzed for total case volume, total operating days, unanticipated return to operating room, and percentage of pediatric cases (<18 years old) for each country visited., Results: Total surgical volume for the five missions was 5,142. The countries most frequently visited were Columbia and Haiti with seven and five visits, respectively. General surgery, ophthalmology, and plastic surgery have had consistent volume over time. Orthopedic surgery volume has steadily decreased with the exception of the 2018 mission., Conclusion: As volume in military treatment facilities declines, alternative sources of surgical volume for military surgeons are being examined. This paper highlights the historical volume which can inform future personnel planning requirements of U.S. Naval Ship COMFORT missions. With the exception of orthopedic surgery, surgical volume has remained consistent over the last decade. For future best practice, historical case data should be used to determine staffing needs on hospital ships and case logs and operating procedures and follow-up protocols should be standardized., (© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Abstract: In the future, United States Navy Role 1 and Role 2 shipboard medical departments will be caring for patients during Distributed Maritime Operations in both contested and noncontested austere environments; likely for prolonged periods of time. This literature review examines 25 modern naval mass casualty incidents over a 40-year period representative of naval warfare, routine naval operations, and ship-based health service support of air and land operations. Challenges, lessons learned, and injury patterns are identified to prepare afloat medical departments for the future fight., Level of Evidence: Literature Review, level V., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Global health engagement missions are conducted to improve and protect the health of populations worldwide. Recognizing the strong link between health and security, the Armed Forces have increased the number of global health engagement missions over the last decade to support force health protection, medical readiness, enhance interoperability, improve host nation capacity building, combat global health threats (i.e., emerging infectious diseases), support humanitarian assistance and disaster relief efforts, as well as build trust and deepen professional medical relationships worldwide. These missions additionally support the US Global Health Security Agenda, US National Security Strategy, US National Defense Strategy and National Military Strategy.Although global health engagement missions are conducted by armed forces with numerous military units and geographical locations, military healthcare personnel assigned to US Naval hospital ships also perform a wide range of these missions. These missions comprise some of the largest global health engagement missions conducted, encompassing hundreds of subject matter expert exchanges, community health exchanges, medical symposiums, and side-by-side partnered healthcare in countries around the world. Military healthcare personnel who have completed past missions possess valuable knowledge related to ship-based global health engagement missions. Capturing and transferring this knowledge to future deployed personnel is important for future successful missions, but has remained a significant challenge. The purpose of this study was to capture and examine first-person accounts of experiential learning among active duty physicians, nurses, and hospital corpsmen who had participated in recent hospital ship-based global heath engagement missions., Materials and Methods: We used the interpretive, ethnographic method of interviewing and data analysis described by Benner. Interviews elicited detailed, narrative examples of experiences from military health care personnel who had participated in previous global health engagement missions aboard hospital ships (N = 141). Our approach to gaining meaning from these narratives was guided by three central strategies: (1) identify paradigm cases, (2) identify themes within and across participant narratives of meaningful patterns, and (3) identify exemplars to represent common patterns of meaning and common situations. Additionally, we collected demographic information., Results: Our findings provide firsthand descriptions of five essential elements to prepare military healthcare personnel for shipboard global health engagement missions. These essential elements are mission clarity, preparedness, experiential knowledge, lessons learned, and flexibility/adaptability., Conclusions: Widespread dissemination of the lessons learned from military global health engagement missions is crucial to shaping forces that operate effectively in a rapidly changing global environment. Sharing lessons learned increases efficiency, adaptability, and agility, while decreasing variance in processes and the need to relearn mission-specific lessons., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Naval cohorts rely heavily on personnel to ensure the efficient running of naval organisations. As such, the wellbeing of personnel is essential. In an occupational setting, naval service personnel experience a variety of physiological and psychological stressors. Most naval services arrange annual physical fitness and body composition tests to ensure the physical readiness of personnel. However, these tests only evaluate a small amount of physiological capabilities. Components such as aerobic and strength capabilities are assessed, however, other components of physical fitness such as speed, agility, anaerobic capacity and flexibility are not. In addition to the physical capabilities, personnel are impacted by fatigue, nutrition and psychological stressors such as copping in stressful situations or dealing with time away from family and friends. This review will discuss the physiological and psychological factors that affect personnel's wellbeing. In addition to this, it will also evaluate the methods that are used to assess both physiological and psychological wellbeing.

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.

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.

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.

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.

Health care organizations face unprecedented fiscal, regulatory, and social challenges. Future executive leadership of health care organizations must be extremely effective for an organization to remain vital. To identify the characteristics that successful leaders of the future will require, 11 senior health care executives in the U.S. Navy Medical Department were invited to describe (1) desirable characteristics of future health care leaders, (2) how to identify individuals with executive potential, and (3) how to prepare individuals to become successful health care executives. The findings provide a blueprint for leadership development for leaders in health care organizations.

The objective of this work was to estimate the cost to the U.S. Navy for obesity-related hospital admissions by examining (1) inpatient utilization associated with obesity; (2) the rank order, probability, and total facility costs of obesity-related diagnosis-related groups (DRGs); and (3) expected inpatient expenses. The frequency and probability of inpatient events in the Navy's active duty population were derived from the Department of Defense's Retrospective Case Mix Analysis System. Medicare-based facility costs per DRG were estimated. These measures were combined in a decision-analytic model. Expected facility costs per obesity-related admission for active duty Navy personnel increased by age group from $3,328 for 18 to 24 year olds to $5,746 for 45 to 64 year olds. The annual avoidable inpatient cost for the Navy was estimated to be $5,842,627 for the top 10 obesity-related DRGs. Improvements to the Navy Physical Readiness Program and other interventions that may reduce obesity, obesity-related health care use, and the public economic burden should be pursued.

Those in the Naval Medical Department are experiencing an exciting time of bridled chaos and creative change. Many mid-career officers are uncertain of the leadership behaviors and skills that will be necessary for successful managerial careers. Changes in the method of health care delivery of this nation combined with the reengineering of the armed forces' world-wide mission has driven military medical leaders to expand their professional skills, knowledge, and abilities beyond the clinical sciences. This research identifies the most critical domains in the science of health care administration and differentiates and ranks job skill, knowledge, and ability requirements that will be necessary for successful health care management into the 21st century. Top Naval hospital executives responded to two iterations of a Delphi inquiry. These medical leaders identified 106 unique issues that were content-analyzed into nine domains by a neutral, expert panel. Domains, in order of ranked importance, were leadership, health care delivery systems, cost-finance, technology, accessibility, professional staff relations, marketing, quality-risk management, and ethics. In the second Delphi iteration, hospital executives reviewed domain results and rated identified job requirements on their required job importance. The top-10 rated skills, knowledge, and abilities are reported. Results indicated that although a business orientation is needed for organizational survival, an emphasis on person-oriented skills, knowledge, and abilities is required for future success as a health care administrator in the Naval health care system.

Estonian National Maritime Board has reported about 16,000 seafarers in Estonia. According to Estonian new national regulations concerning medical examination of employees on board ships issued on 9 April 1998 seafarers are examined only at Estonian Seamen's Hospital by experienced physicians of expertise commission. The validity of the certificates of fitness is 2 years, for persons younger than 21 and older than 50 years of age the validity is 1 year. The medical training of seafrers is carried out according to IMO Model Courses at special training ships and Estonian Disaster Medicine Centre. The International Medical Guide for Ships is used on sea-going vessels which fly Estonian flag.

Now in connection with common situation in Russian Federation the problem of reinforcements of army and fleet by healthy personnel, scare of a call-up quota and its poor quality are the main problems of the Armed Forces at the state level. The uniform complex program of medico-social maintenance of the citizens during preparation for military service is necessary. The modern situation is difficult due to many infectious diseases, so the role and the place of military-medical service grows. In last years structure of quota, served by the military doctors, and number of other parameters have greatly changed, that require revision of some priorities. A problem of reinforcements of the Armed Forces by medical service officers remains actual, for decision of which a full-bodied admission on military medical faculty is required, as well as admission of the officers under contract and calling-up of reserve officers. In article the main lessons, received by the medical service during combat actions in Republic of Chechnya are also formulated.

The new requirements to the military medico-geographical researches, to contents and structure of military medico-geographical descriptions are considered, caused by evolution of global geopolitical situation, by occurrence of the modern information technologies, the geographical information systems, by development of the medical ecology and information medical service. Principles of the concept of the ecological military-medical geography are proved. The priority problems and specific peculiarities of the units are stated. It is recommended wider use of the factor's approach and cartographic method to enhance the organization of medico-ecological maintenance of the Army and the Fleet personnel activity.

We studied the epidemiology, morbidity, and etiology of dermatologic and non-human immunodeficiency virus venereologic disease (Derm/STD) aboard a deployed aircraft carrier to revise Derm/STD training objectives for shipboard primary care providers. Onboard supplies for treatment of Derm/STD were also evaluated. Over 3 months, 929 Derm/STD patients were treated for 1,320 diagnoses generating 2,011 visits. Derm/STD caused 22% of the total morbidity. Pyoderma alone accounted for nearly one-half of that morbidity and involved many work-center groups. Air wing, aircraft maintenance, and engineering work-center groups had lower burdens of pyoderma. Bacterial cultures were performed on 248 exudative dermatoses. Staphylococcus aureus was the dominant pathogen and was overwhelmingly sensitive in vitro to common, inexpensive antibiotics. Strategies to encourage prevention, earlier diagnosis, and rapid treatment of Derm/STD by deployed primary care providers are discussed.

The article analyzes the causes of unsettled problems of troops elements of medical service, the directions toward optimization of there function. The most important factors of the effective work of troops elements of medical service are prophylaxis of widespread diseases, traumas and poisoning among Army and Navy personnel, strengthening of the sanitary epidemiologic control, early and active diagnosis, improvement of the prophylactic medical examination, quality increase of diagnosis and treatment activities. Is emphasized that up to 80% of ill servicemen must complete there stationary treatment in the troops medical institutions. From the point of health protection of servicemen the practical importance of medical post as a centre of diagnosis and treatment in troops is increasing, its readiness to provide emergency medical care in any conditions is growing too. Is given attention to necessity to re-equip the medical service of airborne troops, forming the main part of the Mobile Forces, with mobile medical complex, to increase quantity of providing medical care in the units, to reconsider the structure of troops medical staff, to expand it by surgeons and medical personnel.

In the modern stage of the development of medical service the planning of preventive measures must be accompanied with prognostication and economic estimation of the expenses, as well as by veritable definition of the malady. The improvement of methodological approaches in planning is an important part of a system of prophylaxis of infectious diseases. The complex method of the analysis of epidemiological situation must provide for more effective fulfillment of tasks using short and long-term plans of prophylactic works.

The complicated sanitary-epidemiological situation in Russia and its Armed Forces imposes the necessity to concentrate main efforts of the Army and Navy medical service on prophylaxis. The process of the improvement of prophylactic work must be carried out in accordance with the Russian Armed Forces development concept. The basic trends of this prophylactic work are the following: reformation of the health protection system, sanitary-epidemiological control and proper the medical prophylactic procedures in order to meet the requirements of the present day. During the assignment of new missions it's necessary to stress that prophylaxis must be considered as an important task of the entire Armed Forces Medical Service.

The article analyses the changes which have taken place during the last years in the functioning of the system of specialized medical care in the Armed Forces of Russian Federation. A new definition of this kind of medical care is given in this article, as well as its contents, components, and methods of its further improvement. The authors stress the positive results which were achieved by large multipurpose medical establishments with organic specialized medico-diagnostical units. Trends towards the further development of the system of specialized medical care were created taking into account the regional system of medical support of the Army and Navy. This article has a scientific and practical character and is interesting for the physicians and pharmacists of all specialties.

From the point of view of occupational medicine the Army, Air Forces and Navy may be considered as a specific large-scale industrial branches which has some features in common with civilian branches. The authors propose to join the efforts of military and civilian hygienic science to solve the problems of ecology, sanitary standardization, adaptation and acclimatization in order to estimate and control the risk of professional pathology. The article shows basic trends of fundamental researches and scientific outlines for nearest and long-term period.