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עמוד בית
Wed, 29.05.24

March 2019 (Issue 41)


Articles
Dorit Tzur, Amir Shlaifer, Gilad Twig, Ron Kedem, Dror Yifrach, Elon Glassberg
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Introduction: Hospitalization trend data of IDF soldiers demonstrate the hospitalization trends of the general population (ages 18-24), which are determined by the established processes and adjustments of the healthcare system, as well as the influence of programs for advancing health, preventative medicine, protective gear improvements and treatment protocols of the IDF.

Objective: To examine data about the conditions of all military deaths during the last three decades (1990-2016) and present data from cases of serious injury and intensive care hospitalization in order to identify trends that characterize injuries compared with mortality.

Methods: The study population included all soldiers in compulsory service, permanent service, and active reserve duty who were hospitalized in Israeli hospitals or died from any cause during the years 1990-2016 (233,904 soldiers, including 3,297 mortalities). Details regarding injury circumstances and hospitalization are based on reports to the IDF Manpower Division from hospital medical units. Data regarding mortality events are based on IDF registration system.

Results: Circumstances constituting operational death were 29% of the total mortalities compared to suicide (24%) and traffic accident (21%). It was found that there is a downward trend in cases of death due to disease (2.5% per year) and trauma (2.7% per year). The percentage of operational casualties treated by intensive care units which led to fatality or hospitalization indicates a downward trend of 1.9% per year. The rate of decline of 1.5% was observed in a similar analysis performed on the other trauma conditions. In addition, it was found that there was a downward trend in the percentage of total cases resulting in hospitalization or death: operational conditions – 2.2% per year, traffic accidents – 1.7% per year.

Conclusions & Recommendations: A decrease in mortality trends were found among soldiers in all cases resulting in death, specifically those involving trauma. Responsibility for this reduction may lay with the effectiveness of programs designated to improve military medical response, which has been implemented in recent years. In order to maintain the progress observed, it is imperative to continue exploring and deepening our understanding of the causes of military trauma, hospitalization and death. A rather dichotomous division between death and hospitalization reach operational circumstances implies that is required to continue investing through triage, treatment and evacuation area.

Keywords: Trauma; Hospitalization; Intensive care; Traffic accidents.
Avishai M. Tsur, Victor Rivkin, Lena Koren, Hagay Frenkel, Eva Abramovitch, Sharon Ohayon Cohen
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Background: Body-mass index (BMI) of military service candidates affects service assignment. A screening height and weight measurements are performed about a year and a half prior to recruitment. During this period, changes occur due to growth, dietary habits, and exercise.
Objective: To estimate the percentage of conscripts who are fit for combat roles at the time of recruitment, even they were deemed unfit due to their initial screening height and weight measurements.

Methods: This retrospective cohort study was based on data from the recruitment survey conducted from 2010 to 2016. Height and weight were measured again on the day of recruitment at the induction center. Chi-square was used to indicate differences in BMI groups between the screening and the updated measurement.

Results: The final analysis included 5,250 participants. Of these, 3,051 (58.11%) were men. In men, out of those determined to be significantly underweight (BMI<17) during initial screening, 62.65% were fit for infantry combat roles on the day of recruitment. Out of those suffering from morbid obesity (BMI>35) during screening, 37.5% were fit for combat roles on the day of recruitment, including 17.5% who were fit for infantry combat. In women, out of those were significantly underweight, 46.03% ended up being fit for combat roles on the day of recruitment.

Discussion & Recommendations: An updated BMI measurement prior to recruitment of military service for candidates suffering from being significantly underweight or morbidly obese, both in women and in men, would increase the pool of combatants. Therefore, our recommendation is to summon these candidates a month prior to recruitment for a repeated measurement and updated service assignment.

Keywords: Body Mass Index; Underweight Obesity; Military service candidates.
Arina Gurevich, Orit Bittner, Ilana Schumacher, Meital Zur, Pavel Gorenbein
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Introduction: IDF Medical Supply Service provides medications and medical supplies in emergency scenarios, through medical supply kits stored in IDF stockpiles, and are refreshed once every 18 months. Medical supplies are authorized for use according to strict regulations, however, due to the exposure to uncontrollable storage conditions, examination and quality assessment based on pharmaceutical and analytical research are regularly conducted by the IDF Pharmacy Branch's analytical lab. Objective: This study examined the efficacy and stability of Morphine Amp. and Ketamine Vials stored in uncontrolled (field) conditions, compared to manufacturer recommended conditions.

Methods: Tests performed included active entity analysis (assay), presence of degradation products, particulate matter quantification, pH, elemental impurities and pharmacological efficacy in rats. Studied drugs were stored at controlled: (A) Room Temperature (250C); (B) Accelerated Conditions (400C); and uncontrolled (C) Field conditions, and sampled at 3-time intervals: 0, 6 months and 12 months. Samples stored at 00C throughout the year were used as a reference.

Results: Morphine Amp: There was no change or deviation from normal range in assay results, degradation products, particulate matter, pH and pharmacological efficacy in rats. Moderate increases in Al and Si concentrations were measured in correlation with storage period. Ketamine Vial: There was no significant change in particle concentration, pH or pharmacological efficacy in rats. Slight increases in Ketamine Zn, Cr, Al and Si concentrations after 400C storage was found.

Discussion & Conclusions: Studied medications were found relatively stable in all groups and results were within defined IDF and manufacturer specifications. However, signs of accelerated glass and rubber (packing components) degradation in medications stored at high temperature were evident, a finding that emphasizes the importance of demand for high quality package components and necessity of continuous evaluation of these parameters in additional batches of medications stored at different storage conditions and for longer time periods.

Keywords: Morphine stability; Ketamine stability; Morphine degradation; Ketamine degradation; Storage conditions of medicines; Uncontrolled storage conditions.
Tarif Bader, Charles Milgrom, Aharon S. Finestone
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Introduction: The first prospective stress fracture study performed in the IDF, among elite infantry recruits in 1983, reported an alarmingly high, 31% incidence of stress fractures. Since then the utilization of bone scan and the criteria for diagnosing stress fracture have changed, along with training programs and our knowledge of stress fracture.

Objectives: To reanalyze the original 1983 study based on current IDF diagnostic criterion and current stress fracture knowledge. Methods: The preserved original computerized database and orthopaedic stress fracture forms and the internal report of the Chief Army Medical Officer summarizing the study were used to reanalyze the 1983 study, utilizing the current diagnostic criterion and knowledge of stress fracture.

Results: Using current criteria, the calculated incidence of stress fractures in the 1983 study increased to 47.8% and the incidence of asymptomatic femoral stress fractures increased to 75.8%.

Discussion: The lessons learned from the reanalysis of the 1983 study are presented. The factors thought to have been responsible for the extraordinary high incidence of stress fractures are presented along with the proper utilization of bone scan and commander stress fracture education.

Conclusion: The reanalysis performed of this study shows the stress fracture problem was even more severe than originally described. The one-year follow-up of the soldiers indicates that their stress fracture risk subsequent to basic training was largely confined to those who had sustained stress fracture during basic training.

Keywords: Stress fracture; Incidence, Bone scan; Criteria.
Reviews
Maayan Lustig, Amit Hadid, Rinat Friedman, Amit Gefen, Yoram Epstein
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The decision process of developing or acquiring suitable military gear that improves survivability and functionality, is a complex process. As part of this process, the durability of equipment to external loads is examined. However, because of ethical and practical reasons, the effect of relevant loads on soldiers’ bodies and their biological tissues has hardly been studied. In recent years, a new approach to examine military and athletic gear, based on computational modeling, has been adopted. This computational modeling consists of a precise anatomical three-dimensional model of a relevant organ and its comprising tissues, the biomechanical properties of the tissues, with a computerized representation of the gear. The gear was examined according to its exact geometric structure, its parts and its physical and mechanical properties. This approach constitutes a quantitative, standardized and effective platform for objective comparison between different systems and enables a more informed decision-making process. Through the presentation of several examples, this article will demonstrate the strength of using computational modelling in evaluating the effectiveness of the gear provided to soldiers (in terms of protection, functionality, ergonomics, etc.). Since the computational system includes an accurate anatomical description of the analyzed tissue, it can also be used to study the development of injuries and specifically, those that are prevalent in the military milieu, such as stress fractures.

Keywords: Computational Model; Biomechanics; Head Protection; Protective Goggles; Load Carriage; Ergonomics.
Shany Guly Gofrit, Avishai M. Tsur, Sharon Ohayon Cohen, Lena Koren, Hagai Frenkel
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The number of female soldiers in combatant units in the IDF has steadily increased and has reached about 2,700 soldiers in 2017. These female combatants participate in military operations alongside male combatants. Integrating women in combative roles raises several questions regarding their training, stemming from the anatomical and physiological differences between the genders. During the last couple of years, the number of injuries sustained by female combatants decreased significantly, mostly due to the creation of a specialized multi-disciplinary program lead by the Infantry Division and Medical Corps. In this article, we reviewed the medical literature regarding female combatants in armies across the world and in the IDF, including physiological differences, urogynecological morbidity, diet, iron deficiency and anemia, overuse injuries and the need for medical services. Our goal was to collect and summarize the current knowledge in this area as well as to present potential innovations and their practical applications in the training of border infantry units.

Keywords: Female combatant; Overuse injuries; Anemia; Uterine prolapse
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