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Medical aid to the population stems from a long French tradition of caring for native populations. It has evolved through the various deployments in modern conflicts and is now based on well-defined principles. It is diplomatically important, as it allows the acceptance of the Force by the population. It is governed by military and strategic, legal but also ethical rules.The experience of the surgical assistance offered at the operational base in Gao has highlighted the limits that each surgeon has had to impose on himself to ensure the sustainability of this care.It was necessary to consider the local environment, to learn and adapt to socio-cultural norms, and to assess the needs of the population. Very costly in terms of human and material resources, it was necessary to define the care that could be offered.Confronted by a very large request for care, and the virtual absence of local health structures, not everything can be done, nor should it be done.Throughout his mandate, the military surgeon must consider the operational mission which takes precedence, and the humanitarian side. The principle of beneficence is at the heart of the medical reflection.The transmission of knowledge is essential for sustainability. The basic principles are taught to junior surgeons during specific theoretical courses, and practical training alongside an experienced surgeon.The main idea is that this surgical aid should be beneficial to the greatest number and be sustainable, without compromising the operational mission or giving false hope to the local population.

In 2017, conceptual work began to develop a Role 2 Forward Surgical Capability (FSC) that could be rapidly deployable and manoeuvrable, modular and scalable, delivering Damage Control Resuscitation, Surgery and critical care patient hold. This developmental work was underpinned by lessons from other United Kingdom (UK) Role 2 light manoeuvre capabilities and exercising with a similar French capability. To standardise UK military medical descriptive nomenclature, direction was given to replace FSC with the term Ground Manoeuvre Surgical Group (GMSG).In Autumn 2019, 34 Field Hospital were tasked with delivering a GMSG the following year, supporting a 250-strong Long Range Reconnaissance Group (LRRG) provided by the UK, contributing to the United Nations Multidimensional Integrated Stabilisation Mission in Mali (MINUSMA).Initial planning guidance was to expect long range patrols in a desert environment for four to six weeks duration with no or minimal resupply. Mali has ambient day time temperatures more than 40°C enduring for most of the year. This was judged likely to have significant impact on the safe storage of blood products and components, as well as temperature sensitive drugs while mobile on long range patrols. Existing in-service cold storage equipment was not designed to be operated while mobile nor to operate in a high ambient temperature, risking failure.An innovative integrated temperature control solution was ultimately fielded, consisting of air-conditioned tentage, extended life cold boxes and a power solution to ensure cold box plates could remain frozen in a freezer while mobile on patrol. The integration of these capabilities led to successful delivery of medical support to the LRRG.

BackgroundHeat adaptation is protective against heat illness however its role in heat syncope, due to reflex mechanisms, has not been conclusively established. The aim of this study was to evaluate if heat acclimation (HA) was protective against heat syncope and to ascertain underlying physiological mechanisms.Method22 (17 males, 5 females) endurance trained cyclists were randomised to either 8 days of mixed active and passive HA (HEAT) or temperate exercise (CONTROL). Prior to, and following, the interventions participants underwent a HUT with graded lower body negative pressure (LBNP) continued until presyncope with measurement of cardiovascular parameters. Heat stress testing was performed to determine physiological and perceptual measures of HA.ResultsThere was a significant increase in orthostatic tolerance (OT), as measured by HUT/LBNP, in the HEAT group (preintervention; 28±9 mins, post-intervention; 40±7 mins) compared to CONTROL (pre-intervention; 30±8 mins, post-intervention; 33±5 mins) (p= 0.0116). Heat acclimation resulted in a significantly reduced peak and mean rectal and skin temperature (p<0.0141), peak heat rate (p<0.0033), thermal comfort (p<0.0411) and rating of perceived exertion (p<0.0251). There was a significantly increased plasma volume in the HEAT group in comparison to CONTROL (p=0.0293).ConclusionsHeat adaptation causes improvements in OT and is likely to be beneficial in patients with heat exacerbated reflex syncope. Heat acclimation mediated PV expansion is the likely predominant physiological mechanism underlying improved OT. These data offer opportunities to improve health and wellbeing of service personnel with economic, logistical and reputational benefits for the UK Armed Forces.

Diagnostics remains to be an important and vital capability of any deployed field hospital or surgical team, particularly for teams that find themselves deployed in the most remote locations, such as Mali. The DRGo gives the British military a portable radiography solution. Completely digital, it provides an instantaneous X-ray for clinicians to review. A 6-month period between Dec 21 and Jun 22 saw 29 full X-ray examinations completed with a 50% split between those patients being referred for imaging in the firm base and those referred whilst out on patrol. With no deployed radiologists on the ground, the ability to obtain radiologist reports is pivotal to the patients’ subsequent treatment pathway. X-rays and CT scans were uploaded back to the Royal Centre for Defence Medicine for reporting through the help of Project Lara. Project Lara brings together several separate innovation capabilities to deliver a better improved telemedicine solution. It gives Defence Medical Services personnel the ability to request support or transfer medical information whilst deployed in the field via secure communication systems. The project utilises a SATCUBE satellite terminal, essentially a portable WiFi hotspot. When setup, it allows for a high-speed broadband connection of around 10mbps in less than a minute. Used in conjunction with the secure messaging app, Pando, complete radiologist reports were received back from the UK often in less than one hour of uploading the initial X-rays. A natural fit, the deployed Radiographer took on the role of the communications lead and demonstrated how well the two roles could combine in future remote Operations.