Добірка наукової літератури з теми "Trauma teams; military; Australian Defence Force"

Objective: The study investigated the impact of potentially traumatic events on mental health outcomes among males who had ever served in the Australian Defence Force. Method: Data from a nationally representative household survey of Australian residents, the 2007 National Survey of Mental Health and Wellbeing, were used for this study. Results: Compared with community members, Australian Defence Force males were significantly more likely to have experienced not only deployment and other war-like events but also accidents or other unexpected events, and trauma to someone close. For non-deployed males, Australian Defence Force members were at increased risk of accidents or other unexpected events compared to community members. After controlling for the effect of potentially traumatic events that were more prevalent among all Australian Defence Force members, the increased risk of mental disorders among Australian Defence Force members was no longer evident. For non-deployed males, Australian Defence Force and community members were at comparable risk of poor mental health outcomes. A significant minority of Australian Defence Force members had onset of a mental disorder prior to their first deployment. Conclusions: Deployment and other potentially traumatic events among Australian Defence Force members can help to explain their increased vulnerability to mental disorders compared with community members. Providers should routinely enquire about a range of potentially traumatic events among serving and ex-serving military personnel.

The Australian Government first started to deploy civilian medical teams internationally in the aftermath of the 2004 Tsunami to Banda Aceh, the Maldives, and Sri Lanka. Historically, Australia had relied upon the Australian Defence Force (ADF) to provide overseas medical assistance, but, in this instance, the volunteers deployed were civilian staff, predominantly from tertiary hospital environments. Civilian Australian Medical Assistance Teams (AUSMATs), particularly in Banda Aceh, interacted closely with the ADF after the tsunami and have had a close liaison with the ADF in subsequent disasters, particularly where ADF assistance was required for aeromedical evacuation of patients. This has included assistance after the 2005 Bali bombing, the 2009 Ashmore Reef explosion, the 2009 Samoa tsunami, and the 2010 Pakistan floods. In the latter, Australia deployed a joint military-civilian medical taskforce to provide care to the affected people in Kot Addu in central Pakistan. Having had extensive experience in both military and civilian disaster responses, the authors in this presentation will look at the lessons that can be shared between civilian and military teams in the Australian context. The military brings particular proficiency in command and control, information gathering, security, communications, general logistics, aeromedical evacuation and living in the field. The civilian AUSMATs bring specialized medical expertise, experience in operating in small teams in a range of disaster conditions, health logistics, surveillance, and public health measures in a disaster setting. Learning how to blend these skill sets will be critical in ensuring effective and collaborative international deployments in the future.

AbstractBackgroundTo better understand the associations of childhood trauma and childhood disorder with past-year suicidality (thoughts, plans or attempts), we compared male military and civilian populations aged 18–60 years old.MethodsData derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics Australian National Survey of Mental Health and Wellbeing were compared using logistic regression and Generalized Structural Equation Modelling (GSEM).ResultsA greater proportion of the ADF experienced suicidality than civilians. Those who experienced childhood trauma that was not interpersonal in nature were not at increased odds of suicidality, in either population. A higher proportion of the ADF experienced three or more types of trauma in childhood and first experienced three or more types of trauma in adulthood. Both were associated with suicidality in the ADF and civilians. Childhood anxiety had a strong and independent association with suicidality in the ADF (controlling for demographics and childhood trauma, adult trauma and adult onset disorder). Childhood anxiety fully mediated the relationship between childhood trauma and suicidality in the ADF, but not in civilians.ConclusionsThese data highlight the need to take a whole life approach to understanding suicidality, and the importance of categorizing the nature of childhood trauma exposure. Importantly, childhood anxiety was not only associated with suicidality, it fully mediated the relationship between childhood trauma and suicidality in the more trauma exposed (military) population only. These findings have the potential to inform the development of strategies for suicide prevention.

Background and aims Veterans who have recently left the military (i.e., transitioned) may be vulnerable to the development of psychiatric disorders, but little is known about gambling problems in this population. This study investigated the prevalence and risk factors of gambling problems, help-seeking amongst veterans with gambling problems, and relationships with trauma and posttraumatic psychopathology. Methods Cross-sectional self-report survey data from 3,511 Australian Defence Force members who left the military within the past five years. Surveys included measures of gambling problems (PGSI); depressive symptoms (PHQ-9); posttraumatic stress disorder (PCL-5); help-seeking behaviours; military and non-military-related trauma. Results Prevalence rates for problem gambling (PGSI ≥ 5) were 4.6%, while an additional 8.8% were classified in terms of at-risk gambling (PGSI = 1–4). Time since leaving the military was not associated with gambling problems. Only 2.1% of veterans with problem gambling reported help-seeking for their gambling. While trauma exposure, depression, and Posttraumatic Stress Disorder (PTSD) were all related to gambling problems at the bivariate level, only arousal and dysphoric-related affect were uniquely associated with gambling problems when adjusting for covariates. Discussion Gambling problems may be under-recognised relative to other psychiatric issues. Posttraumatic mental health problems, rather than trauma exposure per se, may explain the relationship between trauma and gambling problems. Conclusions Some veterans are in a period of vulnerability during transition out of military service, and harms associated with gambling problems may be exacerbated during this period.

AbstractBackgroundChildhood adversity is associated with mental disorder following military deployment. However, it is unclear how different childhood trauma profiles relate to developing a post-deployment disorder. We investigated childhood trauma prospectively in determining new post-deployment probable disorder.MethodsIn total, 1009 Regular male ADF personnel from the Australian Defence Force (ADF) Middle East Area of Operations (MEAO) Prospective Study provided pre- and post-deployment self-report data. Logistic regression and generalised structural equation modelling were utilised to examine associations between childhood trauma and new post-deployment probable disorder and possible mediator pathways through pre-deployment symptoms.ResultsThere were low rates of pre-deployment probable disorder. New post-deployment probable disorder was associated with childhood trauma, index deployment factors (combat role and deployment trauma) and pre-deployment symptoms but not with demographic, service or adult factors prior to the index deployment (including trauma, combat or previous deployment). Even after controlling for demographic, service and adult factors prior to the index deployment as well as index deployment trauma, childhood trauma was still a significant determinant of new post-deployment probable disorder. GSEM demonstrated that the association between interpersonal childhood trauma and new post-deployment probable disorder was fully mediated by pre-deployment symptoms. This was not the case for those who experienced childhood trauma that was not interpersonal in nature.ConclusionsTo determine the risk of developing a post-deployment disorder an understanding of the types of childhood trauma encountered is essential, and pre-deployment symptom screening alone is insufficient

Objective: Rates of suicidality are higher in military than comparable civilian populations. The period of transition from regular military service may be a time of particular vulnerability. In order to best inform early intervention and prevention strategies, we sought to investigate the childhood determinants (trauma and disorder) of self-reported past-year suicidality (thoughts, plans or attempts) in a population of Australian Defence Force men who had recently (in the previous 5 years) transitioned from regular military service. Methods: We analysed self-report, and detailed interview, cross-sectional data to investigate the association between retrospectively reported past-year suicidality and childhood factors (disorder and trauma) and whether these relationships were independent of each other and adult-onset trauma and disorder. We utilised logistic regression techniques and generalised structural equation modelling. Results: The prevalence of suicidality in transitioned men was 21.6% (95% confidence interval [CI]: [19.9, 23.3]). Suicidality was associated with childhood-onset interpersonal trauma and anxiety and adult-onset anxiety and depression. Generalised structural equation modelling demonstrated that the pathway between childhood interpersonal trauma and suicidality was not fully mediated by childhood anxiety. Restricting the analyses to those previously deployed demonstrated that suicidality had a direct and significant association with childhood-onset factors (anxiety and interpersonal trauma) and adult-onset trauma (deployment and non-deployment related). Conclusion: This study sheds light onto the significance of childhood factors (interpersonal trauma and anxiety) in a population undergoing transition that may revive pre-existing vulnerabilities. These findings have the potential to aid early intervention and prevention strategies in identifying those at risk prior to transition. These findings also imply that early interventions targeting anxiety and interventions to reduce social instability during the transition period may be useful in reducing suicidality during this time. Further prospective studies are needed to further explore these novel findings.

IntroductionCare of battle casualties is a central role of military medical practitioners. Historically, certain trauma procedural skills have been learnt through live tissue training. However, faced with opposition from community members and academics, who argue equivalence of non-animal alternatives, this is now being phased out. This study explores Australian military medical practitioners’ experiences of and attitudes towards live tissue training.MethodWe performed a phenomenologically driven qualitative exploration of individuals’ experiences of live tissue trauma training. 32 medical officers volunteered for the study. In-depth interviews were conducted with 15 practitioners (60% Army, 20% Air Force, 20% Navy; 33% surgical, 53% critical care, 13% general practice). Qualitative data were subjected to content analysis, with key themes identified using manual and computer-assisted coding.ResultsLive tissue training was valued by military medical practitioners, particularly because of the realistic feel of tissues and physiological responsiveness to treatment. Learner-perceived value of live tissue training was higher for complex skills and those requiring delicate tissue handling. 100% of surgeons and critical care doctors regarded live tissue as the only suitable model for learning repair of penetrating cardiac injury. Live tissue training was felt to enhance self-efficacy, particularly for rarely applied skills. Though conscious of the social and ethical context of live tissue training, >90% of participants reported positive emotional responses to live tissue training.ConclusionIn contrast to published research, live tissue training was thought by participants to possess characteristics that are not yet replicable using alternative learning aids. The experienced positive values of live tissue training should inform the decision to move towards non-animal alternatives.

Medical personnel serving with the Defence Forces have contributed to the evolution of trauma treatment and the advancement of prehospital care within the military environment. This paper investigates the stories of an Australian Medical Officer, Sir Neville Howse, and two stretcher bearers, Private John Simpson Kirkpatrick and Private Martin O'Meara, In particular it describes the gruelling conditions under which they performed their roles, and reflects on the legacy that they have left behind in Australian society. While it is widely acknowledged that conflicts such as World War One should never have happened, as civilian and defence force paramedics, we should never forget the service and sacrifice of defence force medical personnel and their contribution to the body of knowledge on the treatment of trauma. These men and women bravely provided emergency care in the most harrowing conditions possible. However, men like Martin O'Meara may not have been given the same status in society today as Sir Neville Howse or Simpson and his donkey, due to the public's lack of awareness and acceptance of war neurosis and conditions such as post traumatic stress disorder, reactive psychosis and somatoform disorders which were suffered by many soldiers during their wartime service and on their return home after fighting in war.

Abstract Background The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3–4 years of their career to provide evidence to inform early interventions. Methods This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. Results Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. Conclusions The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.

Trauma Teams in Action is a portfolio of research and is comprised of three studies: systematic review, cross sectional survey and phenomenological study. Study one examines 25 years of relevant literature up to December 2006 that focused on the education and professional development of civilian trauma team members and the teamwork practices employed in civilian trauma teams. Only 12 studies were included in the results of the review highlighting the lack of quality studies into the topic. It did however provide a basis of knowledge to inform the development of a cross sectional survey. Of the 12 included studies, five related to trauma team training. In particular, information pertaining to course content and delivery methods used, for example the use of simulation. The remaining seven studies provided details of teamwork management practices. Results highlighted details regarding the use of a formed team as opposed to ad-hoc team formation, and the use of a tiering system to provide optimal care to all trauma patients by the most appropriate sized and manned trauma team. Knowledge relating to optimally sized teams, and the use of a horizontal team approach was also identified. Finally, this component of the review identified knowledge relating to the role of the leader and fact that trauma teams with a dedicated team leader were more successful than those teams who did not have an identified team leader. A cross sectional survey (Study Two), examined the current education and professional development of health personnel in the Australian Defence Force (ADF) for the development of trauma/resuscitation team skills. Details related to deployment history and teamwork practices (team composition, scope of practice and team management style utilised) of the participants. The study involved 128 respondents from the Royal Australian Navy and the Royal Australian Air Force Health Services Branch completing an online survey. The study was limited due to difficulties in having Army personnel not being able to participate, but useful information about the education and deployment of Australian Defence Force trauma teams was provided. The study highlights that the majority of respondents who reported that they had completed trauma training and deployed as a member of a trauma team had served in the ADF for longer than 10 years. The study also provided details of the large variety of courses completed by both permanent and reserve personnel, and highlighted the fact that this may reflect inconsistencies in the training provided. Of the 80 respondents who had completed formal trauma training only 38 respondents subsequently provided details of the deployments they had been involved in as a trauma team member. As the study identified issues relating to the number and variety of courses completed, consideration of strategies to ensure consistency of training should be further examined. The outcome of the study identified that respondents feel that they were well prepared to work as members of a military trauma team in a conflict/humanitarian situation. However, the study also indicated there should be more emphasis on multi-disciplinary training and more focus on teamwork skills. A hermeneutic phenomenological study (Study Three), examined the lived experiences of six Australian Defence Force Nursing Officers working as members of trauma teams. The interviews provided a unique opportunity to share participants’ stories and experiences. Six major themes were identified from the interviews. These included; Telling their stories; The role – Who we are and what we do; The environment – Is it so different?; Training- Will it ever fully prepare you?; Working in teams – There’s no ‘i’ in team; and Leadership – Will the real leader please stand up. The participants provided details of their stories and their want for their stories to be told. Information of the role(s) that the participants held with details regarding the uniqueness of being a military nurse and the need to feel a valued member of the team was reported on. The participants also provided details of the environment in which they work. This included details of both the physical environment in regards to the need to work with less and the fact that in the environments in which they are required to work, the need to have a place for everything and the challengers relating to the areas in which they work. The psychosocial environment they had encountered and which included details of the horrors of the environment and the ways in which they cope when place in these situations was also provided. Details of the training undertaken by the participants, in particular the need to prepare them for uncontrollable environments was spoken of, as too, the training conducted in the field. The theme regarding working in teams provided information about the team and who made up these teams and the need to get to know the team members was spoken of. Finally, details relating to the issue of leadership was identified with information pertaining to the role of the leader in the team discussed by the participants. This study has provided a unique opportunity to gain a deeper understanding of a usually closed section of the nursing profession, that of the military nurse.
Thesis (D.Nurs.) -- University of Adelaide, School of Nursing, 2013

There is an increase in the prevalence of physical symptoms in military veterans who have deployed to combat zones compared to those who have not been deployed. These symptoms can be distressing, disabling, and negatively impact quality of life. Current paradigms regarding the effects of traumatic deployment exposures on military personnel tend to consider non-specific physical symptoms (that are not due to injury) as simply a comorbidity of psychological disorder following trauma, rather than independent sequelae. For example, the diagnostic criteria for a condition specifically caused by traumatic exposures, posttraumatic stress disorder (PTSD), do not include physical symptoms. Uncertainty surrounding the aetiology of physical symptoms has led to some fierce controversies, such as the existence of Gulf War Syndrome. The aim of this thesis was to examine how physical and psychological symptoms occur independently as well as co-occur in veterans post-deployment, and to examine the strength of associations between traumatic deployment exposures (TDEs) and these profiles of physical and psychological symptom presentation. A further aim was to explore how well a checklist of physical symptoms could identify concurrent PTSD. The final aim was to examine whether inflammation mediated associations between TDEs and physical symptoms. Data used in this thesis were from several related studies of Australian Defence Force (ADF) members who deployed to the Middle East Area of Operations (MEAO) from 2001 to 2012. These studies were commissioned by the Australian Government’s Department of Defence to explore the impact of increased operational tempo on the health of military personnel. These large-scale correlational studies surveyed tens of thousands of personnel using self-reported questionnaires which included gold-standard measures of psychological distress and PTSD, as well as checklists of trauma exposure and physical symptoms. This thesis substantiated prior findings of high rates of comorbidity between PTSD and physical symptoms in veterans. While results confirmed that physical and psychological symptoms can co-occur, analyses identified a subgroup of veterans who exhibited physical symptoms without psychological distress; this ‘physical only’ presentation was as common as the ‘psychological only’ and comorbid symptom presentations. Moreover, this presentation was associated with lower quality of life, and as such is worthy of clinical attention. Importantly, TDEs showed similar associations with both ‘physical only’ and ‘psychological only’ symptom presentations. As with First Gulf War research, there did not appear to be a particular post-deployment physical ‘syndrome’; while symptoms often co-occurred, it was symptom number and intensity rather than type that identified affected veterans. A list of 10 physical symptoms demonstrated good diagnostic utility for predicting cases of concurrent PTSD. The findings also suggest that sub-types of PTSD exist, differentiated by the level of somatic symptoms. While a relationship was found between some individual physical symptoms and inflammation, the hypothesis that inflammation mediates the relationship between trauma and physical symptoms was not supported. These findings validate physical symptoms as a discrete symptom outcome following deployment, and this presentation had a similar prevalence to co-occurring physical and psychological symptoms. Therefore, physical symptoms should not be regarded simply as a comorbidity of an underlying psychological disorder for all veterans. As physical symptoms are just as likely to occur as psychological symptoms following TDEs and they impact quality of life, they should be assessed during post-deployment screening and considered in civilian treatment of veterans. Furthermore, the inclusion of physical symptoms in PTSD screening checklists may improve PTSD identification rates and better describe the patient experience.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2019

Combat automation, enabled by rapid technological advancements in artificial intelligence and machine learning, is a guiding principle in the conduct of war today. Yet, empirical data on the impact of algorithmic combat on military personnel remains limited. This chapter draws on data from a historically unprecedented survey of Australian Defence Force Academy cadets. Given that this generation of trainees will be the first to deploy autonomous systems (AS) in a systematic way, their views are especially important. This chapter focuses its analysis on five themes: the dynamics of human-machine teams; the perceived risks, benefits, and capabilities of AS; the changing nature of (and respect for) military labor and incentives; preferences to oversee a robot, versus carrying out a mission themselves; and the changing meaning of soldiering. We utilize the survey data to explore the interconnected consequences of neoliberal governing for cadets’ attitudes toward AS, and citizen-soldiering more broadly. Overall, this chapter argues that Australian cadets are open to working with and alongside AS, but under the right conditions. Armed forces, in an attempt to capitalize on these technologically savvy cadets, have shifted from institutional to occupational employers. However, in our concluding remarks, we caution against unchecked technological fetishism, highlighting the need to critically question the risks of AS on moral deskilling, and the application of market-based notions of freedom to the military domain.