2025 AMMA Conference Poster Presentations

A Longitudinal Investigation of Natural Killer Cell Cytotoxicity in Australian Veterans with Gulf War Illness

Miss Jessica Dwyer^1,2, Dr Natalie Eaton-Fitch¹, Professor Sonya Marshall-Gradisnik¹

1 National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, Australia
2 School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia

Biography:

Jessica Dwyer is a Research Assistant, supporting laboratory research aimed at implementing diagnostic tests and discovering evidence-based treatments to improve health outcomes. She is also a member of the Clinical Trial Team.

Her Master’s research focuses on investigating Natural Killer (NK) cell cytotoxicity dysfunction in Gulf War Illness, aiming to elucidate immune system alterations in affected Veterans.

Introduction

Affecting approximately one-third of veterans of the 1990-1991 Persian Gulf War, Gulf War Illness (GWI) is a complex, multifactorial disease characterised by a range of persistent symptoms including post[1]exertional fatigue, cognitive impairment, and musculoskeletal pain. The aetiology of GWI remains unknown, and no definitive biomarkers or diagnostic tests currently exist. However, GWI has been linked to significant alterations in immune function, with previous research documenting changes in cytokine signalling, the presence of autoantibodies, and, more recently, ion channel disturbances in natural killer (NK) cells of veterans with GWI compared with healthy controls (HCs). Despite these findings, research on the role of NK cells in GWI remains limited. Therefore, this research aims to investigate longitudinal NK cell cytotoxic function in Australian veterans with GWI compared to HCs using flow cytometry.

Methods

Participants included Australian Veterans meeting both the Centers for Disease Control and Prevention (CDC) case definition for GWI. Sex-matched HCs with no history of chronic disease were also recruited as a comparison cohort. Peripheral blood was collected, and NK cells were isolated using negative immunomagnetic selection with commercially available kits. Cytotoxic activity was determined by co-culturing the isolated NK cells with K562 target cells at varying effector-to-target ratios. Apoptotic and necrotic activity was measured using Annexin V and 7-Aminoactinomycin D (7-AAD) staining by flow cytometry. Baseline and 12-month follow-up data were collected and analysed. Statistical analyses were conducted using IBM SPSS and GraphPad Prism.

Results

Baseline analysis revealed a significant reduction in NK cell cytotoxicity in Australian veterans with GWI (n=21, mean 55 years ± 1.07) compared to HCs (n=18, mean 40 years ± 2.43) (p<0.05). Preliminary data of the 12-month follow up data also indicated a significant reduction in NK cell cytotoxicity between Australian veterans with GWI (n=10, mean 54 years ± 1.08) compared to HCs (n=10, mean 43 years ± 3.5) (p<0.05). However, there was no significant difference within groups between the baseline and 12-month follow up time points.

Conclusions

This research aims to characterise the underlying pathophysiology of GWI in comparison to HCs. The consistent findings of reduced NK cell cytotoxicity in Australian Gulf War veterans with GWI over time suggests that it is a key feature in immune dysregulation. Ongoing research will further investigate potential alterations in NK cell phenotypes, degranulation and production of lytic proteins.

A Pilot Study of the Feasibility and Acceptability of Using Virtual Reality for Anxiety and Stress Management with Inpatient Former Serving Australian Defence Force Members in a Mental Health Hospital

Mr Murray Nankivell¹

1 Military And Emergency Services Health Australia, Glenside, Australia

Biography:

Murray is currently a Research Officer at Military and Emergency Services Health Australia and is a PhD candidate in the College of Education, Psychology, and Social Work at Flinders University. He has extensive experience working within trauma population research, leading the VR meditation program within an inpatient veteran hospital and has also been a member of the research team investigating the supports available to first responders and their families following the suicide of a first responder in Australia.

Murray’s PhD, commenced in 2025, is focusing on first responder help seeking behaviours.

His passion for this space derives from his significant family history currently and formerly serving within both the military and first responder occupations.

Murray’s previous affiliations include the University of Adelaide, and the Freemasons Centre for Male Health and Wellbeing.

Introduction

The COVID-19 pandemic has strained healthcare systems especially in inpatient settings, where in cases individuals may resist therapeutic intervention. Virtual Reality (VR) therapy is increasingly recognized as effective, particularly in addressing issues in inpatient settings like anxiety and stress. Combining traditional psychological approaches with digital technology has shown promise, with VR users reporting greater therapy engagement, positive experiences, and improved outcomes. VR serves as a non-pharmacological complement to usual care. Some studies indicate that VR-guided meditation can reduce anxiety in veterans, highlighting its potential usefulness in this population. However, there’s a significant gap in evidence concerning VR’s efficacy for veteran populations, especially in inpatient settings. As such, this study sought to evaluate the feasibility, acceptability, and impact of a virtual reality meditation program among inpatients at a veteran mental health hospital.

Methods

This mixed-methods pilot investigation utilizes self-report measures and qualitative interviews of inpatient former serving Australian Defence Force personnel at a veteran mental health hospital in Adelaide, South Australia. Participants were invited to complete six, 15-minute sessions of the VR program TRIPP over a two-week period. TRIPP offers immersive, meditative experiences aimed at inducing calmness. It generates visually dynamic environments for guided meditation, incorporating interactive breathing exercises with breath visualization, procedurally generated music, and guided reflections. Measures of anxiety, stress, depression, and anger were collected before and after the two-week period. Additionally, semi-structured interviews examining perceptions, experiences, perceived impact of the program were conducted. Emphasizing triangulation, changes in self-report scores supported the qualitative findings assessing acceptability, feasibility, and impact of a VR meditation program in a veteran mental health hospital.

Results

Results of this pilot study highlight issues in feasibility, such as hospital admission/discharge timeframes, hospital staff capacity requirements, and the number of sessions required. However, qualitative data around the experiences of veterans accessing the VR indicate that despite limitations, they found the program to be valuable. Additional constructive and insightful considerations for future studies will be discussed.

Conclusions

This study informs the feasibility of VR supporting wellbeing for inpatient veterans, offering insights about the ongoing, safe, and therapeutic implementation of both VR specifically for veteran and mental health inpatient participants. Given that hospitalization is a stressful and anxiety-provoking situation for any individual, the information sharing from this study may be transferrable to use of VR relaxation technology in other inpatient settings.

Active Choices for Springfield: A Veteran-led Digital Program to Support Physically Active and Connected Lifestyles in a Priority Regional Australian Community

Dr Nicholas Gilson¹, Dr Rebecca Mellor, Dr Lauren Ball, Dr Catherine Haslam, Dr Zoe Rutherford

1 The University of Queensland, Australia

Biography:

Associate Professor Nick Gilson is the lead and principal investigator for the Active Choices for Veterans initiative. He is an affiliate senior researcher in the Health and Wellbeing Centre for Research Innovation, based in the School of Human Movement and Nutrition Sciences, at The University of Queensland. He is widely published in high impact journals, and an internationally recognised expert in developing and evaluating physical activity programs for priority, hard-to-reach groups. Nick has extensive experience as principal investigator on multiple grants and has worked with 1000s of community end-users to co-design and translate PA solutions for physical and psycho-social health outcomes. Examples of successful industry and government collaborations he has led include co-design of physical activity support programs (in-person and digital) with multiple partners that have included The Department of Veterans’ Affairs, the Queensland Government, Exercise and Sports Science Australia, and The Australian Physiotherapy Association.

Rationale and aim

Australian Defence Force (ADF) veterans are significantly less physically active than the general population, placing them at increased risk of chronic health conditions such as anxiety, depression, and cardiovascular disease. This disparity is often rooted in social isolation experienced during the transition from military to civilian life, particularly in regional communities where access to tailored physical activity (PA) support is limited. Springfield, a rapidly growing regional hub in Queensland, is home to a growing veteran population facing these challenges. Active Choices for Springfield aims to address this inequity by developing and evaluating a veteran-led, community-based digital PA program that fosters social connection and supports active lifestyles in the Greater Springfield region.

Key partnerships

This initiative is a collaborative effort between The University of Queensland, Gallipoli Medical Research (GMR), Springfield City Group, and the Queensland Government through Health and Wellbeing Queensland and the Queensland Centre for Mental Health Research. GMR, our major partner, has awarded a $250,000 grant to The University of Queensland to deliver the program over two years (2025-27), leveraging its expertise in biopsychosocial research into veteran health and wellbeing.

Methodology

The project builds on a proven hardcopy in-person program previously implemented in metropolitan areas, adapting it into a digital format and online platform. The digital program will be co-designed with veteran end-users and community stakeholders to ensure relevance and accessibility. Central to the program are trained community veteran champions who will lead delivery and foster peer support networks. A train-the-trainer model will be employed, enabling participants to become future champions and expand the program’s reach. A rigorous multi-method research design will be used to evaluate the program’s effectiveness, including process evaluation, iterative feedback from a veteran advisory group, and oversight by a research steering committee comprising industry and government representatives. This approach ensures the program remains responsive to user needs and evolves as a ‘living repository’ of PA opportunities and community connections.

Impact on veteran health and wellbeing

Regular participation in PA is associated with numerous physical and psychosocial health benefits. Based on previous trials of Active Choices with older, inactive veterans in metropolitan Brisbane, the new digital program is expected to enable at least a 70-minute/week increase in moderate-to[1]vigorous PA among Springfield-based veterans. This increase will help participants move closer to meeting national PA guidelines (>150 minutes/ week), while also enhancing social connectivity during the critical transition from Defence to civilian life. The program incorporates evidence[1]based behaviour change techniques such as action planning, barrier identification, problem-solving, and—most importantly—social support. Promoting shared social identity through veteran-led activity groups will provide psychological resources like role modelling, connection, and encouragement, which are essential for PA adoption and maintenance. This strong community-based support network is a particularly innovative aspect of the program, helping veterans navigate the loss of long-standing military ties and build new, meaningful connections.

Transforming PA support services

Currently, ADF veterans must either pay for or be referred to clinical PA services, or rely on generic, self-directed online resources. Active Choices for Springfield offers a unique, free, inclusive, and community-based alternative—delivered by veterans, for veterans. Transitioning from hardcopy to digital delivery is a significant advancement, especially for reaching disadvantaged groups and creating virtual networks that combat isolation. The program can be delivered in-person or virtually by community champions. At scale, it has the potential to become an interactive, online ‘one-stop shop’ for PA engagement, connecting thousands of veterans across Australia. Post-project, the model may be upscaled nationally and internationally, including through partnerships in the United Kingdom, extending its impact to veteran communities worldwide.

Aeromedical Evacuation of Vietnam Level 2 Hospital in the UN Peacekeeping Mission in South Sudan

Dr Viet Anh Le¹

1 Vietnam Military Medical University, Viet Nam

Biography:

Academic Degree:
– Medical Doctor (Aug.2008).
– Master of Science in Medicine (2011).
– PhD in Medicine (2019).

Current Positions:
Chief and Surgeon of Field Surgery Center, Military Hospital 103, Vietnam Military Medical University (VMMU), Hanoi, Vietnam.

Previous Employment:
Sep. 2001- Aug. 2008: Medical Student, VMMU.
Sep. 2008- Dec. 2011: Resident doctor, Master Medicine Student, Researcher in Department of CardioThoracic Surgery, Military Hospital 103, VMMU.
Dec. 2011 – May 2022: Surgeon, Researcher in Department of CardioThoracic Surgery, Military Hospital 103, VMMU.
May. 2022 – Jul. 2023: Senior medical officer (SMO) – Vietnam Level 2 Hospital Rotation 4 – UN Mission in South Sudan (UNMISS).
Nov. 2023 – Present: Chief and Surgeon of Field Surgery Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.

Objective

To evaluate the results of the aeromedical evacuation of the Vietnam Level 2 hospital in the UN peacekeeping Mission in South Sudan from October 2018 to July 2025.

Subjects and methods

A retrospective study, cross-sectional and non[1]colloquial description of 65 patients evacuated by Aeromedical of Vietnam Level 2 Hospital – South Sudan according to UN regulations, from 10/2018 to 7/2025.

Results

Age < 40 years old (96.92%), the proportion of women was 13.84%, the armed forces were the main (83.08%), and 27.7% could not communicate in English. The majority of transportation is Routine MEDEVAC (56.93%). The cases are Diseases and non-battle injuries – DNBI, of which the majority are internal diseases (64.62%), the most are cardiovascular diseases: 16.92%, trauma-wounds: 13.84%. 06 cases of infectious diseases, including two patients diagnosed with severe COVID-19.

Conclusion

The Vietnam Level 2 hospital has completed aeromedical evacuation in South Sudan, ensuring compliance with UN procedures and transporting patients in a timely and safe manner without accidents or complications during transportation.

Keywords

Aeromedical evacuation, Level 2 Hospital, UNMISS

Air Dominance or Not: The Casualty Outcome

Prof Mansoor Khan¹, Dr Jonathan Kendrew¹

1 Iqarus, United Arab Emirates

Biography:
Professor Mansoor Khan is a highly accomplished trauma surgeon, academic, and retired Surgeon Commander of the Royal Navy, where he served with distinction. With a career spanning military medicine, trauma care, and humanitarian operations, he has been at the forefront of emergency and disaster medicine in some of the most challenging environments worldwide.

After retiring from the Royal Navy, Professor Khan transitioned into global health and remote medical services, currently working with Iqarus, a leading provider of healthcare solutions in complex and high[1]risk settings. In this role, he applies his extensive expertise in trauma, emergency medicine, and crisis response to deliver life-saving care in conflict zones, natural disasters, and austere environments.

A respected educator and researcher, Professor Khan has contributed to advancements in trauma surgery and military medicine, mentoring future generations of surgeons. His dedication to improving medical systems under extreme conditions has made him a key figure in both military and humanitarian healthcare.

The survival and long-term outcomes of combat casualties are heavily influenced by the availability of medical evacuation (MEDEVAC) capabilities and the ability to provide Prolonged Field Care (PFC) in resource-constrained environments. When military forces possess air superiority, rapid evacuation via helicopter or fixed-wing assets enables timely delivery of Damage Control Surgery (DCS) and Damage Control Resuscitation (DCR), significantly improving survival rates. However, in contested or denied airspace where ground evacuation is the only option, prolonged evacuation times and limited en-route care contribute to higher mortality and increased morbidity among severely injured personnel.

We examine the critical role of PFC in bridging the gap between point-of-injury care and definitive treatment when MEDEVAC is delayed or unavailable. In such scenarios, advanced pre-hospital interventions, including haemorrhage control, advanced airway management, and extended critical care monitoring, become essential to sustaining casualties for hours or even days. Historical data from asymmetric conflicts demonstrate that forces reliant on ground evacuation experience worse outcomes due to extended transit times, limited mobility, and vulnerability to ambush, leading to higher rates of preventable death and long-term disability.

Our experience highlights the need for enhanced PFC training, portable medical technologies, and adaptable trauma protocols to mitigate the risks of delayed evacuation. Strategies such as forward[1]deployed surgical teams, telemedicine support, and blood product storage in austere settings can partially compensate for the absence of air MEDEVAC. Ultimately, military medical systems must prepare for both high- and low-resource evacuation environments, recognizing that air superiority is not guaranteed in future conflicts. Proactive investment in PFC capabilities can reduce mortality and morbidity when evacuation timelines are extended, ensuring mission readiness even under logistically constrained conditions.

An Outbreak of Norovirus: Management Considerations in a Military Setting

Dr Meena Nachiappan, Dr Jordan Breed

Biography:

FLTLT Meena Nachiappan is an Aviation Medical Officer posted to No. 2 Expeditionary Health Squadron at RAAF Base Tindal. She completed her MBBS in December 2018 and FRACGP in March 2023. She has participated in domestic and international exercises as medical support to flying squadrons. Her areas of interest include public health, women’s health, chronic disease management and aviation medicine. She was the medical officer onsite overseeing management of the above norovirus outbreak.

Introduction

In September 2024, an outbreak of norovirus took place at a remote Royal Australian Air Force Base during a flying exercise. Within 24 hours, 23 cases of fever, diarrhoea and vomiting sought medical attention – all of whom had landed on the base within the two days prior on a Military C17. The medical officer reported the outbreak to local public health authorities. Relevant cases were identified and managed, control measures were implemented to prevent further transmission, investigations were conducted to identify the source, and findings were communicated to the local public health unit and the members’ originating health centre. The hypothesised source of the outbreak is the inflight meal on the C17, given a known concurrent outbreak associated with the common meal preparation facility, with person to person transmission accounting for later cases.

Methods

25 cases from the squadron cohort of 82 were identified against an outbreak case definition and were interviewed using a structured questionnaire. The diagnosis of norovirus was confirmed through positive stool samples from three of the cases. An outbreak cohort study was conducted to test the hypothesis that the inflight meal served on the C17A on 04 SEP 24 was the source of infection.

Results

Of the 25 cases, one was excluded from the analysis due to missing data on consumption of the inflight meal. Results of the analysis revealed a strong and statistically significant association with illness and consumption of inflight meal on C17 (RR 19.34, 95% CI 2.7-136.5, P<0.05).

Discussion

On declaring the outbreak, a rapid response team was established and immediate control measures were implemented, including re-rooming asymptomatic members, arrangement of an isolation bathroom and isolation of members until 48 hours post symptom resolution. Following implementation of control measures, only two further cases were diagnosed. The outbreak was declared over following deep cleaning of all facilities and 48 hours after symptom resolution in the final case. This emphasises the importance and efficacy of empirical control measures for norovirus outbreaks.

The results of this retrospective outbreak cohort study support the hypothesis that the source was the inflight meal prepared at a facility associated with a concurrent norovirus outbreak in another jurisdiction. This reinforces that commercial kitchens are common sources of norovirus outbreaks and emphasises the importance of strict adherence to food safety and hygiene standards.

Australian Contributions to the Military Medicine Panel (TP22) of the Five Eyes Science & Technology Collaboration

Brigadier Michael Reade¹, Ms Tanja Farmer¹
1 Joint Health Command, Canberra, Australia

Biography:

BRIG Michael Reade

Brigadier Reade is an intensive care physician, anaesthetist and clinician scientist, appointed in 2011 as the inaugural Professor of Military Medicine and Surgery at Joint Health Command. Since 2022 he has been Head of the Greater Brisbane Clinical School of the University of Queensland. He remains an advisor to Joint Health Command on research and education, represents Australia on the NATO Blood Panel, and Chairs the Five Eyes Science & Technology Collaboration Military Medicine Panel. His research programs cover trauma systems design, blood and fluid resuscitation in trauma, and traumatic brain injury.

Ms Tanja Farmer

As Director of Health Research at Joint Health Command, Ms Farmer leads a team responsible for health and medical research with strategic and operational significance to the ADF. Ms Farmer represents Australia in the Five Eyes Science & Technology Collaboration Military Medicine Panel. Through partnerships internal and external to Defence, research outcomes are translated into evidence-based policies that maximise Defence capability. Prior to joining the APS, Ms Farmer was a physiotherapist with a focus on orthopaedics and amputee rehabilitation. She holds a Masters in Health Service Management from Monash University and a Bachelor of Science with Honours from the University of Adelaide.

The Five Eyes Science & Technology Collaboration (formerly The Technical Cooperation Program, TTCP) is Australia’s most important link to the Defence-related laboratories of our partner nations. Commencing in 1957 as a bilateral agreement between the United Kingdom and the United States, the first Declaration of Common Purpose recognised “the concept of national self sufficiency is now out of date. The countries of the free world are interdependent and only in genuine partnership, by combining their resources and sharing tasks in many fields, can progress and safety be found.”. Australia joined TTCP in 1965, sharing the goal of extending its military research and development capabilities at minimal cost, to avoid duplication and to improve interoperability. Australian involvement is led by the Defence Science and Technology Group, with the Chief Defence Scientist as Australia’s Principal.

Australia’s contribution to Technical Panel 22 (Military Medicine) is led by Joint Health Command. The Panel seeks to improve operational readiness and mitigate against the detrimental health effects of military service through collaborative research on prevention, diagnosis, and treatment in four Focus Areas: Combat Casualty Care, Rehabilitation Medicine, Military Operational Medicine and Force Health Protection. Under these topics currently sit five Activity Plans, each of which contains several collaborative projects:

1. optimising and providing alternatives to blood transfusion (specific projects: fibrinogen concentrate, freeze-dried plasma, cryopreserved platelets, whole blood)
2. minimising injury in training (effects of iron deficiency, optimal rates of physical conditioning, impact of arduous military training on immune and metabolic function)
3. mechanisms to make best use of biobanked samples (audit of preclinical samples held by the partner nations)
4. reducing and mitigating military-specific occupational exposures (repetitive low level blast, non-freezing cold injury, flying duties during pregnancy, prophylaxis for intestinal illness)
5. overcoming regulatory impediments to data[1]sharing (harmonising approaches to lifecourse studies, harmonising regulations on use of “big data”)

TP22 aims to provide a mechanism for all military[1]affiliated clinicians and researchers to work collaboratively, making use of the protection of intellectual property afforded by the TTCP Memorandum of Understanding, twice-yearly TTCP meetings, and endorsement of projects submitted for military funding in any of the partner nations. Australian and New Zealand researchers with questions of military relevance are invited to work with their national representatives in achieving these aims.

Benchmarking Civilian Capability for Supporting Military Communities: Developing and Validating the Military Informed Cultural Competency (MICC) Scale Across the Five Eyes Nations

Dr Liz Saccone^1,2, Ms Madelaine Green², Dr Julie Mattiske², Dr Henry Bowen^1,2

1 Military and Emergency Services Health Australia, Adelaide, Australia
2 Flinders University, Bedford Park, Australia

Biography:

Dr Liz Saccone is a quantitative researcher with a background in veteran health and wellbeing, psychology and cognitive neuroscience. She has extensive experience in both public health and academic research settings across Australia and the United States. At MESHA, Liz supports investigations into the health and wellbeing of military veterans and emergency service members and their families, including evaluations of support programs and suicide postvention strategies.

Introduction

Current and former military personnel, along with their families, form a unique cultural community shaped by shared values, experiences, and challenges of military life. Civilian professionals — such as healthcare workers, employers, educators, and government staff — are increasingly aware of the need for military cultural competency: the ability to understand, engage with, and effectively support military-connected individuals. Despite this growing recognition, there are few validated tools available to measure this competency, and existing tools are often limited to healthcare settings or tailored specifically to the American military context. This research addresses this gap by developing and validating the Military Informed Cultural Competency (MICC) Scale — a tool designed to assess civilian cultural competency across multiple professional sectors and the Five Eyes nations: Australia, New Zealand, Canada, the United Kingdom, and the United States.

Methods

The study followed a three-stage process:

1. Development of the initial MICC items based on existing literature & identified competency domains.
2. A three-round Delphi survey with 25 international experts from the Five Eyes countries to refine items, achieve consensus, and establish content validity.
3. Psychometric testing of the final MICC Scale with civilian participants (n > 1600) recruited via Prolific, all of whom will be civilians with no prior military service, were over 18, and fluent in English. Psychometric properties examined included internal consistency, inter[1]rater reliability, and validity testing (content, face, convergent, construct, concurrent, and discriminant), alongside an exploratory factor analysis. Analyses will be conducted overall and stratified by country to assess cross-national applicability.

Expected Results

The final MICC Scale that underwent psychometric testing comprised 41 items rated on a 5-point Likert scale (strongly disagree to strongly agree). The tool was expanded from an initial 37-item draft through the expert consultation in the Delphi process, ensuring relevance across different military contexts. Psychometric testing is anticipated to demonstrate high internal consistency, strong factor structure, and robust validity across all Five Eyes nations. Results will be presented, including recommendations for implementation and benchmarking for civilians working with military communities.

Conclusion

The MICC Scale represents the first validated, internationally applicable tool for measuring military cultural competency in all civilian professionals across the Five Eyes nations. It provides governments, service providers, educators, and NGOs with a standardised approach to assess and improve culturally informed practice. The MICC Scale supports tailored training, workforce development, and international benchmarking, while enabling cross-national research and policy collaboration. Its validation represents a critical step in improving service access, reducing barriers to care, and strengthening culturally competent support for military-connected populations.

Bi-lateral Nation Surveillance of Cardiovascular Disease and Diabetes Risk in Papua New Guinea

CAPT J. Chellappah^1,2, MAJ G. Goina³, CAPT J. Lama³, MAJ K. Mond³, CAPT J. Vovore³, MAJ T. Naig³, CPL A. Trudgian¹, LTCOL B. McPherson¹ and LTCOL P. Kaminiel³

1 ADF Malaria and Infectious Disease Institute (ADFMIDI)
2 University of Queensland, School of Public Health
3 Health Services Directorate, PNG Defence Force

Biography:

Dr Jessica Chellappah is the senior Epidemiologist and Clinical Microbiologist with ADFMIDI. She has worked over 15 years as an Epidemiologist at the Baker Heart Research Institute, VIC, and later a Medical Bacteriologist with Melbourne Pathology, VIC before Joining ADFMIDI in 2017. She has since been on International Health Survey and Training engagements in Thailand, Malaysia, Philippines, Samoa and Papua New Guinea as an ADFMIDI Infectious Disease Research Officer, as well as conducting local surveillance and research of infectious diseases in ADF training sites around Australia in collaboration with UQ and Metro North-PHU.

Aims
In response to public health concerns of high mortality due to lifestyle diseases, several physiological and biochemical tests were performed to assess risk and prevalence cardiovascular disease and diabetes among current PNGDF as a cross-sectional study design in Lae 2023, Port Moresby 2024 and Wewak 2025. Results would inform priority of prevention and management strategies in this population.

Methods
The following were collected from PNGDF who consented:

Physiological measures

• Height and weight – calculated BMI
• Body Fat%, Muscle Mass(kg), Abdominal Visceral mass (kg), Bone Mass (kg)
• Average of 3 consecutive sitting blood pressure (BP) readings (systolic BP, Diastolic BP and resting heart rate) using OMRON automated BP device
• Waist and Hip circumference (cm) to measure waist to hip ratio.

Biochemical measures

• HbA1c from non-fasting venous blood collection measured with Abbot Point of Care AFINION 2 Analyser
• Lipid profile (Total Cholesterol, HDL, LDL and Triglycerides) from non-fasting venous blood collection measured with Abbot Point of Care AFINION 2 Analyser

To analyse the data, mean values were collected for summary baseline values. To investigate correlation of risk factors, Pearson’s Co-efficient and Regression Analysis was performed, adjusting for independent variables and 2-tailed probability.

Results

A total of 650 PNGDF participated in these measurements. The mean age of the population was 37 years of age (min. 21, max. 61).

Summary of findings and recommendations:

• Non-HDL lipids and waist: hip circumference ratio are known predictors with more than ¾ classed at risk for both.
• Systolic and Diastolic blood pressures are known predictors with more than ¼ classed as high to mild hypertensive, and a large proportion classed as lower than healthy range.
• HbA1c (%) is a known predictor with almost ½ classed as pre-diabetic.
• Visceral fat (kg) is a known predictor with almost ½ classed as overweight.

Summary Analysis
This sample size is a third of the full size of the force. There were no significant differences in risk found between sites.

Based on cluster analysis on measurements, W:H ratio or BF% and Visceral Fat (kg) were a better measure of Metabolic Syndrome and Obesity than BMI.

Based on the high number of pre-diabetics and high BP, management strategies need to target those in pre-category as well to prevent escalation in the diagnosed category in the next 2-3 years. The target age group was identified as 30-39yrs of age.

Reducing abdominal fat and improving dietary choices are recommended points of focus for management strategies. Physiological measures of benefit to use for monitoring and managing of members include blood pressure, waist to hip ratio and Visceral fat mass.

Outcomes
The study successfully identified lifestyle risk factors pertaining to this population. Capacity building ensued with Lifestyle disease management clinics set-up on various bases. Specifically chosen physiological and biochemical measures were also included as part of annual PNGDF Medical Board Assessment and this led to further population risk assessment and policy changes within PNGDF Health Services. Population-specific interventions and public health messaging are currently jointly being produced, including nutritional cookbook, posters and pamphlets.

Bridging Military and Civilian Disaster Deployments: Lessons from the USNS Comfort

A/Prof Derrick Tin^1,2,3, Ms Terri Antonio¹

1 Serco, Australia
2 National Leadership Preparedness Initiative, Boston, USA
3 Disaster Medicine Fellowship, Boston, USA

Aims
This abstract explores the intersection between military and civilian disaster medicine through the lens of humanitarian deployments aboard the USNS Comfort. It aims to compare and contrast the protocols and frameworks utilised by military operations with those of civilian disaster response systems, highlighting potential conflicts, challenges, and strategies used to address these differences. The objective is to contrast how lessons learned on deployments can be adapted to enhance preparedness, resilience, and coordination in disaster response during complex emergencies.

Methods
This qualitative analysis draws upon the author’s personal experiences and professional observations during deployments on the USNS Comfort, including pre-deployment, on-deployment, and post[1]deployment phases. Key areas of focus include:

Deployment Challenges and Preparedness: The physical and psychological challenges encountered during deployments, including moral injury and the need for robust pre-deployment preparation. Lessons learned highlight the importance of situational awareness, structured pre-deployment checklists, and mentorship to mitigate deployment risks. The complexities of managing logistics, immunisations, medical clearances, and international coordination.

Civilian-Military Collaboration in Practice: Successful coordination between military operations (USNS Comfort) and civilian organizations, including non[1]governmental agencies. Effective frameworks for collaboration, communication, and resource sharing are examined, emphasising the importance of clearly defined mission goals and adaptable governance structures.

Dangers of Humanitarian/Disaster Work – Engaging Civilians in Potentially Threatening Environments: The inherent risks of deploying into austere environments, including potential threats faced by civilians and aid workers. Strategies for improving safety include threat awareness training, collaboration with local authorities, and developing ethical guidelines to balance security concerns with humanitarian objectives.

Results
The approaches employed during USNS Comfort missions demonstrate valuable lessons for enhancing civilian-military disaster preparedness. Observations highlight the importance of robust command structures, coordinated communication systems, and flexible operational health support. These insights offer guidance for strengthening civilian-military disaster response and collaboration.

Conclusions
Bridging the gap between military and civilian disaster medicine requires collaboration, knowledge exchange, and adaptability. Drawing on the author’s experiences aboard the USNS Comfort, this abstract highlights strategies for enhancing resilience, preparedness, and ethical decision-making in civilian-military disaster response.

Chemoprophylaxis and Personal Protection Measure Compliance in Australian Military Personnel: Lessons from a 2022 Scrub Typhus Outbreak

Dr Rebecca Suhr¹, Mrs Samantha Belonogoff¹
1 ADFMIDI, Arana Hills, Australia

Biography:

CAPT Samantha Belonogoff recently transitioned to RAAMC as an Infectious Disease Researcher, having previously served as the Research Nursing Officer at the ADF Malaria and Infectious Disease Institute. Within the Clinical Studies and Surveillance department, Captain Belonogoff conducts clinical research and epidemiological surveillance of vector-borne diseases and other military-relevant pathogens, working to translate research findings into policy recommendations that enhance force health protection across the ADF.

MAJ Rebecca Suhr is the current Research Medical Officer at the ADF Malaria and Infectious Disease Institute. Coming from a background of Close and General Health within Army, she is focused on communicating current research findings and disease surveillance information to actionable steps for clinicians and health planners.

‘Doxy only works if you take it!’ – Barriers to prophylaxis uptake amongst soldiers.

During the 2022 outbreak of scrub typhus at Cowley Beach Training Area (CBTA), ADFMIDI clinicians had the opportunity to gather information regarding their perceived and actual barriers to uptake of provided chemoprophylaxis and personal protective measures against vector and environmentally borne diseases. This mixed-methods investigation examined survey responses from over 70 participants (15 cases and 57 exposed personnel) from Brisbane and Townsville battalions.

Come and find out why soldiers don’t adhere to their prescribed doxycycline regime or wear permethrin[1]treated uniforms, and what clinicians, health planners and commanders can try and implement moving forward to protect our force.

Clinical Characteristics of Australians with Gulf War Illness: Three Decades On

Dr Natalie Eaton-fitch¹, Dr Etianne Martini Sasso¹, Prof Sonya Marshall-Gradisnik¹

1 National Centre for Neuroimmunology and Emerging Diseases, Health Group, Griffith University, Australia

Biography:

Dr Natalie Eaton-Fitch is a post-graduate research fellow at the National Centre for Neuroimmunology and Emerging Diseases with 9 years research experience in the field of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), and more recently long COVID and Gulf War Illness (GWI). Dr Eaton-Fitch has investigated epidemiological, immunological and ion channels disturbances in Australians living with these conditions. This research has resulted in multidisciplinary research collaborations to further contribute to the knowledge of disease pathomechanisms. Dr Eaton-Fitch’s recent research has focused on the investigation of off-label low dose naltrexone as a potential treatment for ME/ CFS and long COVID and further elucidating the role of ion channel dysfunction in pathomechanism of disease using innovative technology including high throughput applications.

Background
Renewing epidemiological research is crucial to provide new insights into disease progression, the effectiveness or current clinical practice, and patient quality of life (QoL). This is increasingly important to address continuing health challenges in an aging population. A prime example is Gulf War Illness (GWI) also referred to as Chronic Multisymptom Illness. GWI is potentially disabling and is reported in approximately one-third of veterans who served in the Persian Gulf War (1990-1991). While reports have detailed the health impacts of Australian Veterans in the Gulf War, there are limited peer reviewed publications in existence investigating GWI in an Australian cohort. Therefore, this pivotal research aims to provide updated insights into the clinical presentation and health impacts of Australians with GWI.

Methods
This observational investigation is currently underway at the National Centre for Neuroimmunology and Emerging Diseases. Australian Veterans with GWI were recruited to respond to an extensive questionnaire distributed via RedCAP. Participants reported on medical history, routinely administered medications, details of their service and enrolment, symptom presentation and QoL using validated research tools such as the 36-item short form health survey (SF-36) and World Health Organization Disability Assessment Schedule (WHODAS). This abstract details results obtained from n=55 of a growing cohort of veterans with GWI fulfilling the Centre for Disease Control and Prevention criteria.

Results
All research participants were male and aged 56.5 years (SD=8.91). Comorbid diagnoses reported post[1]GWI onset included PTSD (n=12, 21.8%), recent or current malignancy (n=10, 18.2%), arthritis (n=6, 10.9%), and asthma (n=4, 7.3%). Notable occurring symptoms were found to be chronic fatigue (n=45, 91.8%), memory disturbances (n=45, 81.8%), body pain (n=50, 90.9%), sleep disturbances (n=49, 89.1%), and gastrointestinal disturbances (n=40, 72.7%). Symptoms including memory disturbances, fatigue, body temperature dysregulation, and genitourinary disturbances were more likely to be severe in nature. Lastly, research participants reported significant impacts to QOL. Most impact SF-36 domains included general health (20.91 ± 14.99) and Vitality (34.43 ± 21.44); while more severe impacts to functioning were reported in WHODAS domains interpersonal relationships (54.53 ± 36.19) and participation in life activities (45.37 ± 26.04).

Conclusion
These findings indicate the continuing, and potentially significant, impacts of GWI on health outcomes. Therefore, this expanding research project demonstrates the need for further research to ensure Australian veterans with GWI receive appropriate care and recognition.

Critical Care Retrieval in the RAN

CMDR Scott Squires¹, CMDR Peter Smith
1 RAN, Sydney, Australia

Biography:

CMDR Scott Squires is an Emergency Physician with the Australian Defence Force (ADF) Medical Specialist Program. Scott is posted to the Maritime Operational Health Unit, HMAS Penguin as the Director of Clinical Services. Over the past 27 years of service, he has deployed extensively overseas in remote and austere environments, throughout the Middle East and Asia[1]Pacific regions.

CMDR Peter Smith is Anaesthetist with the ADF Medical Specialist Program, posted to MOHU. CMDR Smith is a senior Retrieval MO in the civilian sector. CMDR Smith has extensive operational experience in the middle east and Asia-Pacific regions.

Over the past 5 years MOHU has been developing its Critical Care Retrieval capability. This has largely been via the development of key equipment, training of personnel and progression of SOP’s. This progression has been born from an operational requirement during RPD and HADR deployments.

The presentation will discuss: key equipment which includes the development of a MOHU Retrieval Pack CES and equipment cache; training of critical care MO’s, NO’s and Medics and the progression of SOP’s in areas such as carrying blood products, point of care testing and providing a critical care capability far forward, in the littoral space.

Challenges and limitations will be discussed as will progression of this capability.

Deep Frozen Blood Products, the RAN Experience, from Inception to a Deployed Capability

CMDR Scott Squires¹, CDRE Anthony Holley, CAPT Jessica Inskip
1 RAN, Sydney, Australia

Biography:

CMDR Scott Squires is an Emergency Physician with the Australian Defence Force (ADF) Medical Specialist Program. Scott is posted to the Maritime Operational Health Unit, HMAS Penguin as the Director of Clinical Services. Scott originally entered the ADF as part of the Graduate Medical Scheme. Over the past 27 years of service, he has deployed extensively overseas in remote and austere environments, throughout the Middle East and Asia-Pacific regions.

CDRE Anthony Holley AM is the Principal Consultant, Trauma to the SGADF. CDRE Holley is a Senior Staff Specialist at the Royal Brisbane and Women’s Hospital. CDRE Holley has deployed extensively and is the Chair of the ADF Blood Expert Panel.

CAPT Inskip is a Pathology Officer posted to MOHU. CAPT Inskip has deployed throughout the Asia-Pacific region. She has a keen interest in blood product management and in particular, the deep frozen blood capability.

Uncontrolled haemorrhage is the leading cause of death in battlefield casualties. It has consistently been recognised that 15-20% of battlefield casualties will require blood product resuscitation and each patient, on average will utilise 8 units of whole blood or whole blood equivalents.

There are significant challenges in the provision of blood products in remote and austere environments. Short shelf-life, cold chain constraints and safe storage especially for certain products such as platelets means that balanced haemostatic resuscitation is potentially not feasible.

One approach to address this challenge is the employ of deep frozen blood products. Deep Frozen Blood Products have a shelf life ranging from 2-10 years, and once thawed, are able to facilitate haemostatic resuscitation. Deep Frozen Blood products may also assist with contingency planning when logistic constraints result in supply failure or when there are requirement surges.

The US Navy has deployed with deep frozen blood products for decades and the Netherlands Military Blood Bank has been producing deep frozen products since 1996 and used deep frozen products extensively and safely in Afghanistan from 2006-12.

Since 2010, the ADF has been developing its deep frozen blood product capability.

This presentation considers the development of this capability from its inception, to 2024, when the capability was deployed for the first time during overseas maritime operations.

The presentation will consider the role of deep frozen blood products, models for use. Advantages and limitations will be discussed, in the context of present and future ADF maritime operations.

Defence SafeSide Project: Supporting Defence’s Changing Culture in Suicide Prevention through a System-Wide Approach. Preliminary Data from Workforce Education Evaluations

Ms Jennifer Harvey¹, Ms Kylie Druett¹, Ms Tiyana Gostelow², Mr Dan Mobbs², Ms Sarah Donovan³, Professor Anthony Pisani³

1 Department of Defence, Australia
2 SafeSide Prevention, Australia
3 SafeSide Prevention, United States of America

Biography:

Jennifer Harvey (Assistant Director Mental Health and Suicide Prevention Initiatives at Defence) is an experienced psychologist and educator. Her 13 year career with Defence has included working with members to optimise their mental health and wellbeing; and collaborating with health professionals supporting workforce upskilling. She’s the Defence lead for the creation and customisation of Defence’s SafeSide training.

Kylie Druett is a psychologist and acting/Director of the Mental Health and Wellbeing Initiatives Directorate at Defence. She is responsible for the development and implementation of initiatives that empower personnel and the organisation to improve the mental health and wellbeing. Her career spans non-government and state health services in the sectors of domestic violence, child protection, suicide prevention, sexual assault, mental health and AToD. Outside work she advocates for systemic reform in support offered to families bereaved by domestic violence homicide.

Tiyana Gostelow (Director of Operations at SafeSide Prevention) leads the delivery and implementation of SafeSide Prevention programs, services, and consultancy across Australia. A seasoned leader with expertise in system redesign, co-design, and evidence-informed implementation from her 25+ years in public health and the not-for-profit sector. Over the past year, Tiyana has worked with the Defence team to implement the Defence SafeSide Project.

Defence is dedicated to strengthening suicide prevention across the Enterprise through a system-wide approach that prioritises safety, early identification, and compassionate support.

Suicide is preventable and Defence is advancing significant reform by embedding evidence-based, whole-of-organisation approaches that reach beyond traditional health settings. At the core of this approach is an understanding that everyone – regardless of role – can contribute and make a meaningful difference in our efforts to prevent suicide.

In partnership with SafeSide Prevention, Defence is implementing a unified, prevention-oriented model that empowers our people across the Enterprise to recognise and respond to suicide-related distress. All the supporting artefacts, policies, templates and education products have been co-designed with people who have lived experience, ensuring that our approach is inclusive, practical and culturally aligned with Defence. This has enabled us to tailor the SafeSide Framework for Suicide Prevention and CARE (connect, assess, respond, extend) Model to our clinical system and beyond.

Most training is delivered in person, uses Defence personnel and Defence-specific scenarios to ensure the content looks, feels, and sounds relevant to those who serve. Tailored training packages include:

• CARE-RF/DRF for mental health clinicians and medical officers: This training supports formulation-based clinical decision-making using a prevention-oriented lens. This includes the exploration of foreseeable changes, and contingency planning as part of member-centred safety planning. Extending member networks outside of health, is another key component of this model.
• CARE-LM for leaders and managers: Specific training explores their role in both enhancing key protective areas and collaborating with health to support members at risk in line with the CARE Model.
• CARE-S for health practitioners (not responsible for MH risk assessment), chaplaincy and wellbeing support staff: This training introduces the SafeSide Framework for Suicide Prevention and CARE Model and equips non-clinical personnel to identify signs of concern, initiate compassionate conversations, and provide a warm-handover for a clinical assessment while extending support to complement the health response.

This presentation will share preliminary evaluation data and insights on self-efficacy, learning transfer, use, and attitudes about the systems approach across the SafeSide training packages. Defence is proud to lead globally in being the first military organisation across the globe to implement a systems approach inclusive of a prevention-oriented risk-formulation approach.

Effective Conversations in Complex Environments: A Relational Model for Human Rights and Operational Leadership

Mr. Max Stephens¹

1 Max Stephens High Performance Coaching Conversations, Australia

Biography:

Max Stephens is a Developmental Theorist, Published Author, and Ontological Coach with extensive experience guiding industry leaders across sectors in navigating complex conversational and ethical challenges. His work operates at the intersection of epistemology, behavioural science, and performance psychology, offering a deep understanding of human development and its real-world applications. Max supports leaders globally in becoming more construct-aware, enhancing their capacity to recognise and work with the mental frameworks that shape perception, decision-making, and moral reasoning. His approach integrates integral theory, systems thinking, and effective conversational practice, grounded in a developmental understanding of human meaning-making. His research and coaching emphasise the importance of aligning human development with the vertical (structural) and horizontal (contextual) dimensions that influence how individuals and institutions interpret morality, dignity, and responsibility. His work is especially relevant for leadership roles within complex, pluralistic environments, where psychological flexibility, ethical clarity, and developmental intelligence are critical to long-term effectiveness.

This thesis introduces the Relational Rights Model (RRM), a developmental framework for enhancing the clarity, relevance, and uptake of human rights discourse across culturally and psychologically diverse populations. Drawing from developmental psychology, including Kohlberg’s moral stages, Kegan’s model of evolving consciousness, and Spiral Dynamics’ mapping of cultural value systems, the RRM addresses a persistent yet underdiagnosed issue in global rights communication: epistemic mismatch, the structural disconnect between how rights are conveyed and how they are understood. The RRM positions human rights as meaning[1]making processes, contingent on the moral reasoning and epistemology of the audience. By identifying five distinct stages of rights interpretation, the model provides a practical tool for tailoring communication, advocacy, and leadership training to developmental realities, rather than assuming uniform moral readiness. While designed for broad global applicability, the model holds relevance for institutions operating in complex moral terrain, such as defence, law enforcement, and humanitarian fields, where leaders are frequently required to engage across divergent cultural, moral, and sense[1]making systems. In such contexts, developmental misalignment can contribute to operational breakdowns, disengagement, and ineffective relating. The RRM offers a framework for anticipating and mitigating these risks through structurally informed communication and leadership practice. By offering a metatheoretical lens for diagnosing where and why rights discourse fails, the Relational Rights Model contributes a new tool for advancing more inclusive, intelligible, and developmentally coherent human rights education and leadership development.

Effective Integration of Military and Civilian Aeromedical Evacuation Teams: A Case Report on the Retrieval of a Critically Unwell Patient from Lord Howe Island

Dr Samuel Perotti¹
1 Royal Australian Air Force, Richmond, Australia

Biography:

FLTLT Samuel Perotti is a medical officer in the Royal Australian Air Force having joined in 2015 as part of the graduate medical program training scheme. He is a fellow of the Royal Australian College of General Practitioners and holds a bachelor of medical science with honours, medical doctor degree, and graduate diploma in child health. He has been posted to 3 Aeromedical Evacuation Squadron (3AES) at RAAF Base Richmond, Sydney, NSW since January 2022. Over this time he has completed training in aviation medicine, numerous aeromedical evacuation missions, exercises and operations overseas, while also conducting clinical duties in Australia at military health centers and civilian emergency departments. At 3AES he additionally fills the role of A9 cell flight commander for the unit’s clinical governance, standards and evaluation team. He has a passion for interoperability in the AE space and collaborates regularly with international military partners on international exercises and through working groups.

Background

The aeromedical evacuation system in Australia is multifaceted, incorporating rotary and fixed wing assets that are operated by commercial, state, national and military organisations. Each organisation operates within their own command and control structure in support of their specific jurisdictions and patient dependency. Differences in crew selection and tasking mechanisms reflect this complexity. However, situations inevitably arise that require collaboration between these organisations.

Case
On the 17th of April 2024, New South Wales Ambulance (NSW Ambulance) was tasked to retrieve a critically unwell civilian patient from Lord Howe Island. NSW Ambulance requested assistance from the Royal Australian Air Force (RAAF), which was supported through activation of a C-27J military transport aircraft and a retrieval team from 3 Aeromedical Evacuation Squadron (3AES) based at RAAF Base Richmond, NSW. At short notice, clinicians from NSW Ambulance and 3AES created a joint team, which was able to successfully complete the time-critical mission. RAAF military personnel maintained command of the mission elements and NSW Ambulance were the clinical lead, assisted by the 3AES critical care specialists and retrieval team. RAAF medical equipment was utilised, with the addition of a Hamilton ventilator and medications contributed by NSW Ambulance. The integrated team deployed within five hours of receiving the request for assistance. The patient was safely transferred off Lord Howe Island to an appropriate health facility and there were no significant issues in flight.

Discussion
Effective command and control, clear communication with task delegation, and appropriate crew selection were the key factors enabling mission success. Challenges encountered related to coordination of the various teams involved, crew fatigue management, equipment selection with waivers required, and the need for satellite phones to communicate on Lord Howe Island. These issues were effectively addressed in a timely manner. This mission demonstrated effective integration of military and civilian aeromedical evacuation systems, with the lessons identified forming a strong foundation for future collaborations of this kind

Empowering Health Literacy in Veterans and Veterans’ Families: Findings from a Mix-Methods Study

Dr Sanket Raut^1,2, Dr Tho TH Dang^1,2, Dr Camila Guindalini¹

1 Gallipoli Medical Research, Greenslopes, Australia
2 School of Medicine, The University of Queensland, Herston, Australia

Biography:

Dr Sanket Raut is a Research Fellow at the Gallipoli Medical Research (GMR), based at Greenslopes Private Hospital in Brisbane. Dr Raut works within the Healthy Veterans Research Program at GMR where his research is focused on quality use of medicines in veterans to improve pharmacological management of PTSD. With a background in medicine, pharmacology and neuroscience, Dr Raut’s work bridges clinical care and basic research.

His current research explores patterns of psychotropic and opioid medication use in veterans with mental health conditions. He is the lead investigator of a multi-phase program examining health literacy, and digital health tools development to support informed decision-making in mental healthcare.

He is passionate about reducing preventable harm from polypharmacy, promoting evidence[1]based prescribing, and ensuring veterans receive coordinated care. Dr Raut has published in leading journals including (Nature) Translational Psychiatry, Journal of Psychiatric Research, Pharmacology and Therapeutics and presented his work at national and international conferences.

Background
Veterans experience higher rates of health issues such as post-traumatic stress disorder, chronic pain, and comorbid physical and mental illnesses. Together with their families, they have more complex support needs than the general population. Health literacy, the ability to access, understand, and use health information, is critical for achieving better health and wellbeing outcomes. Little is known about health literacy among Australian veterans and their families. This study aimed to identify health literacy needs and co-design a resource to improve healthcare engagement among Queensland veterans and their families.

Methods
This study used a mixed-method, three-phase design. In Phase 1, an anonymous online survey was conducted using the validated Health Literacy Questionnaire. It consisted of 44 items across nine domains of health literacy: feeling understood by healthcare providers (HCPs), having sufficient information to manage health, actively managing health, social support for health, appraisal of health information, actively engaging with HCPs, navigating the healthcare system, finding good health information, and evaluating health information to support decisions.

Phase 2 involved semi-structured focus groups conducted online, in-person, and in hybrid formats to explore survey findings in depth and capture lived experiences. A thematic analysis was used to identify common experiences, barriers, and enablers related to health literacy.

Phase 3 translated these findings into a health literacy education package, co-designed with veterans and family members, and delivered through expert-led videos.

Results

A total of 190 veterans and 44 veteran family members participated in the survey. Both groups demonstrated ability in understanding health information (mean scores of veterans: 3.69/5; families: 4.13/5), in actively engaging with HCPs (veterans: 3.48/5; families: 3.66/5), and in finding good health information (veterans: 3.48/5; families: 3.92/5). However, they reported lower scores in the finding social support (veterans: 2.71/4, families: 2.77/4) and navigating the healthcare systems (veterans: 3.28/5, families: 3.48/5) domains. Family members consistently reported higher scores across most health literacy domains. Veterans with post-secondary education scored significantly higher in locating and understanding health information than those without (p < 0.05). This educational difference was not observed among family members

Five focus groups were held: three with veterans (11 participants) and two with family members (7 participants). Through thematic analysis, five key themes were identified: Challenges navigating the healthcare system including fragmented care, unclear DVA processes, and difficulty accessing appropriate services. Many veterans struggled to build trust and communicate effectively with healthcare providers. Barriers from military culture such as stigma and internalised reluctance to disclose health issues.

Information gaps where participants noted difficulty in finding trustworthy health information. Lastly, family members often acted as informal case managers but lacked the knowledge and support to navigate systems effectively.

Despite these challenges, participants voiced a strong desire for accessible, plain-language, and trustworthy digital resources to support management of common veteran health issues and to advocate effectively for themselves and their families.

Based on these findings, a suite of three digital education videos was developed. The package provides educational content on health literacy basics, navigating healthcare systems, and finding appropriate professional and social support. To maximise reach, the videos will be distributed through social media and official stakeholder websites targeting Australian veterans and their families.

Conclusion
The findings underscore the multifaceted health literacy challenges faced by veterans and their families, shaped by military culture, systemic barriers, and gaps in accessible information. By integrating quantitative and qualitative insights, and applying co-design principles, we developed practical, culturally relevant tools that reflect lived experience. These resources offer a scalable model for future initiatives, including the development of a mobile app designed to enhance health literacy and improve health and wellbeing outcomes for Australian veterans and their families.

Enhancing Expeditionary Health Skills via Bush Dentistry

FLTLT Alexis Dieu¹
1 RAAF, Darwin, Australia

Biography:

FLTLT Alexis Dieu completed a Bachelor of Biotechnology (Honours) in Drug Design and Development in 2008. She spent seven years working in ISO17025-accredited laboratories, contributing to preclinical drug development and pain research. Motivated by a desire for more direct clinical impact, she transitioned from academia to dentistry, completing her dental training in 2018. Over the past four years, while posted in Darwin, she has worked closely with the Northern Territory Government to deliver oral health services to remote Indigenous communities across the NT. In 2023, she spearheaded the development of a remote clinical placement program to strengthen dental teams’ expeditionary readiness and clinical capability in austere, resource-limited environments. This initiative significantly enhanced her operational preparedness and played a key role in the successful delivery of oral health services during Exercise Kummundoo 2024 in Kununurra, remote Western Australia.

Bush dentistry is a colloquial term referring to the delivery of oral health services in remote Indigenous communities of the Northern Territory (NT), Australia. In addition to the typical challenges associated with remote healthcare, such as security concerns, logistical limitations, and constrained access to resources, health professionals must also navigate language and cultural barriers unique to each region.

Depending on the size of the community, local health centres often provide capabilities comparable to Role 1 enhanced military health support, including aeromedical evacuation. I have led teams comprising myself and a dental assistant to multiple austere locations across the NT, delivering dental care and engaging with communities on behalf of both the Northern Territory Government and the Royal Australian Air Force (RAAF).

This form of service delivery closely parallels Humanitarian Assistance and Disaster Relief (HADR) operations, exposing dental personnel to complex case management outside the typical Defence demographic. It also serves as a valuable training opportunity, fostering core expeditionary competencies such as resilience, adaptability, task and time management, clinical confidence, decision[1]making, teamwork, interoperability, and effective communication.

In this presentation, I will highlight the unique advantages and challenges of operating in remote NT health clinics, and discuss how these experiences cultivate critical thinking and problem-solving skills—key attributes for developing agile, effective leaders in both military and civilian health contexts.

EX Kummundoo 2024

FLTLT Alexis Dieu¹, Mr Rayneil Shandil²

1 Royal Australian Air Force, Darwin, Australia
2 Royal Australian Air Force, East Sale, Australia

Biography:

FLTLT Alexis Dieu completed a Bachelor of Biotechnology Hons in Drug Design and Development with 7 years’ experience in ISO17025-accredited laboratories, contributing to preclinical drug development and pain research. She transitioned from academia to dentistry and completing her dental training in 2018. Over the past four years, while posted to Darwin, she has worked closely with remote health service providerso deliver oral health services to remote Indigenous communities across the NT and WA. In 2023, she spearheaded the development of a remote clinical placement program to strengthen dental teams’ expeditionary readiness and clinical capability in austere, resource-limited environments.

FLTLT Rayneil Shandil is an Environmental Health Officer specialising in occupational hygiene and garrison support during field exercises and deployments. He holds a Bachelor of Science (Forensic Science), a Bachelor of Natural and Applied Science (Environment and Health), a Diploma in Quality Auditing, and certifications in occupational hygiene, emergency management, and WASH in emergencies. Formerly serving in local government, he gained valuable community-focused experience. Currently a Course Leader at Officers’ Training School, he is committed to mentoring future Air Force leaders. His qualifications and operational experience reflect a strong dedication to health protection and capability development within the ADF.

Exercise Kummundoo is a Royal Australian Air Force (RAAF) initiative that supports Aboriginal and Torres Strait Islander communities across Australia. As part of the Whole of Australian Government’s Closing the Gap strategy, the program has run for over a decade, deploying Air Force personnel to deliver essential services focused on health and well-being in remote communities.

The 2024 iteration marked the exercise’s tenth anniversary, featuring expanded community engagement and a multidisciplinary health team comprising Indigenous Liaison Officers, Dental Officers, Dental Assistants, Medical Technicians, a Chef, a Physical Training Instructor, and Environmental Health Officers. The team provided enhanced oral health services, environmental health support, and health education to community members of all ages and backgrounds.

This presentation highlights the achievements, challenges, and contributions of the 2024 team during their deployment to Kununurra, Western Australia. Exercise Kummundoo continues to exemplify partnership, mutual respect, and shared learning, as Air Force personnel work alongside communities to deliver meaningful and lasting support.

Immunohistochemical Imaging Characteristics of Thermoregulatory Neurons in an Experimental Rat Model with Heat Stroke

Dr Van Thu Nguyen¹
1 Vietnam Military Medical University, Hanoi, Viet Nam

Biography:

Education

2005 September – 2007 September: VIETNAM MILITARY MEDICAL UNIVERSITY – Vietnam
2007 October – 2008 August: ROSTOV STATE MEDICAL UNIVERSITY – Russia 2008
September – 2014 June: SIBERIAN STATE MEDICAL UNIVERSITY –
Russia 2017 April – 2017 July: RUSSIAN MILITARY MEDICAL ACADEMIA – Russia
2020 April – 2023 March: JUNTENDO UNIVERSITY – Japan

Work experience
2015 March – 2023 April: Teaching Assistant – Department of Military Occupational Medicine – Vietnam Military Medical University
2019 October -2020 March: Visiting Research Fellow – Juntendo University
2020 April – 2023 March: Research Assistant – Institute of Health and Sports Science & Medicine – Juntendo University
2024 April – Present: Head of the department – Department of Naval Medicine – Vietnam Military Medical University

Journal article

1. Potential role of signal transducer and activator of transcription 3 in the amygdala in mitigating stress-induced high blood pressure via exercise in rats. DOI: 10.1111/apha.14274
2. Involvement of D1 dopamine receptor in the nucleus of the solitary tract of rats in stress[1]induced hypertension and exercise. DOI: 10.1097/hjh.0000000000003809
3. Impact of exercise on brain-bone marrow interactions in chronic stress: potential mechanisms preventing stress[1]induced hypertension. DOI: 10.1152/ physiolgenomics.00168.2022
4. Platelet activation in rabbits with decompression sickness. DOI: 10.22462/10.12.2020.9

Background
Heatstroke is a life-threatening emergency defined by excessive hyperthermia, multiorgan dysfunction, and central nervous system impairment. Although management strategies have improved, the cellular mechanisms underlying heat-induced neuronal injury remain unclear. GABAergic neurons in the hypothalamic thermoregulatory center are thought to play a crucial role in homeostasis under thermal stress, yet their morphological changes during heatstroke are largely uncharacterized.

Objective
This study aimed (1) to establish an indirect immunofluorescence staining protocol for detecting heat-sensitive neurons in rat brain tissue using NeuN and GABA markers, and (2) to characterize immunohistochemical alterations of these neurons in experimental heatstroke.

Methods
Ten adult male Wistar rats (220-238 g) were randomly assigned to a control group (n = 5) or heatstroke group (n = 5). The heatstroke group was exposed to 43 °C and 70% humidity in a microclimate chamber until heat shock or death, defined by core temperature ≥42.2 °C and/or arrhythmia. Core temperature and ECG were continuously recorded. Blood was collected for hematological, biochemical (AST, ALT, urea, creatinine, CK), and electrolyte analyses. Brain tissue slices (40 µm, bregma -1.72 to -1.92 mm) were stained using NeuN and anti-GABA antibodies, with Alexa Fluor 488 and 594 secondaries. GABA-positive neurons were quantified with Fiji-ImageJ. Data were analyzed with SPSS 22.0; significance was set at p < 0.05.

Results
Heatstroke rats showed a rapid rise in core temperature (p < 0.05), sustained tachycardia, and a significantly higher LF/HF ratio (0.47 ± 0.15 vs. 0.27 ± 0.09; p < 0.05). ECG abnormalities appeared after 30 minutes, with significant intergroup differences in R-wave amplitude and JT interval. Hematology revealed increased red blood cell count, hemoglobin, and hematocrit (p < 0.05), with reduced MCHC and granulocytes (p < 0.05). RDW was significantly higher (p < 0.05). Biochemistry showed elevated AST, ALT, and urea (p < 0.05). Electrolytes revealed hyperkalemia, while SpO2 declined at 60 and 90 minutes (p < 0.05). Immunohistochemistry revealed marked neuronal alterations. GABA-positive cell counts were higher in heatstroke rats (90 ± 15.8 cells/mm²) than controls (36 ± 24.1 cells/mm²; p < 0.01). Mean neuronal size increased significantly (25.6 ± 10.9 µm vs. 10.6 ± 3.1 µm; p < 0.05). Both count and size correlated positively with peak core temperature, indicating a direct relationship between hyperthermia and neuronal alterations.

Conclusion
An indirect immunofluorescence protocol for heat[1]sensitive neurons was successfully established. Heatstroke induced significant quantitative and morphological changes in hypothalamic GABAergic neurons, characterized by increased number and swelling consistent with cellular edema. Significance: These findings provide novel evidence that GABAergic neurons play a central role in thermoregulation under extreme heat stress. The correlation between neuronal alterations and hyperthermia suggests a protective adaptive mechanism. This study advances understanding of neuronal responses to heat stress and offers insight for future research on the neuropathology of heatstroke and potential therapies targeting GABAergic pathways.

Keywords
Thermoregulatory Neurons, Heat stroke, IHC, Rat.

Introducing MyCred: Elevating Workforce Credentialing, Compliance & Efficiency

Ms Narelle Basham¹, Ms Terri Antonio¹
1 Serco, Australia

Biography:

Narelle Basham, RN, RM, AICGG, MAppMgt(Nurs), PGDipMidwifery, GradCertPeriOp, ProfCertHSM BNsg, DipPM, DipProfW&E

Head of Clinical Capability, Serco

Narelle is an experienced and committed clinician with a strong background in compliance, credentialing, management and projects. She has over three decades of experience in the Healthcare sector across public and private settings. As a healthcare professional, she is committed to delivering optimal outcomes for the customer while driving quality and safe healthcare with innovation and integrity. Narelle is the primary expert in relation to Serco’s credentialling and compliance platform, MyCred, and led the development and implementation of the system.

Terri Antonio, RN, DipPsych, GCertNsg, MMgnt, FCHSM CHE, AACN, MAPNA, AICGG.

Director Clinical Governance, Serco

Terri is a Registered Nurse and an experienced, certified health executive with over 40 years’ experience in the Healthcare sector. Terri joined Serco in 2016 where she holds responsibility for the organization’s clinical governance systems, processes and performance. Her focus is on supporting growth, innovation, and high functioning teams, to enhance consumer, client and community outcomes.

Ensuring a properly credentialed and compliant workforce is imperative. It not only meets regulatory standards and assures quality but also mitigates risks, builds trust, fosters employee growth, and fulfills legal obligations. Serco has invested in the development of a bespoke credentialing compliance tool – MyCred, designed to streamline and enhance the management of credentialing and compliance. The platform offers a consolidated view of initial candidate credentialing and ongoing employee compliance. It facilitates readily available workforce composition, capability and conformance data whilst promoting organisational efficiency.

MyCred offers a comprehensive solution that enables the configuration, assignment, real-time tracking, and monitoring of both candidate and employee workforce requirements. It allows individual requirements to be defined and assigned based on organisational, contract, location, or role level specifications.

The platform offers a user-friendly interface for both candidates/employees and organisational administrators. Candidates and employees are able to directly view all requirements that apply to them, access instructions relating to the requirements, and identify when they are due. They can review and complete each requirement, including uploading evidence, making declarations, or filling in inbuilt forms before submitting for organisational administrators to review and approve. MyCred includes a messaging and notification tool that allows two-way communicate and sending of customisable, automatic notifications and reminders.

MyCred includes a transparent and comprehensive audit trail of all activities across all touch points within the platform. Every data point within MyCred can be extracted and exported to reporting tools such as Power BI. This provides an opportunity to harvest and analyse real time workforce composition, capability and conformance data and metrics.

Gone are the days of spreadsheets tracking compliance, multiple folders for storing evidence, and reliance on email communications. MyCred now provides Serco with a secure, customisable, user[1]friendly platform to track, monitor and evidence all credentialing and compliance requirements.

Lymphatic Filariasis and its Changing Regional Picture – Summary of the New DHM Chapter

Dr James Smith^1,2, Dr Rebecca Suhr¹

1 ADFMIDI, Brisbane, Australia
2 Queensland Health, Brisbane, Australia

Biography:

MAJ Rebecca Suhr is the current Research Medical Officer at the ADF Malaria and Infectious Disease Institute. Coming from a background of Close and General Health within Army, she is focused on communicating current research findings and disease surveillance information to actionable steps for clinicians and health planners.

MAJ James Smith operates at the intersection between clinical medicine, public health and health systems management. He combines expertise in vaccinology, epidemiology, public health regulatory systems and health data analysis to assist the ADF in communicable disease policy.

The changing epidemiology of lymphatic filariasis due to regional efforts towards eradication in the Pacific has led to a review of the Defence Health Manual Lymphatic Filariasis chapter. A summary of the changes and rationale will be presented. This will include consideration regarding disease pathology, symptomatology and progression, exposure risks and timelines, and screening and treatment recommendations including recommendation against routine provision of eradication therapy for ADF personnel.

We aim to allow clinicians and health planners to become familiar with this policy change and to better understand the reasoning behind its implementation.

Optimising Knee Imaging Pathways in the ADF: Balancing Clinical Best Practice with Operational Requirements

Danielle Addison¹

1 Bupa ADF, Service Delivery Optimisation, Australia

Biography:

Danielle Addison is a health strategy and insights professional with expertise in health economics, clinical data translation, and service quality reporting. She is currently a Program Manager at Bupa Asia Pacific, where she leads initiatives to improve healthcare delivery through evidence-informed reporting, health intelligence dashboards, and stakeholder collaboration.

Previously, Danielle worked in the Health Technology Assessment team at the NHMRC Clinical Trials Centre, University of Sydney, evaluating pharmaceuticals and medical devices for the Department of Health. Her research has been published in the Journal of Resuscitation and presented internationally, including at ISPOR Europe.

She began her career at PwC Australia in public policy and health economics, where she contributed to national health reforms, including the development of Australia’s first National Digital Mental Health Framework and economic analyses that supported Federal Health Budget processes.

Danielle holds a Bachelor of Economics from the University of Sydney, majoring in Economics and Mandarin. She has also completed further study in clinical trials, epidemiology, and data analytics.

She is passionate about using data and evidence to drive meaningful improvements in healthcare access, quality, and outcomes, particularly within complex environments such as ADF and DVA health services.

Background
Knee pain is one of the most common musculoskeletal complaints in the Australian Defence Force (ADF), with implications for deployability, force readiness, and longer-term function. Clinical decisions regarding knee pain- particularly the use of imaging[1]are directly linked to surgical utilisation. Overuse or underuse of imaging, as well as deviation from clinical guidelines, may identify potential areas of low value care and unwarranted variation across regions. Understanding these patterns is critical to improving care quality and ensuring alignment with evidence-based practice.

In the civilian health sector, the Australian Commission on Safety and Quality in Health Care (ACSQHC) developed the Atlas of Healthcare Variation (AoHV) to identify unwarranted clinical variation and promote more consistent, evidence-based care. This study applies the AoHV methodology to the ADF population, with the aim of understanding patterns of knee imaging use, adherence to national clinical guidelines, and operational factors unique to the defence context that may drive divergence from standard care pathways. Findings will support the development of value-based healthcare pathways tailored to the ADF, with the aim of enhancing care quality and patient outcomes.

Methods
Using the ACSQHC AoHV approach, a retrospective analysis was conducted to understand imaging utilisation for knee pain in the ADF population from 2020 to 2023. The review used invoicing data to examine imaging utilisation patterns across multiple modalities including ultrasound, MRI, X-ray and CT for both traumatic and non-traumatic knee pain. Utilisation trends were standardised against the Australian population for comparison, noting the unique characteristics of ADF personnel, and stratified by geographic regions, service lines, age, and gender. Additionally, national evidence-based imaging guidelines were reviewed against utilisation trends, including the clinical appropriateness of first line and follow-up investigations.

Results

ADF members showed a higher utilisation rate of knee imaging for knee pain than the broader Australian population, especially for MRI and among members aged 50 years and over. This trend may reflect higher service expectations, access arrangements and clinical emphasis on maintaining force readiness. Females also showed higher imaging rates, potentially linked to injury risk, health-seeking behaviour, or different reporting practices.

Geographic and service-level variation also emerged, with some sites showing higher imaging intensity that may reflect local capability or clinician preference rather than member factors alone. Ultrasound use was variable with some evidence of overuse of application outside of guideline recommended indications. Imaging pathways often lacked a consistent stepwise approach and were not always clearly aligned with national guidance, although in some cases divergence in the ADF population may be appropriate due to operational imperatives.

Overall, the findings suggest both opportunities to address potential low value care and the need to contextualise variation considering ADF-specific operational requirements.

Conclusions:
While knee imaging pathways in the ADF differ from civilian norms, these differences are not always inherently inappropriate. Higher utilisation of imaging modalities, especially a costly service such as MRI, may be justified by the need for timely diagnosis, deployment readiness, and to meet expectations of serving or transitioning members. However, variation in practice and misalignment with evidence-based pathways point to areas where care can be optimised.

Applying the AoHV framework provides a powerful lens to identify variation, promote quality care, and enhance value in the delivery of imaging services. There is strong value in understanding patient journeys and continuous monitoring of imaging pathways for delivery of best practice care that improves patient outcomes. Additional analysis overlying DVA claims data may help map post[1]service care, inform longitudinal pathway design, and improve stewardship of resources across the service lifecycle.

Outcomes of Percutaneous Administration of Platelet-Rich Plasma as an Independent Treatment for Long Bone Aseptic Nonunion among Military Personnel: A Case Series

MAJ Andrie Lorenzo Ortega, CPT Marlon Mejia, Dr Antonio Manuel Saludo

1 Department of Orthopedic Surgery and Traumatology – V Luna General Hospital, Quezon City, Philippines

Biography:

Andrie Lorenzo F. Ortega, MD, FPOA

I am board-certified orthopedic surgeon with over seven years of clinical practice, specializing in trauma, and degenerative joint disorders. A Fellow of the Philippine Orthopedic Association, I currently serve as Consultant for the Orthopedic Adult and Trauma Section at V. Luna General Hospital, and a Visiting Consultant in several medical centers including PNP General Hospital, Recuenco General Hospital, San Mateo Medical Center, St. Victoria Hospital, and Gen. Malvar Hospital.

Completed my residency in Orthopedic Surgery and Traumatology at the Armed Forces of the Philippines Medical Center, where i also served as Assistant Chief Resident during my senior residency and Ward Officer/Consultant. As a Major in the AFP Medical Corps, I actively engaged in both civilian and military medical service. My contribution to orthopedic research, focused on trauma management, arthroplasty practices, and innovative fixation techniques for non-union fractures.

Introduction

Nonunion occurs when a fracture fails to heal within the anticipated time. Limitations on bone healing management still leaves patients with pain, decreased quality of life, and economical consequences on patients. Standard of care for nonunion includes bone grafting or revision of implant. These would necessitate re-operation, which is more costly, and has risk for various complications. Studies have proposed percutaneous Platelet rich plasma (PrP) injection as non-invasive management for nonunion.

Materials & Methods

A case series design was employed consisting of 7 patients with nonunion. A 15 mL of blood was centrifuged and processed. Around 5 mL of PRP was administered percutaneously as a single dose.

Bone healing time were assessed with mean and standard deviation from various measurement tool such as Visual Analog Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) Score and Modified Lane Radiographic Scoring System.

Results

A significant decreased in pain scale was evaluated with improved functionality in all subjects noted through DASH scoring system. Gradual increase in Radiographic score was observed. Average time to achieve union post-administration was 5.25 months.

Five subjects (71% ) achieved radiographic and clinical union by the time of their last follow up. Two subjects (29%) displayed gradual progress in terms of bone healing. recanalization and still for monthly re-evaluation where serial dose administration can be started.

Discussions
PRP studies showed success on certain studies with a dose of at least 5 mL. Three of the remaining subjects although displayed gradual cortical formation and recanalization, are still subjected for monthly re-evaluation and can be indicated for serial dose administration. Thus, recommendation for serial dosage can be considered on future studies.

Conclusion

PRP is beneficial and cost-effective management of nonunion providing enhanced bone healing to achieve union, pain control and functionality

References

1. Li, S., Et. al (2021, December 31). Clinical effectiveness of platelet-rich plasma for long-bone delayed union and nonunion: A systematic review and meta-analysis.
2. Andersen, C., Wragg, N.M., Shariatzadeh, M. et al. The Use of Platelet-Rich Plasma (PRP) for the Management of Nonunion Fractures. Curr Osteoporos Rep 19, 1–14 (2021). https://doi. org/10.1007/s11914-020-00643-x
3. Esther M.M. Van Lieshout, Dennis Den Hartog,Effect of platelet-rich plasma on fracture healing, Injury, Volume 52, Supplement 2, 2021, Pages S58-S66, ISSN 0020-1383, https://doi. org/10.1016/j.injury.2020.12.005.
4. Ghaffarpasand, F., Shahrezaei, M., & Dehghankhalili, M. (2016). Effects of Platelet Rich Plasma on Healing Rate of Long Bone Nonunion Fractures: A Randomized Double[1]Blind Placebo Controlled Clinical Trial. Bulletin of emergency and trauma, 4(3), 134–140.
5. Chahla, Jorge MD, PhD1; Cinque, Mark E. MS1; Piuzzi, Nicolas S. MD2,3; Mannava, Sandeep MD, PhD1,4; Geeslin, Andrew G. MD1,4; Murray, Iain R. MD, PhD5; Dornan, Grant J. MSc1; Muschler, George F. MD2; LaPrade, Robert F. MD, PhD1,4,a. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. The Journal of Bone and Joint Surgery 99(20):p 1769-1779, October 18, 2017. | DOI: 10.2106/JBJS.16.01374
6. Malhotra, R., Kumar, V., Garg, B., Singh, R., Jain, V., Coshic, P., & Chatterjee, K. (2015). Role of autologous platelet-rich plasma in treatment of long-bone nonunions: a prospective study. Musculoskeletal surgery, 99(3), 243–248. https://doi.org/10.1007/s12306-015-0378-8
7. Cont..

Platelets and Trauma: Not That Straightforward

CDRE Anthony Holley¹
1 Australian Defence Force, Brisbane, Australia

Biography:

Commodore Anthony Holley AM, RAN

BSc. MBBCh. DipPaeds. DipDHM. FACEM. FCICM, AFRACMA

Commodore Holley is a dual qualified Emergency Physician and Intensivist at the Royal Brisbane and Women’s Hospital.

He is currently serving as the Principal Consultant Trauma to the SGADF

CDRE Holley is an Associate Professor with the University of Queensland Medical School. He is a former ANZICS President (2019-22). During his tenure as President, he guided the critical care multidisciplinary professionals through the COVID-19 pandemic. He is a former examiner for the Fellowship of the College of Intensive Care Medicine of Australia and New Zealand. CDRE Holley has authored twelve book chapters, 58 peer reviewed publications. He is a senior Instructor for BASIC and an EMST course director. He is also a director of the Current Concepts in Critical Care course. CDRE Holley serves as a critical care representative for the Australian National Blood Authority in developing the Australian Patient Blood Management Guidelines. He has deployed on active service on multiple occasions, including two tours to Afghanistan, the Persian Gulf (HMAS Toowoomba), border protection, four tours to Iraq, Bushfire assist 2019/20 and as the Senior Medical Officer for the Operation COVID Assist Joint Task Group 629.3.

Exsanguination is responsible for most preventable combat casualty deaths; interestingly even mild thrombocytopenia is associated with a substantial increase in mortality. Massive injury is frequently accompanied by trauma-induced coagulopathy (TIC). The development of TIC coagulopathy is complex, principally resulting from the tissue response to major tissue injury, but also exacerbated by the lethal diamond: cooling, acidosis, dilution and hypocalcaemia.

Platelet function is central to effective coagulation in major trauma. A simplistic view recognises their role in “identifying” trauma, subsequent margination within the vessel flow, resulting in contact with the endothelium, and ultimately forming an important component of the haemostatic thrombus.

The role of platelets in trauma is more complicated and requires recognition that platelets are innate immune particles, acting as vital regulators of inflammation. Platelets are recognised effectors of local and systemic inflammation, expressing a wide array of immune critical receptors.

The immune function may provide an explanation as to why platelet transfusion is not without risk, accounting for 25% of adverse transfusion events and perhaps more importantly why platelet supernatant is efficacious in haemostasis. The challenge in combat casualty care is identifying the optimal transfusion threshold for platelets. Furthermore, platelets are challenging to provide in the austere environment, and hence the interest in cryopreserved platelets and the ongoing efforts to create the “Holy Grail” – an effective, viable, synthetic thrombosome. This presentation will consider the biology, provision and future of platelet transfusion in the care of the combat casualty.

The Difficulties of Malaria Diagnostics in an Austere Environment with an Outbreak Example

Dr Fiona McCallum, Dr Rebecca Suhr¹, Dr Byron Manning
1 ADFMIDI, Brisbane, Australia

Biography:
MAJ Fiona McCallum is a Scientific Officer and senior veterinarian at the Australian Defence Force Malaria and Infectious Disease Institute (ADFMIDI), Brisbane. Her PhD study involved sero[1]epidemiological investigation of P. falciparum malaria in a cohort of Kenyan children.  She  now heads the department of Clinical Studies and Surveillance (CSS), tasked to assist surveillance and molecular investigation of infectious diseases of relevance to ADF personnel within in Australia and regionally. The CSS research team includes clinicians and veterinary, epidemiological and laboratory scientists. Personal research interests are malaria and sero-surveillance of infectious disease.

Malaria is one of the ‘must exclude’ diseases when patients present with a fever in an endemic area, but what is the most reliable way to exclude?

We will summarise a cluster of 8 malaria diagnoses in ADF soldiers on a UN deployment. We will discuss the benefits and limitations of rapid diagnostic tests, microscopy, and molecular tests in malaria diagnosis. We will present malaria diagnoses at the cohort rather than the individual level, to highlight diagnostic challenges. This information will benefit health planners and clinicians.

The Maritime Role 2 Forward Concept

CMDR Scott Squires¹, LCDR Anna Kane, LCDR Sarah Wong, MAJ Kyle Bender
1 RAN, Australia

Biography:
CMDR Scott Squires is an Emergency Physician with the Australian Defence Force (ADF) Medical Specialist Program and is posted to the Maritime Operational Health Unit, HMAS Penguin as the Director of Clinical Services. Over the past 27 years of service, he has deployed extensively overseas in remote and austere environments, throughout the Middle East and Asia-Pacific regions.

LCDR Anna Kane is a Senior NO in the RAN. Anna has extensive operational experience in the middle east and Asia-pacific region.

LCDR Sarah Wong is a Senior Anaesthetist at Westmead Hospital and has deployed on multiple operations in the Asia-pacific region.

MAJ Kyle Bender is a General Surgeon in the ADF Medical Specialist Program and is currently posted to 2 Brigade. MAJ Bender has deployed to the middle east and the Asia-pacific region on multiple occasions.

Damage control surgery is not a new concept, however, the last 25 years has seen a significant progression in this capability.

Forward damage control surgery aims to address immediate threats to life whilst concurrently resuscitating the casualty so that they can be retrieved to a higher echelon of care for further management.

Over many years the Army has be equipped with a forward surgical effect, its present iteration is the R2F. The RAAF has similarly progressed its R2F.

In the RAN, over the last 30 years, the surgical effect has largely been provided in the Amphibious ships, previously the LPA’s and at present the LHD’s (HMAS Adelaide and Canberra).

The surgical effect is deployed as part of the MR2E which is a large footprint of up to 60 personnel and contained within the medical facility on board.

It was proposed that there was a need to review this as the only means of providing a surgical capability, at sea. It was considered that a light surgical team, a MR2F could provide a damage control surgical effect on other RAN platforms, vessels of opportunity or in the littoral space, as required.

To this end, during Indo Pacific Endeavour (IPE) 24, a MR2F was validated in HMAS Stuart, an ANZAC class Frigate, FFH.

A review of the medical equipment, consumables, team numbers, role allocations and SOP’s of the Army and the RAAF R2F was conducted in order to standardise, as much as practicable, across the services.

The aim of this validation was to see if a MR2F capability could be achieved, what limitations exist and todetermine if this capability was viable, moving forward.

The results of this validation will be presented to provide a means for future discussions of the MR2F concept.

The Pilot-RESTORE trial: Driving Innovation in Severe Burns Resuscitation

Dr Elissa Milford^1,2,3,4

1 2 Bde HQ, Brisbane, Australia
2 Intensive Care Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
3 Monash University, Melbourne, Australia
4 University of Queensland, Brisbane, Australia

Biography:

MAJ Milford is an early career clinician researcher. She is a practicing Intensivist, currently working at the Royal Brisbane and Women’s Hospital, and is a full-time Intensive Care Specialist in the Australian Army as part of the Australian Defence Force’s Medical Specialist Program. Her PhD was on the role of the endothelial glycocalyx in severe trauma, and she is now building a research program that spans the management of severe burns, trauma, blood transfusion, and endothelial dysfunction in critical illness. She also has a strong interest in the design of novel clinical trials and is currently completing a Master’s in Biostatistics.

Background
Future conflicts, especially if involving armored warfare, are likely to feature high numbers of casualties with severe burns. Despite fluid resuscitation being the cornerstone of the acute management of severe burns, there has been limited research and little innovation made over the last 50 years on the ideal fluid type, volume, and resuscitation endpoint in severe burns. The acute resuscitation phase of severe burns presents an additional challenge for combat health care environments. One severely injured burn patient can require up to 10-20 L of IV fluid in the first 24 hours of injury, which is a challenge to supply in austere, resource-limited, distributed operational environments, particularly in the situation of multiple and sustained casualties. Support for the multi-organ failure that results from the burn injury and is exacerbated by the large volume fluid resuscitation is also challenging to provide in the combat environment. However, if the acute vascular hyperpermeability and hyperinflammatory response can be attenuated, this may lead to both a reduction in fluid volume and organ-support requirements, and an improvement in patient outcomes.

Plasma is one of the few therapies demonstrated to consistently and significantly repair the endothelium and attenuate vascular hyperpermeability in preclinical studies, through an unknown mechanism. In animal studies of burn injuries, early plasma-based resuscitation prevents intra-vascular fluid extravasation into the interstitium, whereas crystalloid has no effect on vascular permeability. Historically, plasma was used extensively for burns resuscitation, but this was ceased in the 1970s due to high rates of viral hepatitis transmission. Even though that risk is now negligible, only ~14% of clinicians report regular use of plasma (in the form of fresh frozen plasma (FFP)) in burns resuscitation and dosage varies. FFP is frequently used in clinical practice and is considered to be a low-risk intervention.

The only randomized controlled trial (RCT) of plasma in burns patients (N=31) found a significant reduction in 24h fluid volume requirement with no adverse events. Observational studies are limited but report associations between plasma use and lower resuscitation volumes and less weight gain (as a surrogate for tissue oedema). High-quality, appropriately powered clinical trials are needed to determine the effect of plasma in burns on patient[1]centered outcomes. Plasma resuscitation in severe burns has been identified as a high research priority by burns experts and leading international burns organizations including the American Burns Association.

Pilot-RESTORE:
The Pilot-RESTORE trial (a pilot randomised controlled trial of plasma in the RESuscitation of severe burns TO improve patient outcomes by Restoring Endothelial integrity) is the vanguard trial in a program of research that aims to develop innovative therapies and produce high-impact, rapidly translatable evidence to improve outcomes for patients with severe burns. Pilot-RESTORE and the follow-on definitive trial will assess whether a plasma-based resuscitation strategy improves clinical outcomes in severe burn patients and reduces health care resource utilization including fluid volume and organ support requirements.

Led by a Defence clinician, the project brings together researchers and clinicians from all the major adult burns centres in Australia, Australian Red Cross Lifeblood, the Australian and New Zealand Intensive Care Society Clinical Trials Group, the Australian and New Zealand Burn Association, the Australian Defence Force, multiple Australian Universities as well as collaborators from Oxford University in the UK and the University of Pittsburgh in the US. The study will be registered as a Collaborative Project in the Five Eyes Science and Technology (formerly The Technical Cooperation Program) Collaboration.

The results of this study and the follow-on definitive trial are likely to inform clinical guidelines and practice for the use of dried plasma products in environments where FFP is unavailable, including combat care operational environments.

Utilisation of Garrison Health Support in North Queensland

MAJ Jason Selman¹, Ms Ashleigh Broad¹

1 Joint Health Unit – North Queensland, Townsville, Australia

Biography:

Ashleigh Broad is employed as a contracted Quality Manager at JHU-NQ by BUPA. Ashleigh is a registered chiropractor and has practiced in regional areas throughout Queensland, New South Wales, South Australia and Victoria. She has spent time teaching at Macquarie University and Central Queensland University and is currently completing a Master of Public Health through James Cook University. Her clinical and academic interests include disaster health, health protection and surveillance, women’s health, and health service optimisation.

Major Jason Selman is a current serving Army officer posted as the executive / operations officer at JHU[1]NQ. He has served in surveying, construction, and combat engineer appointments; and saw operational service attached to a US Army engineer brigade in Iraq in 2005 on Operation Catalyst. After a break in service that included employment as a Public Health lecturer at Curtin University in 2013 and 2014, Major Selman returned to the Army where his current academic research interests include the public health determinants of combat capability, and the human performance optimisation of military personnel.

The health service provided to uniformed members of the Australian Defence Force is delivered through two organisations – operational health services such as in the field or at sea by uniformed Defence clinical personnel – or through the Garrison (on-base) Health System for deployment readiness, injury and illness prevention, treatment, and rehabilitation. An examination of health utilisation and deployment readiness data for one regional garrison health unit with a dependency of over 8,000 Army, Navy, and Air Force personnel over a three-year period has revealed considerable variation in the volume and type of garrison health services demanded. The demand was found to be closely tied to the operational tempo of the Defence organisation in that region. The utilisation of Garrison Health services over the three-year period demonstrated an increase in presentations by the high readiness deployable units in line with a greater number of overseas training serials and an increase in operational readiness requirements. A large proportion of presentations were for ADF members holding a medical classification for which they were temporarily or permanently unable to deploy. Conversely, a substantial proportion of presentations were likely to comply with pre- and post- deployment requirements including administrative compliance for otherwise medically deployable personnel. Reducing these compliance requirements and reducing sick parade presentations through greater use of sick leave approved by the chain of command could release considerable capacity in the Garrison Health system and reduce wait times overall.

Vagaries of Acute Presentations in Military PTSD Admissions

Dr Julie Simes-phillipps¹

1 Deakin Private Hospital, Deakin, Australia

Biography:

Julie served in the ADF in both full and part time roles for over 20 years prior to moving to a clinical role. Running a PTSD ward for first responders, she is interested in the impact of developmental trauma informing responses to treatment and recovery. By focusing on phenomenology within a biopsychosocial and military cultural frame, a return to accurate psychiatric formulations will reframe most presentations.

Short oral presentation postulating that many PTSD military presentations are rooted in pre-existing developmental trauma precipitating a vulnerability to expressed symptoms.

Current treatment modalities including Psychiatry are inadvertently contributing to perpetuating negative narratives, inadvertently delaying functional recovery.

Segwaying from civilian recovery programs for serious psychiatric conditions (such as in attachment theory principles- HOPE Health Outcomes from Positive Experiences) recommendation for a return to “first principles” care is postulated.

Vector Borne Diseases: Prophylaxis, Vaccination and Eradication Update

Dr Rebecca Suhr¹
1 ADFMIDI, Brisbane, Australia

Biography:
MAJ Rebecca Suhr is the current Research Medical Officer at the ADF Malaria and Infectious Disease Institute. Coming from a background of Close and General Health within Army, she is focused on communicating current research findings and disease surveillance information to actionable steps for clinicians and health planners.

Doxycycline, malarone, tafenoquine, primaquine – what are the differences? Why one over the other? Do I need to eradicate for helminths? What else does it cover? Is there a vaccine for that?

Let your local friendly ADFMIDI clinicians summarise up to date information for your chemoprophylaxis and vaccination options for military relevant tropical diseases and advise on current recommendations on malarial and helminth eradication on return to Australia.

We will cover advice from commonly encountered queries like; prolonged deployments, frequent short deployments, drug allergies/intolerances, G6PD deficiency and exposure risks.

Women in Surgery – Challenges in Training and Beyond

SQNLDR Jane Kee¹
1 RAAF, Australia

Biography:
SQNLDR Jane Kee graduated from medical school at the University of Western Australia in 2014 and began working as an Aviation Medical Officer for the Royal Australian Air Force in 2016. During her medical degree and early residency years, Jane had developed a strong interest in surgery. However, after recognising the challenges many women in surgical specialties face, including balancing both work and family, she commenced post-vocational training in General Practice and attained her Fellowship with the Royal Australasian College of General Practitioners in 2020. While Jane appreciates the experiences and lessons that she has gained from General Practice, her interest in surgery has only grown. Now, as part of the Australian Defence Force’s Medical Specialists Program Jane is finally pursuing her dream career in General Surgery. She is also passionate about creating change for gender equity in surgery so that other doctors may be supported in realising their surgical dreams.

Medicine and in particular, surgery, has traditionally been a male dominated field. Even after women were accepted into medical schools in the early 1900’s, they often faced significant difficulty securing a suitable job following training. This trend was also mirrored in the military sphere, and while Australia has come a long way towards achieving gender parity in medicine, surgical specialties still lag behind. In 2023, only 15% of the active surgical workforce were female. This gender imbalance in the surgical world has become a widely discussed topic in recent years. In early 2017, findings from an Inquiry by the Australian Human Rights Commission found that gender segregation in Australia was significantly impacting women’s economic security and the high levels of poverty experienced by older Australian women. Several months prior to the publication of this report, the Royal Australasian College introduced gender equity targets as a part of their Diversity and Inclusion Plan. The Australian Defence Force’s Gender, Peace and Security Mandate also expresses a commitment to gender equality, human rights and increasing women’s participation across all ranks and employment categories. Today, as the need for ready surgical care has become an essential part of medical support for many military operations, examining gender equity in the surgical capabilities we deliver becomes increasingly relevant. This presentation will examine the gender disparity among surgeons, and more specifically, military surgeons, as well as potential strategies to address this.