A Mixed-Methods Assessment of War-Related Abuses in Ukraine since 2014
Professor Lynn Lieberman Lawry1,3, Dr Bharathi Radhakrishnan2, Dr Kimberly T Johnson-Boua1, Ms Vivitha Mani2,3, Dr Olena Nesterova4, Dr Olga Gvozdetska4, Dr Dmytro Martsenkovskyi5,6, Dr Anastasiia Bibikova6, Ms Christine Dahl7, Dr Jana Asher8
1Uniformed Services University of the Health Sciences, Bethesda, United States, 2The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, United States, 3Center for Health Services Research, Bethesda, United States, 4Center for Public Health of the Ministry of Health of Ukraine, Kyiv, Ukraine, 5Bogomolets National Medical University, Kyiv, Ukraine, 6Scientific and Medical Center “DOSLID”, Kyiv, Ukraine, 7International Criminal Tribunal for the former Yugoslavia, The Hague, Netherlands, 8Statistical Consultant, Pittsburgh, United States
Biography:
Dr Lieberman Lawry is a physician, epidemiologist, and biostatistician more than three decades of experience in humanitarian aid, disaster response, development, and research. She spent 20 years as faculty at Brigham and Women’s Hospital, Harvard Medical School, with concurrent appointments with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins and Uniformed Services where she is currently a Professor of Preventive Medicine and Biostatistics. She has extensive experience in dozens of countries coordinating aid, facilitating development, and conducting population-based studies in conflict and post-conflict settings. Her studies elucidate the needs of populations regarding human rights, healthcare access, mental health, and conflict-related sexual violence among many other public health topics – utilizing these data to improve policy to address global health needs in conflict. Her current focus is trauma system assessments in large-scale combat for understanding needs and gaps for preparedness. She is currently finishing a nationally-representative study of war-related abuses and mental health consequences in Ukraine. In addition to teaching at USUHS, she developed interactive courses for international militaries who serve as Peacekeepers in 48 countries on preventing sexual exploitation and abuse and CRSV and as global health engagements for security cooperation in the human security space.
Background
The February 2022 Russian Federation invasion of Ukraine, following the conflict initiated in 2014, resulted in massive casualties, widespread destruction of civilian infrastructure, and a humanitarian crisis. Numerous violations of international humanitarian law occurred, including indiscriminate shelling, systematic torture, and conflict-related sexual violence (CRSV), suggesting possible war crimes and crimes against humanity (WCCAH). This study explores the experiences of Ukrainian veterans and former Prisoners of War (POWs) since 2014 to systematically document reported abuses and inform accountability and future justice processes.
Methods
A mixed-methods design combined a thematic analysis of semi-structured key informant interviews (KIIs) with quantitative descriptors. Forty Ukrainian veterans and former POWs (20 male, 20 female) from the 2014 and 2022 invasions were interviewed between August and November 2025. The KII instrument contained 32 open-ended questions covering demographics, abuses, psychological impact, and justice. Qualitative data analysis involved deductive thematic content analysis using NVivo 15; four researchers independently coded and achieved consensus. Verbal consent was obtained, and the study received ethical approval from Ukrainian and U.S. institutions.
Results
Participants reported numerous abuses consistent with WCCAH including attacks on civilian infrastructure (healthcare, education, residential, energy); systemic torture, beatings, electrocution, starvation, denied medical care, deliberate targeting of Ukrainian nationality, unlawful killings of civilians and hors de combat; and CRSV targeting both male and female captives and civilians. Internally, female veterans reported facing discrimination, restrictive roles, and military sexual assault. Trauma symptoms, including Post-Traumatic Stress Disorder (PTSD), anxiety, depression, sleep disturbances, and moral injury, were cited as major consequences of the wars.
Conclusions
Abuses appear deliberate, widespread, and consistent with WCCAH. Psychosocial barriers undermine protection and prevention efforts for justice. Stigma, particularly for male survivors of CRSV, and fear of harming loved ones still in captivity obstruct evidence-gathering and truth-telling. The reporting of severe trauma symptomatology necessitates an immediate humanitarian response that prioritizes the recovery of veterans and former POWs through structured, accessible, long-term psychological and psychiatric services. Beyond formal psychiatric diagnoses, participants expressed strong feelings of grief and symptoms consistent with moral injury, stemming from the psychological and emotional turmoil of witnessing the torture, injury, and death of fellow comrades and civilians. Among Ukrainian military personnel, sleep disorders and anger may reflect moral injury, which overlaps with PTSD and has been identified as a major contributor to PTSD among Ukrainian forces. These findings highlight the severity of detention conditions during the war with Russia, particularly torture. Such treatment may constitute “willfully causing great suffering or serious injury to body or health” under Article 8 and its health consequences may provide clinical evidence supporting legal determinations of war crimes. Restrictive roles, discrimination, and military sexual assault reveal a need to establish mechanisms that combat internal sexual violence and reinforce professional military hierarchy.
A Qualitative Assessment of Trauma and Rehabilitation Systems in Sweden for Large-Scale Combat Operation (LSCO) Preparedness
Professor Lynn Lieberman Lawry1,2, Dr Mary F Stuever2, Dr Yohan Robinson3, Dr Jonas Zimmerman3,4, Mr Viktor Glantz3,4, Dr Bharathi Radhakrishnan5, Ms Vivitha Mani5,6, Dr George Smolinski1
1Usuhs, , United States, 2Landstuhl Regional Medical Center, Landstuhl, Germany, 3University of Gothenburg, Centre for Disaster Medicine, Gothenburg, Sweden, 4Sahlgrenska University Hospital, Gothenburg, Sweden, 5The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, United States, 6Center for Health Services Research, Bethesda, Bethesda, United States
Biography:
Dr Lieberman Lawry is a physician, epidemiologist, and biostatistician more than three decades of experience in humanitarian aid, disaster response, development, and research. She spent 20 years as faculty at Brigham and Women’s Hospital, Harvard Medical School, with concurrent appointments with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins and Uniformed Services where she is currently a Professor of Preventive Medicine and Biostatistics. She has extensive experience in dozens of countries coordinating aid, facilitating development, and conducting population-based studies in conflict and post-conflict settings. Her studies elucidate the needs of populations regarding human rights, healthcare access, mental health, and conflict-related sexual violence among many other public health topics – utilizing these data to improve policy to address global health needs in conflict. Her current focus is trauma system assessments in large-scale combat for understanding needs and gaps for preparedness. She is currently finishing a nationally-representative study of war-related abuses and mental health consequences in Ukraine. In addition to teaching at USUHS, she developed interactive courses for international militaries who serve as Peacekeepers in 48 countries on preventing sexual exploitation and abuse and CRSV and as global health engagements for security cooperation in the human security space.
Background
The 2022 Russian Federation invasion of Ukraine spurred unprecedented geopolitical changes including Sweden’s accession to NATO with a focus on preparedness across NATO countries.
Methods
We conducted semi-structured key informant interviews of Swedish healthcare providers working in the trauma and rehabilitation services across Sweden’s trauma centers and smaller hospitals to obtain detailed descriptions of experiences, gaps and needs for armed conflict preparedness. We adapted the Ukraine Trauma System Assessment Tool to include more in-depth assessments of rehabilitation and cold weather operations. The resultant Nordic Trauma System and Rehabilitation Assessment Tool evaluates trauma and rehabilitation systems by assessing the functional capacity of trauma and rehabilitation system domains and preparedness for LSCO. Deductive thematic content analysis was used to identify patterns or themes using NVivo and open coding techniques
Results
Sweden has a robust, advanced healthcare system that is highly capable. However, its surge capacity is lacking which will pose tremendous challenges in LSCO. Preparedness plans in Sweden are restricted access, which is understandable from an Operational Security perspective but nevertheless limits information flow. Many of the smaller hospitals will be overwhelmed by more than three patients. Integrated civilian and military exercises are few as is field practice in LSCO-type environments. Sweden has instituted preparedness training such as “Stop the Bleed” for the civilian population. There is need for lay provider training such as Disaster Rescue and First Aid Training as well as tourniquet training. Highly specialized surgeons would benefit from training on battlefield medical guidelines developed to reduce preventable deaths in combat such as ASSET and TCCC. The rehabilitation system is poorly integrated throughout the trauma continuum and is largely separate from inpatient acute medical care. The wait for rehabilitation beds (Traumatic Brain Injury and Spinal Cord Injury) is problematic in multiple regions and will be an important factor in modern warfare LSCO.
Conclusions
Sweden struggles in its transformation from a healthcare system with trauma care capability optimized for peacetime, to a system with surge capacity meeting the needs in LSCO. Change in Sweden during the upcoming decades should emanate from the national agencies that welcomes local and regional innovative initiatives.
Addressing Brain Injury Risk in the Australian Defence Force: An Integrated, Evidence Based Approach to Prevention, Monitoring, and Care
Dr Antony Sutherland1, Dr Kurt Mudie2, Dr Jemma Coleman2, Dr Zoe Jenkins3
1Army HQ, Canberra, Australia, 2Defence Science and Technology Group, Sydney, Australia, 3Joint Health Command – Directorate of Health Research, Canberra, Australia
Biography:
LTCOL Antony Sutherland is a neurologist with expertise in cognitive neurology, traumatic brain injury and operational brain health. He he has held senior medical leadership roles including supporting Special Operations Command as the former Senior Medical Officer.
LTCOL Sutherland is involved in the development and implementation of brain injury monitoring and surveillance programs for military personnel, with a focus on the neurological effects of repetitive low-level blast exposure. He is the clinical lead for the Australian Defence Force Blast Overpressure Monitoring Study which is looking at the neurophysiological impacts of repetitive low level blast in occupational training.
His broader interests include dementia and other cognitive syndromes, military neurotrauma and brain health policy. LTCOL Sutherland has presented nationally and internationally on operational brain health and contributes to collaborative research initiatives with Defence and academic partners. He is committed to improving early detection, prevention and long-term management of neurological conditions in both military and civilian populations.
Military occupational brain injury, including blast related and non blast related mechanisms, represents a complex and evolving challenge for modern armed forces. In response to Recommendation 61 of the Australian Royal Commission into Defence and Veteran Suicide, the Australian Defence Force (ADF) has implemented a comprehensive, system wide program to better understand, prevent, monitor, and manage brain injury risk across training and operations.
This presentation outlines the ADF’s integrated approach, governed through a senior 1 Star Steering Group and structured using a risk bowtie methodology to align preventative and restorative controls. The framework provides a transparent mechanism for assessing control effectiveness, identifying gaps, and ensuring accountability across multiple Lines of Effort, including engineering controls, training systems, health services, and policy reform.
On the prevention and monitoring side, the ADF has established a phased Blast Overpressure Monitoring Program in partnership with Defence Science and Technology Group (DSTG), Land Engineering Agency, and academic collaborators. Phase 1 trials within Special Operations Command have provided foundational exposure data and methodological lessons, while Phase 2 has expanded baseline data collection into conventional forces. Monitoring is supported by refined system configuration controls, weapon specific exposure testing, range design considerations, and evolving daily and cumulative exposure limits. Emerging findings challenge traditional assumptions, including the relationship between proximity and exposure, the role of acoustics versus blast pressure, and the limitations of fixed “safe” thresholds in the context of repetitive exposure.
In parallel, the ADF is progressing concussion prevention and management reforms across physical training, sport, and operational environments. These include embedded health professionals at training establishments, development of pragmatic screening and self reporting mechanisms, exploration of wearable and instrumented monitoring technologies, and alignment with conditioning models to balance readiness with injury risk.
Training, doctrine, and education are being updated to embed brain injury risk awareness into Army learning systems, supported by revised land publications, e-learning packages, and strategic communications aimed at improving transparency and workforce confidence. Importantly, the ADF is also addressing complex training scenarios involving multiple weapon systems in a single day, with ongoing work to determine when modelling, restriction, or targeted monitoring is most appropriate.
From a clinical perspective, the ADF is strengthening health system integration and care pathways through multidisciplinary approaches informed by international best practice. Engagement with United States and United Kingdom partners has highlighted the importance of coordinated rehabilitation, advances in neuroimaging and biomarkers, and the limitations of existing cognitive testing platforms. These insights are shaping future ADF traumatic brain injury assessment and management models.
International collaboration underpins the program, with Australia actively contributing to NATO Human Factors and Medicine initiatives, including HFM 338 and HFM 441, and engaging across Five Eyes partners to harmonise research methods and data standards.
Collectively, this work represents a shift from fragmented, reactive responses toward a coherent, evidence based system designed to protect brain health while sustaining military capability. The ADF experience offers a practical model for other militaries seeking to address brain injury risk across prevention, monitoring, and care in an operationally realistic manner.
ADF Medical Reporting Standardisation for Interoperable C2 in Combined Joint Operations – Lessons from the CJTMC
CAPT Luke Dekkers1
1Australian Army, Enoggera, Australia
Biography
CAPT Luke Dekkers is the Second‑in‑Command of C Company, 2nd Health Battalion, where he supports the command, readiness, and tactical employment of Close and General health capabilities in land force operations. His professional experience is anchored in the planning and execution of Close Health support, underpinned by a strong focus on medical command‑and‑control problem sets.
He holds a Bachelor of Arts, a Bachelor of Science, and a Postgraduate Diploma of Education. He is currently undertaking a Master of National Security Policy, enhancing his understanding of Australia’s strategic environment and the interoperability requirements of joint and coalition operations.
CAPT Dekkers’ presentation, “ADF Medical Reporting Standardisation for Interoperable C2 in Combined Joint Operations – Lessons from the CJTMC,” highlights the need for a unified medical reporting framework in the ADF and proposes a scalable approach to improving medical situational awareness, doctrinal convergence, and health command and control in multi‑national operational settings.
Background
EXERCISE TALISMAN SABRE 2025 (TS25) exposed a gap in ADF medical C2, the absence of a standardised, doctrinally aligned, joint reporting tool for deployed health elements. During integration with the US 18th Theatre Medical Command and partner‑nation staff, the CJTMC encountered unnecessary friction from inconsistent terminology and organisational unfamiliarity with required reporting lines. This delayed establishment of the CJTMC’s operational picture within the Combined Joint Force Area of Operations and reduced information fidelity. Critically, the ADF lacks a formalised, doctrinally-directed tactical‑to‑operational medical return. This forces reporting frameworks to be individually constructed through activity‑specific Health Support Orders, an approach that contributed directly to the difficulties observed during TS25.
Aim
This work proposes a technically robust ADF Medical Situation Report (MEDREP) as a standardised and doctrinally aligned reporting framework. The MEDREP is designed to meet CJTMC’s information requirements, support rapid operationalisation of Joint Health Command (JHC), and ensure doctrinal convergence with US INDOPACOM and NATO counterparts. The aim is not to describe an implemented tool, but to demonstrate the operational necessity and technical viability of institutionalising one.
Methods
The CJTMC Operations Cell, in collaboration with 18th TMC, developed the MEDREP concept using NATO doctrine as reference standards, enabling harmonisation of medical terminology, patient categorisation, and evacuation classification across coalition partners. The resulting construct is a 10‑line reporting pro forma optimised for:
(1) Scalability
(2) Transmission flexibility
(3) Interoperability with the CJTMC Medical Common Operating Picture (MEDCOP)
(4) Alignment with NATO health surveillance methodology
Each line was weighted against a criticality index developed by the CJTMC to ensure the most time-sensitive information (e.g., capability, evacuation readiness, resource viability) can be reported first.
Technical Design Features
The MEDREP consolidates critical metrics into a unified architecture encapsulating:
(1) Evacuation capabilities
(2) Medical logistics
(3) Bed availability
(4) Epidemiological reporting
(5) Command inputs
The design will support analogue (A5 print form) and digital delivery, enabling future integration with NATO‑standardised platforms or ADF digital health systems.
Results / Operational Impact:
The proposed MEDREP is assessed to significantly reduce reporting friction, increase accuracy of health intelligence inputs, and improve the CJTMC’s ability to rapidly build their MEDCOP with minimal data transformation. Its adoption would support:
(1) Harmonised reporting across ADF, US INDOPACOM, and NATO PNs.
(2) Improved medical C2 through standardised, comparable data inputs.
(3) Significantly enhanced surveillance from forward Role 1 elements.
(4) Accelerated establishment of CJTMC operational awareness in future activations.
Conclusion
The ADF’s lack of a standardised medical reporting mechanism represents a capability gap in combined joint operations. The MEDREP concept provides a technically sound, doctrinally consistent solution that enables interoperability, strengthens force health protection and medical C2, and addresses intelligence gaps identified during TS25. Its formal adoption across single‑service and joint activities would embed an enduring, interoperable, coalition‑aligned reporting framework essential for future ADF deployments.
Agility In Action: Transforming Air Force Role 2 Capability for the Future Fight
Dr Ajitha Naidu Sugnanam1
1Royal Australian Air Force, Amberley , Australia
Biography:
Wing Commander Ajitha Naidu Sugnanam
WGCDR Ajitha Naidu Sugnanam is currently the Commanding Officer of No. 1 Expeditionary Health Squadron. A qualified general dentist with further studies in oral surgery, she joined the Royal Australian Air Force in 2010 and has held postings across Joint and Air Force units including Amberley, Darwin, Tindal, Newcastle, and Canberra. Her career has evolved from predominantly clinical practice to leadership and staff officer roles, including appointments as Health Operations Staff Officer, Staff Officer Capability Development, Staff Officer at the Defence Response Unit, and Staff Officer within the Health Policy and Protection Directorate. She is a graduate of the Australian Command and Staff College (2022).
WGCDR Sugnanam has contributed to humanitarian missions such as the Army Aboriginal Community Assistance Program (AACAP) and Pacific Angel, and has deployed on Operation HIGHROAD and Operation ACCORDION.
She is deeply committed to equitable healthcare access, inspiring her to establish and continue leading the Esesson Foundation as Chief Executive Officer; a non-profit organisation that has delivered healthcare and education initiatives to approximately 30,000 underserved people across Australia and 13 other countries over the past 16 years.
Serving as Commanding Officer of No. 1 Expeditionary Health Squadron provides a unique vantage point to understand both the strategic imperatives of preparedness and the practical complexities of delivering Role 2 health capability. This extends to the precision required to generate and deploy capability, exemplified through detailed air platform load configurations, where sequencing and execution are meticulously planned and delivered down to the minute to ensure operational success.
This presentation explores the evolution of No. 1 Expeditionary Health Squadron as the ADF’s most agile Role 2 capability; a resuscitative surgical capability designed with a scalable and sustainable model to meet future operational demands. Over the past three years, the Squadron has achieved significant success in SERCAT 5 workforce integration and expansion, strengthening sustainable effects and capability depth. Key initiatives, such as the Katherine Hospital partnership, have enhanced team cohesion and clinical readiness, while consistent interoperability efforts across Army and Navy elements have strengthened resilience within the ADF Land Trauma System. The transition from legacy systems to JP2060 has driven innovation, while also presenting challenges in modernising capability delivery within a complex and evolving environment. Looking forward, initiatives such as the Spray Dried Plasma project and deeper integration with the ADF Blood Program represent critical advances in survivability and care at reach. This session will demonstrate how disciplined execution, innovation, and workforce integration are enabling a more agile, resilient, and combat-relevant health capability for the future fight.
AI-Enabled Force Protection: Transforming Health Intelligence and Threat Communication for Modern Defence
Dr Andrew Mathieson1
1Australian National University, Canberra, Australia.
Biography
Dr Andrew Mathieson is a Senior Lecturer in Health Science at the Australian National University (ANU), specialising in health systems, public health, environmental health, disaster risk reduction, and workforce capability. With more than 40 years of professional experience across academic, operational, and international settings, he brings a unique interdisciplinary perspective linking prevention, force protection, and organisational resilience.
Andrew has worked extensively across Australia, the Pacific, Africa, the Middle East, and Asia, supporting governments, defence personnel, NGOs, and communities in areas including public health preparedness, environmental health systems, risk communication, emergency management, and health workforce development. His international work has included projects and training activities in Iraq, Afghanistan, Lebanon, Kenya, Malawi, Tanzania, Fiji, Papua New Guinea, Timor-Leste, Pakistan, and Vanuatu.
Alongside his academic career, Andrew served for more than three decades in the UK Reserve Army, undertaking operational deployments and training missions in complex and high-risk environments. This dual military and academic background has shaped his strong interest in prevention, preparedness, and protecting workforce capability in demanding operational settings.
Andrew is also actively involved in international environmental health leadership, professional education, and global workforce development initiatives through the International Federation of Environmental Health and related professional networks.
Contemporary military operations face an increasingly complex threat environment shaped by emerging infectious diseases, environmental hazards, misinformation, climate-related instability, occupational risks, and rapidly evolving geopolitical pressures. Traditional approaches to force protection and health intelligence are struggling to keep pace with the speed, scale, and complexity of these modern threats. This presentation explores how artificial intelligence (AI) and digital transformation can strengthen force protection capability through enhanced situational awareness, predictive analysis, and more effective threat communication.
The presentation argues that AI is not simply a technological innovation, but a transdisciplinary operational capability requiring integration across public health, environmental health, intelligence, operational planning, logistics, risk communication, and workforce development. Examples will demonstrate how AI-supported systems can assist in hazard surveillance, outbreak prediction, environmental monitoring, workforce health analysis, and rapid decision support in both deployed and domestic settings.
Particular attention will be given to the growing importance of health intelligence as a core component of operational readiness and resilience. The session will examine how modern tools can support in the planning preparation deployment and recovery to identify risks earlier, communicate threats more effectively, and improve evidence-informed decision-making under pressure.
An analysis of the premature deaths of returning New Zealand Nurses of the NZANS in the First world War
Dr Wendy Maddocks1
1University Of Canterbury, Christchurch, New Zealand
Biography
Wendy currently works as ia nurse academic and considers herself to be an amateur nurse historian and has spent the last four years researching various aspects of welfare related to the NZANS in WW1, which has resulted in a number of academic publications and international conference presentations. Recent travel to various key WW1 locations in Europe, UK and has helped to contextualise the research. Wendy recently published A Broken Nurse of the Great War’, the annotated diary of Sister Mabel Crook and has written a chapter on military welfare (Publication August 2026). In 2025 Wendy was commissioned by the NZDF to present a report to the Waitangi Tribunal Kaupapa Enqury on psycholgical welfare in the NZDF post 1949. Wendy has worked with the NZDF as a civilian supporting the delivery of medic training. She draws on a long history of nursing and health education and clinical practice as a nurse in various settings in NZ and UK. Wendy is passionate about ensuring the legacy of military nurses is not forgotten.
Dr. Wendy Maddocks (RN, DHlthSci)
wendymaddocks.nz@gmail.com or nznursinghistory@gmail.com
ORCID ID https://orcid.org/0000-0001-5771-810X
Linked In Dr. Wendy A. Maddocks
In the First World War New Zealand provided over 20% of its nursing workforce as the newly formed New Zealand Army Nursing Service (NZANS) to support the overseas war effort. Around 550 NZANS had overseas service and an unknown number of NZ nurses served privately or for other countries. More than 10% of these nurses returned invalided, 60% had documented sickness in records, and returned to a system that did not provide care and rehabiltation. Subsequent research has found that 20% of the returning nurses suffered a premature death before the age of 70.
Whilst a lot has been written about what the nurses experienced during their service, a detailed analysis of the effects of their service had on them and subsequent premature death, has been missing from the war narrative. This presentation will detail the findings of a comprehensive analysis of all extant information in the military files, and death certificates of 100 nurses who died before the age of 70. The NZANS nurses individually served for up to five years away and many returned to NZ broken, with no provisions made for their welfare upon their return. Investigating the life limiting effects of their service and associated illness helps strengthen the historical context these nurses worked in and poses questions for the contemporary environment. These nurses were over represented in many statistics when compared with non serving women of similar age and time frame.
This presentation will include detailed statistical analysis of findings from the field, and present case studies which are indicative of how they were failed by the NZ government on their return.
Beyond average scores: Health literacy profiles among Queensland veterans and their families
Dr Tho Dang1,3, Dr Sanket Raut1,3, Associate Professor Luke Johnson1,2, Dr Camila Guindalini1,3
1Gallipoli Medical Research Ltd, Greenslopes, Brisbane, Australia, 2The University of Queensland, Faculty of Medicine, St Lucia, Brisbane, Australia, 3The University of Queensland, Greenslopes Clinical Unit, Greenslopes, Brisbane, Australia
Biography
Dr Dang is a Veteran Mental Health Research Fellow at Gallipoli Medical Research. She holds a PhD in Health Economics from The University of Queensland and has expertise in health technology assessment, health economics, and econometric analysis. Her research focuses on the health and wellbeing impacts of military service on veterans and their families, with particular interests in mental health, value for money in service delivery, patient-reported outcomes, and evidence translation.
She has extensive experience applying quantitative and mixed-methods research, including cluster analysis and advanced statistical methods. Dr Dang has contributed to multidisciplinary research on informal caregiving, health literacy, chronic disease management, and healthcare quality, working closely with researchers, clinicians, policymakers, and veteran stakeholders to inform health policy and service delivery.
Her work is driven by a commitment to improving person-centred care and health outcomes for veterans through evidence-based and practical approaches, including translating research into policy-relevant outputs, educational resources, and digital learning tools for veterans and their families.
Background
Veterans experience higher rates of physical and mental health conditions than the general population and often face challenges navigating civilian healthcare following transition from military service. Health literacy—the ability to access, understand, appraise, and use health information and services—is critical for effective healthcare engagement and self-management. However, reliance on average health literacy scores may mask important between-person differences, limiting identification of individuals requiring additional support and constraining equitable, person-centred health system responses. This study examined multidimensional health literacy profiles among Queensland veterans and their family members to identify subgroups with distinct strengths and challenges to inform targeted, health literacy-responsive service delivery.
Methods
A cross-sectional online survey was conducted among Queensland veterans and their family members between March and September 2024. Participants completed the validated 44-item Health Literacy Questionnaire (HLQ), measuring nine domains covering engagement with healthcare providers, accessing and understanding health information, appraisal of information, active health management, social support for health, and healthcare system navigation. Hierarchical cluster analysis was used to identify distinct health literacy profiles. Demographic and service-related variables were used to support interpretation of cluster membership.
Results
Of the 280 individuals who consented, 191 (160 veterans and 31 family members) provided sufficient data for analysis. Veterans were predominantly older than 50 (78%) and male (83%), while family members were mostly older than 50 (63%) and female (84%). Approximately two-thirds of participants had TAFE/trade or university-level qualifications. Veterans had primarily served in the Army (66%), with a mean service length of 18 years and a mean of 23 years since discharge; one-quarter had been medically discharged from the ADF.
Mean HLQ scores were broadly similar across groups, indicating generally moderate-to-high health literacy (approximately 2.7–3.0/4 for Domains 1–5 and 3.2–3.9/5 for Domains 6–9). Family members generally reported slightly higher scores than veterans across most domains.
Cluster analysis revealed substantial heterogeneity, identifying seven distinct health literacy profiles among veterans. Notably, 76% of the sample fell within mid-range to lower health literacy clusters. The largest cluster (V3, 26%) demonstrated moderate health literacy and comprised predominantly older, well-educated veterans with substantial service experience. The lowest health literacy clusters (V6-V7, 23%) experienced pronounced challenges in provider engagement, system navigation, social support, and health information appraisal, and were more frequently characterised by lower educational attainment, medical discharge, and non-urban residence. In contrast, the highest health literacy clusters (V1-V2, 24%) showed consistently strong engagement with healthcare providers, system navigation, and understanding of health information; these participants were generally older and urban-dwelling.
Among family members, five distinct health literacy profiles emerged, with approximately 65% classified within moderate-to-lower health literacy clusters. The lowest (F5, 16%) experienced broad difficulties, particularly in provider engagement, social support, and appraisal of health information, and included a greater proportion of rural residents and participants with lower educational attainment, whereas the highest health literacy cluster (F1, 23%) demonstrated strong capability across all domains. Across both groups, higher health literacy profiles were characterised by stronger engagement with healthcare providers, system navigation, and understanding of health information, while lower profiles consistently demonstrated limited social support.
Conclusions
Health literacy among veterans and their families is heterogeneous, and average scores alone may mask important differences in support needs. Embedding health literacy-informed and targeted interventions within veteran and family healthcare systems may help address differing needs, enhance service navigation and engagement with care providers, contributing to more equitable health outcomes for veterans and their families.
Beyond the ICU: The Role of the Intensive Care Physician in Future Contested Operations
Dr Jonathan Begley1
1HQ 2 BDE, Nightcliff, Australia
Biography
Jonathan is an Australian Regular Army anaesthetist and intensive care physician, with clinical appointments at Royal Darwin Hospital. Jonathan joined the Army Reserve as a medical officer in 2011 and completed his anaesthesia specialty training in 2017. He completed a 12-month fellowship in prehospital and retrieval and worked as an anaesthetist in Wagga Wagga, rural New South Wales, before joining the Army Medical Specialist Program (MSP) in 2020 and completing training in intensive care medicine. He is also a grandfathered Graduate of the Chapter or Perioperative Medicine.
Jonathan is a recipient of the Sidney Sax medal as the top Master of Public Health graduate at James Cook University. He is a keen educator, has completed a Graduate Diploma in Adult Education, and has served as an anaesthesia supervisor of training. Jonathan is an Anaesthesia Top-10 paper author, recipient of the Felicity Hawker Medal, and is a member of the board of the Safe Airway Society. He is an editor of Anaesthesia Reports, and adjunct senior lecturer at Monash University.
Future Australian military operations are likely to occur in environments characterised by distance, dispersion, contested logistics, delayed evacuation. Health facilities may be targeted, preventing the deployment of heavy established facilities. In this context, deploying a conventional intensive care unit (ICU) may not be feasible. However, this should not lead to the conclusion that intensive care physicians have little role in future conflicts. Rather, the potential changing character of military operations may make the broader skill set of the intensivist more relevant, not less.
Intensive care medicine is often understood through the physical space of the ICU: ventilators, monitors, renal replacement therapy, invasive monitoring and high staff-to-patient ratios. In future operations, this may have to be reimagined. The better question may not be whether an ICU can be deployed, but how intensive care expertise can best support patient survival when evacuation is delayed, resources are scarce, and clinical deterioration must be recognised early.
The intensivist brings several capabilities relevant to future deployed care. These include the management of shock, sepsis, major trauma complications, environmental illness, toxicology (including chemical weapon exposure). Intensive care medicine is, at its core, about the prevention of complications – not only does this improve outcomes, but it is a far more efficient use of resources than the alternative. Most importantly, intensivists are accustomed to managing uncertainty, prioritising limited resources, integrating multidisciplinary teams, managing complex ethical dilemmas, and making time-critical decisions with incomplete information. These skills are directly relevant to prolonged field care, damage control resuscitation, post-operative stabilisation, aeromedical evacuation preparation and the care of non-battle injury and disease.
The role may be particularly important given the relative absence of internal medicine physicians in deployed ADF health facilities. Future operations are unlikely to generate only surgical trauma – they will involve infection, tropical disease, chronic disease exacerbations, heat illness and renal injury, and critical illness arising from delayed presentation. In this context, the intensivist may provide a bridge between emergency medicine, anaesthesia, surgery, primary care and evacuation systems.
This presentation argues for a broader conceptualisation of the deployed intensive care physician. Potential roles include clinical leadership in prolonged field care, support to triage and resuscitation, identifying and managing patient deterioration, debriefing and learning from clinical incidents, tele-health advice, and support for ethical decision-making. The intensivist may also contribute to capability planning by identifying which elements of critical care are essential, scalable and survivable in contested environments.
Future conflict may not allow the ADF to deploy an ICU as it would be recognised in established deployed hospital. Nevertheless, the cognitive, procedural and systems expertise of intensive care medicine remains highly relevant. The challenge is to define, train and integrate this role before it is needed. In a future conflict, the intensivist’s value may lie not in bringing the ICU to the battlefield, but in bringing intensive care thinking to every point where deterioration, delay and constrained resources intersect.
Beyond the Battlefield: Child and Family Wellbeing After Military Deployment to the Middle East
A/Prof Miranda Van Hooff1, Dr Camila Guindalini1,2, Dr Pilar Rioseco1, Dr Jie Hue1, Dr Mark Westby, Ms Rochelle Lund1,2, Ms Miriam Kent1, Ms Veena Herron1, Prof Ed Heffernan3, A/Prof Carla Meurk3, Ms Maddison Deery3, Ms Jessica Elliot3, Ms Cynthia Chen3, Mr Nicolas Riveros Weidermuller4, Prof Sharyn Rundle-Thiele4, A/Prof Julia Carins4, Ms Renata Anibaldi4, Mr David Paddison4, Ms Tori Brown4, Mr Luke van der Beeke5, Ms Allison Grainger5
1Gallipoli Medical Research, Greenslopes, Australia, 2University of Queensland, Herston, Australia, 3Queensland Centre for Mental Health Research , Wacol, Australia, 4Griffith University , Brisbane, Australia, 5The Behaviour Change Collective , Perth, Australia
Biography
Associate Professor Miranda Van Hooff is Manager of Research Engagement and Development at Gallipoli Medical Research and an adjunct Associate Professor at the University of Adelaide. She is a nationally recognised leader in veterans’ mental health research, with more than 25 years’ experience in trauma and mental health and over 15 years dedicated to the health and wellbeing of Australian Defence Force (ADF) personnel, veterans, and their families.
Since 2009, Associate Professor Van Hooff has led major longitudinal research programs examining the long-term mental, physical, and social health outcomes of serving and ex-serving ADF members and their families. As a lead investigator on the Transition and Wellbeing Research Programme and the Military Health Outcomes Programme, she has overseen large-scale, multi-wave cohort studies that have generated critical evidence on mental health, transition from military to civilian life, and family wellbeing. Her work produced the first Australian estimates of ICD-10 mental disorder prevalence among serving and ex-serving ADF personnel and has directly informed government policy, service delivery, and veteran support programs.
She has authored 90 peer-reviewed publications and 42 government reports, and is widely recognised for translating high-quality longitudinal evidence into improved systems of care for veterans and military families.
Background
Australian Defence Force deployments to the Middle East Area of Operations (MEAO; 2002–2021) have produced enduring consequences not only for veterans but also for partners, children, and wider family systems. Understanding these long-term impacts is critical to advancing child and family wellbeing across periods of prolonged stress, separation, and reintegration.
Methods
This presentation integrates findings from Phase 1 and Phase 2 of the MEAO Scoping Study Funded by RSL Australia. Phase 1 comprised a comprehensive scoping review of international peer-reviewed and grey literature examining long-term mental, physical, and social health outcomes for MEAO veterans and their families, with dedicated analyses of traumatic brain injury (TBI/mTBI) and moral injury. The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines, synthesising evidence from 2,899 sources. Phase 2 involved participatory workshops with veterans, partners, parents, and community members (n=65) across four Australian cities, using co-design and design-thinking approaches. Data were analysed using inductive thematic analysis and sentiment analysis.
Results
Across both phases, MEAO deployments were associated with sustained strain on family functioning. Convergent evidence highlighted partner distress, relationship conflict, disrupted parenting roles, and secondary traumatic stress linked to veterans’ PTSD, depression, moral injury, and reintegration difficulties. Children experienced emotional, behavioural, and developmental impacts, particularly following repeated deployments. Identity disruption, emotional disconnection, and limited access to family-inclusive supports were prominent. Protective factors included pre-deployment preparation, emotional openness, social and peer support, and proactive, family-centred services, though system-level gaps persist.
Audience takeaway
The presentation will equip the audience with a nuanced understanding of how deployment-related trauma, moral injury, and reintegration challenges intersect with parenting, couple relationships, and child development, highlighting protective factors and service gaps relevant to family wellbeing practice.
Acknowledgement of funding
This research was funded by RSL Australia.
Bridging the Gap’: A Regional Dental Advisor Framework to Strengthen Governance, Capability and Operational Readiness in the ADF
Dr Thomas Van Heumen1
1Garrison Health – JHC
Biography
LTCOL van Heumen was commissioned into the Australian Army in 2006 while undertaking his Bachelor of Dental Science degree at the University of Queensland. Throughout his career he has fulfilled adiverse range of health officer roles, with highlights including the inaugural Brigade Dental Officer for the 2nd Health Brigade, SO1 Health Governance in Army Headquarters and Officer Commanding of 33rd Dental Company in the 2nd General Health Battalion. LTCOL van Heumen is currently the SO1 Dental Garrison in Joint Health Command and is the senior technical advisor for all dental matters across the garrison health facilities in the Australian Defence Force.
LTCOL van Heumen is a Fellow of the Royal Australasian College of Dental Surgeons in General Dental Practice. In 2018 he completed a Doctor of Clinical Dentistry in Periodontics at the University of Melbourne. As a registered periodontist he maintains clinical currency in both garrison clinics and private practice. He stays up to date with dental technologies and research by participating in various professional colleges and societies.
Background
Delivering safe, effective and operationally relevant dental care across geographically dispersed Australian Defence Force (ADF) populations presents persistent governance, workforce and assurance challenges. Historically, dental oversight at regional and local levels has been inconsistent, with limited capacity for clinical governance, contractor assurance, workforce development and integration with operational planning.
To address these gaps, Joint Health Command established the Regional Dental Advisor (RDA) Framework, comprising four uniformed O5 positions embedded across the national Garrison Health system. By January 2027, the framework will be fully implemented, with senior dental leaders embedded within regional JHC headquarters and technical networks, providing governance oversight and subject matter expertise across all ADF dental facilities. Their primary role is to enhance governance, patient safety, workforce capability and operational readiness.
Concept
Strong clinical leadership, governance and assurance are essential for safe, effective and efficient healthcare delivery. However, these principles have not been consistently applied to dental services within Defence. Dentistry presents unique operational and workforce challenges that require dedicated oversight to ensure clinical quality, consistency of care and effective risk management.
The RDA Framework addresses these gaps, with early implementation already demonstrating benefits across multiple domains. This presentation will explore:
– Current gaps in regional and strategic oversight of ADF dentistry
– Structure of the RDA Framework within Garrison Health
– Core RDA functions and responsibilities
– Contributions to capability modernisation and patient experience
– Contract oversight improving accountability and reducing inefficiencies
– Mentorship supporting development of deployable dental capability
– Integration of dental advice into force health protection and planning
– Future RDA priorities and initiatives
Conclusion
This presentation will summarise the RDA Framework and its early contributions to governance, patient safety, workforce capability and contract assurance within ADF health services. It will also highlight broader implications for military readiness and operational capability.
Increasing strategic demands require a more agile and robust dental capability. The RDA Framework is a key enabler of this transformation by bridging existing gaps and strengthening the future of ADF dental capability.
Building Resilient Health Training Capability – 294 Squadron Training and 94 Wing Force Generation in Support of the National Defence Strategy
WGCDR Jason Lynam1
1Raaf, Amberley, Australia
Biography:
Wing Commander Jason Lynam is a Registered Emergency Nurse who trained at the Royal Brisbane and Women’s Hospital before joining the Royal Australian Air Force in 2008 as a Nursing Officer.
He has deployed widely across Australia, the Indo-Pacific, the Middle East, Nepal and Antarctica. Early in his career, he served in the Middle East a number of times as a Primary Health Care Nurse, an ICU Nurse at Kandahar Role 3 Hospital and as an Aeromedical Evacuation Liaison Officer, conducting and coordinating numerous tactical and strategic evacuations.
He has held key operational and leadership roles, notably in Afghanistan (2013) he embedded with US Army 4th Infantry Division where he led Southern Afghanistan regional patient evacuation as Officer-in-Charge of the NATO Patient Evacuation Coordination Cell (PECC).
WGCDR Lynam has also led humanitarian and aeromedical missions, including Operation Nepal Assist and Antarctic AE trials. Subsequent roles include Senior Joint Health Officer South Australia and Executive Officer No. 2 Expeditionary Health Squadron, supporting Operation Bushfire Assist and A5 Health Planner for HQJTF629 COVID-19 response.
He now commands No. 294 Squadron. He holds a Bachelor of Nursing, a Master of Health Science (Health Administration), and a Master of Military and Defence Studies (ANU).
Abstract: The 2026 Australian Military Medicine Association (AMMA) conference theme Shifting Tides of Military Medicine: Geopolitics, Interoperability and Resilience captures the increasing complexity faced by Australian Defence Force (ADF) health services in a potentially contested Indo-Pacific. The Royal Australian Air Force (RAAF) No. 294 Squadron, within 94 Wing, plays a critical role in force generation and assurance by delivering contemporary, mission-focused health training aligned with the Defence Strategic Review (DSR) and National Defence Strategy (NDS).
This presentation outlines how 294 Squadron’s health training continuum prepares personnel for operations in austere, resource-constrained environments across northern Australia and the wider Indo-Pacific. Central to this approach is the Integrated high Performance high Acuity Clinical Training (IMPACT) framework, which addresses critical gaps in clinical readiness through immersive, scenario-based training. Delivered across multiple iterations since 2024, IMPACT leverages experienced specialist faculty to develop high-performing clinical teams capable of managing high-acuity, high-consequence events, with emphasis on trauma care, ethical decision-making, and prolonged field care in degraded and contested environments.
Training scenarios emphasise constrained logistics, degraded communications, and contested aeromedical evacuation pathways, reflecting the realities of future operations. These outcomes are further enhanced through innovative training technologies such as the BlueRoom mixed reality simulator, which integrates C-130J and C-17 Globemaster III platforms and Tactical Combat Casualty Care modules. This sovereign capability enables scalable, high-fidelity rehearsal of clinical and tactical tasks, reducing reliance on aircraft availability while improving preparedness for real-world mission sets.
Beyond individual readiness, 94 Wing strengthens force generation through deliberate collective and multinational training. Integrated exercises and international courses—including aeromedical evacuation training for non-traditional partners—have expanded participation to personnel from across the Indo-Pacific and beyond, fostering interoperability, shared understanding, and coalition readiness. These engagements are complemented by a strong instructional culture, where experienced clinicians are rapidly developed into effective educators through mentorship and a values-based learning environment that promotes excellence and psychological safety.
The training system incorporates iterative clinical governance, innovation, and lessons learned from operational deployments and exercises, ensuring continuous refinement of capability. High levels of individual readiness, professional accreditation, and workforce resilience underpin the system, supported by compassionate leadership and a strong emphasis on mental and physical preparedness.
Through this integrated approach, 294 Squadron and 94 Wing are developing a resilient, adaptable health workforce capable of independent action and sustained operations at range directly supporting NDS priorities for agility, self-reliance, and interoperability.
This presentation demonstrates how RAAF health training delivers a coherent, innovative, and future-focused capability that enables operational resilience and ensures the ADF can project and sustain effective medical support in complex, contested, and dynamic environments across the Indo-Pacific.
Care of the Dying: A Model for Preparing Clinicians
Dr Ash Duncan
Biography:
MAJ Ash Duncan is a GP, currently appointed as the Senior Medical Officer of the 3rd Health Battalion, overseeing Army’s deployable clinicians for SA, Vic and Tas. His career has spanned undergraduate in Philosophy to service as a Rifleman, and deployment to the Middle-East to provide mental health care forward during the peak of Australian casualties. His clinical work currently focuses on persistent musculoskeletal pain, and he has recently commenced Army’s first in-house clinic for assessment and targeted injection-based therapies for contributory pathways.
Despite the inevitability of death in war, care of the dying remains an often overlooked aspect of military medicine. Simple lists of medications exist; but the challenges of clinicians in large scale combat operations (LSCO) are likely to involve austerity, triage, and the risk of moral injury – particularly to junior clinicians. A training model has been developed to assist with these aspects.
This training model introduces junior clinicians to the practical challenges of MASCAS events, criteria for focusing on comfort care, and the ethical framework necessary to reduce the risk of moral injury. Informational aspects introduce changes to expect in the patient, pharmacological and – more importantly – non-pharmacological strategies to assist. Training then considers scene management, self-management, team management, and introduces the practicalities of mortuary affairs.
However, the most challenging aspect of care of the dying remains the actual emotional experience. To be effective, preparation must include this dimension – yet no military medical training package worldwide has yet done so. This model is the first to deliberately engage the experiential aspect, and explore several approaches to prepare for those moments.
This session acknowledges unresolved tensions in policy not yet geared for large scale combat operations, and opens the conversation on the next steps.
Chaplaincy in War: Addressing a Critical Capability Gap in the Land Based Trauma System during Large Scale Combat Operations
Chaplain Scott Doran-Sargent1
1ADF, Australia
Biography:
Chaplain (Lieutenant Colonel) Scott Doran-Sargent is the Senior Chaplain of the 2nd Health Brigade and has served for more than 20 years as an Australian Army Reserve Chaplain, including one overseas and two domestic operational deployments. Throughout his service, he has provided pastoral, spiritual, and welfare support to Army personnel and their families across a broad range of settings. In recent years, his focus has shifted to chaplaincy leadership, training, mentoring, and workforce development.
In 2026, Scott completed the United States Army Combat Medical Ministry Course at Fort Jackson, South Carolina. The course prepares chaplains to provide comprehensive pastoral and spiritual care to the injured and dying in battlefield environments, forward-deployed medical units, and trauma response teams, while also supporting deployed healthcare personnel. He is currently leading the development of training to address a key Australian Army capability gap by preparing chaplains for integrated ministry within medical units during large-scale combat operations.
Before entering ministry, Scott served as a Tasmania Police officer.
He lives in Hobart with his wife, Jan, and they have four adult children.
Large Scale Combat Operations (LSCO) are likely to expose Australian soldiers, medical personnel and chaplains to levels of casualties, death, human suffering and moral distress not experienced by the Australian Defence Force since the Second World War.
Contemporary experience from Ukraine demonstrates that sustained high-intensity conflict places extraordinary demands on casualties, healthcare personnel, and chaplains operating throughout the trauma system. As the ADF prepares for casualty rates and operational tempos more consistent with LSCO, the effective preparation and integration of well-trained chaplains within the LBTS becomes an increasingly important consideration for health system and workforce resilience to ensure the continued delivery of medical care during sustained operations.
This reality is not new. From Australia’s first overseas deployment through to Afghanistan, chaplains have accompanied soldiers into war, providing support wherever personnel are wounded, dying, grieving, or in distress. As Major General Bernard Loeffke (US Army) observed, chaplains are sent where they are needed—where soldiers are wounded and dying.
Yet, while considerable effort has been devoted to preparing medical personnel in the Land Based Trauma System (LBTS), less attention has been given to the preparation and integration of chaplains as a non-clinical workforce capability who care for the wounded and dying, honour the dead, and support medical personnel at risk of vicarious trauma and moral injury.
Further, while Army doctrine recognises the chaplain’s role across the continuum of casualty care, many chaplains have not trained in environments characterised by sustained MASCAL events, complex triage decisions, prolonged exposure to death, or the psychological demands placed on medical personnel. This creates a capability gap within the LBTS at precisely the point where casualties, healthcare personnel, and commanders may require spiritual, pastoral, and moral support the most.
In response, earlier this year, two senior Australian Army chaplains undertook the US Army’s Combat Medical Ministry Course, which prepares US Army chaplains for, among other things, MASCAL events during LSCO. Drawing on lessons from that training and observations from Ukrainian military chaplains operating under wartime conditions, Army Chaplaincy is developing a pilot program to better prepare chaplains to operate effectively during LSCO, particularly where soldiers are injured and dying.
In 2027, a pilot training program will begin where Australian Army chaplains will undergo a MASCAL training exercise, which will firstly involve a day of briefings from a senior medical and psych officer and a senior chaplain. Aspects covered will include:
•Priority of care, caring for the injured and dying, and micro-interventions in support of medical staff (Chaplain input),
•How triage decisions are made under LSCO conditions, why space, flow, and noise matter, and the emotional load on medical personnel (Medical Officer input), and
•Psychological first aid to medical personnel, the chaplain’s emotional regulation, and how trauma can accumulate across repeated MASCALs (Psychologist input).
In partnership with the 2nd Health Brigade and other key health stakeholders, utilising an action-reflection-action approach, chaplains will then participate in a MASCAL simulation designed to prepare them for employment as an integrated capability within the LBTS during war, under the guidance of an experienced senior chaplain.
This paper will explore three questions:
1.What role should trained chaplains play within the LBTS during LSCO?
2.What barriers exist to the effective integration of chaplains within the LBTS during LSCO?
3.How might a scalable training model rapidly prepare Army chaplains for wartime employment within the LBTS should that become necessary?
Cognitive and behavioural processes in problematic anger: Development and validation of three new measures in Australian Defence Force members
Professor Jennifer Wild1,2,3, Dr Zoe Jenkins1, Dr Ellen Wessell1,4
1Directorate of Health Research, Joint Health Command, Department of Defence, Canberra, Australia, 2Phoenix Australia Posttraumatic Centre for Mental Health, University of Melbourne, Melbourne, Australia, 3Department of Experimental Psychology, University of Oxford, , United Kingdom, 4University of Queensland, Brisbane, Australia
Biography:
Jennifer Wild is Professor of Military Mental Health at Phoenix Australia, University of Melbourne, the Australian Defence Force, and Visiting Professor of Experimental Psychology at the University of Oxford. Her area of expertise is in developing interventions to prevent the onset and persistence of PTSD and major depression in high risk occupations at risk of trauma, such as military members, and in developing and evaluating evidence-based interventions for anxiety and stress disorders. She is dedicated to improving treatments so they are more precise and effective and reach the people who need them most. She has written over 100 publications and two books, including a recently published popular science book on resilience, Be Extraordinary: 7 Key Skills to Transform Your Life from Ordinary to Extraordinary. Professor Wild regularly appears in the media giving advice rooted in science for preventing the onset and persistence of trauma-related mental health problems.
Background: Problematic anger is common in military populations and is associated with significant impairment in relationships, occupational functioning, and mental health. Anger frequently co-occurs with posttraumatic stress disorder (PTSD) and may predict subsequent PTSD symptom onset. Yet the cognitive and behavioural processes that maintain problematic anger remain poorly specified, limiting the development of targeted interventions. Three new measures were developed, grounded in interviews with military members experiencing problematic anger: the Anger Cognitions Inventory (ACI), the Anger Behaviours Questionnaire (ABQ), and the Anger-Related Metacognitions Scale (ARMS).
Method: Serving Australian Defence Force members (N=4,329) completed the ACI, ABQ, and ARMS alongside validated measures of problematic anger, PTSD symptom severity, combat exposure and metacognitive anger processing. The ACI comprises 38 appraisals associated with the experience of anger, assessing cognitive themes including perceived injustice, sense of threat, hostile perceptions of other people, perceived devaluation, and reactivated memories, with items such as ‘People are out to get me’, ‘I need to protect what is important to me’, and ‘What I value is under threat’. The ABQ comprises 36 items assessing common behavioural responses to anger, including rumination, suppression, hypervigilance, aggressive expression, and avoidance, with items such as ‘I go over and over what I could have done differently’, ‘I withdraw from friends and family’, and ‘I do something to make someone else feel bad’. The ARMS comprises 11 items assessing positive beliefs about anger, such as ‘Anger is useful to change other people’s behaviour’, ‘Anger shows I am serious’, ‘Anger is acceptable when calm words are not enough,’ and ‘Anger helps you to focus’. All items are rated on a 7-point scale from 1 (totally disagree) to 7 (totally agree), with higher scores indicating greater agreement.
Exploratory and confirmatory factor analyses examined the factor structure of the new measures, and correlations with established measures examined their convergent validity. Hierarchical regression analyses examined whether the cognitive and behavioural processes measured by the new questionnaires predicted anger over and above PTSD symptom severity. The study was approved by the Departments of Defence and Veterans’ Affairs Human Research Ethics Committee (protocol number: 659-25).
Results: As expected, problematic anger was highly correlated with PTSD symptom severity. Anger-related cognitions, behaviours and metacognitions explained significant additional variance in problematic anger over and above PTSD symptom severity, with moderate unique associations for hostile perceptions of other people (ACI) rumination and avoidance (ABQ) and positive beliefs about the usefulness and social acceptability of anger (ARMS). The factor structure of the ACI, ABQ, and ARMS, their psychometric properties, and short-form versions derived from the factor analyses will be presented.
Conclusions: Cognitive and behavioural processes are distinctly associated with problematic anger in military personnel, consistent with a maintaining role, and represent promising targets for treatment.
Note: The opinions expressed in this abstract are that of the authors/presenters, and not of the Department of Defence.
Connections and Divergence: Medics and the Century of Warfare
Dr Kristina Griffin1
1Charles Sturt University, Australia
Biography:
Dr Kristina Griffin an experienced academic who has extensive experience in nursing and healthcare both nationally and internationally. Her focus on education and leadership in public, private and Australian Defence force settings have given Dr Griffin a comprehensive understanding of the healthcare needs of a variety of unique populations and the education requirements vital for those caring for them.
Dr Griffin is also an active member of the Australian Health Practitioner Regulation Agency, and the Australian College of Nursing. These industry, leadership and regulatory bodies are responsible for driving change in healthcare, nursing, and education. Her active involvement in these professional networks ensures she contributes to dialogue and initiatives within the nursing and healthcare education landscape.
Dr Griffin has extensive research interests that include mental health nursing and rural workforce, with a special focus on frontline workers and diverse populations.
The service of an Army medic is a dual role, requiring a commitment both to warfare, and to healing. The self-representations and reflections of army medics are important to social history. To research this, the records of Australian stretcher-bearers during World War One, and combat medics during the contemporary military conflicts in the Middle East, are contrasted. Separated by a century, they have significant commonality as the need to treat and remove wounded from battle to preserve the fighting force is as old as war itself. With dual roles of soldier and healer, they are responsible for both supporting armed conflict and the saving of lives. This duality appears as an irreconcilable psychological burden and an unrepresented aspect of military history. The impact on the people whose stories are reflected in this research is explored, both in the immediacy of events and on reflection, contextualised within historical narrative.
A comparative study of the specialised role of medical assistant in the Royal Australian Army Medical Corps (RAAMC), in World War One (WW1), and the contemporary military interventions in the Middle East, shows the unique features of this form of military service. The Australian Army Medic, or medical assistant, has worked to save lives on battlefields, humanitarian missions, and peacekeeping operations, for over one hundred years. Their service has the dual roles of soldier and healer. Themes such as idealism, ambiguity, trauma and self-scrutiny mark the experience of this liminal role. Contemporary serving medics, who have deployed to conflicts such as Iraq and Afghanistan in the Middle Eastern Area of Operations (MEAO) have key features in common with their forebears, the stretcher bearers of WWI. Those who treat the wounded on the battlefield support victory by saving lives, and also by preserving morale with the assurance that, if wounded, another will risk their life to save them. The history of medical services in military institutions has documented the role of trained medics in supporting combat. This article considers not what medic services meant to the war, but what war meant to the medic. Utilising unpublished letters and diaries from the stretcher bearers, and interviews with current serving army medics, this research explores their unique standpoint, contextualised by the individual narratives.
The duality of the role of the medic as both a soldier in the field, with a duty to support armed conflict, and also in saving lives through clinical care, creates a psychological burden of multiple sets of responsibilities. The primary sources used to analyse the WWI experience relate only to their experiences during the war, but do not directly inform of their post war situation, unlike the interviews which inform both. Despite this, comparative analysis is possible and extremely revealing regarding the convergence of their experiences which are decades apart.
Curate, Understand, Empower: The CUE Framework for Suicidality Surveillance in the Australian Army
Dr Samantha Hodges1,2
1Australian Army, Australia, 2University of Queensland, Australia
Biography:
LTCOL Hodges is a senior military psychologist with 20 years experience providing clinical care and specialist command support within training, operational, joint, and whole of government environments. She holds a Bachelor of Psychology (Honours), a Masters of Clinical Psychology, a Graduate Certificate in Global Health, and a Doctorate of Philosophy. LTCOL Hodges has authored multiple peer reviewed papers, presented at various international mental health conferences, and sits on the peer review panel for a number of Australian and international research journals. Her current areas of research interest include public health surveillance systems, suicidality, and stakeholder integration.
Despite continued efforts and prioritisation, suicidality in military populations globally remains a prominent concern. In Australia, the Royal Commission into Defence and Veteran Suicide highlighted the need to improve the surveillance of suicidality in the serving and veteran ADF community, in order to improve prevention and care strategies. The author presents a proposed framework for effective and culturally competent suicidality surveillance in the Australian Army, drawn from mixed methods research including a quantitative sample of 2,346 suicidality events and in depth stakeholder interviews.
The presentation illuminates the complex, dynamic, and culturally bound ecosystem in which military suicidality surveillance is required to operate. Stigma, fear of negative career consequences, public scrutiny, and other barriers to help seeking must be navigated, and unravelling this complexity pulls the purpose of the system in different directions, raising questions of priorities, privacy, and utility. Despite these challenges, the findings suggest that effective and culturally competent suicidality surveillance is achievable, and may make important contributions to the prevention and management of suicidality both in the Army and other military and industry populations.
Dental Readiness, Combat Effectiveness: The Importance of Dental Readiness in Army Force Modernisation Objectives
LTCOL Thomas Briggs1
1Australian Army, Brisbane , Australia
Biography:
Dr Thomas Briggs completed his Bachelor of Dental Surgery at James Cook University as part of the inaugural graduating cohort in 2013. Following his undergraduate training, Tom took up a scholarship with the Australian Army and served as a General Dentist in the Australian Army from 2014 to 2019. He later pursued specialist training in Periodontology at the University of Queensland, graduating in 2022.
Dr Briggs has maintained a distinguished military career and currently serves as a Lieutenant Colonel, overseeing all dental services across Queensland for the Australian Defence Force. He also practices as a specialist clinical consultant at Gallipoli Barracks, Enoggera, and RAAF Base Amberley, providing advanced periodontal care to Defence personnel.
In addition to his clinical and military roles, Dr Briggs is an Adjunct Lecturer at the University of Queensland. He is an active member of several professional organisations, including ASP, ANZAP, ITI, AOS, and the Royal Australasian College of Dental Surgeons. He is a Fellow of the Pierre Fauchard Academy and the International College of Dentists, and an Associate Fellow of the Australian College of Health Service Management.
Outside of work, he enjoys spending time with his wife, Tiana, and their son, Bodhi.
LTCOL Thomas Briggs, RDA QLD, Joint Health Command (ADF)
Background
Dental morbidity remains a persistent contributor to non-battle casualties, directly impacting deployability, operational capability, and sustainment of the force. In modern and increasingly distributed operating environments, preventable dental conditions can result in avoidable evacuation, loss of combat power, and disruption to operational tempo. Ensuring personnel are dentally fit is therefore fundamental to maintaining readiness and resilience.
Recent insights, including Thietten (2026) Ukrainian Dental Readiness Update, reinforce the operational necessity of reducing dental casualties through proactive and preventative health measures.
Concept
This presentation outlines recent updates to the ADF dental fitness framework in DHM Level 2 Part 11 Chapter 1, designed to strengthen force health protection and align with ADF Modernisation objectives. Central to these reforms is the transition from a risk-based Periodic Dental Examination (6–24 months) to a mandatory annual examination, improving consistency in surveillance and early intervention.
Important changes to the Dental Fitness Classification (DFC) system are also introduced, including refinement of DFC 1–3 categories, the cessation of DFC R, and the introduction of DFC 0, representing personnel with unknown dental risk status. This is particularly relevant to the reserve workforce and reflects the realities of the Total Workforce Model, where not all members have routine access to ADF dental services.
These updates enhance alignment with NATO standards and contemporary preventive care principles while supporting a more proactive, capability-focused model of care.
Conclusion
By reducing the risk of dental casualties and enabling earlier intervention, these policy changes reinforce dental readiness as a force multiplier—ensuring personnel remain “Oral Ready. Combat Capable.” This presentation will inform commanders and clinicians of the operational implications and their role in embedding these changes to sustain combat capability.
‘Digger Spirituality’ and the Sophistry of the Irreligious Australian Defence Force Veteran
Dr Murray Davies1
1Wounded Spirit, Canberra, Australia
Biography:
Dr Murray Davies is the CSO of the veterans charity Wounde Spirit. Wounded Spirit helps veterans who have experienced spiritual damage resulting from military service. A former Australian Army Lieutenant Colonel, Murray is a graduate of the Royal Military College and Australian Army Staff College. Murray’s PhD from the University of Divinity was on ‘The Influence of Spiritual Wounds and Injuries on Australian Defence Force Veterans.’ Additionally, Murray holds a Master’s in Theology, Defence and Internal Relations, a Graduate Diploma in Theology and a Bachelor of Arts (Honours).
There is a popular image of the Australian Defence Force (ADF) member that is often aired on television during ANZAC and Remembrance Days. It is summarised by Gammage’s almost throwaway comment that apparently the average Australian [soldier] was not religious during the Great War (Gammage, 1990, xv). Robert Linden takes this a little further by saying that they were “Rough, hard-bitten, cynical, worldly, irreligious, irrepressible, womanising, gambling, independent-minded hell-raiser(s)” (Lindler 2000, p. 29). The current Australian Bureau of Statistics (ABS) and ADF statistics on religious affiliation would certainly seem to confirm this assumption. Almost 40% of the Australian population reports no religious affiliation (ABS, 2004). At 64%, Defence’s non-affiliation rate exceeds the national average (Hoglin, 2023).
While the popular image of the irreligious soldier may be true in part, it does not mean that Australian Defence personnel and veterans are not spiritually guided, aligned, and attuned. This is particularly evident when following Defence’s definition of spirituality. Likewise, evidence gathered across the spectrum of 20th- and 21st-Century Australian conflicts argues for a much deeper and more pervasive sense of faith unique to Australian Service personnel, which I define as Digger Spirituality. This is a human spirituality that goes beyond the bounds of religious observance and conviction. If an individual has such a sense of spirituality that inspires meaning and purpose, it can be injured and wounded by traumatic events that have been defined as Spiritual Wounds and Injuries (SW&I).
Diving under pressure – when dive trainees present late, is it always a problem?
Dr Aaron Tracey1
1ADF, Perth, Australia
Biography:
LTCOL Aaron Tracey is an Army Medical Officer and holds a Fellowship of the Royal Australian College of General Practitioners and a Masters in Traumatology. He has been posted to pre-hospital and Senior Medical Officer positions since 2016, with training and experience in aspects of remote and austere, occupational, aviation, and diving medicine.
Delayed presentation is not uncommon in civilian diving medicine, due to a myriad of factors. These have been attributed to limited knowledge, poor medical support, and mild symptom severity, amongst other factors.
These factors should be mitigated in the military setting due to structured training, strict adherence to dive tables, robust policy and guidelines, and increased oversight, but military dive trainees also exhibit delayed presentation on occasion.
Military dive trainees have strong incentives to minimise symptoms and delay presentation despite the potential significant personal consequences. The tight schedules of dive training and pressure to keep up with the course to avoid removal from training may play a role.
This presentation will outline a number of case studies of delayed presentation with concerning symptoms and potentially serious pathology.
This prompts the question as to whether further research into dive trainee attitudes to dive related injuries and illnesses should be conducted, and whether current diver health training and course design are effective in encouraging divers to seek care when indicated.
Early insights into the VETS Act
Dr Fletcher Davies
1Department Of Veterans’ Affairs, , Australia
Biography:
Dr Fletcher Davies completed his medical degree at the University of Adelaide and spent the next 15 years working in acute hospital medical throughout South Australia and Victoria. After completing Masters Degrees in both Public Health and Healthcare Management, he joined the Department of Veterans’ Affairs (DVA) in 2013. While at DVA, he has contributed to the design of the current claims processing IT system, rationalisation of provider-facing paperwork, the development of a governance framework for clinical advisers, and the implementation of an assertive case management program for vulnerable veterans. He has been in the role of Principal Medical Adviser, Compensation since 2019.
The Veterans’ Entitlements, Treatment, and Support (VETS) Act was implemented on 1 July 2026. From this date, all new claims have been considered under an improved MRCA. The move to a single Act provides a chance to simplify and speed up claims processing. Significant changes include the introduction of provisional liability, coverage for all ‘on-duty’ injuries, simplified date of effect determination, expanded gold-card eligibility, and a streamlined review pathway. Challenges exist in managing ‘grandfathered’ and transitional arrangements, conversion of historic DRCA assessments, and optimising service periods for presumptive acceptance. This presentation will discuss the impact of these changes on both veterans and their healthcare providers, and early learnings following transition to a single Act. It will also highlight the future opportunities that these changes will create to reframe the Compensation process as one which better promotes recovery, good health, and overall wellbeing, rather than focussing on illness.
Enhancing Forward Medical Support through Drone-Enabled Blood Logistics
Amany Wahba1, Dr Joni Sytsma2
1Saab Australia Pty Ltd, Australia, 2Outer Loop Engineering, Australia
Biography:
Dr. Joni Sytsma is an experienced aerospace engineer and innovative leader who transitioned from the USA to become an Australian citizen in 2022. With a Ph.D. in Aerospace Engineering, her 18+ year career includes significant contributions at the United States Air Force Research Laboratory, where she developed early weaponized drone systems and worked on hypersonics. In Australia, Joni has held key technology leadership roles at Gilmour Space Technologies, developing software for space rockets, and at the counter-drone company Department 13. Currently, she serves as CEO of Outer Loop Engineering, spearheading technological advancements for upcoming drone projects. Joni is also a strong advocate for diversity in aerospace and the application of advanced manufacturing techniques.
At AMMA 2025, our consortium presented the case for ultra-rapid medical resupply at the Point of Injury (POI) using a high-speed, electrically propelled drone, with a vision of 72-second transit to a 5 km POI. Twelve months on, that concept is a flight-validated system, and the path to first operational trials with the Australian Defence Force is set for late 2026. Pre-prepared payloads ready for immediate transit via the AEROMed platform could include blood, medical equipment, pharmaceuticals and other consumables. Coupled with a solution for managing payloads in preparation for rapid delivery, this drone provides medical logistics planners with a means of transporting time-critical, temperature-sensitive medical supplies forwards of Role 1 and Role 2 healthcare facilities.
This presentation reports on the technical, operational, and regulatory progress that has transformed the AEROMed platform from prototype to deployable capability. Over the past year, Rocket Fast Drones (RFD), the productisation arm of Outer Loop Engineering, has in partnership with Saab Australia, completed validated full mission profiles including vertical take-off, forward and back transition between vertical and fixed-wing flight, demonstrated sustained dash speeds consistent with the original 72-second / 5 km mission profile, and proven the predictive accuracy of the simulator-to-flight pipeline against real airframes in 20+ knot winds. Saab Australia, through its Deployable Health Capability Support Centre, has matured the temperature-managed payload architecture for whole blood and pharmaceutical delivery. RFD now operates under a CASA Remote Operator’s Certificate (ReOC) authorising operations of larger drone platforms, removing the regulatory ceiling that constrained last year’s flight programme.
The presentation will share validated performance data on the AEROMed platform: dash speed, range envelope, payload mass and thermal performance, wind tolerance, and reliability across multiple airframes and flight cycles. We will discuss the availability of first AEROMed trial units to ADF. We will close with an honest assessment of the engineering and procurement work that remains between flight-proven capability and POI-resupply in a deployed setting, including the work required to push the range and speed envelopes.
The presenters propose to bring flight-ready airframes to the conference and present the concept at a pre-conference workshop. A static display of operational hardware is committed.
To our knowledge, this is the first presentation within the Australasian military medicine community of a sovereign-developed, electrically propelled, tube-launched high-speed medical resupply drone will be presented with flight-validated performance data and a confirmed pathway into ADF user trials. The Golden Hour, for the casualty in the most isolated position on the battlefield, is finally engineerable as a logistics problem with hardware to match.
Ethical Conflicts and Moral Injury in Australian Defence Force Medics: Exploring challenges faced by military healthcare professionals
Dr Kristina Griffin1
1Charles Sturt University, Australia
Biography:
Dr Kristina Griffin an experienced academic who has extensive experience in nursing and healthcare both nationally and internationally. Her focus on education and leadership in public, private and Australian Defence force settings have given Dr Griffin a comprehensive understanding of the healthcare needs of a variety of unique populations and the education requirements vital for those caring for them.
Dr Griffin is also an active member of the Australian Health Practitioner Regulation Agency, and the Australian College of Nursing. These industry, leadership and regulatory bodies are responsible for driving change in healthcare, nursing, and education. Her active involvement in these professional networks ensures she contributes to dialogue and initiatives within the nursing and healthcare education landscape.
Dr Griffin has extensive research interests that include mental health nursing and rural workforce, with a special focus on frontline workers and diverse populations.
Background: Australian Military medics, who are both professional soldiers and qualified nurses, can face situations where their training and moral ethos conflict in the performance of duty. Their role has intrinsic duality. They are both a soldier, thus a member of a military organisation, as well as well as a healer, a nurse with a corresponding duty of care. Both roles have ethical, legal and professional responsibilities, codes of conduct and moral codes. They are therefore guided by nursing codes of ethics and professional conduct which provides a framework for patient care and professional decision making. These may rival military objectives and orders of battle, leading to a disaccord for the person involved and result in a moral dilemma. Both also are roles which have strong cultural images and distinct expectations from individuals and those around them. This can lead to moral dilemmas, moral injury and long-term psychological illness. In the 2024 Royal Commission into Defence and Veteran Suicide in Australia, moral injury was cited as a relatively new, but not widely acknowledged, risk factor that may lead to suicide.
In the context of defence, moral injury can be described as being experienced by a person who participates in, or witnesses, actions that go against their moral code or moral beliefs. Exposure to traumatising events on operational deployments, both war-like and non-combat, leads to psychological distress. Moral distress triggers emotions of shame and guilt and is not well understood or documented. It has been described as a ‘wounding of the soul, of doing something or witnessing something really wrong’. It manifests as anxiety, depression, self-harm and suicidal thoughts and intent. The risk of such harmful outcomes is increased and exacerbated through the role duality of the Australian Army medic.
Research Design: The research presented is a study into the role duality of the Australian Army medic in warzones. It focuses on interviews from twelve Australian Army medics who have deployed overseas in recent conflicts with the research question: How does the intrinsic duality and resultant ethical conflicts of the role of the medic impact the individual performing this specialised role?
Force Health Protection: Closing a critical gap in ADF health capability
Dr Madeleine Marsland1, Colonel Peta Mantel AM2
1Department of Defence, Australia
2Australian Army, Canberra, Australia
Biography
Colonel Peta Mantel AM is an infectious disease epidemiologist and senior health security leader with over 30 years’ experience across public health, medical intelligence, pandemic preparedness and health diplomacy. She has worked as a senior environmental health officer for the United Nations in Timor Leste and the Peace Monitoring Group in Bougainville, Papua New Guinea. She has also deployed as the Deputy Chief Inspector of the biological weapons inspection team in Iraq in 1998 as part of the United Nations Special Commission on Iraq. Over the past decade she has focused on infectious disease threats to deployed personnel and has led the health intelligence support to Government. In 2020, she was seconded to the Commonwealth Department of Health to lead the COVID-19 epidemiology team in the National Incident Room. She currently serves as Defence’s representative on Australia’s Human Animal Spillover and Emerging Diseases Scanning Group. She holds a Master of National Security and Strategy, a Master of Clinical Epidemiology with Merit, a Master of Applied Science (Environmental Health), and a Bachelor of Science. In 2021, she was appointed a Member of the Order of Australia for services to medical intelligence, epidemiology and health leadership.
Aim
This presentation describes the development of the Australian Defence Force’s (ADF) strategic Force Health Protection (FHP) capability, highlighting key achievements in its first year of operation, and outlines future priorities. The Directorate of Force Health Protection (DFHP) represents an integrated and interoperable public health capability aligned with Australian state and territory civilian systems and Five Eyes partners, designed to enhance force readiness, generation and preservation.
Background
FHP in the ADF is defined as the measures taken to promote, improve, conserve and restore the physical and mental health of personnel to preserve and strengthen operational readiness. Historically, the ADF has lacked a dedicated, centralised public health capability, limiting its ability to systematically anticipate, analyse, and mitigate population-level health risks. This gap has constrained proactive risk management in key areas such as injury prevention, communicable disease control, and environmental health. The establishment of DFHP enhances our capability and aligns the ADF with comparable international military approaches and the Australian civilian public health sector.
Methods
DFHP has been structured across four core teams: Health Surveillance, Communicable Disease Control, Musculoskeletal Injury Prevention, and Environmental Health. The Directorate is staffed by a multidisciplinary and scalable workforce comprising ADF personnel, Australian Public Service staff, reservists, and contracted specialists. This workforce brings combined expertise in epidemiology, public health, environmental health, injury prevention, and health promotion, enabling an integrated, evidence-based approach to force health protection.
Current priorities
A primary focus is the establishment of an ADF health surveillance capability to improve visibility of health trends and enable early identification of risks to the health of the force. While elements of health surveillance have historically existed across the ADF, this capability aims to centralise, coordinate, and enhance these activities into a more systematic and routine function. The surveillance system is intended to be adaptable, scalable, and interoperable.
DFHP also recognises prevention as a critical component of combat power and force readiness. A new health promotion and communications program is being developed to provide a dedicated platform for educational resources and engagement activities aimed at supporting personnel and commanders to optimise health and readiness. Together, these initiatives represent an integrated approach to understanding, managing, and mitigating health risks across the force.
Future priorities
Ongoing priorities include enhancing evidence-informed decision-making, supporting operational readiness, and delivering targeted prevention programs that improve baseline health across the force. Continued capability maturation will focus on meeting stakeholder needs and addressing persistent drivers of attrition and reduced employability and deployability.
Conclusion
DFHP is rapidly maturing into a doctrine-aligned, fully staffed, and interoperable capability that addresses a longstanding gap in the ADF health system. Through the implementation of robust surveillance systems, a strong emphasis on prevention, and alignment with civilian and international partners, DFHP is delivering an integrated public health function that enhances force readiness, resilience, and operational effectiveness in increasingly complex environments.
The opinions expressed in this presentation are that of the authors and not the Department of Defence.
From Demystification to Capability: Reframing Independent Medical Examinations in Military and Veteran Health
Dr Richard Magtengaard, Dr Charles Phillis
1mlcoa
Biography:
Dr Richard Magtengaard is a Consultant Psychiatrist and CMO with extensive experience in trauma-informed care, including complex trauma, PTSD, anxiety disorders, and co-occurring physical health conditions. His clinical background spans adult, child, rural, consultation liaison, and old-age psychiatry, providing him with broad expertise in managing diverse and complex presentations.
He provides independent psychiatric assessments and has consolidated experience in Department of Veterans’ Affairs (DVA) impairment and compensation assessments, including IL, PI, and ARETRO matters.
Additionally, Dr Magtengaard brings significant leadership and governance experience, contributing to multidisciplinary team development, service planning, and clinical governance. He has been actively involved in advisory and board roles, supporting the development of veteran mental health services at both organisational and national levels.
Dr Charles Phillis is a Consultant Chief Medical Officer, Certified Health Manager and Occupational Medical Practitioner who formerly consulted as Contracted Rehabilitation & Compensation Medical Advisor to the Department of Veterans’ Affairs, and as a DMA Government Contracted Doctor for Services Australia (formerly the Department of Human Services). Dr Phillis is an experienced Certified Impairment Rater, skilled in the provision of permanent impairment assessments. Dr Phillis has considerable experience in Health Leadership/Medical Administration and provides Chief Medical Officer Consultancy services pertaining to Health Management, Clinical Governance, Risk, Digital Health and Clinical strategy. Dr Phillis is a Designated Aviation Medical Examiner and Medical Review Officer (AMROA) in active clinical occupational medicine practice.
Independent Medical Examinations (IMEs) sit at the intersection of clinical assessment, medicolegal opinion, and organisational decision-making. Within military and veteran health, they are often experienced as complex, high-stakes assessments requiring clinicians to navigate diagnosis, causation, functional impairment, and prognosis, while maintaining objectivity and professional integrity. At the same time, IMEs are frequently constrained by a narrow focus on compensation and liability, limiting their broader potential to support recovery, rehabilitation, and workforce readiness.
This dual-presenter session offers an integrated and practical reframing of IME practice, combining contemporary psychiatric formulation with governance-driven approaches drawn from high-risk industries. Together, the presenters demonstrate how IMEs can evolve from being retrospective instruments of adjudication into forward-looking tools that enhance both individual recovery and organisational capability.
Dr Richard Magtengaard introduces a structured clinical framework that integrates Megan Fry’s Military Mode Model and the emerging concept of moral injury into psychiatric IME practice. These models provide a clinically grounded way to understand how military culture, identity, and operational conditioning shape symptom presentation, behaviour, and functional capacity. Through case-based examples, this framework assists clinicians in distinguishing adaptive military responses from psychiatric disorder, strengthening diagnostic formulation and improving clarity in opinions regarding causation, permanence, and impairment. Emphasis is placed on delivering assessments that are trauma-informed, clinically rigorous, and suitable for medicolegal contexts.
Building on this foundation, Dr Charles Phillis expands the role of the IME beyond diagnosis and impairment into a strategic decision-support function. Drawing on governance-led IME models from sectors such as emergency services, mining, and workers’ compensation, the session explores how quality assurance systems, standardised methodologies, clinician selection, and expert peer review enhance the reliability and defensibility of medical opinions. These principles are reframed for a military audience through parallels with Command and Control structures, ensuring the right expertise, processes, and information support effective decision-making and mission outcomes. In this context, mlcoa is reinterpreted as an evidence-informed pathway that supports recovery, functional restoration, and sustained operational contribution.
The session highlights how integrating contemporary psychiatric insight with robust IME governance enables more meaningful, consistent, and actionable assessments. It also reinforces that effective IMEs should not simply describe impairment but actively contribute to rehabilitation planning, safe return to work, and long-term workforce capability.
Attendees will gain practical strategies to:
- Conduct structured, clinically robust, and defensible IMEs in military and veteran populations
- Incorporate Military Mode and moral injury into diagnostic formulation and opinion writing
- Improve confidence in assessing causation, functional impairment, and prognosis
- Apply governance frameworks that enhance quality, consistency, and interoperability
- Use IMEs as tools to support rehabilitation, recovery, and workforce readiness
As military medicine continues to evolve, there is a growing need for assessment approaches that reflect both the complexity of service-related experiences and the operational demands of modern defence organisations. This session provides attendees with practical, transferable tools to enhance both the clinical quality and strategic value of IMEs.
From Pilot to Practice: The Evolution of IMPACT
Dr Alan Turner1
1Royal Australian Air Force, Newcastle, Australia
Biography:
Wing Commander Alan Turner, OAM is an Emergency Physician, Royal Australian Air Force Medical Officer and the Principal Medical Instructor at 294 Squadron.
Alan has served in the Royal Australian Air Force for more than 30 years across permanent and reserve service. His clinical and professional interests include emergency medicine, retrieval medicine, aerospace medicine, military medical education, simulation, human performance and clinical readiness.
He is the founder and project lead for Integrated Medical high-Performance, high-Acuity Clinical Training (IMPACT), a high-acuity simulation and team training activity designed to prepare Defence healthcare personnel for operational clinical practice. He is also involved in the development of accredited in-house Advanced Life Support training for Defence clinicians through 294 Squadron’s collaboration with Resuscitation Australia.
In 2025, Alan was awarded a Winston Churchill Fellowship to investigate advances in simulation and scenario-based military medicine. In 2026, he was awarded the Medal of the Order of Australia for meritorious service in the development of health capability for the Royal Australian Air Force.
Integrated Medical high-Performance, high-Acuity Clinical Training (IMPACT) was initially developed as a proof-of-concept activity to address a recognised clinical readiness gap for Air Force clinicians. While civilian clinical placements and externally delivered civilian courses remain valuable, they cannot reliably provide exposure to the high-acuity, low-occurrence presentations, team dynamics and operational constraints most relevant to military healthcare. IMPACT was specifically designed to provide exposure to these scenarios through immersive, team-based simulation.
Since the pilot activity in April 2024, IMPACT has evolved substantially. What began as a resource-intensive, 10-day program has matured into a more sustainable 6-day model, allowing the activity to remain educationally rich while becoming more practical to deliver, staff and repeat. IMPACT has expanded beyond its original Air Force focus to include tri-service faculty and participants, engaged with specialist operational health elements and generated strong interest from at least one allied nation. Despite 294SQN now delivering four iterations per year, demand continues to grow and now outstrips available course capacity, reflecting both the relevance of the model and the broader appetite for high-quality, operationally contextualised clinical readiness training.
Participant feedback has consistently highlighted the value of IMPACT’s realistic scenarios, multidisciplinary team structure, psychologically safe learning environment and focus on non-technical factors such as clinical leadership, communication, decision-making and performance under pressure. The program has also provided an important faculty engagement and development platform, supporting the growth of a cadre of enthusiastic SERCAT 3-7 clinicians experienced in military simulation, debriefing and medical education.
The transition from ten to six days has improved sustainability considerably but has also required the removal or compression of several important clinical and operational topics from the core curriculum. The next phase of IMPACT development will therefore need to consider how these topics can be reintroduced or delivered through a modular or decentralised approach, while preserving the core philosophy of immersive, high-acuity, team-based training.
This presentation will review how far IMPACT has come, summarise key lessons from its evolution and outline options for the next phase of development. In the context of shifting geopolitical risk, interoperability requirements and the need for resilient healthcare teams, IMPACT offers a practical model for building clinical readiness deliberately rather than relying on opportunistic exposure alone.
From Valetudinaria to Role 2: Continuity and Evolution of Roman Military Medical Principles in Modern ADF Health Support
SQNLDR Ben James1
1RAAF, Amberley, Australia
Biography:
SQNLDR Ben James
With over 20 years of service as a Royal Australian Air Force (RAAF) nurse, James has built a career in military healthcare, combining operational experience with clinical expertise. He holds Bachelor degrees in Nursing and Science (Macromolecular and Cellular Biology), providing a strong foundation in both practical care and biomedical science.
James has deployed on operations to Afghanistan and across the Middle East Region, where he delivered care in austere and high-tempo environments. His experience includes participation in multiple Aeromedical Evacuation (AE) missions, supporting the safe transport of critically ill and injured personnel while maintaining high standards of in-flight clinical care.
A highlight of his professional development was being awarded Distinguished Graduate of the United States Air Force Flight Nurse Course, reflecting both his clinical excellence and leadership in aeromedical operations. Throughout his career, he has contributed to the advancement of military health capability and the training of others within Defence. He was also involved in bring the BlueRoom extended reality simulator to the Air Force.
Outside of his professional role, James is a self-described history enthusiast, with a particular interest in military history, reflecting a broader appreciation for the evolution of warfare and military medicine.
From Valetudinaria to Role 2: Continuity and Evolution of Roman Military Medical Principles in Modern ADF Health Support
Military medicine has evolved markedly from antiquity to the present, yet many underlying principles remain consistent. The Roman Army offers one of the earliest examples of an organised medical support system embedded within military operations, particularly in battlefield care and wound management. By comparison, the modern Australian Defence Force (ADF) employs a highly structured, doctrine-driven framework articulated in Land Warfare Doctrine Health Support to Operations and NATO Allied Joint Medical Support Doctrine (AJMedP-1). Although ADF health support reflects significant advances in technology and organisation, it can be understood as a scientific and doctrinal evolution of Roman practice, especially in battlefield care, evacuation, triage, preventive medicine, and wound management.
The Romans institutionalised healthcare through the integration of medici within units and the establishment of valetudinaria, early military hospitals designed for treatment, recovery, and return to duty. This system reflected a pragmatic recognition of health as a contributor to combat effectiveness. However, Roman methods were largely experiential rather than formally codified. In contrast, ADF health support operates along a structured Role 1–2 continuum, ensuring a seamless progression from point of injury to definitive care. This represents a shift from practical adaptation to standardised, doctrine-led capability.
Roman battlefield care shows notable parallels with modern Tactical Combat Casualty Care (TCCC). Medici prioritised early intervention, understanding that immediate treatment improved survival. Their wound care practices included haemorrhage control, removal of embedded weapons, and early debridement. They used substances such as honey, vinegar, and wine for cleaning wounds—materials now recognised for antimicrobial properties. Organic packing materials, including wool and even stale or mouldy bread, were used to absorb fluid and protect injuries. These empirical approaches closely resemble modern wound packing techniques using sterile gauze or haemostatic dressings and anticipate later antimicrobial developments.
Roman dressings were layered and practical, combining absorbent materials such as wool bandages, antiseptic agents like vinegar and wine, and protective substances including olive oil and honey. The use of spider webs to encourage clotting and cauterisation to control bleeding demonstrates an early, if rudimentary, approach to haemostasis. These methods have clear conceptual equivalents in modern damage control resuscitation, including haemostatic dressings, antiseptic irrigation, electrocautery, and advanced wound products. Despite lacking germ theory, Roman practices reveal an emerging understanding of infection control and post-treatment care.
Evacuation practices further illustrate continuity. Roman forces used stretcher-bearers and carts to remove casualties from the battlefield, recognising that prompt evacuation preserved life and morale. Modern ADF doctrine formalises this principle through integrated CASEVAC and MEDEVAC systems and emphasises rapid treatment timelines such as the “golden hour.” Similarly, Roman triage prioritised soldiers based on survivability and likelihood of returning to duty. While modern NATO triage systems are more systematic and ethically structured, they reflect the same utilitarian basis.
Preventive medicine also highlights enduring principles. Roman sanitation, camp design, and water management reduced disease and protected force strength. These observation-based practices underpin modern Force Health Protection, which now incorporates environmental health measures, hygiene, and epidemiology into operational planning. Although Roman methods lacked scientific explanation, their effectiveness prefigures modern preventive strategies.
Roman surgical capability, including debridement, amputation, and the use of specialised instruments, further demonstrates continuity. Though constrained by available technology, the emphasis on early intervention aligns with modern damage control surgery principles.
In sum, Roman military medicine established enduring foundations: early intervention, structured care, organised evacuation, pragmatic triage, and preventive health. The ADF refines these concepts through doctrine, scientific knowledge, and advanced technology. While tools and understanding have evolved, the fundamental aim—preserving life and sustaining combat power—remains unchanged.
Future Medical Force Design for Evacuation-Denied, Drone-Dominated Warfare: The Role of SABRE Teams
Professor Mansoor Khan1, Mr Jonathan Kendrew
1Iqarus Gulf Fz Llc, , United Arab Emirates
Biography:
Professor Mansoor Khan is a trauma and humanitarian conflict surgeon whose career spans frontline medicine, executive leadership, entrepreneurship, and investment. His work uniquely bridges the high-stakes precision of the operating theatre with the strategic demands of global organisations, reflecting a rare ability to lead across both clinical and corporate arenas.
Internationally recognised in the surgical field, Professor Khan has extensive experience in trauma care, complex surgical environments, and austere humanitarian settings. He currently serves as Regional Medical Director at Iqarus, where he provides clinical leadership and operational oversight across diverse regions. In this role, he is responsible for ensuring the delivery of high-quality medical services in challenging environments, guiding multidisciplinary teams, shaping clinical governance frameworks, and aligning medical operations with broader organisational strategy.
His career is defined by adaptability, disciplined execution, and a deep commitment to impact. Whether advancing surgical care in high-risk settings, leading regional medical operations, advising ventures, or investing in innovative projects, he brings a consistent philosophy: innovation grounded in experience, empathy informed by service, and an uncompromising pursuit of excellence.
His work is marked by measurable outcomes and transformative influence, establishing him as a trusted leader and multidisciplinary professional with a truly global perspective.
Modern near-peer conflict is rapidly reshaping the feasibility of casualty evacuation. Persistent drone surveillance, precision strike capability, and electronic warfare are rendering traditional air, ground, and rail evacuation pathways unreliable or untenable early in conflict. Emerging evacuation modalities, including UAV-assisted extraction and autonomous platforms, are likely to provide only transient advantage before adversary countermeasures neutralize them. In this environment, evacuation denial must be considered a predictable operational constant rather than a contingency.
This paradigm shift necessitates a fundamental redesign of military medical systems, prioritizing forward-deployed, mobile surgical capability over reliance on rear-echelon facilities. We propose the Surgical Austere Battlefield Resuscitation and Extraction (SABRE) Team as the foundational unit for future force design. This four-person team, comprising a surgeon, an anaesthetist, and two highly trained combat medical practitioners, is optimized for mobility, low signature, and independent operation within contested environments.
SABRE Teams are designed to deliver rapid hemorrhage control, vascular stabilization, and extremity trauma management at or near the point of injury, while maintaining the capacity for prolonged field care in the absence of timely evacuation. Their small footprint enables dispersion across the battlespace, enhancing survivability and system resilience compared to traditional, centralized medical nodes. This distributed architecture mitigates the risk of catastrophic system failure and ensures continuous clinical reach despite dynamic threat conditions.
While opportunistic integration with evacuation assets remains essential, SABRE Teams are structured to operate under the assumption of delayed or absent extraction. This requires expanded competencies in prolonged care, physiological optimization, and autonomous clinical decision-making within tactically constrained environments.
The adoption of SABRE Teams aligns medical capability with operational reality, preserving the ethical imperative to deliver timely, life-saving intervention in evacuation-denied settings. Embedding these teams within maneuver elements and designing force structures around mobility, dispersal, and survivability will be critical to maintaining combat casualty survival in future warfare.
Governance in Complex Systems – The Power of Being Wrong
LTCOL Tara Miller1
1Department Of Defence, Australia
LTCOL Miller is a South Australian Army officer with 20 years of service, currently Deputy Director Governance in Defence Mental Health and Wellbeing. She leads the governance framework supporting delivery of the Defence and Veteran Mental Health and Wellbeing Strategy 2025–2030, the first interdepartmental strategy co-designed with the Department of Veterans’ Affairs.
Her interests include international relations, health, people policy, women’s leadership, and logistics. She has deployed multiple times to the Middle East, coordinating regional pharmaceutical supply and delivering clinical care to Australian and coalition personnel. In 2024, she was one of two Australians selected for the Senior Defence Officials Course in Vietnam, strengthening her regional awareness and cultural sensitivity. As Operations Officer, 3rd Health Support Battalion, she coordinated Army Reserve health support during the 2019–2020 bushfires and COVID-19 response.
LTCOL Miller began her career as a Pharmaceutical Officer and has served in diverse roles including Recruiting Officer, Training Officer, Officer Commanding, and Operations Officer. Her civilian career spans pharmacy, logistics, procurement, and consulting, alongside running a small business.
She holds a Bachelor of Pharmacy and a Bachelor of Organisational Leadership, and enjoys family life, coaching netball, reading, and creative pursuits.
We often celebrate confidence, certainty and expertise. Leaders are expected to have answers, professionals are expected to apply best practice, and organisations are expected to demonstrate results. Yet many of the most significant advances in health, science and public policy have occurred because individuals and institutions were willing to challenge accepted wisdom and change course when new evidence emerged.
This presentation explores what happens when governance meets complexity. Drawing on the Cynefin framework, it examines the difference between clear, complicated and complex systems, and why approaches that work effectively in predictable environments can fail when cause and effect are only understood in hindsight. While many governance systems are designed around planning, prediction and control, some of the most important challenges facing modern organisations exist in environments characterised by uncertainty, emergence and constant change.
Through a series of engaging case studies, the presentation explores how evidence evolves and why our understanding of “best practice” is often temporary rather than permanent. The changing role of aspirin in cardiovascular disease prevention provides a powerful example of a healthcare system willing to revise decades of accepted practice as new evidence emerged. Similarly, the dramatic reduction in crime observed in New York during the 1990s continues to generate debate. Was it policing reform, demographic change, economic factors, family planning policies, the removal of lead from fuel, or a combination of all of these? Decades later, experts continue to disagree. These examples highlight a common challenge in complex systems: outcomes rarely have a single cause, and certainty is often far less attainable than we would like to believe.
The discussion then turns to contemporary health and wellbeing challenges. Whether addressing workforce wellbeing, mental health, safety culture or organisational performance, leaders are frequently asked to demonstrate impact and prove that a particular intervention caused a particular outcome. Yet these outcomes are often shaped by a complex interaction of leadership behaviours, organisational culture, workload, social influences, individual circumstances, policy settings and external factors. In such environments, simplistic measures of success and linear assumptions about causation can create an illusion of certainty that exceeds what the evidence can genuinely support.
Rather than viewing uncertainty as a weakness to be eliminated, this presentation argues that adaptive leadership is a critical governance capability. The willingness to question assumptions, update beliefs, test new approaches and respond to emerging evidence is not a failure of expertise – it is the foundation of learning, innovation and continuous improvement. Organisations that become overly attached to certainty risk defending outdated assumptions long after the evidence has changed. Those that remain curious, reflective and adaptable are better positioned to navigate complexity and achieve meaningful outcomes.
Combining insights from governance, healthcare, behavioural science and public policy, this session challenges participants to rethink how they approach evidence, decision-making and accountability in complex systems. It offers practical reflections on governing in environments where attribution is difficult, unintended consequences are common and learning may be more valuable than certainty.
In a world of increasing complexity, the organisations most likely to succeed may not be those that are always right. They may be those that recognise they are wrong sooner, learn faster than their environment is changing, and have the courage to adapt accordingly.
Growing beyond trauma. Promoting posttraumatic growth literacy and skills in workgroups exposed to traumatic events
Ms Jennifer Wheeler1
1Department of Defence, Australia
Biography:
Jennifer Wheeler is a registered psychologist and experienced manager, who has worked in the Australian Public Service for over two decades. For thirteen years, Jennifer held the role of Director Navy Psychology in the Department of Defence. In this role, Jennifer managed and oversaw the delivery of psychology services in Navy, in addition to the development and implementation of mental health policy, strategic plans and programs. Jennifer provided high-level contribution and advice to the Royal Commission into Defence and Veterans Suicides, including being a Commonwealth expert witness on two occasions.
Jennifer was selected for the Sir Roland Wilson Foundation scholarship in February 2023 to complete her Australian National University PhD program in posttraumatic growth. Jennifer’s PhD program is focused on measuring and promoting posttraumatic growth literacy and skills in workgroups with trauma-exposed roles. Jennifer completed the Sir Roland Wilson scholarship on secondment from the Department of Defence.
Workgroups, such as the military, emergency service personnel and healthcare workers, can be exposed to potentially traumatic events through their work roles. Historically, research has focused on the development of mental disorders following exposure to a traumatic event. Focusing on a pathogenic framework following a traumatic event, however, may not fully capture or reflect an individual’s experience or functioning post-trauma. A growing body of research has demonstrated that some trauma survivors can experience positive psychological changes following a traumatic event. Positive adaption following a traumatic event has been termed posttraumatic growth (PTG).
A key reason for increasing awareness of, and promoting PTG, are the mental health and wellbeing outcomes which are attributed to growth. Over the longer-term, PTG has been shown to lessen the likelihood of trauma-related mental health problems and can lead to a higher satisfaction with life. Research has found PTG can also offer strong protective elements, including a reduction in suicidal ideation. Research is increasing understandings of how an individual can grow and transform following a traumatic event. This work includes developing programs to promote PTG, following exposure to a traumatic event.
This presentation will detail a research study that systematically developed and evaluated a proactive-focused PTG psychoeducation and skills training program, titled PTG through Education, Growth mindset and Emotion regulation (PTG-EdGE), within a military population. The PTG-EdGE program aims to increase participants’ PTG literacy and confidence in five skills, that have been demonstrated to promote growth.
A pragmatic controlled trial of the pilot PTG program was conducted in a sample of 329 Australian Defence Force Academy (ADFA) Officer Trainees. Principal findings from the evaluation will be presented, including program acceptability and changes in participants’ PTG literacy and confidence using in five skills at three measurement occasions: baseline, post-test and 10-weeks follow-up. Finally, this presentation will discuss key PTG considerations for mental health practitioners who support workgroups exposed to traumatic events.
Healing Ties or Strategic Lies – Measuring the Effectiveness of Health Diplomacy.
MS Peta Mantel1
1Australian Army, Canberra, Australia
Biography:
Colonel Peta Mantel AM is an infectious disease epidemiologist and senior health security leader with over 30 years’ experience across public health, medical intelligence, pandemic preparedness and health diplomacy. She has worked as a senior environmental health officer for the United Nations in Timor Leste and the Peace Monitoring Group in Bougainville, Papua New Guinea. She has also deployed as the Deputy Chief Inspector of the biological weapons inspection team in Iraq in 1998 as part of the United Nations Special Commission on Iraq. Over the past decade she has focused on infectious disease threats to deployed personnel and has led the health intelligence support to Government. In 2020, she was seconded to the Commonwealth Department of Health to lead the COVID-19 epidemiology team in the National Incident Room. She currently serves as Defence’s representative on Australia’s Human Animal Spillover and Emerging Diseases Scanning Group. She holds a Master of National Security and Strategy, a Master of Clinical Epidemiology with Merit, a Master of Applied Science (Environmental Health), and a Bachelor of Science. In 2021, she was appointed a Member of the Order of Australia for services to medical intelligence, epidemiology and health leadership.
This presentation examines the development of a conceptual framework for assessing the effectiveness of health diplomacy. Drawn from my recent thesis – Healthy Ties or Strategic Lies? Navigating China’s use of Health Diplomacy in the Southwest Pacific – the research addresses a critical gap in both global health and international relations literature. More specifically, it addresses the absence of an established methodology for evaluating whether health diplomacy initiatives genuinely strengthen health systems or solely function as instruments of geopolitical influence.
Health diplomacy is positioned at the intersection of global health governance, foreign policy and strategic competition. While traditionally associated with humanitarian assistance and international cooperation, it is now also employed as a mechanism of soft power projection, strategic influence and legitimacy building. China’s use of health diplomacy through its Belt and Road Initiative and Health Silk Road provides a contemporary example of this evolution. In the Pacific, Beijing’s activities include the construction of hospitals, the deployment of medical teams and hospital ships, vaccine diplomacy, and workforce training programs These initiatives often produce immediate health gains, yet questions arise regarding transparency, sustainability, sovereignty and long-term resilience.
The presentation will outline the methodology developed to evaluate these competing dimensions of health diplomacy. Existing literature provides broad definitions of global health diplomacy and extensive discussion of soft power theory, yet offers limited guidance on how to systematically assess the quality or strategic implications of health engagement. To address this gap, I developed an original evaluative framework that integrates principles from both diplomacy and health governance.
The framework was constructed through an exploratory literature review spanning global heath diplomacy, governance theory, humanitarian medicine, soft power and international relations. It combines traditional diplomatic concepts, such as legitimacy, negotiation and cooperation, with health governance principles including accountability, evidence-based policy and systems strengthening. The resulting framework identified seven interrelated criteria for assessing health diplomacy initiatives: mutual benefit; respect for sovereignty and collaboration; transparency and accountability; evidence-informed policy; global solidarity and cooperation; sustainability and long-term vision; and cultural sensitivity and ethics.
The presentation will demonstrate how these criteria can be operationalised to compare external health engagements and identify whether programs primarily support recipient-state resilience or reinforce dependency and strategic influence. Using examples from Fiji and Papua New Guinea, it will show how visible health gains may coexist with governance vulnerabilities, debt exposure and long-term reliance on foreign systems and expertise. The framework enables a more nuanced understanding of health diplomacy beyond purely humanitarian narratives.
The methodology has broader relevance beyond single state actors and the Pacific region. It offers a practical analytical tool for policymakers, military medical planners, development agencies and global health practitioners seeking to evaluate the strategic effects of international health engagement in contested regions. In an era increasingly shaped by pandemics, climate insecurity and geopolitical competition, the ability to critically assess health diplomacy is becoming an essential component of regional health security and strategic policy analysis.
This presentation contributes to military medicine and health security by proposing a structured methodology for measuring the effectiveness, legitimacy and strategic consequence of health diplomacy. It argues that ‘good’ health diplomacy must extend beyond short-term clinical delivery to strengthen sovereignty, local ownership and sustainable health system resilience.
Health Considerations – Human Security within Military Operations
WGCDR Janine Tillott1
1Defence, , Australia
Biography:
WGCDR Janine Tillott, Dental Officer joined the RAAF in 1995. During her career she has completed many roles from clinical service delivery and Defence Senior Aviation Dentist, to being appointed to Command of Joint Health Unit Southern New South Wales (2016-17). She has held Staff Officer roles in Policy, eHealth, Future Health, Career Management and AFHQ. WGCDR Tillott has deployed as the Commander Australian Contingent Exercise PACFIC PARTERSHIP (2007), officer-in-charge (OIC) Australian contingent Exercise PACIFIC ANGEL (2015), and was instrumental in the initiation, development and piloting Exercise KUMMUNDOO (2015). From Oct19-May20 she deployed as OIC Health, Operation ACCORDION in the Middle East Region. On return to Australia she was seconded to COVID Operations Cell and Health liaison officer to COVID Task Force. WGCDR Tillott posted as the Air Force Gender Advisor (2022-24), being responsible for AF implementation of UNSCR 1325+ Women, Peace and Security where she was awarded the Conspicuous Service Cross in 2025. She represented RAAF as a Gender Advisor on Exercise COPE NORTH and PIRAP JABIRU 2022, international staff talks and in overseas combined Exercises.
WGCDR Tillott is happily married with two adult children. She is an endorsed Dental Sedationist and has completed a Masters in Health Management.
The nature of military operations is evolving. Commanders are seeking any advantage that will improve operational effectiveness, enhance mission success, heighten personnel security and safety, reduce risk to personnel – lessening casualties, limit the duration of mission, and expedite a return to peace and stability. Gender in military operations (GiMO) is one aspect of Human Security that the Australian Defence Force (ADF) is implementing in order to enhance our military’s effectiveness. GiMO is intrinsic to all aspects of Defence. It impacts Health from operational planning to health service delivery pre, during and post operation.
This presentation explores the requirement for military health professionals to understand the complex human terrain in which we operate. It explores how every health professional has an opportunity to impact operational effectiveness through the application of aspects of human security in health planning and health care delivery. This will be presented through three key components:
- How did it all start? The release of the United Nations Security Council Resolution (UNSCR) 1325 Women, Peace and Security (WPS) in 2000 acknowledged that women, girls, men and boys experience armed conflict differently and that women and girls are often disproportionally affected by conflict. UNSCR1325 was adopted by the Australian Government in 2012 with the release of Australia’s National Action Plan on WPS; and implemented in Defence in 2020 with the Gender, Peace and Security Mandate.
- Why is GiMO important? Presentation of data released in the Security General Report on Conflict-related sexual violence (CRSV) released in August 2025 notes a 25% increase in CRSV from the previous year with over 4600 survivors reporting violence. The data highlights women, girls, men, boys, including persons with diverse sexual orientation and/or gender identities, racial and ethnic minorities, and persons with a disability, were among the victims, ranging in age from one to 75 years old. It also emphasises that the majority of victims are unable to reach health care within the 72-hour window when life-saving and specialised services are most needed. Additionally, we will discuss data from humanitarian crisis released by UN Women including that 70% of women experience gender based violence (GBV) in a humanitarian crisis context compared with 35% world-wide.
Understanding the implications of this data highlights the importance of human security in operational planning including health planning. Noting that a thorough understanding of all aspects of the population ie age, gender, ability, minority groups etc within an area of operation including the second and third order effects of military actions on civilian populations is essential.
Additionally, we will discuss how ADF personnel may experience moral injury, PTSD and other adverse health effects as a result of encounters with CRSV and GBV and how health personnel must both prepare Defence members for such incidents and be prepared to provide support post incidence.
3. What actions can health planners and clinicians undertake? A broader discussion including case studies will highlight the complexity in planning and how gendered intelligence assists health planners developing Defence actions and activities. We will discuss a number of recent Operations and expand on lessons learnt as Defence integrates Gender, Peace and Security strategies into operational planning, noting the complexity created for clinicians, when gendered health intelligence is not considered in planning operations. We will conclude by discussing the importance of incident reporting to reduce the psycho-social risk to personnel. This will highlight the important role that health personnel play as part of this process and how this enhances mission success by maximising Defence’s most important asset – people.
Identity, Purpose, Belonging and Wellbeing as Markers of Long-Term Functional Recovery
Mr Daniel Vincent1
1Trojans Trek, Upper Kedron , Australia
Biography:
Dedicated to supporting military veterans, Daniel, a former Australian Army Soldier with 16 years of service, is a passionate advocate for their successful transition to civilian life. He has pioneered scholarship and mentoring programs, shaping industry-specific cybersecurity initiatives. He has co-authored three papers on education, employment, and wellbeing. With expertise in mental wellness, education, and employment, Daniel chairs Trojans Trek, fostering self-discovery and introspection among veterans. His diverse roles include COO, Director of Strategy and Innovation, National Director of Health and Wellbeing, and Director of the Monaro Community Access Service Board. Combined with his Master’s in Business and a Graduate Certificate in Mental Health Practices, Daniel’s commitment is evident in his multifaceted contributions.
Despite decades of investment in evidence-based psychological interventions, Australian veterans continue to experience disproportionately high rates of post-traumatic stress disorder (PTSD), major depressive disorder (MDD), social isolation, unemployment, and suicide. While contemporary psychological treatments have demonstrated efficacy in reducing symptoms, they remain predominantly grounded in a medical model that conceptualises recovery through pathology, diagnosis, and symptom reduction. Trojans Trek argues that such approaches insufficiently account for the cultural identity, lived experience, meaning-making, and embodied nature of operational trauma.
Drawing upon phenomenology, Life Design theory, social prescribing, recovery-oriented practice, and peer support literature, Trojans Trek proposes a culturally congruent framework that redefines both the assessment and treatment of operational trauma. Rather than beginning with psychiatric diagnosis, the model begins with the individual’s lifeworld, their identity, values, purpose, relationships, emotional literacy, and connection to community. Treatment is delivered through a peer-led, clinician-supported wilderness intervention that integrates experiential learning, narrative reconstruction, mentoring, and future-oriented life planning within a psychologically safe environment. This approach reflects the Trojans Trek model, in which lived experience forms the foundation of therapeutic engagement and participants co-design a 12-month recovery plan grounded in personally meaningful goals.
Trojans Trek further proposes a novel multidimensional assessment framework that shifts evaluation beyond illness severity towards recovery and human flourishing. In addition to conventional psychological distress measures, outcomes incorporate validated measures of personal wellbeing, self-compassion, thriving, life satisfaction, identity reconstruction, purpose, and social connectedness. Our preliminary program data demonstrates consistent improvements across wellbeing domains, supporting the value of measuring recovery rather than illness alone.
Trojans Trek argues that operational trauma should be understood not solely as a psychological disorder requiring symptom management, but as a disruption of identity, belonging, and purpose requiring holistic reconstruction. By integrating lived experience, phenomenological assessment, positive psychology, and social prescription into a single model of care, this framework represents a potential paradigm shift for veteran mental healthcare.
Introducing Spiritual Wounds and Injuries
Dr Murray Davies1
1Wounded Spirit, Canberra, Australia
Biography:
Dr Murray Davies is the CSO of the veterans charity Wounded Spirit. Wounded Spirit helps veterans who have experienced spiritual damage resulting from military service. A former Australian Army Lieutenant Colonel, Murray is a graduate of the Royal Military College and Australian Army Staff College. Murray’s PhD from the University of Divinity was on ‘The Influence of Spiritual Wounds and Injuries on Australian Defence Force Veterans.’ Additionally, Murray holds a Master’s in Theology, Defence and Internal Relations, a Graduate Diploma in Theology and a Bachelor of Arts (Honours).
Military service at any level or of any nature places tremendous stress on the bodies, minds, and souls of Australian men and women who volunteer to serve in the Australian Defence Force (ADF). That a soldier may experience spiritual damage because of their involvement in a traumatic event is not new and indeed has been discussed for many years and under many different headings. In the past forty years, spirituality and trauma in the domain of military service have been principally viewed through the lens of Moral Injury (MI). Although this topic has generated a body of scholarly research and writing, this paper argues that, for a range of reasons, MI is not the most effective means of addressing damage to an individual’s spiritual health. Accordingly, scholarship and study in this area has been commenced develop, prove, test, and understand the concept that a loss of faith in or anger with God may trigger or contribute to significant mental health issues. Ultimately, this scholarship and study will need to expand upon, describe, and define this overall concept as the basis for establishing a credible dataset that identifies the scale of the issue within the Australian veteran community. Work done on quantifying rates of post-traumatic stress disorder (PTSD) and MI within the community has made important contributions to determining approaches to managing these issues, as well as providing essential justification for government involvement and support; this must now be replicated in the area of spiritual damage.
The overall aim of this project to date is to establish the influence of Spiritual Wounds and Injuries (SW&I) on ADF veterans. In pursuing this aim, this paper has three subsidiary objectives. The first objective is to define the term “Spiritual Wounds and Injuries” (SW&I). This includes surveying the relevant literature, capturing key source material for the project, and identifying any significant research gaps. The existing literature on Moral Injury (MI) is reviewed, and its management of spirituality is analysed. On this basis, the term SW&I is articulated, described, and defended. In the second objective, the SW&I concept is expanded; the potential causes of SW&I are examined, approaches to assessment and management are considered, and new models are proposed. The third objective of the project focuses on a detailed, specific analysis of its relevance to ADF veterans. The scope of what constitutes an ADF veteran is established, and the influences of ADF culture on SW&I susceptibility, presentation, and management are analysed.
“Is there a medically qualified volunteer onboard?”- Would you volunteer to help?
SQNLDR Alex Leedham1
1294 SQN, Amberley , Australia, 2Virgin Australia , Brisbane, Australia
Biography:
SQNLDR Alex Leedham is a Nursing Officer in the Royal Australian Air Force. After 15 years of full-time service, she transferred to SERCAT 5 to take up employment with Virgin Australia as the Aviation Health Specialist. She continues in her reserve capacity as an Aeromedical Evacuation Instructor at 294 SQN and has a deep passion for training and the growth of the next generation of RAAF Clinicians.
Background: In-flight medical events place clinical decision-making inside one of the most austere settings in civilian transport: a narrow cabin, limited privacy, restricted movement, ambient noise, reduced diagnostic capability, and delayed access to definitive care. These constraints make the contribution of military medical professionals valuable. Military clinicians are trained to deliver calm, structured care in uncertain, crowded, high-pressure environments where the available equipment may not match the clinical problem.
Discussion: The aircraft cabin shares distant similarity with deployed and field medicine. Assessment is performed in an aisle, galley, or seat row, often with the patient seated, surrounded by passengers, and with only basic monitoring. The assisting clinician must establish rapport with cabin crew, identify their credentials and scope, obtain a focused history, assess airway, breathing, circulation, disability, and exposure within practical limits, and convert limited findings into actionable advice for the captain and ground medical support. Military medical professionals bring strengths that align closely with these needs: disciplined triage, comfort with incomplete information, communication under pressure, team leadership, improvisation within protocol, and the ability to prioritise stabilisation over definitive diagnosis. Their experience with command structures also supports clear role allocation, closed-loop communication, and respectful escalation, which are essential when cockpit, cabin, ground medical, and passenger volunteer inputs must be coordinated quickly.
Commercial aircraft medical equipment is necessarily limited. It must be safe for aviation use, compact, lightweight, secure, maintainable, and suitable for use by cabin crew, volunteer clinicians, and other trained responders across different jurisdictions. A typical aircraft may carry first aid kits, oxygen, an automated external defibrillator, infection control supplies, and an emergency medical kit containing basic assessment tools, airway adjuncts, a bag-valve-mask, intravenous equipment, saline, and selected medications such as analgesics, antihistamines, bronchodilators, glucose, adrenaline, aspirin, atropine, lignocaine, and nitrates, depending on regulation and operator policy. This inventory supports initial assessment and stabilisation, not hospital-level care. There is no laboratory testing, imaging, continuous multiparameter monitoring, suction, advanced airway capability, broad formulary, or resuscitation team. The responder must therefore adapt the kit to the patient, while staying within their competence and integrating cabin crew procedures, airline policy, and ground medical advice. This adaptation is important because a single kit must be understandable and usable across several scopes of practice, rather than optimised for one specialist group.
The most common events that military medical professionals can expect to assist with are syncope or near-syncope, dizziness, nausea and vomiting, abdominal pain, shortness of breath, asthma or chronic lung disease exacerbation, chest pain, palpitations, anxiety or panic, seizure, altered mental state, hypoglycaemia, allergic reaction, burns, and symptoms suggestive of stroke or acute coronary syndrome. Less common but high-consequence events include cardiac arrest, severe anaphylaxis, major trauma from turbulence, obstetric complications, psychiatric disturbance, infectious disease concern, and death on board.
Conclusion: Military medical professionals are highly valuable on civilian aircraft because they bring an austere-care mindset to an austere aviation environment. They are trained to work with constrained space, constrained equipment, constrained time, and competing operational risks. This presentation will deliver useful information for conference delegates to assist should they volunteer their medical experience on a civilian flight.
Lessons for Australia from the NATO Blood Panel
BRIG Michael Reade1
1Joint Health Command, Ascot, Australia
Biography:
BRIG Michael Reade is an intensive care physician, anaesthetist and clinician scientist, appointed in 2011 as the Professor of Military Medicine and Surgery at Joint Health Command. From 2015-2018 he was additionally the Director of Clinical Services of the 2nd General Health Battalion, and from 2019-2022 he was Director General Health Reserve – Army. Since 2022 he has been Director of the University of Queensland’s Greater Brisbane Clinical School, overseeing UQ’s 10 Brisbane teaching hospitals, >250 general practices and the university campus. He remains an advisor to Joint Health Command on research and education, represents Australia on the NATO Blood Panel and WHO Blood Supply and Transfusion Working Group, and Chairs the Five Eyes Science & Technology Collaboration Military Medicine Panel. His A$37 million current research program covers trauma systems design, blood and fluid resuscitation in trauma, and traumatic brain injury.
Mr Paul Naveau is the Director of Health Materiel, Logistics and Pharmacy for Joint Health Command. In that role, held since 2012, he is charged with the delivery and management of health materiel across Defence and is responsible for the engagement with key government agencies and organisations for the delivery of health materiel products and services into Defence.
Blood for transfusion is a critical strategic capability, both to support military operations and to preserve quality civilian healthcare.1 Worldwide demand exceeds supply even in peacetime: in 2017, 305 million units were needed annually, yet only 272 million units were available. Conflict, such as that in the Russia-Ukraine war, both increases demand through higher blood requirements in trauma and reduces supply due to compromise of resources for collection, processing, storage and transport. Potential negative consequences include more preventable deaths, reduced combat power, erosion of trust in national institutions, and contribution to possible failure of the nation state.
North Atlantic Treaty Organisation (NATO) and Partner Interoperability Advocacy Group (PIAG) nations including Australia seek to ameliorate this situation though policy recommendations made by the NATO Blood Panel. Following finalisation of the draft Standardisation Agreement (STANAG) 2939 Minimum Requirements for Blood, Blood Donors and Associated Equipment in 2025, the Panel has continued to provide guidance to member nations and the European Commission in several areas:
- Awareness of likely transfusion requirements in times of conflict, both for combatants and in threatened civilian healthcare systems.
- Advocacy for investment in, and regulatory approval of, novel transfusion alternatives, such as freeze- or spray-dried plasma, cold-stored and cryopreserved platelets, and fresh / stored whole blood.
- Development of technical protocols to support novel policy for the use of Category 1 (obtained from regulated blood suppliers in NATO and PIAG nations), Category 2 (obtained by NATO / PIAG forces in the Area of Operations, using NATO-mandated protocols), and Category 3 (sourced from a host nation, outside the control of a NATO / PIAG military force) blood.
- Guidance on optimal choices for blood components to be held at the various levels of military medical support, from point of injury to Role 3, when employed in various types of military operation (area denial, low-level stability, and defensive and offensive large scale combat).
- The desirability of harmonising STANAG 2939 with national blood policy and the 2027 European Union Substances of Human Origen (SOHO) regulations, with particular emphasis on removing regulatory impediments to sharing Category 1 blood amongst partner nations.
- Exploration of innovative technical solutions for blood distribution, such as drone delivery.
- The need to specify methods for mandated administrative support, such as transfer and storage of haemovigilance data, and actions on loss or compromise of this data.
- Enhanced resilience of logistic supply chains, in particular identifying critical consumables that would limit blood supply. Investment in local production capacity for such consumables.
- Development of common training packages for military employment of Category 2 blood (formerly termed the “walking blood bank”)
Through its ongoing contribution to the NATO Blood Panel, the Australian Defence Force ensures its national blood policy reflects best-practice and is harmonised with that of our international partners.
References:
- Frescaline N, Beckett A, Reade MC. Call to enhance civilian and military blood preparedness. Lancet, 2026, 407 (10533), 1053-1054
MASCAS on Base: Lessons learned from a mass casualty event at Lavarack Barracks and incident response in Lavarack Health Centre
LTCOL Susan Hill, Ashleigh Broad1
1BUPA
Biography:
Ashleigh holds a Bachelor of Science, a Masters in Clinical Chiropractic and is currently finishing off a Masters in Public Health. She spent her early career in Victoria and South Australia before deciding in 2020 that the weather is better in Queensland, and she’s been there ever since. Her clinical and academic interests include disaster health management, health surveillance, protection, and health service optimization. She is currently the Quality Manager for Joint Heath Unit – North Queensland leading data driven quality improvement initiatives. She has spent the last 18 months gradually improving her understanding of Defence acronyms.
Lieutenant Hill joined the Army in 2007 as a Direct Entry Nursing Officer. She holds a Bachelor of Nursing, a Bachelor of Applied Science (Psychology), and a Master of Advanced Practice Nursing. She has had nursing and regimental roles within the Australian Army including Army School of Health, Army headquarters, infantry battalions and 2 Commando Regiment. LTCOL Hill has had senior leadership roles across Joint Health Command and is living her best life in sunny Townsville as Commanding Officer of Joint Health Unit North Queensland, where she spends a lot of time explaining many Defence acronyms to her contracted quality manager.
On Friday 13 February 2026, the 2nd Cavalry Regiment experienced a significant incident when a photo stand collapsed during a unit photograph, injuring 97 personnel. The immediate on-scene response involved triage by Combat First Aid, 4 Health Battalion and the assistance of 12 Queensland Ambulance Service crews. This initial response was followed by a surge of 67 priority 3 presentations to Lavarack Health Centre (LHC) within a compressed timeframe on a Friday afternoon, placing substantial and unexpected demand on a Garrison Health Facility designed primarily for routine care. This event represented the first large-scale unplanned incident of its kind managed by a Garrison Health service and served as a critical test of its adaptability, resilience, and integration with external emergency response agencies. While the response demonstrated strong clinical capability, professionalism, and commitment from both military and civilian health staff, it also exposed key gaps in systems, processes, and coordination mechanisms that are typically less visible during routine operations.
A comprehensive multistage After Action Review (AAR) identified several critical themes. First, the need for a robust and scalable casualty tracking system was evident. The influx of patients, combined with multiple entry points across Lavarack Health Centre, made real-time patient visibility and accountability challenging.
Second, the incident highlighted the need for clear delineation of command and control within a Garrison Health Emergency context amid staff absences. While clinical care was effectively delivered, strengthening incident command systems, including clearer escalation protocols and designated leadership roles, has since been recognised as essential and informed the development of JHU-NQ’s First Mass Casualty Incident response plan.
Third, coordination with external stakeholders emerged as a critical enabler of effective response. The event demonstrated the importance of pre-established relationships and shared understanding between Garrison Health, Health Battalion elements, Queensland Ambulance Service, and local tertiary hospitals. Formalising AAR processes across these stakeholders has been a key outcome, ensuring shared lessons are captured, communicated, and integrated into future planning and training.
This presentation outlines the incident, the garrison-level response, and the lessons identified through the AAR process. It further highlights how these lessons have been translated into practical improvements across North Queensland, enhancing preparedness, interoperability, and the capacity to respond to larger scale incidents in Garrison Health.
Military Occupational and Environmental Medicine (OEM): perception versus reality
Dr Neil Westphalen1
1Navy, PALMERSTON, Australia
Biography:
Dr Neil Westphalen graduated from the University of Adelaide in 1985 and joined the RAN in 1987. His postgraduate qualifications include Fellowships of the RACGP, AFOEM and ACAsM, an MPH from Curtin University, and a Dip AvMed via King’s College London. In July 2025, he completed a history PhD through UNSW Canberra; entitled ‘Constant Care: health support for Australian naval operations 1901-1976’.He is also a RAN Staff College graduate.
Commander Westphalen’s seagoing service included Swan (III), Stalwart (II), Success (II), Sydney (IV), Perth (II), Manoora (II) and Choules, during which he undertook DAMASK VII, RIMPAC 1996, TANAGER, RELEX II, GEMSBOK, TALISMAN SABRE 2007 and RENDERSAFE 2014. His clinical roles ashore included Cerberus and Penguin, thence Kuttabul, Albatross, Stirling and the Submarine and Underwater Medicine Unit—West as SMO. Staff positions included Director Health at what became Joint Operations Command, Director Navy Occupational and Environmental Health, Director of Navy Health, Staff Officer 1 Medical Employment Classification Advisory and Review Services, and Fleet Medical Officer. On transferring to the RAN Reserve in 2016, Commander Westphalen undertook staff roles for Exercise KAKADU 16, the Director-General Navy Safety and Environment Policy Coordination, and the Navy Personnel Career Management Agency.
Although Occupational and Environmental Medicine (OEM) has received limited attention within the ADF and its health services, understanding of its perceived versus actual scope of practice continues to remain poor. The aim of this presentation is to explain how and why, rather than simply dealing with the more arcane workplace health and safety hazards, OEM uses a holistic biopsychosocial team-based approach to ensuring workforce health through active prevention, clinical treatment and rehabilitation – all of which are highly relevant to ADF operational capability, and the personnel that brings them to life.
Moral Challenges in Current Conflicts – War in Ukraine and Perfidious Warfare
Gpcapt Jeff Stephenson1
1Adf, Australia
Biography:
GPCAPT Stephenson has thirty-eight years’ full-time experience working within Defence Health. He has deployed to East Timor, Bali, Banda Aceh Sumatra and the Middle East.
He is currently the:
• Chair of the ADF Medical Officer Professional & Continuing Development Committee;
• The Clinical Director of Primary Health Care for Air Force Health Reserves;
• A Regional Senior Aviation Medical Officer for the Institute of Aviation Medicine; and,
• The Senior Medical Advisor to RAAF Richmond.
He is a graduate of the Australian War College “Thinking Strategically” course and an observer member on the NATO Interallied Confederation of Reserve Medical Officers. He was selected to attend the Australian War College pilot course on “Strategy in the Australian Region”.
GPCAPT Stephenson’s current focus is on shaping Defence Health to align with the current geopolitical environment.
“The Russia-Ukraine conflict heralded a new philosophy of warfare. President Volodymyr Zelenskyy tasked the Unmanned Systems Forces of Ukraine (the Birds of Madyar) with eliminating 30,000 Russian soldiers per month. They are now exceeding this. Drones, AI, machine learning and cybersecurity have exponentially changed the battlefield. New iterations of drone technology and counter measures are occurring on a two-monthly cycle. Kill zones now have a 50 km bandwidth, with drones the primary strike tool inflicting 70 per cent of personnel injuries and 75 per cent of equipment and vehicle damage. Perfidious warfare ensues, with maiming and disabling preferred over killing. Deliberate targeting of civilians and health personnel occurs with evacuation systems made redundant and military health facilities regularly overwhelmed. The rules of armed conflict are no longer protective. GPCAPT Stephenson first spoke of drones being “A Paradigm Change in Military Medicine” in 2023. Here he provides an update on the moral and clinical lessons from the Ukraine conflict. Contemporary takeaways from NATO are applied in our geostrategic region with the theme that “Moral Injury is now ubiquitous in Warfare.”
Neural Signatures of Moral Injury: Distinguishing Moral Injury from PTSD in the Changing Operational Environment of the Australian Military
Prof/Dr Matthew Bambling1
1Adf, Brisbane, Australia
Biography:
Professor (Retired) Matt Bambling is a Clinical Psychologist, academic, and senior Defence psychologist with over 35 years of experience in clinical, research, and operational psychology. He currently serves as a Wing Commander (WGCDR) in the Royal Australian Air Force and is posted to the Directorate of Air Force Health.
Dr Bambling holds a PhD in the treatment of mood disorders and has led clinical programs, major funded clinical trials, and postgraduate education initiatives across several Australian universities. He has extensive experience working in high consequence operational environments and contributes to Defence initiatives focused on psychological health, resilience, and operational capability.
His clinical and research interests include complex trauma, treatment resistant depression, psychological resilience in high security environments, and moral injury. He has published and presented widely on moral injury and contributes to the development of Australian Defence Force training and treatment frameworks in this area.
Dr Bambling has authored more than 100 peer reviewed publications and continues to advise government, health, and defence organisations on mental health, human performance, and psychological risk in complex operational environments.
Abstract
Although moral injury (MI) and posttraumatic stress disorder (PTSD) frequently co-occur among military personnel and veterans, emerging neuroscientific evidence suggests that MI represents a mechanistically distinct construct. This presentation draws on recent neuroimaging research to examine the neurological and psychological differences between MI and PTSD and considers the implications for diagnosis and treatment within military medicine.
PTSD is primarily associated with hyperactivation in neural circuits involved in threat detection and fear based responses, including the amygdala, anterior cingulate cortex, and insula. In contrast, moral injury appears to engage neural networks associated with moral reasoning, self-reflection, and social cognition. Functional MRI studies have identified increased activation in regions such as the precuneus, inferior parietal lobule, and inferior frontal gyrus, which are implicated in processing guilt, shame, and violations of deeply held moral values.
Research examining moral autobiographical memory retrieval has also demonstrated dysregulated connectivity between the sensorimotor network (SMN) and the posterior default mode network (pDMN), supporting the view that morally injurious experiences may be encoded as embodied, sensorimotor memories rather than solely through narrative fear based processing. These findings are consistent with clinical observations that MI is frequently associated with moral conflict, perceived betrayal, failed action, or violations of core values that challenge identity, meaning, and moral agency.
Conceptualising moral injury as a subtype of PTSD risks conflating distinct neuropsychological mechanisms and may lead to suboptimal therapeutic approaches. Whereas PTSD treatments commonly focus on fear extinction and exposure based interventions, MI may require therapeutic processes centred on moral repair, existential reconciliation, and values based reintegration.
Within the Australian military context, the operational environment is dynamic and evolving, and contemporary forms of warfare increasingly expose personnel to ethically complex situations that may heighten the risk of moral injury. Distinguishing MI from PTSD is therefore critical for improving diagnostic clarity and guiding more appropriate treatment approaches.
This presentation synthesises emerging neuroscientific and clinical evidence to argue that moral injury represents a distinct response to trauma with its own neural signature, psychological profile, and therapeutic implications. Recognising MI as separate from PTSD may contribute to improved assessment, treatment, and mental health outcomes among Australian military personnel and veterans.
Barnes, H. A., Hurley, R. A., & Taber, K. H. (2019). Moral injury and PTSD: Often co-occurring but mechanistically different. The Journal of Neuropsychiatry and Clinical Neurosciences, 31(2), A4–A103. https://doi.org/10.1176/appi.neuropsych.19020036
Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. (2008). The brain’s default network: Anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences, 1124(1), 1–38. https://doi.org/10.1196/annals.1440.011
Lanius, R. A., Terpou, B. A., & McKinnon, M. C. (2023). How the body remembers: The role of the default mode and sensorimotor networks in moral injury. Frontiers in Psychology, 14, 1138047. https://doi.org/10.3389/fpsyg.2023.1138047
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
Lloyd, C. S., Jones, E. P., Brown, A. M., Hutchinson, E., Williams, M., & Adams, R. A. (2021). Moral injury and greater midbrain functional network connectivity in posttraumatic stress disorder. NeuroImage: Clinical, 32, 102849. https://doi.org/10.1016/j.nicl.2021.102849
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017
Neria, Y. (2021). Functional neuroimaging in PTSD: From discovery science to precision medicine. The American Journal of Psychiatry, 178(6), 479–496. https://doi.org/10.1176/appi.ajp.2020.20081288
New Evidence for Whole Blood in Trauma: Understanding the recent SWiFT and TOWAR Trials and their Implications for Defence Transfusion Policy
Dr Elissa Milford1
1Headquarters 2nd Health Brigade, Brisbane, Australia
Biography:
Elissa is an Intensivist and clinician researcher. She is a full-time Intensive Care Specialist on the MSP currently posted to HQ 2 Bde, and works at the Royal Brisbane and Women’s Hospital. She also holds honorary academic titles at the University of Queensland and Monash University. Her PhD was on the role of the endothelial glycocalyx in severe trauma, and she is building a research program that spans the management of severe burns, trauma, blood transfusion, military medicine, and endothelial dysfunction in critical illness. She also has a strong interest in the design of novel clinical trials and is currently completing a Masters in Biostatistics. She is an emerging leader in critical care clinical trials, currently leading the Australian sites of the international, multi-centre, Threshold for Platelets (T4P) clinical trial, and is on the management committee of several other large multi-centre clinical trials. She is an active member of the ANZICS Clinical Trials Group community and supervises several student research projects.
Low-titre group O whole blood (LTOWB) has become increasingly incorporated into civilian and military trauma systems despite an evidence base that has, until recently, consisted only of observational studies. The results from these studies have been mixed, with only some reporting improved survival associated with whole blood. However, observational studies are vulnerable to time-dependent and selection biases that can produce misleading estimates of treatment effect. The recent publications of the SWiFT and TOWAR randomised controlled trials provide the highest-quality evidence to date of the effects of LTOWB in traumatic haemorrhage.
Both SWiFT and TOWAR compared the prehospital administration of up to two units of LTOWB with component therapy in patients with major traumatic haemorrhage. Despite having different populations and different trial designs, neither trial demonstrated superiority of LTOWB for their respective primary (SWiFT: a composite of 24h mortality or massive transfusion; TOWAR: 30-day mortality) or secondary outcomes, and safety outcomes were comparable between treatment groups.
Of note, neither trial was designed as an equivalence or non-inferiority trial. Consequently, the absence of a statistically significant difference should not be interpreted as evidence that whole blood and component therapy are clinically equivalent. Rather, the trials found no evidence that the whole blood intervention evaluated was superior under the study conditions.
The biggest limitation of these trials was the low dose of whole blood used. Patients received a maximum of two units of LTOWB before subsequent transfusion reverted to standard component therapy. Whether such limited exposure is sufficient to produce clinically meaningful differences remains uncertain, particularly out to 30-days and in patients who ultimately require large-volume transfusion. These studies therefore evaluate an early, limited-dose whole blood strategy rather than whole blood resuscitation throughout haemorrhage, limiting conclusions regarding potential dose-response effects.
The discrepancy between these randomised trials that found no evidence of benefit from whole blood, and numerous positive observational studies highlights the limitations of non-randomised evidence in clinical medicine. In observational studies, treatment allocation is heavily influenced by injury severity, transport time, clinician judgement, logistics, and blood product availability. Furthermore, patients must survive long enough to receive additional transfusions, introducing survivor and immortal time biases, while analyses conditioned on post-baseline variables, such as transfusion volume, may induce collider stratification bias. Together, these biases can substantially exaggerate treatment effects even when sophisticated statistical adjustments are performed.
The forthcoming TROOP trial is expected to provide important additional evidence. Unlike SWiFT and TOWAR, TROOP permits administration of up to eight units of LTOWB (commenced in hospital), thereby evaluating a substantially greater exposure to LTOWB. In addition, TROOP will provide an opportunity to better characterise the safety of higher cumulative LTOWB exposure. Although LTOWB, by definition, contains low levels of anti-A and anti-B antibodies, it is not antibody-free. Increasing cumulative exposure could theoretically increase the risk of complications, including low-grade haemolysis of recipient red blood cells or subsequently transfused ABO-specific red blood cells, complement activation, or other occult immunological effects that may not be apparent using short-term clinical outcomes.
Despite these trials not demonstrating superiority of the prehospital administration of up to two units of LTOWB over balanced component therapy, or equivalence between these approaches, the absence of any safety concerns may support the use of LTOWB in military settings where the logistic advantages of LTOWB result in it being the only blood product available in some settings. Results from TROOP will further inform the clinical efficacy and safety of higher-volume LTOWB resuscitation and should therefore greatly influence Defence transfusion policies and procedures.
Optimising Medical Officer training; strengthening the partnership between ADF and RACGP
Dr Andrew Ramage1, Dr Rebecca Lock1
1RACGP, Brisbane, Australia
Biography:
Dr Andrew Ramage is a GP working full time in civilian general practice having retired from military service as a Senior Medical Officer in 2024. He works with the Royal Australian College of General Practice as the QLD Senior Medical Educator for ADF Registrars as part of a team dedicated to ensuring ADF Registrars gain meaningful and relevant training while achieving Fellowship with RACGP.
The development of Medical Officers for the ADF relies heavily on a civilian training pathway for primary care to ensure a minimum standard of capability as the Medical Officer transitions from long term schooling and clinical secondments into the trained force. As the provider of primary care training for the majority of ADF Medical Officers, RACGP has established a strong working relationship with the ADF to ensure the training provided meets both the College standards and ADF requirements.
Historically, ADF registrars have been less successful in exams compared to their civilian cohort. Factors contributing to this include training interruptions, different clinical practice exposures and competing obligations. This has improved with PGY3 clinical development year being 12 months of uninterrupted civilian general practice, but a deficit remains.
RACGP has introduced ADF specific pre-exam support for both written and clinical exams with early results being very promising. RACGP launched an ADF exam support program for the written exam for 2026.1. ADF candidates enrolled in the exam were invited to participate in written exam preparation support. 32 candidates were invited. Participants had a success rate of 92% across written attempts, compared to 80% across all ADF candidates who sat the exam. This was comparable to the cohort success rate of 82% for the written assessments.
RACGP will continue to monitor performance and introduce programs tailored for ADF registrars to enhance the rate of progression through Fellowship training. Ensuring prevocational career advice provided by ADF commanders, career managers and Senior Medical Officers aligns with information provided in the RACGP ADF handbook will further optimize ADF MO capability for the ADF. This will ensure ADF MOs in training are optimising their pathway to fellowship, in receiving the correct guidance during the final years of medical school and hospital rotations.
Shaping hospital rotations to ensure mandatory components for RACGP Fellowship training are met early in the internship/residency years, and allow more opportunities for exposure to rotations in Emergency Medicine in the second year of residency training. If used wisely, this will allow for completion of formal emergency training that can be consolidated with hospital secondments in the RACGP extended skills term and can contribute toward completion of a Rural Generalist Fellowship.
These prevocational activities require the support and mentoring of MOs from medical school through to Fellowship through both RACGP and ADF career management organisations and command elements. Further strengthening the partnership between RACGP and ADF to work together in the prevocational training environments will optimise the clinical training components required for ADF MOs in remote locations as well as establishing the pre-conditions for successful completion of the RACGP Fellowship training program. Once in vocational training, RACGP will continue to work with ADF to facilitate opportunities for registrars to succeed in training through additional education, training and mentorship above that provided to civilian registrars.
Oral Health Inequalities in the Australian Defence Force: A Retrospective Observational Study
LTCOL Anthony Craig1
1Australian Army, Brisbane, Australia
Biography:
LTCOL Tony Craig commissioned into the Royal Australian Army Dental Corps in 2005 while completing dental studies at the University of Queensland. He holds a Bachelor of Physiotherapy, Bachelor of Dental Science with First Class Honours, Master of Clinical Dentistry in Implant Dentistry, and is currently completing a Master of Dental Public Health.
Tony has served across a range of clinical, command, staff and technical appointments, including Senior Dental Officer roles, Officer Commanding 33 Dental Company, Staff Officer Grade 1 – Dental, Brigade Dental Officer Headquarters 2nd Health Brigade, and Head of Corps, Royal Australian Army Dental Corps. He was first appointed Head of Corps from 2021 to 2024 and was reappointed in 2026.
His military experience includes an exchange with the British Army on Exercise Long Look, and deployments as part of a Role 2 Hospital to Papua New Guinea on Exercise OLGETTA WARRIOR and to Bougainville on Operation RENDER SAFE, where he served as the sole dentist. He has also participated in Exercise SAUNDERS.
Tony’s professional interests include improving dental readiness, reducing dental casualties in deployed environments, advancing dental technologies, and strengthening oral health promotion and service efficiency across garrison and deployed settings.
Background: Dental disease is a preventable cause of non-battle morbidity that can degrade individual readiness, consume deployed health resources, and adversely impact operational capability. The Australian Defence Force (ADF) uses the Dental Fitness Class (DFC) to provide commanders with an indication of the risk of a member becoming a dental casualty. While overseas military studies have reported poorer dental readiness among enlisted and lower-ranked personnel, comparable ADF-wide evidence has been limited.
Aim: To describe oral health characteristics, including dental deployability, among serving ADF personnel and examine whether deployability and broader oral health outcomes differ by Service, rank and demographic characteristics.
Methods: This retrospective observational study analysed routinely collected Defence eHealth System dental examination records for serving ADF personnel aged 18 years and older who underwent an initial or periodic dental examination between 1 July 2023 and 30 June 2025. Outcomes included Dental Fitness Class, ADF periodontal assessment, decayed, missing and filled teeth (DMFT), and Basic Erosive Wear Examination (BEWE). DFC was dichotomised as deployable (DFC 1–2) or non-deployable (DFC 3). Multivariable logistic and multinomial regression models estimated adjusted odds ratios, relative risk ratios, 95% confidence intervals and p-values, adjusting for Service, rank, Service × rank interaction, Indigenous status, age category and sex.
Results: Of 61,418 personnel retained for the deployability analysis, 59,553 (97.0%) were dentally deployable and 1,865 (3.0%) were non-deployable. Although the non-deployable proportion was small, it represents a mission-relevant population requiring treatment before deployment. After adjustment, Army personnel had lower odds of deployable dental status than Navy personnel (OR 0.78, 95% CI 0.66–0.91, p=0.002) and Air Force personnel (OR 0.84, 95% CI 0.72–0.98, p=0.030). Officers had higher odds of deployability than enlisted personnel within Navy, Air Force and Army (ORs 1.87–2.48, all p<0.001). Indigenous personnel had lower odds of deployable dental status than non-Indigenous/not-stated personnel (OR 0.60, 95% CI 0.50–0.73, p<0.001).
Broader oral health indicators showed similar patterned inequality. Officers had lower odds of having periodontal pocketing across all Services, while Indigenous personnel had greater odds of periodontal pocketing (OR 0.67, 95% CI 0.60–0.76, p<0.001). Moderate-to-severe tooth wear (BEWE ≥9) increased strongly with age, with personnel aged 55 years and older having markedly higher odds than those aged under 25 years (OR 9.98, 95% CI 9.05–11.00, p<0.001). DMFT burden also increased substantially with age and was higher among Indigenous personnel for DMFT >20 compared with DMFT <5 (RRR 2.15, 95% CI 1.45–3.20, p<0.001).
Conclusion: Dental non-deployability in the ADF is uncommon but not randomly distributed. Army, enlisted and Indigenous personnel demonstrated lower dental deployability, and similar disparities were observed across periodontal status and cumulative caries experience. These findings mirror overseas military cohorts and indicate that dental readiness is not solely an individual clinical issue, but a force health protection and capability concern. Targeted prevention, risk-based recall, early intervention at training establishments and equity-focused access pathways may reduce dental casualties, improve deployment availability and better align dental resources with operational risk.
Partnering with the Veteran Community: Building a Research Ecosystem to Improve Lifelong Health Outcomes for Defence Members and Veterans
Professor Marina Kennerson Kennerson1,2,3, Dr Joanneke Maitz1,2,3, Leon Smith4, Kirsty Chapman4, Dr Patrick Arulanandam4
1ANZAC Research Institute, Concord, Australia, 2Concord Repatriation General Hospital , Concord, Australia, 3Faculty of Medicine and Health University of Sydney, Sydney, Australia, 4National Centre for Veterans’ Healthcare, Concord, Australia
Biography:
Dr Joanneke Maitz is Head of the Burns and Reconstructive Surgery Research Group at the ANZAC Research Institute, Concord Repatriation General Hospital, where she leads a multidisciplinary research program developing regenerative medicine, bioengineering, and innovative technologies to improve outcomes for patients with burns, complex wounds, and reconstructive injuries. Her translational research spans laboratory discovery through to clinical implementation, integrating biomaterials, tissue engineering, and novel therapeutic approaches to address unmet clinical needs. Dr Maitz also leads research into trauma and injury relevant to both military and civilian populations, supported by competitive funding from the Department of Defence. Through close collaboration with clinicians, scientists, engineers and industry partners, her program accelerates the translation of research into practical solutions that improve healing, restore function and enhance quality of life for people living with complex injuries.
The health needs of Defence personnel and veterans are complex, evolving and often extend across the lifespan. Addressing these challenges requires research that is clinically integrated, responsive to community priorities and capable of translating discoveries into meaningful improvements in care.
Established as a memorial to veterans and their families, the ANZAC Research Institute (ANZAC RI) has been embedded within Concord Repatriation General Hospital for more than 25 years, creating an environment where clinicians, scientists and health professionals work together to address real-world healthcare challenges. This model has fostered multidisciplinary expertise spanning ageing, cardiovascular disease, neuroimmunology, neurogenetics, oncology, thrombosis, burns and reconstructive medicine, reproductive health and precision diagnostics.
As part of the Concord veteran health ecosystem, ANZAC RI is strengthening its partnership with the National Centre for Veterans’ Healthcare, Defence organisations and the veteran community to ensure that research priorities are informed by lived experience and aligned with the emerging needs of current and former serving members. This collaborative approach provides opportunities to investigate service-related health conditions, co-morbidities and healthy ageing, while identifying biomarkers, risk factors and new therapeutic strategies that support prevention, diagnosis, rehabilitation and long-term wellbeing.
Importantly, the Institute recognises that improving veteran health requires a holistic approach that extends beyond individual diseases to encompass physical, psychological and social determinants of health. By integrating clinical care, translational research and community partnerships, ANZAC RI aims to support better health outcomes for Defence members, veterans and their families while generating discoveries that benefit the broader Australian community.
This presentation highlights ANZAC RI’s commitment to working alongside the veteran community to co-design and deliver research that addresses the questions that matter most, ensuring that the legacy of service continues to inspire innovation, collaboration and improved healthcare for future generations.
“Research with veterans, not just for veterans.”
Polypharmacy, medication literacy and safety: Co-designing better support for Australian veterans
Dr Sanket Raut1,2, Dr Rebecca Mellor1,3, Dr Andrew Khoo1,4
1Gallipoli Medical Research, Greenslopes, Brisbane, Australia, 2School of Medicine, The University of Queensland, Herston , Australia, 3School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia , Australia, 4Ramsay New Farm Clinic, New Farm , Australia
Biography:
Dr Sanket Raut is a research fellow at the Gallipoli Medical Research (GMR).
He has a background in Medicine (MBBS), Pharmacology (MD) and Neuroscience (PhD). His PhD research was on development of new drugs targeting trauma memories for treatment of PTSD.
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.
His current research explores patterns of psychotropic 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-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.
Introduction
Ex-serving Australian Defence Force (ADF) veterans experience high rates of chronic physical and mental health conditions, resulting in substantial medication use and increased risk of polypharmacy. Polypharmacy is associated with adverse drug events, medication interactions, hospitalisation, and reduced quality of life. While health literacy is a key determinant of safe medication use, little is known about medication literacy among Australian veterans. This study aimed to examine veterans’ knowledge and practices regarding safe medication use, identify treatment preferences, and co-design recommendations for a veteran-focused educational resource to improve medication safety and health outcomes.
Methods
A mixed-methods co-design study was conducted in two phases. Phase 1 comprised a national online survey of ex-serving ADF veterans aged over 18 years who regularly used two or more prescribed medications for physical and/or mental health conditions. The survey collected demographic information and assessed medication knowledge, safety practices, adherence behaviours, and treatment preferences. Phase 2 involved an online co-design workshop with veterans who completed the survey and volunteered to contribute to the development of an educational resource. Workshop discussions explored barriers and facilitators to medication management, treatment decision-making, and preferred resource formats.
Results
A total of 125 veterans completed the survey. Participants were predominantly male (84%), aged over 50 years (80%), married (74%), and evenly distributed across urban (49%) and rural (51%) locations. Most identified ethnically as Australian (71%), with 25% identifying as Anglo-European and 9% as Indigenous Australian. The majority had served in the Army (65%), and 30% had discharged within the previous decade.
Mental health conditions were common, reported by 71% of participants, with post-traumatic stress disorder (79%), anxiety (77%), and depression (66%) most frequently identified. All participants reported at least one chronic physical health condition, most commonly chronic pain (60%) and arthritis (56%). Polypharmacy was prevalent, with 44% taking six or more prescribed medications daily. Although most participants expressed confidence in managing their medications, gaps in medication literacy remained. Fifteen percent were not aware of potential medication side effects, 25% did not understand drug–drug interactions, and 30% had not discussed medication interactions with a healthcare provider. In addition, medication adherence challenges were common, including forgetting doses (56%) and discontinuing medications due to side effects (41%). Medication disposal practices varied, with only 40% regularly returning unused or expired medications to a pharmacy. Sixty-four percent expressed interest in further education regarding medication safety and treatment options.
Workshop participants confirmed that polypharmacy and poor health literacy are common challenges within the veteran community and may be influenced by military culture. Participants emphasised the importance of supporting self-management, improving communication with healthcare providers, increasing awareness of medication impacts on employment and daily functioning, and promoting safe medication disposal. Recommendations included development of short, accessible educational modules featuring real veterans and clinicians, provision of information about medication interactions and non-pharmacological treatment options, and extension of medication literacy education to serving members preparing for transition from military service.
Conclusions
Ex-serving ADF veterans commonly experience multimorbidity and polypharmacy and demonstrate ongoing needs for medication literacy support despite generally high self-reported confidence in medication management. Co-design findings highlighted the importance of veteran-centred, practical, and accessible educational resources that promote informed decision-making, safe medication use, and engagement with healthcare providers. These findings will inform the development of a veteran-focused educational module that will support safer medication practices and improved health outcomes among Australian veterans.
Precision Psychiatry Approaches to Predicting Ketamine Treatment Outcomes in Veterans with PTSD and Treatment-Resistant Depression
Mr Charles Dodds1,2,3, Dr Rachelle Dawson1
1Zed3 Medical Group, Bruce, Australia, 2Queensland Brain Institute, St Lucia, Australia, 3The University of Queensland, St Lucia, Australia
Biography
Charles Dodds is a doctoral candidate at the Queensland Brain Institute, University of Queensland, and a research assistant at Zed3 Medical Group. His research centres on understanding individual variability in treatment outcomes for post-traumatic stress disorder and depression. Using machine learning techniques applied to clinical data, he identifies predictors of treatment response to inform more precise, personalised approaches to mental health care.
Dr Rachelle Dawson is a clinical psychologist and research associate at Zed3 Medical Group. As a psychologist, she works with adults, including veterans, first responders and elite athletes. Rachelle has expertise working with trauma, including developmental trauma, PTSD, and moral injury. As a research associate, she is involved in research exploring how ketamine infusions with adjunctive psychotherapy work to reduce symptoms of PTSD and depression.
Veterans presenting with post-traumatic stress disorder (PTSD), treatment-resistant depression (TRD), and related psychiatric conditions demonstrate substantial heterogeneity across symptom presentation, trauma exposure, comorbidity, and treatment history. This heterogeneity often causes inconsistent treatment outcomes and can complicate clinical decision-making across pharmacological and psychological interventions.
Recent advances in novel psychiatric interventions, including ketamine infusion-assisted therapies, have expanded treatment options for veterans with complex mental health conditions. However, response to ketamine therapy remains highly variable, highlighting the need for precision psychiatry approaches capable of predicting treatment response outcomes and aiding treatment planning.
This study presents outcomes of latent class growth analysis (LCGA) and predictive modelling techniques to longitudinal clinical data collected from veterans undergoing ketamine infusion therapy with adjunctive psychotherapy. Models incorporate demographic, psychometric, diagnostic, and biological variables to identify clinically meaningful response trajectories and predictors of therapeutic outcome. Primary outcome measures include changes in PTSD symptom severity measured by the PCL-5, and symptoms of depression, anxiety and stress measured by the DASS-21/42. Model stability and generalisability will be evaluated using bootstrap resampling and prospective dataset validation approaches.
Preliminary findings suggest that trajectory-based modelling may identify distinct responder profiles and clinically relevant predictors associated with ketamine treatment outcomes. These approaches may support the development of data-driven clinical decision support tools to enhance personalised treatment planning, optimise resource allocation, and improve mental health outcomes for veteran populations.
Preparing for the Worst: Palliation in the Field and Moral Injury Mitigation
DR / LTCOL Sandeep Bhagat, Dr Melanie Van Twest1
1Headquarters 4th Brigade, Australian Army, Melbourne, Australia
Biography
LTCOL Bhagat is a fellow of the RACGP, AChPM (RACP) and associate fellow of the RACMA. He is the current Head of Unit-Palliative Care and Director Medical Services at Bayside Health, Frankston (VIC). LTCOL Bhagat is a board member of Palliative Care Victoria since 2018. LTCOL Bhagat was commissioned in Jun 2010 as a ML3 SERCAT 5 Medical Officer. LTCOL Bhagat has served overseas on multiple operational deployments. He is posted to 4th Brigade as the Senior Medical Officer.
MAJ Van Twest is a long-serving member of the Army Reserve, having first joined as a soldier and becoming a Warrant Officer Clerk Two in administration before being commissioned as a medical officer. She is a Fellow of the Australian College of Rural and Remote Medicine with skills in primary care, emergency medicine and anaesthetics. MAJ Van Twest wintered on Macquarie Island in support of the Australian Antarctic Program and has a special interest in healthcare in austere environments. She currently works as a Rural Generalist Anaesthetist in regional Victoria and is posted to Headquarters 4th Brigade in Melbourne.
The post-World War Two world order is rapidly changing and with it the nature of future conflict. Experiences from the war in Ukraine show us that after many decades of access to air and technical superiority, with rapid aero-medical evacuation and high casualty survival rates, it is very likely that the next war to which the Australian Defence Force is committed will be a near-peer conflict dominated by drone technology that will greatly restrict air and surface transport of all kinds.
In such situations the ability to extract and treat critically wounded personnel in a timely way will be heavily compromised, leading to increased mortality in the field and echoing the experiences of major 20th Century conflicts. In this context it will become necessary to have options for providing humane and dignified end-of-life care for those with non-survivable wounds or where evacuation of critically injured personnel is prevented by the operational constraints and resource mismatching. Such measures will require structured training of military members providing care at all levels to prepare them both clinically and mentally for the decisions they may have to make and the outcomes they may have to witness.
This presentation will discuss a proposed process for palliation of critically wounded personnel in the field in such unavoidable circumstances, including pre-prepared clinical equipment and drugs that would be used in accordance with strict protocols in order to avoid the decision burden morally, ethically and professionally. It will also examine the moral injury and emotional trauma that may arise for those providing care in such a situation, and discuss how we can potentially train to prepare for and mitigate that psychological damage in the hope of reducing its long-term effects, benefitting those members and preserving capability.
Prevention as Force Protection: The Strategic Cost of Failing to Protect the Health and Wellbeing of the Defence Workforce
Dr Andrew Mathieson1
1Australian National University, Canberra, Australia
Biography
Dr Andrew Mathieson is a Senior Lecturer in Health Science at the Australian National University (ANU), specialising in health systems, public health, environmental health, disaster risk reduction, and workforce capability. With more than 40 years of professional experience across academic, operational, and international settings, he brings a unique interdisciplinary perspective linking prevention, force protection, and organisational resilience.
Andrew has worked extensively across Australia, the Pacific, Africa, the Middle East, and Asia, supporting governments, defence personnel, NGOs, and communities in areas including public health preparedness, environmental health systems, risk communication, emergency management, and health workforce development. His international work has included projects and training activities in Iraq, Afghanistan, Lebanon, Kenya, Malawi, Tanzania, Fiji, Papua New Guinea, Timor-Leste, Pakistan, and Vanuatu.
Alongside his academic career, Andrew served for more than three decades in the UK Reserve Army, undertaking operational deployments and training missions in complex and high-risk environments. This dual military and academic background has shaped his strong interest in prevention, preparedness, and protecting workforce capability in demanding operational settings.
Andrew is also actively involved in international environmental health leadership, professional education, and global workforce development initiatives through the International Federation of Environmental Health and related professional networks.
Modern defence capability depends not only on advanced platforms and operational readiness, but on the long-term health, resilience, and sustainability of the workforce. Yet prevention in military and veteran health is frequently under-prioritised compared with reactive treatment models. This presentation argues that failure to invest in prevention represents a strategic, operational, and fiscal vulnerability for defence organisations.
Drawing on examples from occupational health, environmental health, mental health, force protection, and public health systems, the presentation explores how preventable harms accumulate across the defence lifecycle. Poor prevention contributes to avoidable injury and illness, rising compensation liabilities, workforce attrition, reduced deployability, and diminished operational effectiveness. These impacts extend beyond serving personnel, affecting families, veteran outcomes, recruitment pipelines, institutional trust, and long-term retention.
The presentation reframes prevention as a capability and readiness issue rather than solely a health issue. It examines how early intervention, risk reduction, health intelligence, and evidence-based workforce protection strategies can strengthen force effectiveness while reducing downstream fiscal pressures. Particular attention will be given to the hidden costs of delayed action, including chronic disease burden, psychological injury, environmental exposures, burnout, and workforce disengagement.
The session will also explore the importance of integrated prevention systems that connect leadership, workplace culture, environmental health, training, and organisational stewardship. In an era of increasing strategic uncertainty and workforce pressures, prevention must be viewed as a core component of defence resilience and national security.
Ultimately, the presentation argues that failing to prevent today creates operational weakness and unsustainable costs tomorrow. Prevention is not an optional add-on to capability — it is fundamental to protecting people, sustaining readiness, and preserving the future defence workforce.
Project TrainWell: From Fragmentation to Resilience – Mapping Mental Health and Wellbeing Training to Strengthen Workforce Capability in Defence
Dr Joima Pariani1, GPCAPT Joleen Darby1
1Department Of Defence, Australia
Biography
Group Captain Joleen Darby is a Royal Australian Air Force medical officer, General Practitioner, and senior leader in Defence mental health. As Director, Mental Health and Wellbeing Initiatives, she leads enterprise strategy and implementation across mental health, suicide prevention, and alcohol and other drugs. She has held key leadership roles including Director in the Office of the Deputy Surgeon General, Chief of Aeromedical Evacuations, and Commanding Officer of the Institute of Aviation Medicine. A recognised Senior Aviation Medical Officer, she brings deep expertise in aviation, occupational, and operational medicine, underpinned by extensive frontline and command experience. She was awarded the Conspicuous Service Cross for exceptional leadership and clinical care following the 2009 Ashmore Reef disaster. She champions innovation in health systems, contributing to health informatics, Responsible AI, and digital transformation initiatives.
Dr Joima Pariani is Assistant Director, Mental Health and Wellbeing Initiatives, leading Project TrainWell. She previously led key aspects of Defence’s collaboration with the Australian Human Rights Commission, contributing to cultural reform. She holds a PhD from Victoria University focused on belonging and engagement. Her work promotes inclusion, wellbeing, and community connection, recognised in the 2024 VU Leadership Awards and the 2025 Women of Colour in STEM Emerging Leaders.
Mental health and wellbeing training is a critical enabler of workforce readiness and psychological resilience in military environments. However, within large and complex organisations, training systems often evolve organically in response to emerging demands rather than through deliberate enterprise design. While this enables responsiveness at a local level, it can also result in fragmented delivery, inconsistent governance, and limited visibility of how training activities align across the workforce.
As mental health and wellbeing training continues to expand across Defence, there is increasing complexity in how training is developed, delivered, and experienced. Training with similar intent may exist across different organisational areas, with varying alignment in content, delivery, and governance. In the absence of a consolidated enterprise view, it becomes difficult to understand how training interacts across the workforce lifecycle, whether it is proportionate to risk and role, and how effectively it supports capability outcomes. This creates a system-level gap, limiting the ability to ensure training is aligned, proportionate, and effective in supporting workforce capability.
Project TrainWell was established within the Mental Health and Wellbeing Branch to address this gap. The project responds to the need for a structured, Defence wide understanding of mental health and wellbeing training as an integrated system, rather than a collection of individual initiatives. Its aim is to develop an enterprise level Training Needs Analysis to inform a coherent, risk informed training continuum aligned to workforce requirements, operational context, and career progression.
The project adopts a structured, requirements led approach, beginning with comprehensive mapping of the current training landscape. This includes all mental health and wellbeing related training delivered across Defence, spanning centrally governed programs as well as those developed or delivered across Groups, Services, and other functional areas. The intent is not to assess programs in isolation, but to understand how they collectively contribute to workforce capability.
Methods combine documentary analysis, training inventory data, and targeted stakeholder engagement with training owners, subject matter experts, and delivery stakeholders. Information is captured across four domains, such as training content and intent, delivery ownership, target cohorts across the workforce lifecycle, and governance arrangements. This approach enables both descriptive mapping of the training environment and qualitative insight into how training is operationalised in practice.
Preliminary findings indicate a training landscape that is extensive but highly distributed. Multiple initiatives address common themes such as psychological resilience, mental health awareness, leadership responsibilities, and peer support. However, these programs are often developed independently, resulting in variation in emphasis, delivery modality, and oversight. This fragmentation limits our ability to ensure training is effective, proportionate, and aligned to workforce need.
A key emerging gap is the absence of an enterprise framework linking training to defined workforce needs, risk profiles, and career stages. This contributes to duplication in some areas, while creating potential gaps in others, particularly where ownership or accountability is unclear. Variability in messaging also presents a risk of inconsistent interpretation of mental health and wellbeing principles across the organisation.
Stakeholder engagement further highlights that while individual training initiatives are often well designed and contextually appropriate, there is limited visibility of how these components interact as a system. Opportunities for alignment, sequencing, and rationalisation are therefore not consistently realised.
Project TrainWell applies an enterprise systems approach to mapping mental health and wellbeing training, generating early insights into the challenges of managing distributed training environments at scale. It highlights how strengthening visibility, governance, and alignment can support more coherent and effective training systems, with broader relevance across Defence, the Australian Public Service, and other large organisations seeking to integrate fragmented training landscapes.
Prophylaxis and personal protective measure compliance and barriers in Australian military personnel: lessons from a 2022 scrub typhus outbreak
Samantha Belonogoff1,2, Dr Rebecca Suhr1, Dr Fiona McCallum1, Dr James Smith1,2, Professor Dennis Shanks1
1Australian Defence Force Malaria and Infectious Disease Institute (ADFMIDI), Gallipoli Barracks, Enoggera, Australia, 2Queensland Health, Brisbane, Australia
Biography
Captain Samantha Belonogoff, RAAMC, is an Infectious Disease Researcher (IDR) at the Australian Defence Force Malaria and Infectious Disease Institute (ADFMIDI). She began her ADF career as a Nursing Officer (RAANC) and from 2021 served as ADFMIDI’s Research Nursing Officer (ARES), before transferring to her current ARA role as IDR in late 2025. Her research focuses on vector-borne disease surveillance, clinical epidemiology, and infectious disease prevention in military populations. She has led and contributed to multiple research projects examining microbial carriage, outbreak response, and force health protection, with findings presented at national and international conferences and published in peer-reviewed journals.
Captain Belonogoff has experience across both military and civilian health systems, including public health epidemiology and nursing practice and multi-site clinical trials coordination within the Department of Health. Her nursing background continues to influence her research today, with a clinical and population-health lens applied throughout her work. Her current role integrates laboratory, field, and epidemiological approaches to inform policy and improve force health protection for Defence personnel.
Background: Vector-borne diseases (VBD) pose a persistent operational threat to military personnel. Despite mandatory personal protective measure (PPM) doctrine, compliance data from Australian Defence Force (ADF) personnel remain limited.
Purpose: To quantify PPM compliance and identify barriers among case and exposed non-case infantry personnel following a 2022 scrub typhus outbreak at Cowley Beach Training Area (CBTA), Queensland.
Materials and Methods: A mixed-methods investigation examined compliance patterns and barriers among n=72 personnel (15 cases, 57 exposed non-cases) from Brisbane and Townsville-based infantry battalions using structured questionnaires and semi-structured interviews. Thematic analysis of free-text responses was conducted (Braun & Clarke, 2006) to generate a binary coding matrix of common barriers. Fisher’s Exact Test compared barrier reporting by case status.
Results: Repellent application was 100% across all cohorts; however, 42.3% (n=30/71) did not maintain the recommended 6-hourly DEET reapplication schedule. Permethrin compliance was 0% in Townsville cases due to infrastructure absence. Doxycycline completion was 0% in Brisbane cases (0/8) and 28.6% in Townsville cases (2/7). Five barrier themes were identified: doxycycline non-compliance (70.8%), equipment and logistics barriers (41.7%), operational/tactical constraints (23.6%), cultural and organisational factors (22.2%), and knowledge and education gaps (23.6%). Civilian repellent brands were used by 73.6% of participants, reported separately as a substitution behaviour rather than a coded barrier theme. Forgetfulness (p=0.001**), repellent concerns (p=0.002**), equipment barriers (p=0.001**), permethrin access (p=0.010*), and operational constraints (p=0.036*) were significantly more prevalent among cases.
Conclusion: PPM non-compliance in this cohort reflects systemic, logistical, and knowledge gaps as much as individual behaviour. Prioritised recommendations include mandating permethrin infrastructure, reinstating Directly Observed Therapy (DOT) for doxycycline, issuing elevated sleeping equipment, and embedding reapplication schedules into unit routines. Passive protection strategies and command-reinforced routines are essential to sustain force health protection in endemic training and operational environments.
Psychological Preparedness as a Military Capability: An Integrated Approach to 21st Century Psychological Challenges
Dr Kylie Tuppin1, Dr Maureen Montalban1
1Defence, Canberra, Australia
Biography
Kylie Tuppin is a clinical psychologist with a background in military psychology, working in mental health and occupational psychology roles and in capability management. She holds a PhD in Organisational Psychology, and Masters degrees in Clinical Psychology and War Psychiatry. She is the Managing Director of KT Psychology and Consulting, where she works with people managing a wide range of psychological concerns, and consults in psychological selection and personnel management, including leadership and high-performance development. She also holds a strong interest in individual and organisational wellbeing practices. Kylie has served for more than 25 years in the Australian Army as a psychology officer, and throughout her career has gained expertise in strategic personnel and health policy, recruitment and selection, clinical assessment and counselling, and service delivery management. She has deployed several times in support of military operations to war zones, peacekeeping and disaster responses.
Military systems have long recognised the importance of physical readiness, yet psychological preparedness remains less consistently defined, measured and embedded across force generation, deployment and recovery cycles. International military and grey literature increasingly describes psychological readiness as more than individual resilience: it includes anticipatory preparation, realistic stress exposure, leader capability, cohesive teams, family and social supports, ethical command climates, and organisational systems that identify and respond to cumulative strain. Published military psychology research similarly highlights the role of mental health literacy, unit cohesion, leadership, training realism, sleep and fatigue management, peer support, and post-deployment reintegration in sustaining operational performance and wellbeing. Psychological preparedness encompasses all of this and more, and has a significant effect on the mobilisation of people to support a military effect. However, the Australian Defence Force (ADF) has historically developed and applied psychological readiness, risk assessment and resilience measures in siloed, Service-specific ways. Without a Defence-wide framework, complex legal, ethical, operational and clinical considerations are not uniformly understood, and the capacity to be psychologically prepared is thus limited for both Defence, and the nation more generally.
This presentation explores the development of an ADF Psychological Preparedness Framework and how it might apply for both today and into the future. It will cover the following three areas:
- The concepts of psychological preparedness as it is currently understood. This includes the development of a specific Psychological Preparedness definition, and contributions to psychological preparedness including the actions taken to plan, organise, train, and practice to build and sustain the psychological capabilities necessary to prevent, protect against, mitigate the effects of, respond to, and recover from psychological threats. It is mapped against some of the recognised issues currently facing the ADF as defined in the latest Defence Strategic Review. It also explores an argument for considering psychological preparedness beyond just the military, to include the nation as a whole.
- A model for considering the concepts of preparedness. This includes the classic three preparedness questions of:
i. Readiness for what?
ii. For when?
iii. And of what?
These question are then mapped against the ADF defined concept of psychological preparedness. Specifically considered are points such as assumptions, the metrics and analysis of preparedness, risks, trade-offs and recurring tensions in preparedness theory, and how this looks when applied to psychological preparedness. This consideration is stratified at several levels – individual, team, unit, Service.
3. The establishment and work of the Defence Health Expert Network in Psychological Preparedness, including the development of guiding principles for psychological preparedness, and how programs both within the ADF (such as BattleSMART) and external (such as iCover) contribute to psychological preparedness and integrate with other elements of military preparedness.
The presentation will argue that psychological preparedness should be treated as a core component of military readiness rather than a downstream health intervention. The central proposition is that psychologically prepared forces are not simply less likely to become unwell; they are more likely to adapt, decide, recover and perform effectively under conditions of uncertainty, threat and sustained demand.
Reconceptualising Mental Health Screening in Military Populations: The ADF Experience
Dr Maureen Montalban1
1Joint Health Command, Australia
Biography
Colonel Maureen Montalban is a senior military psychologist and Director of Military Mental Health and Psychology within Joint Health Command, Australian Defence Force. With over two decades of service since 2004, she provides strategic leadership and expert advice to Defence senior leaders on mental health policy, resilience, operational readiness, and psychological support across the ADF.
Colonel Montalban also serves as Head of Corps for the Australian Army Psychology Corps, advising Army senior leaders on the Australian Army Psychology Corps capability, undertakes workforce advocacy, maintains Corps history and sustains esprit de corps. Her career spans tactical, operational, and strategic roles, including deployments to Timor-Leste, the Solomon Islands, and the Middle East as part of Psychology Support Teams.
She holds a PhD from the Australian National University, alongside qualifications in public health and health psychology. Her research interests and expertise lies in military psychology, military sociology and gender culture.
Background: Mental health screening has been a longstanding component of military health systems, including within the Australian Defence Force (ADF), where it has been implemented since 1989 to identify personnel at risk of mental health concerns and facilitate early intervention, education, and support. The ADF Mental Health Screening Framework (MHSF) extends beyond traditional screening definitions by utilising a comprehensive, multi-faceted mental health screening continuum (a screening-plus model) that extends beyond symptom detection to include psychoeducation, clinician interviews, and structured follow-up.
Aim: This paper uses the ADF MHSF as a case study to critically examine the role and effectiveness of mental health screening in a military population. Drawing on contemporary literature and Defence policy, it aims to explore the extent to which population-level screening contributes to early identification, engagement, and intervention, while considering known limitations such as variable tool validity, under-reporting, and uncertain long-term outcomes.
Method: This study draws on a narrative review of contemporary peer-reviewed literature on mental health screening in military and high-risk occupational populations, alongside analysis of Defence policy and practice as outlined in the ADF MHSF. The MHSF is examined as a case study of a comprehensive, multi-point screening model incorporating psychometric tools, psychoeducation, and clinician-led interviews across the service lifecycle. Evidence regarding screening validity, treatment uptake, and outcomes is synthesised to critically evaluate the effectiveness, limitations, and broader functions of mental health screening within this integrated framework
Results: The contemporary evidence base presents a paradox. Systematic reviews and military studies consistently indicate limited efficacy of population-level mental health screening in improving clinical outcomes, treatment uptake, or prevalence of mental disorders. Screening tools demonstrate variable psychometric reliability, high rates of false positives, and low treatment initiation following identification. Furthermore, organisational screening contexts may contribute to under-reporting due to stigma, career concerns, and perceived lack of confidentiality—factors exacerbated in hierarchical military environments. These findings have influenced allied nations differently: for example, the United Kingdom has discontinued routine screening following evidence of ineffectiveness, while the United States, Canada and New Zealand maintain structured programs with varying degrees of integration and follow-up.
In contrast, the ADF MHSF illustrates a more comprehensive model of screening that integrates questionnaires with psychoeducation, clinician interviews, and follow-up, potentially enhancing engagement and contextual understanding of risk. While the effectiveness of this multi-faceted approach on mental health outcomes remains unclear, it highlights the broader functional role of screening beyond detection alone.
Conclusion: The ADF MHSF demonstrates a broader, systems-based approach that extends beyond symptom detection to include engagement, psychoeducation, and early intervention. While the impact of this multi-faceted model on long-term mental health outcomes remains unclear, it offers a pragmatic framework for addressing known limitations of traditional screening. Ongoing evaluation is required to determine its effectiveness, cost-efficiency, and potential unintended consequences, and to inform the future design of mental health strategies in military and other high-risk occupational settings.
The opinions expressed in this publication are that of the authors/presenters, and not of the Department of Defence.
Remote Mountain Medicine: Lessons from the Himalayas for Military Care
Dr Rebecca Carpenter1
1Raaf, Australia
Biography
SQNLDR Rebecca Carpenter is a RAAF Medical Officer (MO) currently posted to 3 Aeromedical Evacuation Squadron (3AES) at RAAF Base Amberley. She joined the RAAF in 2003 initially as an Air Defence Officer (now Air Battle Manager) before undertaking medical school via the Graduate Medical Scheme graduating in 2015. As an MO, she has had postings to the Institute of Aviation Medicine, 1 Expeditionary Health Squadron and the Aeromedical Evacuation Control Centre at Headquarters Joint Operations Command prior to posting to 3AES at the beginning of this year. She has deployed on OPs SLIPPER, ACCORDION, ARGOS, SURPAT and the Afghanistan Non-combatant Evacuation.
Background
From March to May 2026, I volunteered as a doctor with the Himalayan Rescue Association (HRA) at a remote medical clinic in Pheriche, in the Khumbu Valley, Nepal. The HRA is a not-for-profit, non-government Nepali organisation founded in 1973. Its mission is to reduce casualties in the Nepali Himalayas through provision of altitude safety education and medical care to trekkers, climbers and Nepali workers.
Located along the Everest Base Camp trekking route at 4260m elevation, the clinic is accessible only by foot, horse or helicopter. It is staffed by three volunteer doctors and three non-clinical staff during the climbing and trekking seasons.
The clinic is austere; equipped with basic bedside diagnostic equipment as well as portable ultrasound and xray devices. There is no pathology capability. There is capacity for four inpatients, with supplemental oxygen provided via solar-powered oxygen concentrators. Intravenous therapies can be provided, however there are no infusion devices, and whilst laryngoscopes and endotracheal tubes are available, there is no ventilator. Foot-powered Gamow bags provide limited redundancy for treatment of severe acute mountain sickness (AMS) in case of no solar power. The pharmacy is relatively well stocked with a variety of emergency and primary health care medications.
Environmental conditions are harsh with average daily temperatures between -15℃ to +4℃ during spring. The clinic is minimally insulated meaning equipment, medications and consumables are routinely exposed to below freezing temperatures potentially compromising efficacy.
Patient demographics and clinical presentations
Between March and May, there were 420 presentations to the clinic, approximately 80% of which were Nepali. Ages ranged between 15 months to 81 years. Tourists, making up the remainder of presentations, were from countries including India, China, Japan, Malaysia, Australia and NZ among others. Language barriers were challenging; compounded by limited wifi for translation.
AMS, High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE), were the predominant presentations to the clinic. HAPE and HACE patients were admitted on average two nights per week. Primary care conditions such as pneumonia, upper respiratory tract illnesses and gastroenteritis were also common.
Patient evacuation
Nepal does not have a national aeromedical evacuation service and weather in the Himalayas is highly variable. Consequently, evacuation of unwell patients is challenging. Patients with minor ailments either wait their illness out or are transported down the valley via horse over several days. Critically unwell patients are opportunistically evacuated via private commercial helicopters with no in-flight medical care. This results in strained clinical resources due to prolonged patient holding as well as increased risk to patients.
Military parallels
Experiences in Pheriche demonstrate strong parallels with military medicine, with the clinic functioning in a manner comparable to a Role 1 facility. Clinical decision-making in resource-limited and austere environments is critical, particularly regarding early patient disposition, evacuation requirements and ceilings of care due to constrained resources and evacuation challenges. The need for prolonged management of unwell patients and for clinicians to operate at the top of their scope is similarly characteristic of military contexts, alongside harsh environmental conditions, complex resupply chains, limited reach-back support and restricted communications. Additionally the multi-national clinic team, with varying training backgrounds and clinical protocols, reflects the complexities of coalition operations. Prior military training and experience proved highly relevant in navigating these challenges whilst also reinforcing transferable lessons applicable to the military’s austere training and deployment environments.
Staying the Course: Demands, Resources, and Career Intentions in the Navy
Dr Monique Crane1, Dr Eyal Karin1
1Macquarie University, North Ryde, Australia
Biography
Monique Crane is a Professor of Psychology at Macquarie University, with a focus on resilience, stress adaptation, and mental health in high-pressure environments, particularly within the Australian Defence Force (ADF). She leads the Resilience Research and Training Systems team and serves as Director of the Performance and Expertise Research Centre, where her work centres on strengthening individual and organisational capability in demanding operational contexts.
Prof. Crane’s research is closely aligned with ADF priorities, examining how personnel can sustain performance, adapt to stress, and maintain wellbeing across the service lifecycle. She has led and contributed to projects focused on prevention, early intervention, and performance enhancement for military populations, with an emphasis on scalable, evidence-based solutions.
Prior to her academic career, Prof. Crane worked within the Australian Department of Defence as a project manager in strategic and operational mental health, providing her with deep insight into Defence systems, culture, and workforce needs. This experience continues to inform her collaborative approach with Defence stakeholders.
In addition to her research, Prof. Crane is committed to teaching and translating evidence into practice, developing programs that support resilience, leadership, and performance across Defence and other high-reliability organisations.
Career sustainability is a priority for the navy, as personnel growth is essential for operational readiness and for responding to competition for navy personnel’s specialized skills. Among military personnel, mental ill-health influences career attitudes. Consequently, career sustainability depends on how effectively workplace demands that contribute to mental health challenges are managed and resourced. This research examined the demands contributing to navy personnel’s intention to leave and willingness to re-deploy, with the individual characteristics and job resources that may moderate these effects. A longitudinal design was applied across the deployment of five navy ships. Deployment was selected as a pivotal career point, potentially affecting career attitudes. One-hundred and thirteen Australian navy personnel responded at three time-points: pre-deployment, mid-deployment, and post-deployment. A series of linear regression analyses were compiled to summarize the main effects of demands and the moderating role of resources and individual characteristics on: (i) intention to leave and (ii) willingness to re-deploy. Interpersonal demands during deployment significantly reduced willingness to re-deploy, while job ambiguity was associated with increased intention to leave the navy. No resources or individual characteristics moderated the effects of interpersonal demands. For other demands, job-based resources, such as job clarity, social support, and belonging, played a moderating role. Individual characteristics, particularly deployment appraisal, autonomous motivation, and sleep quality, also moderated the effects of demands. This synthesis of evidence provides actionable targets for navy retention initiatives and suggests that addressing both organizational and individual factors may help sustain navy personnel in demanding operational contexts.
Suicide prevention and intervention within Defence: Increasing safety, enhancing protective factors and optimising workforce capability through the Defence SafeSide Project’s system-wide approach – where are we three years on?
Ms Jennifer Harvey1, Mr Dean Quirke1, Professor Anthony (Tony) Pisani2, Mr Dan Mobbs3, Dr Sarah Donovan2
1Mental Health And Wellbeing Branch | Dept Of Defence, Australia, 2SafeSide Prevention, United States, 3SafeSide Prevention, Australia,4Department of Defence, Australia
Biography
Jennifer Harvey is the Assistant Director of Suicide Prevention Initiatives within the Mental Health and Wellbeing Branch, Defence, and an experienced psychologist with a diverse background spanning clinical practice and mental health education. Across a 30-year career, she has worked in child protection, rehabilitation, corrections, and disability services, contributing to improved mental health outcomes in complex settings.
For the past 14 years, Jennifer has worked within Defence, where she is dedicated to supporting personnel to optimise their mental health and wellbeing. Her work has included direct clinical support, as well as the development and delivery of early intervention strategies, including awareness and skills-based training programs. She has also contributed to clinical workforce development, with a particular focus on risk assessment and critical incident response.
Jennifer is the Defence SafeSide project lead, overseeing the creation, customisation, and implementation of suicide prevention training across the Defence enterprise.
Dean Quirke brings more than three decades of experience across military service, corrections, government, community development, behavioural change and suicide prevention. A former British Army Royal Engineer, Dean went on to work within the UK prison system before building a career focused on strengthening wellbeing, relationships and social connection. He has spent more than a decade designing and facilitating programs that support men and young people and is a published co-author in the field of domestic and family violence.
Dean now serves as Coordinator, Suicide Prevention Initiatives within the Mental Health and Wellbeing Branch, Department of Defence. In this role, he supports the implementation of the Defence SafeSide Project and other suicide prevention initiatives across Defence. His work combines operational experience, behavioural insights and prevention-focused approaches to strengthen workforce capability and support earlier intervention.
Across remarkably different settings, Dean’s work has been shaped by a consistent question: how do we translate what we know about human behaviour, vulnerability and connection into practical approaches that help people feel safer, seek support and support one another?
Defence is strengthening suicide prevention across the Enterprise through a system-wide, prevention-focused approach that builds workforce capability, resilience, and shared responsibility for safety.
Recognising that suicide prevention extends beyond clinical care, this initiative equips personnel across disciplines to identify distress early, respond effectively, and support recovery.
In partnership with SafeSide Prevention, Defence has implemented a unified model that embeds the SafeSide Framework for Suicide Prevention and the CARE (Connect, Assess, Respond, Extend) model across both health and non-health settings. This approach has been co-designed with people with lived experience, ensuring it is practical, culturally aligned, and grounded in real-world needs. It enabled a shift from risk prediction and stratification to proactive, member-centred prevention-oriented practices.
A key strength of this approach is its multidisciplinary reach, supporting interoperability between clinical and non-clinical workforces, including mental health clinicians, medical officers, health practitioners, leadership, chaplaincy, and wellbeing support personnel. This whole of enterprise approach encompassed changes to policy, clinical practices and workforce education to create shared understanding and a common language.
This presentation will provide an update of the Defence Suicide Prevention Program and it relates to training and insights into the program, now three years since commencement. Sharing key reflections and the evolution to tailored rank and role-based training.
Defence customised in-person training has been tailored for specific ranks and roles ensuring relevance and applicability across operational environments:
• CARE-RF & DRF for mental health clinicians and medical officers, supporting structured, prevention-focused decision-making, including consideration of foreseeable changes and practical safety planning.
• CARE-S for non-mental health practitioners, chaplaincy, and wellbeing staff, equipping them to recognise early signs of distress, initiate compassionate conversations, and facilitate appropriate support, including warm handovers to clinical care.
• CARE-C(A): Advanced skills for command personnel and managers as they support members at risk of suicide, self-harm or harm-to-others. Creating and fostering a positive workplace culture and enhancing unit and individual protective factors as essential components of suicide prevention.
• CARE-C: Skills for early career leaders and managers as they support members at risk of suicide, self-harm or harm-to-others. Fostering a positive workplace culture and building protective factors are promoted as essential components of suicide prevention.
Preliminary evaluation data indicates improvements in workforce confidence, practical application of skills, and attitudes toward shared responsibility in suicide prevention. Early findings also suggest stronger integration between clinical and non-clinical supports, contributing to earlier intervention and more coordinated care.
This initiative represents a significant cultural shift, reinforcing that suicide prevention is a collective responsibility and a core component of workforce resilience and operational readiness. Defence is among the first military organisation to implement this level of system-wide, prevention-oriented reform at scale.
This presentation will share early outcomes, implementation insights, and lessons learned, offering a practical and transferable model for other military and civilian health systems seeking to strengthen suicide prevention capability across diverse workforces.
The association of multi-system conditions on mental health trajectories during naval deployment
Dr Monique Crane1, Dr Eyal Karin1
1Macquarie University, North Ryde, Australia
Biography
Monique Crane is a Professor of Psychology at Macquarie University, with a focus on resilience, stress adaptation, and mental health in high-pressure environments, particularly within the Australian Defence Force (ADF). She leads the Resilience Research and Training Systems team and serves as Director of the Performance and Expertise Research Centre, where her work centres on strengthening individual and organisational capability in demanding operational contexts.
Prof. Crane’s research is closely aligned with ADF priorities, examining how personnel can sustain performance, adapt to stress, and maintain wellbeing across the service lifecycle. She has led and contributed to projects focused on prevention, early intervention, and performance enhancement for military populations, with an emphasis on scalable, evidence-based solutions.
Prior to her academic career, Prof. Crane worked within the Australian Department of Defence as a project manager in strategic and operational mental health, providing her with deep insight into Defence systems, culture, and workforce needs. This experience continues to inform her collaborative approach with Defence stakeholders.
In addition to her research, Prof. Crane is committed to teaching and translating evidence into practice, developing programs that support resilience, leadership, and performance across Defence and other high-reliability organisations.
This study seeks to enhance understanding of mental health trajectories across Navy deployments and the predictors of those trajectories by exploring a range of job design and individual-level factors. Personnel from the Royal Australian Navy were surveyed on pre-deployment, mid-deployment, and post-deployment. At pre-deployment, there were 559 (Mage = 30.19; male = 75.5%) survey responses, N = 112 survey responses could be linked at all time points (retention rate of 20.04% across all time points), and 314 personnel (56.2%) responded at least twice. Latent class growth analyses and growth mixture models were used to determine the trajectories that best fit the data. Separate models were developed for each of the mental health outcomes studied (i.e. psychological distress, perceived resilience, and perceived stress), plus a latent outcome representing a summary measure of psychological ill-health. This latent outcome, estimated as the most comprehensive assessment approach, was used to evaluate all 33 predictors. Consistent with previous work, we identified between two and four trajectories reflecting resilient/low symptom trajectories and heterogeneous symptom trajectories. There were a greater proportion of personnel in the heterogeneous symptom trajectories than identified in previous research. A key contribution of this work is the thorough comparison and ranking of factors that influence the deployment experience. We emphasize the importance of role demands and resources in determining these trajectories when compared directly to self-regulation strategies. Study findings highlight important implications for job design for military personnel during deployment and underscore the importance of adopting a holistic system approach to well-being.
The Brain as the Human Weapon System: A Contemporary International Perspective on Blast Exposure, Brain Health and Military Readiness
Mr Paul Scanlan1
1Vigil Australia, WEST LEEDERVILLE, Australia
Biography
Paul Scanlan is a former Lieutenant Colonel, Australian Army Special Forces, and founder of Vigil Australia – a self-funded social impact organisation focused on blast overpressure and military brain health.
He served operationally across East Timor, Asia, Iraq, and Afghanistan, and domestically on Counter-Terrorism and COVID operations. He commanded from Lieutenant to Lieutenant Colonel, earning the Distinguished Service Medal for leadership in action.
From 2017–2019, he served at Diggerworks, including twelve months as Director, leading the blast overpressure research workstream and representing Australia at NATO and USSOCOM.
He has maintained collaboration since 2018 with the US DoD Warfighter Brain Health Initiative and a global Community of Learners across FVEY and NATO.
He is a member of NATO STO HFM-441 and an observer on the ADF/DVA Expert Advisory Panel on Brain Injury.
His 2026 international program includes the UK National Veteran Brain Health Symposium (presenting alongside UK MoD and US DoD representatives), Imperial College London Blast and Injury Conference (presenting), CIMVHR Blast Exposure Workshop (co-host), Military Health System Research Symposium (accepted poster) and US Department of War Warfighter Brain Health Blast Overpressure Summit, Joint Base Andrews (invited Australian FVEY/NATO panel member).
Background
Blast overpressure (BOP) exposure and its long-term consequences for brain health have moved from contested hypothesis to formally recognised operational risk across allied nations. The evidence base for cumulative sub-concussive exposure – repeated blast events below the threshold of acute clinical injury – has matured significantly since Australian Special Forces exposure data from the SOF Bridges study was first presented in 2025. The global conversation has shifted: the question is no longer whether the risk exists, but how fast allied nations can operationalise their response. For Australian military medicine, understanding that trajectory – and Australia’s position within it – is now the critical task.
The 2026 International Engagement Program
This presentation draws directly on a concentrated 2026 international engagement program spanning six months and four allied nations. The program includes presenting at the UK National Veteran Brain Health Symposium alongside UK MoD and US DoD representatives – including the Director of the US Warfighter Brain Health Initiative; participating in NATO STO HFM-441 sessions; presenting at the Imperial College London Blast and Injury Conference; co-hosting the Canadian Institute for Military and Veteran Health Research Blast Exposure Workshop on closing gaps in exposure measurement, diagnostics, longitudinal monitoring, and family impact across allied nations; presenting at the Military Health System Research Symposium, Kissimmee FL (accepted poster, Session: Sustaining Brain Health Readiness against Emerging Threats in the Operational Environment); and serving as the invited Australian FVEY/NATO panel member at the US Department of War Warfighter Brain Health Blast Overpressure Summit at Joint Base Andrews. Together, these engagements provide a uniquely contemporary view of where allied nations are, what is working, and what remains unresolved.
Key Developments
On 6 May 2026 the US Secretary of War issued a formal directive declaring warfighter cognitive performance a core occupational readiness competency – naming brain health as a lethality issue and mandating a coordinated action plan within 60 days. NATO STO HFM-338 has pre-released its Technical Report, the most significant allied consensus document on mitigating military occupational brain health risks from repetitive blast exposure; successor working group HFM-441 is now active, addressing evidence gaps including indoor range and small-arms cumulative exposure. Emerging research, including Dutch RIVM work on cumulative low-level exposure from smaller weapons in high-frequency training contexts, is extending the evidence base into populations and environments not captured in HFM-338’s primary datasets. Five Eyes partner nations are operationalising exposure governance frameworks, clinical pathways, and readiness monitoring – moving from research to implementation at pace.
Australian Context
Australia has Royal Commission Recommendation 61, a joint Defence-DVA Expert Advisory Panel, and a Senate inquiry committed for 2026. Against the backdrop of allied action – a 60-day US directive, a NATO technical report, and active Five Eyes implementation — the pace of Australian response raises direct questions for military medicine. Are our exposure thresholds calibrated to emerging allied standards? Are clinical pathways connected to current international evidence? Is the architecture in place to connect the operational, clinical, research, and veteran-facing domains into a coherent national response?
Conclusion
The brain is the human weapon system. Protecting it is part of military effectiveness and a direct obligation to those who serve. This presentation synthesises the most current available international intelligence on blast exposure and brain health – from operator experience to research to policy – and applies it to the Australian context. It identifies where Australia aligns with allied best practice, where gaps remain, and what Australian military medicine can do to close them. The evidence base exists. The allied connections exist. The policy mandate exists. The question is whether the governance architecture will follow.
This presentation will be delivered in November 2026 at the conclusion of the full international engagement program described above, ensuring the most contemporary available global perspective at time of delivery.
The Microscopic Enemy: Why the ADF Needs an Interprofessional Tropical Medicine Course for Future Indo-Pacific Operations
Dr Jonathan Begley1,2,3
1HQ 2 BDE, Sydney, Australia, 2Royal Darwin Hospital, Darwin, Australia, 3Monash University, Melbourne, Australia
Biography
Jonathan is an Australian Regular Army anaesthetist and intensive care physician, with clinical appointments at Royal Darwin Hospital. Jonathan joined the Army Reserve as a medical officer in 2011 and completed his anaesthesia specialty training in 2017. He completed a 12-month fellowship in prehospital and retrieval and worked as an anaesthetist in Wagga Wagga, rural New South Wales, before joining the Army Medical Specialist Program (MSP) in 2020 and completing training in intensive care medicine. He is also a grandfathered Graduate of the Chapter or Perioperative Medicine.
Jonathan is a recipient of the Sidney Sax medal as the top Master of Public Health graduate at James Cook University. He is a keen educator, has completed a Graduate Diploma in Adult Education, and has served as an anaesthesia supervisor of training. Jonathan is an Anaesthesia Top-10 paper author, recipient of the Felicity Hawker Medal, and is a member of the board of the Safe Airway Society. He is an editor of Anaesthesia Reports, and adjunct senior lecturer at Monash University.
Australia’s future military operations may occur in an Indo-Pacific environment shaped by strategic competition, climate instability, humanitarian crises, and potential contested island operations. In this context, tropical disease is not a peripheral health issue; it is a force protection, readiness and operational effectiveness problem.
Military history repeatedly demonstrates that infectious disease can degrade combat power as decisively as enemy action. During the Second World War, malaria, dengue, scrub typhus and dysentery affected Allied operations across the Pacific and South-East Asia. Australian, British and American experiences showed that even highly trained forces could become combat ineffective when tropical disease prevention, diagnosis and treatment were inadequate. More recent ADF experience in Bougainville and Timor Leste has reinforced the same lesson: tropical disease prevention depends not only on policy and prophylaxis, but on clinician knowledge, command advice, adherence, surveillance, and early recognition.
This presentation argues that there is a strong case for a dedicated tropical medicine course for medics, nurses and doctors. Such a course should be interprofessional, operationally focused and relevant from point of injury and Role 1 care through to deployed hospital and evacuation settings. Core content should include malaria, dengue, leptospirosis, scrub typhus, melioidosis, diarrhoeal disease, vector control, chemoprophylaxis, and outbreak recognition. The course should allow the translation of public health advice into practical command recommendations.
Comparable allied models exist. The United States offers several structured didactic and field-based courses for military health personnel and many civilian courses exist globally. An ADF course could be regionally and organisationally tailored, supported by the significant expertise within the Malaria and Infectious Disease Institute. It could be delivered through a blended approach: online pre-learning, simulation-based cases, laboratory exposure, field environmental health activities, and scenario-based command advice.
A dedicated ADF tropical medicine course would strengthen readiness for warfighting, peacekeeping, humanitarian assistance and disaster relief across the Indo-Pacific. It would also improve interoperability with regional partners and allies. In future Pacific operations, the enemy may not always be visible. Preparing clinicians to recognise, prevent and manage tropical disease is a practical investment in resilience, operational endurance and mission success.
The Sociotechnical Role of Funeral Professionals in United States Veteran Suicide Surveillance
Prof. Michael Rivera1, Prof D. Alex Hughes1, Justin Norman1, Prof Kathryne Metcalf1, Ella Montgomery1, Leah Black2, Anya Avendano2, Emma Rosas2, Prof. Gino Galvez2, Prof. Erlyana Erlyana2, Prof. Jeremy Ramirez2
1University Of California, Berkeley, United States, 2California State University, Long Beach, United States
Biography
Dr. Jeremy Ramirez is an Assistant Professor in the Department of Health Care Management at California State University, Long Beach. His research focuses on veteran health, suicide prevention, and health information systems.
Dr. Erlyana Erlyana is a Professor in the Department of Health Care Management at California State University, Long Beach. Her work focuses on health care access, underserved populations, health disparities, and social determinants of health care utilization.
Michael Rivera is an Assistant Professor of Practice in the School of Information at the University of California, Berkeley. His work focuses on sociotechnical systems in the fields of politics and healthcare.
Accurate identification and reporting of veteran deaths by suicide are essential for understanding the scope of veteran suicide and informing the allocation of preventative resources. However, determining a decedent’s veteran status and confirming death by suicide is a complex sociotechnical process involving multiple organizations, data systems, and stakeholders. Mortuaries and funeral homes occupy a critical yet understudied position within this process, often serving as one of the first points at which veteran status is identified and communicated following a death.
This paper presents findings from focus groups conducted with mortuary and funeral home professionals across California. To date, two focus groups representing ten mortuaries and funeral homes have been completed. Findings illuminate current practices, barriers, and opportunities related to veteran identification and post-mortem information sharing.
By examining the experiences of funeral and mortuary professionals, this study contributes new insight into an often-overlooked component of veteran suicide surveillance infrastructure. Findings have implications for improving the accuracy of veteran mortality data and offer evidence-informed recommendations for policymakers, public health agencies, and veteran-serving organizations seeking to strengthen veteran suicide identification, reporting, and prevention efforts.
The Tide that does not Turn: Enduring Principles in Military Medicine
BRIG Louise Martin1
1Australian Army, Paddington, Australia
Biography
Brigadier Louise Martin, CSC, is Commander 2nd Health Brigade. A graduate of the Australian Defence Force Academy, the Royal Military College and the Australian Command and Staff College, she has served in a range of senior operational, strategic and command appointments across Army and Defence, including as Director Army Health, Director Logistics Plans, Joint Operations Command, and Chief of Staff, Joint Health Command. Brigadier Martin was awarded the Conspicuous Service Cross for outstanding achievement in command of the 2nd General Health Battalion.
The evolving geopolitical landscape, rapid technological advancement, and renewed focus on interoperability have prompted assertions that military medicine is undergoing fundamental transformation. Framed within the conference theme of “Shifting Tides of Military Medicine,” such perspectives imply that contemporary practice represents a departure from the past. However, drawing on Clausewitz’s enduring observation that the nature of war remains constant while its character changes, it can be argued that the foundations of military medicine are not being reshaped, but rather reaffirmed.
At its core, military medicine has always served a singular purpose: the preservation of fighting strength through minimising the impact of disease and the provision of care for the combat casualty. While modern doctrine emphasises prevention, resilience, and system integration, these are not new priorities but rather extensions of longstanding practice. Across conflicts, the defining task of deployed health systems remains unchanged—stabilising the wounded in austere conditions and returning them, where possible, to duty or onward care.
Despite advances in precision weapons, personal protection, and medical technology, the dominant patterns of injury—penetrating trauma, blast, burns, and psychological harm—persist with striking consistency. Accordingly, the clinical imperatives of care remain familiar: control haemorrhage, secure the airway, support circulation, and move the casualty through a timely continuum of care. Damage control resuscitation and surgery, often framed as modern innovations, instead represent the refinement of principles recognised across generations of conflict—prioritising time, physiology, and pragmatism over perfection.
Framing military medicine as fundamentally “shifting” risks obscuring this continuity and, in doing so, disconnecting contemporary practice from its empirical foundations. Innovation is essential, but it is evolutionary, not revolutionary. The enduring challenge remains unchanged: delivering the right care, at the right time, in the harshest conditions, to prevent otherwise survivable deaths.
In an era preoccupied with change, the real strength of military medicine lies not in reinvention, but in disciplined adherence to principles that, despite changing tides, do not turn.
The Weaponisation of Digital Health
A/Prof Derrick Tin1,2
1University Of Melbourne, Australia
2Serco, ASPAC
Biography
Dr Derrick Tin is an Associate Professor of Critical Care and a US fellowed Disaster Medicine Specialist. His research interests span across both natural, as well as man made disasters with a specific focus on the health impacts of intentional mass casualty events.
Background
Digital health technologies have transformed healthcare delivery through electronic medical records, telehealth, connected medical devices, artificial intelligence (AI), and remote monitoring systems. While these technologies improve efficiency and patient outcomes, they also expand the attack surface available to malicious actors. In modern conflict, healthcare systems are increasingly recognised as critical infrastructure and may represent deliberate operational targets rather than collateral damage.
Methods
This presentation draws upon contemporary literature from cyber security, disaster medicine, counter-terrorism medicine, and conflict health research, including published analyses of ransomware attacks, healthcare cyber incidents, attacks on health systems during armed conflict, and emerging threats associated with AI-enabled technologies.
Results
Healthcare cyberattacks have evolved beyond data theft and financial crime. Ransomware attacks have disrupted hospital operations, delayed treatment, increased morbidity and mortality, and degraded system-wide healthcare capability. Emerging evidence demonstrates the feasibility of manipulating medical images using AI, compromising the integrity of clinical records, and exploiting vulnerable connected medical devices. These threats challenge the traditional information security focus on confidentiality and highlight growing risks to data integrity and availability. For military health systems, disruption of healthcare capability may directly impact force generation, casualty management, rehabilitation, medical evacuation, and operational decision-making.
Conclusion
The weaponisation of digital health represents an emerging health security challenge and a potential component of modern hybrid warfare. As healthcare becomes increasingly digitised, clinicians and military health leaders must recognise healthcare systems as strategic assets requiring protection. Building resilience will require improved cyber literacy, preparedness for degraded healthcare operations, and anticipatory governance frameworks capable of identifying and mitigating the second- and third-order consequences of digital health technologies before they are exploited.
Tourniquet de-escalation by non-medical Defence providers: Rationale, requirements and organisational preparedness for iatrogenic limb ischaemia at scale within mobility contested warfare
Dr Patrick Weinrauch1,2
1Australian Army, Brisbane, Australia
2Counter Terrorism and Operational Medicine, Central Queensland University, Rockhampton, Australia
Biography
Orthopaedic Surgeon
The current Russo-Ukrainian War has exposed limitations in Tactical Combat Casualty Care (TCCC) tourniquet application protocols when employed in the absence of coordinated forward de-escalation measures. Traditional torniquet management protocols, whilst proven within counter insurgency operations, are less suitable for combat environments dominated by extended duration evaluation resulting from contested mobility or longer distance transportation to advanced clinical care. To mitigate the risk of iatrogenic tourniquet ischemia within current and emerging warfare environments, a North Atlantic Treaty Organisation (NATO) expert panel in 2025 recommended extending tourniquet de-escalation interventions to include delivery by appropriately trained non-medical military personnel. Consistent with these recommendations, the recently revised 2026 Joint Trauma System (JTS) CoTCCC guidelines now include an expectation for All Service Member (ASM) proficiency in the conduct of tourniquet de-escalation procedures.
This presentation will deliver the rationale for an organisational policy of universal forward tourniquet de-escalation and how these measures fit within a wider framework of organisational preparedness to manage iatrogenic limb ischaemia in modern warfare. Current CoTCCC guidelines and ADF initiatives to achieve tourniquet de-escalation capability at scale are discussed.
Understanding Burn Injury Requiring Intensive Care Injury in Australia
CDRE Anthony Holley1
1Australian Defence Force, Brisbane, Australia
Biography
Associate Professor Anthony Holley, AM
Bsc. (microbiology) MBBCh. DipDHM. DipPaeds. FACEM. FCICM. AFRACMA
CDRE Holley is a Senior Staff Intensivist at the Royal Brisbane and Women’s Hospital. He is an Associate Professor at the University of Queensland. CDRE Holley is a Former ANZICS President and served on the Board and Executive for more than a decade. He is a former Senior Examiner for the Fellowship of the College of Intensive Care Medicine and serves as a representative for the National Blood Authority Critical Care Group in developing the Australian Patient Blood Management Guidelines.
He is currently serving in Joint Health Command, as the Principal Consultant Trauma to the Surgeon General Australian Defence Force (SGADF). This position is responsible to the SGADF for advising on ADF Trauma Care capabilities and strategy. CDRE Holley, previously served as the Director Navy Health-R and has deployed on active service on multiple occasions, including Bougainville, Timor, several tours to Afghanistan, four Iraq tours, Border protection, Persian Gulf maritime duty in HMAS Toowoomba, Bushfire assist and as the Queensland COVID-19 Task Force Senior Medical Officer. He was the recipient of the Navy Matthew Davey award, facilitating the study of deep-frozen blood products and assisted with integration of this technology into the ADF.
A survey of practicing intensivists was undertaken demonstrating the heterogeneity of practice in caring for critically injured burn patients in Australia. This then informed the development of a dedicated Critical Care Burns Registry, employing Delphi methodology. A RedCap registry, including a potential 192 data elements, across 13 specific domains, was created. All six Burn Referral ICUs in Australia contributed to the collection of prospective data from June 2025 to July 2026. More than 150 patients have been entered into the registry. This presentation will provide a detailed understanding of patients with burn injury in Australia, requiring intensive care. Demographics, extent of burn injury, complications, Length of stay, duration of mechanical ventilation, resuscitation strategies and outcomes will be described.
Understanding intensive care requirements for burn patients is important, both in the civilian and military environment. The registry will be useful in informing health planning and intensive care requirements in contemporary conflict, where burn injury will likely be more prevalent.
Understanding Vulnerability to Sport-Related Burnout in High Performing Young Adults: the contributions of ADHD Symptoms, Training Load and Perceived stress
LCDR Megan Hoare1
1Navy, Mosman/NSW, Australia, 2James Cook University, Townsville, Australia
Biography
LCDR Megan Hoare is a Registered Nurse and Psychology Honours student at James Cook University with over 17 years of clinical leadership and education experience across civilian and military healthcare. She is currently serving as a Nursing Officer in the Royal Australian Navy as the SO2 Clincial Development in the Professional Development Organisation.
Her clinical background includes trauma, emergency and general nursing, as well as simulation based education and design. Megan has a long standing interest in mental health, neurodivergence, resilience and human performance which is informed by both her professional experience, career aspirations, and an extreme love of sports.
Her honours research, completed in September, examines the relationship between ADHD symptoms, perceived stress, training load and sport related burnout in young adults. She hopes that by identifying factors that contribute to burnout, she can inform strategies to support mental health, wellbeing and sustainable performance in high performance settings, including the military.
Megan intends to pursue Masters of Clinical Psychology in 2027 and transfer employment categories from Nursing to Psychology. She has a long term goal of specialising in military and veteran mental health and well being by contributing to research that improves psychological outcomes across high performance populations.
Background
Burnout is increasingly recognised as a significant threat to mental health, wellbeing and performance in high-performance environments. Emerging adult athletes may be particularly vulnerable due to escalating training demands, developmental transitions and psychosocial stressors. While excessive training load has traditionally been viewed as a key contributor to athlete burnout, growing evidence suggests that individual psychological characteristics, including attention-deficit/hyperactivity disorder (ADHD) symptoms and perceived stress, may also influence vulnerability. A broader understanding of these factors may support earlier identification and targeted prevention strategies in sport and other high-performance domains.
Aim
To examine whether ADHD symptoms predict sport-related burnout in emerging adult athletes after accounting for training load, and to determine whether perceived stress contributes additional explanatory value.
Methods
This Honours study uses a cross-sectional survey design. Emerging adult athletes (18–25 years) participating in organised sport are being recruited via sporting organisations and social media. Participants complete validated measures of ADHD symptoms, perceived stress, training load and athlete burnout, alongside demographic and sporting characteristics. Hierarchical multiple regression analyses will assess the unique contribution of ADHD symptoms and perceived stress to burnout after controlling for training load and relevant covariates.
Results
Data collection is ongoing at the time of submission. Analyses will be completed prior to presentation. It is anticipated that ADHD symptoms and perceived stress will demonstrate significant independent associations with athlete burnout, beyond the effects of training load. The relative contribution of each predictor will be reported.
Discussion
This study seeks to extend current models of athlete burnout by integrating psychological factors alongside traditional training-related variables. Findings are expected to inform screening and early intervention strategies aimed at enhancing mental health, well being and sustainable performance in emerging athletes. Although focused on a sporting population, the results may have broader relevance to other high-performance settings, including military and emergency services, where sustained cognitive and physical performance is critical.
Keywords
ADHD; athlete burnout; perceived stress; training load; emerging adulthood; mental health; high-performance
Veteran Mental Health and Wellbeing: Innovation, Engagement, and New Approaches to Care
Dr Rory Morris-Butler1
1Soul Medicine VAR, Sydney , Australia
Biography
Dr Rory Morris-Butler MBBS, MRCPsych, FRANZCP (Maj Retd) is a Consultant Psychiatrist, former British Army Medical Officer, and Founder and CEO of Soul Medicine VAR, a veteran-led psychiatric service supporting current and former Australian Defence Force personnel across Australia.
After completing his medical degree at Norwich Medical School in England, Dr Morris-Butler undertook specialist psychiatry training through the South London and Maudsley NHS Foundation Trust and gained Membership of the Royal College of Psychiatrists in 2017. He relocated to Australia in 2018 and subsequently became a Fellow of the Royal Australian and New Zealand College of Psychiatrists.
Dr Morris-Butler served for 12 years in the British Army Medical Corps, including deployment to Afghanistan, where he provided frontline trauma and primary healthcare support to military personnel and local forces. He has worked across community, inpatient, liaison, forensic, rural, remote, occupational, and military psychiatry settings in both the United Kingdom and Australia.
He has a particular interest in veteran mental health, trauma, military psychiatry, innovative psychological interventions, and improving access to culturally informed care for veterans and serving personnel.
Military service can expose individuals to prolonged stress, trauma, operational demands, moral injury, and repeated psychological strain. While many serving and former Australian Defence Force (ADF) members transition successfully following service, others experience ongoing mental health challenges that may affect wellbeing, relationships, identity, employment, and day-to-day functioning.
Despite increasing awareness surrounding veteran mental health, many individuals remain reluctant to engage in traditional treatment pathways. Barriers such as stigma, distrust, fear of judgement, treatment fatigue, geographic isolation, and difficulty revisiting traumatic experiences may contribute to delayed help-seeking or disengagement from care altogether. This highlights the importance of developing approaches that are accessible, psychologically safe, and responsive to the unique experiences of veterans.
This presentation explores emerging approaches to veteran mental health and wellbeing, with a focus on improving engagement, accessibility, prevention, and early intervention for current and former serving personnel. It will examine how veteran-informed and trauma-aware models of care may assist in creating more effective pathways for individuals who may not respond well to conventional treatment environments, while also supporting resilience, recovery, and long-term wellbeing.
The presentation will discuss the importance of culturally aware, compassionate, and accessible models of care, as well as the growing role of early intervention, telehealth, multidisciplinary collaboration, peer-informed support frameworks, and recovery-focused approaches within veteran mental health services. It will also explore emerging brief intervention models designed to reduce distress and intrusive trauma symptoms without requiring prolonged verbal recounting of traumatic events, particularly for veterans who may struggle to engage with conventional therapies.
Importantly, the discussion will move beyond diagnosis alone and consider mental health within the broader context of wellbeing, identity, social connection, occupational functioning, family relationships, and transition beyond military service. The presentation will highlight the importance of psychologically safe environments and proactive systems of support that encourage individuals to seek assistance before crisis occurs.
As Australia continues to examine new ways to support veterans and their families, there is increasing recognition that innovation, accessibility, prevention, and early intervention must form part of future mental health strategies. This presentation aims to contribute to the broader discussion regarding how military medicine and veteran health services can continue evolving to better meet the needs of those who have served.
We Train Hard – So Why Don’t We Always Learn? Translating Experiential Learning into Military Medical Practice
MAJ Jeremy Barraclough1
1Army, Sydney, Australia
Biography
Major Jeremy Barraclough has had a diverse career within Army and has served both domestically and on deployments internationally. For service with NATO’s Special Operations Command – Afghanistan he was awarded the United States Army Meritorious Service medal. He holds a Bachelor’s degree in Organisational Leadership from University of New England and a Master’s in Special Operations from the University of New South Wales.
Military health services operate in environments no different from other combat operations which are defined by complexity, uncertainty, time pressure, and risk. Despite extensive training, simulation, and real-world experience, healthcare teams—like their combat counterparts—often encounter recurring issues in communication, decision-making, leadership, and system performance. This presentation argues that the core problem is not a lack of exposure to challenging clinical, training scenarios or real-world actions, but a failure to systematically convert experiences into sustained learning and behavioural change. Drawing on Australian Army training practice and leadership doctrine, this presentation translates the principles of the experiential learning cycle into the context of learning for military medicine and proposes a practical framework to enhance clinical and team performance.
The presentation first highlights a common pattern across combat and other environments: high activity without consistent learning. In military medicine, this could manifest in repeated errors, communication breakdowns during high-acuity scenarios, and limited transfer of lessons from simulations, exercises, or real-world cases into routine practice. Experience alone—whether in a field exercise, simulation lab, or deployed clinical setting—does not guarantee improvement. Learning requires deliberate processing.
The experiential learning cycle—experiencing, reflecting, generalising, and applying—provides a structured method to transform clinical experience into capability. Military medical teams are already proficient at creating realistic and stressful training environments, including simulation-based scenarios, mass casualty exercises, and operational deployments. However, the effectiveness of these activities is often limited by how reflection is conducted. Without structured, facilitated reflection, insights remain superficial or are lost entirely.
This presentation places particular emphasis on the role of debriefing (an analogue to the military After Action Review). It identifies common failure modes that could occur in medical debriefs that closely mirror those seen in military training: dominance by senior clinicians, focus on technical events rather than behavioural and cognitive factors, checklist-style reviews that bypass genuine reflection, and failure to translate identified issues into actionable change. These practices limit psychological safety, suppress junior voices, and reduce the effectiveness of learning.
To address this, the presentation proposes a facilitation-focused approach to clinical debriefing grounded in adult learning principles. Leaders—whether commanders, senior clinicians, or team leads—must shift from instructing to facilitating. Effective debriefs should prioritise inclusive participation, emphasise team behaviours and decision-making under pressure, and guide discussion through a simple, structured sequence: “What happened?”, “So what does that mean?”, and “Now what will we do differently?” This approach enables teams to develop shared understanding, uncover cognitive and emotional drivers of performance, and commit to specific behavioural changes.
Importantly, the presentation emphasises that learning is only realised when application occurs. Clinical and organisational improvements require explicit commitments, accountability, and follow-through across subsequent training and operational cycles. Embedding these practices strengthens clinical governance, enhances team performance, and improves patient safety and outcomes.
The implications for military medicine are significant. By adopting disciplined experiential learning practices, health services can better prepare clinicians and teams for the realities of operational care, improve adaptability under pressure, and reduce the repetition of preventable errors. The presentation concludes that improving how military medical teams learn—from simulation suites to deployed environments—is critical to enhancing both operational effectiveness and patient care