This issue of the Journal of Military and Veterans’ Health contains four papers covering a wide spectrum of contemporary and important topics.
Kerry Clifford in his article on the structure of the Defence Health Services (DHS) revisits the thorny issue of command and control and considers whether there are alternative models for that which may lay the groundwork for more effective rebuilding of the DHS. In tackling what has been a difficult and contentious issue for the Australian Defence Force (ADF) over the last few decades, Clifford looks at a number of overseas models and reviews their effectiveness and development. He offers a view that without command being vested in the DHS, the development of a sustainable health system cannot be achieved.
Scott Kitchener considers the logistic challenge currently faced by the ADF in providing Japanese Encephalitis vaccination in the ADF. Noting the difficulty of developing and introducing new vaccines, he traces the history of the development of the original vaccine – JE-VAX© – and its introduction into the ADF and then subsequent concerns related to adverse reactions and cost. Research by the Army Malaria Institute led to the development of an intradermal regime that has the potential to extend the life of current stocks of vaccine. Kitchener finally raises the issue of revisiting the risk assessment to personnel being deployed.
Complex systems demand a focus on systems support to minimise the risk of accident/incident following from individual human error. One component of this that has emerged within the aviation industry is crew resource management (CRM).CRM is routinely delivered to RAAF aircrew but not to other regular users of airframes such as medical staff. In his paper, Jeffrey Stephenson traces the history of CRM training and poses the challenge that it should be introduced as a compulsory training module for ADF aeromedical staff.
All organisations now need to consider the needs of their customers. In traditional healthcare systems, the customers are largely the patients who access services from the organisation. In military health care systems, the organisation itself – as embodied in its command structure – is a key customer. A Defence Force needs fit, healthy and effective personnel, and when their effectiveness is degraded through illness or injury, commands expect them to be restored to fitness quickly and cost-effectively. Dave Parry and Neil Westphalen report on the results of an initial Commanding Officer Satisfaction Survey undertaken in Western Australia and demonstrate how this can be used to improve the provision of health support in ways that not only benefit patients but in ways that enhance the view of the health services amongst command elements. The long-term impact of achieving this is evident.
This edition is rounded out with two Book Reviews. The Toxicology Handbook, a first edition of an Australian text on this subject, is a welcome addition to the lexicon covering poisoning, with a focus on the Australian scene. The second book – Manual of Envenomation and Poisoning: Australian Fauna and Flora – is a purely Defence publication that should surely get wider circulation
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