Between 1942 and 1975, the U.S. Army conducted tests with human subjects to study the effects of a variety of agents, including chemical warfare and biological agents. The potential long-term health effects on the test subjects from their exposures have been evaluated periodically, most recently in a report titled Assessment of Potential Long-Term Health Effects on Army Human Test Subjects of Relevant Biological and Chemical Agents, Drugs, Medications and Substances: Literature Review and Analysis (the Report), which was prepared by a contractor to assist the Army with making determinations about providing medical care to former test subjects. In response to a request by the Army, the National Academies of Sciences, Engineering, and Medicine formed a committee that was tasked with examining whether the Report appropriately identified potential long-term health effects from exposure to the test agents and whether an adequate weight-of-evidence approach was used to characterize the strength of the associations between the agents and their potential health effects. The committee was made aware at its first meeting on November 30, 2017, that the Army had already begun to receive applications for medical care and that some determinations may need to be made before the committee's evaluation of the Report was completed. Because of this urgency, the Army developed a process by which applications for medical care will be reviewed, and as a result, the committee was given the additional task of reviewing the Army's Memorandum that describes the approach that will be used by the Army to evaluate agent- and outcome-specific associations. This interim report was prepared to facilitate the Army's deliberations. A review of the Report is presented first, followed by a review of the Memorandum.

Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.

After years at the margins of medical history, the relationship between war and medicine is at last beginning to move centre-stage. The essays in this volume focus on one important aspect of that relationship: the practice and development of medicine within the armed forces from the late nineteenth century through to the end of the Second World War. During this crucial period, medicine came to occupy an important position in military life, especially during the two world wars when manpower was at a premium. Good medical provisions were vital to the conservation of manpower, protecting servicemen from disease and returning the sick and wounded to duty in the shortest possible time. A detailed knowledge of the serviceman's mind and body enabled the authorities to calculate and standardise rations, training and disciplinary procedures. Spanning the laboratory and the battlefield, and covering a range of national contexts, the essays in this volume provide valuable insights into different national styles and priorities. They also examine the relationship between medical personnel and the armed forces as a whole, by looking at such matters as the prevention of disease, the treatment of psychiatric casualties and the development of medical science. The volume as a whole demonstrates that medicine became an increasingly important part of military life in the era of modern warfare, and suggests new avenues and approaches for future study.

The Politics of Wounds explores military patients' experiences of frontline medical evacuation, war surgery, and the social world of military hospitals during the First World War. The proximity of the front and the colossal numbers of wounded created greater public awareness of the impact of the war than had been seen in previous conflicts, with serious political consequences. Frequently referred to as 'our wounded', the central place of the soldier in society, as a symbol of the war's shifting meaning, drew contradictory responses of compassion, heroism, and censure. Wounds also stirred romantic and sexual responses. This volume reveals the paradoxical situation of the increasing political demand levied on citizen soldiers concurrent with the rise in medical humanitarianism and war-related charitable voluntarism. The physical gestures and poignant sounds of the suffering men reached across the classes, giving rise to convictions about patient rights, which at times conflicted with the military's pragmatism. Why, then, did patients represent military medicine, doctors and nurses in a negative light? The Politics of Wounds listens to the voices of wounded soldiers, placing their personal experience of pain within the social, cultural, and political contexts of military medical institutions. The author reveals how the wounded and disabled found culturally creative ways to express their pain, negotiate power relations, manage systemic tensions, and enact forms of 'soft resistance' against the societal and military expectations of masculinity when confronted by men in pain. The volume concludes by considering the way the state ascribed social and economic values on the body parts of disabled soldiers though the pension system.

An Equal Burden forms the first scholarly study of the Army Medical Services in the First World War to focus on the roles and experiences of the men of the ranks of the Royal Army Medical Corps (RAMC). These men, through their work as stretcher bearers and orderlies, provided a range of labour, both physical and emotional, in aid of the sick and wounded. They were not professional medical caregivers, yet were called upon to provide medical care, however rudimentary; they served in uniform, under military discipline, yet were forbidden, as non-combatants, from carrying weapons. Their service as men in wartime, was thus unique. Structured both chronologically and thematically, this study examines both the work that RAMC rankers undertook and its importance to the running of the chain of medical evacuation. It additionally explores the gendered status of these men within the medical, military and cultural hierarchies of a society engaged in total war, locating their service within the context of that of doctors, female nurses and combatant servicemen. Through close readings of official documents, personal papers, and cultural representations, both verbal and visual, it argues that the ranks of the RAMC formed a space in which non-commissioned servicemen, through their many roles, defined and redefined medical caregiving as men's work in wartime.

Doctors played a bigger role in the First World War than in any other previous conflict. This reflected not only the War's unprecedented scale but a growing recognition of the need for proper medical cover. The RAMC had to be expanded to meet the needs of Britain's citizen army. As a result by 1918 some 13,000 doctors were on active service _ over half the nation's doctors.??Strangely, historians have largely neglected the work of doctors during the War. Doctors in the Great War brings to light the thoughts and motivations of doctors who served in 1914-1918, by drawing on a wealth of personal experience documentation, as well as official military sources and the medical press. The author examines the impact of the War upon the medical profession and the Army. He looks at the contribution of medical students, and the extent to which new professional opportunities became available to women doctors.??An insight into the breadth of responsibilities undertaken by Medical Officers is given through analysis of the work of various medical units on the Western Front, demonstrating the important role played by doctors in the maintenance of the Army's physical and mental well-being. The differences between civilian and military medicine are discussed with a consideration of the arrangements for the training of doctors, and an assessment of the difficulties faced by doctors in adapting to military priorities and dealing with new challenges such as gas poisoning, infected wounds and shell shock.??Doctors in the Great War will undoubtedly appeal to general readers, students and specialists in the history of war and society, as well as to those with an interest in the medical profession.??As featured in the Derby Telegraph, Dover Express and Kent & Sussex Courier