Delivering balanced blood resuscitation at the point of injury remains a significant logistical challenge in prehospital trauma care. To inform optimal transfusion strategies in austere environments, we conducted a simulation-based study comparing the operational demands of three prehospital transfusion approaches. Three doctor-paramedic teams (six clinicians) undertook a crossover simulation of traumatic haemorrhage, completing all three arms in random order: two units red-cells-in-plasma (RCP), two units red blood cells plus two units thawed fresh frozen plasma (RBC+FFP), and two units red cells plus two units lyophilised plasma (RBC+LyoP). Outcomes were flow time (defined as time from decision-to-transfuse to completion of transfusion of all units), touch time (hands-on time) and process burden (steps, equipment, checks, personnel), timed in real-time and verified on video. A postscenario questionnaire captured user perceptions. All scenarios were completed without missing data. RCP consistently required the least time and operational effort. Median flow times (min:s) were 06:31 (RCP), 12:20 (RBC+FFP) and 16:29 (RBC+LyoP) (p=0.019). Median touch times (min:s) were 02:31 (RCP), 05:21 (RBC+FFP) and 13:03 (RBC+LyoP) (p=0.017). Touch/flow ratios were lowest for RCP (0.39), indicating reduced cognitive and physical load. Standardised process mapping identified 26 steps for RCP versus 46 for RBC+FFP and 52 for RBC+LyoP, reflecting a single set-up and one repetition for RCP compared with multiple repetitions and added reconstitution steps for LyoP. Equipment (4, 10, 12), checks (8, 16, 16) and personnel required (2, 2, 3) followed the same efficiency gradient. Five of six participants rated RCP as optimal for the patient, and all six for the crew; LyoP was unanimously judged as the most demanding. In a simulated trauma scenario, a combined RCP component was delivered more quickly and with substantially less process burden than separate components. These operational gains support combined-component strategies for prehospital haemorrhage resuscitation in both military and civilian settings.

Musculoskeletal injuries (MSKIs) are a leading cause of medical downgrades and reduced operational effectiveness in the UK military. Initial military training presents a high-risk period for sustaining MSKI but also provides an important opportunity for promoting positive health-related behaviours to mitigate future MSKI risk. Self-determination theory suggests that environments supporting basic psychological needs of autonomy, competence and relatedness can foster intrinsic motivation regulation and positive health-related behaviours. However, this link between environment and behaviour remains underexplored in military populations. Weight-related health risk (determined from individual body weight, height and waist circumference) and health behaviours (relative to the Defence Health Behaviour Index) were assessed in 1591 Royal Navy participants (15.6% females; age range 16-61 years), comprising 941 recruits, 190 officer cadets and 460 trained personnel. Participants also completed the Work Behaviour Regulation Questionnaire and Basic Psychological Need Satisfaction and Frustration Scale. Linear regression and Multivariate Analysis of Covariance were used to explore relationships and group differences. Supporting basic psychological needs in the workplace was positively associated with autonomous motivation (p<0.002), which was also associated with more favourable health behaviours (β=0.119, p<0.001). Frustrating psychological needs were associated with controlled motivation (p<0.001) and poorer health behaviours (β=0.082, p=0.006). Trained personnel reported higher weight-related ill-health risk, poorer health behaviours and greater psychological need frustration than trainees (p<0.001). Recruit trainees had the highest psychological need satisfaction but also the greatest introjected and external motivation regulations (driven by internal pressures or external rewards). Female and trained personnel exhibited greater weight-related ill-health risk (OR=0.51, p<0.001). The data suggest that creating need-supportive military environments fosters autonomous motivation-promoting positive health-related behaviours. Establishing need-supportive environments during early-career phases could improve effectiveness in supporting positive health behaviours and mitigating MSKI risk.

Individuals who experience repeated suicidality (ideation, self-harm and attempted suicide) are more at risk of future death by suicide and are often more clinically complex than those with a single suicidality event. Despite this, repeated suicidality appears to be under-researched in military populations. This study compares Australian Army personnel who experience one episode of suicidality to those who experience multiple events using army administrative records from 2012 to 2021. Demographics, event characteristics and outcome variables are presented. While similar demographically, those with multiple events were significantly more likely to engage in: self-harm or suicide attempt, to use alcohol or substances around the event, to avoid military locations and support networks around the event, and were significantly less likely to make a successful return to work. Repeat suicidality represents a key opportunity to reduce suicidality morbidity and mortality in the Australian Army. Enhanced data surveillance, reducing the use of alcohol and substances and targeted management and transition protocols may assist in reducing the incidence. Implications for the army and future research directions are discussed.

Emerging constraints across healthcare systems are driving the need for wearable digital health technologies capable of supporting patient monitoring in remote and extreme environments. 1 Advances in materials science and flexible electronics, including miniaturized sensors, low power systems, and edge AI, are enabling autonomous, real time physiological monitoring. 2 Yet, widespread clinical adoption is still limited by the lack of high-quality, real-world data validating system performance. 3 In defense applications, the demand for these innovations is intensified by the realities of modern conflict. Lessons from the Ukraine war highlight the prevalence of contaminated wounds, traumatic amputations, and delays in accessing advanced care. To meet the needs of prolonged field care and prehospital trauma management, modular and portable platforms must support diagnostics, haemorrhage control, resuscitation, endovascular stabilization, analgesia, organ support, blood substitution, and burn and wound care. Continuous physiological monitoring, beyond the ‘golden hour’, is critical for timely intervention and improved survival outcomes. Promising configurations using advanced materials and hybrid printed electronics (HPE) show potential for wound healing, 4 bacterial detection, 5 and continuous monitoring in extreme conditions. However, unresolved challenges remain, including motion artifacts, sensor drift, and integration issues affecting wearability and durability. 6–8 While academic developments demonstrate technological capabilities, many overlook real world deployment needs. There is an increasing need for lightweight, disposable, standalone wearable systems that can be rapidly deployed and resupplied. These technologies can enhance triage, casualty management, and wound care by delivering real time insights in constrained environments. 9 TNO has been conducting exploratory studies to integrate sensor systems for vital sign monitoring and smart wound care into hybrid printed electronic (HPE) designs. Preliminary findings demonstrate promising levels of accuracy, sensitivity, and long-term durability. The investigated sensing modalities include physical sensors, such as temperature and pressure, for monitoring inflammation, perfusion, and thermoregulation; optical sensors for assessing vascularity, tissue oxygenation, and microcirculatory status; and chemical and biological sensors for detecting pH shifts, bacterial load, and infection-related biomarkers (figure 1). In addition, these sensor systems show potential for evaluating broader physiological parameters such as hydration levels and stress responses. This could enable more comprehensive and adaptive health assessment in dynamic, resource-constrained environments. These integrated sensing platforms aim to support earlier and more targeted interventions. Further development of defense specific designs could accelerate real world data collection and advance adoption in both military and civilian healthcare. HPE technologies provide a scalable, adaptable platform for embedding sensor functionality into wearable patches and smart wound management. Customizable to mission needs, these systems can incorporate battery-less communication, sensor multiplexing, and optimized layouts, offering compact, deployable tools to improve frontline care and medical decision making in high risk, resource limited environments. References World Health Organisation, ‘Health Workforce’ https://www.who.int/health-topics/health-workforce#tab=tab_1. B. Srinivasaiah, 2022, Transformative wearables; how AI and ML are shaping healhtcare innovations. International Journal of Science and Research (IJSR) . 2319–7064 Zou KH, Berger ML. Real-world data and real-world evidence in healthcare in the United States and Europe union. Bioengineering (Basel) . 2024 Aug 2; 11 (8):784. doi: 10.3390/bioengineering11080784. PMID: 39199742; PMCID: PMC11351410. Freedman BR, Hwang C, Talbot S, Hibler B, Matoori S, Mooney DJ. Breakthrough treatments for accelerated wound healing . Sci Adv . 2023 May 19; 9 (20):eade7007. doi: 10.1126/sciadv.ade7007. Epub 2023 May 17. PMID: 37196080; PMCID: PMC10191440 Mohamed Salleh NAB, Tanaka Y, Sutarlie L, Su X. Detecting bacterial infections in wounds: a review of biosensors and wearable sensors in comparison with conventional laboratory methods. The Analyst . 2022; 147 (9):1756–1776. https://doi.org/10.1039/d2an00157h O. Such, ‘Motion tolerance in wearable sensors – The challenge of motion artifact,’ 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Lyon, France, 2007, 1542–1545, doi: 10.1109/IEMBS.2007.4352597 Fruytier LA, Janssen DM, Campero Jurado I, van de Sande DA, Lorato I, Stuart S, Panditha P, de Kok M, Kemps HM. The utility of a novel electrocardiogram patch using dry electrodes technology for arrhythmia detection during exercise and prolonged monitoring: proof-of-concept study. JMIR Formative Research 2023; 7 :e49346. Stuart S, de Kok M, O’Searcoid B, Morrisroe H, Serban IB, Jagers F, Dulos R, Houben S, van de Peppel L, van den Brand J. Critical design considerations for longer-term wear and comfort of on-body medical devices. Bioengineering (Basel, Switzerland) . 2024; 11 (11):1058. https://doi.org/10.3390/bioengineering11111058 Hegarty-Craver M, Davis-Wilson H, Gaur P, et al . Wearable sensors for service members and first responders: considerations for using commercially available sensors in continuous monitoring. Research Triangle Park (NC): RTI Press. 2024. Abstract P08 Figure 1 TNO Smart wound care portfolio for current integration of sensors within dressings and conformability of electronics for wearable patches

Introduction O-GlcNAcylation (O-GlcNAc) is a dynamic post-translational modification involved in numerous cellular processes, including the response to cell stress and survival. It is regulated by a unique enzyme pair: O-GlcNAc transferase, which adds the GlcNAc moiety, and O-GlcNAcase (OGA), which removes it. Pharmacological inhibition of OGA with agents such as NButGT increases intracellular O-GlcNAc levels. Previous results from our laboratory demonstrated its benefit in rats subjected to haemorrhagic shock. 1 This study aimed to assess whether NButGT administration influences haemodynamic parameters during the early phase of haemorrhagic shock in a large mammalian model. Materials and Methods Twenty female Large White pigs (mean age: 4 months) were subjected to a traumatic haemorrhagic shock protocol, comprising bilateral femoral fractures, large muscular contusions and passive exsanguination of 60% of the estimated total blood volume (ETBV) via a jugular catheter. Animals were randomised to receive intramuscular NButGT (10 mg/kg; n = 9) or placebo (n = 8) immediately after exsanguination and again at 90 minutes following the defined time point of 40% ETBV drainage (T0). A control whole blood group (n = 3) underwent retransfusion at T120 min. Continuous haemodynamic monitoring was performed using the PiCCO system. Blood samples were collected at defined intervals, and tissue samples were obtained post-mortem. All procedures concluded with euthanasia six hours after T0. Results NButGT administration led to an increase in O-GlcNAcylation levels in cardiac tissue compared to placebo. No statistically significant difference in overall premature mortality was observed between groups (3 animals for NButGT and placebo groups); however, among the three premature deaths in each group, the mean time to death was 2 h 20 min in control animals and 3 h 00 min in NButGT-treated animals (non-significant difference). Cardiac output was significantly higher in the NButGT group at T90 min (p&lt;0.05), and remained elevated at T120 min, although this did not reach statistical significance (figure 1). Arterial and venous lactate concentrations did not differ significantly between groups. Discussion The observed increase in cardiac O-GlcNAc levels following NButGT administration, together with the associated rise in cardiac output, suggests a beneficial effect of NButGT on cardiac function during the acute phase of haemorrhagic shock. The absence of a significant effect on lactate levels supports the hypothesis that enhanced vascular distribution improves tissue perfusion, thereby increasing the proportion of adequately vascularised tissue and facilitating more efficient lactate clearance from these regions into the venous circulation. Although survival was not a primary endpoint, the longer time to death observed among the three premature fatalities in the treated group may indicate a potential survival benefit, which warrants further investigation. Conclusion This study demonstrates that pharmacological enhancement of O-GlcNAcylation via NButGT improves cardiac output in a porcine model of the acute phase of traumatic haemorrhagic shock. The potential impact on short-term survival now merits further exploration. These findings, reported here for the first time in a large mammal, support continued investigation into inhibition of OGA as a potential adjunct therapy. Future studies should include extended observation periods and the assessment of tissue perfusion markers to better elucidate the therapeutic potential and underlying mechanisms. Inhibition of OGA is not intended to serve as a stand-alone treatment for haemorrhagic shock; however, it may represent a promising adjuvant strategy, capable of prolonging the survival window and allowing patients to reach definitive care in a medical facility. Abstract P04 Figure 1 Mean of cardiac output at each time (Picco monitoring). Error intervals: standard error. * : p-value &lt; 0,05 of unpaired unilateral Student’s t-test between NButGT and Placebo (alternative hypothesis NButGT &gt; Placebo). n =20 Reference Vergnaud A, Dupas T, Aillerie V, et al . Sodium potassium pump: a novel O-GlcNAc protein beneficial in hemorrhagic shock situation. Arch Cardiovasc Dis . 2024; 117 :S55. https://doi.org/10.1016/j.acvd.2023.10.100. Disclosure with Conflicts of Interest The authors have no conflicts of interest to declare. approval by sponsoring authority: French armed forces

Medical evacuation (MEDEVAC) is a crucial component of military healthcare, and the time during which evacuation of the wounded, injured and ill individuals happens is one of the most critical factors. The article focuses on the initial phase of ground evacuation from the Point of Injury to the casualty collection point (CCP). Casualty transport is the combat unit's task, triggered by a 9-liner MEDEVAC request. Two variants are considered: evacuation by means of one armoured vehicle per CCP according to the actual doctrine and potential evacuation using a fleet of autonomous unmanned vehicles. The analysis and comparison are based on data (injury time and position) obtained from computer-assisted exercises, and a simulation combining agent-based modelling and discrete events simulation methods is applied to compare two approaches. The simulation results show that using distributed transport capability, represented by unmanned ground vehicles (UGVs), is more effective because it allows for prioritising casualties based on the injury category. The evacuation effectiveness is quantified in relation to the number of UGVs used. The use of UGVs can improve the care of the wounded, assuming the involvement of advanced technologies, including artificial intelligence. Information about the time and place of casualties is the key for decision makers to achieve the benefit, which should be ensured through potential monitoring of the physical condition of the wounded (body sensors and data transmission in case of injury).