Volume 197 - Issue 6
A battlefield occupational risk not to be ignored
Authors: Anthony D Holley, Daniel J Weber and Michael C Reade
Med J Aust 2012; 197 (6): 331. || doi: 10.5694/mja12.10694
Published online: 17 September 2012
Published online: 17 September 2012
To the Editor: The Australian Defence Force (ADF) ensures outstanding medical care for wounded soldiers by providing skilled field medics, sophisticated evacuation services and excellent in-theatre hospital care.
In Afghanistan, in 2011-2012, among 136 troops deployed for 5 months, our ADF medical team dealt with six soldiers who had had significant exposure to blood:
two sharps injuries incurred while searching insurgents
two sharps injuries to medics providing combat casualty care
two ...
To the Editor: The Australian Defence Force (ADF) ensures outstanding medical care for wounded soldiers by providing skilled field medics, sophisticated evacuation services and excellent in-theatre hospital care.
In Afghanistan, in 2011–2012, among 136 troops deployed for 5 months, our ADF medical team dealt with six soldiers who had had significant exposure to blood:
two sharps injuries incurred while searching insurgents
two sharps injuries to medics providing combat casualty care
two blood-splash incidents while soldiers were assisting wounded enemy.
All soldiers are vaccinated against hepatitis B before deployment. In all six cases of blood exposure, immediately afterwards, the soldiers received appropriate prophylaxis, counselling and blood serological testing.
More than 20 pathogens can be transmitted by sharps, including hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV. The transmission risk of HIV after a hollow-needle injury is about 0.3%, compared with 3% for HCV and up to 37% for HBV.1
Viral infection in the Afghan population is probably low, but 25 years of war have precluded more representative epidemiological studies. Khan and colleagues found a population prevalence of 1.9% for HBV and 1.1% for HCV.2 A recent study of 540 Afghan sex workers identified HIV prevalence as 0.19%, HCV 1.92%, and HBV 6.54%.3 Our impression of the high prevalence of intravenous drug use among enemy combatants could suggest similarly high prevalences in the subset of Afghans whose blood military forces are most likely to be exposed to.
Factors which increase the risks of sharps injury to health care providers in the prehospital environment include practitioner inexperience, high acuity environments, fatigue, distraction and equipment difficulties.4 Combat personnel are therefore at particularly high risk, working in a mobile, unstructured environment that is potentially complicated by poor ambient light, lack of standard working space and limitations imposed by personal protective equipment. The risk to military personnel in combat has not previously been described.
Medical practitioners responsible for the care of those on the modern battlefield need to be aware of the dangers of bloodborne infection and must provide postexposure prophylaxis, counselling and follow-up when indicated. Education, appropriate equipment and standard operating procedures will minimise the risk of returning service personnel having to face an entirely new battle.
Competing interests
No relevant disclosures.
References
- Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA 2012; 307: 75-84. ref`
- Khan S, Attaullah S. Share of Afghanistan populace in hepatitis B and hepatitis C infection’s pool: is it worthwhile? Virol J 2011; 8: 216. 0_i1142873
- Todd CS, Nasir A, Stanekzai MR, et al. HIV, hepatitis B, and hepatitis C prevalence and associated risk behaviors among female sex workers in three Afghan cities. AIDS 2010; 24 Suppl 2: S69-S75. 0_i1142875
- Leiss JK. Management practices and risk of occupational blood exposure in US paramedics: needlesticks. Am J Ind Med 2010; 53: 866-874. 0_CBBCFIIA