The outbreak of COVID-19 and the subsequent pandemic brought unprecedented worldwide challenges born out of a rapidly escalating health and economic crisis. From emergency planners to healthcare workers on the front line, and everyone in between, the pandemic, and the uncertainty surrounding it, was likely to become a significant stressor, one with no immediate solution but with the potential to cause enduring distress beyond its conclusion. The UK Defence Medical Services recognised the need to provide an evidence-based programme of care intended to support personnel transitioning from assisting the national response back to normal duties. This was informed by a narrative review that targeted literature exploring strategies for supporting the mental health and well-being of healthcare workers during 21st-century infectious disease outbreaks. The literature identified the experiences most likely to cause enduring distress, which comprised morally challenging decisions, vulnerability, death and suffering, professional and personal challenges, and expectations. The opportunity to find meaning in these experiences, by discussing them with peers who share a contextual understanding, is important to limit the longer-term psychosocial impact of such events. This paper will discuss the design considerations and planned implementation strategy of the Recovery, Readjustment and Reintegration Programme to limit the incidence of distress or longer-term mental ill health among military personnel.

IntroductionSeveral UK military expeditions have successfully used physiological sensors to monitor participant’s physiological responses to challenging environmental conditions. This article describes the development and trial of a multimodal wearable biosensor that was used during the first all-female unassisted ski crossing of the Antarctic land mass. The project successfully transmitted remote real-time physiological data back to the UK. The ergonomic and technical lessons identified have informed recommendations for future wearable devices.MethodThe biosensor devices were designed to be continuously worn against the skin and capture: HR, ECG, body surface temperature, bioimpedance, perspiration pH, sodium, lactate and glucose. The data were transmitted from the devices to an android smartphone using near-field technology. A custom-built App running on an android smartphone managed the secure transmission of the data to a UK research centre, using a commercially available satellite transceiver.ResultsReal-time physiological data, captured by the multimodal device, was successfully transmitted back to a UK research control centre on 6 occasions. Postexpedition feedback from the participants has contributed to the ergonomic and technical refinement of the next generation of devices.ConclusionThe future success of wearable technologies lies in establishing clinical confidence in the quality of the measured data and the accurate interpretation of those data in the context of the individual, the environment and activity being undertaken. In the near future, wearable physiological monitoring could improve point-of-care diagnostic accuracy and inform critical medical and command decisions.

Completing LIVEX made no statistically significant difference to participants' personal perception of their own operational preparedness, but the perception of LIVEX as an appropriate training platform improved significantly after conducting the training exercise.

The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory.Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life. K E Y W O R D Scaring for the carers, medical emergency response team, military, pre-hospital care, psychosocial impact, resilience This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

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