UK Role 4 Military Infection Services: past, present and future

Abstract

NATO describes 'Role 4' military medical services as those provided for the definitive care of patients who cannot be treated within a theatre of operations and these are usually located in a military force's country of origin and may include the involvement of civilian medical services. The UK Defence Medical Services have a proud history of developing and providing clinical services in infectious diseases and tropical medicine, sexual health and HIV medicine, and medical microbiology and virology. These UK Role 4 Military Infection Services have adapted well to recent overseas deployments, but new challenges will arise due to current military cutbacks and a greater diversity of contingency operations in the future. Further evidence-based development of these services will require leadership by military clinicians and improved communication and support for 'reach-back' services.

Tropical skin diseases in British military personnel

“…They are usually non-tender unless secondary infection occurs and do not respond to anti-bacterial treatment. Military personnel with possible CL should be referred to the UK Role 4 Military Infectious Diseases and Tropical Medicine Service at Birmingham Heartlands Hospital5 because of problems that have occurred when cases are referred elsewhere 26. The diagnosis is made from a skin biopsy of the edge of the lesion that is sent for histology and parasitology tests, which can identify the exact species involved.…”

“…They account for about 20% of primary care consultations by British troops in Afghanistan and have relatively high rates of field hospital admission and medical evacuation 3. Skin complaints are also the commonest cause of referral to the UK Role 4 Military Infectious Diseases and Tropical Medicine Service 4 5. This illustrated review focuses on the most significant tropical skin diseases that have occurred in British military personnel in recent years.…”

UK Role 4 military infectious diseases and tropical medicine cases in 2005–2013

“…Current UK military infection services are arranged around BHH with reach-back services providing clinical advice when required 33. Good links with other units that deal with military patients such as RCDM, the Royal Free and the London and Liverpool Tropical Schools mean military issues and appropriate follow-up can be dealt with easily.…”

Leptospirosis in a British soldier after travel to Borneo

“…Fever in returning military personnel is covered extensively. The UK Role 4 Military Infectious Diseases and Tropical Medicine Service at BHH15 is represented at the weekly UK Defence Medical Services (DMS) Joint Theatre Clinical Case Conference (JTCCC) and is available for telephone (01214240357) or email advice (markbailey@nhs.net), outpatient appointments and inpatient management as appropriate. Medical officers dealing with undifferentiated febrile illnesses where there has been possible exposure to leptospirosis should get advice early, exclude malaria (if appropriate) and consider empirical doxycycline or parenteral antibiotics if definitive care is likely to be delayed.…”