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What do environment-related illnesses tell us about the character of military medicine and future clinical requirements?
  1. Michael John Stacey1,2,
  2. S Brett2,
  3. G Fitchett3,
  4. N E Hill2 and
  5. D Woods1,4
  1. 1 Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Faculty of Medicine, Imperial College London, London, UK
  3. 3 Blood Far Forward, British Army HQ, Andover, UK
  4. 4 Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  1. Correspondence to LtCol Michael John Stacey, Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK; M.stacey13{at}


Extreme environments present medical and occupational challenges that extend beyond generic resuscitation, to formulating bespoke diagnoses and prognoses and embarking on management pathways rarely encountered in civilian practice. Pathophysiological complexity and clinical uncertainty call for military physicians of all kinds to balance intuition with pragmatism, adapting according to the predominant patterns of care required. In an era of smaller operational footprints and less concentrated clinical experience, proposals aimed at improving the systematic care of Service Personnel incapacitated at environmental extremes must not be lost to corporate memory. These general issues are explored in the particular context of thermal stress and metabolic disruption. Specific focus is given to the accounts of military physicians who served on large-scale deployments into the heat of Iraq and Kuwait (Operation TELIC) and Oman (Exercise SAIF SAREEA). Generalisable insights into the enduring character of military medicine and future clinical requirements result.

  • porphyria
  • occupational & industrial medicine
  • chemical pathology
  • biochemistry
  • pathology

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  • Contributors MJS and NEH conceived the work. MJS, NEH and DW drafted the manuscript. GF and SB critically appraised and edited the work. All authors agree to publication of the final version and accept responsibility for it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The opinions expressed are personal and not those of the MOD.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.