_RT03.1_ ARMED FORCES DEVELOPMENT PROGRAMME - THE CONSEQUENCES OF INCREASED READINESS IN MEDICAL LOGISTICS D. R. Aeschbach1,* 1Armed Forces Logistics Organisation AFLO, Swiss Armed Forces, Bern, Switzerland Biography: Profession Career officer/veterinary (DVM) Military rank LTC GS Education 2002 - 2006 Degree in veterinary medicine, Clinic for small animals, Animal Hospital Bern (Measurement of antigen specific IgE and IgG in the serum and feces of dogs does with diet-responsive chronic enteropathy) 2004 - 2005 Diploma course at the Swiss Armed Forces Military Academy, Swiss Federal Institute of Technology ETH, Zurich 1995 - 2000 Studies in veterinary medicine, Zurich Further education 2012 - 2013 Official veterinary training, FVO 2011 International Crisis Management Course, Swedish Defence College 2009 US Army Logistics University CLC3, Fort Lee VA USA 2001 Meat inspector with final degree in veterinary medicine, slaughterhouse and veterinary services of the city of Zurich Professional activities 2005 – 2013 Career officer, Swiss Armed Forces Competence Centre for Veterinary Service and Military Animals (career officers unit) 2002 - 2004 Veterinary, Swiss Armed Forces Competence Centre for Veterinary Service and Military Animals 2001 - 2002 Scientific assistant, Veterinary Service of the Swiss Armed Forces 2001 Veterinary, armed forces dog training centre, Sand, Bern Current assignment Since 2014 Project Manager AFLO Armed Forces Development Programme Internships 2012 Cantonal veterinary office Bern 2010 VETCOM and MWD Training Center US Army / Air Force San Antonio TX USA Abstract Content: On 1 January 2018, the Swiss Armed Forces underwent significant changes. Regionalising the forces, providing full equipment to the operational units, improving officer training, and in particular increasing readiness have had a major impact, especially in the field of logistics. The readiness system allows the deployment of up to 35,000 military personnel in support of the civilian authorities within 10 days. These operations require 55,000 troops on military duty together with the support forces. The system of graduated readiness provides for rapidly deployable conscript units to be ready for action in the area of operation within 24 to 96 hours after call up. 48 hours after the order for deployment has been issued, up to ten battalions a day can be mobilised nationally. This speedy procedure and the extensive strength greatly affects the provision of logistics services. Medical logistics must be in a position to provide several hundreds of pallets of Cl VIII supplies within 24 hours and to distribute them throughout Switzerland proficiently. In this context, great efforts have been made as regards alerting, operational organisation, storage, provision and transport. Disclosure of Interest: None declared

_PL01.2_ PLAYING THE ETHICAL MIDFIELD: PHYSICIAN FIRST, LAST, AND ALWAYS G. J. Annas1,* 1Boston University, Boston, United States Biography: Warren Distinguished Professor at Boston University, Director of the Center for Health Law, Ethics & Human Rights of Boston University School of Public Health, and Professor in the Boston University School of Medicine, and School of Law. He is the cofounder of Global Lawyers and Physicians, a transnational professional association of lawyers and physicians working together to promote human rights and health. He has degrees from Harvard College, Harvard Law School, and Harvard School of Public Health. He is the author or editor of 20 books on health law and bioethics, including Worst Case Bioethics: Death, Disaster, and Public Health, and American Bioethics: Crossing Human Rights and Health Law Boundaries. Abstract Content: Debates about the ethical obligations of physicians in the armed forces have historically been hampered by over-reliance on inapplicable concepts (e.g., divided loyalties), and misleading examples (e.g., allocation of penicillin during WWII). Drawing on recent post-9/11 events, and the obligations of military officers who are lawyers or chaplains, it will be suggested that the rule that best comports with doing what is “right” is a recent recommendation to the US Department of Defense (DoD) by its Defense Health Board: “Throughout its policies, guidance, and instructions, DoD must ensure that the military health care professional’s first ethical obligation is to the patient.” Formal adoption and implementation of this recommendation would both comport with international medical ethics standards and boost the morale of both medical and nonmedical military personnel. Disclosure of Interest: None declared

_SS06.3_ EXTREME MEDICINE IN THE HIMALAYAS S. Baniya1,* 1Department of General Practice and Emergency Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal Biography: Dr. Baniya is a resident trainee in MD General Practice and Emergency Medicine at Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu. He has been actively involved with Mountain Medicine Society of Nepal (MMSN) and Himalayan Rescue Association in promoting mountain medicine in Nepal. Dr. Baniya was the local organizing chairperson of recently completed prestigious XII ISMM World Congress on Mountain Medicine 2018, Kathmandu in November, 2018. After completing Diploma in Mountain Medicine from Nepal in 2015, he worked as a team doctor in IPPG Machhermo Rescue post (post monsoon season) in 2016, has led medical team to high altitude medical camp to Lake Gosaikunda (4,380m) twice and worked as team doctor for various expedition team and trail race in the high altitudes of Nepal. Abstract Content: The presentation will give brief overview of how extreme medicine in the Himalayas “Mountain Medicine” evolved in last 4-5 decades. The presentation focuses on the how mountain medicine is being practiced in Nepal focusing in the brilliant works of Himalayan Rescue Association and Mountain Medicine society of Nepal in running rescue posts in the extreme altitudes to save lives in the high altitude. The presentation will also focus in the academic development in mountain medicine and Nepalese diploma in Mountain Medicine which have been proven to become instrumental in training doctors locally so that they are able to work in the extreme altitude of the Himalayas. In addition to this, the presentation will focus in unique group of population (porters and pilgrims) and high altitude sports like skiing in Himalayan, ultra marathon, trail running who are always at risk of altitude illnesses. Disclosure of Interest: None declared

_SS06.1_ UPDATE ACUTE HIGH-ALTITUDE ILLNESSES P. Bärtsch1,* 1hoehenmedizin.eu, Zürich, Switzerland Biography: Professor emeritus at the University of Heidelberg; born in St.Gallen, Switzerland, Medical School in Zürich, promotion and habilitation (PhD equivalent) at the Inselspital Bern, Switzerland; head of the Division of Sports Medicine at the Department of Internal Medicine of the University Clinic Heidelberg from 1991 to 2013; director of the German Diploma Courses in Mountain Medicine; principal investigator in research on prevention, treatment and pathophysiology of acute high altitude illnesses at the Capanna Regina Margherita since 1984; mountaineering in the Alps, Andes and Himalayas; president of the International Society of Mountain Medicine (ISMM) 1997-2000; head of the scientific council of the German Society of Sports Medicine and Prevention (DGSP) from 2000 – 2011; corresponding member of the Swiss Academy of Medical Sciences; received King Albert Mountain Award 2012 for outstanding contributions in the world of mountains and the World Congress International Award of the Wilderness Medical Society (WMS) 2016, Hypoxia Honoree at the 20th International Hypoxia Symposium in Lake Louise, 2017, Research Award of the WMS 2018. Abstract Content: Rapid ascent of not acclimatized individuals to high altitude may cause acute mountain sickness (AMS), high altitude cerebral edema (HACE) or high altitude pulmonary edema (HAPE). AMS can already occur at an altitude of 2500 m, while HAPE and HACE usually occur at altitudes above 3000 - 4000 m. AMS and HACE are considered different stages of the same underlying pathophysiology involving predominantly the brain. The major symptoms of AMS are headache, nausea and dizziness. More severe headache, vomiting and apathy indicate a progression to HACE, which is characterized by truncal ataxia and decreased consciousness and which may lead to death within 24 hours. The underlying pathophysiology of AMS is not fully understood. Edema in the corpus callous during HACE and hemosiderin found in the brain after HACE indicate a blood barrier leak (i.e. vasogenic edema) in this condition. HAPE causes reduced exercise performance, dyspnea and chest tightness that may rapidly progress and lead to death. It is a non-cardiogenic pulmonary edema resulting from excessive pulmonary vasoconstriction. The major risk factors for all three illnesses are altitude, lack of acclimatization, rate of ascent, and individual susceptibility. General measures of prevention for all three illnesses include pre-acclimatization by frequent exposures to intermediate altitudes or increasing the altitude at which one sleeps by no more than 300 - 500 m/day above 2500 m. If this is not possible acetazolamide (first line) or dexamethasone (second line) can be recommended for prevention of AMS and HACE, while pulmonary vasodilators (nifedipine or phosphodiesterase-5 inhibitors) should be given only to individuals with a history of HAPE. Treatment of mild to moderate AMS consists of a day of rest, symptomatic treatment for headache or nausea, and acetazolamide. Severe AMS with vomiting should be treated with dexamethasone. If symptoms do not improve during the day of rest, descent is necessary for recovery. When beginning HACE or HAPE are suspected, immediate descent should have first priority with simultaneous intake of dexamethasone for HACE or a pulmonary vasodilator for HAPE. If available, supplemental oxygen or intermittent treatment in a hyperbaric bag should be installed as well. Disclosure of Interest: None declared

_SS01.3_ MEDICAL LOGISTICS AND SUPPLY CHAIN MANAGEMENT CHALLENGES IN REFUGEE RELIEF INITIATIVE A. H. Basari1,* 1Health Services Division, Ministry of Defence Malaysia, Kuala Lumpur, Malaysia Biography: Brigadier General Dato’ Dr A Halim Basari graduated from the College of Pharmacy, Medical University of South Carolina (USA) with a BS Pharmacy in 1989. He then completed his MS in Hospital Pharmacy from the University of Kansas Medical Centre (USA) in 1992 with an ASHP Accredited Residency in Hospital Pharmacy in 1991. He was commissioned into the Malaysian Armed Forces (MAF) as an Army Lieutenant in the Royal Medical & Dental Corps in 1992 as the first military pharmacist in the country. While in the service, he obtained his Graduate Diploma in Logistics Science (Distinction) from the Anglia Polytechnic University, UK in 2000. Later he was awarded a PhD (Healthcare Supply Chain Management) from the Australian Institute of Business (AIB) in 2009. He is the Director of Pharmacy at the Health Services Division of the MAF HQ & is leading the management of the military pharmaceutical care & pharmamedlog/supply chain management services. His special interests are Halal Pharmaceutical, Shariah Compliant Pharmacy/Pharmamedlog and Pharmacy Robotics/Automation/Industrial Revolution 4.0. He is a recipient of multiple medals of honour and was conferred his Dato’ship (DIMP) from His Majesty Sultan of Pahang in 2015. He was also awarded with an Honorary Professor title from the CUCMS in 2017. He is an active member of the Malaysian Board of Pharmacy since 2016 and life members of the Malaysian Pharmaceutical Society (MPS) & Academy of Pharmacy (APh). He is also the Vice President of The International Pharmaceutical Federation (FIP) – Military & Emergency Pharmacy Section (MEPS) for 2018-2020. Abstract Content: The success of a Humanitarian Aid and Disaster Relief operation in foreign soil depends on effective logistical planning and procurement. This is challenging especially when Pharmaceutical and Medical Logistics (pharmamedlog) intelligence is scarce to the participating nations. The Malaysian Government established a level 3 Field Hospital (MFH) in Cox’s Bazar, Bangladesh on 29 November 2017. Together with international field hospitals and level 1-2 multinational health centres, MFH provides medical support for 2 million Rohingya refugees who fled from Myanmar. 56 personnel provide multispecialty services and is the most complete field facility. MFH is made the referral field hospital for all 27 camps. This report explores the pharmamedlog and supply chain challenges to sustain MFH. The MFH saw an increasing number of patients and case-mix intensity. From 60,000 cases seen, 1,500 were surgeries. The earlier pharmacy teams took to task in gathering as much information regarding the supply chain profile of the Bangladesh market for the benefit of subsequent teams to improve their modus operandi and standard operating procedures. As more local pharmamedlog intelligence is known, procurement of pharmamedlog supplies became more organised to sustain the effectiveness and efficiency of MFH’s operation. A lot of technical information regarding its supply chain was sought to better control its operational expenditures and budgetary constraint. Challenges in dealing with the local players and clients include communication, inadequate staffing, sociocultural and working philosophy differences. A study was conducted to assess the pharmaceutical supply chain profiling of the Bangladesh market based on the information gained from missions prior to December 2018. Market price surveys and historical procurement data were analysed. Findings include vast difference in the supply chain actors’ profile, regulatory system and requirement, manufacturing, procurement, distribution processes and integrity issues in comparison to Malaysia and other foreign missions that Malaysia had participated before. Recommendations from this study were used to guide the new pharmamedlog team to manage its resources better. Principles for Good Supply Chain Practices were tested and evaluated from the perspectives of partnership, negotiation, agility, standardisation, training, technology and deployability. Disclosure of Interest: None declared

_PL03.3_ PRESENTATION OF THE COMPETENCE CENTER ABC KAMIR OF THE SWISS ARMED FORCES C. Baumberger1,* 1NBC-EOD Center of Competence, Spiez, Switzerland Biography: Professional status: Colonel, Deputy Commander of the NBC-EOD Center of Competence, Military function (militia): Colonel, Chief CBRN of the Swiss Air Force Education 1979 High School Diploma, College Calvin, Geneva, Switzerland 1984 B.Sc., Biochemistry, University of Geneva, Switzerland 1987 M.Sc., Biochemistry, University of Geneva, Switzerland 1991 Ph.D., Biochemistry (Doctorat ès Science, Biochemistry), University of Geneva, Switzerland 1997 Federal diploma of professional officer, Swiss Military College at the Swiss Federal Institute of Technology (ETHZ) 2002 Advanced Military Formation 1/2002, Swiss Military College at the Swiss Federal Institute of Technology (ETHZ) 2006 Advanced Military Formation 2/2006, Swiss Military College at the Swiss Federal Institute of Technology (ETHZ) COL Christophe Baumberger, a Swiss national, holds a PhD in Biochemistry of the University of Geneva, Switzerland. He is currently working as regular officer and Deputy Commander of the NBC-EOD Center of Competence of the Swiss Armed Forces in Spiez, Switzerland. He has the lead in the various projects building up the Swiss military CBRN Defence capabilities. COL Baumberger is a member of different international working groups and participates in various civilian and military expert groups such as the Coordinated Medical Service in Switzerland (CMS) or the EEDDPS, the professional civil-miltary CBRN rapid intervention element in Switzerland. He has participated in various military training exercises such as (Croatia (ASSITEX 1 from OPCW), EURAD 2010 (as NCC from the Swiss contingent) and was head of project D-CH ABC FTX 14 in Geneva. In his military function (militia), he is the CBRN Officer of the Swiss Airforce. COL Baumberger is married and has a son and a daughter. Abstract Content: The NBC-EOD Centre of competence of the Swiss Armed Forces is responsible for NBC-EOD Defence within the Armed Forces. It issues guidance for all commanders on NBC-EOD matters, is involved in arms procurement projects and training. The CO of the centre is also the commander of all NBC Defence Troops of the Swiss armed forces. The NBC Defence troops comprise a professional and a militia component. The first is formed by 4 EOD teams and an ad hoc NBC engagement element. The latter counts a NBC Defence laboratory with three NBC laboratory companies, a NBC Defence battalion with 4 NBC Defence companies and a NBC Defence operational company as well as a NBC specialist staff. The NBC Defence laboratory units are employed mainly near Spiez with the mission to assist the Swiss Armed forces and, in case of need civilian authorities with NBC analysis up to forensic level. The NBC Defence companies are supposed to deploy wherever needed in Switzerland as well as in the cross-border areas in case of a request by neighbor countries. The NBC Defence companies are formed each by a NBC reconnaissance platoon with 3 NBC recce vehicles, a SIBCRA platoon with each a R/N, B and C analysis vehicle and sampling groups, and two decontamination platoons able to thoroughly decontaminate persons, patients, tool and vehicles. They also dispose of a water production, water transportation and wastewater collection capacity. The NBC-EOD Centre of competence has the primary mission to support the armed forces in case of a threat or attack by NBC agents or EOD. It also assists civilian authorities in case of need, i.e. if the civilian means are not sufficient to cope

with a given situation (principle of subsidiarity). The Centre also assists the Organization for the Prohibition of Chemical Weapons (OPCW) with training in Switzerland and abroad. One EOD team is constantly deployed to KFOR in Kosovo, EOD and mine-clearing specialists assist the United Nations with mine clearing expertise and/or ammunition stockpile management issues. Furthermore, the EOD Command is responsible for removal of unexploded ordinance removal in Switzerland. Disclosure of Interest: None declared

_RT01.4_ MINI NAVIGATION IN DENTAL IMPLANTOLOGY - HOW THE NEW TECHNOLOGY WORK B. Benitez1,* 1Universitätsspital Basel, Basel, Switzerland Biography: Specialization in Oral and Craniomaxillofacial Surgery at the University Hospital Basel, Switzerland Battalion doctor (Captain, OF-2) of the 75th Hospital Battalion Special Training in Maxillofacial Surgery for Military Dental Surgeons Medical Officers‘ School, Swiss Army Infantry Military Cadet School of the Swiss Army Dental and Medical School Zurich Switzerland Abstract Content: The development of a miniaturized, hand-guided navigation system for dental implantology will be demonstrated. Further the functionality and ergonomic aspects are explained Disclosure of Interest: None declared

_SS12.4_ MANAGEMENT OF BURNS M. Berger1,* 1University of Lausanne Hospitals - CHUV, Lausanne, Switzerland Biography: Intensive care physician and associate professor in the Lausanne University Hospital, with an anesthesiology background, specialized in burn care and in clinical nutrition. Coordinator of the Lausanne burn centre. Associate Editor of Clinical Nutrition. MD degree from the Lausanne School of Medicine, and medical PhD from the Umeå University, Sweden. Training in anaesthesiology and intensive care medicine at the CHUV with intermittent fellowships in Stockholm, Sweden and Sydney, Australia. Training in nutrition in Nancy, France. Research in clinical nutrition, micronutrition, and major burns. She developed the concept of maximal tolerable energy deficit during the ICU stay. She has conducted randomized trials with combined enteral and parenteral nutrition guided by indirect calorimetry in patients with insufficient or failing enteral feeding: the results show that combined feeding to measured goal from day 4 reduces infectious complications and costs, due to an improved immune response. She belongs to ESPEN’s ICU guideline group, and to ESICM’s MEN- metabolism and nutrition working group, which she chairs. She belongs to the ICALIC (Indirect Calorimetry in the ICU) working group to enable individual adaptation and monitoring of feeding targets. Lecturing worldwide in 4 languages. Teacher for the LLL-ESPEN training program. Publications: Over 220 peer reviewed publications and 40 book chapters. Edited a Nutrition book in 2018 Abstract Content: Burn injuries happen in civilian and conflict situations, but differ regarding the epidemiology, the type of burns and their association with trauma. In peacetime, burn injury combined with traumatic, chemical, or radioactive casualties is rarely encountered and often unrecognized; during conflict and disasters, burn injury is unlikely to be the only trauma. During an armed conflict, a wide range of patterns of wounding arising from combat and non-combat related military and civilian trauma and burns are seen and treated. In conflicts the percentage of burns casualties usually varies between 10 and 30%, but can be up to 70%. The type of conflict impacts significantly on the incidence of burns. High use of armored vehicles, warships and aircraft increase the proportion of burn victims. Available treatment facilities differ significantly. Battlefield medicine, a sub field of emergency medicine, treats the emergency cases in the battlefield, and is often confronted a high number of injured (mass casualty): caregivers are operating in the field without proper staff and equipment, and often under fire. Mass casualty whether civilian or warfare situations, implies triage, i.e. the sorting into immediate, urgent, and non‐urgent cases with the use of the holding category in the warfare situation. Three phases are considered. 1) prehospital triage in order to dispatch ambulance and prehospital care resources. 2) triage at scene by the first clinician attending the patient. 3) triage on arrival at receiving hospital. Triage is a dynamic process, as the patient's status can change rapidly: this of course applies to burn injuries. Treatment strategy needs adaptation. While in civilian context, the objective generally is maximal care for the single individual patient, a resource consuming process, the conflict or mass casualty context will require an adaptation of treatment to maximize the number of patients receiving care. Burn mass casualty plans differ from trauma plans, the triage being particularly important and difficult, and the burn center resources sparse. The Swiss burn plan was inspired by international experience, and required integration into a 26 Cantons system with independent health care and emergency medicine structures. It is based on the use of existing resources, upon which a national coordination is superposed. National hospitals have been included in a network that can be activated in case of mass casualty. The two national burn centers (Lausanne and Zürich university hospitals) have generated an internal plan which proposes “degraded” simplified treatments adapted to high number of casualties. Nevertheless all the steps remain: airway management, fluid resuscitation, nutrition, surgery, and infection prevention strategies. The burn center teams have implemented teaching of primary burn care to their respective allied hospitals. Disclosure of Interest: None declared

_SS14.4_ THE CULTURAL CHALLENGE OF LEADING IN MILITARY MEDICINE M. Bricknell1,* 1Conflict and Health Research Group, Kings College London, London, United Kingdom Biography: Professor Bricknell served 34 years in the UK Defence Medical Services, culminating his service as the last Surgeon General. He undertook operational tours in Afghanistan, Iraq, and the Balkans with multiple additional overseas assignments. In 2010 and 2006, he held senior Medical Adviser appointments in the NATO ISAF mission. He commanded 22 Field Hospital in 1999-2002. He has trained as a general practitioner and is an accredited specialist in both Public Health and Occupational Medicine. He holds two doctorates and 3 masters degrees. He has published over 100 academic papers across military medical subjects. He is especially interested in how organisations learn, care pathways in military healthcare, and the political economy of health in conflict. He was awarded the Companion of the Order of Bath, the Order of St John and the US Bronze Star during his military service. He took up his current appointment in April 2019. Abstract Content: Rationale: This paper will present personal reflections of the challenges of cross-cultural leadership from a career culminating as the Surgeon General of the UK Defence Medical Services. Methods: This presentation will analyse the culture of a military medical service using the Cultural Web as described by Johnson and Scoles. It will consider the insertion of cultural tribes that impact on the unifying paradigm that represents the purpose of a military medical service. The presentation will be illustrated by personal vignettes. Results: No specific results Conclusions: One of the many facets of senior leadership is to identify the components of an organisation’s culture and the cultures of the tribes that form and influence the organisation. This presentation will suggest that many of the domains of the cultural web are universal in military medical organisations, and have global application. References: Johnson, G. and Scholes, K. (1997), Exploring Corporate Strategy (4th ed.), Prentice-Hall, London Disclosure of Interest: None declared

_SS07.3_ RESEARCH IN MILITARY NURSING – CHALLENGES AND OPPORTUNITIES A. F. Brockie1,* 1Joint Hospital Group (South West), UK Defence Medical Services, Plymouth, United Kingdom Biography: Lt Cdr Brockie is the SO2 Quality and Training at Joint Hospital Group (South West), based in Plymouth in the UK. He has had a varied career in the Armed Forces, serving at home, abroad and on operations in both regular and reserve Army and Navy units. He is an experienced operating theatre nurse, and a burgeoning bioethicist. Pondering the ethical dilemmas encountered in field hospitals on operations in Kosovo, Iraq and Afghanistan prompted Lt Cdr Brockie to undertake a Master’s Degree in Healthcare Law & Ethics to broaden his knowledge and understanding, and was awarded his LLM in 2014. Still pondering the finer points of the character of nurses, our ethical self-awareness and how we develop our ethical decision-making skills in line with Aristotle’s concept of practical wisdom, Lt Cdr Brockie commenced a PhD study in January 2017; examining those very subjects. Abstract Content: Rationale – One of the UK Academic Department of Military Nursing’s (ADMN) most important functions is to monitor and assist Defence nurses’ engagement with higher education and research, in order to sustain quality improvement in healthcare. We distributed an anonymous pilot survey and a wider online survey six months apart to Defence nurses; which aimed to gather data on their collective attitudes towards research activity, its accessibility and perceived importance to them. Methods – The pilot survey was distributed in hard copy to attendees of a research forum run by ADMN in March 2017. The results of this prompted the design of an online survey, gathering the same data as the pilot study, but which would be accessible by a much wider population; and be easier to analyse. Analysis was achieved with the use of simple descriptive statistics to prepare an internal Defence report and an academic paper (forthcoming). Results – The results from the pilot survey (n=69) and the wider study (n=216) were broadly correlative. 87% of respondents said research was important to their primary roles; however only 58% of these were conducting any research themselves. 46% of respondents had recently conducted clinical audits, 21% service evaluation and 13% primary research. Five key barriers to research activity (including a lack of time, knowledge or confidence) and five likely enablers (including protected time, a research-positive culture and better support from managers) were also identified. Conclusions – The survey data broadly correlates with findings in literature from civilian nursing. Defence nursing is proactively employing mitigating strategies to work towards overcoming perceived barriers to engaging in research; such as building quality improvement networks and structures throughout its Units. This renewed focus will legitimise research as an ‘approved’ activity for military nurses, and help make future research efforts more coherent and beneficial to Defence. Disclosure of Interest: None declared

_SS06.2_ ON-SITE MANAGEMENT OF AVALANCHE VICTIMS H. Brugger1,2,* 1Institute of Mountain Emergency Medicine, EURAC research, Bozen, Italy, 2Medical University, Innsbruck, Austria Biography: Hermann Brugger MD, born in Bruneck / Bolzano / Italy, December 30th, 1951; married to the painter Elfriede Gangl, 1978; children: Franz, Johanna. MD at the University Vienna, Austria, 1978; Medical assistant at the Hospital Sisters of Charity, Linz, Austria, 1979-1983. General Practitioner at the National Health Service, Bruneck, Italy, from 1983. Emergency physician for the Emergency Medical System and mountain rescue physician of the Mountain Rescue Organization of South Tyrol with 2000 rescue operations. Eduard Wallnöfer Prize Tyrolean Industry, 1992; Georg Grabner Prize University Vienna, 1995; Research Award of the Wilderness Medical Society USA, 2012; Paul Auerbach Award Wilderness Medical Society USA, 2016. Member of the Board of the Italian Society of Mountain Medicine, 1999-2005; Member of the Board of the Medical Commission of the Union Internationale des Associations d’Alpinisme UIAA MEDCOM, 2001-2009; President of the International Commission for Mountain Emergency Medicine ICAR MEDCOM, 2001-2009; Member of the Board of the International Society of Mountain Medicine ISMM, from 1999; President of the International Society of Mountain Medicine ISMM, from 2016; Member of the International Commission for Mountain Emergency Medicine ICAR MEDCOM, from 1991; Associate Editor of High Altitude Medicine and Biology, from 2001; Guest lecturer University Padova, from 1999; Associate Professor and lecturer at the Innsbruck Medical University, from 2006; Founder and head of the EURAC Institute of Mountain Emergency Medicine at the European Academy Bolzano, Italy, from 2009. President of the International Society of Mountain Medicine ISMM, from 2016. Around 60 book chapters, 190 publications (current cumulative IF [2018-01-29]: 693) on mountain emergency medicine, enthusiastic mountaineer and skitourer, several ascents in Europe, the Americas and Asia. Abstract Content: In North America and Europe, approximately 165 people die of avalanches per year. Four factors are decisive for survival: grade and duration of burial, presence of a free airway, and severity of trauma. The overall mortality rate is 23%, but 52.4% in completely buried (i.e. head below the snow) victims in contrast to 4.2% in partially buried (i.e. head free) victims. Survival in completely buried victims drops to 30% within the first 35 minutes due to trauma and asphyxia. Thereafter survival decreases more gradually and victims slowly succumb to a trias of hypoxia, hypercapnia and hypothermia if they are able to breath. In the absence of fatal injuries, rescue strategies depend primarily on trauma, duration of burial, the victim’s core temperature and the patency of the airway. In 2015, the European Resuscitation Council proposed an algorithm for the management of avalanche victims. With a burial time <60 minutes (or core temperature ≥30°C) rapid extrication and prevention of asphyxia is essential, with adequate airway management and cardiopulmonary resuscitation. With a burial time >60 minutes or core temperature <30°C tackling severe hypothermia should be expected. Gentle extrication and continuous core temperature and cardiac monitoring are recommended. Pulseless victims with a patent airway, duration of burial >60 minutes or a core temperature <30°C should receive continuous or intermittent cardiopulmonary resuscitation and be transported to a hospital with extracorporeal rewarming facilities. Disclosure of Interest: None declared

_SS05.1_ ROLE OF PHARMACISTS IN MANAGEMENT OF CBRN DISASTERS P. Burnat1,* 1service santé des armées France, Ecole du Val-de-Grâce, Bonneuil sur Marne, France Biography: The divisional general Pascal Burnet finished his pharmaceutical studies at the Faculty of Pharmacy of Lyon in 1980. Then, he held positions as medical biologist in laboratories of military hospitals (Lorient and Freiburg in Germany) and then 26 years at the Biology Laboratory of the Army Hospital Bégin in Saint Mandé as assistant manager then head of biology department and as Associate professor of the Val-de-Grâce in pharmaceutical sciences and chemical risks in the armed forces. He specializes in clinical biochemistry and toxicology as well as in CBRN risks. His last post, which he left in 2018, was that of technical inspector of pharmaceutical Services in the french army. Abstract Content: The military health services, and in particular military pharmacists are key players in the national medical defense system againt CBRN risks. Military pharmacists have important and multiple roles in the management of CBRN disasters but theses roles are highly variable depending on the nations. These national variables include specific geopolitical threats, the place of pharmacists within their army, the country's budgetary means and the organization of their health service. Among their operational implications are the creation and distribution of preventive lots containing antidotes, antibiotics and means of decontamination. As in France, the pharmacists can also manufacture specific pharmaceutical products for crisis scenarios, participate in training within their army and civilian populations, promote civil-military cooperation, plan, organize and participate in their professional structure in the detection, protection, decontamination and analyze the CBRN agents. Overall, it clearly appears that military pharmacists and their specific skills are suitable for the CBRN management : their multiple roles need to be developed in the future. Disclosure of Interest: None declared

_PL03.2_ SPIEZ LABORATORY, THE SWISS FEDERAL INSTITUTE FOR NBC-PROTECTION M. Cadisch1,* 1SPIEZ LABORATORY, Spiez, Switzerland Biography: Dr. Marc Cadisch Director SPIEZ LABORATORY Dr. Marc Cadisch was born in 1962 in Thun, Switzerland. After obtaining a degree in pharmaceutical studies in Berne, he pursued his studies with a doctoral thesis in organic chemistry at the Swiss Federal Institute of Technology Zurich, Switzerland. Dr. Cadisch then worked in various areas of the pharmaceutical industry. Parallel to his professional career he completed further post-graduate studies at the University of St. Gallen, earning an Executive MBA in January 2003. Dr. Cadisch joined SPIEZ LABORATORY, the Swiss Institute for NBC protection, on 1 December 2002 and on 1 April 2003 he assumed the position as director of SPIEZ LABORATORY. He is Honorary Member of the Swiss Society of Industrial Pharmacists (SSIP), member of the Board of the SSIP foundation, and the Swiss Federal Commission for NBC Protection. Abstract Content: Spiez Laboratory, the Swiss Federal Institute for NBC-Protection, is one of the world's leading laboratories dealing with the prevention, detection and mitigation of NBC-related incidents. It is a designated partner of several international organisations, including the three Nobel-Prize recipients: The Organisation for the Prohibition of Chemical Weapons (OPCW), the International Atomic Energy Agency (IAEA) and the International Committee of the Red Cross (ICRC). The presentation offers an introduction to current activities and tasks of the laboratory in all areas of security policy, including arms control initiatives as well as forensic work supporting counter-terrorism efforts. Disclosure of Interest: None declared

_SS02.2_ ACADEMIC AND CLINICAL FELLOWSHIP IN CAPE TOWN D. Cadosch1,* 1Universitätsspital Basel, Basel, Switzerland Biography: I was born in the southern part of Switzerland in 1970. I received the MD and PhD degrees from the University of Lausanne Switzerland and Western Australia, in 2001 and 2012, respectively. Since January 2018, I have been working at the Department of Orthopedic and Trauma Surgery of the University Hospital of Basel. Prior to my current position, I completed my surgical training (general and trauma) at the State Hospital of Winterthur, Switzerland and at the Department of Trauma Surgery in Zurich under the leadership of Professor Otmar Trentz. To broaden and complete my education in trauma and orthopedic surgery, I worked at the Trauma Centre of the Groote Schuur Hospital in Cape Town under the leadership of Professor Andrew Nicol and Professor Pradeep Navsaria and at the John Radcliffe Hospital and Nuffield Orthopaedic Centre in Oxford UK. Abstract Content: During my talk, I will report on my personal experience as Clinical Trauma Fellow (enabled by the University Hospital Zurich and the Federal Department of Defence, Civil Protection and Sport (VBS/DDPS)) at the Groote Schuur Hospital in Cape Town 2013-14 under the leadership of Professor Andrew Nicol and Professor Pradeep Navsaria. The talk will highlight similarities and differences between trauma training and management in South Africa vs. Switzerland. Disclosure of Interest: None declared

_PL04.4_ LEVERAGING MANAGEMENT SCIENCE IN THE MILITARY MEDICAL SETTING: A UNIQUE ENVIRONMENT AT THE CROSSROADS OF A NEW PARADIGM? G. Cassourret1,* 1Department of Health Defense Plans & Strategy, French Military Health Service, Paris, France Biography: Major (OF-3) Guillaume Cassourret is the health program and policy evaluation advisor at the Central Directorate of the French Military Health Service. Before specializing in public health, he started his career as a ship's surgeon, participating to overseas operations including joint operations on the Libyan theater and in Middle East. He then was appointed as an emergency physician aboard Paris Fire Department’s intensive care units, leading teams on large-scale events, among which the terror attacks in November 2015 in Paris. Educated at the French Military Health Service schools, he also earned a Master of Public Health (MPH) in the United States, during which he specialized in healthcare management. Abstract Content: At the crossroads of the military and the medical worlds, military medicine became to be known over time as a field of medicine in its full sense, with specific needs and knowledge. Today, the definition of this field must yet again evolve to better emphasize the domain of management. Military health services are faced with the growing managerial role of the doctor and nurses, a rising expectation that the latest know-how coming from diverse civilian sectors be integrated, and a strong financial pressure. In addition, the digital age constantly reshapes the role of health professionals requiring management skills to be embedded within organizations in order to manage transformations. These various forces at play drive us to consider the integration of management in the military medical setting as a structural requirement. Meanwhile, management science has brought increasing factual evidence of its impact in the medical realm and will continue to reshape health institutions across the globe. From methodologies such as lean management and the agile approach to managerial tools such as bidirectional team-to-leader feedback: what potential can we unlock for the health and the performance of an institution in the military medical setting? Disclosure of Interest: None declared

_WS04.1_ JUS AD BELLUM AS A RISK REDUCTION STRATEGY FOR THE USE OF OFF LABEL AND NOT YET APPROVED MEDICATIONS ON MILITARY PERSONNEL N. Coleman1,* 1Royal Australian Air Force, Canberra, Australia Biography: CHAP (FLTLT) Revd. Dr. Nikki Coleman is an applied ethicist who works in military bioethics and space ethics. She is a visiting research fellow at the Royal Australian Air Force Air Power Development Centre, a research associate at the Case Western Reserve University Inamori Center for Ethics and Excellence, a member of the summer teaching faculty at Yale Interdisciplinary Center for Bioethics, an adjunct lecturer at UNSW Canberra in the Space department, and a chaplain in the Royal Australian Air Force. She is also a member of the Australian Departments of Defence and Veteran’s Affairs Human Research Ethics Committee. Abstract Content: Occasionally, due to extreme operational pressures in military operations, medications need to be approved for "off label" use or for use prior to clinical trials. Before these medications can be used on military personnel, approval must usually be gained from an appropriate ethics approval body, albeit with a severely shortened time frame compared to usual ethical approval processes. This short time frame, combined with the use of medicines not yet fully tested or approved for use in humans, creates a high risk situation for military personnel and for the medical staff caring for them. Previous situations such as these have been dealt with on a case by case basis by ethics approval committees, who may not have experience in dealing with such expedited medication use approvals, thus compounding this risk. This paper explores this situation as a type of supreme emergency, and examines whether the principles of jus ad bellum might provide a framework for making such decisions for committee members with limited experience of approving military use of off label medications for urgent operational use. It is hoped that this framework might provide a risk reduction strategy for such approval processes in the future. Disclosure of Interest: None declared

_WS08.1_ MILITARY MEDICAL ETHICS: AN EXAMINATION OF POLICY AND PRACTICE S. M. Eagan1,* 1Bioethics and Interdisciplinary Studies, East Carolina University, Greenville, United States Biography: Sheena Eagan is an assistant professor in the Department of Bioethics and Interdisciplinary Studies at Brody School of Medicine, East Carolina University. She is a medical ethicist with advanced and specialized training in military medical ethics, the history of medicine, and public health. Dr. Eagan has published original research and presented papers on the topics of military medical ethics, military medical history, bioethics, and public health ethics. Abstract Content: In recent years, there has been increasing academic attention focused on military medical ethics. The fields of medical ethics, professional ethics, and political science have begun to analyze the context of the military institution and the conflict zone, considering how the risks inherent in these settings may complicate moral decisions for those involved. The institutional purpose of the military and the context of deployment present risks that are rarely paralleled in civilian medicine, making risk management an essential part of military medical ethics. In recognition of this, militaries have begun including ethical principles and subject matter experts in mission planning and risk management decisions by way of formal doctrine. This paper will provide a comparative analysis, exploring the ways in which different militaries have included ethical discussion within the doctrine and policy. Through comparative analysis, this research will explore recurring themes in military medical ethics policies, and explore the different ways that various nations have chosen to integrate ethical issues into planning and practice. It will examine how the nature and context of the military mission, whether it is humanitarian, disaster relief, peacekeeping or armed conflict, influences the ethical decision making process. To accomplish these goals, this paper will utilize an interdisciplinary methodology grounded in primary source analysis of both relevant policies and proposed actions within NATO and its member states. Disclosure of Interest: None declared

_WS05.2_ THE ETHICS OF BIOMEDICAL MILITARY RESEARCH: THERAPY, PREVENTION, ENHANCEMENT, AND RISK A. Erler1,* 1Philosophy/CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Biography: Current position: Research Assistant Professor, Department of Philosophy and CUHK Centre for Bioethics, The Chinese University of Hong Kong Areas of specialization: Applied and Biomedical Ethics, with a particular interest in emerging technologies. My doctoral dissertation, written under the supervision of Profs. Roger Crisp and Julian Savulescu and supported by a grant from the Swiss National Science Foundation, focused on "enhancement technologies" and their potential impact on human identity and authenticity. Education: BA in Philosophy, English, and History, University of Neuchâtel, Switzerland; MA in Philosophy and Literature, UEA Norwich; DPhil in Philosophy, University of Oxford Abstract Content: A debate is ongoing in military ethics about the development of new technological interventions that would enhance the “normal” capacities of soldiers. One issue concerns the conditions under which it might be ethically appropriate to test such interventions using active military personnel as research subjects, with the associated risks for them. Some bioethicists have argued that enhancement research is more difficult to justify than research aimed at therapeutic or preventive interventions, because of the former’s worse risk-benefit ratio (RBR). In response, others have countered that the therapy-enhancement distinction is difficult to uphold in the military context, and that there are no grounds for viewing enhancements differently than therapies when it comes to assessing their RBR. We argue for an alternative approach relying on a tripartite distinction between “therapeutic”, “preventive” and “pure” enhancements. After offering examples from each category, we argue that, all else being equal, therapeutic enhancements can be expected to have a better RBR than preventive ones, thus making human trials easier to justify, and that the same can be said of preventive enhancements as compared with pure ones. That said, since things won’t always be equal, we agree that there is ultimately no substitute for individually assessing the RBR of each prospective enhancement. Still, we contend that our tripartite distinction does provide both a taxonomy and a rule of thumb that can be useful in the context of research ethics. We conclude by considering some potentially complicating factors, including the risk of triggering a new technological arms race. Disclosure of Interest: None declared

_PL05.5_ TEN IMPORTANT MEDICAL DISCOVERIES THAT MOVED FROM BATTLEFIELDS TO URBAN ER - A PERSONAL PERSPECTIVE A. Exadaktylos1,* 1Inselspital Bern / University Hospital, Department of Emergency Medicine, Bern, Switzerland Biography: Professor of Emergency Medicine, Director Department of Emergency Medicine, University Hospital / Inselspital Bern. Fellow of the Royal College of Emergency Medicine (UK) Fellow of the Swiss Society of Anesthesiology Fellow of the Swiss Society of Emergency and Resuscitation Training: Switzerland, South Africa, Ireland, US Research: >270 peer reviewed publications, numerous book chapters Special interests: Patient safety, tactical medicine, geography, politics Abstract Content: Without conflicts no progress, without bloodshed no survival. Civilian medicine has always benefited from military medicine and research. This presentation will highlight the ten most important discoveries that moved from battlefields to urban emergency rooms. This is a personal perspective. Without conflicts no progress, without bloodshed no survival. Civilian medicine has always benefited from military medicine and research. This presentation will highlight the ten most important discoveries that moved from battlefields to urban emergency rooms. This is a personal perspective. Without conflicts no progress, without bloodshed no survival. Civilian medicine has always benefited from military medicine and research. This presentation will highlight the ten most important discoveries that moved from battlefields to urban emergency rooms. This is a personal perspective. Disclosure of Interest: None declared

_RT02.4_ ALLIED HEALTH CARE PROFESSIONALS – MULTIPROFESSIONAL COLLABORATION A. Faas1,* 1Swiss Army, Frauenfeld, Switzerland Biography: Graduated at University of Zurich 1998, Promotion MD 1999, ZH University. Fellowship in different Swiss Hospitals (Zug, Münsterlingen, Zürich, Aarau). Internist Deployed in Kosovo 2003 and 2005. Deployed for Disaster relief operation with Swiss Rescue in Indonesia 2007. Deployed as trainer for the Moroccan Civil Protection during 3 years in Casablanca and Rabat. Chair of the NATO COMEDS Military Health Care Working Group for 9 years. Current position: Medical Director of the Regional Military Medical Centre of Frauenfeld, Swiss Armed Forces Staff. Abstract Content: In different nations, the individuals that make part of the Allied Health Care Professional community have not the same skills and are trained and credentialed according to the national legislation. Therefore, in the context of international military missions, the focus in doctrine and training must be the skills rather than types of professions. Doctrine should tell you what to do, maybe how - but not by whom. To enhance multiprofessional collaboration among Allied Health Professionals, nations must overcome legal constraints to transfer of skills to the right person and to train and credential the national medical personnel accordingly. Multiprofessional collaboration can help mitigating the shortfall in medical personnel. Disclosure of Interest: None declared

_SS09.2_ FUTURE CHALLENGES: SCIENTIFIC AND TECHNOLOGICAL CHANGE J. Forman1,* 1Organisation for the Prohibition of Chemical Weapons, The Hague, Netherlands Biography: Jonathan Forman currently holds the post of Science Policy Adviser at the Organisation for the Prohibition of Chemical Weapons (OPCW), also serving as the Secretary to OPCW’s Scientific Advisory Board. He holds a Bachelor’s of Science in chemistry from the California State University at San Bernardino and a Ph.D. in chemistry from the California Institute of Technology. After completing graduate studies in 1996, Dr Forman worked for a series of biotechnology companies developing molecular diagnostic and bioanalytical assay technologies for genomic, immunoassay, and cell capture applications; eventually becoming an independent consultant for process and product development of chip-based assay platforms. His professional interests include assessment of emerging technologies, bringing effective science advice into policy making, and science diplomacy. Dr Forman has been at the OPCW (and away from California) since March of 2013. Abstract Content: The Chemical Weapons Convention is a treaty underpinned by science and technology; its implementation calls for continual review of new developments, and the consideration of the potential impact scientific and technological change may bring. Scientific reviews, conducted by the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW), highlight a trans-disciplinary, dynamic and rapidly evolving scientific and technological landscape, enabled by the emergence of new and innovative technologies, as well as the repurposing of existing technologies for unanticipated new applications. New advances across the chemical sciences are often enabled by ideas and tools originating from sectors outside this discipline (and chemistry itself influences other scientific disciplines in a similar manner), and relevant developments may not be easily recognized by a scientific review limited to chemical-specific fora. The potential challenges to the implementation of the Chemical Weapons Convention arising from scientific advancements are accompanied by the challenge of recognizing where to look, and how to identify relevant advances. In this presentation, the Science Adviser of the OPCW will review and discuss areas of concern typically discussed as posing a risk to the Convention Weapons Convention, along with findings from recent work of the SAB. Approaches to addressing the inevitable scientific and technological evolution, that in future, will influence the operating environment of chemical weapons (and other) non-proliferation and disarmament regimes. Disclosure of Interest: None declared

_SS13.2_ THE IMPORTANCE OF Q FEVER IN MILITARY MISSIONS D. Frangoulidis1,* 1Bundeswehr Institute of Microbiology, Munich, Germany Biography: LtCol Priv.-Doz. Dr. med. Dimitrios Frangoulidis is a M.D. and member of the Department for Special Diagnostics and Bio-Safety-Laboratory at the Bundeswehr Institute for Microbiology in Munich. He is a Specialist in Clinical Microbiology and Infectious diseases. In his field of responsibility is the expert laboratory for Q fever. His research interest is in epidemiology, pathogenesis and laboratory diagnosis of bacterial zoonoses, especially the Coxiella burnetii disease Q fever. In addition, he supervised several basic research projects and has already successfully applied for national and European grants. He is work-package leader in one granted project. Dimitrios Frangoulidis is author or co-author of more than 40 peer-reviewed publications and acts as a reviewer for international scientific journals. Abstract Content: Since its first description as a clinical entity based on the Gram-negative bacterium Coxiella burnetii in the 1930-ies, Q-fever infections have been seen in soldiers during military missions. Reports during the Second World War from Italy, the Balkans and the Crimean Peninsula raised the awareness in the Military. Reports about Q fever infections in deployed soldiers in Kosovo, Iraq and Afghanistan, as examples, have been published in the recent years. This demonstrates very well that this worldwide zoonotic disease is an ongoing risk for soldiers in missions. Although up to 50% of the affected persons show only mild to no symptoms and the fact, that in immunocompetent humans the disease is often self-limiting without antibiotic treatment, diagnosis, therapy, traceback analysis and identification of risk factors are mandatory. Undiscovered and untreated Q fever bears the risk of getting chronic in up to 2% of the acute cases with extremely difficult and long-lasting therapy and poor outcome (mortality rate up to 50%!). In addition nearly 40% of infected people have had the risk to develop a fatigue syndrome which could reduce mental and physical capacity and quality of life for years. Therefore fact finding and planning in preparation of Military missions must include Q fever, areas of risk e.g. sheep and goat farming nearby Camps should be identified and avoided. In addition awareness in medical staff and diagnosis of this clinical entity should be drawn constantly. Keeping in mind these issues consequently most of the Q fever infections could be avoided, the risk minimized and safe and controlled therapy guaranteed to avoid complications and sequalaed like chronification and fatigue syndrome. Disclosure of Interest: None declared

_SS13.3_ ZIKA VIRUS IN THE BRAZILIAN MILITARY HEALTH SYSTEM L. C. B. Fróes1,* 1Diretoria de Saúde da Marinha, Marinha do Brasil, RIO DE JANEIRO, Brazil Biography: Rear Admiral MD Luiz Claudio Barbedo FRÓES Director of the Naval Hospital Marcílio Dias Born on January 13, 1959, in the city of Rio de Janeiro, Brazil. Graduated from the Federal University of the State of Rio de Janeiro, in 1982. He joined the Brazilian Navy in 1983. He held a medical residency in General Surgery at the Naval Hospital Marcílio Dias and in Vascular Surgery at the Hospital of Andaraí, in the city of Rio de Janeiro, obtaining the title of specialist in General Surgery by the Brazilian College of Surgeons. He received a postgraduate degree in Hospital Administration from the Pontifical Catholic University of Rio de Janeiro and an MBA in Health Management from the COPPEAD Institute of Administration at the Federal University of Rio de Janeiro. He attended Air Force Aviation Medicine and majored in Aerospace Medicine from the University of the Air Force in 1988. In 2002, at the Air Force Station in Pensacola, Florida, he completed the US Naval Fligth Surgeon course. In 2003, he held the CENIPA Aeronautical Accident Prevention and Investigation Course. In addition to career courses, he hás completed the Course of Maritime Policy and Strategy by the Naval War School and the Course of Higher Studies of Politics and Strategy by the Superior School of War. Main functions performed: - Deputy Director of the Naval Polyclinic of São Pedro da Aldeia; Head of the Planning Department of the Navy Health Directorate; Director of the Naval Hospital of Brasilia; Deputy Director of the Navy Health Directorate; and Director of the Center for Operative Medicine of the Navy. Abstract Content: Zika virus (ZIKV) is a flavivirus transmitted by mosquitoes. Between 2015 and 2018, the World Health Organization declared ZIKV and its associated complications a public health emergency between February and November 2016. This presentation will summarize the impact of ZIKV on Brazilian Navy military personnel and their families, and will also bring out the BN contribution in response to ZIKV in the huge Brazilian territory. The emergence and rapid spread of ZIKV started an alert in the Brazilian Navy Health Care bought multiple actions: lectures in schools and hospitals, production of articles of public awareness in magazines and websites aimed to the military public, direct action to combat the focus of mosquitoes transmitter in civil and military areas and the creation of a molecular biology laboratory in Hospital Naval Marcílio Dias (HNMD) for arbovirus studies. Since 1 January 2017, HNMD maintains a ZIKV molecular detection research project. The study population consisted of all beneficiaries with suspected case of arboviruses on HNMD. These samples are tested by qPCR. The results of those projects will be discussed. Attentive surveillance of ZIKV infection and awareness of our beneficiaries are our weapons in the fight against this emerging virus. Disclosure of Interest: None declared

_PL02.3_ BREAKING THE BIOCOMPATIBILITY BARRIER FOR LONG-TERM IMPLANTABLE BIOSENSORS: TISSUE-INTEGRATING OPTICAL SENSORS FOR LONG TERM MONITORING OF BODY CHEMISTRIES E. Gadsby1,* 1Profusa, South San Francisco, United States Biography: Dr. Wisniewski co-founded Profusa, and currently serves on the Board of Directors and as Chief Technology Officer. She is PI on $30M of NIH and DARPA grants, and has over 100 papers, patents & invited lectures. She earned her BS in Chemical Engineering from Purdue University and PhD in Biomedical Engineering from Duke University. Dr. Gadsby leads innovation as the Program Manager for DARPA grants and for feasibility clinical studies. Prior to joining Profusa last year, Dr. Gadsby was Head of Product Dev. and Clinical for Kimberly-Clark Sofusa transdermal drug delivery and holds over 25 patents. She earned her BS in Microbiology from University of Florida and her PhD in Biochemistry from Georgia Institute of Technology. Abstract Content: Continuous tracking of body chemistry through mobile phones would enable a revolutionary advancement in chronic disease management and personal health monitoring. Few techniques exist for continuously monitoring tissue analyte levels and they are time intensive, costly and often require anesthesia or restraint. This presentation will summarize ongoing research and development of novel, low-cost, tissue-integrating microsensors that enable real-time measurement of tissue analytes for months to years, with special focus on our first sensor approved for human use: a continuous hypoxia monitoring for systemic oxygenation and localized tissue ischemia. These tissue-integrating oxygen microsensors have demonstrated utility for elucidating the oxygen environment in trauma, cancerous tumors, tourniquet models, irritable bowel research and tissue engineering. This same sensor platform is being engineered to detect medically relevant analytes including glucose, lactate, pH, carbon dioxide and others with the potential to help make more informed therapeutic, real-time decisions about various disease states. Disclosure of Interest: E. Gadsby Consultant for: Profusa

_RT04.2_ MILITARY WORKING DOGS IN BEHAVIORAL RESEARCH AND MANAGEMENT N. Gfrerer1,* 1Veterinary service, Swiss military, Bern, Switzerland Biography: Dr. phil. nat. Nastassja Gfrerer joined the veterinary service of the Swiss military in 2018 after finishing her PhD in biology at the University of Bern where she focused on fundamental and applied research. Abstract Content: Military dogs show direct and generalized reciprocity in different helping tasks and are able to respond appropriately to information obtained about a cooperator or defector just by observing two interacting partners. In these experiments, dogs are comparable to humans. Further, I studied two management questions. Although Swiss military dogs had not or only rarely interacted with other dogs before, I was able to demonstrate that these dogs showed less offensive and defensive behaviour towards conspecifics after only eight socialisation training sessions. Second, I chemically castrated some male dogs to test for potential effects of castration on the behavioural performance and compared their working ability. Results show that there are no differences between castrated and intact dogs, neither in their overall working ability nor in single parts of the test. Disclosure of Interest: None declared

_WS06.1_ UNPRECEDENTED RISK OF IRREVERSIBLE HARMS? MILITARY EXPERIMENTAL RESEARCH USING IMPLANTABLE BRAIN-COMPUTER INTERFACES F. Gilbert1,* 1University of Tasmania, Sandy Bay, Australia Biography: At the time of writing this bio, I am an Australian Research Council (ARC) Discovery Early Career Research Award Fellow, affiliated with the Ethics, Policy & Public Engagement program of the ARC Australian Centre of Excellence for Electromaterials Science (ACES), located at the University of Tasmania, Australia. I am concomitantly an Ethics Consultant for the Centre for Sensorimotor Neural Engineering, for which I conduct research at the University of Washington, in Seattle, USA. I have published over 60 articles in bioethics and neuroethics, including studies investigating risk of harms associated with experimental trial trying to establish safety parameters, especially within first-in-human trials Abstract Content: How much risk should patients be exposed to when participating in invasive brain experimentation testing innovative technologies? The US Defence Advanced Research Projects Agency (DARPA) is currently running high risk trial using various sets of AI brain-computer interfaces (BCI) for medical and enhancement purposes in human. What risk of harms is it morally acceptable to expose patients to when experimenting cutting-edge implantable brain technologies? What kind of necessary risks may allow prescribing implantation or explantation of brain devices? The aim of this presentation is to explore novel and unprecedented risk of iatrogenic harms associated to BCIs experimental trials. The Declaration of Helsinki states that research with the “prospect of discovering new ways of benefitting people’s health” is only justifiable if “it can be carried out in ways that respect and protect, and are fair to, the subjects of that research”. The question with high risk and dangerous experimentation linked to BCIs is whether trial design can respect, protect, and be fair to the research subjects. The current investigational trials of BCI by DARPA target small number of participants, due to their experimental nature. As such, it imposes and exposes on participants severe risks of harms that are largely not accommodated by existing clinical practices. This is of most concern with irreversible physical and psychological harms at early trial stages, 1) where participants may forfeit any future therapy, and 2) in AI BCI personalised medicine, where the individual participant assumes all of the trial risk. I’ll illustrate our presentation by using examples from experimental BCI trials. Disclosure of Interest: None declared

_SS03.3_ TRANSLATING WARTIME INNOVATIONS INTO CIVILIAN PRACTICE: LESSONS LEARNED FROM A DECADE OF CONFLICT M. Givens1,* 1United States Army, Bethesda, United States Biography: Colonel Melissa Givens has served in the United States Army for 30 years. She is a graduate of the United States Military Academy and the Uniformed Services University of the Health Sciences where she is now an Associate Professor of Military and Emergency Medicine. She is board certified in Emergency Medicine, Medical Toxicology and Sports Medicine. She has served with both Conventional and Special Operations Forces with multiple combat and non-combat deployments around the world. Abstract Content: This lecture intends to provide an overview of advances in medicine that were laregly driven by innovation during over a decade of conflict in the middle east. Topic will include pre-hospital trauma management, resuscitation, pain ccontrol, and trauma data systems. The signficance of these advances will be applied to the civilian setting. Disclosure of Interest: None declared

_SS11.2_ AN ANTARCTIC SPACE ANALOGUE: LIFE, MEDICAL SCIENCE & PSYCHOLOGY AT CONCORDIA STATION A. Golemis1,* 1Space Medicine Team, European Astronaut Centre, MEDES-IMPS / ESA, Cologne, Germany Biography: Adrianos Golemis studied Medicine at the Aristotle University of Thessaloniki in Greece. He subsequently attained his Master’s degree on Space Studies from the International Space University (ISU) in France, having completed an internship at the European Space Agency’s (ESA) European Astronaut Centre (EAC) in the process. Adrianos was then selected as ESA’s research doctor to implement medical experiments at the Antarctic Station of Concordia. There he helped study the effects of living in extreme conditions on the human body and psychology while in isolation for 1 year. He carried out his obligatory military service for Greece and subsequently worked for the French Space Medicine and Physiology institute (MEDES) at Toulouse on ESA’s 2017 bedrest campaign. In 2018 he made his return to the European Astronaut Centre where he is now working as a Flight Surgeon, monitoring the health of European Astronauts before, during and after spaceflight. He is also a volunteer for the Space Generation Advisory Council (SGAC) in Greece, taking part in science communication and space outreach. Abstract Content: Medicine can sometimes extend well beyond the classic definition that we usually have in mind, and which encompasses the vital task of providing healthcare to patients in a hospital. Medicine can reach out as far as the reach of human presence: well unto the unknown, extreme and exotic, even as far as leaving the familiar surface of our planet and venturing into space. The first part of this presentation focuses on sharing facts about the responsibilities of medical doctors working as Flight Surgeons for the European Space Agency (ESA), taking care of Astronauts’ health and ensuring their well-being before, during and after spaceflight. The second part aims to share the interesting peculiarities of conducting medical research in space analogues: environments on the Earth that closely resemble the conditions of spaceflight, ranging from physiologically simulating microgravity in a bedrest study to being immersed in real isolation in the heart of the Antarctic continent. The medical challenges and scientific gain of such expeditions is also explored. Disclosure of Interest: None declared

_RT06.4_ LOGISTIC CHALLENGES OF PHARMACY INSTITUTIONS IN "JUST-IN-TIME" SUPPLY S. Grenier1,2,3,* 1Canadian Armed Forces, 2Medicine, University of Ottawa, 3Plasma Protein Products, Canadian Blood Services, Ottawa, Canada Biography: Commander Sylvain Grenier graduated in 1995 from Université Laval, Québec with a Bachelor of Pharmacy. In 2008, he completed a Doctor of Pharmacy degree from University of Toronto. He was the National Practice Leader for pharmacy for the Canadian Armed Forces, as well as the Military Occupation Advisor for military pharmacists for the last seven years before he transferred from the Regular Force to the Reserve Force earlier this year. He is now the Director of Plasmas Protein Products Program with the Canadian Blood Services. Cdr Grenier is also an Adjunct Professor with the Faculty of Medicine of the Ottawa University, where he teaches Clinical Pharmacology and he is involved as the Pharmacy consultant for the Ontario Primary Health Care Nurse Practitioner program. He is the current President of the Military and Emergency Pharmacy Section of the Fédération Internationale Pharmaceutique. Dr Grenier has presented to numerous pharmacy conferences both national and international, including the FIP congresses in Sydney 2003, Cairo 2005, Bangkok 2014, Dusseldorf 2015, Buenos Aires 2016, Seoul 2017 and the Pan Arab ICMM congress in Hamamet 2018. Abstract Content: Just-In-Time (JIT) logistics has become the standard for most healthcare institutions in North America. Basic principles of JIT logistics are being exploited in order to streamline and provide cost-efficient medical logistics to military organizations as well. However; there are limitations to JIT logistics, which can affect delivery of care and operational readiness. Furthermore, current procurement practices in North America have created a medical logistics environment prone to shortages. These shortages become more and more challenging, especially in a JIT logistics model. This presentation will identify these challenges that have been introduces due to JIT logistics, it will also identify risk mitigation strategies to face these challenges. Disclosure of Interest: None declared

_PL03.4_ DISEASES AND MEDIA, REALITY OF FAKE NEWS? C. Griot1,* 1Institute of Virology and Immunology, Mittelhäusern, Switzerland Biography: DVM; PhD (University of Zürich, 1982) Master of Public Administration University of Bern (2005) Professor for Veterinary Public Health Vetsuisse Fakulty Bern and Zürich (2013 to current) Director IVI (1994 to current) Abstract Content: The World Health Organization warned in its 2007 report that infectious diseases are emerging at a rate that has not been seen before. Since the 1970s, about 40 infectious diseases have been discovered, including SARS, MERS, Ebola, Hendra, Niphah, chikungunya, avian flu, swine flu and, most recently, Zika. With people traveling much more frequently and far greater distances than in the past, living in more densely populated areas, and coming into closer contact with wild animals, the potential for emerging infectious diseases to spread rapidly and cause global epidemics is a major concern. These diseases are of major concern also for the public. The media including social media should add a value to the public perception and discussion of the impact of a disease on humans and animals including livestock. Do they really do this? Alternatively, is a “story” of the danger of a disease a unique selling point? Two examples on how media were dealing with two emerging diseases (SARS and avian influenza H5N1) will be presented. Disclosure of Interest: None declared

_SS03.1_ THE SWISS MILITARY MEDICAL EDUCATION AND TRAINING BENEFITS N. Gültekin1,* 1Centre of Competence for Military and Disaster Medicine, Ittigen, Switzerland Biography: Nejla Gültekin (MD, MPH) is specialist in Anaesthesiology and in Public Health. She worked at University Hospitals and at Federal Health Ministries abroad as well as in Switzerland. Since 2015 she works for the Swiss Federal Department of Defence, Civil Protection and Sport. As Chief of the Centre of Competence for Millitary and Disaster Medicine (CC MDM), she is in charge of education and research in the field of military and disaster medicine. She coordinates and provides the education and training of military doctors as well as other healthcare professionals. Abstract Content: The militia system of the Swiss Armed Forces will be explained; furthermore, an overview on the military medical education and training of medical doctors will be given. The military doctors, the army as well as the civilian healthcare benefit from the basic and advanced training of military doctors, nevertheless the army faces recruiting challenges that require further incentives to remain attractive. Disclosure of Interest: None declared

_SS08.2_ BIO-THREATS AND THE CIVIL-MILITARY INTERFACE C. Haggenmiller1,* 1Health Security, German Institute for Defence and Strategic Studies, Hamburg, Germany Biography: Dr. Christian Haggenmiller graduated 1992 as physician at the Freie Universität Berlin and received his research doctorate 1996 at the Medical Faculty, Humbolt University in Berlin. He joined the German armed forces in 1997 assuming several positions in German medical facilities and in missions. Being posted for 6 years at NATO’s Joint Analysis and Lessons Learned Centre (JALLC) he conducted 8 analysis projects in all NATO mission during 2006-2013 to provide strategic and operational recommendations to NATO’s top mission concerns. From 2013-2016 he served at the German Operational Forces Command in the Department Joint Medical, responsible for the health/medical support of German contingents deployed to UN missions. Since 2016 he assumes a lecturing position at the Command and Staff College of the Bundeswehr and belongs to the first crew of the German Institute for Defence and Strategic Studies as Research Coordinator in Health & Security. He is a founding member and chair of the interdisciplinary network “Global Health Security Alliance” GloHSA and joint the WHO roaster of experts in public health emergencies and bio weapons for the next 4 years. Abstract Content: Global Health Security depends on multifactorial events and domains. The most prominent one is hard to control epidemics with an impact on societal function and since a couple of years risks arising from changing characteristics of micro species, either through natural mutation or man-made through chemical or biological modification. These threats are becoming increasingly complex when adding additional layers such as climate change, migration, conflicts and disrupted health systems. With increasing access to “high tech” for “low budget,” the options to misuse biotechnology to create new or modified pathogen species have reached already a disturbing likelihood but will continue do so in the near future. The question is how well are those trends monitored and analyzed? How well are we prepared to mitigate potential threats at a global level and is there a specific role that the military can assume to prevent catastrophic biological disasters? Disclosure of Interest: None declared

_SS09.3_ BIODEFENSE IN THE AGE OF SYNTHETIC BIOLOGY D. Hassell1,* 1US Department of Health and Human Services, Washington, United States Biography: Dr. Chris Hassell serves as the Senior Science Advisor to the Assistant Secretary for Preparedness and Response, in the US Department of Health and Human Services. Dr. Hassell most recently served as the Deputy Assistant Secretary of Defense for Chemical and Biological Defense, and prior to that as an Assistant Director of the FBI where he served as Director of the FBI Laboratory. He has also held several R&D and leadership positions at Oklahoma State University, Los Alamos National Laboratory and DuPont. Dr. Hassell is an analytical chemist with specialization in sensor and diagnostics development, and he is a Fellow of the Society for Applied Spectroscopy. Abstract Content: The age of synthetic biology has brought with it opportunities to transform approaches to treating disease, manufacturing chemicals, producing fuels, remediating contaminants, and numerous other applications with benefits to humankind. Some synthetic biology capabilities, however, have dual use potential—that is, they can be misdirected to cause harm to humans, animals, plants, and the environment. Synthetic biology makes possible new types of weapons and adversaries that the United States’ approach to biodefense was not originally designed to counter. This presentation will discuss the recent US National Academy of Sciences report, which developed a framework to guide an assessment of the security concerns related to advances in synthetic biology, assessed the levels of concern warranted for such advances, and identified options that could help mitigate those concerns. Disclosure of Interest: None declared

_KS02.1_ MECHANISMS AND MANAGEMENT OF INFLAMMATION IN TRAUMA AND SHOCK C. J. Hauser1,* 1Harvard Med School, Boston, United States Biography: Carl J. Hauser, MD, FACS, FCCM trained at NYU Medical School and Harbor-UCLA Medical Center. He is a clinical trauma and Acute Care surgeon who has practiced at the University of Southern California, the University of Mississippi, Rutgers and Harvard. His laboratory’s research centers on how tissue injury modifies innate immunity. His discovery (Nature, 2010) that mitochondrial Danger signals initiate inflammation after trauma is considered a landmark in injury and sepsis research and that paper has been cited over 2000 times. Dr. Hauser serves as Trauma Medical Director at Beth Israel Deaconess Medical Center in Boston, and he is Principal Investigator of the Harvard-Longwood (HALO) trauma research consortium. This Department of Defense funded program project investigates how tissue injury suppresses innate immunity and so is permissive of infection. Dr. Hauser is also a dedicated musician with a lifelong interest in the Blues. Abstract Content: Recent research concerning the molecular biology of injury has begun to describe an important group of mechanisms by which injury alters immunity, causes inflammation and permits infection. Rather than mobilizing bacteria from the gut or exposing antigens that activate humoral and cellular immunity, trauma exposes innate immune cells to a wide variety of intracellular molecular motifs that are normally hidden from immune cells that patrol the extracellular space. These motifs are generally known as «danger-associated molecular patterns», or DAMPs. Moreover, they are often very similar to the molecular motifs that allow our immune cells to detect pathogens, that are called «pathogen-associated molecular patterns» (PAMPs). In each case, «danger signals» are sensed by engagement of pre-performed «pattern recognition receptors» (PRR). Intrinsic to this system however, is a conundrum whereby the very ancient PRR are often poly-functional, sensing both bacterial PAMPs and autogenous DAMPs. Thus the toll receptor TLR4 that senses endotoxin can also be activated by heat shock protein; and the formyl-peptide receptors that sense bacterial peptides can also be activated by mitochondrial peptides. Thus a major overlap exists between the immune detection systems for infection and injury. This overlap accounts for the well-known clinical difficulty in discriminating sterile inflammation, as happens in trauma, from infection. Subtle differences do exist however, between the responses of immune detection systems to injury and infection and our current work suggests that there is an inherent competition between wound healing and antimicrobial surveillance. Application of these principles to clinical management of trauma patients will yield novel approaches both to wound care and to the prevention and treatment of infection. Disclosure of Interest: None declared

_SS07.2_ BUILDING RESILIENCE IN NURSES: A CHALLENGE G. Hyams1,* 1The Teaching Center for Trauma, Emergency and Mass Casualty Situations (MCS), Rambam, Israel Biography: Mrs. Gila Hyams is the Chairman of the Nursing Directors Association in Israel since 2018 and the Director of Nursing at Rambam since 2015. Director of The Teaching Center for Trauma, Emergency and Mass Casualty Situations (MCS) at Rambam Health Care Campus since 1999 and the Trauma Coordinator of Rambam’s Trauma Unit Mrs. Hyams received her BA (RN) from the Hebrew University, Jerusalem and Assaf Harofe Medical Center School of Nursing, Tzrifin, in 1990, followed by an MA in Nursing from Tel Aviv University (2002) and Diploma of expertise in policy and administration from the Ministry of Health (2018). Mrs. Hyams has coordinated fifteen international courses on developing and organizing a trauma system and mass casualty situation (MCS) organization. In addition, she has organized and led workshops and courses to advance development of local emergency and trauma systems in Italy, Malta, Bulgaria, Czech Republic, Portugal, Latvia, Estonia, Croatia, Puerto Rico, U.S.A., Chile, India, and Thailand. In April 2005, Mrs. Hyams coordinated the NATO Advanced Research Workshop on Mass Casualty Situations held in Haifa, Israel. Since then, two other NATO courses were held at Rambam, one in November, 2009 and another one in November 2014. The 2014 course was Hospitals Under Fire—Operating Hospitals Under Extreme Circumstances. Among her public activities, Mrs. Hyams is a member of the Israel National Trauma Council and has collaborated with the Israel Trauma Society in forming the Nine Definitive Surgical Trauma Care (DSTC) Courses. She also established and organized the Israeli Trauma Mass Casualty Nursing Courses. Continuing Education / Courses: Health System Management Course Trauma Coordinator Course ATLS Professional Positions: 1. Director of Nursing, Surgical Division 2. Trauma Coordinator 3. Director, The Teaching Center for Trauma, Emergency and Mass Casualty Situations Selected Professional and Research Interests: 1. Organizing and conducting international courses in trauma 2. Building treatment pathways in Case Management Program for surgical patients 3. Development of clinical specialization in trauma / pain Abstract Content: Personal resilience is the ability to maintain well-being and effective functioning in the face of high levels of disruption. It involves adapting well in the face of adversity, trauma, threats and stress. Resilience is a tremendously important capability for professional caregivers, who often operate in environments filled with unexpected events and need to maintain their effectiveness in challenging circumstances. The Israeli health care reality deals with changes in the health system on daily basis that create unlimited challenges for nursing staff. The Challenges for the Nursing staff divided to 3 groups – Burnout, Secondary traumatization including Compassion fatigue. Burnout defined as the feeling of physical and emotional exhaustion, due to stress from working with people under difficult or demanding conditions. Burnout can be followed by signs such as chronic fatigue, quickness to anger, susceptibility to colds, headaches and fevers. According to burnout surveys in Israel, nurses in the ages 18-40 reports on higher percentage of burnout. The nurses report of over 3.51 in burnout scale. The causes related to burnout reported as negative stressors that have a physical effect Factors that protect the nurses from burnout were working or social conditions such as reducing physical workload and exposure to violence. In addition, working in a hot tempered multicultural environment and health situation that lead to life or death often produces incidents of verbal and emotional violence that cause the nursing staff feelings of personal uncertainty in their safety that also lead to burnout. The activities that helps to prevent burnout are creating diversity and interest in the workplace, the employer's commitment to employee health and wellbeing and improving the working environment by reducing the physical loads.

Secondary trauma can be incurred in first responders, nurses and physicians, mental health care workers, and children of traumatized parents. When an individual is exposed to people who have been traumatized themselves or disturbing descriptions of traumatic events by a survivor the nurses can develop symptoms of secondary trauma similar to those of PTSD (e.g. intrusive re-experiencing of the traumatic event. I will present 2 case studies that displays and demonstrate the models the systemic processes performed at the Rambam Medical Center for prevention, support, treatment and creation resilience in Nurses. Disclosure of Interest: None declared

_RT01.2_ ORAL SCANNERS IN DENTAL MEDICINE K. Jaeger1,2,* 1Biomaterial Science Center, University of Basel, Basel, 2Schweizer Armee, Sanität, Bern, Switzerland Biography: Kurt Jaeger is a medical dentist leading the dental centers "Praxis-Team St. Margarethen" (www.margarethen.ch). He earned his phd and his habiltation at the university of Basel. After his assistant position at the clinic of oral rehabilitation and TMJ-disorders (1983-1991) he has served as a lecturer at the university of Basel (Institute of operative dentistry). Now he ist still active at Biomaterials Science Center at the Department of Biomedical Engineering, faculty of medicine, at the university of Basel. Furthermore he ist since 2001 the chief dentist of the swiss army forces. He has published more than 200 papers in national and international journals. His research domains are ceramics, digital dentistry and TMJ-Disorders Abstract Content: Intraoral scanners are important in dental practices. The new working process generates digital data scans instead of impressions with conventional plaster models. A milling machine produces the specimen of inlays, crowns or bridges. The aim of the study was to compare the precision of the models by a scanning method of 5 different scanners in relation to the conventional plaster model after the impression with polysiloxane. The results indicate a high level of precision which is reached with the currently available intraoral scanners. They differ more in scanning time, ease of handling and pricing. A reference model of a full arch upper jaw was designed on the basis of clinically relevant data and measured with microCT. The data of the different scanners were compared with regard to the accuracy of the reference model. The data of the available oral scanners conclude that there is enough accuracy for a dental framework. Disclosure of Interest: None declared

_SS10.3_ THE B. CEREUS GROUP - A FOOD SAFETY CHALLENGE FOR ARMY CATERING FACILITIES S. Johler1,* 1Swiss Society for Food Hygiene, Zurich, Switzerland Biography: PD Dr. Sophia Johler is the President of the Swiss Society for Food Hygiene and a research group leader at the Institute for Food Safety and Hygiene, University of Zurich. She studied Veterinary Medicine at the Ludwig Maximilians University Munich, Germany and completed her doctoral thesis on stress response in Cronobacter sakazakii in the group of Prof. Roger Stephan at the University of Zurich, before joining the prestigious Skirball Institute of Biomolecular Medicine (PI Prof. Richard Novick) at New York University as a postdoctoral researcher. She returned to Zurich as a group leader at the Institute for Food Safety and Hygiene and completed her habilitation on “Minimizing the risk of staphylococcal food poisoning”. She worked as visiting scholar at the University of Veterinary Medicine Vienna, and the German Federal Institute for Risk Assessment (BfR, Berlin). Her main research focus is on foodborne microbial toxins. She was awarded the Konrad-Bögel Award for Veterinary Epidemiology and Veterinary Public Health 2017 (University of Veterinary Medicine Hannover) and the Inventor of the Year Award 2015 (patent UZ-17/359, University of Veterinary Medicine Vienna). PD Dr. Johler also is an Editor for FEMS Microbiology Letters and Frontiers in Microbiology and acts as reviewer for over 40 peer-reviewed scientific journals, the Research Executive Agency of the European Commission, and OPUS. Abstract Content: The members of the B. cereus group represent a particular challenge for Army catering facilities. Heated food is known to be often contaminated with B. cereus, leading to cases of diarrhoeal or emetic diseases. Battalion kitchens or army catering facilities present a food safety risk, as temperature abuse and long storage time can result in serious public health problems affecting a high number of served people. In contrast to civil catering facilities, no microbiological monitoring systems are currently implemented in Swiss military kitchens. We studied toxin gene profiles and cytotoxicity levels of B. cereus group isolates originating from Army catering facilities in Switzerland. Several B. cytotoxicus strains were identified and one cereulide-producer was isolated out of vegetables. While most isolates displayed low cytotoxicity, highly cytotoxic strains were detected, with several isolates even exceeding the cytotoxicity level of the reference strain for high-level toxin production, underpinning that cytotoxicity cannot be deduced only from presence or absence of toxin genes. These findings further underline the importance of rapid cooling of foods or maintenance over 65°C before serving. This is especially important in mass catering facilities, such as military kitchens, in which food is often prepared a long time in advance. Disclosure of Interest: None declared

_PL02.2_ VIRTUAL REALITY IMMERSIVE ASSESSMENT OF SPINAL ANATOMY IN VIRTUAL REALITY G. F. Jost1,* 1Spine Surgery, University Hospital Basel, Basel, Switzerland Biography: Gregory Jost is a fellowship-trained spinal neurosurgeon practicing at the University Hospital Basel. His clinical interest involves application of aviation-approved safety procedures in the OR. His research focusses on alternative surgical guidance systems such as inertial measurement units and Virtual or Augmented Reality to prepare and perform spinal surgeries. Abstract Content: Spine surgeries demand a sound understanding of patient-specific anatomy, which is currently gained by studying serial cuts of computed tomography scans (CT) and magnetic resonance imaging (MRI). Based on those medical images, the surgeon reconstructs in mind the anatomy in 3D. This works well for everyday cases but the more the anatomy is off a familiar anatomic constellation, the more difficult it is to imagine it in 3D. Meanwhile the computer and gaming industry has come forward with exciting virtual reality (VR) equipment that is powerful and affordable. Elaborate programming makes such equipment visualize standard DICOM data which enables surgeons to study a patient's anatomy in an unforeseen immersion. SpectoVR is an application that was developed at the Department of Biomedical Engineering at the University of Basel. It feeds a VR headset with 180 images per second, rendering in front of the viewer a hologram of the DICOM data (CT or MRI). Hence the viewer sees an object with depth and volume. It is possible to walk around it, view it from different perspectives, scale it and position it in space to the need of the surgeon. Visualization works best for bones and angiograms. As SpectoVR presents to the user somehow a real object, thus an entity the human mind has been exposed to ever since existence, it appears to greatly support understanding and memorization of the anatomy, foregoing the process of reconstructing a three-dimensional understanding of serial twodimensional images. Whereas it does however not omit the advantages of tomographic views, it appears to improve the surgeon's situation awareness of the case. In combination with conventional imaging and multiplanar reconstruction of CT data it appears to improve the surgeon's situation awareness of the case. Virtual and augmented reality technologies are by now also entering the operation room for navigation tasks. Disclosure of Interest: None declared

_SS10.2_ FIGHT AGAINST HIGHLY CONTAGIOUS ANIMAL DISEASES - ROLE OF THE ARMY T. Kalbermatter1,* 1Medical Service / Veterinary Service, Swiss Armed Forces, Ittigen, Switzerland Biography: Lt Col Dr. med. vet. Thomas Kalbermatter joined the Veterinary Service of the Swiss Armed Forces in 2012. His professional training includes several years as a veterinary practitioner for large and small animals and many years as an official veterinarian in the civil veterinary service. He is the Head of Food Safety and Animal Disease Control of the Swiss Armed Forces. Abstract Content: The Swiss Army supports the civilian authorities in dealing with exceptional situations. The army can assist with logistics, equipment and security troops. In the field of animal disease control, the army has the veterinary company (militia). The crew and cadres of the veterinary company are trained in the fight against epidemics in the context of the recruit school and the cadres schools. The veterinary company has special equipment, the so-called "animal disease assortments". The veterinary company can handle up to four livestock farms at the same time. If the veterinary company is reinforced by civilian or military forces, up to 12 livestock farms can be restored simultaneously. The decontamination of an affected livestock farm includes in particular: a) barrier to prevent the spread of the disease; b) set up of the installations; c) assisting with the killing and disposal of the animals; d) pre-disinfection, cleaning and disinfection of the establishment. In training, in the evaluation and procurement of special equipment, the civil veterinary services work closely with the veterinary service of the army. Disclosure of Interest: None declared

_RT04.3_ THE LARGE ANIMAL VERTICAL RESCUE SYSTEM (LAVRS) – DEVELOPMENT AND EVALUATION OF THE RESCUE OF 47 HORSES AND COWS L. Kenel1,* 1Department of Veterinary Surgery, Equine Hospital, University of Zurich, Zurich, Switzerland Biography: 2009-2012 Bachelor of Veterinary Medicine (UZH) 2012-2014 Master of Veterinary Medicine (UZH) 2015 Veterinärarztoffiziersschule Swiss Armed Forces 2015 – 2016 Doctoral Thesis (UZH), Assistant doctor at the animal hospital Zurich and in an private practice Since 2016 Member of LIA (Lebensmittelhygieneinspektorat der Armee) Since 2016 Official Veterinarian Private: Married and father of a girl Abstract Content: The Rescue of large animals out of narrow spaces such as wells and pits is difficult, amongst others because of limitation of space. To perform a horizontal rescue, the opening to the space must be enlarged, which usually requires a great deal of work and loss of valuable time. The animals often died or were severely injured because of the rescue. To improve rescues out of such caverns, the LAVRS (Large Animal Vertical Rescue System) has been developed. It was used by the Swiss Large Animal Rescue Service GTRD CH/FL 37 times. In a retrospective study these rescues were evaluated. It showed that 47 animals have been rescued. 9 of them were horses and 38 were cattle. All horses were sedated or under general anaesthesia. In 95 percent of all cases the animal/s had to be rescued out of a cesspit. Only in 2 cases the animal was trapped in a cellar (5 percent). Usually only one animal had to be rescued (n=31). The injuries the animals had originated of the accident and not of the rescue with the LAVRS. All animals but one survived without complications. One cow died because of hypothermia and exhaustion. If it is used by experienced personal, the LAVRS is a great and the only system to perform a vertical rescue safe and gentle for both the rescuers and the animal. Disclosure of Interest: None declared

_SS14.2_ FACING CASUALTIES: PREPARING SWISS MILITARY OFFICERS FOR "IN-EXTREMIS LEADERSHIP" F. Kernic1,* 1Leadership and Communication Studies, MILAK at ETH Zurich, Birmensdorf, Switzerland Biography: Since 2013 head of Leadership and Communication Studies at MILAK / Swiss Federal Institute of Technology (ETH Zurich). Previous positions: professor of sociology in Sweden; visiting professor at various universities in the US, Canada and Chile; senior researcher and lecturer in Austria and Germany. Studies in history, political science and philosophy at the University of Vienna; postdoctoral lecture qualification (habilitation) in political sciences at the University of Innsbruck (2001); postdoctoral lecture qualification (habilitation) in sociology at the University of the German Bundeswehr in Munich (2004). Abstract Content: This presentation focuses on leadership training in the Swiss armed forces with respect to in-extremis leadership challenges and tasks. Its focus is on leadership performance and group behavior among soldiers when facing death and when being confronted with a significant number of casualties. It discusses both theoretical considerations (based on empirical studies) and practical aspects of military leadership and introduces new approaches toward leadership training and development regarding the current system of officer education at the Swiss Military Academy. Disclosure of Interest: None declared

_PL05.2_ ORGANIZATIONAL-LEGAL ISSUES OF CIVIL-MILITARY COOPERATION IN PREVENTION AND RESPONSE TO EMERGENCY AND DISASTER SITUATIONS: A RUSSIAN PERSPECTIVE I. Kholikov1,* 1Chair of International and European Law, Institute of Legislation and Comparative Law under the Government of the Russian Federation, Moscow, Russian Federation Biography: Colonel (ret.) Ivan Kholikov is a graduate of Military University, Moscow. He participated in such international campaigns as United Nations Mission in Angola (UNAVEM III) – 1996, Multinational Operation in Kosovo (KFOR) – 2001 and United Nations Mission in Chad (MINURCAT) – 2009. In 2014 he was a leader of the Russian military Ebola response team in the Guinea Republic. Having completed 24 years in the military he retired in March 2016 from active duty service being decorated with a number of awards and medals for the distinguished service. Currently he works in the Institute of Legislation and Comparative Law under the Government of the Russian Federation. Colonel (ret.) Kholikov is a Doctor of Law and a Professor in international law, author of numerous publications on peacekeeping, international humanitarian law and cooperation in the field of military medicine. He is a faculty member of the International Committee of Military Medicine (ICMM) Law of Armed Conflict (LOAC) courses since 2010 and also holds the position of a Legal Advisor to the Secretary General of the ICMM. Abstract Content: Russian military medicine actively participated in rendering assistance to the population in disaster both at home and abroad from 1875 up to present time. Military medical service, being the most organized component of all medical assets that are called to the disaster scene, has some advantages over civilian healthcare bodies, which suffer themselves from a disaster, sometimes very significantly. However the common goal, which is to liquidate the consequences of the disaster in the shortest possible time, is normally reached by mutual efforts of both military and civilian specialists where the key factor is joint command and control along with constant interaction. Cooperation of civil and military medical assets during disaster response includes complex of measures of coordination, mutual support, joint planning and constant exchange of information at all levels between military structures and civilian bodies, humanitarian organizations and agencies accomplishing similar tasks in disaster area. It must be conducted both on national and international levels. One of the examples of best practice in such area in Russia was the creation of Unified state system of disaster prevention and response, which functionally united disaster medicine services of the Ministry of Health, Ministry of Defence, assets of the Ministry of Emergency, Ministry of Interior and other federal bodies of executive power. The All-Russia Disaster Medicine Service became the major functional component of this system. It is designed to conduct complex measures to prevent medical-sanitary consequences and to provide medical assistance to population in case of natural disasters, accidents, catastrophes, epidemics, local armed conflicts, terrorist acts and other emergencies. Significant experience of the Russian military healthcare in humanitarian domain continues to be in demand both at national and international levels. Constructive civil-military cooperation between medical professionals and its legal regulation will, no doubt, contribute to further development of medical means and methods of response to various disasters. Disclosure of Interest: None declared

_RT06.2_ LOGISTIC CHALLENGES OF PHARMACY INSTITUTIONS IN “JUST-IN-TIME” SUPPLY - THE GERMAN PERSPECTIVE B. Klaubert1,* 1Division Pharmacy and Food Chemistry, Bundeswehr Medical Service Head Quarters, Koblenz, Germany Biography: Study of Pharmacy and Food Chemistry; PhD in Pharmaceutical Analysis; Expert in Toxicology and Ecology Abstract Content: “Just in time” support of the troops with medicinal and medical products on missions abroad as well as in case of national and alliance defense is a main task in medical logistics. Therefore, the clear-sighted stockpiling and production of military medical material is the foundation of a successful and powerful military medicine. The objective of this oral presentation is to point out the German perspective in the supply chain of the Bundeswehr with medicinal and medical products. Basic principle of the supply with these items is a combination of strategic stockpiling and manufacturing of not or poorly available medicinal and medical products. The main focus is the strategic stockpiling and the manufacturing of antidotes and emergency pharmaceuticals. The aim is the production of auto-injectors (AI), filled with morphine, atropine and finally with a combination of atropine and obidoxime as well as the production of special medicinals like artesunate injection solution. From the current point of view, the production of morphine and atropine AI will start in 2022. For the storage of medical material, different models are suitable: increase of storage capacities including a controlled turnover of the material, contracts with the civilian industry for the support with all required medical material in time, industrial scale production of pharmaceuticals with an adequate shelf life without expiry date and multinational storage capacities, respectively. For the support of the troops with indispensable AI, an own production site is the only possibility to guarantee a stable and safe supply chain. In the near future, the Bundeswehr Military Hospital in Ulm could be a center for the manufacturing of military important AI in Europe and part of the NATO framework nations concept. Disclosure of Interest: None declared

_WS05.1_ RE-ENVISAGING MEDICAL RESEARCH ETHICS IN THE MILITARY CONTEXT S. Kolstoe1,2,* 1School of Health Sciences, University of Portsmouth, Portsmouth, 2MODREC, Ministry of Defence, London, United Kingdom Biography: Dr Simon Kolstoe is the civilian chair of MODREC and chair of the Hampshire A NHS research ethics committee. Originally a biochemist working in pre-clinical drug development, he is now a Senior Lecturer at the University of Portsmouth, UK, with a research programme focussing on all ethical aspects of medical research. One particular area of interest is the governance of research ethics committees, and he has acted as a policy advisor to Universities, Government departments and independent organisations seeking to establish robust research ethics processes. Along with a PhD in Biochemistry he holds degrees in Philosophy and Research Ethics. Abstract Content: The UK’s national health service (NHS) has an extensive network of over 60 research ethics committees committed to facilitating and embedding research in healthcare settings. UK military medical personnel often hold joint contracts with the NHS, ideally allowing the free-flow of clinical innovation between military and civilian contexts. Important principles in research ethics can be borrowed from the civilian world, but not always applied in exactly the same way. Challenges include gaining appropriately informed consent, dealing with incidental (and potentially career limiting) findings, conducting research on vulnerable recruits, managing research risks in environments of very high overall risks, and requirements for transparency. This paper will provide a brief overview of human participant research reviewed by the UK’s Ministry of Defence Research Ethics Committee (MODREC) before discussing efforts being made to harmonise MODREC philosophy, practice and procedures with existing civilian medical research ethics paradigms. Disclosure of Interest: None declared

_SS11.3_ MEDICAL CHALLENGES OF FUTURE SPACE MISSIONS TO THE MOON AND MARS M. Komorowski1,* 1Faculty of Medicine, Imperial College London, London, United Kingdom Biography: Matthieu Komorowski MD PhD is a clinical senior lecturer in the department of Surgery and Cancer at Imperial College London and an honorary consultant in intensive care at Charing Cross Hospital. He holds full board certification in anaesthesia and critical care in both France and the UK. He was previously a research fellow at the European Space Agency and holds additional qualifications in space, mountain, diving and hyperbaric medicine. He worked with the NASA Human Research Program (Houston, Texas) where he developed simplified anaesthesia protocols for future space exploration missions. He completed in Master of Research in Biomedical Engineering and a PhD in Medicine and Bioengineering at Imperial College London. In 2016/2017, he was a visiting scholar at the Laboratory for Computational Physiology at Harvard University and the Massachusetts Institute of Technology. In his research, he applies artificial intelligence techniques to build the next generation of decision support systems for critical care with a specific focus on sepsis. His PhD research was awarded the first prize of Research and Innovation by the British Royal Society of Medicine and published in November 2018 in Nature Medicine. Abstract Content: In the near future, space programs will shift their focus toward long‐duration interplanetary missions, in particular to the Moon and Mars. During these exploration missions, an autonomous crew may have to perform emergency care without real-time telemedical support. In these circumstances, advanced medical care may have to be provided in extremely scarce conditions, with minimal equipment and consumables, possibly by individuals with a very limited training and on an unstable patient. The risk of death from suboptimal medical management is huge, and could jeopardize the safety of the rest of the crew. The presentation will discuss how we could address such a challenge and prepare for a scenario so alien to our daily practice. Disclosure of Interest: None declared

_SS14.1_ LEADERSHIP DEVELOPMENT FOR THE AIR FORCE MEDICAL SERVICE A. Kosaraju1,* 1Dentist , United States Air Force, Washington DC, United States Biography: Colonel Amar Kosaraju is currently the Commander of the United States Air Force 11th Dental Squadron located at Joint Base Andrews outside of Washington, D.C. He is board certified by the American Board of General Dentistry and a fellow of the Academy of General Dentistry and the International College of Dentistry. In his prior assignments, he served as a residency director, deputy director, support flight commander, and clinical flight commander. He is a published researcher and has served as a peer reviewer for multiple journals. Colonel Kosaraju currently serves as the chairperson for dentistry and on the editorial board for the International Committee of Military Medicine. Abstract Content: The lecture will review the programs offered by the Air Force Medical Service in developing our leaders from “Captain to Colonel.” While military medicine typically excels regarding the delivery of medical care with excellent residency programs and other medical training programs, it has more difficulty in developing leadership skills in that clinician that also needs to be a commander. The lecture will present the leadership development courses and training offered by the United States Air Force Medical Service throughout the progression of an officer’s career. Disclosure of Interest: None declared

_RT01.1_ THE UTILIZATION OF CAD-CAM TECHNOLOGY IN THE US AIR FORCE DENTAL CORPS A. Kosaraju1,* 1Dentist , United States Air Force, Washington DC, United States Biography: Colonel Amar Kosaraju is currently the Commander of the United States Air Force 11th Dental Squadron located at Joint Base Andrews outside of Washington, DC. He is board certified by the American Board of General Dentistry and a fellow of the Academy of General Dentistry and the International College of Dentistry. He is a published researcher and has served as a peer reviewer for multiple journals. Colonel Kosaraju currently serves as the chairperson for dentistry and on the editorial board for the International Committee of Military Medicine. Abstract Content: The use of Computer Aided Design and Computer Aided Machining (CAD/CAM) design technology is being integrated into all aspects of dentistry. For the military, this technology can serve as a key readiness tool with the ability to complete dental treatment in one day that previously took 4-6 weeks over multiple appointments to complete. This roundtable discussion will review the United States Air Force Dental Corps incorporation of this technology into their dental practice which spans 77 clinics serving 330,000 patients across the world. Disclosure of Interest: None declared

_RT01.3_ DIGITAL TECHNOLOGIES IN CRANIOMAXILLOFACIAL SURGERY DIGITAL TECHNOLOGIES SUCH AS VIRTUAL PLANNING AND NAVIGATION OFFER INNOVATIVE TREATMENT OPTIONS IN A COMPLEX OPERATION FIELD, WITH IMPACT ON PRECISION AND OUTCOME QUALITY OF SURGICAL PROCEDURES C. Kunz1,* 1Clinic for Oral and Craniomaxillofacial Surgery, University Hospital Basel, Switzerland, Basel, Switzerland Biography: Prof. Dr. Dr. Christoph Kunz MD DDS FMH SSOS, Head of Clinic for Oral and Craniomaxillofacial Surgery, University Hospital Basel Major Christoph Kunz, Head of Section "Dentistry and Oral and Craniomaxillofacial Surgery" of the Center of Competence of Military and Disaster Medicine, Swiss Army Abstract Content: Title: Digital Technologies in Craniomaxillofacial Surgery Severe trauma, postraumatic secondary deformities or malformation of the facial structures offer complex challenges to reconstructive surgery. Innovative technologies based on virtual reality (VR) and augmented reality (AR) may have high impact on precision and quality of treatment outcome. Several cases where different technologies such as virtual 3D planning, navigation, patient specific implants or template based surgery have been applied are presented. Disclosure of Interest: None declared

_RT02.6_ A NOSE FOR BEDBUGS U. Lachmuth1,2,* 1formaco pmc ag, Regensdorf,, Switzerland, 2Bed Bug Foundation, Chepstow, United Kingdom Biography: Biologist, age 64, in professional Pest Control since 1982. Member of the Bedbug Foundation, co-author and translator of the European Code of Practice for Bedbug management and the Guidelines for the use of Scent Detection Dogs in Bed Bug Management. Owner and founder of formaco pmc ag, providing consultancy and training for professional pest control since 2007. Before that, Field Biologist for Rentokil Germany and Technical Manager for Rentokil Switzerland. Abstract Content: Rationale: Bedbugs are considered an increasing problem in the accomodation and transport industries, private homes andtherapeutic institutions. Medical importance is discussed, although no clear data are available.Methods: The presentation summarizes the current status of discussion on bebdug biology, medical importance, identification,monitoring and prevention and treatment methods.Results: Bedbugs accompany humanity since the stone ages. Widely present and "accepted" until the development of modernpesticides, they seemed to have been more or less eradicated by the late 1950s.Significant changes in pesticide awareness, the ban of organophosphorous compounds for domestic use and a shift to bait based andother tailored approaches in domestic pest control as well as a growing resistance to pyrethroid compunds in bed bugs lead to aresurrection, first observed in Australia and the US, since some 15 years in the rest of the world.Today, bedbugs are one of the most difficult-to-treat domestic pests, infestations are established in hotels and domestic residences aswell as in caring and medical facilities, any type of mass accomodation (refugee temporary homes, facilities for the elderly, militarybarracks, ...). Occasional infestations are observed in commercial aircraft, taxis, commuter trains, cinemas, etc.The medical importance of bed bugs is still unclear. Being blood feeders, the certainly do have some vectoring potential, although asper today not a single instance is known where bed bug presence has led to a transmission of disease.In 2016 the Bed Bug Foundation established a European standard for the training and examination of bed bug sniffer dogs. Thisstandard is available in English and German through the BBF web site and constitutes the first independent standard on how toimplement this valuable inspection tool in the course of bed bug management programs.Conclusions: Bed bugs are the one pest where it is required to inspect for, find, and treat every single insect in order to eradicate aninfestation. Few effective insecticides are available. The most promising approach today is a combination of heat and desiccant dusts.Experience and knowledge is needed to achieve eradication.References: http://www.bedbugfoundation.org/en/home/http://www.bedbugfoundation.org/en/canine-code/ Disclosure of Interest: None declared

_RT03.4_ INCREASED READINESS OF THE ARMED FORCES – CHALLENGES IN MEDICAL LOGISTICS; PREPOSITIONING OF MEDICAL MATERIEL A. Lange-Boehmer1,* 1Logistic, Bundeswehr Medical Service Headquarters, Koblenz, Germany Biography: Colonel Pharmacist; Degreed Food Chemist; MBA Health Care; Head of Branch: Logistic Command & Control/Logistic Mission Planning Abstract Content: The logistics elements of the Bundeswehr Medical Service are tasked to ensure the sustainability of all medical treatment facilities in routine duty and theatre. Planning and executing an effective medical logistics remains a national responsibility although a multinational approach is getting more and more important. Since Wales summit the focus in NATO shifted back to three essential core tasks: collective defense, crisis management and cooperative security including assurance and deterrence measures. Aim is a better preparedness and responsiveness of forces. Based on the specifications and derivations resulting from ministerial instructions and taking into account the current experience and the secured results from the project development of the Logistic System of the Bundeswehr, it is necessary to adjust the forward deployed logistics to the new challenges. To increase the operational readiness of the Bundeswehr Medical Logistics, the storage, the manufacturing and the contracting up to the pre-positioning of medical materiel have to be evaluated. To cover these areas of interest it is necessary to do further researches on: selection of essential medicines, standardization, cost efficiency warehousing and multinational coordination. The presentation takes a view on possibilities and introduce the current work on this topic in the Bundeswehr Medical Service. Disclosure of Interest: None declared

_RT03.2_ 2019 WEF MISSION: THE IMPLEMENTATION OF MEDICAL LOGISTICS R. Lutz1,* 1Training and education unit - logistics training unit, Swiss armed forces, Deisswil bei Münchenbuchsee, Switzerland Biography: 2019 WEF mission: The Implementation of Medical Logistics Maj Ralph Lutz Chief of Military Veterinary Service in the Competence Centre for Veterinary Servi 2019 WEF mission: The Implementation of Medical Logistics Maj Ralph Lutz Chief of Military Veterinary Service in the Competence Centre for Veterinary Service and Military Animals Swiss Armed Forces – Training an Education Command – Logistics Training Uni 1993 – 1998 Studies of Veterinary Medicine at University of Basle and Zurich 1999 Assistant Veterinary Surgeon in the Swiss National Stud, Avenches 2000 – 2007 Assistand Veterinary Surgeon in the Veterinary Clinic Schönbühl 2008 Border Veterinarian in the Federal Food Safety and Veterinary Office 2009 – 2012 Assistant Veteriary Surgeon in a Equine Veterinary Practice, Oberwil/BL 2013 Professional Training as Career Officer in Swiss Armed Forces 2014 - Competence Centre for Veterinary Service and Military Animals 1992 – 2007 Platoon Leader in a Armor Brigade 2013 – 2017 Commander of the Dog Handler Compagnie 2018 - Chief of Veterinary Service in Territorial Division Abstract Content: Disclosure of Interest As former commander of the dog handler compagnie as well as chief of veterinary service of the competence centre, in the past I've got used to deal with several problems in medical logistics in the WEF mission. Since 2018 the dog handler compagnie has the status of a compagnie with increased readiness, so there is a real need to have these processes working properly. Summary The presentation will show the implementation of medical logistics in the WEF mission of this year in human and veterinarian sector as well as its problems and some conclusions. Disclosure of Interest: None declared

_RT06.1_ LOGISTIC CHALLENGES OF PHARMACY INSTITUTION IN "JUST-IN-TIME" SUPPLY, THE SWISS PERSPECTIVE T. Meister1,* 1Central Pharmacy of the Swiss Armed Forces, Ittigen, Switzerland Biography: Age: 62 Profession: Pharmacist, PhD Position: Head of the pharmaceutical provision and production in the Central Pharmacy of the Swiss Armed Forces since 1997, Deputy Head of the Central Pharmacy of the Swiss Armed Forces since 2007. Abstract Content: The "just-in-time" supply of the troops represents a growing regulatory challenge for the Swiss Armed Forces Pharmacy. This includes the compliance with GDP-guidelines during the whole supply chain, a stockpiling as optimal as possible and the securing of the supply of essential medicinal products by an own emergency production. These are the aspects to be highlighted by the oral presentation. As a manufacturing site authorized by the competent Health Authority, the Swiss Armed Forces Pharmacy has to comply fully with the civil guidelines concerning trade with therapeutic products. The services of the Swiss Armed Forces Pharmacy extend beyond the Army into the Swiss public health system. The focus of the supply chain is the observance of the temperature, but also the full traceability of batches. Intensive effort is being made to install online temperature monitoring for all the warehouses of the Armed Forces Pharmacy. The shipments to the troops can be monitored partly by temperature loggers, partly by actively refrigerated transportation means. Until handover to the troops, the traceability is ensured by the SAP-system of the Armed Forces Pharmacy. Among big challenges ranks the optimal size of the intervention reserve. The partly short expiry dates as well as the low goods turnover represent our cost drivers. To date, the controlled extension of storage time of purchased merchandise is not possible; in the future, for the in-house products, we however strive for longest possible expiry dates supported by appropriate long-term stability studies. It is with quite some concern that we observe the growing disappearance of preparations with known active substances from the Swiss Medicinal Products market. For essential products, the Armed Forces Pharmacy tries to keep certain products on the market by means of in-house production. This is very burdensome, since the medicinal products of the Armed Forces Pharmacy have to go through the same marketing authorization procedures as the Pharmaceutical Industry. The focus is placed on the production of antidotes, especially atropine. Due to the high dependency upon civil pharmaceutical manufacturers in the field of the auto-injectors, the Armed Forces Pharmacy plans to alleviate the situation by having its own production in the medium to long term (2023/2024). Disclosure of Interest: None declared

_SS01.2_ COMPARISON OF OXIMES AND POSSIBILITIES ON THE MARKET I. Meskens1,* 1Medical Component, Belgian Armed Forces, Neder-over-Heembeek, Belgium Biography: Pharmacist Captain Isabell MESKENS obtained a Master of Science in Drug Development at Ghent University in 2013. Afterwards, she began her career in the Military Pharmacy, where she worked as Head of Purchasing. In 2017, she attended the French Military Medical School l’École du Val-de-Grâce where she obtained a Master’s Degree in CBRN (Chemical, Biological, Radiological and Nuclear incidents) in 2018. She teaches pharmacology, medical logistics and CBRN at the Medical Component of the Belgian Armed Forces. Abstract Content: Chemical warfare agents have been used in the past and will remain present in the future. Nerve agents form a particular threat due to their direct toxic effect. It is important to be ready to deal with these agents and possess the necessary antidotes. The preferred antidote against the cholinesterase inhibitors is an anticholinergic drug like atropine. It antagonizes the effect of accumulated acetylcholine. A second therapeutic principle is the reactivation of inhibited acetylcholinesterase (AChE) by cholinesterase reactivators or oximes. Multiple studies show that an oxime can further improve the outcome of a neurotoxic intoxication. Each oxime has a different reactivation efficacy against the most common nerve agents (tabun, sarin, soman, cyclosarin, VX and Russian VX). Typical oximes that are researched are pralidoxime, trimedoxime, obidoxime, methoxime, HI-6 and HLö-7. A comparison of these six oximes was conducted in order to select the best oxime for a future purchase. Unfortunately, a "universal oxime", which would be able to reactivate AChE inhibited by various nerve agents, is not yet discovered. Other possibilities such as bioscavengers were briefly researched, but they appeared to be in preclinical study phase only. Aside from the discussion on the "best of oximes", lies the reality of the market. Only a small number of oximes are available in auto-injectors (the desired form to administer antidotes). The current possibilities on the market are discussed and show the lack of interest of the international market in CBRN antidotes. Disclosure of Interest: None declared

_WS06.2_ AI PARTNERSHIP VS. AI SUBJUGATION: THE BIG RISK OF MILITARY MEDICAL AUTOMATION T. Miletić1,* 1Philosophy, University of Rijeka, Rijeka, Croatia Biography: Tomislav Miletić, born on May 7, 1984, in the city of Rijeka, Croatia. Doctoral student, third year, postgraduate doctoral study programme: “Philosophy and Contemporaneity”, Faculty of Humanities and Social Sciences in Rijeka. Personal and academic interests predominantly lie in exploring the ethical and social impacts of Artificial Intelligence inside the paradigm of Human Enhancement (Human Augmentation) specifically engaging the prospect of Human-AI Symbiosis and the formation of novel Human-AI moral-epistemic systems. As such, his research gravitates at the intersection of machine ethics and moral philosophy, philosophy of mind and epistemology, philosophy of technology and computer science. Abstract Content: AI automation systems are already part of many social, healthcare, and business systems in the world. In healthcare alone, AI automation systems are rapidly and deeply changing the medical landscape in many of its important dimensions. As the influence of automated decision and treatment administration grows, numerous important ethical and legal questions are raised. The pertinent one among these is, should AI systems be designed to operate inside limited autonomy or should they be fully autonomous in their monitoring, evaluation, and administration of treatments and what are the main risks involved in both of these cases? Such risks can become exacerbated in military environments with the development and use of autonomous AI systems which can either remove the human partner out of the decision loop or, on the opposite, place a heavy cognitive and skill-related burden on her. Both of these approaches constrain rather than empower medical efficiency as they impoverish the proper utilization of synergetic human-AI collaboration. To answer properly, military medical AI systems should be designed for human-AI partnership which achieves joint system collaboration that fully utilizes the capacities of its human and AI partners. In doing so, a relation of symbiotic interaction which optimizes Human-AI medical partnership and facilitates a successful mission outcome can be achieved. Disclosure of Interest: None declared

_SS09.1_ A CASE STUDY (SALISBURY) R. Milton1,* 1Emergency Response Department, Public Health England, Salisbury, United Kingdom Biography: Dr Milton is an expereinced public health physician working as a senior medical adviser in the Emergency Resopnse Department in Public Health Engalnd, from where the public health response to CBRN events is coordinated. Her role includes medical intelligence and she was significantly involved in the Public Health England's response to the salisbury poisonings in 2018. She is a co-editor of the 2018 revised "Chemical, Biological, Radiological and Nuclear Incidents: Clinical managemnet and Health Protection". Abstract Content: The response to poisoning of a small number of people with a novel malicious chemical agent in Salisbury in 2018 was facilitated by the UK's multiagency approach to preparing and planning for civil emergencies (The Civil Contingency Act (2004)). The identification of the causal agent and subsequent clinical management, the environmetal response and subsequent decontamination, all benefited from the close partnership working across UK agencies including the military. The public health response benefited from ongoing scientific analysis to inform ongoing dynamic risk assessments. The implications of responding to a novel agent include maintaining an honesty that there will be a changing knowledge basis during the response. Disclosure of Interest: None declared

_RT04.1_ THE ROLE OF THE HORSES IN THE SWISS ARMED FORCES S. M. E. Montavon1,* 1Veterinary Medical Servicesrmee, Swiss Armed Forces, Ittigen bei Bern, Switzerland Biography: Colonel Dr Méd. Vét. Stéphane Montavon joined the Swiss Armed Forces in 2003. His training begins as a veterinarian at the National Stud in Avenches, then as a resident in equine reproduction and equine medicine at UC Davis, CA, USA, further as an ambulatory equine practitioner in Geneva, Switzerland and as the CEO from Biokema S.A. High Veterinary Technology - Pharmaceutical Industry in Crissier, Switzerland. He's since 2003 the Chief Veterinarian of the Swiss Armed Forces Abstract Content: In the first part, the author explains the role of three breeds of horses used by the Swiss Armed Forces. First, we will focus on the horse of the "Freiberger" breed. The Army uses this Freiberger "Packhorse" for transport of logistic goods on difficult terrain and at altitude for the benefit of the troop and the civil authorities. The second breed used, is the mule, which is a crossbreed between a Freiberger mare and a donkey. The Army uses mules as "Packhorse" in very difficult and abrupt treks in mountains. The third breed, which the Army is using, is the Swiss half-breed: a high-performance saddle horse that is committed to riding instruction purposes. In a second part, it will be explained why the use of horses and the riding education are considered as benefits in the training of the cadres of the Swiss Armed Forces Disclosure of Interest: None declared

_RT03.5_ INCREASED READINESS OF THE BUNDESWEHR MEDICAL LOGISTICS - PRE DEPLOYMENT OF MEDICAL MATERIEL B. Most1,* 1BwMedSHQ, Koblenz, Germany Biography: Brigadier General, Medical Corps Dr. Bruno Most DCOS, Directorate A "Health Care Planning, Control and Management" - BwMedSHQ Director MMCC Born in Kassel in 1962 Military career From - to Assignment 1982 - 1984 Officer candidate engineer corps, Armored Engineer Company 1984 - 1992 Human medicine studies, University of Goettingen, 1992 - 1994 Medical intern, Bw Hospital Giessen 1994 - 1996 Senior Medical Service officer / unit physician, Garrison Medical Clinic Fritzlar 1996 - 1997 Staff Officer J3, Army Support Command, Div. III, M’gladbach 1997 - 1999 40th National General/Admiral Staff Officer Course, Bw Command and Staff College, HH 2000 Staff Officer J3, Med Serv Div, Army Forces Command, Koblenz 2000 - 2001 ACOS Ops Support, HQ Med Brig1, Leer 2001 - 2004 Director, Medical Maneuver Training Center, Weissenfels 2004 - 2007 Deputy Chief of Branch FüSan II 1, FMOD, Bonn 2007 - 2014 ACOS G3, Reg Med Com III/ Op Med Support Com, Weissenfels 2015 - 2016 DCOS, Special Staff Directorate, BwMedSHQ, Koblenz Since Mar 2016 DCOS, Directorate A, BwMedSHQ, Koblenz Since April 2018 Director MMCC (as additional duty) Since Sept 2018 Presidency member of the German Red Cross (DRK) Abstract Content: In 2014, the NATO Council endorsed the “Framework Nations Concept” (FNC). The purpose of FNC is to assist Allies in delivering the capabilities required, both quantitative and qualitative, to meet NATO’s Level of Ambition and successfully undertake the three essential core tasks of the 2010 Strategic Concept: collective defence; crisis management; and cooperative security. In 2017 9 nations of the FNC Cluster Medical Support laid the foundation for a Multinational Medical Coordination Centre (MMCC). There were three essential points in this declaration of intent. First there shall be a coordination of medical planning for exercises and operations, second there shall be a coordination of the existing and future capabilities of the member nations for a better efficiency of ressources and third redundancies to other structures shall be avoided. The last point was of major importance for the next step. In December the majority of the European Union defence ministers signed the documents for a permanent structured cooperation the so called PESCO . One of the 17 agreed projects was the decision for a European Medical Command (EMC), again with Germany as Lead Nation. And again the aim of this project was at first to coordinate ressources in an efficient way to improve medical support for european operations. The analysis of both projects was, that we have to avoid double structures and

redundancies and to concentrate our ressources. The only real existing option was a single set of forces and a single staff for both initiatives merging into one entity as MMCC/EMC. Looking into the challenge of enhancing the medical capabilities of the participating nations in order to increase the readiness for operations, there are several fields for the MMCC/EMC to deal with. We have already started projects on future MEDEVAC and the development of medical facilities, but multinational medical logistics is still an open issue. Without a better coordination of existing national medical logistic structures and the establishment of multinational medical logistic institutions it will doubtful to ensure the sustainability of larger formations. MMCC/EMC will take this question on its agenda for the next years. Disclosure of Interest: None declared

_KS02.3_ PENETRATING ABDOMINAL TRAUMA P. H. Navsaria1,* 1Trauma Center, Groote Schuur Hospital and University of Cape Town, Observatory, Cape Town, South Africa Biography: Qualifications: MBChB, FCS (Surg) (SA), MMed (Surg), Trauma Surgery (HPCSA), FACS (International) Clinical Position: Deputy-director: Trauma Center, Groote Schuur Hospital, Cape Town Academic Position: Professor of Surgery: Department of Surgery, Health Sciences, University of Cape Town Immediate Past- President: Surgical Research Society of Southern Africa (2015 – 2017) Chairperson: Surgical Research Society of Southern Africa Scientific Committee (2017 – 2021) Clinical researcher: National Research Foundation (NRF) rated researcher. Special interests include civilian penetrating trauma, negative pressure wound therapy, temporary abdominal wall closure, non-operative management of penetrating abdominal, vascular and neck trauma, and under- and post-graduate surgical education. Associate Editor: South African J Surgery Certified instructor: ATLS®, DSTC® and BSS® courses. Colleges of Medicine of South Africa: Chairperson and Convenor: Examination Board: Cert Trauma and Critical Care Sub-specialty Recent Achievement/s: University of Cape Town Distinguished Teacher’s Award: 2017 Publications: PUBMED: https://www.ncbi.nlm.nih.gov/pubmed/?term=navsaria+p Google Scholar: https://scholar.google.co.za/citations?user=fPhsfXoAAAAJ&hl=en Abstract Content: Although mandatory laparotomy has been standard of care for patients with abdominal gunshot wounds (GSWs) for decades, this approach is associated with non-therapeutic operations, morbidity, and long hospital stays. This lecture will review and summarize outcomes of selective nonoperative management (SNOM) of civilian abdominal GSWs. Review of the literature, together with interactive case studies will be presented. The speaker hopes to show that SNOM of abdominal GSWs is safe when conducted in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis. Failure of SNOM may be lower in patients with GSWs to the back, flank, or right thoracoabdomen and be decreased by mandatory use of abdominopelvic CT scans. Disclosure of Interest: None declared

_KS02.2_ PENETRATING CHEST AND HEART TRAUMA A. Nicol1,* 1Groote Schuur Hospital Trauma Centre, Cape Town, South Africa Biography: Professor Nicol has been the Director of the Groote Schuur Hospital Trauma Centre, in Cape Town South Africa, for the past 20-years and is a Professor of Surgery at the University of Cape Town. This centre is one of the busiest level 1 Trauma Centres in the world seeing over 1000 trauma patients per month and has become an international trauma surgical training centre. He has a particular interest in cardiac trauma and received his PhD from the University of Cape Town on the; "The current management of Penetrating Cardiac Trauma." This included the first, ever, randomized study on cardiac trauma. He is the editor of the Oxford Handbook of Trauma and has over 120 peer review trauma publications. He is the current President of the Trauma Society of South Africa. Abstract Content: The mortality rate from a penetrating chest wound is a major contributor to non-natural deaths. However, the vast majority of these deaths occur in the pre-hospital phase. The in-hospital mortality rate can be as staggering low at 2% of admissions, this obviously being relative to the proportion of gunshot (GSW) to stab wounds (SW) encountered. At Groote Schuur Hospital in Cape Town, South Africa approximately 25% of our penetrating thoracic injuries (PTI) are gunshot related. We have found that 83% of PTI can be managed by observation and/or tube thoracostomy. Selective operative management (SOM) is safe and effective and the trend towards more conservative, non-operative management continues but it must be recognized that patients can deteriorate rapidly and there is a need for very close monitoring. A practical surgical talk will be presented on the clinical management of these injuries. Disclosure of Interest: None declared

_SS03.4_ COLD WEATHER OPERATIONS A. J. Norheim1,2,* 1Institute of Military Primary Healthcare, Norwegian Armed Forces, Joint Medical Services, 2058 Sessvollmoen, 2Faculty of Medicine, UiT-The Arctic University of Tromsø, Tromsø, Norway Biography: Arne Johan Norheim (MD, PhD, Lt Col) is specialist in family medicine and professor in Healthservices at the Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway. He has been working as general practitioner and military doctor in the Norwegian Armed Forces since 1998. He is currently Lieutenant Colonel and head of the Institute of Military Primary Healthcare in the Norwegian Armed Forces Joint Medical Services. He has a special interest in cold injuries and is the principal investigator (PI) in several cold injury research projects in the Norwegian Armed Forces. Abstract Content: Cold weather injuries have for decades been a relevant problem in military activity and continue to be so. Human performance in cold weather operations is challenging, and as a soldier you need to handle the constraints of extreme winter conditions. History and experience have been the major guidelines for military training, but recent studies might have impact on future military education. The presentation gives an overview over topics like nutrition, training, and equipment from the preventive aspect. Research within Cold Weather Injuries (CWI) like hypothermia and frostbites is also presented. The presentation attributes the knowledge gained in military research to be valid also outside the military campuses. Learning from Cold Weather Operations in the military context might contribute to winners for both Civilian and Military Healthcare. Disclosure of Interest: None declared

_RT05.4_ CHALLENGES OF DELIVERING MEDICAL SUPPORT IN CENTRAL AFRICAN REPUBLIC (MINUSCA): PERSPECTIVE OF A CHIEF MEDICAL OFFICER S. Oteng1,* 1United Nations, MINUSCA, Bangui, Central African Republic Biography: Sophia Oteng, Dr. med., MPH is the Chief Medical Officer of the United Nations Integrated Stabilization Mission in the Central African Republic, known by the acronym MINUSCA. She was the first civilian medical officer to deploy to the Mission prior to its inception and re-hatting of AU in the year 2014. She coordinated the medical start-up phase, which included development of the Medical Support Plan, the construction of a Level 2 hospital in Bangui from scratch, which today provides the highest level of medical care in the capital, Bangui, and serves not only UN personnel in CAR, but also members of the international community and diplomatic missions in CAR. Dr. Oteng currently oversees 40 level I clinics distributed all over CAR, and 4 Troop contributing country level I+ and level II hospitals, all with damage control capabilities. With over 16 years of experience in delivering medical support in peace keeping settings, Dr. Oteng has served in the Democratic Republic of Congo (in both MONUC and MONUSCO), Kenya/Mogadishu (UNSOA – United Nations Support Office to AMISOM), Central African Republic (in both BINUCA, a Political Mission, and MINUSCA) and has vast experience in addressing medical support challenges in very difficult settings and circumstances. Prior to joining the UN, Dr. Oteng served in the University Hospital in Frankfurt, Germany, University of Bielefeld School of Public Health also in Germany, and the Planned Parenthood Association of Ghana. Dr. Oteng has an unwavering passion to constantly seek ways of improving the quality of life of the people she serves and works with, and she is ready to drive change where needed. She has an Interest in photography of natural scenery, brisk walking, and spending quality time with family. Abstract Content: MINUSCA is located in the Central African Republic, a relatively vast, landlocked country, sparsely populated, with a total population of 4.83 million covering an area of 622,980 square kilometers. It is war-torn and is one of the most impoverished countries in the world. It has poorly developed or even near to non-existing medical infrastructure in most part of the country. With a deployed mission strength of 14,685, comprising of 12,938 uniformed personnel, MINUSCA faces an enormous challenge to deliver adequate and timely life and limb-saving medical services to all its personnel in all locations, particularly in very remote, locations that are difficult to access. Given the above scenario, this presentation will seek to elaborate briefly on the medical infrastructure in MINUSCA, implementation of medical emergency response, casualty evacuations and established procedures, while elaborating on the challenges involved in carrying out these activities. It will also delve into the main reasons for evacuations, the main causes of deaths, and how the Mission plans to address the current challenges in its efforts to reduce mortality and permanent disability among the personnel. Disclosure of Interest: None declared

_RT06.3_ PERSPECTIVE BELGE (TABLE RONDE 6) L. Pierre-Victor1,* 1Belgian Defence, Bruxelles, Belgium Biography: Lise Pierre-Victor Captain Pharmacist Belgian Army I obtained a master’s degree in Pharmaceutical science from “Université libre de Bruxelles” in Brussels in 2009. My military career for the Belgian Army Forces started in October 2015. At the moment, I'm working as Office Manager in the Secretariat General of the ICMM. Abstract Content: Rationale: Comment l'armée belge, et plus précisément, les pharmaciens militaires belges s’organisent au sein de leur institution afin de garantir un approvisionnement en médicament et matériel médical et y confèrent un système de Qualité ? Methods: Le Service Qualité du 5ème Elément d’Intervention Médical (anciennement dénommé la Pharmacie Centrale) dirigé par un pharmacien d'industrie a mis au point des documents de qualité, appelés procédures, en se référant aux Bonnes Pratiques de Distribution (GDP) pour régir le travail journalier effectué par les pharmaciens des différentes unités et les équipes de ravitaillement médical. Results: En collaboration avec différents services au sein des unités médicales, sous la supervision d’un pharmacien responsable, un approvisionnement en médicaments et matériel médical est assuré chaque semaine au sein des différents « Elément Médical d’Intervention » implantés en Belgique. Le processus de distribution pharmaceutique sur le territoire belge est un processus bien rodé. Lors des missions hors territoire belge, les règles GDP sont également applicables mais leur application relève dans ce cas d’un travail de concert et de conscientisation avec les membres des autres Composantes. Plusieurs paramètres rentrent alors en compte afin d’assurer un approvisionnement selon les normes GDP. Certains paramètres sont parfois hors de portée du Pharmacien engendrant des écarts et des actions ultérieures pour palier à ces écarts. Conclusions: Le Pharmacien travaille chaque jour, sur base des expériences apprises et avec l'aide d'un Service Qualité, pour améliorer la chaine de distribution Pharmaceutique « sur et en dehors » de la Belgique. Une collaboration à tous les niveaux se révèle être primordiale afin de garantir les missions. Disclosure of Interest: None declared

_SS12.5_ « TRAINING THE MILITARY SURGEONS. FRENCH EXPERIENCE. (NEW SIMLIFE MODEL FOR DAMAGE CONTROL SURGERY - INTEREST FOR CIVILIAN SURGEONS) » F. Pons1,* 1Ecole du Val de Grâce , SERVICE DE SANTE DES ARMEES, Paris, France Biography: Major General (Ret), Visceral and Thoracic Surgeon, Deployments in Middle East, Chad, Rwanda, Bosnia, Kosovo, Afghanistan, Head of the Department of Surgery of the French Military Health Service (Ecole du Val de Grâce) in Paris from 2005 to 2012, Creation in 2007 of the French Advanced Course for Deployment Surgery, Director (Dean) of the Ecole du Val de Grâce until 2017, Member of the Conseil National de l’Urgence Hospitalière (French National Council for the Hospital Emergencies) since 2017, Creation of SimLife Damage Control Surgery Course at the University of Poitiers (2017, 2018) Abstract Content: The education of the military surgeons is a very important issue for every Military Medical Corps. In France, like in many countries, it is more and more concerning because of the increasing gap between the education of a civilian surgeon and the skills required for a military surgeon. Surgeons in France are more and more subspecialized for one organ, perform few Trauma surgery, use mini-invasive surgery, refer to Evidence Based Medecine …. When deployed the military surgeons must, of course, know the principles of War surgery, Triage and Damage Control Surgery. But also, they must be able to perform, for the French soldiers, any kind of Trauma and non Trauma emergency surgery, including head and neck surgery, vascular surgery, peritonitis, etc.. So, to train these young surgeons and to try to keep polyvalence and adaptability for emergency surgery a course, named Cachirmex (Cours avancé de Chirurgie en Mission Extérieure, Advanced Course for Deployment Surgery), created in 2007 is organized every year at the Ecole du Val de Grâce. It involves 5 modules, about 110 hours, for the whole course with case reports, lessons learned, lectures and hands on exercises (simulation) on cadaver or live tissue. (1 : Generality about the war wounded and the Organization of the Medical Corps in the Theatre - 2 : Trauma of extremities and soft tissues – 3 : Head, Neck, Chest, and Spine Trauma – 4 : Abdominal and pelvic Trauma – Module 5 : Control of Hemorrhage). One other module is dedicated to vascular surgery. A module for Damage Control Surgery has been created in 2017 using a new model SimLife of ventilated and perfused cadavers at the University of Poitiers. It is used as a part of the military Course Cachirmex, but also for the training of civilian surgeons because in case of terror attacks a surgeon in France, will find some of the same conditions as a military surgeon on-deployment : type of injuries, necessity of large approaches, Damage Control Surgery, mass casualties and necessity of triage Disclosure of Interest: None declared

_PL01.1_ COUNTER-TERRORISM CHALLENGES TO MEDICAL ETHICS L. Rubenstein1,* 1Center for Public Health and Human Rightsf, Bltimore, United States Biography: Leonard S. Rubenstein Leonard S. Rubenstein is Director of the Program in Human Rights, Health and Conflict at the Center for Human Rights and Public Health at the Johns Hopkins Bloomberg School of Public Health, and a core faculty member at the Berman Institute of Bioethics and the Center for Humanitarian Health at Johns Hopkins University. Prior to coming to Johns Hopkins in 2009, Mr. Rubenstein was a Jennings Randolph Senior Fellow at the United States Institute of Peace, and for a decade before that, Executive Director and then President of Physicians for Human Rights. He has a J.D. from Harvard Law School. Mr. Rubenstein has engaged in extensive research and writing on human rights, health and national security. His current work focuses on health services in volatile environments. He founded and chairs the Safeguarding Health in Conflict Coalition, a group of humanitarian, human rights, health provider organizations working at the global and national levels, that seeks to reduce attacks on and interference with health workers, patients, facilities and transports. He is the recipient of numerous awards, including the Congressional Minority Caucuses’ Healthcare Hero Award, the Sidel-Levy Award for Peace of the American Public Health Association, and the Syrian American Medical Association recognition award. Abstract Content: Starting in the late 1990s and accelerating after the attacks of September 11, 2001, counter-terrorism and related laws have increased in scope and breadth, so much so that they have been employed to restrict humanitarian organizations in functioning in conflict zones according to their humanitarian principles and preventing physicians and health care providers from providing care to all in need in accordance with the requirements of the Geneva Conventions, human rights law, and ethical obligations. The breadth of such laws is vast and they have been employed to harass, arrest, detail and prosecute health professionals. The practices have also created dual standards, one for military medicine and one for civilian health professionals, contrary to best practices in medicine as a whole. Such laws are also used to outlaw medical care on a population scale. States, with the support of the UN Security Council, need to reform their laws and practices. Disclosure of Interest: None declared

_SS08.3_ NANOMEDICINE FOR TARGETED DRUG DELIVERY T. Saxer1,2,* 1Swiss army, BIERE, 2University of Geneva, Geneva, Switzerland Biography: Author: Till SAXER, MD in 2001 at the University of Geneva, is specialized in internal medicine and critical care FMH. He practices as physician and teaches for pre-graduated training at the University of Geneva. As Lieutenant Colonel, he is chief officer for the military primary care and temporarily replaced the surgeon general of the Swiss army until 2018. Initiating a nanomedicine technology for targeted drug delivery, he received a public fund (FNS PRN 62) in 2009 with Bert MÜLLER and Andreas ZUMBÜHL. Co-Author: Bert MÜLLER, PhD in 1994 at Hannover University with Master in Physics and English is since 2006 Thomas Straumann Professor for Materials Science in Medicine at the Medical Faculty of the University of Basel and since 2008 Head of Materials Science Institute, Dentistry, University of Basel, Switzerland. Co-Author: Andreas ZUMBÜHL, PhD in 2004 at ETH Zurich was from 2012 to 2018 boursier Professor at University of Fribourg, Switzerland and heads actually a start-up project in collaboration with Dr. Pierre-Alain MONNARD and Roger MEIER in the field of targeted drug delivery. Abstract Content: Cardio-vascular disease is the number one cause of death worldwide. Stenosed segments of arteries significantly alter the blood flow known from healthy vessels. In particular, the wall shear stress at critically stenosed arteries is at least an order of magnitude higher than in healthy situations. This alteration represents a change in physical force and might be used as a trigger signal for drug delivery. Mechano-sensitive drug delivery systems that preferentially release their payload under increased shear stress are discussed. Therefore, besides biological or chemical markers, physical triggers are a further principle approach for targeted drug delivery. We hypothesize that such a physical trigger is much more powerful to release drugs for vasodilation, plaque stabilization, or clot lysis at stenosed arteries than any known biological or chemical ones. To engineer the therapy for better patient outcome, the knowledge of anatomical changes in terms of lumen morphology and tissue composition of constricted arteries is crucial for designing a localized drug delivery to treat atherosclerosis disease. Traditional tissue characterization by histology is a pivotal tool, although it brings disadvantages such as vessel morphology modification during decalcification and slicing. X-ray tomography in absorption and phase contrast modes yields a deep understanding in blood vessel anatomy in healthy and diseased stages: measurements in absorption mode make visible highly absorbing tissue components including cholesterol plaques, whereas phase contrast tomography gains better contrast of the soft tissue components such as vessel walls. Technique of synchrotron radiation-based micro-CT techniques ensure high performance in terms of 3D visualization of highly absorbing and soft tissues are discussed here. A new type of phospholipid vesicle was introduced in the interdisciplinary project: Natural liposomes made from eggPC leak their content spontaneously and will do so even more if they are shaken. Other liposomes made from 16:0 SM or DPPC do not leak spontaneously or when shaken. However, vesicles from the artificial synthetic 1,3-diamidophospholipid Pad-PC-Pad2 with a lentil-shaped morphology show no spontaneous leaking but can release their content under mechanical stress. This observation qualifies these vesicles as drug delivery vehicles and are also discussed here. Disclosure of Interest: None declared

_SS13.1_ MIGRANTS AND THEIR INFECTIOUS DISEASE PROFILES P. Schlagenhauf1,* 1University of Zurich - Centre for Travel Medicine, WHO Collaborating Centre for Travelers’ Health, Zurich, Switzerland Biography: Prof. Dr. Patricia Schlagenhauf-Lawlor, PhD, FISTM, FFTM, RCPSG (Glasgow) Patricia Schlagenhauf is a Professor and Senior Scientist at the University of Zürich Centre for Travel Medicine and Co-Director of the WHO Collaborating Centre for Travellers’ Health at the Institute for Epidemiology, Biostatistics and Prevention UZH, Zürich, Switzerland. Her research areas are travellers’ malaria, epidemiology and surveillance of travel-related infections, medications and vaccines for the prevention of travel-associated illness including gender/age response issues and development of novel technologies and digital tools for travel medicine. Since 2015, she is a member of the Military and Disaster Medicine Commission (Eidg. Komm. Militär-Katastrophenmedizin) in Switzerland and colaborates in military medicine research. In travel health, surveillance networks she is active as the Zürich, GeoSentinel Site Director since 2004, in the EuroTravNet Steering Committee since 2009, and she served in the GeoSentinel Global Leadership Team from 2015 - 2018 where she initiated and chaired the “Tracking-Communications” group with the goal of tracking illness in travellers, defining trends and initiating a fast chain of response to outbreaks. She is a member of the Steering Committee of the ECCMID Travel Medicine Group and of the Swiss Expert Group for Travel Medicine. Formerly European Senior Editor at the Lancet, she is now Editor-in-Chief of Travel Medicine and Infectious Disease. Her publication list includes more than 150 travel medicine papers and books such as "Travelers' Malaria" (BC Decker 2001, 2nd edition 2008) …Infectious Diseases – a Geographic Guide (Wiley 2011, 2nd edition 2016) and "PDQ handbook of Travelers' Malaria" (BC Decker 2005). Abstract Content: Large numbers of migrants and asylum seekers have presented in Europe over the past five years. Such migration challenges health systems in host countries. Population movements have an impact on infectious disease epidemiology. Migrants are generally young and healthy, but may present to local medical facilities in host countries with unfamiliar infectious diseases that often require unlicensed or unavailable treatments. These circumstances have implications for screening, diagnostics, medication procurement and adherence to treatment. It is important that the infectious disease (ID) profile of the disparate groups is known in order to pre-empt care, vaccination and treatment needs. This talk will look at the infectious disease profiles of many migrant groups including Syrian and Eritrean migrants. A recent systematic review showed that in migrants from Syria, leishmaniasis was the most frequently reported infectious disease. In addition, Gram-negative bacteria with high-level, drug resistance were reported. In the migrants from Eritrea, the infectious diseases most described are louse-borne relapsing fever, Plasmodium vivax malaria and scabies. This raises a challenge, in Europe, especially with regard to the treatment of P. vivax malaria as the pre-requisites for vivax malaria treatment, namely Glucose-6-Phosphate- Dehydrogenase (G6PD) deficiency testing and primaquine drug treatment are both difficult to procure. One recent paper has raised the issue of Eritreans acquiring malaria in areas that are hitherto considered malaria-free such as the holding camps in Libya. When one considers that capable vectors are present in Libya and this, coupled with the presence of migrants with parasitaemia then such a possibility is feasible. This presentation will also look at the varied approaches to vaccination of migrants in Europe countries. It will also examine the infectious disease profiles of the children who are alone, without parents on the migration route, the Unaccompanied Minors (UAMs), who present for screening at European centres. Disclosure of Interest: None declared

_WS03.2_ PREFERENCE PREDICTION UNDER FIRE N. Sharadin1,* 1Philosophy, The College of New Jersey, Ewing, United States Biography: Nathaniel Sharadin is an Assistant Professor of Philosophy at The College of New Jersey. His research focuses on normative and meta-normative issues in ethics and epistemology. More about his research available here: www.natesharadin.com Abstract Content: It’s famously difficult to make treatment decisions for incapacitated patients in a way that respects their autonomy: surrogates are epistemically unreliable, and advance directives are notoriously imprecise. Healthcare personnel working in both military and humanitarian relief contexts face an acute version of this problem, since a higher proportion of their patients are likely to be incapacitated and in many cases surrogates and advance directives will be either unavailable or impractical. What to do? Here, I argue that recent proposals regarding so-called patient preference predictors (PPPs) have a natural home in this context. Briefly, PPPs are statistical models that take us from known demographic facts about a patient to unknown facts about that patient’s treatment preferences. The idea, then, is that we can respect a patient’s autonomy by making a treatment decision based on our best prediction of what the patient would want in the circumstances in which she’s incapacitated (and so unable to indicate her preferences). Elsewhere, I’ve argued that the use of PPPs in making these sorts of treatment decisions presents novel ethical challenges. In short, the problem mirrors one familiar from legal scholarship: the problem of using naked statistical evidence to arrive at normative results. Here, I show that in the context of either military medicine or humanitarian relief, these challenges either do not arise or at least are much less serious. I argue that, especially in the case of military medicine, we should welcome the use of PPPs as a novel solution to a serious, widespread ethical problem faced by healthcare personnel. Disclosure of Interest: None declared

_SS03.2_ DOCTORS IN THE MILITARY: THE AUSTRALIAN EXPERIENCE T. Smart1,* 1Joint Health Command, Canberra, Australia Biography: ir Vice-Marshal (Dr.) Tracy Smart AM, BMBS, Dip Avmed, MPH, MA, FRACMA, FACASM, FAsMA, FCDSS, FCHSM (Hon), joined the RAAF as a medical undergraduate in 1985. She served as a Medical Officer and Senior Medical Officer at bases around Australia, had postings with the RAF and USAF, and was the first female Commanding Officer of the RAAF Institute of Aviation Medicine. Her operational experience includes Rwanda, Timor Leste, the Middle East and Lebanon, and she received a CAF Commendation for her role in a fatal air accident investigation in Malaysia. AVM Smart also served as Officer Commanding, Health Services Wing in which she commanded all Air Force health units and dispatched health teams on operations and in response to natural disasters. AVM Smart was promoted to Air Commodore in 2009 and undertook a succession of Director General roles within Joint Health Command including responsibility for management of health care at over 70 locations on Defence bases throughout Australia. She was promoted to Air Vice-Marshal and assumed the positions of Commander Joint Health (CJHLTH) and Surgeon General of the Australian Defence Force (SGADF) in December 15. As CJHLTH she is responsible for the provision of health care to members of the ADF and the health preparedness of the ADF for operations. As SGADF she is responsible for providing strategic health advice to the ADF and technical oversight of operational health across the ADF. AVM Smart is also a member of the Prime Mininster’s Advisory Council on Veterans’ Mental Health, the Board of Phoenix Australia Centre for Posttraumatic Mental Health, and the Military Rehabilitation and Compensation Commission. AVM Smart was made a Member of the Order of Australia in the 2012 Queen’s Birthday Honours List. Abstract Content: The recruitment and retention of Doctors into the Military is an ongoing challenge for the Defence Forces of most countries, particularly so when we add the uncertainties of service life and the competition provided by the civilian market and its very attractive remuneration. The Australian Defence Force (ADF) shares these challenges but has chosen to address them head on through the use of innovative workforce practices, and a dedicated Medical Officer Training and Retention Reform Program within what it calls Project DUNLOP. Through a combination of supported undergraduate and graduate medical schemes the ADF has been very successful in recruiting Doctors into military service. The ADF also has a high proportion of female doctors (roughly 33% for Navy, 20% for Army, and 56% for Air Force) and the introduction of improved, and more flexible, workplace practices, that takes a Total Workforce approach, provides more flexibility to the way in which they can serve throughout their career by providing opportunities to balance their needs with those of their service. Long term retention has been challenged by the well remunerated civilian market place but the ADF has determined that the provision of active mentoring, ongoing clinical development and operational medicine opportunities, and well-structured career development, that can be tailored to balance individual aspirations and service needs, are as equally important as remuneration in the calculus of the retention of doctors in the military. This presentation highlights the Australian Defence Force experience in ensuring it recruits, trains and retains the doctors necessary to keep its force fit to fight” Disclosure of Interest: None declared

_SS14.3_ ON TOP DOWN UNDER: CHALLENGES IN STRATEGIC MILITARY MEDICAL LEADERSHIP T. Smart1,* 1Joint Health Command, Canberra, Australia Biography: A ir Vice-Marshal (Dr.) Tracy Smart AM, BMBS, Dip Avmed, MPH, MA, FRACMA, FACASM, FAsMA, FCDSS, FCHSM (Hon), joined the RAAF as a medical undergraduate in 1985. She served as a Medical Officer and Senior Medical Officer at bases around Australia, had postings with the RAF and USAF, and was the first female Commanding Officer of the RAAF Institute of Aviation Medicine. Her operational experience includes Rwanda, Timor Leste, the Middle East and Lebanon, and she received a CAF Commendation for her role in a fatal air accident investigation in Malaysia. AVM Smart also served as Officer Commanding, Health Services Wing in which she commanded all Air Force health units and dispatched health teams on operations and in response to natural disasters. AVM Smart was promoted to Air Commodore in 2009 and undertook a succession of Director General roles within Joint Health Command including responsibility for management of health care at over 70 locations on Defence bases throughout Australia. She was promoted to Air Vice-Marshal and assumed the positions of Commander Joint Health (CJHLTH) and Surgeon General of the Australian Defence Force (SGADF) in December 15. As CJHLTH she is responsible for the provision of health care to members of the ADF and the health preparedness of the ADF for operations. As SGADF she is responsible for providing strategic health advice to the ADF and technical oversight of operational health across the ADF. AVM Smart is also a member of the Prime Mininster’s Advisory Council on Veterans’ Mental Health, the Board of Phoenix Australia Centre for Posttraumatic Mental Health, and the Military Rehabilitation and Compensation Commission. AVM Smart was made a Member of the Order of Australia in the 2012 Queen’s Birthday Honours List. Abstract Content: Military health services are different from their civilian counterparts. Whereas the latter is primarily focussed on the health care of individuals, military health services have two key roles. These are; enabling operational capability by ensuring our people are fit to do their role particularly in front line and high risk environments; and caring for our people when they become unable to maintain fitness for the fight, including through their transition to civilian life. Thus we need to serve two customers – Commanding Officers and our patients – needing to be both patient-centred and Command responsive. At the strategic level we also have a third customer – our non-health political masters. Military health personnel also have to acquire and maintain professional skills from both military and civilian health domains, including leadership skills. They often have to apply these skills in remote, austere, and sometimes hostile environments where the usual civilian health and community infrastructure is damaged or even non-existent. They need to be flexible, adaptable and cognisant of the needs of not just their customer but their own people. This can be a difficult challenge but it also equips military health leaders to undertake any challenges the civilian health system may throw at them. This presentation examines how the world of a medical and military leader merge, and demonstrates that lessons learned from the “best of breed” approach to leadership in military health can be translated into civilian health sector. Disclosure of Interest: None declared

_SS05.2_ PROVISION OF BLOOD AND BLOOD PRODUCTS IN THE BUNDESWEHR AS A PHARMACEUTICAL AN REGULATORY CHALLENGE M. Sprenger1,* 1Bundeswehr Medical Service Headquarters, Koblenz, Germany Biography: Colonel Pharmacist Dr. Michael Sprenger Qualification: Pharmacist and Food Chemist PhD Pharmaceutical Specialist in Analytics Assessor/Technical Expert for the German Accreditation Body DAkkS and Swiss Accreditation Body SAS Activities: 2004 – 2008 Scientific Officer in the pharmaceutical department of the German Ministry of Defense 2008 – 2012 Competent Authority of the Bundeswehr for medicinal products and pharmacies since 2012 Head of a Pharmaceutical Branch in the Bundeswehr Medical Service Headquarters Abstract Content: The German Armed Forces (Bundeswehr) provide blood and blood products, e.g. red blood cell concentrate (RBC), plasma, plasma components and platelets (PLT), for patient care in military hospitals (Bundeswehr Hospitals) in Germany as well as in medical treatment facilities (MTF) in military operations and missions abroad. These life-saving products are either purchased from providers on the civilian market or manufactured by Bundeswehr’s own Blood Donation and Processing Center, e.g. RBC and fresh frozen plasma (FFP). The preparation is based on whole blood or apheresis. The transport of medicinal products to supply even remote MTF on mission is a key process in medical logistics. An almost GDP compliant transport of blood products, e.g. in order to minimize the physically induced hemolysis, poses a major challenge for the Bundeswehr. Another challenge arises from GMP compliant manufacturing processes for RBC and FFP to assure quality, efficacy and safety of blood products. In contrast to most other countries RBC, FFP and PLT are medicinal products in Germany that require marketing authorizations. Therefore, the special legal and regulatory requirements for blood and blood products will be pointed out. This has to be considered for the regulatory strategy of research and development activities for blood products with prolonged shelf life and new products in general. Disclosure of Interest: None declared

_SS01.1_ TO TAKE OR NOT TO TAKE, THAT IS THE QUESTION V. Stanovsky1,* 1Medical supply center, Medical Corps, IDF, Tel Aviv, Israel Biography: Valina Stanovsky, B.Sc.Pharm, MBA, is the Head of Procurement Section at the Medical Supply Headquarters of the IDF. In the past 12 years, she has served in various positions in the Medical Corps, focusing on procurement, inspection, education, and operations. She lead the efforts of allocation, preparation and shipment of the medical equipment to the IDF humanitarian missions to disaster areas, such as to Nepal and Haiti.Valina earned her Pharmacy degree from the Hebrew University of Jerusalem and her master in business administration from Tel Aviv University and her work she specializes in emergency planning and procurement. Abstract Content: The success of any humanitarian medical delegation to an area hit by a disaster depends on whether it has the right medical equipment. The ability of medical personnel to provide the best care in each disaster always starts with the right amount and appropriate variety of the medical equipment taken to the mission. But are we able to accurately predict what uncertainties the delegation will face during the mission? What do we need to do thousands of miles away to prepare the team for unknown scenarios? How can we ensure the logistic independence of the delegation in a foreign area that just a few hours ago was hit by a devastating disaster? In this presentation, we will learn from the rich experience of the Medical Corps of the Israeli Defense Forces - one of the most experienced organizations in the world in providing humanitarian aid to disaster areas. We will discuss the factors that can help identify the appropriate equipment for each type of disaster, and ways to make it available for the mission in the shortest possible amount of time. The lessons that will be learned can be applied in various emergency preparedness protocols. Disclosure of Interest: None declared

_SS08.1_ IMPACT OF THE RESEARCH COLLABORATION BETWEEN UNIVERSITY AND MILITARY MEDICAL SERVICE K. Staub1,* 1Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland Biography: Senior Researcher and Head of Research Group at the Institute of Evolutionary Medicine, University of Zurich. Collaborating with the Military Medical Service of the Swiss Armed Forces since 2005. Abstract Content: This presentation will outline the possibilities and the impact of research collaborations between Universities and Military Medical Services by looking at the example of Switzerland. The look backwards will highlight what has been done on different levels (cohort studies, health monitoring, etc.) during the past 5-10 years, and the look at the present and the future will emphasize possibilities to further exploit the potential of such cooperation. Benefits for both sides shall be addressed. Disclosure of Interest: None declared

_RT05.6_ UNITED NATIONS HEALTHCARE QUALITY AND PATIENT SAFETY STANDARDS A. Tiwathia1,* 1Division of Healthcare Management and Occupational Safety and Health, United Nations, New York, United States Biography: Dr Adarsh Tiwathia is a Senior Medical Officer and Chief of the Clinical Governance Section at the United Nations Division of Healthcare Management and Occupational Safety and Health. She has served with United Nations for 18 years at United Nations(UN) Headquarters and 2 years in the field. At present, Dr Tiwathia is engaged in implementing the recommendations of the High-level Independent Panel on Peace Operations (HIPPO) Report (2015) and the Santos Cruz report (2017) which includes among others the rolling out the standardised UN Buddy First Aid Course (UNBFAC) for master trainers and standardising Health Care Quality and Patient Safety (HQPS) Standards in all United Nations civilian and military medical facilities. She is also engaged, in introducing clinical governance into the United Nations healthcare system by implementing not only standards but also a system wide adverse event reporting system and ensuring that the UN adopts and embraces a blame free and just culture around medical errors. Previously as the Chief Medical Officer for peacekeeping, Dr Tiwathia engaged in building Field Health Systems in existing and new missions. Having travelled to over 25 duty stations worldwide, she has first-hand experience of world-wide health-environments and medical infrastructure available to UN staff and their dependents. Having received a Master’s Degree in Disaster Medicine and Management, Dr Tiwathia worked closely with the Medical Directors of the UN system to establish the United Nations Medical Emergency Response Team. Before joining the United Nations, Dr Tiwathia served in the Indian Army Medical Corps; UN Dispensary in Hanoi, Vietnam; and worked with NGOs engaged in Public Health Programs including HIV/AIDS. Abstract Content: In the context of these high-level recommendations, the United Nations Medical Services Division, presently known as Division of Healthcare Management and Occupational Safety and Health (DHMOSH) conducted a gap analysis in the chain of care for injured or ill personnel in peacekeeping missions. Major gaps in this chain were recognized and projects undertaken to resolve them. The two presentations will elaborate on the salient action taken by the DHMOSH, with special emphasis on the United Nations Buddy First Aid Training, Field Medics and Healthcare Quality and Patient Safety Standards, to ensure that the UN provides a robust, timely and responsive medical support. Disclosure of Interest: None declared

_RT05.3_ MEDICAL SUPPORT IN PEACEKEEPING: UNITED NATIONS BUDDY FIRST AID COURSE AND UNITED NATIONS FIELD MEDICAL ASSISTANT COURSE A. Tiwathia1,* 1Division of Healthcare Management and Occupational Safety and Health, United Nations, New York, United States Biography: Dr Adarsh Tiwathia is a Senior Medical Officer and Chief of the Clinical Governance Section at the United Nations Division of Healthcare Management and Occupational Safety and Health. She has served with United Nations for 18 years at United Nations(UN) Headquarters and 2 years in the field. At present, Dr Tiwathia is engaged in implementing the recommendations of the High-level Independent Panel on Peace Operations (HIPPO) Report (2015) and the Santos Cruz report (2017) which includes among others the rolling out the standardised UN Buddy First Aid Course (UNBFAC) for master trainers and standardising Health Care Quality and Patient Safety (HQPS) Standards in all United Nations civilian and military medical facilities. She is also engaged, in introducing clinical governance into the United Nations healthcare system by implementing not only standards but also a system wide adverse event reporting system and ensuring that the UN adopts and embraces a blame free and just culture around medical errors. Previously as the Chief Medical Officer for peacekeeping, Dr Tiwathia engaged in building Field Health Systems in existing and new missions. Having travelled to over 25 duty stations worldwide, she has first-hand experience of world-wide health-environments and medical infrastructure available to UN staff and their dependents. Having received a Master’s Degree in Disaster Medicine and Management, Dr Tiwathia worked closely with the Medical Directors of the UN system to establish the United Nations Medical Emergency Response Team. Before joining the United Nations, Dr Tiwathia served in the Indian Army Medical Corps; UN Dispensary in Hanoi, Vietnam; and worked with NGOs engaged in Public Health Programs including HIV/AIDS. Abstract Content: The High-level Independent Panel on Peacekeeping Operations report (HIPPO report, 2015,) and the report on “Improving Security of United Nations Peacekeepers ” (Cruz Report , 2017); after reviewing the changing political and military context of peace keeping, the new challenges including significant increase in fatalities; recommended several important measures to improve medical support to Peacekeeping missions, and reduce fatalities on account of malicious actions in the field. Disclosure of Interest: None declared

_SS03.5_ MILITARY – CIVILIANS PARTNERSHIPS FOR OPERATIONAL MEDICAL NEEDS: THE TURKEY EXPERIENCE H. Turkan1,* 1Turkish Armed Forces Health Command, Ankara, Turkey Biography: Professor Surgeon Captain (N) Hulya TURKAN is the Supervisory Board Chair at Turkish Armed Forces. She obtained her medical degree in 1986 at Gazi University Medical Faculty. She worked as anesthesiology fellow at Department of Anesthesiology and Reanimation of Gülhane Military Medical Academy between 1987-1993. She became Associate Professor in Anesthesiology and Critical Care in 1998. She worked as research fellow at Department of Critical Care, GeorgeWashington University Hospital in DC at 2002, 2006, 2011,2013,2016 ; and at Department of Critical Care, Erasmus University Hospital in Brussels, at 2008,2009 and 2011. She has sub-specialty in Critical Care , PhD in Toxicology and Master Degree in Education Management. She became full-profesor in 2018. She attended many advance courses on Advance Trauma Life Support, Advanced Life Support, Aeromedical Transportation of ICU Patient, Disaster Management. She is actively involved in European Resuscitation Council as a Advanced Life Support Course Director and Instructor; in National Clinical Toxicology Society Board as a instructor. She has numerous research, articles, book chapters and awards. Abstract Content: The Turkish Armed Forces (TAF) Medical Command with its subsidiaries, Gülhane Military Medical Academy (GMMA) and 43 military hospitals, had worked on universal missions for supporting military operations from the point-of-injury to flying ICUs and providing beneficiary care and aimed to readiness, population health and experience of care for more than 100 years. Turkey’s Government closed all military schools including GMMA and 43 military hospitals across Turkey in 2016. After all military medical network was dismantled, the need for a military-civil partnership suddenly appeared was unprepared, unplanned and challenging. Partnership protocol between TAF Command and Ministry of health included both health care services in peace period and medical support for deployed personnel in war period. Before the protocol, the most experienced physicians on trauma were at GMMA and at the military hospitals while civil physicians have little experience in this regard. Therefore, working together after protocol provided civilian physicians getting trauma experiences from military physicians. In addition in the long term, we can improve the care of all injured patients in our country regardless of whether the injuries are caused by traumatic events, natural disaster or terrorist attack by combining the casualty care with the existing expertise at civilian trauma and burn centers. However, we have a significant gap in the number of military doctors now. We consider this process as a dynamic process and develop new strategies for recruiting military physicians and military medical students. Paying for tuition, books, and fees, as well as a monthly stipend for military students enrolled in civilian medical schools and implement new career models for military physician near future can be considered as important steps for these strategies. Our efforts also include demographic diversity on Turkish medical corps as it is important for decision-making perspectives, innovation, and creativity and understanding of the patient population being treated. As a conclusion, we will continue to develop the efficiency and quality of health care services to provide medical support to Army, Navy and Air Force in our new transformed system. Disclosure of Interest: None declared

_SS07.1_ BESLAN SCHOOL HOSTAGE TRAGEDY 2004: SHORT, MEDIUM AND LONG TERM PSYCHO-SOCIAL INTERVENTIONS FOR CHILDREN. - THE DOS AND DON’TS S. Vetter1,* 1Adult Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland Biography: Stefan Vetter was born 1964 in Thun/Switzerland. He attended the medical school of the University of Berne and obtained his medical degree 1991. As registrar he was trained in Zurich, Winterthur as well as St. Gallen and completed his specialization as psychiatrist 1997. From 1998 on he worked at psychiatric counselor in different psychiatric hospitals in greater Zurich area. 2000 Stefan Vetter was appointed chief psychiatrist of the Swiss Armed Forces, a function in which he served till the end of 2013. 2002 he became head of the Centre for Disaster and Military at the University of Zurich and specialized in mental health problems and interventions in the aftermath of large scale disasters. In his civil and military function he was running different disaster. Among other missions he managed in the aftermath of 9/11 the mental health interventions for Swiss citizens at the Swiss general consulate in New York; 2004-2007 he was in charge of the Psychosocial Centre in Beslan/North Ossetia, dealing with the psychological traumatization due to the school kidnapping by terrorists and he monitored and assisted the Swiss Disaster Victim Identification Team during and after the Tsunami in the Indian Ocean 2004/2005. Since 2009 he is Lead Physician at the Psychiatric University Hospital Zurich and in charge of three inpatient units. Abstract Content: In the aftermaths of the Beslan School hostage tragedy, Switzerland supported the Russian federation with several mid and long term mental health and social activities to foster children’s mental recovery from the traumatic event. In this regard Swiss specialists were in charge of a psycho-social center and organized two years later summer and winter camps for traumatized children. The learned dos and don’ts will be the focus of this presentation. Additionally, the scientific control respectively the outcome results of the cognitive-behavioural camps will be presented. Disclosure of Interest: None declared

_PL04.2_ THE MANAGEMENT OF MEDICAL OPERATIONS - DOES IT EXIST AN OPERATIONAL MEDICAL COMMAND ? J.-A. Weber1,* 1French Military Heath Service, Paris, France Biography: As military physician, Julie-Anne Weber supported units of the French army during the first part of her military career. She has been deployed three times in operation, in Africa and in Afghanistan, to support a battalion. Then she was posted in Eurocorps, as operation officer, and in the surgeon general office, as staff officer, dealing with doctrine and training and exercise. She is currently posted in the French joint operational headquarters dealing with all medical matters related to the French military commitments. She is graduated with a master’s in health economics/ care facilities management and has an university degree in crisis management. She attended the course of the French War College. Abstract Content: There is only one chain of command in the military operations. This is the guarantee for an efficient and a coherent military action. Nevertheless, the medical support is under the responsibility of a medical director. The need for a medical direction has become an evidence through the history of the French Military Health Services. During the first world war, physicians were put into the headquarters in the position of line officer. Then the medical command built up gradually. In the current operations, it is strong and robust. The more complex the situation becomes, the more the medical command will give a benefit in providing the best care for the patient at the right time and in the right place, according to the operational situation. This is relevant for all type of medical operations (military commitments as well as rescue operations or emergency medical care). Furthermore, the inclusion of a medical direction in the chain of command will reassure the caregiver, sometimes facing with dramatic situations. This must not be underestimated when dealing with human lives. Disclosure of Interest: None declared

_SS05.3_ IMPROVING TRAINING AND RESEARCH IN MILITARY AND DISASTER PHARMACY N. Widmer1,2,* 1Logistics Training Unit, Swiss Armed Forces, Thun, 2Geneva-Lausanne School of Pharmacy, University of Geneva and Lausanne, Geneva, Switzerland Biography: Chief Pharmacist of the Pharmacy of Eastern Vaud Hospitals in Vevey, Privatdozent at the University of Geneva and Adjunct Research Fellow at the Lausanne University Hospital in the field of Emergency and Disaster Pharmacy as well as Therapeutic Drug Monitoring. Major of the Swiss Armed Forces in the Staff Logistics Training Unit in charge of the training of candidate pharmacy officers. PhD in Life Sciences and bearer of various postgraduate degrees in Hospital Pharmacy, Clinical Pharmacology, Clinical Pharmacy and Public Health. Abstract Content: The world has recently faced more natural and manmade disasters than ever before. The role of pharmacy in emergency and disaster preparedness and management is essential. The education of pharmacists in this field remains however to be improved and their responsibilities are still to be clarified in various countries. In Switzerland, modernization of the training of the military pharmacists, recognition and integration of this training with the civil world and development of a civilian postgraduate education in emergency and disaster pharmacy is especially warranted. Academic research in this field and definition of the role of pharmacy in mass casualty incidents, in compliance with the recent guidelines of the International Pharmaceutical Federation, is also necessary. To achieve this, a Centre for Emergency and Disaster Pharmacy was recently built at the University of Geneva thanks to the support of the Competence Centre for Military and Disaster Medicine and the Swiss Federal Department of Defence, Civil Protection and Sport. This specialised centre presently develops cooperation with national and international civilian and military partners to reach its aims. Disclosure of Interest: None declared

_KS01.3_ MEDICAL CHEMICAL DEFENCE: OLD PROBLEMS AND NEW CHALLENGES T. Wille1,* 1Bundeswehr Institute of Parmacology and Toxicology, Munich, Germany Biography: LtCol PD Dr. Timo Wille joined the Bundeswehr Institute of Pharmacology and Toxicology after finishing medical school. His training as medical specialist in pharmacology and toxicology included a deployment as general practitioner and a research stay at the Technical University in Munich. Dr Wille’s research is focused on Medical Chemical Defence, particularly on nerve agents. Abstract Content: The dissemination of chemical warfare nerve agents (CWNA) in military conflicts or terrorist attacks may account for many casualties. Early detection and diagnosis of poisoning with CWNA are key requirements to initiate protective actions and medical countermeasures (MedCM). Therefore, an OP skin disclosure kit and a point-of-care device to diagnose nerve agent poisoning were developed. Despite extensive research in the last six decades, there are still significant gaps in therapeutic efficacy when it comes to the reactivation of tabun-, soman- and cyclosarin-inhibited acetylcholinesterase. Experimental approaches addressing therapeutic shortcomings will be discussed. Until these approaches will be translated into commercial products in the future, death due to respiratory failure by CWNA poisoning can only be prevented by artificial ventilation and optimized intensive care treatment. Additionally, the spectrum of threatening agents has broadened: Toxic industrial chemicals, old “well-proven” compounds as chlorine and sulfur mustard next to a broad range of nerve agent derivatives and pesticides, but also pharmaceutical based agents as synthetic opioids need to be considered for future concepts in Medical Chemical Defence. Disclosure of Interest: None declared

_PL02.4_ PHAGE THERAPY: AN ALTERNATIVE TO ANTIBIOTICS IN THE AGE OF MULTI-DRUG RESISTANCE? C. Willy1,* 1Military Hospital Berlin, Berlin, Germany Biography: General Surgeon, Trauma Surgeon, Orthopedic Surgeon Clinical Director Clinic of Trauma and Orthopedic & Septic and Reconstructive Surgery Research Center of Reconstruction of Severe Combat Injuries Wound Center Berlin (ICW) Bundeswehr Hospital Berlin (Federal Armed Forces of Germany) Scharnhorststr. 13 10115 Berlin, Germany +49 30 2841 1901 (Sek) +49 30 2841 1900 (direct line) +49 30 2841 1909 (Fax) cell phone: +49 30 179 940 81 33 Office: ChristianWilly@Bundeswehr.org Privat: Christian_Willy@hotmail.com Abstract Content: Background. The key elements in the therapy of surgical site infections (SSI) are surgical debridement and local and systemic antibiotic therapy; however, due to increasing antibiotic resistance, the development of additional therapeutic measures is of great interest for future trauma and orthopedic surgery. The rise of multidrug-resistant bacteria has resulted in an increased interest in phage therapy, which historically preceded antibiotic treatment against bacterial infections. To date, there have been no reports of serious adverse events caused by phages. They have been successfully used to cure human diseases in Eastern Europe for many decades. More recently, clinical trials and case reports for a variety of indications have shown promising results. However, major hurdles to the introduction of phage therapy in the Western world are the regulatory and legal frameworks. Present regulations may take a decade or longer to be fulfilled. It is of urgent need to speed up the availability of phage therapy. Method. Against the background of our own experimental and clinical experiences and on the basis of the current literature, possible future anti-infective strategies were elaborated. Results/conclusions. Bacteriophages were discovered and clinically implemented approximately one century ago and have been used in Western Europe for about one decade. They are currently used mainly in patients with burn injuries. It is likely that bacteriophages will become of great importance in view of the increasing antibiotic multi-drug resistance; however, they will probably not entirely replace antibiotic drugs. A combined use of bacteriophages and antibiotics is likely to be a more reasonable efficient therapy. Disclosure of Interest: None declared

_PL05.3_ ROLE OF CIVIL-MILITARY PARTNERSHIP IN DISASTER RELIEF OPERATIONS: A JAPANESE PERSPECTIVE T. Yoshizaki1,* 1Director of Policy Simulation, The National Institute for Defense Studies (NIDS), Ministry of Defense, Tokyo, Japan Biography: Prof. Tomonori Yoshizaki is Director of Policy Simulation at the National Institute for Defense Studies (NIDS) of Japan’s MOD, where he is in charge of directing research projects and military education on strategic issues. After Fukushima nuclear disaster in March 2011, he was tasked to organize NIDS Symposium on International Security featuring The Role of the Military in Disaster Relief. As a mentor of Civil-Military Coordination, he runs seminars at International Peace Cooperation Activities Training Unit, Ground Self-Defense Forces. He is also a visiting professor at Self-Defense Forces Staff Colleges and Graduate School of Tokyo University for Foreign Studies. Abstract Content: On March 11, 2011, a mega earthquake struck off the coast of Tohoku (Northeastern) region of Japan. Subsequently, a gigantic tsunami hit approximately a 500km-wide area along the coastlines, making local governments and infrastructures suddenly unable to function. Black Swan suddenly came with the “meltdown” in Fukushima Daiichi Nuclear Power Station, making the Great East Japan Earthquake a complex disaster consisting of earthquake, tsunami, and industrial accidents. In the face of this unprecedented national crisis, Japan’s Self Defense Forces (SDF) deployed at most 107,000 personnel during a 174-day period from March 11 to August 31. This presentation explores the role of the military in disaster relief operations through examining the SDF’s biggest operation in history. It focuses on the three agenda: (1) civil-military cooperation, inclusive of emergency medical support; (2) new challenges in “multi-domain” operations across cyber and space; and (3) impact on regional and global security cooperation. Disclosure of Interest: None declared

_SS12.3_ THE OPTIMAL INTEGRATION OF MILITARY AND CIVIL HEALTH CARE SERVICES UNDER A SINGLE HOSPITAL MANAGEMENT: AZERBAIJAN MODEL K. Yusif-zada1,* 1Military Hospital of State Border Service of AR, Baku, Azerbaijan Biography: Prof. Dr. KananYusif-zada, MD, PhD, MBA, FACS Colonel yusifzadekr@yahoo.com Date of Birth: 28/06/1973 Education: 2013-2016 ADA University, School of Business, Executive MBA, Baku, Azerbaijan 2013-2015 Maastricht School of Management, MBA, Maastricht, Nederland 01.11/03.12.2008 Research Fellow in Department of Colorectal Surgery in Cleveland Clinic, Cleveland, Ohio,USA 05.12.2008 Visitor Physician, Department of General Surgery and Kidney and Pancreas Transplantation, Mayo Clinic, Rochester, Minnesota, USA 1998-2004 Residency in General Surgery Gazi University, Faculty of Medicine, Ankara, Turkey 1996-1998 Clinic ordinatory in General Surgery, Azerbaijan Medical University, Baku, Azerbaijan 1990-1996 Doctor of Medicine, MD Azerbaijan Medical University, Baku, Azerbaijan (With a degree of honour) Work experience: From 2016 Professor, Fundamentals of Medical Aid in Civil Defense, Dept. of Chemical Engineering, Baku Higher Oil School, Baku, Azerbaijan (www.bhos.edu.az) Up to now From 2010: Head of Military Hospital of State Border Service up to now of Azerbaijan Republic, Baku 2005-2010 Chief of Department of Endoscopic Surgery and Diagnostics, Central Hospital of Oil Workers, Baku 2004-2005 Chief of Department of Surgery, City Hospital, Baku 1993-1996 A senior preparatory in the department of “Operative surgery and topographic anatomy” of Azerbaijan Medical University, Baku Scientific activity: 2016 Academic degree of doctor of sciences in medicine 2008 Scientific degree of the doctor of philosophy (PhD) on medical sciences on surgery 2004 Has protected scientific work under the name “Role of Anandamine at mesenteric ischemia-reperfusion” 2004 Successfully having passed theoretical and practical examinations at University Gazi in Ankara has received the certificate 03.05.2004 In the framework of “TUBITAK” supporting the NATO Scientific and Technical Research grant PC program in the gastroenterology section of Gazi University Faculty of Medicine, Department of Internal Medicine lead on the project on a theme “Invasive Endoscopy and Endoscopic Retrograde, Ankara, Turkey, Choledochopancreatography” and received a certificate of qualification “Invasive gastroenterology and endoscopy” Professional work: - Founder and chairman of the “Azerbaijan Association of Military Surgeons” Membership: - Fellow of the American College of Surgeons (FACS) - International Surgical Society (ISS), - Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), - Association of Endoscopic and Laparoscopic Surgery in Turkey, - European Renal Association (ERA-EDTA), - European Association for Transluminal Surgery (EATS), - Turkish Society of Thoracic Surgery, - Russian Society of Surgeons-Gastroenterologists,

- Ambroise Pare International Military Surgery Forum (APIMSF), elected President for 2017-2019 Books: - Military Medical Explanatory Dictionary, 2018, 1195 p. - “Fundamentals of Civil Defense and Medical Aid”. Textbook, 2018 - “Semi-Public Hospital Management”, 2016 (www.amazon.com). - “Surgical Endoscopy” (2012) and “Gastrointestinal Endoscopy” (2011). - In “Gynaecologic and Obstetrical Surgery” (2005): “Ventral Abdominal Hernias” and “Malign and Benign diseases of breast”. - Co-author in “General Surgery” (2002) Abstract Content: Establishing a hybrid hospital on the basis of a military hospital that also serves the general public requires significant adjustments and new developments. Thus, a number of different techniques can be used to determine the critical areas where the adjustments need to be made. Given the requirement that a hybrid hospital is an organization that is formed on the back of merging public and private healthcare mechanisms, value systems and action logics and seeks to serve the healthcare needs of various groups of customers, which include both publicly funded military patients and privately funded civilians. The first model we considered was Policy governance model, as a steward of the community, whose main objective is to make organization accountable to its stakeholders. A second approach considered is called Constituent/representative board model Unlike the previous mode, the constituent/representative approach to governance is based on the idea of creating a direct link between board of directors and stakeholders of the organization. And a third option was Entrepreneurial model. This model is based on the approach used in corporations and is mainly concerned with profitability and innovation, which in turn requires the organization to be efficient and effective to the financial targets are met, which allows for achieving greater ROI. Turning a military hospital to a civilian hospital essentially requires changes at all levels of the organization. The major aspects of this transition are: - Surveying the possibilities and creating initial conditions for the creation of the hospital. - Creating necessary departments, equipments and staffing that can serve patients that come from the army as well as from the civil life. - Choosing governance model that is suitable for the local context and the initiative. - Choosing a specific marketing strategy and creating quality assurance mechanisms. - Managing income and distributing the revenue for the betterment of the hospital work. In conclusion, under what conditions this hybrid hospitals can be necessary and how this model can be implemented. Disclosure of Interest: None declared

_RT03.3_ INCREASED READINESS OF THE ARMED FORCES – CHALLENGES IN MEDICAL LOGISTICS; THE GERMAN PERSPECTIVE R.-E. Ziegler1,* 1Logistics, Bundeswehr Medical Service Headquarters, Koblenz, Germany Biography: Colonel Pharmacist; Head of Division X (Pharmacy, Armament, Logistics, Protection Task) Abstract Content: Based on the specifications and derivations resulting from ministerial instructions and taking into account the current experience and the secured results from the further development of the Logistic System of the Bundeswehr, it is necessary to adjust the forward deployed logistics to the new challenges. The professional guidelines for quality assurance and the established clinical timelines serve as the rationale for the planning of medical treatment facilities. On this basis the extent of the necessary medical service support to serving units is determined. The assumed casualty rates are a substantial planning basis for the determination of the necessary abilities, forces and means to the design of the rescue chain and the resulting logistical support. From the type and number of medical treatment facilities and the structure of the medical task force the logistical needs are described, which are covered by the forward deployed logistics of the Bundeswehr Joint Medical Service in cooperation with the theatre logistics. Only through a sustainable operational logistics - with ready-for-use and operational materiel, which must correspond professionally the standard of the national health care - a treatment according to the principles of the medical service in theatre can be ensured. Disclosure of Interest: None declared

_SS10.1_ FOOD SAFETY AND HYGIENE IN THE SWISS ARMED FORCES C. Zweifel1,2,* 1Federal Food Safety and Veterinary Office (FSVO), 2Food Hygiene Inspectorate, Swiss Armed Forces, Bern, Switzerland Biography: After working for more than 15 years at the Institute for Food Safety and Hygiene of the University of Zurich, Prof. Dr. med. vet. Claudio Zweifel recently joined Federal Food Safety and Veterinary Office. His work and research focused on microbiological health hazards in food of animal origin along the food production chain (from feed to food), and in particular on aspects of meat safety at slaughter. In the Swiss Armed Forces, LtCol Claudio Zweifel is a member of food hygiene inspectorate. Abstract Content: To ensure a safe, hygienic, and sensory flawless catering of military troops with food, strict adherence to the food safety and hygiene requirements is of central importance. In particular, such measures prevent food-associated outbreaks and are therefore critical to guarantee the operational capability of the troops and their mission fulfillment. The food safety and hygiene concept of the Swiss Armed Forces comprises basically the education of the military kitchen staff, the infrastructure, the processes in the military kitchen, the compulsory self-control warranted by the kitchen staff, and the official food control of the armed forces. In line with the revision of (civil) food law in 2018, the food safety and hygiene concept of the Swiss Armed Forces have also been revised. In terms of content, the legal requirements have been complemented by a military enforcement aid (“Food Hygiene in the Armed Forces”) containing clear hygiene rules, process descriptions, and (critical) control points. This enforcement aid also serves as basis for documentation of the compulsory self-control in the military kitchen. Thus, the Swiss Armed Forces implemented a forward-looking food safety and hygiene concept addressing current and future challenges in the military kitchen. Disclosure of Interest: None declared