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Background: Combat soldiers face a wide variety of mental challenges on the battlefield. Despite the broad common denominator of combat activity, it is worth identifying and mapping distinctive mental challenges which characterize specific combat units in unique missions. In this mixed-methods study we sought after the specific mental challenges of individual augmentees.

Methods: The study was conducted in the first half of 2021, in three units: "OKETZ" (dog handlers), "YAHALOM" (special engineering) and the Combat Documentation Squad (photographers). Data was collected from 109 combat soldiers, using seven questionnaires. In addition, focus groups were conducted to examine the functional aspects of their military activities.

Results: A qualitative content analysis of the focus group findings revealed 4 main themes relating to individual augmentees' operational functioning: (a) before carrying out the mission, (b) while performing the mission, (c) after completing the mission, (d) an overall sense of meaning versus a sense of burden. A general finding that overarches the four themes was the feeling of loneliness. Quantitative results from the questionnaires point to differences between the three units which are in line with the qualitative analysis.

Conclusions: The most demanding mental challenge that the individual augmentee combat soldier faces is the sense of loneliness. This general conclusion expresses the importance of satisfying the basic human need for social belonging, a need that intensifies in life-threatening situations. We propose a few changes in the combat preparation programs of individual augmentee units, as well as in officer training courses for commanders of organic combat units.

Keywords: joint forces, mental fitness, mental challenges, loneliness, a mixed-methods study

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Background: Burnout is a prominent feature in the military medical profession, and can affect the way
clinicians perform and provide care for patients. Furthermore, malingering on the part of soldiers has been found to negatively affect the clinician's professionalism. The relationship between clinician’s burnout and their perceptions of patients' malingering has yet to be examined in military medicine.

Methods: Data was collected using the Maslach Burnout Inventory questionnaire, answered by IDF medical personnel from the fields of: medicine, dentistry and nursing. A comparison was made between two burnout groups – high/ low. Demographic indicators affecting burnout were examined, as was the relationship between burnout level and clinicians' perceptions of patients' malingering.














Results: The study included 101 respondents, of whom 76 physicians, 17 dentists and 8 nurses. 56.4% of the respondents were with high burnout level. Factors contributing to reduced burnout: dentistry (p=0.001) and open base (p=0.011). Factors contributing to increased burnout: medicine (p=0.001), living on base (p=0.011), and low rank (p=0.003). Clinicians in the high burnout group felt that soldiers were unreliable (p=0.013), tended to spend less time on anamnesis (p=0.009), felt more disrespect from soldiers (p<0.001), and treated in a less professional manner (p<0.001).

Conclusions: High burnout characterizes army medical personnel, and is more prominent among physicians, doctors living on base, and those that are at the beginning of their military service. A correlation was found between burnout level and the intensity of perceived soldiers' malingering, and how these perceptions affected professional care

Keywords: attrition, initiation, military therapists, the IDF.

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Mass casualty events (MCEs) are complex scenarios that require appropriate preparedness prior to the event and suitable management during the event, in order to ensure proper medical care is given and as many lives as possible are saved. In Israel, these two goals are achieved through collaboration between the emergency branch of the Ministry of Health and the medical department of the Home Front Command. The two disastrous events that occurred in 2021 in Israel have highlighted the importance of the Home Front Command in assisting the national health system. This paper details the different components of the management and the lessons that can be learned from it.

Keywords: Mass casualty event, Home Front Command, Mount Miron, Givat Ze'ev

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Background: Workers in various industries and fields may be exposed to a variety of risk factors during their work, including harmful noise. The Israeli Air Force has a wide variety of positions, during which air crews and ground crews are exposed to harmful noise. By law, the employer has a duty to provide instruction regarding the health damage, which may be caused by prolonged exposure to noise and provide appropriate protective equipment. The most commonly used ear protection among workers exposed to harmful noise, are earplugs made of sponge. The objectives of this study were to evaluate the effectiveness of the use of sponge ear plugs among soldiers in the air force and to examine the relationship between proper earplug use instruction and the perceived attenuation values.

Methods: Soldiers in the air force, who have been routinely evaluated by an aviation or occupational physician in the Air Medicine Unit (“Yarpa”), have been tested on a 3M E-A-R fit Dual-Ear Validation System machine. Subjects, who did not achieve the required attenuation value, underwent a brief proper earplugs use instruction by the examiner at Yarpa and subsequently performed a reexamination.

Results: 133 soldiers in the Air Force were examined, whose average age was 24.6 (S.D. 6.7). Among the subjects, 90% were men and 67% were ground crews. Less than 50% of study participants had been previously instructed on how to use earplugs, and less than 40% of participants had properly worn the earplugs. It was found that participants who had not been previously instructed achieved statistically significant lower attenuation values compared to those who had been previously instructed (p=0.011). The results of the study further showed that participants who did not achieve the required attenuation value, and were subsequently instructed on proper use of earplugs by the examiner at Yarpa, significantly improved their attenuation values (p<0.001).

Conclusions: Most participants had not been previously instructed on how to use earplugs and as a result did not use them properly. Adequate instruction significantly improved the effectiveness of using earplugs. We recommend requiring commanders to instruct on proper earplug use before all activities where they are necessary, as well as periodic instruction for populations exposed to noise on a regular basis as part of their work.

Keywords: occupational health, occupational noise, harmful noise, ear plugs, hearing loss.