Journal of the Royal Army Medical Corps
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Penetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs. ⋯ War PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.
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Often known as 'globalhealth diplomacy', the provision of medical care to accomplish strategic objectives, advance public diplomacy goals and enhance soft power is increasingly emphasised in international affairs and military policies. Despite this emergent trend, there has been little critical analysis and examination of the ethics of military actors engaging in this type of work. This type of mission represents the most common form of military medical deployment within the International Security Assistance Force in Afghanistan and is now explicitly emphasised in many militaries' defence doctrine. ⋯ The relationship between non-military humanitarian actors and military actors will be a focal point of discussion, as this relationship has been historically complicated and continues to shift. Relevant differences between these two groups of actors, their motivations and work will be highlighted. In order to examine the morally important differences between these groups, analysis will draw on relevant international doctrine and codes that attempt to provide ethical guidance within the humanitarian sphere.
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Military medical ethics has been challenged by the post-11 September 2001 'War on Terror'. Two recurrent questions are whether military physicians are officers first or physicians first, and whether military physicians need a separate code of ethics. In this article, we focus on how the War on Terror has affected the way we have addressed these questions since 2001. Two examples frame this discussion: the use of military physicians to force-feed hunger strikers held in Guantanamo Bay prison camp, and the uncertain fate of the Department of Defense's report on 'Ethical Guidelines and Practices for US Military Medical Professionals'.
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The WHO Constitution enshrines '…the highest attainable standard of health as a fundamental right of every human being.' Strengthening delivery of health services confers benefits to individuals, families and communities, and can improve national and regional stability and security. In attempting to build international healthcare capability, UK Defence Medical Services (DMS) assets can contribute to the development of healthcare within overseas nations in a process that is known as Defence Healthcare Engagement (DHE). ⋯ DHE is a long-term collaborative process based on the establishment and development of comprehensive relationships that can help transform indigenous healthcare services towards patient-centred systems with a focus on safety and quality of care. Short deployments to allow clinical immersion of UK healthcare workers within indigenous teams can have an immediate impact. Coworking is a powerful method of demonstrating standards of care and empowering staff to institute transformative change. A multidisciplinary group of Quality Improvement Champions has been identified and a Hospital Oversight Committee established, which will offer the prospect of longer term sustainability and development.
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Primary blast lung injury (PBLI) is a prominent feature in casualties following exposure to blast. PBLI carries high morbidity and mortality, but remains difficult to diagnose and quantify. Radiographic diagnosis of PBLI was historically made with the aid of plain radiographs; more recently, qualitative review of CT images has assisted diagnosis. ⋯ In these example cases quantitative CT lung density analysis allowed blast-injured lungs to be distinguished from non-blast-exposed lungs.