Journal of the Royal Army Medical Corps
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Indirect ballistic fractures occur when a projectile passes close to, but not contacting, the bone. The mechanism of how these fractures occur is not yet proven, but recently the acoustic shockwave has been excluded as a cause. The objective of this study is to determine whether the expanding temporary cavity, the collapse of this cavity or its oscillation causes these fractures. In addition, we describe the fracture morphology and biomechanical causes of this injury. ⋯ Indirect fractures are caused by the expansion of the temporary cavity and relate to the proximity of this cavity to the bone. Fractures occur from flexion of the bone and classically display wedge-shaped fracture patterns with the apex of the wedge pointing away from the expanding cavity.
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To determine whether full sets of physiological observations and the Defence Medical Services (DMS) Early Warning Scoring (EWS) tool were applied to patients admitted to the ward at the UK Role 3 Field Hospital in Afghanistan. ⋯ This pilot audit has provided an insight into the recording of physiological observations and use of the DMS EWS within a deployed field hospital. It demonstrated core observations were well recorded in data collection periods and while compliance with using the DMS EWS increased, accuracy remained less than 50%. The DMS EWS is one tool used by healthcare professionals to recognise and respond to the deteriorating patient and incorrect use of this tool or failure to use it at all is a significant patient safety issue.