Journal of the Royal Army Medical Corps
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The lack of need for immediate renal replacement treatment for military trauma victims suggests that the current policy of restricting operational deployment of those Service personnel with active inflammatory renal disease and significantly impaired renal function, combined with good prehospital care for all trauma casualties, is probably correct. No published estimates of renal function in civilian or military trauma victims in the earliest period following injury have been retrieved. The purpose of the present retrospective study was to assess the renal function of military trauma victims on arrival in the Emergency Department of the field hospital. ⋯ Prehospital resuscitative measures are effective in maintaining renal function at an adequate level until arrival in the field hospital. The combination of tachycardia and hypothermia predicts lower renal function, variables already employed in the assessment of injury severity. The observations in the present study support restriction of recruitment and operational deployment where renal problems exist.
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Most of the emergency care delivered in Afghanistan is currently provided by the military sector and non-governmental organisations. Main Operating Base (MOB) Price in Helmand Province has a small medical centre and due to its location provides critical care to civilians and military casualties and this article describes the patterns in trauma patient care at the MOB Price medical centre regarding the types of patients and injuries. ⋯ Both civilians and military personnel benefitted from the in-theatre Role 1 medical facility treatment. The most frequent injuries were fragmentation damage and GSW.
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Op HERRICK in Afghanistan remains the current focus of the British Armed Forces. General Duties Medical Officers (GDMOs) commonly deploy to Role 1 locations in Afghanistan, which remains a continuously evolving theatre of operations. This article is based on the experiences of four GDMOs who deployed to forward Company locations on Op HERRICK 15 (September 2011-April 2012) and aims to offer an insight into the challenges of this role and identify areas in which improvements could be made to the training and preparation for future tours.
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Management of blunt splenic injury (BSI) in battlefield casualties is controversial. Splenectomy is the traditional treatment, as setting the conditions for selective non-operative management (SNOM) is difficult in the operational environment. On mature operations, it may be feasible to adopt a more conservative approach and manage the patient according to civilian protocols. The aim of this study was to document the contemporary practice of deployed military surgeons when dealing with BSI and to compare this against a matched cohort of civilian BSI patients. ⋯ Patients with BSI, an uncommon finding in combat casualties, are occasionally selected for conservative management, contrary to previous military surgical paradigms but in keeping with the civilian shift to SNOM. Guidelines to clarify the place of SNOM are required to assist surgical decision making on deployed operations.