Journal of the Royal Army Medical Corps
-
The accepted mechanism of blast-mediated traumatic amputation (TA) is blast wave induced fracture followed by limb avulsion from the blast wind, generating a transosseous amputation. Blast-mediated through-joint TAs were considered extremely rare with published prevalence <2%. Previous studies have also suggested that TA is frequently associated with fatal primary blast lung injury (PBLI). However, recent evidence suggests that the mechanism of TA and the link with fatal primary blast exposure merit review. ⋯ The previously reported link between TA and PBLI was not present, calling into question the significance of primary blast injury in causation of blast mediated TAs. Furthermore, the accepted mechanism of injury can't account for the significant number of through-joint TAs. The high rate of through-joint TAs with either no associated fracture or a non-contiguous fracture (74%) is supportive of pure flail as a mechanism for blast-mediated TA.
-
The Defence Medical Services (DMS) primarily recruits its trained General Practitioners (GPs) from the NHS and since 1970, the number of men entering medicine has doubled whereas the number of women has increased 10-fold; female GPs will outnumber their male counterparts by 2017. This study performs a quantitative assessment of the potential impact of feminisation of UK General Practice upon the DMS recruitment and workforce planning. ⋯ The national increase of only 3% infers feminisation of UK General Practice is not an immediate challenge for the DMS. Nevertheless, as feminisation of the UK GP workforce is expected to continue, the future cohort from whom the DMS will recruit its GPs is likely to contain increasing numbers of women. With the return to contingency, the DMS may wish to consider the implications of increasing numbers of female GPs upon service delivery in the UK and overseas, and explore more flexible medical employment models.
-
The Role 3 Medical Treatment Facility (Field Hospital) in Camp Bastion (R3 Bastion) is acknowledged to be one of the busiest dedicated trauma facilities in the world. Casualties typically present with severe injuries and in physiological extremis. ⋯ They traverse the spectrum of clinical research, ranging from data collection to a randomised control trial. The aim is to discuss some of the problems encountered and the solutions that made it possible to undertake research in a theatre of operations, thereby providing a starting point for others who may wish to initiate research in a similar environment.