Journal of the Royal Army Medical Corps
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The deployed Intensive Therapy Unit (ITU) in the British military field hospital in Camp Bastion, Afghanistan, admits both adults and children. The purpose of this paper is to review the paediatric workload in the deployed ITU and to describe how the unit copes with the challenge of looking after critically injured and ill children. ⋯ With appropriate support, it is possible to provide intensive care to children in a deployed military ITU.
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Comment
The Role 1 capability review: mitigation and innovation for Op HERRICK 18 and into contingency.
The Role 1 orientated JRAMC of September 2012 was a welcome addition to the body of Role 1 literature. In particular, the Role 1 capability review by Hodgetts and Findlay detailed both current issues and future aspirations for Role 1 provision. This personal view considers issues still prevalent during Op HERRICK 18 namely the provision of primary healthcare by combat medical technicians on operations and the organisational issues that contribute to historical structural and attitudinal obstructions to the employment of combat medical technicians in firm base primary healthcare. It also considers a dynamically updating dashboard capable of displaying risk across the Role 1 network with the implied move to a model of continuous healthcare assurance.
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We report the case of successful management of a transcranial penetrating high-energy transfer injury in a 20-year-old soldier. The bullet traversed both cerebral hemispheres and lacerated the superior sagittal sinus rendering him unconscious. We detail the care received at all stages following injury from 'Buddy Aid' on the battlefield, resuscitation by a forward medical team through to prompt neurosurgery within 2 h of injury. Subsequent aeromedical evacuation and continuing aggressive critical care has allowed the patient to survive with acceptable neurological impairment after what is generally considered an unsurvivable injury.
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To develop and run a primary healthcare (PHC) refresher package to address the range of clinical presentations to Combat Medical Technicians (CMTs) on deployment and improve their confidence and capability in providing PHC for Op Herrick 18, with particular regard to the first month of deployment. ⋯ By delivering a training package acceptable to the majority of medics, we have increased the confidence and capability of CMTs in delivering PHC within the context of their protocols and prepared them for their first month of deployment. It suggests that PHC delivery can be improved by such a package and consideration should be given to formalising this into a military training qualification.
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At present, UK field hospitals use standard flexible bronchoscopes which require specialised disinfection services that are not integral to the hospital. This leads to prolonged turnover of used bronchoscopes as they have to be sent away to external facilities, which takes 1-3 days and is dependent on air transport to other facilities. ⋯ We evaluated the Vision Sciences EndoSheath Bronchoscopy system, which uses a disposable outer sheath to remove the need for specialised disinfection. We report our experience of using this system in a deployed field hospital in Afghanistan.