Journal of the Royal Army Medical Corps
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Review Meta Analysis
Coupled plasma haemofiltration filtration in severe sepsis: systematic review and meta-analysis.
Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe sepsis with the intention of removing the proinflammatory and anti-inflammatory mediators from the systemic circulation. It is believed that this interrupts and moderates the septic cascade, but there is uncertainty about the benefits of this therapy. ⋯ Evidence for CPFA in severe sepsis is sparse, of poor quality and further research is required, however, this meta-analysis noted improvements in survival rates of those patients treated with CPFA.
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Randomized Controlled Trial
An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases.
Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. ⋯ The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.
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Considerable evidence has discussed the significant workload and advances in clinical care by UK Defence Medical Services (DMS) during recent conflicts in Iraq and Afghanistan. Although the DMS is not doctrinally staffed to deal with children on operations, severely ill and injured paediatric casualties continue to present to military medical facilities; therefore, staff must be competent to deliver the appropriate level of care. This paper reports the paediatric presentations to the emergency department (ED), at the Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan, over a 21-month period. The aim was to provide quantitative, statistical data of paediatric presentations seen by deployed ED nurses, to identify whether the current training was appropriate and to make recommendations for further training requirements for DMS ED nurses. ⋯ Although the exposure to paediatric polytrauma during the conflicts in Afghanistan and Iraq is not replicated in peace time roles, it is likely that wherever emergency nurses are deployed the treatment of children will continue. Analysis of the service evaluation has led to the recommendations for specific skills that emergency nurses could develop during the pre-deployment phase to better prepare for caring for such patients. These include recognition of the sick child/triage, paediatric drug calculations, awareness of the massive transfusion requirements for children and skills to gain intravenous/intraosseous access in a child.
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Over the past 10 years the UK Defence Medical Services has deployed healthcare personnel to a variety of operational areas in support of UK Operations. The unique nature of every operational deployment, in conjunction with the wide variety of roles which healthcare staff undertake, necessitates bespoke educational preparation of the military healthcare force. This paper explores the creation and development of one of the four modules which comprise the BSc (Hons) in Defence Health Care studies, entitled 'The Diverse Nature of Defence Healthcare'. It demonstrates the unique contribution that the Defence School of Healthcare Education makes towards Generation and Preparation of the Force for deployment.
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Trauma care delivery in England has been transformed by the development of trauma networks, and the designation of trauma centres. A specialist trauma service is a key component of such centres. The aim of this survey was to determine to which extent, and how, the new major trauma centres (MTCs) have been able to implement such services. ⋯ A large proportion of MTCs still do not have a dedicated major trauma service. Furthermore, the models which are emerging differ from other countries. The relative lack of involvement of surgeons in MTC trauma service provision is particularly noteworthy, and a potential concern. The impact of these different models of service delivery is not known, and warrants further study.