Journal of the Royal Army Medical Corps
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Editorial Comment
Pain: an increasingly common cause of discharge from military service.
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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.
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Sepsis, a syndrome caused by severe infection, affects a small proportion of military casualties but has a significant effect in increasing morbidity and mortality, including causing some preventable deaths. Casualties with abdominal trauma and those with significant tissue loss appear to be at a greater risk of sepsis. In this article, the diagnosis and management of sepsis in military casualties with reference to the Surviving Sepsis Campaign guidelines are examined. We discuss the management considerations specific to military casualties in the deployed setting and also discuss factors affecting evacuation by the UK Royal Air Force Critical Care Air Support Team.
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Review Historical Article
A brief history of British military experiences with infectious and tropical diseases.
Infectious and tropical diseases have been a problem for British expeditionary forces ever since the Crusades. Outbreaks were especially common on Navy ships from the 16th to 18th centuries due to poor living conditions and travel to the tropics. However, since these occurred in small, isolated and controlled environments it meant that naval medical practitioners were able to keep detailed records and develop empirical approaches for their prevention. ⋯ Even in the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments, but the military clinical and academic resources to deal with them are now much reduced. Preventive measures such as hygiene, sanitation, infection control, vaccination and chemoprophylaxis are invaluable, but history shows that these can become neglected over time and disrupted or overwhelmed during the early or most intense stages of military operations. This is why military specialists in infectious diseases, tropical medicine, sexual health, medical microbiology and communicable diseases control are still required.