Journal of the Royal Army Medical Corps
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Ballistic cervical injury has become a significant source of both morbidity and mortality for the deployed UK soldier. The aim of this paper was to document a case series of ballistic cervical wounds to describe the pattern of these injuries and relate them to outcome. ⋯ Penetrating cervical ballistic injury is a significant source of injury to deployed UK service personnel, predominantly due to neurovascular damage. Neck collars if worn would likely prevent many of the injuries in this case series but such protection is uncomfortable and may interfere with common military tasks. Newer methods of protecting the neck should be investigated that will be acceptable to the deployed UK soldier.
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To determine how Injury Severity Score (ISS) and mortality relate to height fallen, and to determine other predictors of mortality including intent and body region injured. ⋯ Height fallen correlates with ISS and is a significant predictor of death. Chest and/or head injuries significantly increased the likelihood of death following a FFH. This information may enhance triage criteria applied to tasking of emergency response vehicles, and strategies in injury prevention. Other potential predictors of mortality were not found to be significant.
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To describe spinal fracture patterns presenting to deployed medical facilities during recent military operations. ⋯ Injuries to the spine caused by explosive devices account for greater numbers, greater associated morbidity and increasing complexity than other means of spinal injury managed in contemporary warfare. With the predominance of explosive injury in current conflict, this work provides the first detail of an evolving injury mechanism with implications for injury mitigation research.
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Damage Control Resuscitation and Damage Control Surgery (DCR-DCS) is an approach to managing severely injured patients according to their physiological needs, in order to optimise outcome. Key to delivering DCR-DCS is effective communication between members of the clinical team and in particular between the surgeon and anaesthetist, in order to sequence and prioritise interventions. ⋯ A system is described which builds on the 'World Health Organisation (WHO) safer surgery checklist' and formalises certain stages of communication in order to assure the effective passage of key points. We have identified 3 distinct phases: (i) The Command Huddle, once the patient has been assessed in the Emergency room; (ii) The Snap Brief, once the patient has arrived in the Operating Room but before the start of surgery; and (iii) The Sit-Reps, every 10 minutes for the entire theatre team to maintain situational awareness and allow effective anticipation and planning.
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Recent military campaigns in Iraq and Afghanistan have resulted in the treatment of children in British Medical facilities. In order to determine how care for children may develop in the future, it is necessary to understand the current situation. The aim of this article is to examine the pattern of paediatric trauma on recent operations in Iraq and Afghanistan. ⋯ The treatment of children in British medical facilities whilst deployed on operations is likely to continue. An assessment of the injury patterns of paediatric patients on current deployments allows development of training and an understanding of logistic requirements. Data collection will also need to be adapted to meet the needs of paediatric patients. These remain issues that are being addressed by the Defence Medical Services.