Journal of the Royal Army Medical Corps
-
Case Reports
Hereditary neuropathy with liability to pressure palsies occurring during military training.
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant peripheral neuropathy characterized by recurrent isolated nerve palsies, which are precipitated by trivial compression and trauma. Although HNPP has been well-described in literature, it often goes unrecognized. We report a case of HNPP occurring during military training to promote recognition and proper management of this entity.
-
Historical Article
Anaesthetic and other treatments of shell shock: World War I and beyond.
Post-traumatic stress disorder (PTSD) is an important health risk factor for military personnel deployed in modern warfare. In World War I this condition (then known as shell shock or 'neurasthenia') was such a problem that 'forward psychiatry' was begun by French doctors in 1915. Some British doctors tried general anaesthesia as a treatment (ether and chloroform), while others preferred application of electricity. ⋯ However, by 1945 medical thinking gradually settled on the same approaches that had seemed to be effective in 1918. The term PTSD was introduced in 1980. In the UK the National Institute for Health and Clinical Excellence (NICE) guidelines for management (2005) recommend trauma-focussed Cognitive Behavioural Therapy and consideration of antidepressants.
-
In 2002 - 2009 Danish forces suffered a mortality rate of 0.09% in Iraq and 0.38% in Afghanistan, and a morbidity rate of 0.30% in Iraq and 1.01% in Afghanistan, as a result of weapons effects. In Afghanistan the survival rate is 97.0% for Danish wounded who were alive on arrival at UK R3 Hospital. British data from Afghanistan are compared to the Danish figures and there is no significant difference. ⋯ The study also indicates that the great majority of fatalities occur almost immediately at the point of injury. Most of the wounded survive, and a large of number of them are only lightly injured with a partial incapacity level of less than five percent. Haemostatic's and active employment of tourniquets, improved first aid training and training of medics, better evacuation methods including optimised in-flight diagnostics and treatment (including blood transfusion) by Medical Emergency Response Teams, Damage Control Surgery as well as access to quicker diagnostic methods have increased survivability.
-
The UK Defence Medical Services has developed a Massive Transfusion Protocol (MTP) that forms part of the initial Damage Control Resuscitation process for severely injured combat casualties. The key objectives of this retrospective review of MTP recipients are to document the survival rates, level of critical care support required and the blood components transfused as part of the Massive Transfusion Protocol in Afghanistan during 2009. In addition to providing a measure of our current effectiveness it should also provide a reference point for future reviews as the MTP continues to evolve. ⋯ The use of the current MTP was associated with a high rate of survival. Survivors require a continuity of critical care with a median demand for 3 days. The early use of plasma and platelets can be successfully delivered in the battlefield despite operational and logistic constraints.
-
Definitive laparotomy (DL), with completion of all surgical tasks at first laparotomy has traditionally been the basis of surgical care of severe abdominal trauma. Damage control surgery (DCS) with a goal of physiological normalisation achieved with termination of operation before completion of anatomical reconstruction, has recently found favour in management of civilian trauma. This study aims to characterise the contemporary UK military surgeon's approach to abdominal injury. ⋯ This review examines the activity of British military surgeons over a time period where damage control laparotomy has been introduced into regular practice. It is performed at a ratio of approximately 1:2 to DL and appears to be reserved, in accordance with military surgical doctrine, for the more severely injured patients. There is a high rate of unplanned relook procedures for DL suggesting DCS may still be underused by military surgeons. Optimal methods of selection and implementation of DCS after battle injury to the abdomen remain unclear.