Journal of the Royal Army Medical Corps
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Case Reports
Selective non-operative management of ballistic abdominal solid organ injury in the deployed military setting.
This article describes the non-operative management of five patients with ballistic abdominal solid organ injuries in a role 2E medical treatment facility. The selective non-operative management of ballistic abdominal solid organ injury is an accepted management strategy in high-volume civilian trauma centres, and appears to be equally safe and effective in the deployed military setting.
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Optimal clinical timelines--a consensus from the academic department of military surgery and trauma.
There are no published studies directly addressing the issue of what is an acceptable timeline from point of wounding to surgical intervention within the military context. The proximal threshold has previously been determined by personal opinion, tactical, logistic and practical imperatives rather than by clinical demands. The aim of this paper is to review all relevant military and civilian studies where timelines have been quoted and to reach a number of unambiguous consensus statements to state the perceived ideal upper limits from point of wounding to holistic and realistic surgical care in modern war. ⋯ Continuation of in-flight resuscitation then allows physician-led decision making on critically unstable casualties. This allows either an expedited straight move from the HLS direct to the operating theatre or direct transfer to a regional neurosurgical centre. To prevent avoidable death,our unequivocal conclusion is that there must be an upper limit of 2 hours from wounding to surgical intervention (surgical haemorrhage control) for all casualties.
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The nature of conflict is evolving, with current warfare being associated with an initial "shock and awe" phase followed by protracted periods ofcounter-insurgency and peace support missions. As conflict has changed, so have the munitions deployed and the resulting patterns of injury. Improvised Explosive Devices have become the preferred weapon of the insurgent and the resultant explosive and fragmentation injuries are the hallmark of modern military wounding. ⋯ New curriculum development, streamlined and run-through training programmes have combined with the legal requirements of the European Working Time Directive to produce a training landscape almost unrecognisable with that of previous years. This article investigates the development of current military wounding patterns and modern surgical training programmes. It describes processes already in place to address the unique training needs of military surgeons and proposes a framework for enabling appropriate training opportunities in the future.
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Review
Current concepts in the epidemiology and management of battlefield head, face and neck trauma.
There has been a significant increase in the incidence of head, face and neck (HFN) injuries in the 21st century in comparison to that experienced in the previous century. In the majority of HFN injuries the primary cause of death is secondary to airway compromise and with the exception of severe neck wounds haemorrhage is an unusual cause of death. ⋯ Equivalent armour to protect the neck and face is not yet effective and requires development. We describe the current epidemiology and management of battlefield head, face and neck trauma.