Journal of the Royal Army Medical Corps
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A retrospective study was undertaken of all epidurals inserted on the labour ward in BMH Rinteln from 1980 to 1985 inclusive, during which time both obstetricians and anaesthetists participated in providing an epidural service. It was impossible to show any difference between the expertise of anaesthetists and obstetricians in siting epidurals, when the incidence of complications or failed analgesia was compared. However, epidurals inserted by obstetricians were more likely to be converted to general anaesthetics for operative procedures than those inserted by anaesthetists, although no adequate explanation for this could be found. Given increasing patient demand for a 24-hour epidural service, and the logistic difficulties in Service hospitals of providing sufficient anaesthetic staff for this, obstetricians can be trained to help provide such a service.
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Changes in thoracic electrical bioimpedance during the cardiac cycle have been related to the ejection of the stroke volume of blood during cardiac systole. Refinements in the recording and analysis of these changes permit estimation of cardiac output. ⋯ While there are limitations, the advantages of this technique are sufficient to make bioimpedance cardiography attractive to the military physician. It is for these reasons that the principles of this technology are reviewed in this paper.
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The injuries likely to occur during a future general war will differ in severity and number from those experienced during recent short campaigns, terrorist incidents and natural disasters. If general war should break out in Europe, casualty numbers will lean towards the First World War rather than the Second in scale. Medical assets can expect, at least temporarily, to be overwhelmed with casualties. ⋯ Sorting will be achieved by the application of a crude scoring system known as Military Triage. We examine this concept and discuss its likely effectiveness in a scenario characterised by limited medical resources and a high flow of casualties. With the widespread introduction of modern and complex injury severity scoring systems into civilian trauma practice it is timely to examine their potential role in augmenting or replacing the current Military Triage system.
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Following a large earthquake in Nepal, the experience of a small hospital in dealing with the resulting mass casualties is described. The value of pre-planning and effective triage of the injured is stressed, and aspects of surgical and medical care specific to earthquake victims discussed. Clinical and administrative challenges encountered in mounting a major relief exercise in a Third World setting are also described. frequent exercising of military hospitals and personnel in handling mass casualties is an applicable to civilian natural catastrophies as to battlefield medical support.
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In August 1988 an aircraft of the Italian aerobatic display team fell into the spectator enclosure at the Ramstein Airshow, causing over 500 casualties. The survivors were triaged, treated and evacuated from Ramstein within 96 minutes. The speed and efficiency of this evacuation was a result of prior planning, thorough training, medical reinforcement, co-operation with other agencies and the availability of an abundance of vehicles for both air and road evacuation. Not suprisingly, though, problems did occur, especially with communications, casualty identification and documentation.