Journal of the Royal Army Medical Corps
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Randomized Controlled Trial
Randomised controlled trial comparing marksmanship following application of a tourniquet or haemostatic clamp in healthy volunteers.
In a care under fire situation, a first line response to haemorrhage is to apply a tourniquet and return fire. However, there is little understanding of how tourniquets and other haemorrhage control devices impact marksmanship. ⋯ Application of a tourniquet to the dominant arm negates effective return of fire in a care under fire setting after a brief time window. Haemorrhage control devices that preserve function may have a role in care under fire situations, as preserving effectiveness in returning fire has obvious operational merits.
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Review
Formation of Defence Primary Healthcare: a new way of delivering firm base primary healthcare.
Following the Strategic Defence and Security Review of 2010, the UK Surgeon General was directed to merge the delivery of primary healthcare from the three single Service organisations to a unified Defence Primary Healthcare. Although front line clinical staff were to be preserved, considerable savings were to be made in headquarters staff. ⋯ The changes were completed on time with the transfer of UK and overseas general practice, specialist community services and dentistry, with a later requirement to add healthcare for the Reserves. The first years of this initiative have been remarkably successful, and Defence Primary Healthcare (DPHC) has progressively increased performance in all the QOF criteria measured by Defence Statistics.
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While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. ⋯ This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes.
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Some military specialists wear body armour that is more similar to police armour and provides protection from ammunition fired from pistols. During ballistic testing, these armours are mounted on a standardised type of modelling clay and the back face signature (BFS; depth of depression) formed as a result of the non-perforating impact event on to the armour is measured. This study investigated the effect of impact angle on the BFS and on the deformation of the bullet. ⋯ Understanding the deformation of bullets may assist with recreating a shooting incident and interpreting forensic evidence.
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To provide the first annual audit of Defence Medical Services (DMS) medical appraisal and revalidation activity. ⋯ To assist DMS compliance with GMC quality assurance requirements, HQ Surgeon General now maintains a central database of appraisal and revalidation data across the five DMS DBs. Appropriately targeted appraiser training and 'revalidation ready top-up' training should be provided to ensure the demand for military appraisers is met, and that DMS appraisers appropriately maintain their skills. MOD now maintains a central live database for ongoing appraisal and revalidation monitoring.