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With the development of British Army doctrine it is necessary to review the concepts underlying medical support to the modern battlefield. In particular, the provision of timely and balanced resuscitation to the high intensity battle is an issue requiring an understanding of both the tactical and the clinical demands. The wholesale application of civilian techniques and approaches to trauma management is not possible given the austerity of the battlefield clinical environment. The commitment to excellence and quality of care implicit in modern mainstream practice is of continuing relevance to the battlefield. A doctrinal approach involving the definition of desired clinical outcome and the constraints of operational feasibility, is proposed. Specifically, the introduction of a triad approach to trauma management is offered. The triad comprises readily available Battlefield Advanced Trauma Life Support (BATLS) skills, Surgical Resuscitation deployed forward and the provision of Field Intensive Care. Such an approach would marry together the clinically ideal with the tactically.

SUMMARY: The deployment of British Contingent (BRITCON) to United Nations Force in Rwanda (UNAMIR) on Operation GABRIEL in 1994, proved to be a successful deployment on humanitarian operations. Many of the lessons have been successfully incorporated into training, equipment and organisational structures since the deployment. Others require further work to develop and assimilate. The essential issue concerning principles of humanitarian relief doctrine, mission definition, understanding the Disaster-Development continuum, capability mix, spectrum of military utility and the importance of force maintenance were all highlighted by the Rwanda deployment. Implications for future humanitarian operations include a co-operative approach to pre-deployment training with the Non-Governmental Organisation (NGO) community. This will help to promote understanding between the 2 arms of the humanitarian effort and will exploit the strengths of both sides. Equally, the military medical services have to be fully aware of mission definition and its centrality to planning, execution and audit of performance.

Many recent operations have highlighted the problem of hazard exposure in troops. This is a difficult area since it depends upon both post-deployment and possibly mid-deployment health surveillance and crosses the traditional limits of occupation and public health medicine. Health surveillance is itself a term which straddles occupational and public health medicine. For the military population at risk on operations, a combined approach is required incorporating the separate activities of needs and risk assessments. There is an existing vehicle to develop this approach using the new J95 methodology. Equally, a system of data access crossing medical and personnel records is necessary. The important requirement is that health surveillance is included in pre-deployment planning. Only by this method can adequate resources and significance be accorded to appropriate health surveillance strategies both during and following an operation as required.

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