Armed Forces General Practice is in an unprecedented time of challenge with the demands of contiguous worldwide operations in austere environments, reorganisation of defence, budgetary constraints and manpower shortfalls. We propose a model of this crucial area of military medical care as a key academic and practical reference point, which will help retain, and perhaps even enable, the development of this clinical speciality over the next decade. It provides a formalised definition and a basis for education, training and research in Military General Practice; it also has the advantage of highlighting the all-encompassing nature of military primary care when compared to the nearest equivalent model--that of civilian General Practice.

The long term military careers of soldiers who had completed an in-patient alcohol treatment programme in 1983 were examined. Compared to a matched control group, soldiers who had received treatment served for a significantly shorter time post-treatment. Only 40% of the treatment group were discharged from the service on normal grounds. It is suggested that post-treatment career provides a useful outcome measure and indicates that even after extensive inpatient treatment, the results are poor.

The Unified Emergency Care System (UECS) provides an integrated system of medical support from point of injury to the time a casualty is handed over to specialist care within hospital. It enables personnel at all skill levels to deliver life-saving support to casualties with a broad range of acute injuries and illness. The UECS facilitates standardised training with each level building upon the previous, yet it retains an inherent flexibility to adapt to specific operational and service requirements.

Emergency medicine is increasingly compartmentalised. The Unified Emergency Care System (UECS) requires the user to consider every option for emergency care for each patient, in a logical manner that transcends these artificial compartments and recognises the relative priority of concomitant medical, surgical, environmental and toxicological problems. The system is presented as a series of icons, allowing considerations to be made at a glance. Drop shadows refer the user to detailed management protocols for specific conditions. The system follows the logical sequence of quick history, quick look, primary survey with resuscitation and secondary survey. Established management principles of airway-breathing-circulation-disability (ABCD) are incorporated. The complexity of the management algorithms increases from first aider through medic, paramedic, and primary care physician to emergency physician. The stepwise care facilitates seamless immediate medical care between providers, teamwork, and the development of a structured series of training programmes.

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