Aims: This article is designed to demonstrate the problems of infection in a time without antibiotics and to raise awareness and stimulate discussion about the future and the next steps for managing antibiotic resistance. Methods:Access was gained to original journals and letters of three doctors, who joined the army working as medical officers during the First World War. Transcripts of interviews of the doctors performed after the war, in 1977-1979, were also looked at. These original records were studied and any references to infection were collected. A literature search was then performed to identify research carried out during the First World War on the development of the management of infection and sanitation during that time period. A further literature search was then performed to identify modern day concerns with infection, in particular with regard to antibiotic resistance. Results:The three doctors made many comments about infection in their journals and letters written during the war. It was clearly a major concern in the treatment of injured soldiers and few effective remedies were available. The literature search demonstrated that this concern was worldwide with massive investment in research between 1915 and 1917. This produced a drive of innervation and development, rapidly improving the management of infection during that time. Now, with concerns of rising antibiotic resistance, infection is again becoming a medical challenge that requires a renewed drive to push research forward. Conclusions:This article demonstrates that without effective antibiotics infection is massive medical challenge. However when a problem is identified it is possible to produce rapid solutions with research and development. Antibiotic resistance is on the rise. Further research with international cooperation is now required to ensure a simple wound does not become untreatable condition.

This article reports a multicentre quality improvement project on the use of clinical waste bins and aims to raise awareness of the importance of sorting waste. It also makes recommendations for hospital clinical and management staff to improve compliance.An audit on the contents of clinical waste bins at two NHS trusts was performed against hospital guidelines. Eighty clinical waste bins were spot-checked and their visible contents recorded.In total, 347 items were seen in 80 bins; 59% of items were non-clinical, 40% clinical. The results were presented at a medical department meeting and to the hospitals waste management teams with suggestions for improvement. A re-audit on a test ward was then performed. No improvement was seen, with 66% of the waste found to be non-clinical, 31% clinical.Therefore, the aims of this article are to educate clinicians and hospital staff and encourage waste separation to improve compliance on the use of clinical waste bins, resulting in savings in the environmental and fi nancial costs of waste disposal.

Femur fractures are rare within mountain rescue. Traction splints may be no more effective than other methods of splinting in prehospital care. We failed to identify evidence that supports the hypothesis that traction splints reduce morbidity or mortality. We advocate the use of a femoral traction splints but recognize that other splints may also be appropriate in this environment.

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