Background Making Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and treatment escalation decisions facilitate a dignified death for patients in acute hospital settings, but not all doctors find it easy to have the necessary discussions with patients. 1 The GMC's "Tomorrow's Doctors" requires that medical schools adequately prepare trainees to "contribute to the care of patients and their families at the end of life". 2 We conducted a survey of the experience of junior doctors in UHBristol NHS Trust. Method An online questionnaire was sent to all junior doctors. Respondents were asked to rate their confidence when discussing DNACPR decisions with patients and their families, what training they had received and whether or not they felt their undergraduate training had adequately prepared them for these conversations. A comments space was provided. Results We received 84 responses. 68% of juniors felt confident when discussing DNACPR decisions with patients and families. However 15% did not. Only 5% felt they had been well prepared by undergraduate teaching. 40% felt they could have been better prepared and 22% felt very unprepared. 50% reported learning by observing senior colleagues in the clinical environment. There were mixed comments regarding which grade was the most appropriately placed doctor to have these discussions with patients; some believed only a consultant should, but others stated junior doctors were usually first to recognise the need for escalation decisions. Several commented that they had learnt by observing seniors conducting these consultations but noted they were not always done well. Some thought practicing in the clinical environment (trial and error) was the best way to improve their communication skills. Conclusion Acute hospitals cannot assume their junior doctors feel prepared to discuss DNACPR decisions with patients. Formal teaching opportunities should be provided to supplement the observation of seniors, the current mainstay of their learning.

Haemostatic resuscitation with blood products has become the expected standard of care for trauma casualties. As UK Defence increases its deployment of small-scale, short-term training teams (STTTs) in Defence Engagement and influence operations, ever greater reliance is being placed on emergency donor panels (EDP) as a source of whole blood. This paper outlines the practical limitations of using EDPs as a risk mitigation in conventional STTTs which must be considered prior to every deployment.

In 2015, the UK government published the National Strategic Defence and Security Review (SDSR) 2015, which laid out their vision for the future roles and structure of the UK Armed Forces. SDSR 2015 envisaged making broader use of the Armed Forces to support missions other than warfighting. One element of this would be to increase the scale and scope of defence engagement (DE) activities that the UK conducts overseas. DE activities traditionally involve the use of personnel and assets to help prevent conflict, build stability and gain influence with partner nations as part of a short-term training teams. This paper aimed to give an overview of the Specialist Infantry Group and its role in UK DE. It will explore the reasons why the SDSR 2015 recommended their formation as well as an insight into future tasks.

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