Introduction The COVID‐19 pandemic caused an unprecedented impact to haemophilia healthcare delivery. In particular, rapid implementation of telehealth solutions was required to ensure continued access to comprehensive care. Aims To explore patient and healthcare provider (HCP) experience of telehealth in a European Haemophilia Comprehensive Care Centre. Method A systematic evaluation was performed to survey patient and HCP experience and compare clinical activity levels with telehealth to in‐person attendances. Results Public health measures implemented in March 2020 to reduce COVID‐19 spread resulted in a 63% decrease in medical/nursing clinic consultation activity compared to the same period in 2019. Implementation of digital care pathways resulted in marked increase in activity (52% greater than 2019). Importantly, enhanced patient engagement was noted, with a 60% reduction in non‐attendance rates. Survey of patients who had participated in medical/nursing teleconsultations demonstrated that teleconsultations improved access (79%), reduced inconvenience (82%), was easy to use (94%) and facilitated good communication with the HCP (97%). A survey exploring the telemedicine experience of HCPs, illustrated that HCPs were satisfied with teleconsultation and the majority (79%) would like to continue to offer teleconsultation as part of routine patient care. In addition to medical/nursing reviews, continued access to physiotherapy with virtual exercise classes for people with haemophilia and teleconsultation for acute dental issues was equally successful. Conclusion During an unprecedented public health emergency, telehealth has enabled continued access to specialized haemophilia comprehensive care. Our novel findings show that this alternative is acceptable to both patients and HCPs and offers future novel opportunities.

Aim To assess the safety of buccal infiltration local anaesthetic (LA) without additional factor replacement in patients with haemophilia (PWH) and association with clinical experience of the operator. Methods A consecutive sample of participants with mild, moderate and severe haemophilia scheduled to have dental treatment were recruited from a comprehensive care centre in Ireland. Infiltration LA was administered using a standard technique. Safety was defined as any adverse event at time of administration, immediate postoperative, or postoperative period. Clinical experience was dichotomized into fewer or greater than three years clinical experience. Results N = 135 buccal infiltration LAs without additional factor replacement were provided to N = 71 participants with mild (n = 20; 28%) and moderate to severe haemophilia (n = 51; 72%). Successful local anaesthesia was achieved in n = 133 cases (99%). No (0%) adverse bleeding events were recorded for any participants at time of administration of LA or during follow‐up. Three out of 135 (2.2%) LAs recorded superficial bleeding 30 seconds after administration of LA, all of which resolved within 2 minutes with application of pressure; 4 out of 135 (3%) LAs produced a superficial haematoma at the site of injection no greater than 2 mm all of which resolved at 4 minutes. There were no differences in bleeding rates between clinicians by level of experience (P = 0.435) or by severity of bleeding disorder (P = 1.0). Conclusion Local anaesthetic is safe to administer via buccal infiltration for people with mild, moderate and severe haemophilia without additional factor cover. This finding holds true regardless of operator experience.

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Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. This directive, the goal of which was to allow trauma surgery to take place within the "golden hour," was determined to have resulted in a marked reduction in the case fatality rate. 1 A re-examination of the data confirmed the importance of rapid transport of casualties to a forward surgery facility. 2 During recent conflicts in Afghanistan and Iraq, casualty evacuation was provided heroically by the Blackhawk squadrons of the US military, known colloquially by the Vietnam War era callsign "Dustoff." Role 2 hospitals were designed and deployed to provide rapid access to damage-control surgery. 3 The success of casualty evacuation allowed medical planners to concentrate first on providing high-value on-site care through the tactical combat casualty care program. 4 Recent conflicts involved an asymmetric balance between opponents, where the conventional side retained control of the air and the ability to complete casualty evacuation within the mandatory period. There is concern that rapid casualty evacuation may not be possible in future conflicts because of remoteness, lack of a secure zone or loss of air superiority. Advanced resuscitation, which had been added to the concept of damage control, is more amenable than surgery to being pushed forward toward the point of injury. 5 Although damage-control resuscitation should augment initial care, it is not a substitute for trauma surgery. Far-forward surgery has been developed as a means to bring surgical services closer to the point of injury so that the casualty may have access to damage-control surgery within the golden hour. 6 Surgeons have accompanied soldiers to war since ancient times. Illustrations from the time mainly show "first-aid" procedures being performed. Clearly, some patients with serious injuries survived. Alexander the Great and his father Philip II of Macedon both endured an astounding array of injuries during combat. The surgeon Kritoboulos was acknowledged by Pliny the Elder for his skill in treating Philip in the field. Philip was injured by either an arrow or a spear that destroyed his right eye, crushing the orbital bones and forehead. The severity of the injury was proven recently when Philip's ossuary was discovered. However, most injured soldiers were left on the field of combat until hostilities ceased and care was rendered only by permission of the victor. This was the situation that caused Henri Durant to found the Red