The Experience Of The Intensive Care Unit In A British Army Field Hospital During The 2003 Gulf Conflict

Mj, Roberts; Fox, MA; Hamilton-Davies, Colin; Dowson, Simon

doi:10.1136/jramc-149-04-08

Cited by 48 publications

(7 citation statements)

References 3 publications

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“…Initially the data were presented as case series collated by medical personnel during their operational tours in individual medical units. 8–10 This evolved into systematic data collection based on the Operational Emergency Department Admission Record, in which the data from all admission log books from field hospitals were collated into a single electronic database thus creating the first registry of all admissions to field hospitals. 11 Data on all trauma cases admitted to field hospitals were captured in a standardised data form and incorporated into the Joint Theatre Trauma Register (JTTR), 12 which was initially managed by RCDM, but as the requirement for MOD official medical statistics emerged, the JTTR transferred to Defence Statistics (Health).…”

Section: Medical Statistics and Workloadmentioning

confidence: 99%

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

Bricknell

Nadin²

2017

J R Army Med Corps

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This paper provides the definitive record of the UK Defence Medical Services (DMS) lessons from the organisation of medical services in support of Operation (Op) TELIC (Iraq) and Op HERRICK (Afghanistan). The analysis involved a detailed review of the published academic literature, internal post-operational tour reports and post-tour interviews. The list of lessons was reviewed through three Military Judgement Panel cycles producing the single synthesis ‘the golden thread’ and eight ‘silver bullets’ as themes to institutionalise the learning to deliver the golden thread. One additional theme, mentoring indigenous healthcare systems and providers, emerged as a completely new capability requirement. The DMS has established a programme of work to implement these lessons.

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Section: Medical Statistics and Workloadmentioning

confidence: 99%

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

Bricknell

Nadin²

2017

J R Army Med Corps

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“…The limited level and availability of local medical resources within our current Theatres of Operation mean the endogenous population may require medical management entirely within the Field Hospital. During the war fighting phase of Operation Telic, a significant difference in ITU length of stay was recorded between coalition and local patients [2]. A declaration made by the Ministry of Defence has stated that 'servicemen and women, ill or injured should, whenever possible be offered medical care to a standard equal to that which they would receive in the UK in peacetime' [3].…”

Section: The Role Of the Field Hospital Itumentioning

confidence: 99%

“…The mechanism of injury and age of patients differs markedly from civilian practice in the UK [2]. Whilst we might wish to apply the same principles to admission of patients, their care and discharge, this may not always be possible within the confines of an Operational role.…”

Section: Who Should Be Admitted?mentioning

confidence: 99%

Who Benefits from Intensive Care in the Field?

Birch

2009

J R Army Med Corps

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The limited capacity and resources of a Field Hospital Intensive Care Unit may necessitate the triage or prioritisation of critically ill patients requiring admission. The use of critical care resources by members of the local population in certain Areas of Operation, who can not be discharged or transferred to equivalent care in their local health service, impacts significantly on bed occupancy. Therefore available resources must be distributed efficiently and equitably with decisions guided by the principles of advocacy for the patient. Patientsmust be admitted only on the concept of potential benefit and reasonable chance of recovery, which would not be available elsewhere. Discriminating between seriously ill patients before admission and decision making regarding withdrawal of care is very difficult. Senior clinicians working regularly in a critical care setting demonstrate a better level of discrimination in assessing outcome of seriously ill patients and are best placed to make decisions regarding admission, continuation and withdrawal of treatment.

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“…Injury following ballistic trauma is the most prevalent indication (50%) for providing organ system support to UK personnel within an intensive care unit (ICU) in the field [1]. In general the role of the field ICU is to continue the postinjury resuscitation process and provide organ system support, until the casualty is discharged to the ward or evacuated to the Role 4 facility.…”

Section: Introductionmentioning

confidence: 99%

Field Intensive Care - Weaning and Extubation

et al. 2010

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Anaesthesia causes an impairment of pulmonary function, irrespective of whether the patient is breathing spontaneously, or is being mechanically ventilated. Impaired oxygenation of blood occurs in most subjects who are anaesthetised [6]. Lung function remains impaired postoperatively, and clinically significant pulmonary complications can be seen in 1% to 2% after minor surgery, and in up to 20% after upper abdominal and thoracic surgery [7]. AbstractInjury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the Systemic Inflammatory Response Syndrome (SIRS) and are important causative factors in the development of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.

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The Experience Of The Intensive Care Unit In A British Army Field Hospital During The 2003 Gulf Conflict

Cited by 48 publications

References 3 publications

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

Who Benefits from Intensive Care in the Field?

Field Intensive Care - Weaning and Extubation

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