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“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?”

“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?” Lt Col Tom WOOLLEY Surg Lt Cdr Stuart MERCER Surg Cdr Steve BREE Lt Col Douglas BOWLEY Civilian pre-hospital helicopter High profile Charitably-funded Accepted as invaluable by the general population

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“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?”

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  1. “DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?” Lt Col Tom WOOLLEY Surg Lt Cdr Stuart MERCER Surg Cdr Steve BREE Lt Col Douglas BOWLEY

  2. Civilian pre-hospital helicopter • High profile • Charitably-funded • Accepted as invaluable by the general population

  3. Military pre-hospital care • Helicopters accepted as vital: • terrain • time-lines • hostile action

  4. Critical report • “In Vietnam, wounded soldiers arrived in hospital within 25 minutes of injury. In Iraq in 2005, that figure is 110 minutes, on Operation Herrick IV, (Afghanistan 2006 ) the average pre-hospital time was seven hours. ” Parker PJ. Damage control surgery and casualty evacuation: techniques for surgeons, lessons for military medical planners. J R Army Med Corps. 2006 Dec;152(4):202-11.

  5. Introduction of MERT • Dedicated air asset • Doctor • Flight nurse • Paramedics • “We are bringing the emergency department forward on to the helicopter”

  6. MERT: HERRICK 9 • July – Nov 2008 • 324 missions • 429 patients • 303/324 [94%] to Bastion Hospital • Median patients carried was 1 • [range 1 – 13]

  7. Nationality of patients • 242/429 [56%] were local nationals • 150 [35%] were UK forces • 37 [8.6%] coalition allies

  8. Medical category assigned • 95/429 [22%] were assigned category T1 • 223 [52%] were T2 • 93 [21.5%] were T3 • 18 [4%] were dead

  9. Mechanism • 208 [48%] had received blast injury • 109 [25%] had GSW • 6 [1.5%] had both blast & GSW • 41 [9.5%] were medical • 23 [5%] were from MVC • 42 [10%] had other diagnoses

  10. Flight timings • Median time from take off to delivery of casualty: 44 minutes • Range [10-183 minutes] • Doctor flew on 283/320 [88%] of missions

  11. Did the doctor contribute? • Of 283 missions, it was thought that the doctor was not required in 219/283 [77%]

  12. Of 62 missions where doctor was useful, • RSI 28/62 [45%] • Provision of analgesia/sedation/ blood products: 21/62 [34%] • Chest drain/thoracosotomy: 3/62 [5%] • Pronouncing life extinct: 4/62 [6%]

  13. MERT: a difficult balance • 77% missions doctor was simply a passenger • Ground-to-air threat • Distance from point of wounding to MERT landing site

  14. MERT: a difficult balance • 23% missions doctor made +ve contribution • Knowing when NOT to intervene • Morale effect to troops on ground

  15. Summary The MERT is a high value asset which makes an important contribution to patient care. A relatively small proportion of missions require interventions beyond the capability of well-trained military paramedics.

  16. Conclusion • Casualty care is thought to by presence of a physician • Military pre-hospital care should be led by doctors / paramedics

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