Military and Civilian Trauma System Integration: A Global Case Series.

INTRODUCTION: Traumatic injury is a leading cause of morbidity globally, particularly in low-income and middle-income countries (LMICs). In high-income countries (HICs), it is well documented that military and civilian integration can positively impact trauma care in both healthcare systems, but it is unknown if this synergy could benefit LMICs. This case series examines the variety of integration between the civilian and military systems of various countries and international partnerships to elucidate if there are commonalities in facilitators and barriers. METHODS: A convenience sampling method was utilized to identify subject matter experts on civilian and military trauma system integration. Data were collected and coded through an iterative process, focusing on the historical impetuses and subsequent outcomes of civilian and military trauma care collaboration. RESULTS: Eight total case studies were completed, five addressing specific countries and three addressing international partnerships. Themes which emerged as drivers for integration included history of conflict, geography, and skill maintenance for military physicians. High-level government support was a central theme for successful integration, and financial issues were often seen as the greatest barrier. CONCLUSIONS: Various approaches in civilian-military integration exist throughout the world, and the studied nations and international partnerships demonstrated similar motivators and barriers to integration. This study highlights the need for further investigation, particularly in LMICs, where less is known about integration strategies.

Medical civil-military interactions on United Nations missions: lessons from South Sudan.

This paper outlines the United Nations' integrated response to complex humanitarian emergencies and the different types of interactions that may occur between militaries and civilian organisations involved in them. It uses a recent UK deployment to South Sudan as an example, drawing on the experience to highlight areas of particular interest to healthcare workers. It identifies several domains that should usefully be developed for both civilians and military personnel in these environments-including sharing our expertise in major incident management, proof-of-concept testing for novel diagnostic and treatment solutions and offering to engage in joint continuing medical education. These gaps in organisational policy should be addressed and appropriate training pathways designed to maximise the contribution of the Defence Medical Services in similar contexts in the future.

UK Defence Medical Services' support to the development of a multiagency major incident plan in South Sudan.

UK Defence Medical Services personnel deployed in support of the United Nations Mission in South Sudan as part of Operation TRENTON in 2017-2018. One key contribution was the development of a multiagency major incident plan in collaboration with key stakeholders within the region, including our UN partners, other troop-contributing countries and non-governmental organisations. This paper describes the process and contribution made, with some transferable lessons for future similar operations, such as adaptation of our courses. Major incident management is one of several technical areas ripe for a proactive Defence Healthcare Engagement strategy, seeking to offer capacity building in areas where Defence is rich in expertise that is highly sought after by other sectors.