An audit of the quality of deployed DMICP records on Operation HERRICK 14.

BACKGROUND: Troops deploying to remote and hostile environments are exposed to numerous threats to their health and wellbeing. Medical care is provided by dedicated but often inexperienced young doctors, nurses and medics. This audit looks at the quality of medical records that are available to these deployed clinicians and the quality of their record keeping against nationally set guidance for the Summary Care Record (SCR) and Out of Hours record keeping. METHODS: The data was collected from consecutive GP and nurse medical consultations at Camp Bastion Primary Health Care Centre during Op HERRICK 14. RESULTS: Only 21.7% of personnel had an imported medical record from the UK and only 1% had a summary fitting the guidance for the SCR. Additionally the quality of record keeping for consultations did not conform to standards set by the Royal College of General Practitioners 'Out of Hours Clinical Audit Tool'. CONCLUSIONS: The low numbers and poor quality of imported medical records into Op HERRICK 14 alongwith the inexperience of clinicians in keeping medical records compliant with relevant standards is of primary importance in the context of patient safety on operations. This audit highlights a number of areas of potential concern for the Defence Medical Services and areas for enhancement of pre-deployment training.

Factors affecting front line casualty care in Afghanistan.

OBJECTIVE: Limited research has been undertaken to assess the effectiveness of pre-hospital care given at the point of wounding, nor how battlefield conditions affect the implementation of Battlefield Advanced Trauma Life Support (BATLS). This study examines the quality of care given at Role 1 and the psychological impact on clinical personnel of the application of current pre-hospital trauma management guidelines. METHOD: Data was collected through 17 digitally recorded semi-structured interviews with healthcare clinicians deployed in Role 1 medical facilities on OP HERRICK 14 following major medical incidents. Interview transcripts were subjected to content analysis based on a modified grounded theory approach. RESULTS: Triage was found to be done poorly with individuals treating patients as they were found rather than by identifying clinical priorities. Pain management was not always achieved. Fluid replacement was hampered with difficulty in obtaining parenteral access. Subsequently fluids were sometimes given in excess of protocols. Clinical documentation was not always completed even after a patient had been evacuated. Some interesting elements were noted, such as post incident reports being used as a reflective process which may be self-developmental and help clinicians deal psychologically with the incident. Clinical personnel carry out their duties, irrespective of personal injury or threats to their safety. However their performance may be tapered under such stress. Human factors training prior to deployment may help to ensure adherence to BATLS protocols despite the complexities of the battle space. CONCLUSIONS: The data identified a number of factors that affected clinicians ability to provide a high standard of casualty care. The general perception of this research cohort was that despite all the obstacles, the level of trauma care was of a high nature. However, the study provides pointers to a number of areas for future exploration where patient care was not BATLS protocol compliant.