Defining capabilities in deployed UK military prehospital emergency care.

The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the 'Medical Emergency Response Team' (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.

Measuring wet bulb globe temperatures at point-of-exertion in worldwide UK military settings: a longitudinal observational study determining the accuracy of a portable WBGT monitor.

INTRODUCTION: Heat illness among the UK Armed Forces is usually exertional, and therefore preventable, yet the incidence has not reduced since 2011. JSP 539 explicitly states that wet bulb globe temperature (WBGT) should be measured 'at the location of greatest heat risk', not 'that of most convenience'. A handheld WBGT tracker used at point-of-exertion could reduce this incidence if proven to be as accurate as the current in-service device. METHODS: Longitudinal observational comparison and equipment feasibility study of the Kestrel 5400 and QUESTemp 34 (QT-34) in worldwide firm base and deployed UK Armed Forces locations. The locations chosen were Kenya, South Sudan, Belize, Tidworth, Aldershot and Brecon. Paired data points of WBGT readings were collected from November 2017 to August 2018 in all weather conditions. RESULTS: WBGT readings were comparable between the QT-34 and Kestrel 5400 across the UK and overseas. In addition, there was no change in accuracy between readings taken from the Kestrel 5400 when tripod-mounted and handheld. The Kestrel was easy to set up and far less susceptible to resupply or power supply limitations, as it requires no user input for wet bulb temperature, and runs on AA batteries. CONCLUSION: This equipment feasibility study has shown that the Kestrel 5400 gives an acceptable accuracy and is easier to use than the QT-34. The authors recommend that the Kestrel 5400 is introduced as an adjunct to the QT-34, and its use within the military setting monitored through ongoing comparative data collection in a large-scale proof-of-concept study.

Outcomes of UK military personnel treated with ice cold water immersion for exertional heat stroke.

INTRODUCTION: Despite mitigation efforts, exertional heat stroke (EHS) is known to occur in military personnel during training and operations. It has significant potential to cause preventable morbidity and mortality. International consensus from sports medicine organisations supports treating EHS with early rapid cooling by immersing the casualty in cold water. However, evidence remains sparse and the practice is not yet widespread in the UK. METHODS: Following changes to enable on-site ice cold water immersion (ICWI) at the Royal Marines Commando Training Centre, Lympstone, UK, we prospectively gathered data on 35 patients treated with ICWI over a 3-year period. These data included the incidence of adverse events (e.g. death, cardiac arrest or critical care admission) as the primary outcome. Basic anthropometric data, cooling rates achieved and biochemical and haematological test results on days 0-5 were also gathered and analysed. RESULTS: Despite being a cohort of patients in whom we might expect significant morbidity and mortality based on the severity of EHS at presentation, none experienced a serious adverse event. In this cohort with rapid initiation of effective cooling, biochemical derangement appeared less severe than that reported in previous studies. Higher body mass index (BMI) was associated with a lower cooling rate across a range of values previously reported as potentially of clinical significance. CONCLUSIONS: This case series supports recent updates to UK military guidance that ICWI should be more widely adopted for the treatment of EHS. Clinicians should be aware of likely patterns of blood test abnormalities in the days following EHS. Further work should seek to establish the impact of lower rates of cooling and develop strategies to optimise cooling in patients with higher BMI.

Fellowship in Immediate Medical Care examination: applicability to the Defence Medical Services.

The Fellowship in Immediate Medical Care (FIMC) is the highest level of formal qualification available for pre-hospital practitioners, aiming to test the knowledge, technical and non-technical skills of those providing specialist Pre-Hospital Emergency Care (PHEC). The FIMC is a multiprofessional examination with the potential to support continuous quality improvement of the PHEC that the Defence Medical Services (DMS) can offer to our patients now and in the future. The aim of this article is to inform the readership about the evolution of the FIMC examination and its applicability to military clinicians (and their civilian counterparts). A secondary aim is to inform those who are preparing for the examination.

Medical support to military airborne training and operations.

INTRODUCTION: Airborne operations enable large numbers of military forces to deploy on the ground in the shortest possible time. This however must be balanced by an increased risk of injury. The aim of this paper is to review the current UK military drop zone medical estimate process, which may help to predict the risk of potential injury and assist in planning appropriate levels of medical support. METHOD: In spring 2015, a British Airborne Battlegroup (UKBG) deployed on a 7-week overseas interoperability training exercise in the USA with their American counterparts (USBG). This culminated in a 7-day Combined Joint Operations Access Exercise, which began with an airborne Joint Forcible Entry (JFE) of approximately 2100 paratroopers.The predicted number of jump-related injuries was estimated using Parachute Order Number 8 (PO No 8). Such injuries were defined as injuries occurring from the time the paratrooper exited the aircraft until they released their parachute harness on the ground. RESULTS: Overall, a total of 53 (2.5%) casualties occurred in the JFE phase of the exercise, lower than the predicted number of 168 (8%) using the PO No 8 tool. There was a higher incidence of back (30% actual vs 20% estimated) and head injuries (21% actual vs 5% estimated) than predicted with PO No 8. CONCLUSION: The current method for predicting the incidence of medical injuries after a parachute drop using the PO No 8 tool is potentially not accurate enough for current requirements. Further research into injury rate, influencing factors and injury type are urgently required in order to provide an evidence base to ensure optimal medical logistical and clinical planning for airborne training and operations in the future.