The non-combatant status: importance and implications for medical personnel.

Under the laws of armed conflict military medics are deemed non-combatants, and as such are subject to certain protections and limitations. The non-combatant status is defined in the famous Geneva Conventions, which form the basis of the international law of armed conflict. The protections afforded to medical personnel in armed conflict are a result of the need to protect and treat the sick and injured during times of hostility. This paper describes the history and legal development of the non-combatant status, and summarises the importance and implications of the contents of the Geneva Conventions that are relevant to medical personnel as non-combatants. We conclude that, despite scope for criticism of its relevance in contemporary operations, the non-combatant status for medical personnel highlights our commitment to alleviating suffering in armed conflict, and provides a vital legal basis to protect those who serve to treat the sick and injured. The ultimate beneficiaries of this protected status for medical personnel are our patients themselves. This paper also aims to stimulate debate and discussion of the importance of the non-status amongst military medical personnel.

Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study.

UNLABELLED: A retrospective study was performed in 100 children aged between two and 16 years, with a dorsally angulated stable fracture of the distal radius or forearm, who were treated with manipulation in the emergency department (ED) using intranasal diamorphine and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs, the final radiographs and the clinical notes were reviewed. A successful reduction was achieved in 90 fractures (90%) and only three children (3%) required remanipulation and Kirschner wire fixation or internal fixation. The use of Entonox and intranasal diamorphine is safe and effective for the closed reduction of a stable paediatric fracture of the distal radius and forearm in the ED. By facilitating discharge on the same day, there is a substantial cost benefit to families and the NHS and we recommend this method. TAKE HOME MESSAGE: Simple easily reducible fractures of the distal radius and forearm in children can be successfully and safely treated in the ED using this approach, thus avoiding theatre admission and costly hospital stay.

Children who harm themselves: development of a paediatric emergency department triage tool.

INTRODUCTION: Children who harm, hurt or kill themselves are a significant issue for health professionals in emergency departments (ED), with over 60 000 young people presenting to ED in the UK each year following self-harm. METHODS: In response to the development of a regional integrated pathway for the management of self-harm encompassing acute care, primary care and child and adolescent mental health services, it was felt that a triage tool developed specifically for children and young people presenting with self-harm was required. A multidisciplinary group encompassing nursing, managerial and medical staff from both paediatric emergency and child and adolescent mental health services was convened to determine the priorities for this tool. In this paper the development of this paediatric-specific triage tool is discussed focusing on suicide risk, substance misuse and physical issues associated with the common presentations of self-harm in young people. The available literature is also reviewed and the multidisciplinary approach to developing a user-friendly tool is discussed. RESULTS: A modified risk of suicide questionnaire, the CRAFFT questionnaire, and three questions about physical manifestations of self-harm were used to form a 14-point triage/screening tool, requiring only yes/no answers. CONCLUSION: A paediatric triage tool was developed that allows the more appropriate triage of young people who harm themselves and is acceptable to all stakeholders involved in their care.