Understanding the burden of injury in children from conflict: an analysis of radiological imaging from a Role 3 hospital in Afghanistan in 2011.

INTRODUCTION: There is a need for quality medical care for children injured in conflict, but a description of injuries and injury burden from blast and ballistic mechanisms is lacking. The radiology records of children imaged during the war in Afghanistan represent a valuable source of information about the patterns of paediatric conflict injuries. METHODS: The UK military radiological database was searched for all paediatric presentations to Camp Bastion during 2011. Reports and original images were reviewed to determine location and severity of injuries sustained. Additional information was obtained from imaging request forms and the Joint Theatre Trauma Register, a database of those treated at UK medical facilities in Iraq and Afghanistan. RESULTS: Radiology was available for 219 children. 71% underwent CT scanning. 46% suffered blast injury, 22% gunshot wounds (GSWs), and 32% disease and non-battle injuries (DNBIs). 3% had penetrating head injury, 11% penetrating abdominal trauma and 8% lower limb amputation, rates far exceeding those found in civilian practice. Compared with those with DNBI, those with blast or GSW were more likely to have serious (Abbreviated Injury Score, AIS, ≥3) injuries (median no. AIS ≥3 injuries were 1 for blast, 1 for GSW and 0 for DNBI, p<0.05) and children exposed to blast were more likely to have multiple body regions with serious injuries (OR for multiple AIS ≥3 injuries for blast vs DNBI=5.811 CI [1.877 to 17.993], p<0.05). CONCLUSIONS: Paediatric conflict injuries are severe, and clinicians used only to civilian practice may be unprepared for the nature and severity of injuries inflicted on children in conflict. Whole-body CT for those with conflict-related injuries, especially blast, is hugely valuable. We recommend that CT is used for paediatric assessment in blast and ballistic incidents and that national imaging guidelines amend the threshold for doing so.

UK medical support to non-combatant evacuation operations.

This review presents the UK Defence Medical Services' involvement in non-combatant evacuation operations (NEOs) in the last two decades. It examines the key medical lessons identified from those operations from publications and witness statements, and discusses key aspects that medical commanders and clinicians should consider in the future, particularly preparation, training and equipping personnel and units for future NEOs. The majority of those UK medical assets that are likely to deploy on NEOs have little or no NEO training and are ill equipped to deal with the common non-battlefield casualties seen in NEOs. Medical management of the elderly, paediatrics, chronic disease and infectious diseases are particular capability gaps.

Fatal fat embolism following femoral head resection in total hip arthroplasty.

We report a rare complication during primary total hip arthroplasty. A fatal fat pulmonary embolism immediately followed removal of the femoral head, prior to further preparation of the acetabulum or femoral shaft. Fat embolism syndrome is a well-known complication during total joint arthroplasty, usually attributed to preparation of the femoral shaft, particularly intramedullary reaming and insertion of the prosthesis. These risk factors have previously been identified in the literature. We believe that this case highlights the need for further research to establish the intramedullary pressures during the processes of dislocation and resection of the femoral neck and the attendant risk.

Attendances at a field hospital emergency department during operations in Iraq November 2003 to March 2004 (Operation Telic III).

OBJECTIVE: This study investigated the types of presentations; time lines and disposal of patients from the international, local and military community in Southern Iraq. METHODS: All presentations to the Emergency Department (ED) were clinically and demographically coded and entered onto an electronic database. RESULTS: During the period studied the emergency department dealt with 1455 new presentations of which 75% were UK Armed Forces personnel. CONCLUSIONS: This represented a busy period in the field hospitals time in Iraq and offered valuable training to emergency medicine trainees in an unusual environment.