Medical provision in forward locations in Afghanistan: the experiences of General Duties Medical Officers on Op HERRICK 15

Medical equipment trends during the UK military exercise SAIF SAREEA 3 in Oman

Introduction

Ex SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical treatment facilities (MTFs) deployed with medical equipment as per the UK 300 medical module.

Method

Retrospective analysis was undertaken of prospectively collected equipment usage data from two Role 1 MTFs in Duqm (MTF 1) and Muaskar Al Murtafa (MTF 2) camps over a period of 6–8 weeks. Data were analysed alongside routinely collected epidemiological data (EPINATO) during the deployment. Equipment used in addition to the module was also recorded.

Results

MTF 1 used 50 out of the 179 different items from the module over the 8-week period. MTF 2 used 45 out of the 179 different items from their module over the 6-week period. The most commonly used items across the sites were non-sterile examination gloves, plastic aprons, tympanic thermometer probe covers, disinfectant wipes and self-adhesive plasters. Extramodular items (blunt fill needle, water pump sprayer, Jelonet gauze and stool specimen pot) accounted for 5% of all equipment used in MTF 1.

Conclusion

The study showed that the 300 module accommodates 95% of Role 1 patients’ needs but highlights the requirement for dedicated equipment for the treatment of heat casualties if deemed likely and blunt fill/filter needles for the administration of parenteral medication. Commanders must perform a thorough medical estimate and risk assessment prior to deployment to ensure that the 300 medical module is likely to provide the necessary equipment and supplement the module if required.

Is intramuscular morphine satisfying frontline medical personnels' requirement for battlefield analgesia in Helmand Province, Afghanistan? A questionnaire study

BACKGROUND

All deployed British Army personnel carry intramuscular (IM) morphine auto-injectors to treat battlefield casualties. No other nation supplies parenteral opiate analgesia on individual issue. Studies highlight this agent's inefficacy and safety issues, but are limited by a relative lack of inclusion of frontline personnel. We aimed to determine the opinions of frontline medical personnel on current battlefield analgesia.

METHODS

We surveyed 88 British Army frontline medical personnel (medical officers (n = 12), nurses (n = 7), combat medical technicians (CMTs) (n = 67), paramedics (n = 1) and health-care assistants (n = 1)) upon completion of a six-month deployment (September 2011 to April 2012) to Helmand Province, Afghanistan, using Likert scale questions on the efficacy of battlefield analgesia, complications of IM morphine, safety of morphine auto-injectors and its suitability for treating child casualties.

RESULTS

A total of 88/88 questionnaires were returned. Of these, 61/88 had treated casualties on the battlefield, 26/86 agreed that current battlefield analgesia is effective, 80/87 agreed that a more potent analgesic with a faster onset than IM morphine is desirable in the first hour following injury, 47/65 CMTs agreed that they can manage complications of current battlefield analgesia and 53/86 respondents correctly disagreed that current battlefield analgesia is suitable for child casualties. The potential for accidental self-injection was reported.

CONCLUSIONS

A more potent, faster onset analgesic than IM morphine is desirable in the first hour following injury. Pre-deployment training should emphasise management of complications of opiate analgesics and treatment of child casualties. Oral transmucosal fentanyl citrate is now being issued to all frontline medical personnel. IM morphine will remain on individual issue to all deployed soldiers for environments where an oral agent is not suitable, for example, chemical, biological, radiological and nuclear warfare.

SUMMARY POINTS

Frontline medical personnel agree that a more potent, faster onset analgesic than IM morphine is desirable in the first hour following injury.The two most desirable features of the ideal analgesic were ranked as rapid onset of action, and when fully onset produces a high degree of pain relief.Oral transmucosal fentanyl citrate (OTFC) has now been issued to all frontline medical personnel as an adjunct to IM morphine.IM morphine will remain on individual issue for situations where parenteral analgesia is required.Consideration should be given to individual issue of OTFC to all deployed personnel in the future.Pre-deployment training should emphasise management of complications of opiate analgesics and treatment of child casualties.

Firebase medicine: extending the Role I aid station

The unique nature of counterinsurgency warfare in Afghanistan highlights the tactical and technical challenges of the non-contiguous battlefield. Although remote military outposts distant from their support hubs help project NATO power, they also operate without the advantages of a secure rear area or interior lines of communication. Commonly referred to as 'firebases', these outposts typically house a platoon or company-sized element and present numerous challenges to the delivery of medical care and support. Medical planners and providers can mitigate many of these inherent risks through targeted interventions designed to increase the capabilities of these remote outposts. These interventions include focused higher-level trauma and non-trauma medical training for both medical and non-medical personnel, expanded equipment lists, ongoing medical education, training and rehearsals, and a proven and redundant communications plan.