Consideration of the medical care and biomedical support of women and children on Role 2 Afloat maritime contingency operations

The Royal Navy’s Role 2 Afloat (R2A) capability has now been firmly established in support of United Kingdom (UK) troops on contingency operations such as humanitarian aid and disaster relief operations. This article reviews the current capability of R2A to deliver medical care to children and pregnant women, including the challenges facing the deployed Biomedical Scientist (BMS).

The Maritime Medical Emergency Response Team: what do we really need?

Since 2006, the Defence Medical Services (DMS) pre-hospital care focus has been the Medical Emergency Response Team (MERT), which has enabled the projection of Damage Control Resuscitation (DCR) to the point of wounding as part of consultant- delivered care. Now in a period of contingency operations, the Royal Navy (RN)’s Role 2 medical capability, Role 2 Afloat (R2A) delivers DCR (including surgery) on a maritime platform. This article will focus on the development of the Maritime MERT component of R2A (termed Maritime In Transit Care (MITC) in Maritime Medical Doctrine) and will discuss the requirements based on experience of and preparation for an operation in 2016. Also discussed are the individual competencies and training required to be part of the Maritime MERT; it is hoped that this will simulate debate around this evolving team.

Establishing and maintaining a robust Role 2 Afloat organisation within the Royal Naval Medical Services

In 2009, the Royal Navy (RN) reconfigured the Role 2 maritime medical treatment capability, the Role 2 Afloat (R2A). This capability is now firmly established on a number of platforms in the fleet and was recently externally validated on RFA MOUNTS BAY prior to completion of an operational deployment supporting contingency operations in the Mediterranean. This article outlines the future challenges for R2A and offers suggestions on how to maintain a robust R2A organisation within the Royal Naval Medical Service (RNMS).

Paediatric traumatic cardiac arrest: data from the Joint Theatre Trauma Registry

BACKGROUND

Traumatic cardiac arrest (TCA) in children is associated with a low probability of survival and poor neurological outcome in survivors. Since 2003, over 600 seriously injured local national children have been treated at deployed UK military medical treatment facilities during the Iraq and Afghanistan conflicts. A number of these were in cardiac arrest after sustaining traumatic injuries. This study defined outcomes from paediatric TCA in this cohort.

METHODS

A retrospective database review was undertaken using the UK Joint Theatre Trauma Registry. This includes UK military, coalition military, civilians and local security forces personnel who prompted trauma team activation. All children in this series were local nationals. Patients aged less than 18 years who presented between January 2003 and April 2014, and who underwent cardiopulmonary resuscitation, were included.

RESULTS

27 children with TCA were included. Four children survived to discharge from the medical treatment facility (14.8%), though limited data are available regarding the long-term neurological outcome in these patients.

CONCLUSIONS

This study demonstrates that the outcomes for paediatric TCA in our military field hospitals were similar to other paediatric civilian and adult military studies, despite patients being injured by severe blast injuries. Further work is needed to define the optimal management of paediatric TCA.