Journal of the Royal Army Medical Corps
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Prevention against head wounds from explosively propelled fragments is currently the Mark 7 general service combat helmet, although only limited evidence exists to define the coverage required for the helmet to adequately protect against such a threat. The Royal Centre for Defence Medicine was tasked by Defence Equipment and Support to provide a framework for determining the optimum coverage of future combat helmets in order to inform the VIRTUS procurement programme. ⋯ We recommend relating the margins of the brain to three identifiable anatomical landmarks (nasion, external auditory meatus and superior nuchal line), which can in turn be related to the coverage provided by the helmet. Early assessments using an anatomical mannequin indicate that the current helmet covers the majority of the brain and brainstem from projectiles with a horizontal trajectory but not from ones that originate from the ground. Protection from projectiles with ground-originating trajectories is reduced by helmets with increased stand-off from the skin. Future helmet coverage assessments should use a finite element numerical modelling approach with representative material properties assigned to intracranial anatomical structures to enable differences in projectile trajectory and helmet coverage to be objectively compared.
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Editorial Historical Article
A short history of Camp Bastion Hospital: the two hospitals and unit deployments.
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Post-traumatic Acute Respiratory Distress Syndrome (ARDS) continues to be a major critical care challenge with a high associated mortality and extensive morbidity for those who survive. This paper explores the evolution in recognition and management of this condition and makes some recommendations for treatment of post-combat ARDS for military practitioners. It is aimed at the generalist in disciplines other than critical care, but will also be of interest to intensivists.
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Modern body armour clearly reduces injury incidence and severity, but evidence to actually objectively demonstrate this effect is scarce. Although the Joint Theatre Trauma Registry (JTTR) alone cannot relate injury pattern to body armour coverage, the addition of computerised Surface Wound Mapping (SWM) may enable this utility. ⋯ Computerised SWM has objectively demonstrated the ability of body armour worn on current operations in Afghanistan to reduce wound incidence and severity. We recognise this technique is limited in that it only records the surface wound location and may be specific to this conflict. However, gathering electronic SWM at the same time as recording injuries for the JTTR was simple, required little extra time and therefore we would recommend its collection during future conflicts.
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This paper suggests that 1 g tranexamic acid should be incorporated as an intramuscular auto-injector and issued to combat troops for self- or buddy-administration in the event of suffering severe injury. Early administration of tranexamic acid has shown to be beneficial in preventing death from bleeding in trauma patients in both the military and the civilian settings. ⋯ Future conflicts may be characterised by prolonged pre-hospital times and delayed access to advanced medical care. The use of this drug is the next logical step in reducing combat trauma deaths.