Journal of the Royal Naval Medical Service
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Due to the nature of IED injuries, during the conflicts in Iraq and Afghanistan The traditional, two-stage amputation for unsalvageable combat lower limb injuries has evolved into a strategy of serial debridement and greater use of plastic surgical techniques in order to preserve residual limb length. This study aimed to characterise the current treatment of lower limb loss with particular focus on the impact of specific wound infections. ⋯ A final more proximal amputation level was required in 21 stumps (30%). Recovery of A. hydrophillia from wounds was significantly associated with a requirement for a more proximal amputation level (p=0.0038) and greater number of debridements (p=0.0474) when compared to residual limb wounds withoutA. hydrophillia.
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Pre-hospital emergency care (PHEC) in the military has undergone major changes during the last 10 years of warfighting in the land environment. Providing this care in the maritime environment presents several unique challenges. This paper examines the clinical capabilities required of a PHEC team in the maritime environment and how this role can be fulfilled as part of Role 2 Afloat. It applies to Pre-hospital emergency care projected from a hospital not to General Duties Medical Officers at Role 1.
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The embarkation of detainees is complex and medical requirements and ethical considerations can collide with operational requirements. Morally and ethically the correct route of action is always to disembark the patient at the earliest opportunity to a first rate medical facility; however this is not always possible for a variety of geographical, operational, financial and political reasons. It is ultimately a command decision utilising the best advice that the Medical Officer can provide. It is important that Commanding Officers and Medical Officers have a strong working relationship and understand each other's responsibilities and constraints.
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Biography Historical Article
The death of an admiral--surgery and medicine in Nelson's Navy.