Doctor on board what is the optimum skill mix in military helicopter casevac
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“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?” Lt Col Tom WOOLLEY Surg Lt Cdr Stuart MERCER Surg Cdr Steve BREE Lt Col Douglas BOWLEY Civilian pre-hospital helicopter High profile Charitably-funded Accepted as invaluable by the general population

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“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?”

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“DOCTOR ON BOARD – what is the optimum skill-mix in military helicopter casevac?”

Lt Col Tom WOOLLEY

Surg Lt Cdr Stuart MERCER

Surg Cdr Steve BREE

Lt Col Douglas BOWLEY


Civilian pre-hospital helicopter

  • High profile

  • Charitably-funded

  • Accepted as invaluable by the general population


Military pre-hospital care

  • Helicopters accepted as vital:

    • terrain

    • time-lines

    • hostile action


Critical report

  • “In Vietnam, wounded soldiers arrived in hospital within 25 minutes of injury. In Iraq in 2005, that figure is 110 minutes, on Operation Herrick IV, (Afghanistan 2006 ) the average pre-hospital time was seven hours. ”

    Parker PJ.

    Damage control surgery and casualty evacuation: techniques for surgeons, lessons for military medical planners.

    J R Army Med Corps. 2006 Dec;152(4):202-11.


Introduction of MERT

  • Dedicated air asset

  • Doctor

  • Flight nurse

  • Paramedics

  • “We are bringing the emergency department forward on to the helicopter”


MERT: HERRICK 9

  • July – Nov 2008

  • 324 missions

  • 429 patients

  • 303/324 [94%] to Bastion Hospital

  • Median patients carried was 1

  • [range 1 – 13]


Nationality of patients

  • 242/429 [56%] were local nationals

  • 150 [35%] were UK forces

  • 37 [8.6%] coalition allies


Medical category assigned

  • 95/429 [22%] were assigned category T1

  • 223 [52%] were T2

  • 93 [21.5%] were T3

  • 18 [4%] were dead


Mechanism

  • 208 [48%] had received blast injury

  • 109 [25%] had GSW

  • 6 [1.5%] had both blast & GSW

  • 41 [9.5%] were medical

  • 23 [5%] were from MVC

  • 42 [10%] had other diagnoses


Flight timings

  • Median time from take off to delivery of casualty: 44 minutes

  • Range [10-183 minutes]

  • Doctor flew on 283/320 [88%] of missions


Did the doctor contribute?

  • Of 283 missions, it was thought that the doctor was not required in 219/283 [77%]


  • Of 62 missions where doctor was useful,

  • RSI 28/62 [45%]

  • Provision of analgesia/sedation/

    blood products: 21/62 [34%]

  • Chest drain/thoracosotomy: 3/62 [5%]

  • Pronouncing life extinct: 4/62 [6%]


MERT: a difficult balance

  • 77% missions doctor was simply a passenger

  • Ground-to-air threat

  • Distance from point of wounding to MERT landing site


MERT: a difficult balance

  • 23% missions doctor made +ve contribution

  • Knowing when NOT to intervene

  • Morale effect to troops on ground


Summary

The MERT is a high value asset which

makes an important contribution to patient

care. A relatively small proportion of

missions require interventions beyond the

capability of well-trained military paramedics.


Conclusion

  • Casualty care is thought to by presence of a physician

  • Military pre-hospital care should be led by doctors / paramedics


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