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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

“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
Civilian pre-hospital helicopter
  • High profile
  • Charitably-funded
  • Accepted as invaluable by the general population
military pre hospital care
Military pre-hospital care
  • Helicopters accepted as vital:
    • terrain
    • time-lines
    • hostile action
critical report
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
Introduction of MERT
  • Dedicated air asset
  • Doctor
  • Flight nurse
  • Paramedics
  • “We are bringing the emergency department forward on to the helicopter”
mert herrick 9
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
Nationality of patients
  • 242/429 [56%] were local nationals
  • 150 [35%] were UK forces
  • 37 [8.6%] coalition allies
medical category assigned
Medical category assigned
  • 95/429 [22%] were assigned category T1
  • 223 [52%] were T2
  • 93 [21.5%] were T3
  • 18 [4%] were dead
mechanism
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
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
Did the doctor contribute?
  • Of 283 missions, it was thought that the doctor was not required in 219/283 [77%]
slide12

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
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 balance14
MERT: a difficult balance
  • 23% missions doctor made +ve contribution
  • Knowing when NOT to intervene
  • Morale effect to troops on ground
summary
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
Conclusion
  • Casualty care is thought to by presence of a physician
  • Military pre-hospital care should be led by doctors / paramedics