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 l.jpg

“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 l.jpg
Civilian pre-hospital helicopter

  • High profile

  • Charitably-funded

  • Accepted as invaluable by the general population


Military pre hospital care l.jpg
Military pre-hospital care

  • Helicopters accepted as vital:

    • terrain

    • time-lines

    • hostile action


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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.


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Introduction of MERT

  • Dedicated air asset

  • Doctor

  • Flight nurse

  • Paramedics

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


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MERT: HERRICK 9

  • July – Nov 2008

  • 324 missions

  • 429 patients

  • 303/324 [94%] to Bastion Hospital

  • Median patients carried was 1

  • [range 1 – 13]


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Nationality of patients

  • 242/429 [56%] were local nationals

  • 150 [35%] were UK forces

  • 37 [8.6%] coalition allies


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Medical category assigned

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

  • 223 [52%] were T2

  • 93 [21.5%] were T3

  • 18 [4%] were dead


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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


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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


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Did the doctor contribute?

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


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MERT: a difficult balance

  • 77% missions doctor was simply a passenger

  • Ground-to-air threat

  • Distance from point of wounding to MERT landing site


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MERT: a difficult balance

  • 23% missions doctor made +ve contribution

  • Knowing when NOT to intervene

  • Morale effect to troops on ground


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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.


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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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