Critical Care at Role 4

Abstract

This descriptive paper focuses on the sequence of events that occur during the admission and ongoing management of the Military Polytrauma patient to Critical Care, Area B, Queen Elizabeth Hospital Birmingham (QEHB). It is intended to inform new clinical staff, the wider DMS, and potentially other NHS intensive care units which may be called upon to manage such patients during a military surge or following a UK domestic major incident.

Clinical and microbiological evaluation of epidural and regional anaesthesia catheters in injured UK military personnel

“…In particular, the signature injury presented by dismounted detonation of IEDs in Afghanistan involved high bilateral leg amputations with perineal disruption; a subset suffers actual wound infection/systemic sepsis from bacterial and/or fungal pathogens 4. The wounds culture a variety of organisms, although the anticipated threat from multidrug-resistant organisms was minimal 6. The potential for infection is theoretically increased by the duration of CPNB catheter and epidural insertion, which was often prolonged in comparison with UHB's civilian trauma population (104 of our total 236 insertions (44%) were in situ for 6 days or more).…”

“…Patients were generally given co-amoxiclav or meropenem as antibacterial prophylaxis, depending on the severity of their injuries 6. Antibacterial prophylaxis was given until there had been thorough surgical debridement and the wounds appeared ‘clean’.…”

Military Anaesthesia in contingencies: what skill sets are required and how will we prepare our trainees?

“…Role 4 (Queen Elizabeth Hospital, Birmingham): This is where our servicemen and women will be ultimately transferred to and there are discussions on how Role 4 operates42 and the specifics of critical care at Role 443 including the Joint Theatre Clinical Case Conference (JTCCC) 44…”

The Deployed Medical Director: Managing the Challenges of a Complex Trauma System

“…With a field hospital at the end of a supply chain that is thousands of miles long, the capacity to sustain aggressive resource-dependent resuscitation is vulnerable if casualty figures unexpectedly rise before planning assumptions can be adjusted. Furthermore, the 'reverse supply chain' to evacuate the severely injured by Royal Air Force Critical Care Air Support Team (CCAST) is finite yet dually pivotal to maintaining the bed availability and 'combat effectiveness' of the field hospital, and to delivering the critically injured following primary surgery to definitive care in Birmingham [6] within a time window of opportunity. Should the finite reverse supply chain be overwhelmed, a field hospital with a full Intensive Care Unit (ICU) (using all inherent measures of flexibility to cope with a casualty surge) would present an inability to continue support to kinetic combat intervention, and the delay to evacuation of the most seriously injured would predictably adversely affect their outcome.…”