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Lessons from the first operational deployment of emergency medicine
  1. Lieutenant Colonel T J Hodgetts, OStJ FRCP FFAEM DipIMCRCSEd DipMedEd RAMC, Consultant and Specialty Adviser, Professor1,2,
  2. Captain G Kenward, RGN QARANC, Nursing Officer3 and
  3. Captain S Masud, MB ChB DipIMC RCSEd RAMC, Regimental Medical Officer4
  1. 1Accident and Emergency, Defence Medical Services
  2. 2Emergency Medicine and Trauma, University of Surrey tim.hodgetts{at}virgin.net
  3. 3Accident and Emergency Department Frimley Park Hospital
  4. 41 RWF, Ballykelly, BFPO 802

Abstract

The first operational deployment of emergency medicine in the UK Defence Medical Services was in support of a 50-bed field hospital during OP AGRICOLA, Kosovo, from 25 June-26 August 1999. In preparation, new equipment scales were designed to extend the traditional surgical-based approach to the reception of patients. The organisation of the front end of a field hospital was modified to reflect the current UK peace-time practice of emergency medicine. Specialist emergency medicine trained doctors and nurses provided the core personnel. 1189 patients were treated in the 2-month deployment. 903 were KFOR troops (862 BRITFOR), 187 Kosovo-Albanian, 69 Serbian and 30 derived from United Nations or nongovernment organisations. There were 63 resuscitations, with 21 relating to KFOR troops. 42 patients met the criteria for a trauma team activation; age was 33.4 ± 18.7 years (mean ± SD). Mean Injury Severity Score (ISS) was 16.3 ± 18.6; mean New Injury Severity Score (NISS) was 22.5 ± 20.5. 14 of 42 were ‘major trauma’ characterised by ISS ≥16; 22 had a NISS ≥16. 36% of the major trauma by ISS was gunshot wound (GSW), 7% blast and fragmentation, and 57% blunt; age was 33.3 ± 20.4 years (mean ± SD for ISS ≥16 group). Standardised Mortality Ratio was 1.50. The Effectiveness E value for outcome was 0.85. NISS detected 3 further patients with GSW, 3 with blast/fragmentation, and 2 with blunt injury. A diverse range of medical emergencies was encountered. The extended role of the emergency physician was exploited to include coordination of major trauma audit and clinical feedback, local and national disaster planning, and co-ordination of humanitarian support to design, build and equip an emergency department at the University Hospital of Pristina. The operational value of emergency medicine within UK Defence Medical Services has been firmly established.

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