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UK Role 4 Military Infectious Diseases at Birmingham Heartlands Hospital in 2005-9
  1. JS Glennie, Department of Infection & Tropical Medicine1 and
  2. Lt Col Mark S Bailey, RAMC, Consultant Physician in Infectious Diseases & Tropical Medicine2
  1. 1Birmingham Heartlands Hospital, UK
  2. 2Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Department of Military Medicine, Royal Centre for Defence Medicine, Vincent Drive, Birmingham, B15 2SQ mark{at}ramc.org

Abstract

Objectives Infectious diseases affecting British troops are mostly due to gastrointestinal and respiratory illnesses, but these are usually minor in severity, easy to manage and short in duration. To assess the importance of infections that are more severe, difficult to manage or longer in duration, it is necessary to look at military cases that are evacuated or otherwise referred to the UK Role 4 (definitive care) medical facility for infectious diseases.

Methods Case notes from military infectious disease patients seen at Birmingham Heartlands Hospital in 2005-2009 were reviewed to extract data on demographics, origin of infection, diagnostic categories, exact diagnoses, type and duration of care, time off duty, quality of care and costs incurred.

Results Over a 4-year period, 138 cases were referred, 131 (95%) were male and 98 (71%) were from the Army. The origin of infection was Afghanistan in 52 (38%) and Belize in 19 (14%). From 131 patients (95%) that attended, 59 (45%) had dermatological illnesses and 38 (29%) had undifferentiated febrile illnesses. Diagnoses included 35 (27%) with cutaneous leishmaniasis and 21 (16%) with “Helmand Fever” due to sandfly fever, acute Qfever or rickettsial infection. For 51 in-patients, the median (range) length of stay was 3 (1-17) days and time off duty was 20 (5-127) days. For 80 out-patients, the median (range) number of attendances was 1 (1-23) and time off duty was 22 (1-228) days. All cases were seen promptly (within 7 days for in-patients and 28 days for out-patients), but only 59 (45%) had appropriate letters sent to the referring medical officer and none had FMed 85 notifications of infectious disease submitted. Aeromedical evacuation costs could not be calculated, but UK hospital care cost ∼ £ 78 000 per year.

Conclusions Dermatological infections and undifferentiated febrile illnesses that require management at a UK Role 4 facility are important causes of disease non-battle injury. Prospective collection of this data in the future will be a valuable asset.

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