In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery a... more In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. The UK military Joint Theatre Trauma Registry (JTTR) was searched for all UK survivors in Afghanistan and Iraq between 2004 and 2014 requiring craniectomy and cranioplasty resulting from trauma. Fourteen decompressive craniectomies and cranioplasties were performed with blast and gunshot wounds equally responsible for head injury. Ten survivors (71%) had an Injury Severity Score (ISS) of 75, normally designated as 'unsurvivable'. Most were operated on the day of injury. Seventy-one percent received a reverse question mark incision and 7% received a bicoronal incision. Seventy-nine percent had bone flaps discarded. Overall infection rate was 43%. Acinetobacter spp was the caus...
BackgroundIn our experience, the anterior carotid sheath forms an important plane of dissection w... more BackgroundIn our experience, the anterior carotid sheath forms an important plane of dissection when excising temporal bone region cancers. However, its anatomical composition, relationships, and radiological appearance remains unclear.MethodsEight sides of cadaveric heads were dissected. Anatomical findings were correlated with a high‐resolution baseline T1 MRI.ResultsThe anterior carotid sheath was formed by the tensor‐vascular‐styloid fascia, stylopharyngeal fascia, buccopharyngeal fascia (BPF), and longus capitis fascia (LCF), and appeared as a hypointense line on MRI. Not previously described, the glossopharyngeal nerve pierced the sheath 9.0 mm (SD 2.1 mm) below the skull base and traveled through its LCF and BPF layers to exit near the pharynx.ConclusionMultiple fascial layers formed the anterior carotid sheath at the skull base, and this was radiologically identifiable. Further studies are required to validate findings and investigate the role this fascial plane has in forming an effective barrier to spread of malignancy.
The Annals of The Royal College of Surgeons of England, 2015
Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous ... more Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements. Methods We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR–DCS). This system identifies four key stages: ‘command huddle’, ‘snap brief’, ‘sit-reps’ (situation reports) and ‘sign-out/debrief’. The attitude of staff to communication and decision making is also evaluated. Results Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff...
ObjectiveTo examine the relationship between sublingual microcirculatory measures and frailty ind... more ObjectiveTo examine the relationship between sublingual microcirculatory measures and frailty index in those attending a kidney transplant assessment clinic.MethodsPatients recruited had their sublingual microcirculation taken using sidestream dark field videomicroscopy (MicroScan, Micro Vision Medical, Amsterdam, the Netherlands) and their frailty index score using a validated short form via interview.ResultsA total of 44 patients were recruited with two being excluded due to microcirculatory image quality scores exceeding 10. The frailty index score indicated significant correlations with total vessel density (p < .0001, r = −.56), microvascular flow index (p = .004, r = −.43), portion of perfused vessels (p = .0004, r = −.52), heterogeneity index (p = .015, r = .32), and perfused vessel density (p < .0001, r = −.66). No correlation was shown between the frailty index and age (p = .08, r = .27).ConclusionsThere is a relationship between the frailty index and microcirculatory health in those attending a kidney transplant assessment clinic, that is not confounded by age. These findings suggest that the impaired microcirculation may be an underlying cause of frailty.
The journal of trauma and acute care surgery, Dec 1, 2012
I n an effort to describe periods of profound change in military organization and practice, histo... more I n an effort to describe periods of profound change in military organization and practice, historians have given us a unique way to classify and describe these developments in a historical perspective. The concept describes advances in the art and practice of combat arms resulting in profound change as ''military revolutions'' accompanied by supporting ''revolutions in military affairs.'' Military Revolutions Murray and Knox 1 equated military revolutions to ''earthquakes.'' These earthquakes forced a fundamental change in society and a state, and the state consequently altered the way it created and projected military power. Murray and Knox recognize five major military revolutions that have had that impact on Western history: the 17th century creation of the modern state and modern military institutions; the French Revolution; the Industrial Revolution; World War I; and, most recently, nuclear weapons and ballistic missile delivery systems. This concept of military revolutions has also carried into the field of military medicine. Military Medical Revolutions Throughout recorded history, there have been several profound medical enlightenments that can be seen as revolutions or ''earthquakes'' in the management of combat wounded (Table 1). With incremental and cumulative advances, the concept of the military medical revolution (MMR) can be defined by the amalgamation of the multiple and progressively complex medical advances defined by the term revolution in military medical affairs (RMMA). RMMAs supporting the overall MMR occurred during the American Civil War, World War I, World War II, the Korean War, and the Vietnam War. MMRs in the past two centuries have been born of multiple advances that form the underpinnings of a true revolution. The American Civil, Crimean, and Franco-Prussian Wars saw the nascent practice of battlefield anesthesia, system of multiple hospitals, nursing care, and antisepsis that, in the aggregate, would meet the definition of the first MMR supported by multiple RMMAs. Subsequent examples of RMMAs supporting the overall MMR (Fig. 1) occurred during the World War I/ World War II era and during the Korean/Vietnam War era. 2Y5 Many advances in combat casualty care from the point of injury to rehabilitation in the continental United States were made during the overseas contingency operations in Iraq and Afghanistan within the decade from 2001 to 2011. The prehospital advances categorized as individual RMMAs are shown (Table 2). Many of these RMMAs were directly translated from civilian trauma practice, whereas others were developed by the military and subsequently translated into the civilian injury care environment. The RMMAs that occurred during the last 10 years of combat casualty care in the realm of prehospital care are detailed in the following sections.
Annals of The Royal College of Surgeons of England, Oct 1, 2009
INTRODUCTION Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare... more INTRODUCTION Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. PATIENTS AND METHODS Data were prospectively collected on 100 consecutive patients either injured or killed from hostile action from January 2006 who presented to the sole coalition field hospital in southern Iraq. RESULTS Eighty-two casualties presented with penetrating missile injuries from hostile action. Three subsequently died of wounds (3.7%). Forty-six (56.1%) casualties had their initial surgery performed by British military surgeons. Twenty casualties (24.4%) sustained gunshot wounds, 62 (75.6%) suffered injuries from fragmentation weapons. These 82 casualties were injured in 55 incidents (mean, 1.49 casualties; range 1-6 casualties) and sustained a total 236 wounds (mean, 2.88 wounds) affecting a mean 2.4 body regions per patient. Improvised explosive devices were responsible for a mean 2.31 casualties (range, 1-4 casualties) per incident. CONCLUSIONS The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons.
Annals of The Royal College of Surgeons of England, May 1, 2015
INTRODUCTION The concentration of major trauma experience at Camp Bastion has allowed continuous ... more INTRODUCTION The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements. METHODS We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR-DCS). This system identifies four key stages: 'command huddle', 'snap brief', 'sit-reps' (situation reports) and 'sign-out/debrief'. The attitude of staff to communication and decision making is also evaluated. RESULTS Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff were collected. All patients were haemodynamically shocked with a median pH of 7.25 (range: 6.83-7.40) and a median of 18 units of mixed red cells and plasma were transfused. In 89% of instances, theatre staff were aware of what was required of them at the beginning of the case, 86% felt there were regular updates and 93% understood what was required of them as the case progressed. CONCLUSIONS The evolution of the hospital at Camp Bastion has been a unique learning experience in the field of major trauma. The Defence Medical Services have responded with continuous innovation to optimise DCR-DCS for seriously injured patients. Together with the improvements in clinical care, a communication and decision making matrix was developed. Staff evaluation showed a high degree of satisfaction with the quality of communication. KEYWORDS Trauma-Military-War-Afghanistan-Battlefield injuries-Gunshot wounds-Blast injuries-Landmines
Background: The Physiological and Operative Severity Score for enUmeration of Mortality and morbi... more Background: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is a simple scoring system previously validated in general surgical patients which enables estimation of the risk of complications and death after operation. The Portsmouth predictor equation (P-POSSUM) is a modi®cation that may result in more accurate prediction of death than POSSUM. The aim of this study was to test the validity of POSSUM and P-POSSUM in patients undergoing major arterial surgery in a specialist unit. Methods: Physiological and operative severity scores in 221 patients undergoing elective and emergency arterial surgery in a pure vascular practice under a single consultant were recorded prospectively. Observed morbidity and mortality rates were compared with the rates predicted by POSSUM and P-POSSUM using a linear method of analysis. Results: The POSSUM equation overestimated deaths with this analysis but the mortality rate estimated by P-POSSUM was not signi®cantly different from the observed death rate. The risk of morbidity predicted by POSSUM was not signi®cantly different from the observed complication rate. Conclusion: The POSSUM methodology combined with the P-POSSUM adjustment for death allows satisfactory prediction of mortality and morbidity rates in patients undergoing vascular surgery.
British Journal of Surgery 1996, 83, 812-815 An evaluation of the POSSUM surgical scoring system ... more British Journal of Surgery 1996, 83, 812-815 An evaluation of the POSSUM surgical scoring system M. S. WHITELEY, DR PRYTHERCH, B. HIGGINS*, PC WEAVER and W. G. PROUT ... Page 3. 814 MS WHITELEY, DR PRYTHERCH, B. HIGGINS, PC WEAVER and WG PROUT ...
The network connectivity of selfish wireless networks (SeWNs) constituted by selfish nodes (SeNs)... more The network connectivity of selfish wireless networks (SeWNs) constituted by selfish nodes (SeNs) is investigated. The SeN's degree of node-selfishness (DeNS) is used for characterizing the effects of its energy resources and the benefits of the incentives provided for enhancing its transmission willingness. Furthermore, the SeNs' signal to interference plus noise ratios are defined in terms of both their DeNSs and their interference factors. We then continue by quantifying the effect of node-selfishness on the grade of network connectivity and derive both the upper and lower bounds of the critical DeNS. Explicitly, the network is deemed to be connected when the DeNS is below the lower bound and unconnected for a DeNS above the upper bound. This allows us to quantify the asymptotic critical DeNSs for our SeWNs. In addition, we develop an energy-conscious node-selfishness model for characterizing the relationship between the SeN's residual energy and its DeNS. Based on this model and on the asymptotic critical DeNS derived, the critical amount of residual energy required for maintaining a specific grade of network connectivity is determined, which is verified by our simulation results.
It is generally accepted that the human abdominal wall is comprised of skin, subcutaneous tissues... more It is generally accepted that the human abdominal wall is comprised of skin, subcutaneous tissues, muscles and their aponeuroses, and the parietal peritoneum. Understanding these layers and their mechanical properties provides valuable information to those designing procedural skills trainers, supporting surgical procedures (hernia repair), and engineering-based work (in silico simulation). However, there is little literature available on the mechanical properties of the abdominal wall in layers or as a composite. This work characterizes the tensile properties of the human abdominal wall by layer and as a partial composite. Tissues were collected from fresh-never-frozen and fresh-frozen cadavers and tested in uniaxial tension at a rate of 5 mm/min until failure. Stress-strain curves were created for each sample, and the values for elastic moduli, ultimate tensile strength, and strain at failure were obtained. The experimental outcomes from this study demonstrated variation of tensil...
Annals of The Royal College of Surgeons of England, Mar 1, 2012
INTRODUCTION International humanitarian law requires emergency medical support for both military ... more INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1-26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice. Dedication This paper is dedicated to the memory of Lt Col Peter Templeton, who served on this tour (Herrick 13B, January 2011) and inspired this study but who sadly died unexpectedly before its completion. 'They shall not grow old, as we that are left grow old'
Objective: The objective of this scoping review is to identify the availability of quantitative b... more Objective: The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available. Introduction: Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers. Inclusion criteria: This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings. Methods: This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results. Scoping review protocol registration: Open Science Framework https://osf.io/fgb34
In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery a... more In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. The UK military Joint Theatre Trauma Registry (JTTR) was searched for all UK survivors in Afghanistan and Iraq between 2004 and 2014 requiring craniectomy and cranioplasty resulting from trauma. Fourteen decompressive craniectomies and cranioplasties were performed with blast and gunshot wounds equally responsible for head injury. Ten survivors (71%) had an Injury Severity Score (ISS) of 75, normally designated as 'unsurvivable'. Most were operated on the day of injury. Seventy-one percent received a reverse question mark incision and 7% received a bicoronal incision. Seventy-nine percent had bone flaps discarded. Overall infection rate was 43%. Acinetobacter spp was the caus...
BackgroundIn our experience, the anterior carotid sheath forms an important plane of dissection w... more BackgroundIn our experience, the anterior carotid sheath forms an important plane of dissection when excising temporal bone region cancers. However, its anatomical composition, relationships, and radiological appearance remains unclear.MethodsEight sides of cadaveric heads were dissected. Anatomical findings were correlated with a high‐resolution baseline T1 MRI.ResultsThe anterior carotid sheath was formed by the tensor‐vascular‐styloid fascia, stylopharyngeal fascia, buccopharyngeal fascia (BPF), and longus capitis fascia (LCF), and appeared as a hypointense line on MRI. Not previously described, the glossopharyngeal nerve pierced the sheath 9.0 mm (SD 2.1 mm) below the skull base and traveled through its LCF and BPF layers to exit near the pharynx.ConclusionMultiple fascial layers formed the anterior carotid sheath at the skull base, and this was radiologically identifiable. Further studies are required to validate findings and investigate the role this fascial plane has in forming an effective barrier to spread of malignancy.
The Annals of The Royal College of Surgeons of England, 2015
Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous ... more Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements. Methods We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR–DCS). This system identifies four key stages: ‘command huddle’, ‘snap brief’, ‘sit-reps’ (situation reports) and ‘sign-out/debrief’. The attitude of staff to communication and decision making is also evaluated. Results Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff...
ObjectiveTo examine the relationship between sublingual microcirculatory measures and frailty ind... more ObjectiveTo examine the relationship between sublingual microcirculatory measures and frailty index in those attending a kidney transplant assessment clinic.MethodsPatients recruited had their sublingual microcirculation taken using sidestream dark field videomicroscopy (MicroScan, Micro Vision Medical, Amsterdam, the Netherlands) and their frailty index score using a validated short form via interview.ResultsA total of 44 patients were recruited with two being excluded due to microcirculatory image quality scores exceeding 10. The frailty index score indicated significant correlations with total vessel density (p < .0001, r = −.56), microvascular flow index (p = .004, r = −.43), portion of perfused vessels (p = .0004, r = −.52), heterogeneity index (p = .015, r = .32), and perfused vessel density (p < .0001, r = −.66). No correlation was shown between the frailty index and age (p = .08, r = .27).ConclusionsThere is a relationship between the frailty index and microcirculatory health in those attending a kidney transplant assessment clinic, that is not confounded by age. These findings suggest that the impaired microcirculation may be an underlying cause of frailty.
The journal of trauma and acute care surgery, Dec 1, 2012
I n an effort to describe periods of profound change in military organization and practice, histo... more I n an effort to describe periods of profound change in military organization and practice, historians have given us a unique way to classify and describe these developments in a historical perspective. The concept describes advances in the art and practice of combat arms resulting in profound change as ''military revolutions'' accompanied by supporting ''revolutions in military affairs.'' Military Revolutions Murray and Knox 1 equated military revolutions to ''earthquakes.'' These earthquakes forced a fundamental change in society and a state, and the state consequently altered the way it created and projected military power. Murray and Knox recognize five major military revolutions that have had that impact on Western history: the 17th century creation of the modern state and modern military institutions; the French Revolution; the Industrial Revolution; World War I; and, most recently, nuclear weapons and ballistic missile delivery systems. This concept of military revolutions has also carried into the field of military medicine. Military Medical Revolutions Throughout recorded history, there have been several profound medical enlightenments that can be seen as revolutions or ''earthquakes'' in the management of combat wounded (Table 1). With incremental and cumulative advances, the concept of the military medical revolution (MMR) can be defined by the amalgamation of the multiple and progressively complex medical advances defined by the term revolution in military medical affairs (RMMA). RMMAs supporting the overall MMR occurred during the American Civil War, World War I, World War II, the Korean War, and the Vietnam War. MMRs in the past two centuries have been born of multiple advances that form the underpinnings of a true revolution. The American Civil, Crimean, and Franco-Prussian Wars saw the nascent practice of battlefield anesthesia, system of multiple hospitals, nursing care, and antisepsis that, in the aggregate, would meet the definition of the first MMR supported by multiple RMMAs. Subsequent examples of RMMAs supporting the overall MMR (Fig. 1) occurred during the World War I/ World War II era and during the Korean/Vietnam War era. 2Y5 Many advances in combat casualty care from the point of injury to rehabilitation in the continental United States were made during the overseas contingency operations in Iraq and Afghanistan within the decade from 2001 to 2011. The prehospital advances categorized as individual RMMAs are shown (Table 2). Many of these RMMAs were directly translated from civilian trauma practice, whereas others were developed by the military and subsequently translated into the civilian injury care environment. The RMMAs that occurred during the last 10 years of combat casualty care in the realm of prehospital care are detailed in the following sections.
Annals of The Royal College of Surgeons of England, Oct 1, 2009
INTRODUCTION Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare... more INTRODUCTION Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. PATIENTS AND METHODS Data were prospectively collected on 100 consecutive patients either injured or killed from hostile action from January 2006 who presented to the sole coalition field hospital in southern Iraq. RESULTS Eighty-two casualties presented with penetrating missile injuries from hostile action. Three subsequently died of wounds (3.7%). Forty-six (56.1%) casualties had their initial surgery performed by British military surgeons. Twenty casualties (24.4%) sustained gunshot wounds, 62 (75.6%) suffered injuries from fragmentation weapons. These 82 casualties were injured in 55 incidents (mean, 1.49 casualties; range 1-6 casualties) and sustained a total 236 wounds (mean, 2.88 wounds) affecting a mean 2.4 body regions per patient. Improvised explosive devices were responsible for a mean 2.31 casualties (range, 1-4 casualties) per incident. CONCLUSIONS The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons.
Annals of The Royal College of Surgeons of England, May 1, 2015
INTRODUCTION The concentration of major trauma experience at Camp Bastion has allowed continuous ... more INTRODUCTION The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements. METHODS We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR-DCS). This system identifies four key stages: 'command huddle', 'snap brief', 'sit-reps' (situation reports) and 'sign-out/debrief'. The attitude of staff to communication and decision making is also evaluated. RESULTS Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff were collected. All patients were haemodynamically shocked with a median pH of 7.25 (range: 6.83-7.40) and a median of 18 units of mixed red cells and plasma were transfused. In 89% of instances, theatre staff were aware of what was required of them at the beginning of the case, 86% felt there were regular updates and 93% understood what was required of them as the case progressed. CONCLUSIONS The evolution of the hospital at Camp Bastion has been a unique learning experience in the field of major trauma. The Defence Medical Services have responded with continuous innovation to optimise DCR-DCS for seriously injured patients. Together with the improvements in clinical care, a communication and decision making matrix was developed. Staff evaluation showed a high degree of satisfaction with the quality of communication. KEYWORDS Trauma-Military-War-Afghanistan-Battlefield injuries-Gunshot wounds-Blast injuries-Landmines
Background: The Physiological and Operative Severity Score for enUmeration of Mortality and morbi... more Background: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is a simple scoring system previously validated in general surgical patients which enables estimation of the risk of complications and death after operation. The Portsmouth predictor equation (P-POSSUM) is a modi®cation that may result in more accurate prediction of death than POSSUM. The aim of this study was to test the validity of POSSUM and P-POSSUM in patients undergoing major arterial surgery in a specialist unit. Methods: Physiological and operative severity scores in 221 patients undergoing elective and emergency arterial surgery in a pure vascular practice under a single consultant were recorded prospectively. Observed morbidity and mortality rates were compared with the rates predicted by POSSUM and P-POSSUM using a linear method of analysis. Results: The POSSUM equation overestimated deaths with this analysis but the mortality rate estimated by P-POSSUM was not signi®cantly different from the observed death rate. The risk of morbidity predicted by POSSUM was not signi®cantly different from the observed complication rate. Conclusion: The POSSUM methodology combined with the P-POSSUM adjustment for death allows satisfactory prediction of mortality and morbidity rates in patients undergoing vascular surgery.
British Journal of Surgery 1996, 83, 812-815 An evaluation of the POSSUM surgical scoring system ... more British Journal of Surgery 1996, 83, 812-815 An evaluation of the POSSUM surgical scoring system M. S. WHITELEY, DR PRYTHERCH, B. HIGGINS*, PC WEAVER and W. G. PROUT ... Page 3. 814 MS WHITELEY, DR PRYTHERCH, B. HIGGINS, PC WEAVER and WG PROUT ...
The network connectivity of selfish wireless networks (SeWNs) constituted by selfish nodes (SeNs)... more The network connectivity of selfish wireless networks (SeWNs) constituted by selfish nodes (SeNs) is investigated. The SeN's degree of node-selfishness (DeNS) is used for characterizing the effects of its energy resources and the benefits of the incentives provided for enhancing its transmission willingness. Furthermore, the SeNs' signal to interference plus noise ratios are defined in terms of both their DeNSs and their interference factors. We then continue by quantifying the effect of node-selfishness on the grade of network connectivity and derive both the upper and lower bounds of the critical DeNS. Explicitly, the network is deemed to be connected when the DeNS is below the lower bound and unconnected for a DeNS above the upper bound. This allows us to quantify the asymptotic critical DeNSs for our SeWNs. In addition, we develop an energy-conscious node-selfishness model for characterizing the relationship between the SeN's residual energy and its DeNS. Based on this model and on the asymptotic critical DeNS derived, the critical amount of residual energy required for maintaining a specific grade of network connectivity is determined, which is verified by our simulation results.
It is generally accepted that the human abdominal wall is comprised of skin, subcutaneous tissues... more It is generally accepted that the human abdominal wall is comprised of skin, subcutaneous tissues, muscles and their aponeuroses, and the parietal peritoneum. Understanding these layers and their mechanical properties provides valuable information to those designing procedural skills trainers, supporting surgical procedures (hernia repair), and engineering-based work (in silico simulation). However, there is little literature available on the mechanical properties of the abdominal wall in layers or as a composite. This work characterizes the tensile properties of the human abdominal wall by layer and as a partial composite. Tissues were collected from fresh-never-frozen and fresh-frozen cadavers and tested in uniaxial tension at a rate of 5 mm/min until failure. Stress-strain curves were created for each sample, and the values for elastic moduli, ultimate tensile strength, and strain at failure were obtained. The experimental outcomes from this study demonstrated variation of tensil...
Annals of The Royal College of Surgeons of England, Mar 1, 2012
INTRODUCTION International humanitarian law requires emergency medical support for both military ... more INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1-26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice. Dedication This paper is dedicated to the memory of Lt Col Peter Templeton, who served on this tour (Herrick 13B, January 2011) and inspired this study but who sadly died unexpectedly before its completion. 'They shall not grow old, as we that are left grow old'
Objective: The objective of this scoping review is to identify the availability of quantitative b... more Objective: The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available. Introduction: Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers. Inclusion criteria: This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings. Methods: This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results. Scoping review protocol registration: Open Science Framework https://osf.io/fgb34
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Papers by Mark Midwinter