Page 35 - QARANC Vol 14 No 7 2013

Royal College of Nursing Defence Nursing Forum Conference
The Royal College of Nursing (RCN) Defence Nursing Forum (DNF) is the largest professional organisation for military nurses and Health Care Assistants (HCAs). A joint conference was held with the RCN Critical Care and In- Flight (CCIF) forum on 14 June 13 in Birmingham.
The theme of this joint civilian and military conference was ‘sharing best practice’. A variety of presentations relating to military nursing, field intensive care and current critical care practices were delivered by military speakers. The following are the speaker abstracts, which demonstrate the military contribution to ‘sharing best practice’ with our civilian colleagues.
Keynote Speech:
How will the future look?
Col Bates D L/QARANC. Defence Nurse Advisor, SG Department
The support to personnel injured on operations is of an excellent standard because all Armed Forces personnel are supported by a dedicated and comprehensive medical services, including mental health support (CQC 2011). This must be ensured and assured post 2014 when combat operations have ceased in Afghanistan.
DCDC’s Strategic Trends Programme: Global Strategic Trends – Out to 2040 (UK MOD 2012), assesses that the UK will continue to have a global influence in a world that is threatened with environmental disasters as well as those caused by man including war for which the DMS and its nurses need to be prepared for.
Individuals and teams will be training for smaller, more frequent, difficult and possibly distant missions. These missions are likely to be conducted by all three services (joint), by military coalitions (combined) and other government departments, international organisations and non- governmental organisations including contractors (integrated). This approach presents opportunities such as sharing best practice, economic leverage and gearing capability but also challenges in particular governance across organisations (Bullivant 2011).
The Defence Nursing Vision and Intent as part of the DMS Sub-Strategy (UK MOD 2012) recognises this future need and the need to research and invest in improvements to remain a world leader. It is preferable to do this in partnership rather than competition but is difficult to be convincing in an age of austerity.
The one constant will always be people and any health and care delivery system needs to ensure and assure that people’s needs are prioritised and appropriately resourced.
The paper is intended to provoke discussion within the Critical Care, In-Flight and Defence Nursing community which will contribute to the future delivery of nursing effect to people and patients.
Recommended Reading List
UK MOD (2012), Strategic Trends Programme: Global Strategic Trends – Out to 2040. Development, Concepts and Doctrine Centre, Shrivenham.
John Bullivant (2011), Integrated Governance II, Governance Between Organisations. The Good Governance Institute (Online). Accessed 4 Jun 13.
Catastrophic Haemorrhage
Dr Emrys Kirkman, Principle Scientist, DSTL Porton Down
Haemorrhage is the leading cause of military battlefield deaths and the second leading cause of death in civilian patients after trauma. Addressing problems associated with severe blood loss is the subject of intense research by a number of groups worldwide. A variety of techniques have been developed to help control catastrophic haemorrhage, which is the first priority in seriously injures patients. Once the bleeding has been controlled and immediate issues such as ensuring a patent airway and adequate breathing have been achieved, several pathophysiological problems need to be addressed. Sufficient tissue oxygen delivery needs to be maintained to sustain life and, if possible, limit physiological deterioration during the evacuation to hospital. Competing challenges include ensuring adequate tissue blood flow whilst minimising the risk of iatrogenic re-bleeding.
In collaboration with the Royal Centre for Defence Medicine we have developed a resuscitation strategy called ‘Novel Hybrid’ (NH) to address this issue during prolonged evacuation, especially if there is concomitant lung damage e.g. blast lung after explosive injuries. NH involves early hypotensive resuscitation, followed after approximately one hour by a revision of the target blood pressure to normotensive levels. This has been shown to improve survival after combined blast and haemorrhage and reduce physiological deterioration after haemorrhage, even in the absence of blast. A related problem involves the development of acute trauma coagulopathy, which affects 30-40% of seriously injured casualties. The pathophysiology of this condition is currently being examined. Significant clinical advances include early, proactive, use of blood products (e.g. fresh frozen plasma) in addition to packed red cells.
Finally haemorrhagic shock and the reperfusion associated with resuscitation leads to ischaemia-reperfusion injury and systemic inflammatory responses. A range of adjuncts (drugs) have been proposed as potential treatments to ameliorate this condition and future advances have seen some of these incorporated into early resuscitation strategies.
Intended Learning Outcomes:
At the end of this session, participants should be able to:
• Discuss strengths and weaknesses of pre-hospital fluid
resuscitation strategies
• Explain potential causes of acute trauma coagulopathy
• Identify potential adjuncts to reduce secondary organ
damage after haemorrhage and resuscitation
Recommended Reading List:
Kirkman E, Watts S, Copper G. Blast injury research models. Philos Trans R Soc Lond B Biol Sci. 2011; 366:144-159 Brohi K, Cohen MJ, Ganter MT, Matthay MA Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypooerfusion: modulated through the protein C pathway? Ann Surg. 2007; 245:812-818
Watts S. Military trauma research at Porton Down – a view from the benches. Journal of the Association of Surgeons of Great Britain and Ireland. 2013; 39:29-31
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