Satisfactory military orthopaedic service provision in the UK suffers significantly from a lack of basic resources, notably overall consultant numbers and host trust support. The waiting time to see an appropriate consultant (uniformed or contracted) can be as long as nine months. Many of these referrals from the primary care sector do not, in fact, need to see a consultant. Appropriately trained individuals such as; GP’s with special interests, Nurse Practitioners and Extended Scope Practitioners may all have a role to play in patient management. Military Physiotherapists are uniquely qualified to deal with these referrals. They can provide military input, advice on grading, order appropriate investigations (including MRI scans and X-rays) and give guidance on further management and arrange follow-on treatment. Although popular in spinal assessment clinics, we are unaware of this facility being formally used in a general military orthopaedic setting. We have now reviewed the results of our first 100 patients. The average waiting time to first appointment was 2 weeks. 75 patients were dealt with solely by the screening clinic. 21 MRI scans, were ordered. Only 25 patients required review by the orthopaedic team. 7 patients required surgery. Our conclusion is that such clinics represent a clinically beneficial and cost-effective screening tool at the primary/secondary care interface. A high patient satisfaction at the short waiting times and outcomes was also noted.
Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 x-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser. 100 units of mixed blood were carried by each AASG. Fifty-one surgical procedures were performed on thirty-one patients. Twenty-one of these patients were Iraqi prisoners of war or civilians. Seventeen wound debridements, five amputations, five laparotomies, four insertions of Denham pins with Thomas splintage for femoral fracture, three external fiations and one axillary artery repair formed the basis of the major cases undertaken. The first field use of activated factor 7 by the British Army was successful in the resuscitation of a patient with exsanguinating haemorrhage after an open-book (APC-III) pelvic fracture and a ruptured intrapelvic haematoma. The other cases included eleven manipulations under anaesthetic/application of plaster and four finger terminalisations. Forward military surgery has a continued role to play on the modern fast moving battlefield. 16 Close Support Medical Regiment normally supports 16 Air Assault Brigade with its remit for out-of-area operations and SF support. Its experience on Op Telic should influence planning for future deployments.
