A revolutionary approach to improving combat casualty care

Hodgetts, Timothy (2012). A revolutionary approach to improving combat casualty care. (Unpublished Doctoral thesis, City University London)

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Abstract

Background: Military medicine has historically advanced in war. Advances in concepts, technology, organisation and operational processes have occurred during the contemporary conflicts of the last decade.

Aims: To determine whether the advances constitute a ‘Revolution in Military Medical Affairs (RM2A)’; to demonstrate my role within a revolutionary transformation; and to introduce new theory to determine if advances have been appropriately matched to clinical need.

Definition: An RM2A is defined here as a radical change in the character or practice of military medicine. Methods: 20 papers are selected (15 first author; 5 second author) that describe the changes in modern combat casualty care. These are clustered into conceptual (doctrine) innovation; changes to organisational structure and operational processes; and advances in technology. These are analysed against Lambeth’s (1997) criteria for a Revolution in Military Affairs (RMA); Cohen’s (2009) three tests for an RMA, but adapted for an RM2A; and Toffler’s (1993) criteria for a ‘true revolution’. The null hypothesis for the novel theory (Homunculus Casualty Theorem) states that the concept, training, equipment and practice changes within the RM2A are not correspondingly or proportionately matched in importance to the immediately life-threatening injuries and physiology of contemporary combat trauma.

Results: The creation of new concepts (<C>ABC, DCR) and doctrine (MIMMS, 1st Aid) are demonstrated, incorporating a raft of novel heuristics. Developments in trauma governance are described that have provided both the evidence to drive change and the proof of effect of change. Specific evidence for avoidable in-hospital cardiac arrest is presented, together with an organisational solution for prevention that highlights the NHS barriers to innovation adoption. The results of system transformation are demonstrated as a cohort of 75 unexpected survivors of critical combat injury; traumatic cardiac arrest survival of 24% is unexpectedly high.

Conclusions: An RM2A is proven that meets the sentinel criteria. The scope of advances in combat casualty care has appropriately reflected clinical need particularly for the rapid and effective treatment of haemorrhage, although battlefield analgesia has failed to advance. Most importantly, it is asserted that the proven RM2A is responsible for the unexpected positive outcomes following critical combat injury. There is evidence I have played a central role in this transformation of military medicine. Effort to transfer the learning into NHS practice has begun

Item Type: Thesis (Doctoral)
Additional Information: This thesis contains some graphic images of injuries that some viewers may find unsettling.
Subjects: R Medicine > R Medicine (General)
Divisions: School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/2040

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