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Biomedical subjects

D J Lockey

Publications and source records attributed to D J Lockey.

12 recordsLinked to original sources

Military perspective on the civilian response to the London bombings July 2005.

With the break up of the Warsaw Pact and changing global relations, current military deployments are becoming smaller and more expeditionary (e.g. Afghanistan, East Timor and Sierra Leone). During the Cold War, the use of weapons of mass effect was highly likely to have been seen on the battlefield. Ironically, the proliferation of CBRN agents and the knowledge of their application, as well as the manufacture of improvised explosive devices, have lead to the targeting of civilian populations by extremist groups. One of the benefits of military clinicians embedded in NHS hospital trusts, as well as a strong reservist cadre, is a greater understanding of the implications and management of asymmetric attacks against the U.K. The experience and skills of military clinicians may be of benefit to NHS trusts while this type of threat exists. Military clinicians are also likely to benefit from the experience that they get in certain NHS posts that provide skills that are readily transferable to military medicine. The events of 7th July highlighted the dynamic use of deployable medical resources and a rapid return to normal service provision. This type of 'Health Resilience' can only be achieved with a combination of effective emergency planning, on scene clinical risk management and clinical leadership.

Communication↗

London bombings July 2005: the immediate pre-hospital medical response.

On July 7th 2005 a series of terrorist bombs exploded in London. The transport system was targeted and at least 54 passengers were killed and around 700 injured. This paper describes the immediate pre-hospital medical response to the four scenes. From the perspective of the London Helicopter Emergency Medical Service the deployment, difficulties on scene and the initial lessons learned are discussed.

Blast Injuries↗

The deployment of an intensive care facility with a military field hospital to the 2003 conflict in Iraq.

The deployment of an intensive care unit with a forward British military field hospital to the conflict in Iraq in March 2003 is described. The 10 bedded unit treated 47 patients in the first month of activity. Thirty seven were adults and 10 were children. Forty two (89%) were trauma patients, mostly related to the conflict. Sixty eight percent of patients were ventilated and mortality to discharge was 6%. Mean bed occupancy was five beds and the mean duration of patient stay was 3.3 days. The difficulties of the working environment are described including the problems of a desert climate and close proximity to a conflict. Several critical incidents occurred including total power failure, extreme ambient temperatures and gas attack alarms. Despite these challenges, the facility attempted to provide a standard of intensive care similar to that seen in UK practice.

Adult↗

Pre-hospital anaesthesia.

Effective management of the airway may have the greatest impact on mortality and morbidity of all pre-hospital interventions. The administration of a pre-hospital anaesthetic may not only facilitate effective management and protection of the airway but may also be fundamental to maintaining adequate ventilation and reducing times to definitive treatment for casualties who are trapped and those with major chest and head injuries. Pre-hospital anaesthesia is a highly skilled technique that requires considerable training and experience. Inappropriate attempts to anaesthetise critically injured casualties may prove fatal if the operator does not have the requisite knowledge, skills and equipment. For those that do, this article provides an operational framework within which pre-hospital anaesthesia can be developed (Box 5).

Anesthesia, General↗

Aspiration in severe trauma: a prospective study.

The incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway.

Adolescent↗

SCOTI vs. Wee. An assessment of two oesophageal intubation detection devices.

The SCOTI (Sonomatic Confirmation of Tracheal Intubation) is a newly marketed electronic device that relies on recognition of a resonating frequency for detection of tracheal intubation. It was compared with the modified Wee oesophageal intubation detection device, which works on a mechanical principle, in 50 elective surgical patients. All had simultaneous tracheal and oesophageal intubations. The Wee device correctly detected oesophageal and tracheal placement of the tracheal tube in all 50 patients. The SCOTI device incorrectly identified 1 of 50 tracheal intubations and was unable to identify the position of another. It correctly identified all 50 oesophageal intubations. The SCOTI is no better than the simple, cheap and reliable Wee device.

Adult↗