title: Doctor on board? What is the optimal skill-mix in military pre-hospital care?
abstract: BACKGROUND
  In a military setting, pre-hospital times may be extended due to geographical or operational issues. Helicopter casevac enables patients to be transported expediently across all terrains. The skill-mix of the pre-hospital team can vary.
  
  
  OBJECTIVE
  To quantify the doctors' contribution to the Medical Emergency Response Team-Enhanced (MERT-E).
  
  
  METHODS
  A prospective log of missions recorded urgency category, patient nationality, mechanism of injury, medical interventions and whether, in the crew's opinion, the presence of the doctor made a positive contribution.
  
  
  RESULTS
  Between July and November 2008, MERT-E flew 324 missions for 429 patients. 56% of patients carried were local nationals, 35% were UK forces. 22% of patients were T1, 52% were T2, 21.5% were T3 and 4% were dead. 48% patients had blast injuries, 25% had gunshot wounds, 6 patients had been exposed to blast and gunshot wounds. Median time from take-off to ED arrival was 44 min. A doctor flew on 88% of missions. It was thought that a doctor's presence was not clinically beneficial in 77% of missions. There were 62 recorded physician's
  
  
  METHODS
  the most common intervention was rapid sequence induction (45%); other interventions included provision of analgesia, sedation or blood products (34%), chest drain or thoracostomy (5%), and pronouncing life extinct (6%).
  
  
  CONCLUSIONS
  MERT-E is a high value asset which makes an important contribution to patient care. A relatively small proportion of missions require interventions beyond the capability of well-trained military paramedics; the indirect benefits of a physician are more difficult to quantify.
authors.affiliation: Joint Forces Hospital, Camp Bastion, Helmand Province, Afghanistan, and the Royal Centre for Defence Medicine, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Calderbank
authors.forename: Tom
authors.initials: T
authors.lastname: Woolley
authors.forename: Stuart
authors.initials: S
authors.lastname: Mercer
authors.forename: Jason
authors.initials: J
authors.lastname: Schrager
authors.forename: Mike
authors.initials: M
authors.lastname: Kazel
authors.forename: Stephen
authors.initials: S
authors.lastname: Bree
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Bowley
mesh_terms: D017732:Air Ambulances; D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D004634:Emergency Medical Technicians / Q000458:organization & administration / Q000592:standards*; D004635:Emergency Medicine / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008887:Military Medicine / Q000458:organization & administration*; D011446:Prospective Studies; D006113:United Kingdom