title: Management of children in the deployed intensive care unit at Camp Bastion, Afghanistan.
abstract: BACKGROUND
  The deployed Intensive Therapy Unit (ITU) in the British military field hospital in Camp Bastion, Afghanistan, admits both adults and children. The purpose of this paper is to review the paediatric workload in the deployed ITU and to describe how the unit copes with the challenge of looking after critically injured and ill children.
  
  
  METHODS
  Retrospective review of patients <16 years of age admitted to the ITU in the British military field hospital in Camp Bastion, Afghanistan, over a 1-year period from April 2011 to April 2012.
  
  
  RESULTS
  112/811 (14%) admissions to the ITU were paediatric (median age 8 years, IQR 6-12, range 1-16). 80/112 were trauma admissions, 13 were burns, four were non-trauma admissions and 15 were readmissions. Mechanism of injury in trauma was blunt in 12, blast (improvised explosive device) in 45, blast (indirect fire) in seven and gunshot wound in 16. Median length of stay was 0.92 days (IQR 0.45-2.65). 82/112 admissions (73%) were mechanically ventilated, 16/112 (14%) required inotropic support. 12/112 (11%) died before unit discharge. Trauma scoring was available in 65 of the 80 trauma admissions. Eight had Injury Severity Score or New Injury Severity Score >60, none of whom survived. However, of the 16 patients with predicted mortality >50% by Trauma Injury Severity Score, seven survived. Seven cases required specialist advice and were discussed with the Birmingham Children's Hospital paediatric intensive care retrieval service. The mechanisms by which the Defence Medical Services support children admitted to the deployed adult ITU are described, including staff training in clinical, ethical and child protection issues, equipment, guidelines and clinical governance and rapid access to specialist advice in the UK.
  
  
  CONCLUSIONS
  With appropriate support, it is possible to provide intensive care to children in a deployed military ITU.
authors.affiliation: Faculty of Medicine, Imperial College, Wright Fleming Institute, London, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Inwald
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: G S
authors.initials: GS
authors.lastname: Arul
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Montgomery
authors.affiliation: Ministry of Defence Hospital, Unit Northallerton, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: J
authors.initials: J
authors.lastname: Henning
authors.affiliation: Ministry of Defence Hospital Unit Portsmouth, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: J
authors.initials: J
authors.lastname: McNicholas
authors.affiliation: Ministry of Defence Hospital Unit Derriford, Derriford Hospital, Plymouth, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bree
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008887:Military Medicine / Q000458:organization & administration*; D008952:Mobile Health Units / Q000458:organization & administration*; D012189:Retrospective Studies; D006113:United Kingdom; D014947:Wounds and Injuries / Q000209:etiology / Q000473:pathology / Q000628:therapy*
keywords: Trauma Management