Human factors in decision making in major trauma in Camp Bastion, Afghanistan.
BACKGROUND
The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements.


METHODS
We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR-DCS). This system identifies four key stages: 'command huddle', 'snap brief', 'sit-reps' (situation reports) and 'sign-out/debrief'. The attitude of staff to communication and decision making is also evaluated.


RESULTS
Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff were collected. All patients were haemodynamically shocked with a median pH of 7.25 (range: 6.83-7.40) and a median of 18 units of mixed red cells and plasma were transfused. In 89% of instances, theatre staff were aware of what was required of them at the beginning of the case, 86% felt there were regular updates and 93% understood what was required of them as the case progressed.


CONCLUSIONS
The evolution of the hospital at Camp Bastion has been a unique learning experience in the field of major trauma. The Defence Medical Services have responded with continuous innovation to optimise DCR-DCS for seriously injured patients. Together with the improvements in clinical care, a communication and decision making matrix was developed. Staff evaluation showed a high degree of satisfaction with the quality of communication.
212 Field Hospital, Sheffield , UK.
G S
GS
Arul
16 Medical Regiment, Colchester , UK.
H E J
HE
Pugh
Aintree University Hospital NHS Foundation Trust , UK.
S J
SJ
Mercer
Royal Centre for Defence Medicine, Birmingham , UK.
M J
MJ
Midwinter
D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001753:Blast Injuries / Q000628:therapy*; D003657:Decision Making; D006801:Humans; D008297:Male; D008887:Military Medicine; D010820:Physicians / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014948:Wounds, Gunshot / Q000628:therapy*
Afghanistan; Battlefield injuries; Blast injuries; Gunshot wounds; Landmines; Military; Trauma; War