DAY ONE - THURSDAY 14TH APRIL 08:30 COFFEE & REGISTRATION 12:20 PANEL/QUESTIONS 09:00 Opening Address and introduction of Conference Chairman 12:30 LUNCH & EXHIBITION OPEN Conference Chairman: Lt Col Jeremy Henning, Consultant in Anaesthesia and Intensive Care Medicine, Royal Army Medical Corps 14:00 Modern Concepts In Fluid Resuscitation Lt Col Ian Greaves RAMC, Consultant in Emergency medicine and Lt Col Jeremy Henning is a Consultant Intensivist / Anaesthetist in the Visiting Professor in Emergency Medicine, University of Teesside British Army with operational experience in the Gulf and the Balkans. Areas of especial interest are the pre-hospital care of the trauma This presentation will cover the rationals for different rates of fluid patient and the transport of the critically ill patient. admin and for different fluid types.

14:20 An overview of CBRN Medicine, and the management of Casualties. Keynote Presentation Mainly focusing on chemical incidents and the problems relating to triage, treatment and transfer 09:15 Increasing Survival – The Current Military Approach Lt Col Mark Byers, S01 Occupational and Environmental Medicine, HQ Major General L P Lillywhite MBE, QHS APHCS (NE), Royal Army Medical Corps. Director General Army Medical Services • CBRN Medicine an overview The military environment produces casualties with extensive and • Care in the Hot Zone severe injury that in civilian life is seen only in terrorist incidents. • Decontamination Unlike civilian terrorist incidents, military casualties often occur some • Transfer of casualties – Clean or Dirty hours away from modern hospitals. The military is thus faced with the duel challenge of reducing the historic 20 – 25% mortality rate at 14:45 Tactical Extrication by the Three step rocket the scene of injury, sustaining that survival until definitive care can Maj. Finn Warburg, Orthopedic Surgeon, Ass. Professor. Danish Armed be provided in a distant hospital, doing so in adverse environmental Forces Health Services, stationed as trauma surgeon with the State conditions with limited resources and under logistic constraints. University Hospital Trauma Centre. An overview of the military medical doctrine and the technological The three step tactical extrication was developed 20 years ago to advances being developed in various military forces to ensure the organize first aid and emergency surgery for the Danish Special highest possible quality of survival will be described, setting the scene Forces. A course was then created to teach the principles of swiftly for the subsequent presentations. removing the shooter from the battlezone, dead or alive, to render first aid under the nearest cover and to evacuate the casualty to 09:45 The Spectrum Of Injury Amongst Military Casualties In Recent Conflicts a “safehouse” for “top to toe examination” and necessary surgical Lt Col Jonathan Clasper DPhil DM FIMC FRCSEd(Orth) DMCC RAMC(V) intervention. The principles proved themselves useful during Consultant Orthopaedic and Trauma Surgeon. involvement in Kosovo and Afghanistan and have now been included This talk will outline the spectrum of wounds sustained by military in the trauma concept of the Danish Armed Forces Medical Services. casualties and the mechanism of injury. It will concentrate on the Application will usually be by a doctor or a paramedic. The link to a recent conflict in Iraq but draw comparisons with other historic wars, responsive forward surgical team and evacuation with ICU services to particularly the differences in modern warfare. a well organized trauma centre is crucial and international cooperation mandatory. 10:05 British Military Combat Casualty Care Research at Dstl Graham Cooper OBE PhD, Biomedical Sciences, Defence Science and 15:00 PANEL/QUESTIONS Technology Laboratory, Porton. 15:15 AFTERNOON TEA EXHIBITION OPEN Dstl Porton undertakes basic and applied research to facilitate the Defence Medical Services fulfilling their roles in maintaining the 16:00 3 CASEVAC SQUADRON – ROYAL AIR FORCE fighting strength, and providing a standard of trauma care - where Wing Commander Beth Baker BMedSci BM BS MRCGP DRCOG DCH possible within operational constraints - that matches or exceeds DAvMed RAF, Senior Medical Officer, RAF Lyneham civilian practice. The principal focus of research activity is the This presentation will provide an overview of land-based casualty acute consequence of military trauma, and measures that may be transfer by air during II. employed to staunch haemorrhage and restore physiological function • Role of air CASEVAC during conflict to enable survival and evacuation. The presentation will focus on • The CASEVAC environment – hostile to patients and monitoring novel approaches to haemorrhage control, and principles of fluid resuscitation for those with combined trauma. 16:20 Supporting Telemedicine Applications in Deployed Operations Valerie Savoy Combat Medic Class 1, 306 Field Hospital York and 10:25 Training For Combat Casualty Care International Business Development Manager - Paradigm Secure Lieutenant Colonel Martin Bricknell DM MMedSci MRCGP MFOM Communications MFPHM DRCOG DMCC Chief Medical Officer United Kingdom This presentation will show how specialist secure communications Support Command (Germany). Formerly Chief Instructor Defence services can support telemedicine applications: Medical Services Training Centre Keogh Barracks. • Computer Tomography • Military Acute Care - an integrated framework for combat casualty • High Value Image Transfer care training. • Videoconferencing and information dissemination • Skills Escalator - a training paradigm for combat casualty care. • Real life case study from Paradigm Secure Communications • Simulation - training to get combat casualty care right first time. • The future - linking from experience to training. 16:40 Intensive Care Provision at the Field Hospital LtCol Matthew Roberts MA BM BCh FRCA Royal Army Medical Corps (V) 10:45 PANEL/QUESTIONS Associate Professor of Anesthesiology University of Colorado Health 11:00 COFFEE & EXHIBITION OPEN Sciences Center, Denver. 144 PARA Sqn RAMC(V) 11:30 Training Tactical Medics For Police Firearms Units This talk will highlight the recent advances in the provision of intensive Mr Paul Reeves, SR Para. Emergency Care Lecturer Practitioner with care facilities at the field hospital and discuss some areas in which Ambulance NHS Trust and Bournemouth University. Tactical further improvements can be made. The discussion will draw on the Paramedic, Dorset Police Tactical Firearms Unit. experiences of 202 Field Hospital in Kuwait and Iraq in 2003 as well as Mr David Halliwell, Head of Education and Professional Development, referring to previous operations for the sake of comparison. Dorset Ambulance Service. • Inside the perimeter: Concepts in providing emergency medical care 17:00 Care Of Ventilated Patients Forward Of The Field Hospital at Police special operations Lt Col Sam Pambakian, MBE BSc MBBS DA FRCA RAMC, 16 Close • Hostile Environments, Police vs. Ambulance: Who makes the best Support Medical Regiment, Royal Army Medical Corps medical provider? • Incidence • Less theory more practice: Teaching what you really need to know. • Survival Benefit • Issues on skill retention: Medical Program vs. Medical Course • Equipment Required • British Airbourne Forces Experience 11:50 Pre-hospital Medical Services In Civilian Hostile Environments Mr David J Connell, Managing Director, Ex+Med UK Ltd 17:20 PANEL/QUESTIONS The presentation will discuss the increasing demand for medical 17:30 CHAIRMAN’S CLOSING REMARKS services for civilian companies and organisations in remote and hostile environments. It will discuss the operational climate focusing on problems and barriers to a successful deployment and will take 17:30 – 18:30 LOGICA CMG ex+med UK’s experiences in Afghanistan during the 2004 Presidential DRINKS RECEPTION Elections as a case history.

Page 1 DAY TWO - FRIDAY 15TH APRIL 2005 08:30 COFFEE & REGISTRATION 14:00 Operational Use Of Haemostatic Agents: QuikClot versus Hemcon John H Hagmann MD, Medical Director, Operational and Emergency 09:00 Opening Remarks From The Chairman Medical Skills Programs Surgeon, FBI Hostage Rescue Team Only two of the many haemostatic agents currently marketed are 09:10 Primary Casualty Receiving Facility RFA Argus successful at controlling severe or arterial bleeding as encountered Surgeon Captain DRC Sanderson, , Medical Officer In Charge in combat wounds. Theoretical issues and laboratory models have Surgeon Captain Sanderson served as the Medical Officer In Charge been found to mislead the comparison of these agents. The ultimate (MOIC) on board the Argus during Op Telic in determinant must be success in controlling life threatening bleeding by 2003. RFA Argus has a 100 bed role 3 hospital facility on board for forward personnel in combat type wounds. In all cases, the success medical support afloat. The presentation will provide a description of of haemostatic agents depends on appropriate training. Data and the facilities & functions on board. experience with QuikClot and Hemcon in combat type wounds will be presented: 09:30 Role 2 Medical Support to the • Advantages and limitations of each agent Surgeon Lieutenant Commander Andy Brown MA BM BCh DipSTI • Experience and factors for success MFSEM MRCGP Royal Navy, Officer Commanding Medical Squadron, • Use protocol for each agent 3 Commando Brigade Royal Marines • Training requirements This talk will present an overview of the provision of Role 2 support to the Royal Marines on operations. It will discuss the different Roles of 14:45 Aeromedical Evacuation of the Critically Ill, an RAF Perspective medical care, in comparison with those afloat, the functional structure Group Captain Neil McGuire FRCA RAF, Consultant Adviser In of Medical Squadron and its future aspirations. Anaesthetics (RAF), Lead Clinician, RAF Critical Care Air Support Teams, Consultant Intensivist John Radcliffe Hospital Oxford 09:50 Summary Of Royal Navy Medical Support Ashore & Afloat The RAF Medical Services Critical Care Air Support Teams have Surgeon Captain Lionel J Jarvis NB BS FRCR MRCS LRCP MIEE, accumulated considerable experience in the transportation of the Royal Navy, Deputy Director Medical Operations Division, Fleet critically ill by air over extended times and great distances. The Headquarters Service necessarily operates in hostile environments but expectation is the delivery of high quality intensive care proactively throughout the transfer period. This expectation is fulfilled by using appropriately trained personnel with some of the best transfer equipment available. The aim is to deliver an intensive care capability to the patient and move the patient with it. • Overview of the Service 10:00 The Implementation Of A Combat Casualty Care Training • Equipment Programme – The Italian Navy Experience • Aeromedical Considerations Rear Admiral Giovanni Fascia, ITN MC, Head Of Department, General • Preparation of the Patient Directorate Of The Italian Military Medical Services. • Packaging for transfer Author: LTC ITN MC Andrea Tamburelli, Alternate Assistant Medical • Transfer logistics and in Transfer care of the patient Officer ITN Rome Command Medical Service, Secretary Nato/Comeds Emergency Medicine Working Group, Head Medical Branch Of The 15:05 PANEL/QUESTIONS Course at ITN Amphibious RGT “S.Marco” Brindisi. 15:15 AFTERNOON TEA EXHIBITION OPEN

This presentation will be divided into two parts. The first part will 15:45 Strategic Air Medevac and Intensive Care Medicine - Possibilities focus on the need for a new concept in medical training in the combat and Limitations of the German Concept. environment. The second part will consist of a short video showing Lt.Col. Dr. Thomas W. Dietze, M.D., M.B.A Consultant in some highlights of the course that has been developed. Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy. 10:20 PANEL/QUESTIONS Head of the Intensive Care Section. German Armed Forces Medical 10:30 COFFEE & EXHIBITION OPEN Center Oberer Eselsberg Within this presentation the concept, the development and a few recent 11:15 Mobile Computing Supporting Remote Medicine missions with the Medevac Airbus A 310 including the repatriation of Mr Tommy Morris IPA, Director Mobile Computing, CITO injured victims from South-East Asia after the flood - will be depicted. U.S. Army telemedicine & Advanced Technology Research Center Special emphasis will be placed upon the “lessons learned” during This presentation will be divided into two parts. The first part will those missions as well as the possible pitfalls in future missions. focus on the need for a new concept in medical training in the combat • PTU: patient transport unit environment. The second part will consist of a short video showing • STRATAIRMEDEVAC some highlights of the course that has been developed. • Airbus in MEDEVAC Configuration • Optimizing Patient Care • Intensive Care Medicine on an airplane • Establishing a true longitudinal patient record • Advanced respiratory and kinetic therapy onboard an aircraft • Maximizing the amount of information for health surveillance • Enhancing military health care by improving medical decision 16:05 RAF Strategic Aeromedical Evacuation making and reducing medical errors beginning with the first Sqn Ldr Martin McGrath, Group Flight Medical Officer, Royal Air Force responders Aeromedical Evacuation Control Centre. • Improving responsiveness to medical situations The RAF is responsible for the provision of Strategic Aeromedical Evacuation (AE) transfers for all entitled Armed Forces patients and 11:45 DMICP - The UK MOD’s Medical Information Revolution those for whom responsibility has been accepted by the MOD. The Colonel Mike Manson MA, Assistant Director Medical Information presentation outlines the unique organisational challenges involved in Management matching aircraft, equipment and escorts appropriate to the patient’s Defence Medical Services Department, MOD UK clinical condition. The Defence Medical Information Capability Programme is a change • Principles and Organisation programme enabled by IT that will greatly enhance the capability of • Current Commitments the Defence Medical Services both in peacetime locations and on • Aircraft and Clinical Considerations operations. The presentation will cover the entire programme and • Special AE Moves emphasise the deployable capability, discussing the potential benefits • The Future while acknowledging the initial limitations due to the lack of a fully integrated Battlefield Information Infrastructure. 16:25 PANEL/QUESTIONS • Current capability gaps 16:40 CHAIRMAN’S CLOSING REMARKS • Main functional components of the IT • Outline concept of operations • Communications issues CONFERENCE & EXHIBITION CLOSED • Interfaces with other Defence IS and the NHS • Benefits for medical personnel, patients and casualties, the Defence Medical Services, and commanders.

12:15 PANEL/QUESTIONS 12:30 LUNCH & EXHIBITION OPEN

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