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Mission Creep: An Analysis Of Accident And Emergency Room Activity In A Military Facility In Bosnia-Herzegovina
  1. Maj G Kenward, MSc BSc(Hons) RGN QARANC, Acute Care Rotation Programme Co-ordinator1,
  2. Capt TNM Jain, MSM CD MD CCFP, Canadian Forces, Associate Staff Physician of Emergency Medicine2 and
  3. Capt K Nicholson, MSc BSc(Hons) MBChB RAMC, Senior House Officer Medicine3
  1. 1Royal Centre for Defence Medicine, Selly Oak Hospital, Birmingham, B29 6JD
  2. 2Quinte Health Care Region, Ontario, Canada
  3. 3Frimley Park Hospital, Camberley, Surrey, GU16 5UJ


Objective To evaluate accident and emergency (A&E) room activity at a Role 3 Multinational Integrated Medical Unit (R3 MIMU) facility in Bosnia- Herzegovina.

Methods Retrospective analysis of all patients attending the A&E room from 1st October 1999 – 30th September 2002.

Results 1864 casualties are included in the analysis. 52.1% of casualties were Bosnian, 43.8% were military. Mean age of casualties was 35.5 years (SD 18.3), range 1 – 88 years. Traumatic injury was the leading cause of presentation (58.1%). Following treatment 66.7% of all cases were discharged or returned to unit, with 19.8% admitted to a ward area. During the 3 year period there was a 5 fold increase in the number of Bosnian nationals treated, this included 80 children (<13 years).

Conclusion There has been a dramatic increase in A&E use during the period evaluated, particularly by the local population. The increasing number of locals treated, both adult and child, has the potential to undermine the R3 MIMU mission and increase dependency within the Bosnian population. A balance is needed to ensure the staff and functions of a hospital are maintained whilst preserving the capability to deal with an influx of military casualties.

  • Bosnia
  • military
  • mission
  • clinical governance
  • humanitarian aid

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