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Difficult Decisions in the Surgical Care of Military Casualties with Major Torso Trauma
  1. DM Bowley, Academic Department of Military Surgery and Trauma1,2,
  2. JO Jansen3,
  3. D Nott4,
  4. W Sapsford2,5,
  5. CG Streets2,5 and
  6. Lt Col Nigel Tai, RAMC1,2,5
  1. 1Royal Centre for Defence Medicine
  2. 2Joint Medical Command
  3. 3144 Parachute Medical Squadron(V), 16 Medical Regiment, 16 Air Assault Brigade
  4. 4612 Sqn, Royal Air Force Leuchars
  5. 5Medical Support Wing, 16 Medical Regiment, 16 Air Assault Brigade
  1. Trauma Clinical Academic Unit, Royal London Hospital, London E1 1BB nigel.tai{at}


Testing and difficult decision-making is a sine qua non of surgical practice on military operations. Better pre-hospital care protocols, reduced evacuation timelines and increased scrutiny of outcome have rightfully emphasised the requirement of surgeons to “get it right, first time and every time” when treating patients. This article addresses five contentious areas concerning severe torso trauma, with relevant literature summarised by a subject matter expert, in order to produce practical guidance that will assist the newly deployed surgeon in delivering optimal clinical outcomes.

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