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Balloons on the battlefield: REBOA implementation in the UK Defence Medical Services
  1. Max E R Marsden1,2,
  2. A M Buckley3,4,
  3. C Park5,6,
  4. N Tai1,2 and
  5. P Rees4,7
  1. 1Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
  3. 3jHubMed, UKStratCom, London, UK
  4. 4Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  5. 5Critical Care, King's College Hospital, London, UK
  6. 6London's Air Ambulance, Barts Health NHS Trust, London, UK
  7. 7Barts Heart Centre, Barts Health NHS Trust, London, UK
  1. Correspondence to Surg Cdr P Rees, Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham EC1A 7BE, UK; cardiacexpert{at}


Established in 2018, the Defence Endovascular Resuscitation (DefER) group recognised that resuscitative endovascular balloon occlusion of the aorta (REBOA) offered an option to improve survival in battle casualties dying from haemorrhage, particularly in remote and austere surgical settings. Following a successful jHub opportunity assessment, DefER purchased training and operational kit at pace. By 1 April 2019, the first forward surgical group undertook a bespoke endovascular training and assessment package. Results of the pilot were presented back to a jHub 4* Innovation Board, which initially awarded £500 000 to fund the project to full implementation. Med Op Cap provided a solution to establish REBOA as a core capability on to the 370 modules. REBOA catheters and arterial access kit are now available to deployed Role 2 facilities across defence as an adjunct to damage control resuscitation in specific circumstances. REBOA has, from a standing start, gained pan-Defence Medical Services (DMS) endorsement and has been integrated into deployed damage control resuscitation. To establish a new resuscitation capability across all Role 2 platforms within 15 months of inception represents implementation at pace. This agility was unlocked by empowering clinicians to develop the platform in conjunction with commercial procurement. This article describes how this innovative pathway facilitated the rapid introduction of a lifesaving haemorrhage control technique to equip DMS clinicians.

  • trauma management
  • protocols & guidelines
  • risk management
  • organisational development

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  • Twitter @maxmarsden83, @drandrewbuckley, @DrPaulRees

  • Contributors MERM and AMB wrote the manuscript. Critical revision was provided by CP, NT and PR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.