How much is enough? Using Delphi to explore the clinical-contact-time and return-to-practice needs of military nurses.

Aim Military nurses are required to deploy worldwide at any time to support British forces. They must maintain military and clinical skills, and fulfil other military commitments as required. These diverse responsibilities make it challenging for military nurses to maintain the level of clinical expertise they require for short-notice deployments.

Experiences of military nurses in Iraq and Afghanistan.

Since 2001 military nurses have successfully supported military operations in deployed field hospitals in both Iraq and Afghanistan. These deployments have presented unique challenges for military nurses. This article reviews the literature on the experience of nurses during these deployments and, using a thematic analysis approach, aims to understand their experience.

Confidence vs competence: basic life support skills of health professionals.

The provision of prompt effective resuscitation is fundamental in ensuring successful outcomes following cardiac arrest but historically nurses and doctors have lacked competence in performing basic life support (BLS), despite being confident in their abilities. The object of this study was to assess BLS confidence as assessed against competence of doctors' in-training, qualified nurses and healthcare assistants (HCAs) following the development of structured resuscitation training. This study has highlighted that the introduction of a structured resuscitation training programme has resulted in a noticeable improvement in BLS skills, particularly with regard to doctors.

False cardiac arrests: the right time to turn away?

Aim: Cardiac arrest teams may be activated only to find that the patient does not require cardiac or respiratory resuscitation. Members of the cardiac arrest team are drawn from medical personnel with other responsibilities who may disperse quickly, leaving ongoing care of the patient to existing ward staff. The outcome for such false cardiac arrests, however, is rarely reported.

Using a Delphi approach to develop a strategy for A&E in defence nursing.

The Armed Forces has seen an increase in the number of operational deployments overseas and a greater demand for Accident and Emergency (A&E) trained nurses. This article describes a modified Delphi study used to contribute to the development of a strategy for emergency nursing in the Defence Nursing Services. Twenty-eight A&E specialists took part and the key issues raised were recruitment and retention, staff development, new roles, research priorities, increased internal recruitment of A&E nurses to meet operational demands, and the need for a structured career pathway to help retention.

Nurses training doctors: evaluation of a fifth year medical school pilot.

In October 2004 a request was made to the Royal Centre for Defence Medicine to support a pilot project for a leading Midlands medical school. The aim of the project was to standardize clinical skills training for medical students prior to House Officer jobs. Experienced military emergency nurses provided clinical training including cannulation, catheterization and phlebotomy in a simulated environment.

Findings of the first consensus conference on medical emergency teams.

Background: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO).

Evaluation of a medical emergency team one year after implementation.

Aim: To evaluate the activity and impact of a Medical Emergency Team (MET) one year after implementation.

Setting And Population: A 700-bed District General Hospital (DGH) in Southeast England with approximately 53,500 adult admissions per annum. The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001.

Pre-printed 'do not attempt resuscitation' forms improve documentation?

Objective: Do not-attempt-resuscitate orders are fundamental for allowing patients to die peacefully without inappropriate resuscitation attempts. Once the decision has been made it is imperative to record this information accurately. However, during a related research projected we noted that documentation was poor and we thought that the introduction of a pre-printed Do Not Attempt Resuscitation (DNAR) form would improve the documentation process.

Avoidable cardiac arrest: lessons for an A&E department.

Deterioration to cardiac arrest is not always sudden and unexpected and on a significant number of occasions cardiac arrest could be prevented. This has important messages for the Accident and Emergency (A&E) department as the vast majority of emergency admissions originate via A&E.

Preparing to receive patients with trauma.

Appropriate preparation could prevent up to 70% of trauma-related deaths in hospital. In this article, a military trauma team discusses the infrastructure required to receive patients with major trauma. It explains who should be in a trauma team and the tools needed to ensure efficient communication between team members.

Nurse concern: a predictor of patient deterioration.

Nurses who have cared for a patient for some time often develop an intuitive sense of when that patient's condition is deteriorating. This article discusses how this intuition can be quantified and presented to medical staff so that patients receive timely and appropriate intervention.

Health system costs of in-hospital cardiac arrest.

This paper reports on the health system resources used in the treatment of in-hospital cardiac arrests in a British district general hospital. The resources used in resuscitation attempts were recorded prospectively by observation of a convenience sample of 30 cardiac arrests. The post-resuscitation resource use by survivors was collected through a retrospective record review (n = 37) and by following survivor members in the prospective sample (n = 6).

The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team.

Aim: (1) To identify risk factors for in-hospital cardiac arrest; (2) to formulate activation criteria to alert a clinical response culminating in attendance by a Medical Emergency Team (MET); (3) to evaluate the sensitivity and specificity of the scoring system.

Methods: Quasi-experimental design to determine prevalence of risk factors for cardiac arrest in the hospitalised population. Weighting of risk factors and formulation of activation criteria to alert a graded clinical response.

Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital.

Aims: To determine the incidence of avoidable cardiac arrest among patients who had received resuscitation in a district general hospital. To establish how location and individual or system factors influence avoidable cardiac arrest in order to develop an evidence-based preventive strategy.

Methods: Expert panel review of case-notes from 139 consecutive adult in-hospital cardiac arrests over 1 year.

A specialist team of A&E doctors and nurses establish emergency care units in Kosovo.

On June 12, 1999 NATO troops led by British paratroopers of 5 Airborne Brigade entered Kosovo and secured key military sites. This multinational operation (code named 'OP AGRICOLA') was in response to the ethnic cleansing of Kosovo-Albanians, and followed a sustained period of aerial attack in Kosovo and Serbia. The ground operation required substantial medical support, and the British hospital element was provided by 22 Field Hospital RAMC.