Monitoring in the field

This review looks at the challenges faced when monitoring patients in the field environment. It is considered from the perspective of the UK Defence Medical Services and their experiences over the past 20 yr. The lessons learned are applicable to many other circumstances where a high standard of care, for a large spectrum of patients, is to be delivered in the most inhospitable conditions. The environmental influences on monitoring equipment such as extremes of heat, cold and altitude must be considered and dealt with. Minimal monitoring standards required by professional bodies have to be undertaken, but there is a need to exceed them to compensate for the untoward effects of hostile environments. Patient and machine variables monitored and their relative importance in the field are also explored. Varying field locations are illustrated and the types of monitoring required to care for patients in different areas of field units are discussed. Patient transfers and the particular difficulties encountered in the military context are also reviewed. Undertaking aeromedical evacuation is one of the most challenging environments in the field and the solutions required to undertake it are explored. These considerations are used to propose design requirements necessary to provide appropriate monitoring in all other field conditions. The standards set for carriage of equipment in the air and the testing required allowing compliance with the regulations in force in the UK, are outlined. Finally the importance of practitioner training to undertake these roles in the field is discussed.