What are the clinical challenges of contemporary conflicts? How can we solve them? Developing a modified Delphi approach


Shehan Hettiaratchy, Imperial College/UK-MED

Much of our knowledge and research on conflict injuries over the last 20 years has been based on UK and US military experience gained in expeditionary campaigns. These were characterised by a coherent casualty evacuation chain and ability to match resource to need in a timely and effective way. Current conflicts (Ukraine, Gaza) operate in a different paradigm where clinical need overwhelms resource and management timelines are often extended. This creates a different set of clinical challenges that need to be met. Identifying these and understanding how they can be mitigated will allow more effective management of casualties and better outcomes. The issues include:
  • the management of large soft tissue defects
  • the management large bone defects
  • treatment of chronic bone and soft-tissue infection with multi-resistant organisms
  • limb salvage decisions
  • large volume paediatric casualties
  • lack of reconstructive surgical capability
  • lack of prosthetic and orthotic capability 
  • lack of rehabilitation capability
  • lack of psychological/psychiatric
The aim of the workshop is to develop a modified Delphi/e-Delphi approach to characterise the clinical challenges and potential solutions in contemporary conflicts. The process will attempt to prioritise the most significant.
The panel will consist of individuals with contemporary experience of healthcare in modern conflicts. It will include both military and humanitarian clinicians, surgeons, rehabilitation experts, prosthetists and others. It will also include patients who have been affected in recent conflicts. Confirmed panellists include representatives from:
  • Shehan Hettiaratchy (Imperial College/UK-MED)
  • Ben Hall (Fox News, author of “Saved”)
  • Tim Goodacre (RCS England)
  • Ram Vadi (Medical Director, UK-MED)
  • Steve Mannion (UK-MED)
  • Nigel Tai (MoD)
  • Giles Duley (Legacy of War Foundation)
  • Ghassan Abu-Sittah (AUB/Imperial College)