EP 112 Mind The Gap. How to Map Applicability of Civilian Trauma Guidelines to Military Practice
Prashanth Ramaraj, Ben Watkins, Nigel TaiAbstract
Aims
To create and evaluate a methodology for gauging military applicability of civilian guidelines, and to identify capability gaps derived from the 2025 ESVS Vascular Trauma guidelines.
Methods
Each ESVS guideline was reviewed and analysed for translatability to military surgical practice in terms of 1) unacceptable disparity between civilian and military evidence 2) applicability (surgical training: general surgery, vascular surgery); infrastructure/equipment availability (Role 2 Enhanced, Role 3, Role 4); 3) Other. Where guidelines were not applicable, authors identified capability gaps and suggested potential solutions. Each guideline was also rated in terms of timelined implementability (now, <2 yr, > 2yrs) to take account of likely developments in military surgical capability. Two raters independently undertook this with arbitration by a third.
Results
46% (48/105) of the guidelines are not currently applicable to military surgical practice in the R2E setting, and 24% (25/105) are not achievable at R3. Four main capability gaps are identified. 36% (38/105) recommendations were not achievable due to “CT scanner” capability gaps. 21% (22/105) of recommendations were not achievable due to “endovascular” capability gaps. 22% (23/105) of recommendations being achievable was dependent on “surgeon capabilities”. 5% (5/105) being achievable was dependent on “resources” availability.
Conclusion
Whilst useful, caution has to be applied when considering translation of civilian-derived surgical guidelines for military surgeons. The methodology allows analysis of guidelines in a structured manner which may be applicable in generic fashion. The subset of ESVS guidelines that were deemed suitable for military practice will help to inform military clinical practice guidelines.