EP.FRI.344 Training in remote and austere emergency surgery - Is it UK relevant or Medical tourism?

Aims Military surgical trainees from ST4 were deployed to Afghanistan. They gained extensive experience of surgical trauma. The placement no longer exists, and the type of deployment has moved from fully equipped, multi-disciplinary team scenario to small team, remote and austere. With increasing specialisation and advancing technology how do surgeons prepare for remote and austere surgery with resource-limited decision making? One consideration is an out-of-programme experience in a developing nation. This needs to be balanced with the impression of “medical tourism. Methods A charity-funded experienced UK general surgeon was needed in an Eastern Province hospital, Rwanda. This provided opportunity for a registrar to assist. “Give back” was by assisting in the training of Rwandan doctors and establishing a stand-alone surgical service.  Results The workload included resource-constrained operative and non-operative management of significant trauma (including head injuries and burns), general surgery, vascular, urology and gynaecology disease in all age groups. 114 operations in 29 working days, Non-operative management decisions were the most challenging, resulting in immersive trauma and emergency surgery experience. The surgery involved unusual operations and creative clinical and technical thinking. There was a significant amount of trauma, most presenting very late, creating management complexities due to infection risk.  Conclusions The role of remote and austere surgery is applicable to UK trainees, in particular military trainees, those who wish to work in remote and austere environments and for real life critical thinking exposure that could apply to resource limitation or delay-to-surgery in mass casualty situations.