Mission creep: an analysis of accident and emergency room activity in a military facility in Bosnia-Herzegovina

OBJECTIVE: To evaluate accident and emergency (A&E) room activity at a Role 3 Multinational Integrated Medical Unit (R3 MIMU) facility in Bosnia-Herzegovina. METHODS: Retrospective analysis of all patients attending the A&E room from 1st October 1999-30th September 2002. RESULTS: 1864 casualties are included in the analysis. 52.1% of casualties were Bosnian, 43.8% were military. Mean age of casualties was 35.5 years (SD 18.3), range 1-88 years. Traumatic injury was the leading cause of presentation (58.1%). Following treatment 66.7% of all cases were discharged or returned to unit, with 19.8% admitted to a ward area. During the 3 year period there was a 5 fold increase in the number of Bosnian nationals treated, this included 80 children (<13 years). CONCLUSION: There has been a dramatic increase in Methods A&E use during the period evaluated, Setting of study particularly by the local population. The increasing number of locals treated, both adult and child, has the potential to undermine the R3 MIMU mission and increase dependency within the Bosnian population. A balance is needed to ensure the staff and functions of a hospital are maintained whilst preserving the capability to deal with an influx of military casualties.