Matthew Keith Charalambos Arnaouti (Boston, MA / US), Emad Madha (Boston, MA / US), Michael David Baird (Boston, MA / US; Bethesda, NY / US), John Whitaker (Birmingham / GB; London / GB), Aldo Ayvar-Fuentes (Callao / PE), Ghassan Alswaiti (Amman / JO), Amila Ratnayake (Colombo / LK), Tamara J. Worlton (Bethesda, NY / US), Michelle Nyah Joseph (Boston, MA / US; Bethesda, NY / US; Coventry / GB)
Abstract text (incl. references and figure legends)
Objectives Trauma is a leading cause of morbidity and mortality. Military-Civilian Partnerships (MCP) can be mutually beneficial in trauma care delivery and advancement. Nation specific guidelines for developing MCPs in High Income Countries (HIC) exist, but are not globally transferable. The role of MCPs to support developing trauma care in other settings, including Low- and Middle-Income Countries (LMICs), is unclear. The literature was reviewed to identify themes, and to inform an international framework.
Methods An extensive scoping review was performed, to identify literature describing Mil-Civ trauma systems integration. Multi-stage screening was then conducted. After inclusion, articles were analysed to delineate whether the response was related to disaster or armed conflict, relevant data was extracted and coded into themes, and the level of integration was assessed. Author affiliation and study location were classified by World Bank income group.
Results 8172 studies were screened, 74 met inclusion criteria. Experiences in 22 nations were described. The majority (91.9%) of authors were affiliated with institutions in HICs. Identified themes included: skill sustainment, academic integration, geography, event-based integration, and high-level government support. Level of integration consisted of coordination (16.2%), collaboration with formal agreement (50%), partial (24.3%), and full-integration (9.5%). 18 studies described experiences in LMICs, 17 occurring only in response to an event (14 disasters, 2 conflicts, 1 during both disaster and conflict). Only six (33.3%) papers describing experiences in LMICs included authors from that setting.
Conclusion Based on available literature, MCPs largely occur in HICs where partnerships can benefit both sectors. Examples identified in LMICs are limited to event-based partnerships. Further prospective investigation into MCPs in LMICs is needed to identify factors supporting successful integration in those settings.
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