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Left Of Bang Interventions in Trauma: ethical implications for military medical prophylaxis
  1. Neil Eisenstein1,2,
  2. David Naumann1,2,
  3. Daniel Burns1,2,
  4. Sarah Stapley1,
  5. Heather Draper3
  1. 1Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
  2. 2Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
  3. 3Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Major Neil Eisenstein, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK; eisenstein{at}


Advances in medical capability should be accompanied by discussion of their ethical implications. In the military medical context there is a growing interest in developing prophylactic interventions that will mitigate the effects of trauma and improve survival. The ethics of this novel capability are currently unexplored. This paper describes the concept of trauma prophylaxis (Left Of Bang Interventions in Trauma) and outlines some of the ethical issues that need to be considered, including within concept development, research and implementation. Trauma prophylaxis can be divided into interventions that do not (type 1) and those that do (type 2) have medical enhancement as an unintended side effect of their prophylactic action. We conclude that type 1 interventions have much in common with established military medical prophylaxis, and the potentially enhancing qualities of type 2 interventions raise different issues. We welcome further debate on both interventions.

  • prophylaxis
  • military medicine
  • ethics
  • trauma
  • left-of-bang

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  • Contributors NE conceived the article and cowrote it with DN and DB. All authors contributed to critical review. SS and HD provided supervision and direction.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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