 John Duncan considers the debt that civilian practice owes to military surgery
Civilian practice has benefited from the experience of military surgery for centuries. Over the last eight years British medical teams have been serving in Iraq and Afghanistan and the intensity of these engagements has meant that a generation of military doctors has become expert in the management of trauma.
The man in the street knows something of the organisation involved and certainly is acutely aware of the mortality and disability which our forces have sustained. Less clear is the humanitarian nature of the work of the medical services deployed in these war zones. Much of their treatment is of civilians and the ‘enemy’. The media rightly focus on the impact of the conflict on our own troops. It is clear that our medical colleagues treat all combatants with the same skill and humanity.
"It is our own profession which is rather slow to acknowledge the extent to which forces now deployed in Afghanistan are leading the way in the development of trauma care and integrating cutting-edge techniques in an unforgiving and hostile environment"
The spectrum of injuries which present to and are treated in modern conflict has produced huge challenges in logistics and complexity. Modern protective equipment, battlefield stabilisation techniques and rapid evacuation has resulted in many more survivors than would have been expected in previous conflicts. Those survivors bear a burden of disability which we need to acknowledge and manage.
Our forces acknowledge the contribution which medical staff make by awarding its officers with what, in 1898 when the RAMC was set up, was described as ‘substantive rank’. It is our own profession which is rather slow to acknowledge the extent to which forces now deployed in Afghanistan are leading the way in the development of trauma care and integrating cutting-edge techniques in an unforgiving and hostile environment.
The articles of our cover feature show how many of the techniques employed by the Defence Medical Services have resonance in civilian practice.
John Duncan, Editor
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Military surgery: an update from the specialists
In November, surgeons from all grades and specialties visited the College for two days of events about recent developments in trauma. Ballistic Facial Injury and Injury of Conflict were hosted in conjunction with the Royal College of Physicians and Surgeons of Glasgow and 205 Scottish Field Hospital (V). In this special feature, speakers from the events discuss aspects of their presentations.
In the first article, Jon Clasper reviews developments in military surgery over the last 20 years, from the impressive results achieved during the Falklands conflict to present-day experience in Afghanistan. Many of the lessons we continue to learn are finding their way into civilian practice where service redesign may well benefit trauma care in the NHS.
In their joint article, Alasdair McMillan and Jon Mathews discuss teamwork in ballistic injuries and how the military develops teams from individuals, trained in civilian NHS posts. These teams often function in austere and challenging environments, to deliver what has been described by a Health Care Commission review as ‘Exemplary practice from which civilian equivalents can learn’.
Mark Mantle highlights the uro-genital injuries associated with Improvised Explosive Devices and massive lower limb trauma, and illustrates this with cases from recent experience on Op Herrick in Afghanistan. Another complex area for penetrating injury is the pelvis. Due to the nonanatomical nature of the injuries, surgeons may find themselves dealing with damage to multiple organs, including the bony pelvis and challenging bleeding. The teamwork developed in the military operational environment enables damage control resuscitation in the most severely injured patients, giving them the best possible chance of survival.
Finally, Douglas Kennedy discusses penetrating facial trauma. Such injuries are unusual in civilian practice and the experience gained by battlefield injuries has important implications for all specialists involved in this complex area.
Graham T Sunderland, Consultant Colorectal Surgeon and Lieutenant Colonel RAMC (V)
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