Lessons from the battlefield

doi:10.1136/bmj.39568.496424.94

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Anne Gulland, freelance journalist

¹London

annecgulland{at}yahoo.co.uk

Last month the UK government announced it wanted non-military doctors to work in Afghanistan and Iraq. Anne Gulland investigates what they might learn

War is a very efficient schoolmaster, said an unnamed US surgeon general quoted in historian Roger Cooter’s study on the effects of war on medicine.1 That phrase could have been uttered by Colonel Tim Hodgetts, defence consultant adviser in emergency medicine and honorary professor of emergency medicine at Birmingham University. He has been nurturing the specialty of emergency medicine since its introduction to the armed forces in Kosovo in 1999.

Emergency medicine’s importance and influence has risen exponentially since then, says Colonel Hodgetts. So much so that: “In terms of managing serious injury we are several steps ahead of what the NHS does.”

First class care

A solider injured in Afghanistan or Iraq will get treatment that a pedestrian knocked down by a car on a high street in the United Kingdom could only dream of. To start with, he will be surrounded by soldiers who are trained and tested in first aid annually—a quarter of whom will have advanced first aid training and carry extra equipment including a HemCon bandage made of a positively charged material that attracts negatively charged red blood cells and rapidly stops blood flow, a tourniquet that can be applied with one hand, and a suction device for clearing the airway. This first aid kit shows how the military has changed the model of treatment of severely injured patients from airway, breathing, and circulation to chronic haemorrhage, airway, breathing, and circulation. Care is embedded at the point of wounding, says Colonel Hodgetts.

The soldier will then be picked up by a helicopter carrying a crew of emergency medics, one of whom will either be a consultant anaesthetist or a consultant emergency specialist. “We are …