What war is good forBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2416 (Published 20 April 2011) Cite this as: BMJ 2011;342:d2416
All rapid responses
There is no doubt that there have been significant surgical advances
during periods of war resulting in decreased morbidity and mortality. The
well-acclaimed account of Ambroise Pare's contribution during the 16th
century to gunshot wound healing is an example of this. In addition, there
have been accounts of advances in management of traumatic nasal injuries
in army officers and skin grafting to injured soldiers during war times in
the 19th century. One of the more recent examples is the evolution of
plastic and reconstructive surgery as a specialty in the United Kingdom
during world wars one and two, which had little recognition as a specialty
prior to world war one (1).
Civilian casualties during natural state disasters such as tornado's,
hurricanes and earthquakes can have a significant impact on civilian
morbidity and mortality. Recent natural disasters such as the Tsunami and
earthquake in Japan are a prime example of this. There is no doubt that
the injuries sustained from ballistics differs from those sustained during
natural disasters, mostly due to the mechanism of injury. However,
principles of patient stabilization by adhering to principles learnt from
advanced trauma life support still remain. The patient population during
natural disasters also differs, with fewer young fit servicemen and
intermingled with the very young and the elderly. This poses greater
challenges and requires experience. Reports from the United States navy
suggest that complex craniofacial surgery can be delivered during natural
disasters, provided there are systems in place (2).
Trained personnel deployed in modern war times have reflected on
lessons learnt abroad. The transportation of injured civilians by trained
personnel in Aeromedical Evacuation is an example with training in
transportation of injured individuals, taking into account the stresses of
altitude during transfer, medical interventions and the role of patient
safety. Individuals are usually from a range of specialties including
plastic surgery, intensive care, emergency medicine and burns (4). It is
these individuals that are called upon and serve the state during natural
disasters. Therefore, though many lessons are learnt from war, we can als
oadd to our experience during times of natural disasters. However, our
significant military experience abroad may not be as easily transferrable
to our National Health Service at present, which is not often faced by
military trauma or the magnitude of natural disasters seen in recent times
by the Indian ocean Tsunami, earthquake in Haiti or the devastation caused
in Japan (3).
Although no direct comparisons can be made, we are aware of what 'war
can be good for'. However, for all accounts of war dating back in history
as long as human existence, I am almost certain natural disasters have
plagued earth for much longer.
1. Chambers JA, Ray PD. Achieving growth and excellence in medicine:
the case history of armed conflict and modern reconstructive surgery. Ann
Plast Surg. 2009 Nov;63(5):473-8.
2. Ray JM, Lindsay RW, Kumar AR. Treatment of earthquake-related
craniofacial injuries aboard the USNS Comfort during Operation Unified
Response. Plast Reconstr Surg. Dec;126(6):2102-8.
3. Hettiaratchy S, Tai N, Mahoney P, Hodgetts T. UK's NHS trauma
systems: lessons from military experience. Lancet. Jul 17;376(9736):149-
4. Moore W. What war is good for. BMJ.342:d2416.
Competing interests: No competing interests