Intended for healthcare professionals

Career Focus

Mobilised to Iraq: a surgical trainee's tale

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7447.s178 (Published 01 May 2004) Cite this as: BMJ 2004;328:s178
  1. Jo Krysa, specialist registrar in general surgery
  1. Maidstone General Hospital, Kent ME16 9QQ

Mobilisation papers to go to Iraq arrived on my desk during the first year of my specialist registrar training in surgery.

I have been in the territorial army for over four years, but the unit had not been deployed since the second world war and so compulsory mobilisation was a bit of a shock. At that time I did not know how my training would be affected, and to be honest the idea of spending six months in Iraq scared me. I was given two weeks to organise my life and present myself at the army unit. My deployment was fully supported by my family and the programme director of the higher surgical training committee, for which I am grateful. I completed the predeployment training and arrived in Iraq at the beginning of July.

“Heat illness”

We spent five days acclimatising in Kuwait. We then moved on to our respective posts. I was a medical officer in a role 1 facility, tasked with stabilising trauma casualties and providing primary care to the troops. I worked with several trauma cases, but most patients needed primary care advice and treatment. Many soldiers suffered from the heat. The term “heat illness” covers any casualty incapacitated by heat related symptoms such as headaches, nausea, and dizziness, whether their core temperature is raised or not. In severe cases heat illness can lead to heat stroke, which includes two critical factors: a reduced level of consciousness and a core temperature above 40°C, which can lead to renal and cardiac failure.

Damage control surgery

After a few weeks I was moved to a role 2 facility. Its job was to stabilise trauma patients and to provide damage control surgery. Helicopter evacuation time to the hospital was about 45 minutes; if a patient needed emergency surgery within that time, we had the capability to operate. As the local medical facilities were not up to the NHS standard, the damage control surgical team was also a back up facility in case casualty evacuation was not possible.

Figure1

Future patients?

Credit: AHMED AL-RUBAYE/GETTY

Working in a role 2 facility was interesting. I was part of the immediate response team, which meant we were on a five minute standby to recover casualties by helicopter. Treating patients without the immediate back up of pathology or radiology departments was a learning experience. Doing an old fashioned bleeding time test to assess the coagulation state of a snake bite victim took me right back to the basics.

Field hospital

The rest of my tour was spent in the field hospital. This was where the definitive surgery was carried out. It had most of the departments you'd expect to find in an NHS hospital, but it didn't stretch to some of the more specialised services such as angiography and computed tomography. In one month the hospital admitted a few patients with shrapnel wounds, gunshot wounds, and blast injuries. Other surgical cases included patients with appendicitis and abscesses. We also admitted many patients with diarrhoea and vomiting, and musculoskeletal problems, and a few with renal colic, and bites. Overall, I had some surgical exposure but not much.

Highlights

The highlights of being mobilised included a sense of comradeship, working as part of a team, and a feeling of achievement at the end of the tour. It was a unique learning experience—treating a wide variety of patients with acute pathophysiology in an unfamiliar culture. Managing acute trauma such as gunshot wounds was particularly valuable as the number of ballistic casualties being admitted to UK hospitals is increasing. We also did a structured battlefield advanced trauma life support course.

Limited surgical exposure

Overall, however, I do not feel that I had enough surgical exposure for this experience to count towards my surgical training. My certificate of completion of surgical training date has rightly been postponed for six months.

During the tour my role was that of a general doctor covering general medicine, general surgery, and orthopaedics. At my level of training I felt confident to cover a variety of specialties as the basic surgical training was still fresh in my mind.

But with increasing subspecialisation in both medicine and surgery in this country, will the NHS be able to provide truly general territorial army doctors? At the moment, the posts are being filled by experienced physicians and surgeons, some of whom have retired from the NHS. They had much longer training in different subspecialties than the current trainees.

If the army plans to rely on territorial army soldiers to provide medical services, it may need to consider training junior doctors specifically for the role.

Footnotes

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