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Views & Reviews Review of the Week

Lessons from the killing fields

BMJ 2008; 337 doi: (Published 05 November 2008) Cite this as: BMJ 2008;337:a2394
  1. Jonathan Kaplan, war zone surgeon and writer, London
  1. kaplanj{at}

    A remarkable textbook will allow for the rapid application in surgery of lessons from the wars in Iraq and Afghanistan, finds Jonathan Kaplan

    Combat conditions in Iraq and Afghanistan are producing new patterns of wounds. Advances in body armour allow soldiers to survive explosions that would previously have been mortal, though at the expense of limbs ripped off by blast. The addition of a tourniquet to each soldier’s field kit—and the training to apply it before excessive blood loss—has reduced the death rate through shock from traumatic amputation by 90%, while ultra-rapid evacuation allows soldiers with previously unsurvivable injuries to reach advanced surgical care with vital signs still present. One consequence has been bold advances in the treatment of major trauma. Another consequence, perhaps equally dramatic, has been the rewriting of the war surgery textbook.

    Far from a traditional reference, War Surgery in Afghanistan and Iraq is instead a series of individual case studies in which treatment decisions and their consequences are followed through to their rigorously analysed conclusions. Cases cover every surgical discipline, crossing anatomical and specialty boundaries to …

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