Lessons and legacies of warBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1119 (Published 25 February 2010) Cite this as: BMJ 2010;340:c1119
All rapid responses
During the recent unrest in Kashmir ambulances as well as the private
cars of various healthcare professionals played a very pivotal role in the
continued functioning of various hospitals.As the streets were plagued
with fighting between stone pelting youth and the police, these vehicles
were attacked by both the parties on several occasions. Numerous incidents
of damage to the ambulances and cars were reported. The occupants were
roughed up regularly.Most of the staff travelled to hospitals in
Ambulances are adorned with passive visual warnings including a prominent
emblem. In Kashmir the international Red Cross carried out an information
drive whereby hospitals as well as doctors were asked not to display the
Red Cross symbol on their ambulances and private vehicles. It was also
requested that the Red Cross symbol be replaced by the Star of Life.It is
pertinent to mention that the Red Cross symbol is copyright protected.
Over a period of time, the star of life was painted on all ambulances
and private vehicles in Kashmir. The Star of Life is a blue, six-pointed
star, outlined with a white border which features the Rod of Asclepius in
the center, originally designed and governed by the U.S. National Highway
Traffic Safety Administration (NHTSA) (under the United States Department
of Transportation, DOT).
During the prolonged unrest in the valley of Kashmir, the ambulance
drivers and healthcare professsionals regularly reported that the crowds
and the security personnel who stopped them found the symbol to be
incomprehensible. Almost all drivers and occupants of the vehicles thought
that the symbol was not 'protective', under those conditions.
The red cross, in comparison, is however universally seen as a symbol of
humanity. To avoid frequent attacks and checks, some healthcare
professionals started putting prominent red cross markings on their
ambulances during their movement in the streets. This was done in an
unauthorised manner. A significant drop in the number of attacks and
checks was reported. This method has caught on to the extent that almost
all ambulances and vehicles plying on the roads at this moment have Red
Cross insignias prominently displayed on their bodywork.
This does bring into question the influence and propriety of copyright
protected symbols in conflict zones especially when pivotal workers like
ambulance drivers and other healthcare professionals feel a sense of
safety provided by them. Is it important to prevent 'misuse' of copyright
protected symbols in situations where the delivery of health care is
helped by this misuse?
Competing interests: No competing interests
In your article “Lessons and legacies of war” your associate editor asks
your readership to let her know about lessons from modern warfare. In the
field of prehospital medicine I need only to look at my new Intraosseous
drill, and my tourniquet (now back in favour) to infer lessons learnt of
the toll on all sides in the recent conflicts.
However, the article concerning the ethics of Priority treatment for
veterans and it’s suggestion that the moralistic question should be passed
to Parliament is Intriguing.
Britain currently has 5 million veterans, who until 1/1/2008 were entitled
to priority treatment only relating to the condition(s) for which they
receive a war pension.
Following the new department of health guidance now all veterans are
entitled to priority treatment from the NHS.
There are approximately 140,000 armed forces personnel serving in the UK,
Leave each year. Many will have served in combat zones. Physical wounds
may be obvious but as you are aware the symptoms of PTSD may show
themselves several years after the event.
If we take previous reports we can expect future veterans to have higher
rates of mental health problems, illicit drug use and alcoholism than
their peers. With the mental health foundation having quoted frontline
soldiers under 24 being three times as likely to commit suicide than their
cohorts, and evidence suggesting a disproportionate number of homeless
persons being ex service, the future may not seem so bright for a few of
our frontline personnel.
In the article it states that it is Parliament who should adjudicate on
the issue of priority treatment . Since 2008 as a result of the new
guidance, “ Parliament” has already decided , and we as Clinicians should
now give veterans priority, the ethics and morals already determined by
who we voted for .
What we need now is robust policies . The work of the Charities such as
The Royal British legion, Combat Stress et al ,is excellent, but for the
guidance to work ,the whole of our health organisation needs clarity of
Primary care physicians need clearer guidance of conditions deemed related
to service, and secondary care need clear referral pathways and relevant
commissioning mechanisms in place to streamline veterans` care.
It is now all of our responsibility to avoid the follies of the past and
prepare for our veterans future health and social needs.
Dr Ian Morris
GP South West.
Articles cited BMJ 2010;340;c642
Competing interests: No competing interests