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Feature Emergency Medicine

Doctors on the front line

BMJ 2010; 340 doi: (Published 18 February 2010) Cite this as: BMJ 2010;340:c379
  1. Helen Macdonald, associate editor
  1. 1BMJ, London WC1H 9JR
  1. hmacdonald{at}

    Images of dead soldiers returning from Afghanistan are frequently in the media, but there would be many more if it were not for the expert medical treatment casualties receive. Helen Macdonald reports

    Multinational forces fighting the Taliban in Afghanistan are experiencing escalating rates of devastating injury and death caused by homemade roadside bombs (improvised explosive devices). The tactic is also putting increased pressure on the military doctors working there.

    Colonel Hodgetts, defence professor of emergency medicine for the College of Emergency Medicine, the body that sets UK training standards and administers examinations in the specialty, has served in war zones every year for the past 10 years. “The severity of the trauma now is worse than anything I have seen,” he says. The improvised devices cause injuries by multiple mechanisms, he explains. The blast can rip limbs off, and penetrating injuries result from pieces of the bomb or its contents (such as nails) or from environmental debris such as stones, wood, or even other injured people. Mechanical trauma can occur if the victim is thrown by the blast, and burns are also common. As well as physical damage, the psychological injuries can be severe.

    The combat environment, injury pattern, and emphasis on pre-hospital management make military medicine and the care delivered to injured soldiers different from that in civilian hospitals. Surgeon Lieutenant Lara Herbert is a junior doctor in emergency medicine. She returned from an operational tour with the joint force medical group in Helmand Province, Afghanistan, in April 2009, working in a front line hospital. Trainees such as Surg Lt Herbert are the first doctors to see casualties, but by the time soldiers reached her, a defined chain of care had already begun.

    Care at the blast

    “All soldiers receive mandatory training in battlefield first aid prior to deployment,” explains Surg Lt Herbert. …

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