War and medicine
George Porter Hippocrates once said that ‘War is the only proper school for a Surgeon’ (C.460-370BC). Like many quotes from the classical era, this simple sentiment has stood the test of time up to the 20th Century. As we move into the 21st century, however, we can ask if the military still has a role to play in the development of modern medicine. Do advances developed on the battlefield even have a place at home and if they do can we expect to see more medical developments from the military with effective non- military applications? It was a privilege, recently, to meet and discuss these issues with an Anaesthetist, a Captain in the Queen Alexandra's Royal Army Nursing Corps and a Sergeant Combat Medical Technician. This essay was born out of ideas gleaned from these discussions and shall look at the advances in Trauma Medicine specifically, as these were solely made by the military and then transferred to civilian medicine. Prosthetics and Rehabilitative Psychiatry, while significant were more joint projects between civilian and military staff. I will examine these advances in detail to demonstrate ways in which developments on the battlefield have recently improved medicine at home. One such example of a military medicinal advance that has transferred into the civilian sector and proved beneficial is the introduction of Trauma Centres. Major Trauma is defined by NHS England as ‘multiple injuries which could result in death or serious disability,’ for example excessive blood loss or amputation. Before the introduction Trauma Centres a patient who had received trauma would be taken to the Accident and Emergency Department of the nearest hospital via ground or helicopter based ambulance. The problem with this is that while the patient may have a short travel time to the hospital so care is received quickly many, A&E Departments do not have the specialist equipment nor experienced staff to provide comprehensive care to the patients both during and after treatment (1) . This is mainly due to a lack of resources as the equipment for dealing with it is scarce and expensive to maintain (1) . Staff in an average an A&E Department might see Major Trauma once a week or less (1) . Furthermore the specialist staff required for dealing with Major Trauma are quite rare and so cannot be deployed to all hospitals. NATO forces in the Second and Third Gulf Wars (the Iraq and Afghanistan Intervention, respectively) had the same problems in dealing with Major Trauma, especially a lack of the proper equipment. Rather early into the war in Afghanistan (2004) injured troops were, instead of being evacuated to field hospitals, evacuated to the Major Trauma Ward at Camp Bastion for treatment by the specialist staff there. After this in 2010 Trauma Wards such as St Mary's were first introduced in Britain along with Trauma Networks. Trauma Networks, were introduced in 2012, enable casualties to be identified and transferred to the nearest Trauma Centre via improved systems of communication between Clinicians at A&E and Ambulance Personnel (2) . The Trauma Audit and Research Network's (TARN) National Audit in 2013 showed an increase in survival rates for patients with Major Trauma since the introduction of the system, with 1 in 5 patients who would have died under the A&E system now surviving (2) . One issue that seems to be key to the success of Trauma Centres is resources. Individual A&E Departments may be less well equipped to deal with trauma as many of the specialist surgeons are now working in Trauma Centres. This was highlighted when a panel of Surgeons and Ambulance Personnel in Scotland rejected the government's plan to build four Trauma centres, recommending two at most as the personnel needed to staff them would be required in front line A&E care (3) . There has to therefore be a balance at a local level however, I would support the introduction of Trauma Centres as an advance for the much higher quality of after-care given there and increased survival rates. The true advantage of the system lies in the Trauma centres being staffed by after-care
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