Skip to main content Accessibility help
×
Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T06:50:45.618Z Has data issue: false hasContentIssue false

Chapter 14 - The Changing Face of Clinical Medicine in Major Trauma

Lessons from Civilian Practice and Military Deployments

from Section 2 - Clinical Aspects of Traumatic Injuries, Epidemics, and Pandemics

Published online by Cambridge University Press:  11 January 2024

Richard Williams
Affiliation:
University of South Wales
Verity Kemp
Affiliation:
Independent Health Emergency Planning Consultant
Keith Porter
Affiliation:
University of Birmingham
Tim Healing
Affiliation:
Worshipful Society of Apothecaries of London
John Drury
Affiliation:
University of Sussex
Get access

Summary

The survival rate of 90% among wounded UK troops in Afghanistan (2004–2014) was the highest in the history of warfare. Foremost among these were severely disabled amputees, who emerged as an unexpected cohort of survivors of critical injuries. Soldiers who would have died from injuries in earlier wars were kept alive thanks to fellow soldiers highly trained in trauma medicine, paramedics who accompanied the helicopters, and the trauma care that the troops later received in hospital. We discuss our UK experience of learning from warfare, what made a difference, and how new knowledge could be used to improve physical injury and mental health related to trauma care in the UK. For the sake and sacrifice of our fallen and injured soldiers and for the benefit of our future NHS patients, an obligation rests with the NHS to allow the lessons learned from past conflicts to benefit the injured of the future.

Type
Chapter
Information
Major Incidents, Pandemics and Mental Health
The Psychosocial Aspects of Health Emergencies, Incidents, Disasters and Disease Outbreaks
, pp. 89 - 98
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Houses of Common. Defence Committee Second Report. House of Commons, 2000.Google Scholar
Hodgetts, T, Kenward, G, Masud, S. Lessons from the first operational deployment of emergency medicine. J R Army Med Corps 2000; 146: 134–42.CrossRefGoogle Scholar
National Audit Office. Major Trauma Care in England. National Audit Office, 2010.Google Scholar
McMonagle, M. Trauma: Who Cares? National Confidential Enquiry into Patient Outcome and Death, 2007.Google Scholar
Hodgetts, T, Russell, R, Russell, M, Mahoney, P, Kenward, G. Evaluation of clinician attitudes to the implementation of novel haemostatics. J R Army Med Corps 2005; 151: 139–41.CrossRefGoogle Scholar
Mahoney, P, Hodgetts, T, Russell, R, Russell, M. Novel haemostatic techniques in military medicine. J R Army Med Corps 2005; 151: 176–8.CrossRefGoogle ScholarPubMed
Fear, N, Jones, E, Groom, M, Greenberg, N, Hull, L, Hodgetts, T, et al. Symptoms of post-concussional syndrome are non-specifically related to mild traumatic brain injury in UK Armed Forces personnel on return from deployment in Iraq: an analysis of self-reported data. Psychol Med 2009; 39: 1379–87.CrossRefGoogle ScholarPubMed
Hodgetts, T, Mahoney, P, Kirkman, E, Midwinter, M. Damage control resuscitation. J R Army Med Corps 2007; 153: 299300.Google Scholar
Bellamy, RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med 1984; 149: 5562.CrossRefGoogle ScholarPubMed
Bellamy, RF, Maningas, PA, Vayer, JS. Epidemiology of trauma: military experience. Ann Emerg Med 1986; 15: 1384–8.CrossRefGoogle ScholarPubMed
Hodgetts, T, Mahoney, P, Clasper, J. Battlefield Advanced Trauma Life Support 4th ed. Joint Service Publication, 2008.Google Scholar
Hodgetts, T, Mahoney, P, Evans, G, Brooks, A. Battlefield advanced trauma life support: 3. J R Army Med Corps 2006; 152(suppl); 4.Google Scholar
Hodgetts, TJ, Mahoney, PF, Russell, MQ, Byers, M. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J 2006; 23: 745–6.Google Scholar
Hodgetts, T, Russell, R, Russell, M, Mahoney, P, Kenward, G. Evaluation of clinician attitudes to the implementation of novel haemostatics. J R Army Med Corps 2005; 151: 139–41.CrossRefGoogle Scholar
Kirkman, E, Watts, S, Hodgetts, T, Mahoney, P, Rawlinson, S, Midwinter, M. A proactive approach to the coagulopathy of trauma: the rationale and guidelines for treatment. J R Army Med Corps 2007; 153: 302–6.CrossRefGoogle Scholar
Jansen, JO, Thomas, R, Loudon, MA, Brooks, A. Damage control resuscitation for patients with major trauma. BMJ 2009; 338: b1778.CrossRefGoogle ScholarPubMed
Wright, C, Mahoney, P, Hodgetts, T, Russell, R. Fluid resuscitation: a Defence Medical Services Delphi study into current practice. J R Army Med Corps 2009; 155: 99104.CrossRefGoogle ScholarPubMed
Jackson, G. Ashpole, K. Yentis, S. The TEG vs the ROTEM thromboelastography/thromboelastometry systems. Anaesthesia 2009; 64: 212–15.Google Scholar
Koch, CG, Li, L, Daniel, I, Sessler, DI, Figueroa, P, Hoeltge, GA, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–39Google Scholar
Kenet, G, Walden, R, Eldad, A, Martinowitz, U. Treatment of traumatic bleeding with recombinant factor VIIa. Lancet 1999; 354: 1879.CrossRefGoogle ScholarPubMed
Williams, D, McCarthy, R. Recombinant activated factor VII and perioperative blood loss. Lancet 2003: 361: 1745.CrossRefGoogle ScholarPubMed
Hodgetts, T, Mahoney, P, Kirkman, E, Russell, R, Thomas, R. UK Defence Medical Services guidance for use of recombinant factor VIIa in the deployed military setting. J R Army Med Corps 2007; 153: 307–9.CrossRefGoogle ScholarPubMed
Mercer, S, Tarmey, N, Woolley, T, Wood, P, Mahoney, P. Haemorrhage and coagulopathy in the Defence Medical Services. Anaesthesia 2013; 68(suppl 1): 4960.CrossRefGoogle ScholarPubMed
Tai, N, Russell, R. Right turn resuscitation: frequently asked questions. J R Army Med Corps 2011; 157(suppl 1): s310–14.CrossRefGoogle ScholarPubMed
Blackbourne, LH. Combat damage control surgery. Crit Care Med 2008; 36(suppl): s304–10.Google Scholar
The Royal College of Radiologists. Standards of Practice and Guidance for Trauma Radiology in Severely Injured Patients. National Institute for Health and Care Excellence, 2015 (www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr155_traumaradiol.pdf).Google Scholar
Trauma Audit and Research Network (www.tarn.ac.uk).Google Scholar
Clasper, JC, Aldington, DJ. Regional anaesthesia, ballistic limb trauma and acute compartment syndrome. J R Army Med Corps 2010; 156: 77–8.CrossRefGoogle ScholarPubMed
Iversen, A. Greenberg, N. Mental health of regular and reserve military veterans. Adv Psychiatr Treat 2009; 15: 100106.CrossRefGoogle Scholar
Lee, C, Porter, K, Hodgetts, T. Tourniquet use in the civilian pre-hospital setting. Emerg Med J 2007; 24: 584–7.CrossRefGoogle Scholar
Hodgetts, T, Mahoney, P. The military tourniquet: a response. J R Army Med Corps 2007; 153: 1015.Google Scholar
McLeod, J, Hodgetts, T, Mahoney, P. Combat ‘Category A’ calls: evaluating the pre-hospital timelines in a military trauma system. J R Army Med Corps 2007; 153: 266–8.CrossRefGoogle Scholar
Breeze, J, Bowley, DM, Harrisson, SE, Dye, J, Neal, C, Bell, RS, et al. Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts. J Neurol Neurosurg Psychiatry 2020; 91: 359–65.Google Scholar
Cooper, B, Mahoney, P, Hodgetts, T, Mellor, A. Intra-osseous access (EZ-IO) for resuscitation: UK military combat experience. J R Army Med Corps 2007; 153: 314–16.Google Scholar
Russell, R, Hodgetts, T, McLeod, J, Starkey, K, Mahoney, P, Harrison, K, et al. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Philos Trans R Soc Lond B Biol Sci 2011; 366: 171–91.Google Scholar
Lockey, D, Crewdson, K, Davies, G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 2006; 48: 240–44.CrossRefGoogle ScholarPubMed
Hoejenbos, M, McManus, J, Hodgetts, T. Is there one optimal medical treatment and evacuation chain for all situations: ‘scoop-and-run’ or ‘stay-and-play’. Prehosp Disaster Med 2008; 23: s74–8.CrossRefGoogle ScholarPubMed
Cowley, RA. A total emergency medical system for the State of Maryland. Md State Med J 1975; 24: 3745.Google ScholarPubMed
Penn-Barwell, J, Roberts, S, Midwinter, M, Bishop, J. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma Acute Care Surg 2015; 78: 1014–20.Google Scholar
Russell, R, Hodgetts, T, Ollerton, J, Massetti, P, Skeet, J, Bray, I, et al. The operational emergency department attendance register: a new epidemiological tool. J R Army Med Corps 2007; 153: 244–50.CrossRefGoogle Scholar
Hodgetts, T, Mahoney, P, Evans, G, Brooks, A. Battlefield advanced trauma life support: 1. J R Army Med Corps 2006; 152(suppl); 572.Google Scholar
Hodgetts, T, Mahoney, P, Evans, G, Brooks, A. Battlefield advanced trauma life support: 2. J R Army Med Corps 2006; 152(suppl); 4.Google Scholar
Hodgetts, T, ed. Clinical Guidelines for Operations. Joint Defence Publication 4-03.1. Development, Concepts and Doctrine Centre, 2009.Google Scholar
Hodgetts, TJ. Lessons from the Musgrave Park Hospital bombing. Injury 1993; 24: 219–21.Google Scholar
Hodgetts, T, Mackway-Jones, K. Major Incident Medical Management and Support: The Practical Approach. BMJ Publishing, 1995.Google Scholar
Hodgetts, T. Training for major incidents: evaluation of perceived ability after exposure to a systematic approach. Pre-Hosp Immed Care 2000; 4: 1116.Google Scholar
Malik, NS, Chernbumroong, S, Xu, Y, Vassallo, J, Lee, J, Bowley, DM, et al. The BCD Triage Sieve outperforms all existing major incident triage tools: comparative analysis using the UK national trauma registry population. EClinicalMedicine 2021; 36: 100888.Google Scholar
Bennett, AN, Dyball, DM, Boos, CJ, Fear, NT, Schofield, S, Bull, AMJ, et al. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study. BMJ Open 2020; 10: e037850.CrossRefGoogle ScholarPubMed
Inoue, C, Shawler, E, Jordan, CH, Jackson, CA. Veteran and Military Mental Health Issues. StatPearls Publishing, 2023.Google ScholarPubMed
Dyball, D, Bennett, AN, Schofield, S, Cullinan, P, Boos, C, Bull, A, et al. Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study. Lancet 2022; 9: 547.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×