Huge steps forward at a Birmingham hospital have led to much better survival rates for soldiers who have suffered terrible injuries in Iraq and Afghanistan.
The study, which has just been published in the Journal of Trauma, highlighted work at the Royal Centre for Defence Medicine, which is based at the Queen Elizabeth Hospital. But the report warned it was important to take action to ensure the expertise and lessons learned was not lost now the two major conflicts had ended.
In the decade to 2012 there were 2,792 UK Military casualties, sustaining 14,252 separate injuries – of which 608 died.
Around 70 per cent of all injuries came from explosions – and the report found over the ten years there was a marked improvement in survival rates.
Improvements in care meant that, over the course of the decade, an estimated 265 casualties survived injuries that would have been judged likely to be fatal at the start of the conflicts.
It found that 572 casualties survived despite injuries classed by the NHS as “life-threatening”, while 38 casualties survived with injures classed as “unsurvivable”. Three-quarters of combat casualties were due to explosive weapons, which is consistent with most of the major wars of the last century.
The evolution of a complex response package, beginning on the battlefield, including emergency surgery in Camp Bastion, Afghanistan, and finally in Birmingham, was attributed to improvements in survival rates.
The study by Navy surgeons and an academic at the University of Birmingham has been described as the fullest examination of battlefield casualties released by a Nato member after a war.
Primary author of the study, Surgeon Lieutenant Commander Jowan Penn-Barwell RN said: “While both the UK military and our American colleagues always believed that survival rates had improved, this is the first time that it has been demonstrated scientifically.
“This study is the most detailed analysis of combat casualties ever released on either side of the Atlantic and is the first to definitively prove that the huge efforts to advance and improve the care of our wounded have been enormously effective.
“It is important to recognise that this work describes the efforts of thousands of people, from the patrol medics out on the ground, to the vast range of surgeons, physicians, nurses, therapists and scientists in both the Defence Medical Services and the NHS, and most importantly the sacrifice of the 2,792 casualties, including the 608 who died in service during this decade.”
The report found that returning patients to a single treatment facility was an important factor, with the expertise concentrated in one area.
It said: “Management of trauma in deployed UK Military medical facilities is both consultant led and consultant delivered. With the high tempo and unpredictability of military operations during the last decade, consultants have gained experience across multiple previous deployments.
“This knowledge is further consolidated by the cyclical predeployment training system through which clinicians returning from deployment instruct their colleagues about to deploy via the bespoke Military Operational Surgical Training (MOST) course run with the assistance of the Royal College of Surgeons of England since 2007.
“This team-based training involves rehearsing damage-control resuscitation and surgical techniques on cadaveric material and third-generation simulation mannequins with the complete team of surgeons, anaesthetists, emergency physicians, and theatre staff using current equipment and protocols.”
The report said it was vital to ensure, for the good of future soldiers, that the expertise is kept.
It said: “It is possible that improvements in UK military trauma system performance achieved during the last ten years might be lost at the cessation of hostilities.
“The associated decreased exposure to severe combat trauma may result in a loss of some of the gains in survival demonstrated by this study in the initial phases of subsequent conflicts.”
And Lt Com Penn-Barwell added: “While it is hard to pin-point individual treatments or techniques that have led to the improvements in survival rates, we have examined every facet of our practice and worked hard to refine and improve it.
“We have done this again and again. And we have worked hard with our NHS colleagues to disseminate these vital, life-saving lessons. It is now of the utmost importance that these advances are maintained in order to care for casualties during any future conflict and to the continued benefit of civilian healthcare.”