Medical matters on Afghanistan war’s front line

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“EVEN my most professional and dedicated personnel are a little bit shocked when they see how much damage an improvised explosive device can do.”

The words of Colonel Mark Pemberton, the officer in charge of Sheffield’s 212 Field Hospital, who is now overseeing the running of the hospital at Camp Bastion.

Although some of the team of medics, doctors and nurses have been to Iraq and Afghanistan before, the severity of roadside bomb blasts has still taken some getting used to.

Col Pemberton, who has been in charge of the regiment for a year, said: “We are very well-trained for dealing with the types of injuries but, having said that, I don’t think anything can prepare you for the complete and utter devastation that comes from an IED bomb.”

Among the worst casualties his staff have dealt with - and there have been around 10 such cases in 212’s first seven weeks of the tour of duty – suffered what Col Pemberton calls “Afghanistan’s signature injury”.

He said: “It’s when a guy who is doing the bomb detection with a hand-held device steps on an IED.

“He has his arm in front of him as he stands on the device – therefore, he inevitably loses the leg on top of the bomb quite high up. He’ll lose the other leg from lower down and the hand holding the detector because it was above the bomb.

“These injuries – a triple amputation and horrific blast wounds to the rest of the body – are beyond comprehension, and would have been unsurvivable even a year or so ago.”

That such casualties survive, Col Pemberton said, is a credit to the training of the soldiers in the field, who are equipped to use tourniquets and first aid.

State-of-the-art tourniquets and field dressings are now used to stem bleeding and keep dirt from wounds. There is also a type of treatment which helps seal wounds.

Before soldiers are deployed, part of their training includes how to deal with amputees, using real-life volunteers who have lost limbs, including former troops.

Other improvements include every patrol being accompanied by a combat medic and doctors based at forward operating bases.

Col Pemberton added: “I want to give great praise and credit to the hospital but we wouldn’t get the casualties here if it wasn’t for the first aid.”

Further improvements in soldiers’ equipment are also helping to reduce the impact of blast injuries. Infantry soldiers are now told to wear specially-made ‘blast pants’ – like cycling shorts, which are made of several layers of fabric and protect the groin from bomb damage – plus cod pieces made from a type of soft Kevlar.

Such items may be a discomfort in the sweltering heat of Helmand, where temperatures can reach 50C in the summer, but can do much to preserve soldiers’ quality of life if they become injured, Col Pemberton said.

Another key factor in saving lives is time. Casualties can be flown back to the hospital from anywhere in the British sector of Helmand, an area of more than 200 square kilometres, with the helicopter ambulance returning in as little as 20 minutes from departure.

In the hospital, Col Pemberton said staff first work trying to save the patient’s life - then “as much of the patients’ limbs as possible”.

This task falls to a dedicated plastic surgeon, who is on hand at Camp Bastion.

For example, if even one finger on a damaged hand can squeeze, there is enough nerve and muscle left for movement to be potentially restored to the rest of the limb via nerve grafts. Such more specialist surgery is carried out once patients have been flown back to the UK or America.

Col Pemberton described how he has seen some “outstanding” treatment in the operating theatre by members of his squadron since their arrival.

He said: “We had one of the signature cases in, and his pelvis had also been disrupted, which is normally fatal, and he was bleeding to death in front of our eyes. The medics were pumping fluid into him and, at the same time, two surgeons opened the abdomen. They found the arteries to the limbs and managed to stop the bleeding.

“At the same time, two orthopaedic surgeons put a frame in place to stop the pelvis from moving. The whole process took four minutes. They saved his life.”

The advanced equipment at Camp Bastion hospital – including cutting-edge CT body scanners – is also a big help to the medics.

“We are only in a pre-fabricated building but the equipment is vastly superior to anything I have seen before,” Col Pemberton said.

The serious injuries dealt with at Camp Bastion hospital means it uses more blood than the whole of the Scottish NHS, according to Col Pemberton.

Most is flown in from the UK and America but, if stocks are running low, there are around 200 people on the base who can be asked to come in and donate.

Col Pemberton said: “We have cases that require more than 100 units of blood – one took 140 units.

“We also use a lot of plasma. It only lasts five days, so we have a delivery every day.”

- 212 Field Hospital is constantly recruiting healthcare professionals. Contact Capt Mike Rutkowski by emailing 212HOSP-ROSO@mod.uk or calling 07771 958311.

- How our local lads are helping keep British forces’ Apache helicopters in the air: see The Star tomorrow.