How medical techniques born on the battlefield saves NHS patients' lives

British trauma surgeons are using lessons learned in Afghanistan and Iraq to keep crime victims alive

It is an unexpected dividend of war. Medical techniques developed through treating injured British soldiers in Iraq and Afghanistan are regularly saving the lives of NHS patients in the UK.

Trauma surgeons are increasingly using battlefield procedures to tackle medical emergencies in Britain such as a knife wound to the heart, a bullet in the lung or the loss of a limb.

Surgeons hope that by applying lessons learned in the conflicts, they will reduce the 16,000 deaths a year caused by trauma, more than 3,000 of which are believed to be preventable.

At the Royal London Hospital in Whitechapel, two or three trauma patients a week have an operation that is partly or wholly based on recent advances in wartime surgery, said vascular surgeon Nigel Tai, who is also a lieutenant-colonel in the army and a military surgeon. He has operated on troops in Iraq and Afghanistan who have been shot or caught in blasts, often involving homemade bombs, known as improvised explosive devices (IEDs).

"You can argue the rights and wrongs of the two ongoing conflicts, but there's no doubt that what we have learned from the way we treat injured patients from these conflicts is increasingly proving of benefit to patients back in the UK," Tai said.

"I get off the plane from a deployment in Afghanistan and go to the Royal London Hospital and I'm doing there, in a major inner-city trauma centre, the same things I've been doing with injured troops."

Previously, people who lost a leg when, for instance, they fell under a train would probably have died. But some have recently survived because doctors from the London-wide Helicopter Emergency Medical Service, which is based at the Royal London, have applied tourniquets to staunch the bleeding with methods soldiers routinely use on severely injured comrades, said Tai. The same action could also prevent someone who had been stabbed in a major blood vessel in the abdomen from bleeding to death.

"Techniques that have evolved and things we have learned in recent years from the conflicts in Iraq and Afghanistan in fields such as the control of bleeding and blood transfusion are being transferred to the care of civilians who have been stabbed in a knife fight, or shot by an assailant, or injured by a fall from height or struck by a car," said Tai.

Last week the Royal London became the first British hospital to make training in "damage control surgery" mandatory for trainee surgeons. Paul Srodon, the vascular surgeon who has devised the training programme, said: "Damage control surgery involves large, dramatic and urgent, but also limited, surgical procedures that are especially relevant to gun and knife injuries.

"They are intended to stop bleeding, avoid the wound getting infected and allow the patient to survive and return later for further surgery. It's about doing the minimum focused major procedure required to pull someone through. A surgeon may only have 90 minutes to save someone's life, so cannot afford to learn on the job."

He cited sewing up a knife wound to the heart and controlling bleeding from a gunshot injury to the lung as examples of practice from the two conflicts buying time for patients who arrive in the hospital's accident and emergency department.

The biggest advance British military surgeons have made is giving bomb-injured soldiers large amounts of blood products during an operation, not just replacement blood, said Tai.

That can ensure that a patient's blood manages to clot and thus help them to survive a spell in theatre tackling their injuries. It is widely credited with saving the lives of troops who would previously have died.

The Royal College of Surgeons is helping spread war-inspired procedures through courses in what it calls definitive surgical trauma skills, where military surgeons such as Tai pass on their knowledge. "That same technique is being increasingly used for critically injured patients in the UK", added Tai, whose postings have included Camp Bastion field hospital in Afghanistan's Helmand province, which has been the scene of heavy British casualties.
