Surgeons learning from the war zone

The ancient Greek physician Hippocrates said that "war is the only proper school for surgeons".

After a head-on crash, Dawn Pickett had injuries to her spleen, liver and lungs. Both arms, legs, her pelvis, ribs and foot were broken and at one point her heart stopped. It seemed inconceivable that she would survive.

In techniques pioneered by medics dealing with wounded troops on the frontline in Afghanistan, surgeons managed to save Pickett's life before rebuilding her shattered limbs.

The 32-year-old catering manager is one of the 20,000 trauma injury victims in Britain each year who may have a greater chance of survival because of the progress made by military surgeons.

In the National Health Service the rate of patients who live in spite of injuries that would normally be expected to kill them is 6 per cent. Yet 26 per cent of troops with potentially fatal wounds are surviving.

There is a long history of learning from the battlefield. Anaesthetics were first used during the Crimean War and in World War I the first blood bank was developed and modern plastic surgery was born.

The introduction of penicillin and antibiotics in World War II meant only 10 per cent died of disease, and Mobile Army Surgical Hospitals were developed during the Korean War.

In Afghanistan, roadside bombs have led to injuries on the frontline such as double or triple amputations, severe burns and abdominal and facial injuries. But of the 528 military men and women who have lost their lives in Iraq or Afghanistan, only 36 died of wounds after reaching a hospital.

The severity and number of such injuries has led military surgeons and doctors to cast aside conventional wisdom. Instead of the traditional "scoop and run", they have learned to "stay and treat". The golden hour to save a critically injured patient has been supplanted by the "platinum 10 minutes" at the scene.

In cases of massive haemorrhaging, medics learned it was better to deal with blood loss before the established "airway, breathing then circulation" assessment. They also realised patients were more likely to live if they received swift "damage control" surgery.

So in the case of Pickett, she was initially taken in for an emergency operation so medics could stem her internal bleeding and remove her spleen. Then six days later she underwent more than 17 hours of surgery.

The NHS has reintroduced tourniquets and introduced the drug tranexamic acid, which prevents blood clots breaking down and renewed bleeding.

Infection from fragmenting bombs buried in filthy environments also meant that disease prevention has become a "huge issue," explained Julie Moore, chief executive of University Hospitals Birmingham. Doctors have learnt not to close up wounds but to keep them open and repeatedly clean them out.

Surgeons will focus on the techniques at the new National Institute of Health Research for Surgical Reconstruction and Microbiology, based in Birmingham.

- INDEPENDENT