Table Of ContentMilitary Medicine in Iraq
and Afghanistan
A Comprehensive Review
http://taylorandfrancis.com
Military Medicine in Iraq
and Afghanistan
A Comprehensive Review
Edited by
Ian Greaves
United Kingdom Defence Medical Services
and
James Cook University Hospital
Middlesbrough, United Kingdom
CRC Press
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Contents
Preface viii
Role of honour xi
Disclaimer xxvi
Introduction xxvii
Contributors xxix
Military abbreviations xxxii
Medical abbreviations xxxviii
A note on operation names xli
Echelons and levels of clinical care xlii
Acknowledgements xliii
Colour plate acknowledgements xlv
1 A brief history of Operations Telic and Herrick 1
2 Organisation of the medical services in Iraq and Afghanistan 42
3 Pre-hospital emergency care 87
4 Emergency medicine and resuscitation 107
5 Anaesthesia and pain management 122
6 Intensive care medicine 139
7 Strategic medical evacuation – The critical care air support team 158
8 Torso trauma 173
9 Limb trauma 186
10 Ballistic weaponry, blast and personal protective equipment development 221
11 Head and neck 247
12 Internal medicine and communicable disease including diet and lifestyle 276
13 Imaging 302
14 Transfusion medicine 322
15 Mental health 347
16 Primary care 384
17 Defence rehabilitation 400
18 Paediatrics 441
19 Trauma governance: Scoring and data analysis 450
20 Ethics, legal and humanitarian issues 458
21 Deployed experience at sea 470
vi
Contents vii
22 Education, training and human factors 485
23 Developments in equipment and therapeutics 510
24 The research dimension 528
Appendix A: Forces deployed on Operation Telic 556
Appendix B: Forces deployed on Operation Herrick 561
Appendix C: Medical units deployed on Operations Telic and Herrick 568
Appendix D: Publications by subject 572
Appendix E: Extracts from the key findings of the CQC Report Defence Medical Services:
A Review of Compliance with the Essential Standards of Quality and Safety 634
Appendix F: Summary of the report Treating Injury and Illness arising on Military Operations
National Audit Office 2010 639
Appendix G: Campaigns in Iraq and Afghanistan reading list 644
Index 647
Preface
A LASTING LEGACY? In the 1990s, there were enormous reduc-
tions in military medicine. Some were sensible
The concept of regular advances in care for the and necessary, but others reduced overall care
military casualty arising from combat experi- pathways and degraded clinical capability. It
ence and forming steps in a continuous process of took until 2006 to achieve real improvement, and
improvement in clinical care is an attractive one the resulting advances in regimes and research
but is an aspiration that more often than not fails innovations described in this book demon-
to happen. The period between conflicts is often strated a capacity for forward thinking and an
associated with loss of corporate knowledge as ability to learn from experience that has been
individuals retire and as the political imperative of great benefit nationally and internationally,
to maintain support (and indeed interest) in the in military and civilian practice alike. By 2014,
Defence Medical Services fades. This is a phenom- however, the reduction in visible warfare in Iraq
enon affecting not only the United Kingdom but and Afghanistan, and the consequent decline in
also the majority of nations. casualty numbers, led to overall reductions in
Unsurprisingly, therefore, most conflicts start military numbers and problems with financial
with limited medical capability. There is thus an management across Defence. The supply of medi-
inevitable need as each conflict progresses for rapid cal capabilities inevitably came once more under
development in the delivery of clinical care to ensure review, with finances being under especially close
that the wounded and ill are looked after, and mor- scrutiny.
tality and morbidity are reduced where possible. It is therefore important that the readers of this
Experience shows that from the Crimean War book are aware that although many of the devel-
onwards, advances in treatment have occurred opments have now found their place in contem-
during conflict, yet there has been relative failure porary civilian practice, the ability of the DMS to
to consolidate this knowledge with the coming of respond in the same way in the future is inevitably
peace. The phenomenon is well accepted by most a function of political support, military commit-
North Atlantic Treaty Organisation forces, but ment and financial policy. Nothing can be taken
medical delivery during periods of peace, or more for granted.
specifically when casualties are not being taken, is What is clear is that effective interaction between
seen as too expensive by the higher commands of primary healthcare, secondary healthcare, nurs-
most nations and indeed by their political leaders. ing, mental healthcare and rehabilitation ensures
It is this perpetual fluctuation in patient manage- the continuance of the best care pathways, reduces
ment that we must try to avoid whilst remaining inappropriate investigation, prevents duplication
fiscally prudent and politically realistic. of effort and consequently facilitates effective care,
viii
Preface ix
allowing, where possible, a successful return to do require commitment from clinicians, command-
active duty. Consequently, the cost is reduced. The ers and politicians alike.
option to see a reduction in medical care as part
of the ‘peace dividend’ will, in the longer term, be Alasdair Walker, CB, OBE, QHS
counterproductive and, perhaps counter- intuitively, Surgeon General 2015–2017
expensive. Working together as multidisciplinary
teams, focusing research profiles and always Martin Bricknell, OStJ, QHP
remembering that the patient is at the heart of all we Surgeon General 2017–
