Battlefield medicine
HOW MILITARY MEDICS SAVE THE LIVES OF SOLDIERS DURING CONFLICT
We speak to a combat medic and discover how the military trains personnel to save lives on the front line
All throughout history, conflicts around the world have directly affected how civilian medicine has evolved, with countless advancements and inventions born on the battlefield. During his reign from 27 BCE to 14 CE, the Roman emperor Augustus was one of the first to establish military medical academies to train an army of war doctors to treat his fallen soldiers. These Roman surgeons were given practical experience on the battlefield and carried tool kits containing earlier versions of inventions that are still used today, such as scalpels, forceps and tourniquets.
Dominique Jean Larrey, a French surgeon, is credited with inventing a lightweight horsedrawn wagon to ferry fallen soldiers quickly from the battlefield to receive immediate care in the late 1700s. These wagons were known as ‘flying ambulances’ and were the start of the development of the modern-day ambulance. Larrey is often referred to as the first military surgeon, pioneering amputation techniques and gunshot wound treatments. He was also the first to treat fallen soldiers according to the severity of their injuries, now referred to as triage, as opposed to their social class.
One of the biggest advancements in medicine came about during World War II: the development of the drug penicillin. Though the ‘miracle drug’ was accidentally discovered by Alexander Fleming in 1928, penicillin has saved countless military and civilian lives since. As the world’s first antibiotic, Fleming noticed that bacteria couldn’t survive in its presence, but ceased work on the drug in 1931, having published his findings in 1929. However, scientists Howard W. Florey and Ernst B. Chain
continued the drug’s development on the cusp of World War II. Florey took penicillin research to the US, which had just joined Britain’s side in the war, in December 1941. Seeing the potential to save many soldiers’ lives from infections that had devastated the ranks in World War I, the US agreed to produce the drug. By 1944, US companies were producing 100 billion units of penicillin per month.
MODERN-DAY MEDICINE
Every country has its own structure and strategies to provide a medical response. All soldiers, sailors and airmen are instructed and trained to deliver the same life-saving care. In the British Armed Forces, at the point a soldier has incurred a combat injury, such as a bullet wound, burn or broken bone, what follows is known as pre-hospital emergency care. Ideally, no more than the next two hours are spent stabilising the injured soldier in preparation for delivery to a hospital for further treatment.
“Within ten minutes of injury – we call this the platinum ten minutes – soldiers should have immediate life-saving care delivered to them,” says Lieutenant Colonel Harvey Pynn, defence consultant advisor in pre-hospital emergency care. This care is delivered by their nearest colleague – all personnel receive annual training in life-saving first aid. “In this sort of instance, they stop life-threatening bleeding, keep airways open and make sure patients are safe and they survive that initial insult,” adds Pynn.
Every UK serviceman or woman carries a certain amount of medical equipment, which includes medical gloves, two tourniquets and an emergency pressure dressing. Tourniquets help to combat catastrophic external haemorrhage on a limb. When vital arteries or veins are severed, 40 per cent of blood can be lost within three to four minutes. These vice-like devices work to squeeze blood vessels against solid structures such as bone, stopping blood flow through the vessels and preventing large amounts of blood loss. “Tourniquets probably saved more lives during the Afghanistan campaign than any other intervention,” says Pynn.
To provide immediate pain relief, all UK service personnel carry a small lollipop-looking device called a fentanyl lozenge. However, rather than sucking on the lozenge, it’s rubbed on the cheeks of the patient to release the strong opiate drug, which much like morphine is an effective painkiller.
Medical care is continuous. Once lifethreatening external bleeding has been addressed in the platinum ten minutes, further life-saving interventions are undertaken as soon as possible thereafter. Combat medics – who receive 26 weeks of medical training – are rapidly deployed or the casualty is brought to them. A combat medic will have a greater range of medical skills and will commence ‘damage control resuscitation’, focusing on replacing lost blood. To address some of the most critical patient injuries, combat medics descend upon the patient with several pieces of life-saving equipment and medication.
One of these life-saving medications is tranexamic acid (TXA), administered via blood