War zone medicine is revolutionising healthcare

WHEN you're injured in a war zone, the speed and efficiency of your treatment can make the difference between life and death.

That's why some of today's most ground-breaking medical developments are used first on the battlefield before finding their way into the mainstream.

Things such as a mobile X-ray machine that works like a touch-screen telephone, enabling the operator to zoom in on the affected area for a rapid, on-the-spot diagnosis. Or a blood-clotting agent made from seaweed that stops bleeding in minutes.

And a revolutionary, more efficient way of taking blood that means an almost limitless supply.

The wars in Iraq and Afghanistan are pushing the boundaries of modern medicine in these areas, and in the fields of reconstructive surgery, infection control, pain management and physiotherapy.

So, while Kevin McKidd plays a former military surgeon in Grey's Anatomy, bringing the skills learned on the battlefield to a civilian hospital, art is, in fact, imitating life.

Last weekend, the British Conference of Acupuncture and Oriental Medicine in London was introduced to battlefield acupuncture. A super-fast form of pain relief, it involves placing needles in the ear.

This easy access to acupuncture points means treatment is delivered quickly and without the need to lie on a couch, making it ideal for war zones.

"In my own practice I have seen amazing results," says Colonel Heather Pickett, a doctor in the US air force. "Firstly, it allows me to achieve rapid pain relief. Secondly, I can see twice as many patients for initial visits.

"I always carry needles on me when out and about for anyone with headaches, back/neck aches or acute trauma. I've had good results with fibromylagia as well as nausea due to pregnancy."

Unfortunately, this kind of development is nothing new. "What we're doing is fulfilling a very sad tradition," says Col David McArthur, CO of 205 Field Hospital, which has squadrons in Glasgow, Edinburgh, Aberdeen and Dundee, and who recently commanded the hospital at Camp Bastion in Afghanistan.

"It's always been the case that, following wars, we've seen innovations in the way surgical treatments are carried out. We are able to take revolutions in medical care further forward, much faster in a wartime environment than we'd be able to do if we were in the health service."

He adds: "The vast majority of major trauma advances have been made because of warfare. Some of them have been quite legitimate; others less so. The Germans, for example, produced some outstanding work on the treatment of hypothermia on downed aircraft pilots in the Second World War. However, they used prisoners of war and concentration camp victims as part of the tests."

Current treatments for tropical diseases, too, came about because the British Army was so widespread. "These diseases were endemic and represented a huge loss of efficiency. We lost more people through disease up until the 20th century than in war wounds."

Among the 21st century's innovations is a mobile, digital X-ray machine. "Because it's digitised it's a bit like using a touch screen at home. You bang on the icon, the picture comes up, you can zoom in and go for greater resolution on that part, zoom in again ... the pictures are amazingly clear. But the beauty of it is you can then send them wirelessly to the department they're going to. That means the patient can be looked after and nursed much more effectively."

Every soldier is also trained to use a combat applied tourniquet (CAT). "It's a very simple device but it's an absolute life-saver," says Col McArthur. "It's a one and a half inch-wide band with Velcro and the band goes through a series of buckles. When the fire fight is going down and people can't get to you, even if you only have one hand that works, you can apply your tourniquet. You could bleed to death in seconds. But if you can get that tourniquet on, you've saved your own life."

The military are also using a revolutionary product called HemCon, made from seaweed, which causes blood to clot extremely quickly. "It comes in a pad and you can put it on the wound, in the wound, or it can be applied by way of a pressure bandage."

Blood donations, too, are a vital resource, but it's important to ensure donors aren't out of action for long, which is where the apheresis machine comes in. "We can take the blood and put it through the machine, which can break the blood into its constituent parts," says Col McArthur.

"Some of that goes back into the donor so he can go straight back to work; the other bits – the white cell parts and the parts that are needed to assist clotting – can be taken away and administered to the patient. "What this means is that, effectively, you have an almost endless supply."

The big question is, how does this knowledge translate back home? "Many of my surgeons go straight back to the health service and will use some of those techniques in their routine work," says Col McArthur.

"We also have a close relationship with the Royal College of Physicians and will be running a study period with them in November where we formally articulate our views on casualty and trauma care."

So, while the challenges are extreme and the outcomes often tragic, the rest of us continue to benefit from the lessons learned at the front line of medicine.

This article was first published in Scotland On Sunday, 19 September, 2010