Theatre of war

The doctors and nurses at the state-of-the-art field hospital at Camp Bastion, the main UK military base in Helmand Province, admit it has been a gruelling few months.

But they continue to work round the clock dealing with all the patients brought through their doors, from British troops with Taleban gunshot wounds to Afghan children who have lost both legs to an improvised explosive device (IED).

Colonel Tim Hodgetts, the hospital's medical director, who has previously done four tours in Iraq and two in Afghanistan, jokes that in terms of his working hours it is like being a junior doctor again. "The last month I've been here has been a very intense period," he said. "It's been busier here than probably any other tour I've done, including 2003 in Iraq, and it's been sustained."

About half the casualties admitted to the hospital are British servicemen, some of whom have lost two and sometimes three limbs in IED attacks. The medics also treat other Nato troops based in southern Afghanistan – primarily Americans, but also Danes and Estonians – and Afghan soldiers, police officers and civilians.

The wounded are generally flown in on a UK or US military helicopter and can arrive at any time of the day or night, although there are certain regular peaks in activity. Col Hodgetts said: "Some of the worst things seem to happen in the morning, when the patrols go out and IEDs have been laid in the night. The guys are coming in with horrific amputations."

The 200 hospital staff – currently half Danish, a quarter British and a quarter American – daily treat injuries they would hardly ever encounter at home. That morning an Afghan child had died with a brain injury from an IED blast. Col Hodgetts said: "You would see more paediatric trauma in three months here than you probably would in a lifetime in an NHS hospital. It's quite harrowing for the staff to deal with injured children. The innocence and vulnerability is upsetting."

It has fallen to Royal Navy Surgeon Commander Sarah Stapley, 44, from Gosport, in Hampshire, to operate on many of the shockingly wounded patients that arrive at the hospital. She normally works at the Queen Alexandra Hospital in Portsmouth but has medical experience in Iraq and Afghanistan. "Casualty numbers have been pretty high for the last couple of months unfortunately," she said.

The Camp Bastion field hospital is set up so casualties can be resuscitated in the operating theatre while the surgeons scrub up. At times there can be as many as 20 staff working on a seriously injured patient. Col Hodgetts said: "They can have their operation within minutes of arriving at the hospital. This is critical for our patients, especially bilateral amputees, of whom we see far too many."

People who donate blood in the UK may not realise that a significant amount of it is used to save the lives of wounded British troops in Afghanistan. Some casualties – such as those who have several limbs amputated – need "enormous amounts" of blood, in some cases up to 32 litres.

Col Hodgetts praised the "phenomenal" logistics chain that delivers huge quantities of blood products to Afghanistan. On rare occasions the hospital runs low on blood, but there is no shortage of willing donors in Camp Bastion. "We put a Tannoy message out to the camp, and we were overwhelmed, even though it was in the middle of the night. The US Marines came over in a bus and said, 'we'll help'. The goodwill is absolutely huge," he said.

Critically wounded British troops are generally flown back to the UK within 24 to 48 hours, but Afghans tend to stay in the hospital for longer because they will not receive adequate treatment at local health facilities. Those treated at the hospital can include suspected insurgents, although the staff insist that everyone receives the same care.

Col Hodgetts said: "What we will do is try and use areas of the ward for different types of patient. If necessary we will screen certain patients off. But the fundamental principle for us is we are just treating people to the same standard. I know it must be uncomfortable for the soldiers so be close to a potential enemy, but at the moment that is the way it is, the way that it's been for serial deployments before us."

Many more troops now survive their wounds thanks to the quality of the trauma care offered in Afghanistan. In a study of 296 service personnel and civilians who survived serious injuries after being treated at Camp Bastion field hospital between April 2006 and July 2008, an expert panel found that 75 would not have been expected to live. Col Hodgetts said: "There are people surviving now who probably would not have survived 12 months ago."

But despite these incredible statistics, death is ever present in the hospital. Col Hodgetts deals with all fatalities personally, feeling it is unfair to pass the grim job on to his staff.

"I will have seen between 60 and 70 dead since I got here in mid-July. It's a case of examining the body, doing a death certificate," he said. "It's a horrible, horrible place to be, particularly when you are dealing with our own guys, when you see your own uniform and the extent of the injuries."

He says the medical staff have ways of "defusing" these distressing experiences, but accepts that he is sometimes hit by the scale of the loss of life. "In Iraq I certified the first UK soldier dead, and on a later tour I certified the 100th. That was a particular low point."

INSTANT ACTION WHEN THE CALL COMES IN

COLONEL Tim Hodgetts was doing his ward rounds when a sequence of beeps from his pager alerted him to yet more casualties. Five soldiers – one whose condition was classed as category A, the most serious, two in category B and two in category C – were being flown into the British field hospital at Camp Bastion in Helmand province in 15 minutes. It was not clear at first what nationality they were, but the medics were more interested in what treatment they would need.

Col Hodgetts, the hospital's medical director, put out an urgent announcement over the public address system: "Trauma teams to ED (emergency department)."

The hospital had been relatively empty until then, but all of a sudden it was buzzing with medics readying equipment and donning green plastic aprons and surgical gloves. Exactly 14 minutes later, at 4:39pm, the British medical emergency Chinook helicopter touched down at the nearby landing site.

Four Estonian soldiers who had been hurt by a roadside bomb in Nad-e-Ali in Helmand were quickly transferred into two ambulances for the 200 metre journey to the hospital.

Two of the men were carried in on stretchers while the other two were able to walk out and get into wheelchairs by themselves. Within minutes they were all receiving some of the world's best trauma care.

A fifth Estonian soldier involved in the incident had died from his wounds and was taken straight to the mortuary. Word then came through that more casualties were on their way. At 5:16pm two Pedros – adapted Black Hawk helicopters operated by US Air Force special forces – landed.

Four British soldiers from 4 Rifles injured in an improvised explosive device (IED) blast came off, one on a stretcher and three walking wounded.

One, his top removed to reveal a large tattoo, was on a drip and his camouflage trousers were stained with blood.

In a moment of black humour one of the injured men joked to a comrade whose shirt sleeve had been torn off by medics: "You're going to lose your arm, mate – no more boxing."

At the same time a body bag containing a second dead Estonian soldier was brought off one of the helicopters.

Both 4 Rifles and the Estonian contingent in southern Afghanistan are part of the Welsh Guards battle group based in Nad-e-Ali.

One of the Britons and one of the Estonians were so badly wounded that they will have to be sent home, but the others are expected to be able to return to their units after rehabilitation.