Learning lessons from the battlefield

It is an ironic fact that some of the greatest medical and surgical breakthroughs and innovations have happened as a result of war and armed conflicts. The Romans, for example, introduced the first military medical corps to deal with battlefield casualties, where the first tourniquets were also employed to control blood loss and opium derived from poppies was administered to patients for use as pain relief. Other Roman innovations included the sterilisation of medical instruments by vinegar and also the application of honey-based dressings to control wound infection. More was to follow in later conflicts with the first recorded use of horse-drawn ambulances to remove battlefield casualties by the French army in the Napoleonic Wars, followed by pioneering advances in infection control techniques on casualties during World War Two, right up to the introduction of emergency medicine itself as a specialty in the armed forces in Kosovo in 1999 – all of which outline how the lessons learned on the battlefield can later be successfully employed within civilian medicine. Thanks to the continuing partnership between NHS Blood & Transplant (NHSBT) and the UK military’s Blood Supply Team, combined with new advances in pre-hospital care and trauma surgery to control massive blood loss, British and allied troops on duty in Afghanistan are currently experiencing the highest ever survival rates for lifethreatening injuries in the history of warfare. Opened in 2003, the combined operations field hospital and headquarters of the British forces at Camp Bastion, Afghanistan contains a state-of-the-art medical complex that rivals any similarsized NHS hospital facilities. Containing 40 beds and employing 100 military staff and five emergency room doctors, the temperature controlled building features four operating tables, two CT scanners, two mobile digital Dragon X-ray machines and a pathology laboratory, treating around 2,000 casualties a year – many suffering from life-threatening injuries. The blood demand at Camp Bastion is similar to that of a district general hospital in the UK. Blood is crucial to the treatment of battlefield casualties and its provision is the result of the partnership between the UK military’s Blood Supply Team (part of the larger Medical & General Supplies Team) and NHSBT. Since 2005, this partnership has worked to provide a global, safe, secure supply of blood and blood products to military personnel, while also complying with the latest EU and UK blood quality standards.

The Golden Hour

 Developments in UK military massive haemorrhage policy has led to the early use of blood components such as fresh frozen plasma (FFP), cryoprecipitate and platelets, which (as part of new resuscitation protocols) is currently associated with a casualty survival rates greater than 85% – among the best in the world. The use of these blood components, however, has required an increasingly sophisticated logistical response. As such, the innovation and service improvements designed to meet this challenge, are collectively known as the ‘Blood for the Battlefield’ project. A key part of this project has been the introduction of fully validated ‘Golden Hour’ transport boxes and cold chain temperature monitoring systems. This allows controlled transport conditions for red cells and platelets to field hospitals up to 3,500 miles away, for periods of up to 48 hours, in temperatures often up to 50°C. The UK Armed Forces is currently the only organisation in the World that has a validated blood transportation system of this type for both red cells and platelets. Blood is provided from the UK by NHSBT, which has successfully supported the delivery of over 10,000 blood components overseas during the last year, representing a ten-fold increase in the supply over the last three years.