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Last Updated: Monday, 22 October 2007, 10:50 GMT 11:50 UK
Helping wounded soldiers defy the odds
By Victoria Bone
BBC News

British soldier being airlifted to hospital
Giving treatment while in the rescue helicopter can save precious time
More British servicemen were seriously injured in Afghanistan in the first nine months of 2007 than in the whole of the rest of the present conflict.

Grim as that fact is, many of those so-called "catastrophic" wounds would have been fatal in previous wars.

Even as recently as five years ago many would not have returned home alive, the head of battlefield medicine for the armed forces says.

Indeed, military medicine has come so far that Professor Tim Hodgetts believes the chances of a soldier surviving can be greater than a civilian with similar injuries.

Medical advances

Prof Hodgetts told the BBC: "These are very, very serious injuries that a good number of people would not really be expected to survive.

"We're talking about penetrating brain injuries. We're talking about multiple injuries of limbs which would include amputations with life-threatening blood loss at the scene."

Soldiers are at the peak of physical fitness, which certainly helps them defy medical odds.

Healthcare is embedded at the point of wounding
Prof Tim Hodgetts

But great strides in clinical techniques and technology have also made a big difference.

Prof Hodgetts says the military has a "sophisticated trauma system" that puts field hospitals like that in Camp Bastion in Afghanistan "ahead of the National Health Service" when it comes to dealing with casualties.

All doctors know the ABC protocol for handling emergencies - first clear the Airway, then check Breathing, then focus on Circulation.

But military medics learn CABC, so "catastrophic haemorrhage" is tackled first of all.

And the equipment available to do so is second to none.

Prof Hodgetts himself helped develop a dressing containing crushed prawn shells which can stop bleeding from the aorta - the body's main artery - in just two and a half minutes.

'Instantaneous treatment'

Army doctors have also mastered the technique of "intra-osseous access", injecting drugs or vital fluids into bones when access to a vein is impossible due to massive injury.

Then there is the training of the soldiers themselves. As Prof Hodgetts puts it: "Healthcare is embedded at the point of wounding."

Lance Bombardier Ben Parkinson
Lance Bombardier Ben Parkinson suffered severe brain damage

Soldiers know how to apply a tourniquet to stem bleeding and they practise in realistic situations to deal with the worst-case scenario.

Finally, improved communications technology means field doctors can send live 3D pictures of a soldier's injuries via satellite back to specialists in the UK for a second opinion.

And combat medics can call from the rescue helicopter to the field hospital to prepare them for arrival.

"We can get all the right people and all the right equipment ready so as soon as they hit that trolley in the field hospital they get all the right treatment started instantaneously," Prof Hodgetts says.

And it is not just British soldiers who are benefiting.

'Hit by a bus'

Recently, four members of the Afghan National Army survived very serious brain injuries because of the treatment they were given by the Helmand province field medics.

Prof Hodgetts said: "These are people who really should have died."

Selly Oak treats all UK forces medical evacuees from Iraq and Afghanistan
6,000 military personnel have been admitted since 2001, of whom nearly 200 were hurt in conflict
30,000 military outpatients have been treated since 2001
Its specialities are trauma, orthopaedics, burns, plastic surgery and neurology

All seriously injured medical evacuees from Iraq and Afghanistan are treated at a dedicated unit at Selly Oak Hospital in Birmingham.

The MoD says there are 24 there at present.

Lance Bombardier Ben Parkinson - often described as the most badly injured soldier ever to survive - was treated there, something his mother thinks made all the difference.

Diane Dernie told BBC Radio Five Live: "One specialist said that if it had been a member of the public who was hit by a bus outside Selly Oak Hospital they couldn't possibly have survived.

"It was only because of the extreme fitness of the boys and because of the improvements in battlefield medicine that we even got Ben back to the UK."

L/Bdr Parkinson lost both legs and suffered severe brain damage while serving in Afghanistan.

His case hit the headlines when the level of compensation he was given by the MoD was branded as derisory.

Injured serviceman in the gym at Headley Court
Headley Court helps soldiers recover from catastrophic injuries

Like many soldiers he has now reached a suitable stage of recovery to be transferred to Headley Court, the military's dedicated and much-praised rehabilitation centre in Surrey.

There are currently 45 inpatients there, according to the MoD.

Wing Commander Steve Beaumont, who runs Headley Court, says he has three to four patients at any one time that he would put in the same severely injured category as L/Bdr Parkinson.

"We're constantly seeing a handful of patients at all times through Headley Court which five years ago we wouldn't have seen," Wing Cdr Beaumont said.

Long-term care

In Afghanistan, between 1 January 2006 and 15 September 2007, the MoD reported 72 seriously and very seriously injured personnel.

For the same period in Iraq, the figure was 94.

While many severely wounded personnel do recover and some even return to the military, there are others whose injuries leave them unable to undergo rehabilitation.

A small number - less than five, according to Veterans Minister Derek Twigg - are so badly injured that they cannot be sent to Headley Court.

They are being cared for in long-term high dependency beds in other hospitals.

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