Page last updated at 12:23 GMT, Sunday, 31 January 2010

'For Care and Duty' - medics on the front line

By Jackie Bird
Presenter of Reporting Scotland

There is a scene early in The Wizard of Oz, after the house has crash-landed, where Dorothy leaves her monochrome world and by opening a door enters the Technicolor land of Oz.

Training for a stint as a medic in Afghanistan is a bit like that.

One minute you're splashing though the grey Yorkshire slush and by simply opening a door you're transported to a state-of-the-art field hospital in a warzone.

Drip in forefront
The medics are being deployed to Camp Bastion in Helmand

But the scene that greets you isn't so much MGM musical as Quentin Tarantino horror movie.

A dozen combat troops with an assortment of horrific injuries and countless other walking wounded are being treated by more than a hundred medics in desert camouflage. The wounds are fake, the tension is real.

The white-walled giant warehouse in which this drama unfolds has been kitted-out as an almost perfect replica of the Camp Bastion hospital in the heart of Afghanistan's Helmand Province.

On this rainy Friday around 50 NHS workers from across Scotland have travelled to an Army base near York for the final crucial stages of their training.

In just a few days' time they'll leave for the desert and for the next four months will take over what is effectively the busiest A&E on the planet.

I'm part of a small TV crew from Reporting Scotland travelling with them, and this exercise is also a training opportunity for us.

The medical experts are honing their skills. We're learning how to capture what is happening and not get in the way.

In charge is Col David McArthur, a former nurse turned charity boss who is the commanding officer of 205 Field Hospital, Scotland's only dedicated volunteer Field Hospital.

His soldier-medics are on loan from most of Scotland's healthcare trusts, the bulk from Grampian, Lothian and Greater Glasgow and Clyde.

They include surgeons, anaesthetists, pharmacists, nurses, physiotherapists and blood specialists.

All are members of the Territorial Army, that band of part-time soldiers once pejoratively known as "weekend warriors", but whose role is now vital in an overstretched regular Army.

Platinum Ten

Gesturing to a nearby operating table, where a blood-soaked "soldier" is surrounded by medics and technology that would be the envy of any hospital in the NHS, David McArthur explains: "Each person around this table has an individual clinical field of expertise.

"The challenge of this exercise is to mesh those skills together. Here is where the mistakes are made, where new procedures are tried.

"The aim here is to build competence and confidence."

The TA makes up 75-80% of the Army's medical capability. When they reach Camp Bastion the Scots will form the leadership and the core of the hospital medical team.

Serving with them will be individuals from field hospitals in England and Wales and a 40-odd contingent of Americans.

In comparison with wandering off into the desert with a shovel and some toilet-roll, this will be a lot more civilised
Graham Sunderland

Col McArthur goes on: "We've got the physical bits in place. Now we're working on what we call the 'moral component'. Everyone has to get the mind-set right.

"Exercises like this replicate what's going on in Bastion. It's all about the 'what if'; moral, ethical elements. Everything from badly injured Afghans to how do I get my washing done."

The hospital in Bastion has never been busier. It's one of the few hard shell buildings in the vast tented British HQ in the middle of the Afghanistan desert, and it's where casualties from across Helmand Province are brought.

They don't just deal with allied troops, Afghan military and many civilians make up their injured.

Last year was the bloodiest of the nine-year conflict so far. More than 250 UK soldiers have been killed since the operation began.

The trauma teams at Bastion hospital are dealing increasingly with the devastation caused by the Taliban's use of IEDs - improvised explosive devices - which often cause multiple limb loss and major chest and abdominal injuries.

The teams work in what's known in battlefield medicine as the Golden Hour - the optimum timescale to move a seriously injured soldier to a stabilising trauma unit.

Jackie Bird
Jackie Bird is travelling with the team to Helmand Province

But recently that's been subdivided into the Platinum Ten, the initial minutes where treatment is given by highly trained combat medics on the ground.

A combination of the two means more soldiers are surviving what would have been fatal injuries.

Back at the exercise, Graham Sunderland takes a break from his virtual operating theatre and reflects on the role-playing scenario he's just completed; a patient with massive chest wounds who ultimately couldn't be saved.

Sunderland's day job as a consultant colorectal surgeon at Glasgow's Southern General hospital is far removed from the 24/7 ER demands of the desert.

A medical veteran of the second Iraq war, he's aware this deployment will be challenging.

"Iraq was an entirely different theatre," he said.

"In comparison with wandering off into the desert with a shovel and some toilet-roll, this will be a lot more civilised.

"In medical terms then it was a more constrained endeavour.

"It began with minor injuries and appendicitis, but then I was with the close support squadron and that depended on the tactical situation at the time.

"Let's just say it was steady."

'Violent action'

But members of 205 Field Hospital have a dichotomous existence. As the unit's motto - For Care and Duty - implies, they straddle two roles.

Does he see himself as a medic first or a soldier?

"Always a medic. There's no question. But we have to have a medical military matrix.

"We have to have certain training in medical terms to perform at the level we have to in a field hospital - we also have to be militarily competent."

But even for a surgeon war brings its emotional challenges.

"Some of the things we see are children, injured children," he said. "A child dying is something you are not confronted with at all.

"I'm not that comfortable with anyone dying, but for some reason it's much more so (emotional) if it's a child."

War also brings its own ethical dilemmas.

One of the most intriguing elements of battlefield care for an outsider like me is the assertion that enemy combatants are treated as well as our own.

If an injured member of the Taliban is brought to Bastion alongside a British soldier he will be treated first if his wounds require it.

Graham Sunderland is matter of fact. "Medical training helps us with that.

fake wound
The team train using detailed prosthetic make up of wounds

"All the way through medical training we're taught to treat people on medical priority, so that makes it much easier.

"We occasionally see people in hospitals here in Scotland who might be under arrest for some violent action and we still have to treat them in the same way."

Speakers around the walls of the cavernous warehouse burst into life again.

The sound of helicopter rotor blades heralds the arrival of more patients. The teams brace themselves.

This training exercise, the last major scenario before deployment, is no picnic.

It takes place in real-time over 48-hours. The emergency department is reaching saturation point as more victims are stretchered in.

Their wounds are realistic. No spurting joke shop blood here; the bullet wounds, burns and explosion injuries are the result of detailed prosthetic make up.

Often real amputees are involved. I didn't get the chance to ask if they were ex-military, but if they were I was left wondering about the psychological impact of taking part in such an exercise.

Capt Margot McCrone takes a breather from her tasks as a theatre nurse.

The demands of the last 24 hours are a world away from the sterile precision of her full-time job as a team leader in orthopaedic surgery at the Golden Jubilee Hospital in Clydebank.

There, surgery is elective and considered. Not the split-second relentlessness of what lies ahead. Afghanistan will be her first deployment.

"I'm apprehensive; it's not something I've done before," she reveals.

"I'm out of my comfort zone but I think I'll very quickly settle into the routine.

"The experience will add vastly to my clinical skills and it'll enhance my ability to think fast and work with a small team."

Despite the fact Camp Bastion isn't on the front line, Margot's friends and family have their concerns.

She said her final goodbye to her parents to report for duty just after New Year.

"They're worried," she admits, "but they don't have the Army experience.

"My mum wouldn't actually talk about it for a while but now she does. As parents do, they worry.

"I consider it a privilege that I'm going to be able to do my job for these guys. They're out on the front line."

You can follow Jackie Bird as she reports on 205 Field Hospital in Afghanistan next week on Reporting Scotland. There will also be a special programme, "For Care and Duty", on Wednesday 3 February at 2130 GMT on BBC One Scotland.

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