a
hospital with good light and with a patient not moving
around. Although the patient was paralysed, we had a whole
helicopter moving around and juddering. And you have
actually got to put a tube the diameter of your finger, and
about a foot long, through the vocal cords of the patient. So
my target was probably about 10mm and the tube diameter
was about 8 mm: you have got to be accurate and it's a
relatively skilled procedure. But it's a potentially life-saving
procedure – the guys who need it wouldn't survive the
twenty-five minutes back [to Bastion] without it.
Then the ODP assessed the patient for further bleeding,
external bleeding. He couldn't find much but the patient had
a broken right leg – it was pointing in the wrong direction.
There was no bone sticking out but the leg had an extra
'joint', which it shouldn't have had. The patient was covered
in crap – mud, stuff like that. Everything was happening
simultaneously. Once we had secured the airway, we didn't
want to lose it. Then we used blades to slit his clothes off to
expose his chest, making sure there were no injuries to it. We
use blades with a curved bottom so you can't stab the patient
by accident: they're childproof, basically. I was concerned
because there was no obvious injury to his chest but we were
not ventilating very well. One side of his chest was not
moving and I thought, because he had been in a blast
situation, that he might have blast lung, caused by the
pressure wave of an explosion. An explosion can burst a lung.
His abdomen had no obvious injury. It was soft, it was not
expanding and there was no bleeding into it. It was just his
leg.
You can lose a lot of blood from a broken femur and he was
quite shocked so I was assuming he was losing blood from
his leg internally. And once we had checked there was no
reason why the ventilation was not working – i.e. the tube
was in the right place – I decided, technically, to operate.
Basically, that meant making two holes in the side of his
chest.
He was unconscious, he was sedated, he couldn't feel anything.
So I put two holes with a big scalpel blade mid-way
down both sides [of his chest]. Then I could stick my finger
into his chest, making sure there was no obstruction and
making sure that the lung was up. And the lung was down on
one side because I couldn't feel it. As soon as I stuck my
finger in, the next thing I could feel was a 'sponge' and that
was the lung. The right lung had collapsed. I was releasing
any trapped air that had caused the lung to collapse. And
gradually it came up and the ventilation became easier. He
was obviously responding to that treatment. Only a senior
clinician could have done that. And that is the sort of intervention
that putting a senior clinician on the MERT can
achieve. Probably only five per cent of all casualties require
that intervention so the argument [from critics of the MERTs]
is: why are we endangering the life of a senior clinician, a
valuable asset, to help such a small number of people?
I would say a valuable asset is only valuable if it is used
appropriately. Otherwise it becomes an expensive ornament.
So unless you're going to put them out there, they can't
help. And each patient saved is a British soldier who is now
back with his family at home. His injuries may be severe,
but he's back with his family. Anyway, we did all this
[treatment] in twenty-five minutes because, after that, we
landed in Bastion.
The hospital HLS in Camp Bastion is approximately five
hundred metres from the front door. When the Chinook
arrives, bringing in casualties, military ambulances are
already waiting to ferry the injured to the emergency department.
Everyone knows how many casualties are on board
because of the number of ambulances waiting: one per
casualty. The next few minutes can be the most dangerous for
the casualties, moving them quickly from the back of the
Chinook into the ambulances without causing them further
harm. Usually there's no time for the
hospital with good light and with a patient not moving
around. Although the patient was paralysed, we had a whole
helicopter moving around and juddering. And you have
actually got to put a tube the diameter of your finger, and
about a foot long, through the vocal cords of the patient. So
my target was probably about 10mm and the tube diameter
was about 8 mm: you have got to be accurate and it's a
relatively skilled procedure. But it's a potentially life-saving
procedure – the guys who need it wouldn't survive the
twenty-five minutes back [to Bastion] without it.
Then the ODP assessed the patient for further bleeding,
external bleeding. He couldn't find much but the patient had
a broken right leg – it was pointing in the wrong direction.
There was no bone sticking out but the leg had an extra
'joint', which it shouldn't have had. The patient was covered
in crap – mud, stuff like that. Everything was happening
simultaneously. Once we had secured the airway, we didn't
want to lose it. Then we used blades to slit his clothes off to
expose his chest, making sure there were no injuries to it. We
use blades with a curved bottom so you can't stab the patient
by accident: they're childproof, basically. I was concerned
because there was no obvious injury to his chest but we were
not ventilating very well. One side of his chest was not
moving and I thought, because he had been in a blast
situation, that he might have blast lung, caused by the
pressure wave of an explosion. An explosion can burst a lung.
His abdomen had no obvious injury. It was soft, it was not
expanding and there was no bleeding into it. It was just his
leg.
You can lose a lot of blood from a broken femur and he was
quite shocked so I was assuming he was losing blood from
his leg internally. And once we had checked there was no
reason why the ventilation was not working – i.e. the tube
was in the right place – I decided, technically, to operate.
Basically, that meant making two holes in the side of his
chest.
He was unconscious, he was sedated, he couldn't feel anything.
So I put two holes with a big scalpel blade mid-way
down both sides [of his chest]. Then I could stick my finger
into his chest, making sure there was no obstruction and
making sure that the lung was up. And the lung was down on
one side because I couldn't feel it. As soon as I stuck my
finger in, the next thing I could feel was a 'sponge' and that
was the lung. The right lung had collapsed. I was releasing
any trapped air that had caused the lung to collapse. And
gradually it came up and the ventilation became easier. He
was obviously responding to that treatment. Only a senior
clinician could have done that. And that is the sort of intervention
that putting a senior clinician on the MERT can
achieve. Probably only five per cent of all casualties require
that intervention so the argument [from critics of the MERTs]
is: why are we endangering the life of a senior clinician, a
valuable asset, to help such a small number of people?
I would say a valuable asset is only valuable if it is used
appropriately. Otherwise it becomes an expensive ornament.
So unless you're going to put them out there, they can't
help. And each patient saved is a British soldier who is now
back with his family at home. His injuries may be severe,
but he's back with his family. Anyway, we did all this
[treatment] in twenty-five minutes because, after that, we
landed in Bastion.
The hospital HLS in Camp Bastion is approximately five
hundred metres from the front door. When the Chinook
arrives, bringing in casualties, military ambulances are
already waiting to ferry the injured to the emergency department.
Everyone knows how many casualties are on board
because of the number of ambulances waiting: one per
casualty. The next few minutes can be the most dangerous for
the casualties, moving them quickly from the back of the
Chinook into the ambulances without causing them further
harm. Usually there's no time for the
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