Falklands war 25TH anniversarY - Boekje Pienter

Vol. 153 Supplement 1 JOURNAL OF THE RAMC 

Falklands war 

25 T H anniversarY 

RAMC Journal Publications 

HQ AMS, FASC, Slim Road, Camberley, Surrey GU15 4NP 

Telephone 01276 412790 

JOURNAL OF THE RAMC 

VOLUME 153 

SUPPLEMENT 1

FALKLANDS WAR 25th ANNIVERSARY 

Editorial 

Major General M von Bertele, Chief Executive DMETA 

30 years ago when this author joined the RAMC he was told by 

colleagues that it would be a short and dull career. Wars were a 

thing of the past and a life stationed on the Inner German Plain 

would soon pale. The Falklands war almost confirmed that. It was 

a conflict fought by foot soldiers, in a hostile environment against 

an enemy of unknown capability who nevertheless proved capable 

of inflicting high casualties. Never again we were told. Future wars 

would employ overwhelming force to minimise casualties. The 

easy victory in the first Gulf war when a large complement of 

hospital beds had been deployed, followed by relatively bloodless 

peace-keeping missions in Africa and the Balkans, all conspired to 

reassure political and military planners alike that risks could be 

taken with their medical Services. Following the collapse of the 

Soviet Union there was review after review, but the net effect, when 

the logic was stripped away, was a reduction in capability, 

culminating in the closure of military hospitals and a focussing of 

attention on deployable capability. Yet now casualties have 

returned in earnest and the capabilities of the Medical Services are 

being stretched to the limit coping with them, so it is worth asking 

in this anniversary edition of the Journal of the RAMC, what has 

changed and what still needs to be done 

The first point to be made is that the problems are largely 

unchanged. The patient is the same, the environmental and 

weapon threats vary from theatre to theatre, but disease and 

wounding mechanisms are the same, despite the impact of body 

armour and altered patterns of trauma, and the medical mission is 

the same. Despite the controversy about military hospitals and care 

of casualties in the UK, there are encouraging trends in almost all 

areas of deployed capability and considerable successes in a few: but 

fundamental problems remain in others. They will be considered 

in turn; medical advances, resource challenges, and most 

importantly perhaps, the people problem. 

In 1982 we had a good understanding of war surgery. If the 

patient got to a surgical facility we had surgeons who knew what to 

do. Their daily practise was generalist, they had memories, if faint, 

of service in small wars, and more recently in Northern Ireland, 

and they worked in military hospitals with the colleagues with 

whom they would deploy. They exercised together at least annually, 

and they still reigned supreme in a Corps that was focussed in large 

part on the doctrine of General War, where the best would be done 

for the most, but where resources would be overwhelmed and 

mortality was expected to be high. The challenge then, as now, was 

in getting the casualty to the surgeon. Most would be expected to 

die either in the immediate period following injury – they were 

then, and are now, largely unsalvageable, or died from haemorrhage 

over the next few hours, or died later from complications. With 

fewer casualties, attention has focussed on providing better 

resuscitation earlier for everyone, arresting non-compressible 

haemorrhage, and getting the patient to surgery earlier. The 

surgical team of general and orthopaedic surgeon. with consultant 

anaesthetic support, introduced in the 1990’s, has delivered 

outstanding success, and the provision of skilled aeromedical 

evacuation for even the most critically injured patients has enabled 

rapid return of casualties to the full spectrum of specialist services 

that the NHS can offer. There has finally, been a recognition that 

military casualties require more than just treatment on the NHS, 

and the confirmation that a formal role 4 capability is required as 

the final component of a comprehensive military medical 

capability that will be able to deliver a seamless patient care 

pathway. 

Our medical assistants are better trained and better equipped. 

Significant advances in development of haemostatic agents and 

revision of doctrine on the use, and provision, of new tourniquets 

has enabled haemorrhage to be better controlled. Better 

understanding of fluid replacement means that resuscitation can be 

tailored to give the patient the best chance of resuscitation and 

surgery at the earliest opportunity. In the Falklands the focus was 

on dressings, compression, and getting as much fluid as possible 

into the patient. Tourniquets were almost a dirty word. Many 

patients remained on the battlefield for hours, and by the time they 

reached the surgical facility they were significantly hypothermic. 

Coagulopathies were rare suggesting that the amount of blood lost 

in survivors might have been small. Oxygen was not carried, and 

was not even available during surgery. Now, the monitoring of 

vital signs, including oximetry, is considered essential. Pain relief 

was administered by morphine syrettes which were inadequate for 

the task, and there was a problem of overdosing with subcutaneous 

morphine, released later when a patient was being resuscitated. 

Other agents were tried, sub-lingual buprenorphine was popular at 

the time, and ketamine was used for the first time as both an 

analgesic and short acting anaesthetic, but only now are we really 

starting to address the problems and epidemiology of many 

different types of pain. Battle injuries were not the only cause and 

the management of pain from non-freezing cold injury (trench 

foot) proved challenging even for the anaesthetist. 

Evacuation in the Falklands was problematic Vehicles were 

almost non-existent and helicopters were barely up to the task and 

in short supply. But distances and therefore journey times, were 

short. Escorts were not present on battlefield helicopters. Now we 

agree that every casualty requires a comprehensive response, often 

including a medical team to provide resuscitation and a helicopter 

to ensure rapid evacuation. However, with finite resources we must 

not lose sight of the need to reduce risk to the responders and the 

aircraft, particularly as the more dispersed battlefield places 

increasing demands to evacuate over greater distances. Better 

decision making at the scene may reduce urgency and increase 

flexibility, but we must now focus on training more paramedics to 

perform this task and carry out research that will enable us to 

understand the prognostic indicators in order to focus resources on 

those who need them. The survival rates of those reaching surgery 

in 1982 were high, but the question has never been satisfactorily 

answered, were they the ones destined to survive Current research 

is aiming to answer some of these questions, so that medical 

commanders can make more informed decisions and deploy the 

right resources, in the right time scale, to give optimal care to the 

casualty, and optimal support to the operational commander that 

will increase his freedom to manouevre. 

In the deployed surgical facility, a battery of tests is now possible; 

then there was only a simple cross match, but the essence of surgery 

is the same, and the challenge now is to train a surgeon to be 

competent in trauma surgery when in peacetime practice the 

emphasis is on ever greater specialisation. The competencies 

expected of the war surgeon cannot be delivered in routine practise 

in the NHS and we shall have to look either at taking a lead in the 

JR Army Med Corps 153(S1): 3-5 3

training of trauma surgeons within the NHS, or continue to rely 

on additional training, much of which can only be obtained in 

other countries. The loss of training places in South Africa has 

been a significant loss to our ability to train trauma surgeons and 

although simulation has been heralded for many years as the 

answer to filling the skills gap, it is not yet sufficiently developed to 

deliver this. In 1982 the first surgical teams deployed had only one 

consultant ashore, a truly general and experienced surgeon, and he 

had to oversee a number of senior registrars. That generation of 

general surgeons is rapidly approaching retirement. Recently we 

have been reluctant to deploy surgeons below consultant grade, 

largely because of the impact on training programmes, but the 

training opportunities available on current deployments under 

consultant supervision may make us reconsider that stance. 

We have been fortunate over the past few years, in that the rate 

and complexity of casualties have increased slowly, giving us time 

to learn from American experience, and develop our techniques. 

Surgical facilities are well established, and our teams have an 

opportunity to rehearse before deployment; in future they may 

have to start again from scratch. As with our surgeons, the dash to 

specialisation in the nursing cadre is in danger of distracting from 

the training of generalist military nurses, but we have inadequate 

data to prove whether the quality of care has suffered or benefited 

from that trend. In the meantime we follow accepted wisdom but 

risk over-qualifying some of our personnel at the expense of 

delivering the right competencies to all of them. 

Data collection in 1982 was largely based on the field medical 

card and a retrospective interview survey of casualties was 

conducted by medical officers in an attempt to inform work being 

led by the Professor of Military Surgery. It was hardly systematic 

but since then many advances have come about through 

application of simple audit and the adoption of the principles of 

clinical governance. For many years however we have struggled to 

define and collect the comprehensive data sets that inform that 

audit. The promise of information systems that would facilitate 

and automate data collection and retrieval has distracted from 

practise but the imminent roll out of DMICP will produce a step 

change in capability, initially in the peacetime environment. The 

momentum must be maintained into the deployed environment 

and progress from being an electronic patient record to a functional 

operational medical decision support tool. That will have to be 

supported by a new organisation that will integrate data collection, 

storage, retrieval and analysis, and that will inform epidemiological 

analysis and decision making across Defence. 

In considering equipment, logistic support, and sustainability, 

we have probably turned the corner. In 1982 the scales were 

adequate, but old; re-supply was geared towards General War, and 

was woefully inadequate for light mobile forces. A RAP requiring 

20 litres of Hartman’s would receive 2 or 3 large tri-wall boxes, 

which collapsed in the rain and spewed their contents over the 

mountainside. Now we have finally started to sort out scales in 

modules, re-supply by single line item, rapid response to UORs 

[urgent operational requirements], an understanding of the 

acquisition process, and a supply chain that is responsive and 

improving all the time. Further improvements will only be made, 

however, if we start to place medical support officers into logistic 

staff appointments at every level. 

The debate about evacuation continues, but structures are still 

geared to evacuation of the majority of land casualties by vehicle, 

with the attendant escorts, and yet experience has shown that the 

majority of serious casualties over the past 20 years have been 

evacuated by helicopter. Coupled with strategic aeromedical 

evacuation this has enabled progressive reductions in the deployed 

medical footprint but without assurances on how helicopters will 

be employed in future conflicts we risk moving out of step with 

other acquisition strategies. We must fight, not for dedicated 

helicopters which would restrict flexibility, but for better 

equipment in assigned aircraft, and better training for all medical 

personnel who are likely to deploy. The debate about who should 

be on the helicopter has been clouded again by inter-Service rivalry, 

but articulation of clear doctrine and the delivery of the 

competencies required to deliver the capability must be delivered 

urgently. 

Organisational change has been driven by many factors, but not 

always by design. In 1982 control of the medical services was 

dominated by secondary care clinicians, but they have now been 

almost totally removed from the decision making process. The gap 

has been filled by a small cadre of medically trained staff officers, 

predominantly from the occupational and public health cadres, 

and by a rapid increase in the number of direct entry medical 

support officers. Despite improvements in staff training there is 

still a long way to go, and there is an increasing need for clinicians 

to return to the staff and policy forum. Promotion rules, changed 

to introduce common terms of service for professional officers and 

enable professional pay spines, now discriminate against the able in 

favour of the eligible, and are an increasing source of irritation. We 

serve and compete in an increasingly joint environment, alongside 

and against officers of the other Services, who, while intellectually 

and clinically gifted, are often operationally inexperienced and 

untested in command. 

As Yellowleas noted 30 years ago, the single greatest impediment 

to progress and rationalisation is the influence of the single Service 

medical directorates, and that remains true today. We must of 

course retain the best of single Service identity but must accept that 

cooperation and joint effort is essential if we are to overcome the 

challenges of the future. Each Service is too small to sustain their 

current posture, and this insularity has meant that too much time 

has been wasted fighting internal battles. In each Service there is 

still reluctance to allow able officers to compete against their 

Service colleagues for staff appointments outside of the medical 

services. Under intense media pressure there is also a danger that 

attention will be focussed on today’s tactical issues and insufficient 

attention given to the operational challenges of tomorrow. 

A strategic vision is required for the next 20 years and that must 

recognise the move from a tri-Service DMS to a truly joint DMS, 

recruited through the single Services but delivered jointly. Where 

a common standard can be applied to a capability, it should be 

delivered jointly. We must train more officers and NCOs at every 

level who will be able to sustain current levels of operational 

capability, train the next generation, and provide the leadership to 

deliver that vision. That training should be delivered through joint 

structures where sensible, and when specific to the medical services 

it should be designed and delivered to a joint audience, 

supplemented by environmental differences only when essential. 

We are moving in the right direction. Operations are 

increasingly joint; clinicians from all 3 Services work together, 

predominantly in a land environment; and there are moves to 

manage them more strategically, optimising their training and 

employment. . Paradoxically the only reason we are so strong today 

is because of the operational challenges of the past 5 years. Should 

conflict cease, because of our geographical dispersion, we risk being 

fragmented, with too many clinicians focussing on their immediate 

clinical practice in MDHUs, medically qualified staff officers 

concentrating on clinical governance and policy in headquarters, 

and medical support officers concentrating on the field medical 

services. Much work is required to bring them together in new 

peacetime organsiations. 

Ultimately it is our people who deliver medical capability, and it 

is hard to predict how we will fare over the next few years. In 1982 

the NHS looked stable. You chose either a military career or a 

civilian one; you could transfer one way but rarely the other; and 

the routine practice of military medicine was satisfying, if not 

always too demanding. Now we are fully embedded in the rapidly 

changing training pathways of our NHS colleagues, and practice in 

4 JR Army Med Corps 153(S1): 3-5

an increasingly specialised world. The requirement to receive knee 

surgery from someone who only operates on knees may hold good 

in peacetime specialist centres, but is not the environment in which 

to train a generalist trauma surgeon. We must continue to work 

together to agree on the competencies required by our staff, and 

secure placements where they can be achieved. 

Our people at every level tell us that they want to be trained to 

do the military clinical task, but it is still hard to achieve that 

training as we try to balance career needs, single Service demands, 

and the wider service need. DMETA currently responds only to 

customer demand, but in future should be placed to inform the 

customer of the requirement, design it, and deliver. More needs to 

be done to focus training on the military requirement, while 

acknowledging the need to place and employ people in the NHS. 

This can only be done if the 3 Services agree. Training overall must 

improve, not just clinical, but importantly in command, leadership 

and management, and focus on delivering a multi-disciplinary 

command and staff cadre, open to clinical and non-clinical officers, 

properly trained in medical planning. 

The Royal Navy and the Royal Air Force should allow their 

people to work more closely with their Army colleagues, and 

develop early the right career profiles to allow better application of 

common terms of service. The Army must offer up some 

command appointments to the other Services, especially as 

opportunities expand with implementation of Improved Medical 

Support to the Brigade (IMSB). Single Service differences should 

be retained either out of necessity, for example at role 1, or to meet 

specific environmental needs, but as a source of strength, not 

protectionism. This will only be achieved in an organisation that 

has a clear purpose, is adequately resourced, and properly organised 

and managed, with a focus on the fundamental output – the 

delivery of a full range of military medical support to servicemen 

and women of all 3 Services. That is the essence and purpose of a 

Joint element in our medical Services. With greater acceptance 

than for many years of the need for a comprehensive and capable 

Defence Medical Service, now is the time to make the change. 


FROM THE EDITOR 

In 1982, the editor wrote “The purpose of this editorial is to 

stem the drift into oblivion of the object lessons adduced [from 

the war]”. This remains, in a more general sense, one of the 

aims of the RAMC Journal. Sadly, experience bears out the 

suspicion that history is composed of lessons forgotten as often 

as it is of lessons learnt. 

I remember watching film on the news of Sir Galahad 

burning whilst I was a medical student and realising that my 

belief that wars had become something that didn’t happen 

anymore was wrong. The Vietnam and Korean wars had been 

years previously and World War II had been more than thirty 

years earlier, talked about only by people of my parent’s and 

grandparent’s generations. Times have changed again, and we 

now live with a continuing backdrop of wars involving British 

service personnel. Barely a week goes by without news of 

another death in action, yet I still remember the emotional 

shock to the Nation of the human cost of the conflict twenty 

five years ago. What also marked out the conflict in the South 

Atlantic was the almost universal support for what was judged 

to be a “just war”. It is surely a matter of pride that the people 

of the Falklands are as proud of and grateful to the Armed 

Forces now as they were all those years ago and that the Islands 

are more populated and more prosperous than ever before. And 

still British as their inhabitants wish. 

It is right, therefore, that we take this opportunity to mark 

the anniversary of the Falklands War and to pay tribute to those 

who served and to those who died. It is also important that we 

draw on their experiences in any way we can to ensure that the 

“object lessons” are not forgotten. Anyone reading the articles 

in this issue will readily realise that in many respects the 

challenges facing the medic at war have changed little since, just 

as they had changed relatively little in the years before. 

Much of this special issue consists of articles originally 

published in the Journal in the immediate aftermath of the 

War. Where necessary, I have included commentaries placing 

the articles in a modern context. Brief biographies of the 

original authors are also included. I am most grateful to Surg 

Capt Walker and Col Jim Ryan for their recollections of their 

service during the War, one on board ship, the other in the Field 

Hospital at Ajax Bay. 

The Army Medical Services are extremely lucky to have 

someone as enthusiastic and knowledgeable as Capt Peter 

Starling as their museum curator and I am immensely grateful 

to him for his patient responses to my many queries regarding 

this issue. 

In conclusion, the Royal Army Medical Corps lost four of its 

members in the Falklands Conflict and it is to them in 

particular that this issue is dedicated: 

Major Roger Nutbeem 

S. Sgt Phillip Currass QGM 

L/Cpl IR Farrell 

Pte K Preston 

2 JR Army Med Corps 153(S1): 2


Fighting for the Falklands 

Capt. Piers R. J. Page 

"They landed approx 0930 GMT this morning in landing craft 

and stormed the capital Port Stanley and have taken over the 

government office - they landed with heavy armoured vehicles. 

We're now under their control. They are broadcasting that all 

local people will be treated as normal. Fairly peaceful in Stanley 

at present time." 

With these words, transmitted by Bob McLeod broadcasting 

as VP8LP from Goose Green, the UK discovered at 1600 hrs 

London time on 2nd April 1982 that the Falkland Islands had 

been invaded by Argentine forces. 

industrial base for the South Atlantic whaling industry. By the 

mid 1960s, however, maritime engineering had produced the 

factory ship and there was no use for the giant factories on the 

shores of the island. 

Background 

The roots of the conflict (war never officially being declared by 

either side) lay several hundred years previously, in the rapid 

expansion of the empires of several European nations. In the 

1690s the body of water between the islands was named after 

5th Viscount Falkland, a future First Lord of the Admiralty, by 

John Strong as he sailed between them. In 1765, the western 

region was claimed for Britain by John Byron, on the grounds 

of their prior discovery. Unfortunately, the eastern reaches had 

been settled the year before by the French, who took exception 

to the British claim before selling the settlement to Spain a year 

later. Spain promptly took the British settlement in 1771, 

returning it shortly after. 

In 1774, the British left, assuring continued possession by 

means of a brass plaque asserting the fact. Spanish government 

continued from Buenos Aires until 1816, when Argentina 

became independent and claimed inherited rights from Spain. 

A brief but catastrophic period of Argentine rule, which 

included a spat with the USA culminating in an armed visit 

from the USS Lexington and a failed penal colony whose 

soldiers mutinied and killed its governor prompted a British 

return in 1833. 

Over the following years, a British colony was established, 

which thrived throughout the colonial era. Much later, at the 

time of independence for many colonies, Lord Shackleton 

(grandson of explorer Ernest) was commissioned to explore the 

potential for viability and economic growth in the Falklands 

(during which his ship was fired upon by the Argentine navy). 

This inquiry found the islands to be net producers of wealth in 

British public purse terms, and to be stable, settled and selfmanaging. 

This was not the answer the Argentine government 

wanted to hear; when HMS Endurance, the naval exploration 

vessel was listed for withdrawal by May 1982 and the “Kelpers” 

of the Falklands were denied full British citizenship in 1981, 

the junta saw its opportunity. 

South Georgia 

First landed on by Captain James Cook, the barren island of 

South Georgia experienced an intense half century as an 

Corresponding Author: Capt Piers RJ Page RAMC, Academic 

Department of Emergency Medicine, James Cook University 

Hospital, Marton Road, Middlesborough, Teeside, TS4 3BW 

Queen Elizabeth Military Hospital, Woolwich 

Email: piers.page@gmail.com 

HMS Chatham off South Georgia 

On 19th March 1982 an Argentine flag was seen flying at 

Leith, the centre of the old whaling station. It had been run up 

by Constantino Davidoff, a scrap merchant who had decided to 

dismantle the station. 

The flag was run down after immediate British diplomatic 

action, but a further 7 days yielded no further co-operation; 

Davidoff had been ordered to present himself and his permit for 

the expedition to the British Antarctic Survey delegation on the 

island. He continued to resist this and by the 27th this Steptoe 

situation had escalated to the dispatch of a troop of British 

marines aboard Endurance, countered by the Argentine 

removal of nearly all the scrap men and replacement with their 

own marines. On the 27th, the writing was on the wall when 

two further missile boats arrived to support the Argentine 

marines and aircraft from the mainland remained almost 

constantly in the sky over Port Stanley. 

What has never been clarified is the degree of orchestration of 

this event by Buenos Aries. It seems quite possible that the 

initial action was in fact spontaneous, but offered an ideal 

opportunity for the junta to escalate its provocation of Britain. 

Britain awakes 

On Wednesday 31st March John Nott, Margaret Thatcher’s 

defence minister, visited her to tell her that signals intelligence 

confirmed preparations by the Argentine fleet for invasion of 

the Falklands. This would be news to very few, as the entire fleet 

were at sea and had deviated from the course of their normal 

spring exercise. 

By Thursday evening, the Navy had committed a task force 

based around Hermes and Invincible, which it had vowed to 

put to sea by the Monday morning. Land forces were put on 

standby for immediate deployment and further ships set sail 

from Gibraltar to meet the force on its way south. 

Contact! – 2 April 

At 0230 contact was called amongst the waiting marines; a fleet 

could be seen assembling off Cape Pembroke, as intelligence 


had predicted. What was not predicted, however, was the arrival 

at 0430 of Argentine special forces by Puma helicopter at 

Mullet Creek, south-west of their expected approach on Port 

Stanley. They landed here unopposed and began their 

infiltration. Within two hours their fierce assault on the 

thankfully empty British marines’ accommodation at Moody 

Brook demonstrated their will to win and destroyed any 

credibility the argument that they had aimed to take the islands 

without unnecessary losses might have had. 

Simultaneously, a large force of Amtrack LVTP-7 armoured 

personnel carriers was reported to be coming ashore by the OP 

above Yorke Bay – already, 18 were rolling across the island. 

Shortly after, assaults began on Government House, defended 

by the marines who had not formed the initial OP parties. Rex 

Hunt, Governor of the islands, called a meeting with Admiral 

Busser (leader of the invasion) and requested immediate 

Argentine withdrawal of forces. Busser replied that he felt with 

nearly 3000 men on the island and 2000 more in reserve at sea, 

he was unlikely to be made to leave. 

At 0925, the miniscule force of marines surrendered to the 

600 Argentine special forces who they had held at bay through 

the early morning. Argentina had the Falklands. 

Within a day, South Georgia fell after a similarly heroic 

defence. Lt Mills of the Naval Party garrisoned at Stanley 

previously and due for replacement had taken 12 marines to 

the island after the escalation of the scrap metal affair. On 3rd 

April, an Argentine icebreaker ship hove into view, 

accompanied by one of the missile corvettes sent to reinforce 

the landed marines. As he watched the jetty he had boobytrapped 

awaiting further incursions, a Puma brought Argentine 

special forces to the island and discharged them in front of his 

face, whilst the missile boat brought fire down on the position. 

Mills immediately opened fire on the helicopter and one of his 

marines scored a waterline hit on the missile corvette with a 

Carl Gustav launcher. After ninety minutes of spirited defence, 

the inevitable was accepted and surrender agreed. 

As Operation Corporate began, careers were ending. Lord 

Carrington had grossly underestimated Argentine will for the 

invasion and as such his diplomatic efforts as Foreign Secretary 

were far too little too late. He resigned, describing the invasion 

as “a humiliating affront to this country.” John Nott also 

tendered his resignation as Defence Secretary but Mrs. 

Thatcher, concerned that the outbreak of war was no time to be 

losing a cabinet, did not accept it. 

Due South 

The assembly of the task force saw the initiation of a measure 

last implemented in the second world war – “take up from 

trade” of merchant ships. It was on this basis that that P&O’s 

flagship cruise vessel the SS Canberra sailed its final leg from 

Naples to Southampton for conversion to a giant troop ship. 

As Canberra sailed home to its renaissance as the floating 

home of the land force, the rest of the task force set sail on the 

morning of Monday 5th April. Hermes and Invincible left 

Portsmouth with Fearless, an amphibious assault vessel with 8 

landing craft in its wake. Sir Galahad and Sir Geraint, both 

logistics craft escorted by Antelope, steamed to join from 

Plymouth sound and await the arrival of their partner ship Sir 

Tristam from Canada. Arrow and Plymouth joined the carrier 

group in the channel as their escorts. Another key vessel was 

Glamorgan, a missile-destroyer carrying Admiral Woodward, 

commanding the task force. 

While the impressively rapidly assembled task force sailed on 

towards the Falklands, Canberra metamorphosed from luxury 

liner to high-capacity troop ship. Its living quarters were 

chopped into tiny cabins and the swimming pool was drained 

to be fitted with a helicopter deck. This helipad would in time 

become the less favoured of the two (the other being a 

sundeck), due to its alarming tendency to move with a 

helicopter in the hover above it. 

Total recall 

Having found the floating contingent, land forces were now 

needed. Brig Julian Thompson, commanding 3 Commando 

Brigade had been warned off 5 hours before the invasion; his 

brigade was now feverishly reassembling itself for war, just days 

after many units had returned from NATO exercises. 42 Cdo 

was based locally but on leave, so recall notices were issued and 

policemen sent to relatives’ houses all over Britain to deliver the 

news to relaxing marines. 40 Cdo in the North-West and 45 

Cdo in Arbroath began their preparations as 42 personnel 

streamed from all over Britain back to the South-West. 

Further strength was needed, preferably at high readiness. 

2nd and 3rd battalions of the Parachute Regiment fitted the 

bill, but were also dispersed on leave (the later famous CO 2 

PARA, Lt Col H Jones was skiing in the French Alps when he 

heard of his unit’s deployment). 2 and 3 PARA were recalled in 

a similar fashion – at one point, tannoy announcements could 

even be heard on London stations informing all Parachute 

Regiment personnel that they were to return to Aldershot 

immediately. 

“H” Jones VC, Commanding Officer 2 Para 

Background noise 

As April wore on and the task force elements steamed south, 

other elements of the plan continued. Ascension “Wideawake” 

Island, over 1000 miles west of Africa, was to be used as a 

staging post and therefore had to be reinforced. An RAF 

deployable Marconi radar was quickly installed, giving a tactical 

perimeter to the island, and a fuel farm established. Wideawake 

had a vast runway for the American satellite station there, and 

with extra logistic support was the ideal outpost to support the 

operation. 

Despite its excellent facilities, the British force still put great 

pressure on the infrastructure and visits were strictly limited, 

with several ships receiving their resupply by helicopter rather 

than putting ashore. 

The assembled land forces on their respective ships put the 

cruising time to good use. Weapons were inspected, fired and 

stripped daily, the decks of Canberra reverberated to the sound 

of regimental PT and ceremonial bandsmen refreshed their 

skills as combat medics. Despite wearing conditions and frayed 

tempers, the British land forces were going to arrive ready to 

fight. 

Back in the UK, a diplomatic effort slowly gathered 

momentum. Al Haig, the US ambassador to Britain, spotted 


the diplomatic difficulties in the USA’s twin interests of Britain 

against the Eastern Bloc and hard-right South American states 

(amongst whom Argentina was one of the foremost) against the 

central American Marxists. He volunteered himself to conduct 

negotiations personally, and consequently spent much of April 

in the air. Unfortunately, his fellow ambassador to the UN was 

not of a similar inclination and set a frosty backdrop to 

negotiation by attending an Argentine banquet on the night of 

the invasion and declaring that she could see no problem in 

Argentina repossessing its own islands. To Galtieri and his 

colleagues in power, a scantily opposed invasion of the islands 

followed by a senior US diplomat apparently showing support 

for their actions, suggested things were going very well indeed. 

Over the first few days, though, some progress was made. The 

EEC nations showed surprising solidarity; several put in place 

immediate import sanctions (symbolically if not economically 

significant), with an EEC-wide order being put in place on 9th 

April. On 3rd April, the UN had passed resolution 502, 

permitting use of force to regain the sovereignty of the islands. 

The USSR had made objections but stopped short of using its 

veto, sensing an ultimate battle it did not wish to be on the 

losing side of. 

Black Buck – 1 May 

This was the name given to the nothing short of spectacular feat 

of delivering bombs onto (around, in the event) Port Stanley 

airfield by RAF Vulcan bomber. These behemoths of Cold War 

airpower were due retirement within weeks; this, their 

swansong, was a feat of logistics sadly unmatched by its tactical 

impact. 

A Vulcan bomber 

Staging out of Wideawake, the formation of 2 bombers and 

supporting Victor air-air refuellers set out on 1st May. The first 

Vulcan was obliged to turn back rapidly due to a technical fault, 

leaving Flt Lt Martin Withers to make the lonely journey in 

XM607 to the airfield. A complex system of sequential refuelling 

by the Victors ensured viability of the mission – at each stage, one 

tanker would give all its fuel bar return and reserve quantities 

before turning for home. The final tankers gave more, in fact, 

than was safe, relying on calling a Victor back out from 

Wideawake before reaching home. 

When the bombs finally hit the airfield, some fell to the side 

causing minimal damage to the dispersal and parked aircraft, 

while some only cratered the runway. Just seconds after 

appearing, XM607 was on its way home, payload delivered. 

Although the tactical impact was short-lived with most damage 

repaired within the day, the impact on morale of Britain’s 

capability to strike the heart of the invasion force from such a 

distance must have been significant. Withers won the DFC for 

flying this mission, and Sqn Ldr Bob Tuxford, pilot of the 

underfuelled Victor who had risked his life for the mission the 

AFC. 

Follow-up sorties were made by the Sea Harriers of the task 

force, punching further holes in Argentine air capability and 

morale. 

The Belgrano goes down – 2 May 

For more than a week, the crew of HMS Conqueror had been 

tracking the movements of the General Belgrano after a warning 

from Chilean intelligence that she had put to sea in the 

direction of the task force. Conqueror’s initial task was to watch 

and wait; as time wore on, however, it became obvious that the 

vessel was likely to be forming part of a pincer attack on the 

force. By the beginning of May, she was about to reach the 

shallower waters of the Total Exclusion Zone, into which 

Conqueror would not be able to follow her undetected. 

It was unthinkable that the group should come under direct 

threat, even with the inevitability of the global condemnation 

that would follow an act of aggression such as this. Conqueror 

was, therefore, ordered to engage Belgrano. Several Mk 8 

torpedoes struck her as she turned, exposing a massive target. 

The damage was catastrophic, and within the hour she was 

sunk. Predictably, this caused outrage in many quarters – even 

the British press quickly quelled their riotous headlines such as 

“Gotcha!” as the extent of the disapproval became clear. One 

more step had been taken down the path to war, with 

consequences to be seen very quickly. 

On the same day, the Sea Harriers took their first loss when 

Flt Lt Paul Barton (on exchange to 801 NAS) engaged a Mirage 

at close quarters whilst on Combat Air Patrol around the group. 

Belgrano is avenged – 4 May 

At 1400 hours 2 days later, a plume of white smoke snaked 

towards HMS Sheffield as it protected Hermes and Invincible, 

the only sign of the Exocet missile about to bury itself deep in 

the ship. It had been fired by a low-flying Super Etendard, a 

class of aircraft flown by the most able of Argentine pilots. 

Although its warhead did not detonate, the ship was ablaze 

within a minute and direct hits had been taken to both the 

main engine and main generator. An unserviceable backup 

generator curtailed all smoke extraction facilities and the 

survivors struggled through acrid black smoke to reach safety. 

20 were lost, as was the ship when it finally sank on tow 6 days 

later. 

A sombre mood prevailed back home when news of the loss 

broke, and delight at early successes forgotten. Loved ones 

would not be returning, and the fight had barely begun. 

5 Brigade put to sea – 12 May 

The Cunard liner QE2 left Southampton on 12th May, 

carrying 5 Inf Bde, commanded by Brig Tony Wilson in 

chipboard-lined splendour. The 3000 strong brigade consisted 

chiefly of the Welsh and Scots Guards, in addition to a 

Ghurkha battalion. Their routine was much the same as those 

who had sailed before them – weapons handling, PT and 

boredom. 


Pebble Island – 14 May 

Boat troop, D Sqn 22 SAS recreated the regiment’s North 

African successes in this raid on the main Argentine air asset. It 

had been adopted due to its proximity to the mainland and 

distance from the hazards of constant bombardment which its 

sister airfield at Stanley was suffering. The invaders had thus far 

used this strip unopposed – resupplying at leisure and flying 

frequent harassment sorties at the task force. A previously 

placed OP instructed that numerous aircraft were seen at the 

location, which they advised should be attacked overnight. 

After the patrols were reinforced by Sea King, the attached 

Naval Gunfire Officer called in support from Glamorgan which 

enabled attachment of plastic explosive to equipment whilst the 

garrison was pinned down. 

The total Argentine losses numbered 11 aircraft, the fuel 

dump and radar facilities. The cost of this was 2 minor injuries 

to SAS raiders, all of whom were successfully exfiltrated by 

helicopter. Events continued apace. 

San Carlos – 21 May 

The time at sea had been productive for the command element 

of 3 Commando Brigade. The key question was where to come 

ashore; Julian Thompson favoured a direct attack into Stanley, 

various SF elements proposed disparate “softening” raids, but 

one voice, and a relatively junior one at that, was heard above all 

others. Major Ewen Southby-Tailyour had previously 

commanded the marine party in the Falklands, and as a keen 

sailor had spent a great deal of spare time exploring the 

coastline. He had kept a sketch-book; this added a great deal of 

weight to his opinion that San Carlos offered a sheltered, 

navigable approach. The only problem was that it was on the 

wrong side of the island. 

There was no better fighting composition in the world for 

long-distance terrain coverage, however, than the combination 

of the Parachute Regiment and Commando Brigade. It was 

decided at a meeting on 10th May that the landings would be 

at San Carlos, with a 3 pronged move east to Port Stanley 

supported by helicopter for troop movement where possible. 

At around 0400, 2 PARA and 40 Cdo scrambled ashore at 

San Carlos unopposed, with 45 Cdo reaching Ajax Bay at first 

light. For several hours before the landings, there had been 

diversionary raids at several other possible landing points; the 

only possible resistance to the San Carlos landings had been at 

Fanning Head. This had been signalled in by a special forces OP 

just the day before, so the prelude to the landings had been a 

helicopter-borne assault to neutralize the threat. 

40 Cdo immediately secured the area to the east, into the 

Verde mountains – in combination with 45 Cdo’s position at 

Ajax Bay, the harbour was now well defended. 3 PARA cleared 

HMS Ardent on fire 

Fanning Head definitively whilst 2 PARA dug in, having scaled 

the ridge of the Sussex Mountains. Now, 42 Cdo could be 

brought ashore from reserve. 

As the light gathered, the inevitable attention from the air 

began. Sorties of Argentine jets maintained constant pressure on 

the group – Argonaut, Antrim, Broadsword and Ardent all took 

repeated hits. Eventually Ardent, forming the southern screen as 

well as keeping the pressure on Goose Green, took its 17th and 

final hit. As its civilian NAAFI manager (a retired SASC 

instructor) brought its machine guns to bear on the raiders, 

Yarmouth took survivors on from alongside. Argonaut was 

luckier – although hit repeatedly, it was crippled but not sunk. 

By the end of the day, a huge defect had emerged in 

Argentine tactics. Their zeal to destroy the defensive capability 

of the group had blinded them to the fact that they had clear 

shots on Canberra throughout. By the time Ardent was being 

abandoned, Canberra had disgorged not only the fighting 

troops, but their logistic support as well. The brigade was ashore 

and ready to fight. 

The Conveyor stops – 25 May 

By 25th May Antelope was lost in a very similar fashion, 

forming a perimeter well out into the Sound with no screening 

mountains. The aerial assault was relentless and eventually 

delivered a WWII design bomb which punched its way into the 

ship, but like the Exocet which finished Sheffield, did not 

detonate. Sgt Jim Prescott was tragically killed whilst trying to 

defuse the rapidly overheating bomb – he managed, however, to 

talk through the process to his team, ensuring that handling 

knowledge was passed on in case of further incidents. 

Atlantic Conveyor being refuelled by RFA Tidepool 

A loss more pivotal to the assault was that of the Atlantic 

Conveyor. She had been taken up from trade due to her massive 

carriage capacity, and was bringing the Chinooks so critical to 

the brigade’s overland assault in addition to tents, munitions 

and Harrier mats. Ironically the Exocet that sank her may well 

have been destined for Hermes; when the radar signature was 

detected, chaff rockets successfully diverted the missile. When 

it sought a second target, the giant, defenceless Conveyor was 

in the frame. 

As its oil-soaked plywood decking roared with flames, the 

task force’s air assets went up in smoke as well. The only way to 

Stanley was now by foot. 

East to Stanley – 26 May 

Julian Thompson’s original plan had been a direct advance on 

Stanley when the balance of the troops arrived. On 26 May 

news arrived from London – an immediate advance should be 

made, with a simultaneous attack on Goose Green. This 

dilution of an already understrength force pleased nobody but, 


orders being orders, 2 PARA dutifully turned south and set out 

from the Sussex Mountains. Airlift was available for heavy 

weapons, but boot leather would have to suffice for everyone 

else. 

Meanwhile, 45 Cdo and 3 PARA set off on the long tab 

North and East, destination Stanley. 

Sunray is down – 27 May 

Goose Green was to result in one of the conflict’s highest profile 

casualties – Lt Col Herbert “H” Jones VC. Naval gunfire began 

to soften the target in the early hours of the morning, with 

infantry fighting beginning at around 0600. The early phases of 

the attack involved repeated contacts with entrenched machine 

gun positions; well-dispersed, they bogged down the attack at 

several points. It was to break such a bottleneck that H Jones led 

his tactical HQ into the gully to the right of Darwin Hill, 

which A Coy had so far failed to overpower. He was cut down 

by an emplacement eventually neutralized by 66mm LAWs, 

and with the words “Sunray is down” command of 2 PARA was 

devolved to Maj Chris Keeble. It was time to test the alternate 

command structure set out for just such an eventuality – Jones 

had designated an entire alternate tactical HQ. 

Thankfully, the strategy held good and the battle continued 

apace. 3 were lost in one of the most distasteful episodes of the 

war, when Lt Jim Barry sighted a white flag flying in the 

trenches by the schoolhouse. He took 2 NCOs with him to take 

the surrender of the position; once in plain ground, all were cut 

down in a hail of machine gun fire. 

That night, Darwin was taken and with it came the 

information that the community hall at Goose Green held 

civilians in large numbers. Keeble’s plan of softening the 

settlement with an overnight bombardment was clearly now 

unworkable; permission was sought from Brigade HQ to 

negotiate. After a night of hasty field diplomacy Keeble went 

forward to the Argentine position with 2 reporters to witness 

talks, offering the options of surrender or release of hostages 

followed by continued military action. 

Air Vice Commodore Wilson Pedroza offered the surrender 

of the garrison and shortly afterwards the men of 2 PARA 

watched agape as the parade of 250 men were joined by another 

three times as many. The British battalion had defeated a 

defending force 3 times its size; the excrement smeared on walls 

and destroyed furniture was testament to the brave new 

Argentine world the islanders had been liberated from. 

3 PARA now turned east to take Teal Inlet, a waypoint to 

Stanley, while 45 Cdo had drawn the short straw (but long 

walk) and were to head north to Douglas before following the 

paras’ trail through Teal Inlet. 

Stanley in sight – 31 May 

42 Cdo’s move was less footsore but potentially far more lethal. 

Key high ground to be secured in the battle for Stanley was 

Mount Kent and the ground around it, which overlooked the 

town. The only way to move the marines this far forward within 

the required timeframe was helicopter – an unarmoured flight 

in appalling weather, necessitating several hops for the required 

numbers. 

After being forced back by a whiteout on 30 May, 2 Sea Kings 

deposited K Coy of 42 Cdo and Lt Col Mike Rose of 22 SAS 

on Mount Kent, a Chinook following shortly behind with a 

105mm gun and 300 rounds. After a day of isolation, the Sea 

King force brought the rest of the battalion in a series of daring 

low-level flights. 

Once established the unit quickly secured Mount Challenger, 

Estancia House and Bluff Cove Peak, tightening the grip on 

Stanley and providing an LUP for 3 PARA and 45 Cdo. With 

these units in place, a pincer was forming ready to close on the 

increasingly beleaguered Argentine garrison. 

Closing in – June 

After cross-decking from QE2 to Canberra and Norland, 5 Bde 

were put ashore on 1 June. Their immediate task on 2 June was 

to head east and form the southern prong of the attack, 

potentially entailing a long, cold walk. A local civilian suggested 

that telephone communications might still be working at 

Fitzroy, so a heliborne party deployed to the nearest working 

line at Swan Inlet. They managed to raise a farmer at Fitzroy 

who confirmed that Argentine forces had been and gone, 

leaving a golden opportunity. This was later confirmed by 

Patrols Coy 2 PARA, now under brigade command. 

Tony Wilson was keen to exploit this at the earliest 

opportunity, and so commandeered the sole Chinook to move 

the brigade to Fitzroy. A near blue-on-blue due to the 

unannounced nature of the flight brought criticism from San 

Carlos, but the brigade had, nonetheless leapt ahead. 

By 3 June 3 PARA under Hew Pike were established at 

Mount Estancia, staring up at Mount Longdon which stood 

between them and the final objective of Stanley. As the days 

passed, recce parties went forward to assess the strength and 

disposition of Argentine defence and artillery was brought 

forward to the battalion. 

Farewell Sir Galahad – 8 June 

Another blow was struck from the air with the bombing of Sir 

Galahad as it lay in Port Pleasant near Fitzroy, with the Welsh 

Guards aboard. After the Scots Guards were deposited by 

Intrepid 3 days previously, it was decided that logistics ships 

should be used to land the Welsh. In Fitzroy, 16 Field 

Ambulance were due to disembark with a Rapier air defence 

unit, but the Welsh were supposed to be at Bluff Cove, not 

navigable by the ship. As the debate over safety at sea or a long 

walk to Bluff Cove continued, 4 jets screamed over and 

dropped a stick of bombs squarely on target. 

As petrol, ammunition and equipment blazed, the embarked 

troops triaged, treated and evacuated as best they could, many 

working with horrific injuries themselves. 

RFA Sir Galahad 

The final days – 10-14 Jun 

The formation took shape, Stanley was encircled by 

commandos, guardsmen and ships and the task force steeled 

itself for the advance into Stanley. The plan was divided into 3 

stages. Firstly, Mounts Longdon, Two Sisters and Harriet were 

to be secured by 3 PARA, 45 Cdo and 42 Cdo (aided by the 

Welsh Guards) respectively. This first phase was to take place in 

the early hours of 12 Jun. 

Phase two involved the capture of Wireless Ridge by 2 PARA, 

who would be held in reserve during the first phase before 


moving through and beyond 3 PARA. The Scots Guards were 

to take Mount Tumbledown, the Gurkha rifle battalion Mount 

William and the Welsh Guards Sapper Hill. This was scheduled 

for the night of the 12th. The third and final phase would be a 

move through 5 Brigade’s consolidated positions and into 

Stanley, to defeat the occupiers in the street. 

Longdon 

Longdon proved a fearsome environment for the Paras; the two 

months of occupation had allowed the Argentine forces to 

develop two well defended positions with numerous bunkers and 

machine gun emplacements. A combination of armament and 

topography made Longdon a challenge for the toughest of 

soldiers resulting in a hard fought engagement. The western 

position, “Fly half” was taken rapidly, although the platoon 

advancing from the west bypassed a position in the dark and 

subsequently took rounds to their rear. 

“Full back” lay to the east and was ferociously defended. The 

advancing Paras began taking rounds from at least 2 GPMG 

emplacements, joined by a .50 calibre heavy machine gun. 

At the start of the attack on the position, the detonation of an 

antipersonnel mine had triggered the beginning of a 

bombardment, the grids having already been set. As the shells 

rained in, the Paras tried sending a flank attack to the north of 

the position. They sustained withering fire, and the flank was 

recalled. The advance was finally made in true infantry style, on 

their bellies from the west along the ridgeline, expending virtually 

all grenades and finally resorting on 66mm weapons to clear 

positions. The summit was finally taken at the closest of quarters, 

with bayonet fighting in the trenches. The cost to the battalion 

was 23 dead and 47 injured, but a decisive victory was had. 

Harriet 

In contrast to the heavy fighting from the outset on Longdon, 

surprise minimized losses on Mount Harriet. After a delayed 

start, the Welsh Guards and 42 Cdo got to the foot of the slope 

undetected, and called in the spectacular firepower of the 

assembled batteries of 29 Cdo Regt RA, a firm deterrent to even 

the most committed occupier. As the rounds fell, the assault 

continued forwards and cleared to the summit using small 

arms, anti-tank weapons and grenades. 

Milan, the latest hi-tech anti-tank weapon was used in anger 

against the well established bunkers on the summit. When these 

were overrun, a treasure trove of rations, ammunition, maps 

and even a battlefield radar were taken. 

Two Sisters 

45 Cdo’s assault on Two Sisters was another triumph of 

committed, brutally tough soldiering. The men had to fight up 

the rocky outcrops under perpetual bombardment, eventually 

ransacking the captured positions for shelters, warm kit and 

food as they lay exhausted on the peaks of the mountain. Phase 

one was complete, with all objectives taken. 

Two Ssters 

Wireless Ridge 

The already battle hardened soldiers of 2 PARA readied 

themselves once more for battle, their objective to take Wireless 

Ridge in readiness to move into Stanley. In contrast to the austere 

logistics supporting Goose Green, they had armour, artillery and 

air support. At first light, the winning partnership of the 30mm 

cannon of the Blues and Royals and GPMGs of the battalion had 

cleared the bunkers and the assault on Tumbledown (in 

conjunction with Scout-borne SS12 missiles) had neutralized the 

Argentine guns which had hampered the final phase of the assault 

from across Moody Brook. A and B companies, with the Blues 

and Royals, finally got to look down to Stanley. 

Tumbledown 

The original plans for the Scots to assault Tumbledown directly 

from the south up a fearsome slope were soon abandoned as a 

result of the ferocity of resistance met by an initial recce party. 

Given that 3 Cdo Bde were already dug in to the west, a 

flanking attack from there seemed to offer (relative) safety. 

The three companies assaulted from the west, moving 

through each other in the line of march. With each wave, more 

men were occupied by clearing and holding sangars as they 

went, leaving a dangerously understrength force holding the 

front line of attack. 

The series of dogged and relentless attacks eventually took the 

summit from, as it transpired, a very professional Argentine 

marine company. The fighting had been every bit as bloody as 

that on Tumbledown. 

Mount Tumbledown 

Two more hills to go… 

As the light gathered and battle raged on adjacent Tumbledown, 

the Gurkha rifle battalion waited to start their assault on Mount 

Williams. When Tony Wilson deemed the Scots close enough to 

the finish line, the Gurkhas were waved off, again with all the 

support that could be mustered. Artillery, Milan and .50 cal once 

again entered the fray but equally potent was the dedication of 

the Nepalese unit, which moved round Tumbledown under its 

Scottish stewardship to assault Williams from the north. The 

aggression worked up for the final attack proved unnecessary as 

the Argentines fled in the face of the Gurkhas, who they had been 

reliably informed were cannibals. 

The composite of the hugely depleted Welsh Guards and 40 

Cdo waited impatiently to take the final ground before Stanley, 

Sapper Hill. White flags were already flying in the town, and 

nobody wanted to miss the action. 

For expediency, a company sized assault was launched by 

helicopter and followed up by the rest of the composite on foot. 

This made quick work of the few brave stay-behinds and by late 

afternoon the Welsh and commandos watched the Paras move 

into Stanley. 

Going to town 

The move down from Wireless Ridge began at 1300, after 

Julian Thompson surveyed the situation from the air. The 

armour of the Blues and Royals, one vehicle proudly displaying 


their regimental colour, ferried the Paras in as they swarmed 

towards Stanley. The order was received to halt at the racecourse 

– the occupiers wished to discuss terms. 

Surrender – 14 Jun 

For several days before the encirclement of Stanley, Col Reid 

(listed as being 22 SAS) and Capt Rod Bell RM (who had been 

raised in Latin America) had been transmitting on the medical 

advice frequency of the King Edward Memorial Hospital, 

known to be occupied. Although no reply was received, it 

became clear early in negotiation that Gen Menendez’s staff had 

been listening. They now wanted to talk. 

In the afternoon of 14 Jun, Reid and Bell were carried 

forwards by Gazelle to a bizarrely formal meeting with 

Menendez. After quibbling over whether he could surrender the 

geographically but not geopolitically separate islands in the 

group, Menendez acquiesced to all terms except the use of 

“unconditional” in describing the surrender. 

After bad weather grounded him, Maj Gen Moore, task force 

commander, eventually arrived for a final round of talks at 

2300. At 2359 on 14 Jun 1982, Britain took the surrender of 

the Argentine occupiers of Stanley – the Falklands were retaken. 

As Britain celebrated its reassertion as a world power, the 

units of both the task force and the occupation buried their 

dead. To come was a massive effort in repatriating prisoners of 

war and a long journey home. For now, though, it was enough 

that the fighting was over. 

Falkland Islands Memorial Chapel, Pangbourne, Berkshire 



Chronology of events 

The Falklands Conflict, 2 April to 14 June 1982, followed the invasion of the Falkland Islands by Argentina on 2 April 1982. It 

was a unique period in the history of Britain and Argentina and, although war was never formally declared, the brief conflict saw 

nearly 1,000 lives lost on both sides and many more wounded. 

March 1982 

Davidoff workers land on South Georgia 

illegally. HMS Endurance sent to South 

Georgia. Argentine naval vessels sent to 

'protect' the workers. 

April 1982 

2 April Argentine Forces occupy the Falkland islands. 

3 April Debate in House of Commons. UN 

Resolution 502. Argentine forces take South 

Georgia 

5 April Lord Carrington, Humphrey Atkins and 

Richard Luce resign. Ships of the Royal Navy, 

including the aircraft carriers HMS Hermes 

and HMS Invincible, leave Portsmouth and 

elsewhere. 

8 April US Ambassador Haig arrives in London to 

begin his diplomatic 'shuttle' between the 

nations. 

9 April Haig arrives in Buenos Aires. 

10 April EEC declares sanctions against Argentina. 

12 April Britain declares maritime exclusion zone 200 

miles around Falklands. 

19 April EEC foreign ministers declare support for 

Britain. 

23 April Britain warns Argentina that any warship or 

military aircraft representing a threat to the 

task force would be dealt with accordingly. 

25 April South Georgia recaptured, Argentine 

submarine Santa Fe damaged. 

29 April Argentina rejects Haig's peace proposals. 

30 April Britain declares total exclusion zone. US 

announces support for Britain. 

May 1982 

1 May First British attacks. 

2 May Argentine cruiser General Belgrano sunk. 

4 May HMS Sheffield hit by Exocet missile. 

7 May British Government warns Argentina that any 

warships or military aircraft more than 12 

miles from Argentine coast could be regarded 

as hostile. UN Secretary-General begins talks 

with Britain and Argentina. 

14/15 May SAS raid on Pebble Island supported by naval 

gunfire. Several Argentine Pucara aircraft 

damaged or destroyed. 

16 May Final British proposals worked out. 

17 May Proposals sent to Argentina. 

18 May Argentine government rejects British 

proposals. 

20 May UN Secretary-General admits failure of UN 

talks. 

21 May Beachhead establishes at San Carlos. HMS 

Ardent sunk, fifteen Argentine planes shot 

down. 

23 May HMS Antelope damaged (explodes and sinks 

next day). Seven more Argentine aircraft shot 

down. 

25 May HMS Coventry sunk by air attack and 

container ship Atlantic Conveyor destroyed by 

Exocet missile. 

27 May British Forces move forwards to Teal Inlet and 

Mount Kent. 

28 May British victory at Battle of Goose Green (2 

Para). 

June 1982 

1 June 5 Infantry Brigade arrive at San Carlos. 

4 June Britain and USA veto UN call for immediate 

cease-fire. 

8 June Royal Fleet Auxiliaries Sir Galahad and Sir 

Tristram bombed at Fitzroy. 

11/12 June Mount Harriet, Two Sisters and Mount 

Longdon taken by British forces. HMS 

Glamorgan hit by land-launched Exocet. 

13/14 June Tumbledown Mountain, Wireless Ridge and 

Mount William taken by British forces. 

14 June General Menéndez surrenders to Major- 

General Jeremy Moore 

17 June General Galtieri resigns. 

20 June Southern Thule retaken. EEC lifts economic 

sanctions against Argentina. 

22 June General Bignone replaces General Galtieri. 

25 June Governor Rex Hunt returns to Port Stanley. 

July 1982 

26 July Ceremony of thanksgiving at St. Pauls in 

London. 

October 1982 

12 October Victory parade in London. 

November 1982 

4 November A resolution calling for a peaceful solution to 

the sovereignty dispute voted by UN General 

Assembly. 

i 

JR Army Med Corps 153(S1): i


ROLL OF HONOUR 

MEM(M)1 F O ARMES 

ACWEA J D L CADDY 

MEM(M)l P B CALLUS 

APOCA S R DAWSON 

AWEM(R)1 J K DOBSON 

PO(S) M G FOWLER 

WEM(O)1 I P HALL 

LT R R HEATH 

AWEM(N)1 D J A 

OZBIRN 

LT CDR G S ROBINSON- 

MOLTKE 

POAEM(L) M J ADCOCK 

CK B EASTON 

AEM(M) M 

HENDERSON 

AEM(R)1 B P HINGE 

LACAEMN D LEE 

AEA(M)2 K I McCALLUM 

AB(S) D D ARMSTRONG 

LT CDR R W BANFIELD 

AB(S) A R BARR 

POAEM(M) P BROUARD 

CK R J S DUNKERLEY 

ALCK M P FOOTE 

MEM(M)2 S H FORD 

ASTD S HANSON 

AB(S) S K HAYWARD 

AB(EW) S HEYES 

WEM(R)1 S J LAWSON 

MEM(M)2 A R 

LEIGHTON 

LT CDR G W J BATT 

POACMN K S CASEY 

LT W A CURTIS 

LT CDR J E EYTON- 

Royal Navy 

HMS Coventry 

HMS Glamorgan 

HMS Ardent 

HMS Hermes 

LRO(W) B J STILL 

MEA2 G L J 

STOCKWELL 

AWEAl D A 

STRICKLAND 

AAB(EW) A D 

SUNDERLAND 

MEM(M)2 S TONKIN 

ACK I E TURNBULL 

AWEA2 P P WHITE 

WEA/APP I R WILLIAMS 

CK B J MALCOLM 

MEM(M)2 T W PERKINS 

L/CK M SAMBLES 

L/CK A E SILLENCE 

STD J D STROUD 

LT D H R TINKER 

POACMN C P VICKERS 

AEMN(I) A McAULEY 

ALS(R) M S MULLEN 

LT B MURPHY 

LPT G T NELSON 

APOWEM(R) A K 

PALMER 

CK J R ROBERTS 

LT CDR J M SEPHTON 

ALMEM(M) S J WHITE 

ALMEM(L) G 

WHITFORD 

MEM(M)1 G S 

WILLIAMS 

LT N TAYLOR 

HMS Invincible 

JONES 

NA(AH)1 B MARSDEN 

LT CDR D I BALFOUR 

POMEM(M) D R BRIGGS 

CA D COPE 

WEAl A C EGGINGTON 

MEA(P) A S JAMES 

AB(R) I M BOLDY 

STD M R STEPHENS 

AEM(R)1 A U ANSLOW 

CPOWTR E FLANAGAN 

CPL J G BROWNING 

MNE P D CALLAN 

MNE C DAVISON 

SGT R ENEFER 

SGT A P EVANS 

CPL K EVANS 

CPL P R FITTON 

LT K D FRANCIS 

L/CPL B P GIFFIN 

MNE R D GRIFFIN 

A/SGT I N HUNT 

C/SGT B R JOHNSTON 

SGT R A LEEMING 

CPL M D LOVE 

GDSM D J DENHOLM 

GDSM D 

MALCOLMSON 

L/SGT C MITCHELL 

GDSM J B C REYNOLDS 

HMS Sheffield 

HMS Fearless 

HMS Argonaut 

HMS Antelope 

Atlantic Conveyor 

Royal Marines 

Royal Marines 

Army 

Scots Guards 

S/LT R C EMLY 

POCK R FAGAN 

CK N A GOODALL 

ALMEM(M) D MILLER 

S(M) M J STUART 

LAEM(L) D L PRYCE 

MNE S G McANDREWS 

MNE G C MacPHERSON 

L/CPL P B McKAY 

MNE M J NOWAK 

LT R J NUNN 

MNE K PHILLIPS 

SGT R J ROTHERHAM 

MNE A J RUNDLE 

CPL J SMITH 

CPL I F SPENCER 

CPL A B UREN 

CPL L G WATTS 

MNE D WILSON 

SGT J SIMEON 

GDSM A G STIRLING 

GDSM R TANBINI 

WO11 D WIGHT 




L/CPL A BURKE 

L/SGT J R CARLYLE 

GDSM I A DALE 

GDSM M J DUNPHY 

GDSM P EDWARDS 

SGT C ELLEY 

GDSM M GIBBY 

GDSM G C GRACE 

GDSM P GREEN 

GDSM G M GRIFFITHS 

GDSM D N HUGHES 

GDSM G HUGHES 

GDSM B JASPER 

GDSM A KEEBLE 

L/SGT K KEOGHANE 

GDSM M J MARKS 

GDSM C MORDECAI 

L/CPL S J COCKTON 

S/SGT J I BAKER 

MAJOR M L FORGE 

Welsh Guards 

Army Air Corps 

Royal Signals 

L/CPL S J NEWBURY 

GDSM G D 

NICHOLSON 

GDSM C C PARSONS 

GDSM E J PHILLIPS 

GDSM G W POOLE 

GDSM N A ROWBERRY 

L/CPL P A SWEET 

GDSM C C THOMAS 

GDSM G K THOMAS 

L/CPL N D M THOMAS 

GDSM R G THOMAS 

GDSM A WALKER 

L/CPL C F WARD 

GDSM J F WEAVER 

SGT M WIGLEY 

GDSM D R WILLIAMS 

S/SGT C A GRIFFIN 

CPL D F McCORMACK 

Royal Electrical and Mechanical Engineers 

CFN M W ROLLINS 

CFN A SHAW 

SPR P K GHANDI 

SPR C A JONES 

CPL A G McIIVENNY 

CPL M MELIA 

L/CPL B C BULLERS 

PTE A M CONNETT 

L/CPL I R FARRELL 

MAJOR R NUTBEEM 

L/CPL BUDHAPARSAD 

LIMBU 

Royal Engineers 

L/CPL A R STREATFIELD 

L/CPL J B PASHLEY 

S/SGT J PRESCOTT 

SPR W D TARBARD 

CPL S WILSON 

Army Catering Corps 

PTE M A JONES 

PTE P W MIDDLEWICK 

Royal Army Medical Corps 

Gurkha Rifles 

PTE K PRESTON 

LT J A BARRY 

L/CPL G D BINGLEY 

L/CPL A CORK 

CAPTAIN C DENT 

PTE S J DIXON 

C/SGT G P M FINDLAY 

PTE M W FLETCHER 

CPL D HARDMAN 

PTE M HOLMAN- 

SMITH 

PTE R J ABSOLON 

PTE G BULL 

PTE J S BURT 

PTE J D CROW 

PTE M S DODSWORTH 

PTE A D GREENWOOD 

PTE N GROSE 

PTE P J HEDICKER 

L/CPL P D HIGGS 

CPL S HOPE 

PTE T R JENKINS 


3RD ENG C HAILWOOD 

2ND ENG P HENRY 


Royal Air Force & Others 

FLT LT G W HAWKINS 

DOREEN BONNER 

MARY GOODWIN 

2 Para 

3 Para 

Royal Air Force 

Falkland Civilians 

Royal Fleet Auxiliary 

1ST RADIO OFF R R HOOLE 

PTE S ILLINGSWORTH 

LT COL H JONES 

PTE T MECHAN 

PTE D A PARR 

CPL S R PRIOR 

PTE F SLOUGH 

L/CPL N R SMITH 

CPL P S SULLIVAN 

CAPTAIN D A WOOD 

PTE C D JONES 

PTE S I LAING 

L/CPL C K LOVETT 

CPL S P F McLAUGHLIN 

CPL K J McCARTHY 

C/SGT I J McKAY 

L/CPL J H MURDOCH 

L/CPL D E SCOTT 

PTE I P SCRIVENS 

PTE P A WEST 

SUE WHITLEY 

3RD ENG A MORRIS 





BOSUN J DOBSON 

MECHANIC F FOULKES 

STD D HAWKINS 

RFA Sir Tristram 

YU SIK CHEE 

YEUNG SWI KAMI 


NG POR 

CHAN CHI SING 

HMS Coventry 

KYE BEN KWO 

Merchant Navy 

Chinese 

MECHANIC J HUGHES 

CAPT I NORTH 

MECHANIC E VICKERS 


LEUNG CHAU 

SUNG YUK FAI 

HMS Sheffield 

LAI CHI KEUNG 

A/CPL R E ARMSTRONG 

A/SGT J L ARTHY 

A/WO1 I M ATKINSON 

A/CPL W J BEGLEY 

A/SGT P A BUNKER 

A/CPL R A BURNS 

SGT P P CURRASS 

A/SGT S A I DAVIDSON 

WOll L GALLAGHER 

CAPTAIN G J 

Special Air Service 

Special Air Service 

HAMILTON 

A/SGT W C HATTON 

A/SGT W J HUGHES 

A/SGT P JONES 

L/CPL P N LIGHTFOOT 

A/CPL M V McHUGH 

A/CPL J NEWTON 

A/WOll P O'CONNOR 

CPL S J G SYKES 

CPL E T WALPOLE 



Introduction 

These papers were published in the Journal of the Royal Army 

Medical Corps in the months following the Falklands War. In 

many respects they reflect medical practice at the time. 

Unfortunately, they also draw attention to lessons we seem 

compelled to relearn on a regular basis. 

There are, essentially, two groups of papers. The first, personal 

experiences provide a vivid description of life as a medical officer 

in conflict twenty five years ago. The second are papers which 

review particular areas of the practice of military medicine and 

surgery. Where appropriate, these are accompanied by a modern 

commentary. 


THE FALKLANDS WAR 

Original Contributors 

AFG GROOM. Commissioned July 1974. Retired in the rank 

of Lieutenant Colonel June 1993. Consultant Orthopaedic 

Surgeon. 

CG BATTY. MB ChB 1973. FRCS Glas 1984. SSC 2nd Lt 9 

Nov 1970 

DS JACKSON Commissioned 1979. Retired as a Lieutenant 

Colonel 1988. Consultant Surgeon 

IP CRAWFORD. Commissioned October 1960. 

Commandant and Post Graduate Dean RAM College 1989-93. 

GM. QHP 1991. 

JB STEWART. Commissioned October 1958. Retired June 

1983 in the rank of Colonel. Consultant Pathologist. Professor 

of Army Pathology 1981-83. 

JE BURGESS. Commissioned September 1975. Director 

Primary Care – Health Alliance 1998. 

JM RYAN. MB ChB 1970. FRCS 1978. SSC 2nd Lt (Cadet) 

October 1967. DA Surg 1994-95. 

JT COULL. Commissioned March 1960. Retired in the rank 

of Major General December 1988. Consultant Orthopaedic 

Surgeon. Director of Army Surgery 1988-92. CB 1992. 

MD JOWITT. Commissioned 1972. Retired Lieutenant 

Colonel 1989. Recalled April 1995. Retired as a Lieutenant 

Colonel November 1995. Consultant Anaesthetist. 

P ABRAHAM. National Service Commission August 1958. 

Retired as a Brigadier February 1992. Director Army Psychiatry 

1984-92. QHP. 

P CHAPMAN. Commissioned October 1972. Retired 

Lieutenant Colonel July 1995. Consultant Surgeon 1988. 

RJ KNIGHT. Commissioned 1966. Retired as a Lieutenant 

Colonel May 1982. Consultant Anaesthetist. 

R SCOTT. Commissioned October 1956. Retired August 1989 

in the rank of Major General. Commandant and Post Graduate 

Dean RAM College 1982. QHS. 

RP CRAIG. Commissioned March 1963. Retired in the rank 

of Major General September 1994. Director Army Surgery 

1992-93. Commander Med UKLF 1993-94. QHS 1992. 

WSP MCGREGOR. MB ChB 1958. FRCS Ed 1967. SSC 

Lt 29 Jan 1959. Cons Surgeon. Retired 1 Oct 1992. Died 4 

March 2005. 

M BROWN. National Service Commission January 1956. 

Retired August 1980 as a Major General. Director of Army 

Medicine , RAM College. 

JR Army Med Corps 153(S1): 93 93

THE EVE OF THE SINKING OF THE ‘SIR GALAHAD’ 

Sir Galahad, Sir Galahad 

My heart for you doth weep 

You’re going to die tomorrow 

So that fifty souls can sleep 

For on a cold June morning 

Rained madness from the sky 

Our soldiers, screamed and perished 

You heard and knew not why 

You burnt and writhed and twisted 

And you knew all their pain 

But you kept it all within you 

Your memories and our slain 

Your burning funeral pyre 

Was there for all to see 

A reminder of man’s inhumanity 

And of how stupid we can be 

But when you die Sir Galahad 

The picture God will see 

Mankind washing its conscience 

In this cold and bitter sea 

So Sir Galahad we will sink you 

We will send you to the deep 

Lay quiet in your watery grave 

And guard our soldiers sleep 

For your name will stand in history 

As guardian of our slain 

You will die with honour 

While men will bare the shame 

(This poem was written by Jack Crummic, bosun on the 

Tugboat “Typhoon” and handed to WO2 Viner.) 



The Battle for Goose Green – The RMO’s view 

Capt SJ Hughes 

Abstract 

Summary: By virtue of the Battalion I serve with, I was the first Task Force Doctor on to the Falklands. On Friday the 

21st May, 2 Para made an assault beach landing, thankfully unopposed, on San Carlos beach, the RAP was with them 

Introduction: As 2 Para occupied the Sussex Mountains for six days and on Wednesday 2 May, moved off at last light 

to Camilla Creek House, 5 miles from Darwin. The Battalion laid up in the area of Camilla Creek during 27 May and early 

the next morning moved out to create history…. 

Goose Green – Friday 28th May, 1982 

We set off from Camilla Creek House at about 2 a.m. tired 

before we started after the previous night’s TAB. On our backs 

the RAP (Regimental Aid Post) Medics were all carrying in 

excess of 80lbs of medical kit and the uneven ground ensured 

that we all fell regularly. 

We laid up near the mortar line just north of the Darwin 

Peninsula whilst A and B Companies put in their first attacks. 

There was a steady drizzle, and those of us who had worn our 

waterproofs were glad of them – some of us even dozed. 

About 2 hours after the initial H hour, Battalion Main HQ, 

(including the RAP) moved off and down the narrow track onto 

the Peninsula itself. To our left, a large area of gorse had been 

ignited by white phosphorous grenades and the flames lit up the 

night sky. The crackle of burning gorse could be heard above the 

reassuring crump of the naval gunfire support. We had just come 

level with the first cache of Argentinian prisoners, on the edge of 

the track, when the first salvo of the Argentinian guns bracketed 

the track. 

We heard the distant crump and the incoming whistle and 

barely hit the ground before the first rounds of “HE” hit the peat 

either side of the track. We wormed our bodies in, face down to 

the banks on either side of the track, so that our Bergens gave 

our backs some protection. The reality of the war began to sink 

in. 

Again we were bracketed, but miraculously nothing landed on 

the track, and the soft, wet peat, off the track, kept the shrapnel 

to a minimum. We had no casualties. 

A tracer round cracked 6 ins over my head from somewhere 

off to the right – a stray round buried my head further into the 

earth. 

The first two attacks had had no casualties, but now D Coy 

came up against stiffer opposition and Chris Keeble, the Bn 

21C, asked me to move forward up the track to deal with the 

first casualties. His parting words, as I led the RAP off were, 

“Watch out for the sniper on the right flank.” 

I then realised where that not so stray round had come from, 

and was convinced that the collar of my waterproof jacket, white 

on the reverse, would make me a perfect target. It may well have 

but nothing happened. 

We ran low and fast for about 400 metres, until we came 

across the two D Coy wounded, both minor gunshot wounds. It 

was about 6 a.m. still with a further 4 hours of darkness – so after 

finishing our treatment regime, all we could do was reassure 

them and keep them warm and sheltered from the rain until 

dawn, when the first choppers would fly. 

The CO, ‘H’ appeared, with his TAC HQ and came to find 

out how the casualties were – “Alright Sir, we’ll try and get them 

back to Camilla Creek in the captured Landrover.” He and the 

Adjutant, one of my close friends, David Wood, were joking 

about a shell that had landed between them, yet left them both 

unscathed. “These Argies have got some shit ammunition.” It 

was to be the last time I would see either of them alive again. 

TAC 1 disappeared and Battalion Main moved in around us. 

Time drifted by and the shelling periodically came our way. As 

the sky started to brighten we lost the benefit of the naval gun 

support and at dawn we found ourselves in a natural bowl of 

land to the north of Coronation Point. 

One or two more casualties were brought in, together with our 

first dead. Two of my Medics had lost friends and I had lost some 

of my own patients – we were all affected. We improvised shelter 

for the wounded using a captured Argie tent until at first light 

helicopters came in bringing ammunition resupply. We got the 

casualties into the Choppers and I went back to my routine of 

listening in to the Battalion Command net – Reading the Battle. 

There was a big battle raging ahead of us, and nothing seemed 

to be moving. We all began to dig into the peat because the 

shelling was now more constant, our own guns becoming less 

vociferous. 

Shortly after 1300, I heard the message over the net “Sunray 

has been hit.” The Battalion called for a helicopter to pick him 

up and it became obvious that there were other casualties in 

trouble. I rounded up my Medics and split them up into two 

teams – one under my command and the other under Capt Rory 

Wagon, the Doctor who had been attached to us from Ajax Bay 

Field Hospital (Table 1). 

Table I 

2 Para Regimental Aid Post (2 & 9) 

Team A 

Team B 

RMO (Doctor) 

Attached Doctor 

Radio Op 

Radio Op 

L/Cpl – RMA 

Cpl – RMA 

Pte – RMA (3) Pte – RMA (2) 

Table 1. Padre and his bodyguard moved with Team A. RAP Deployment 

possibilities – 1. A & B Co-located. 2. A & B Deployed independently. 3. A & 

B “Leapfrog” One moves, other deals with casualties. 

Both forward companies had casualties in locations 1½ km 

apart. Rory’s team went out to the right flank and I moved my 

lads out to the left, to the hills around Darwin. As we moved 

forward we had to dive for cover as two Pucara aircraft appeared 

ahead. They roared over us and I turned in time to see them 


spot two scout helicopters emerge from the direction of Camilla 

Creek House. The Pucara swooped, like hawks, and the 

choppers took desperate evasive action. One chopper 

disappeared up the valley whence it had come and managed to 

escape. The other chopper exploded in a ball of flame. The 

Pucara disappeared. 

We found ‘A’ Company on a hill 1 km to the west of Darwin, 

their casualties collected together at the base of the hill, 

amongst them the Company Medic. Again the shock of dealing 

with people you knew in a far from clinical environment – but 

we steeled ourselves and went to work. 

We dealt with the casualties and I’d once more called for 

helicopters. Ahead of us the battle carried on. There was no sign 

of ‘H’ so I asked the Sgt Major. “H is dead, Sir, and Captain 

Wood, and Captain Dent” – the CO and two good friends all 

at once; - but there was nothing else but to continue the job. 

The casualties had all had their wounds dressed and drips set 

up. We’d given them pain killers and filled them full of 

antibiotics. We tried to keep them dry and warm and kept up a 

steady banter to reassure them, especially a lad with a head 

injury, who I didn’t want to go into a coma. 

By now we were beginning to run low on medical supplies – 

there’s a limit to how much you can manpack. At least no more 

casualties had come in, although there were some wounded 

amongst the Argie prisoners for whom we did what we could. 

Then over the hill came what for me will always be the 

Seventh Cavalry – 4 scout helicopters, fitted with Casevac Pods 

and bringing our medical resupply. We got all the wounded 

away and even some of the more seriously wounded Argie 

prisoners. Then the shelling started again and we moved up the 

hill slightly, into a gully which gave natural cover against low 

trajectory artillery fire. 

It was here that we spent the rest of the day. The helicopters 

coming in under cover of the hill. 

We continued to treat casualties, our own, and in quiet 

phases Argentinians, with the smoke of the battle field and the 

burning gorse at times almost fogging us out. Fatigue was 

setting in and we all wondered how much longer this could go 

on. For most of the afternoon the battle had seemed to be going 

against us, but, as dark set in, it swung back in our favour and 

as darkness fell the artillery fell silent and gunfire became 

sporadic. We were still holding three battle sick – twists and 

sprains – and though we tried for a helicopter we knew they 

would keep, if it didn’t arrive. 

We were all expecting the battle to start afresh the next day, 

so we set up a stag system to look after the casualties and laid 

down in the gorse to sleep, after I’d first sat down with the RSM 

and the Padre to work out who our dead were. 

The day had been long and hard, tragic and frightening, the 

night was bitterly cold, and we none of us had sleeping bags. 

Some people lay down actually in burning gorse to keep warm. 

I lay down in a clump of non-burning gorse and thanked my 

stars for the space blanket I’d bought in the UK and shoved in 

the back of my smock! 

I managed to wrap my body in this totally non-tactical piece 

of foil. The silvered surface caught the flicker of gorse flames 

and I crinkled like a Sunday roast, but it made the temperature 

bearable. 

Although I was exhausted I wondered whether I would sleep 

after the horrors of the day and as I lay in a twilight state every 

rustle of my foil blanket was a machine gun and every gorse was 

an artillery shell. I was aware of the tricks my mind was playing 

on me – and I wondered if I was cracking up. 

I slept. 

I awoke in the half light of mid-morning and couldn’t feel my 

feet. Then I could and they were painful. Around me the RAP 

was stirring. 

Chris Keeble happened by and told the Padre and I of his 

plan. He would give them the opportunity of an honourable 

surrender. 

There followed a void; a lack of hostilities. Whilst the 

Battalion took the time to fly in ammunition, we took the time 

to fly out our casualties and do what we could for the remaining 

injured amongst the prisoners. 

It was as we were treating the prisoners that we heard the 

news of the surrender. The battle was over. Although our work 

was not quite finished yet, at least it would not get any worse. 

All told we treated 33 of our own (Table 2) and over twice 

that number of Argentinians. 

Gunshot 

Wounds 

Shrapnel/Frag 

ments 

Shot down – 

Helicopter 

Pilot (Massive 

injuries) 

Wounded 

Killed in 

Action 

All Wounds 

Fatal and 

Non-Fatal 

*16 12 28 (56%) 

*17 4 21 (42%) 

0 1 1 

Totals 33 (66%) 17 (34%) 50 

Table 2. There were no burns, psychiatric or mine injuries. One case of a fatality 

caused by close proximity explosion of a 30mm anti-aircraft shell has been 

included as a fragment wound. 

*All survived. 


2 Para Memorial at Goose Green 



My experiences in the Falkland Islands War (Operation 

Corporate) 

Captain J Burgess RAMC 

It all began for us on the Second of April 1982, when we heard 

that the Argentinians had invaded the Falkland Islands. Most 

had never heard of these remote parts and had not been 

following the events of the previous week when the 

Argentinians had moved into the Island of South Georgia. 

At the time of the Invasion 3 Para were on Spearhead, as well 

as being part of the Parachute Contingency Force. All the 

medical boxes had already been packed and were fully scaled for 

a quick move. At 16.45 that Friday I asked the Intelligence 

Officer whether we would be required that weekend and he said 

there were no plans for the battalion to be deployed. I left for 

London. Minutes later a call came through from UKLF putting 

the unit on a greater stage of alert. A message was phoned to me 

in London and I hastily returned to Tidworth. 

Nothing happened until the following morning when the 

CO spoke to his officers, though he knew few facts. Every 

organisation in the battalion hastily obtained further war 

stocks, and on the medical front this meant taking a trip to 

Ludgershall to collect a large number of individual first aid 

packs and extra dressings and drips. 

These preparations went so smoothly that by the following 

day they were nearly completed. Meanwhile, a small group of 

the unit had flown to Gibraltar on the Friday night to 

requisition the SS Canberra and arrange the accommodation. 

There followed a few days of waiting; would we go or was it a 

preparation for nothing Eventually the date for leaving 

Tidworth was agreed and on Wednesday, 7th we boarded the 

coaches for Southampton, 

This was a moving experience, large crowds turning up to 

wave goodbye as the police-led convoy drove to the docks. 

Once on board the Canberra it all shook into place, with the 

Regimental Aid Posts of 3 Para, 40 and 42 Commando 

occupying the crews’ hospital in the stern of the ship. This 

arrangement worked extremely well with sufficient space for 

each unit. The medics shared cabins while the doctors were in 

the old First Class areas of the ship. Drugs and other medical 

stores required for the journey were removed from the hold and 

brought to the crew hospital. On Good Friday we sailed away 

from Southampton to great cheers from a massive crowd that 

lined the shores on either side of the water. Car hooters blew, 

lights flashed and the cheers could be plainly heard coming over 

the calm water. If this was going to war it was a great way of 

setting about it. 

Life soon became more of a routine with morning sick 

parade, and then the rest of the day split into physical training 

and lectures on various topics from interrogation to first aid. 

Everyone received extra medical lectures and soldiers have never 

been so keen to learn all about these important matters. An 

extra team of stretcher bearers was found on the voyage and 

these consisted of the cooks, mess staff and soldiers from the 

Pay Corps. They were to do sterling work on the slopes of 

Mount Longdon. A few medical problems were encountered on 

the way: one soldier developed appendicitis and was operated 

on by a Royal Navy Surgeon in the passenger hospital on SS 

Canberra; he recovered in time to be fit enough to go ashore 

with the rest of the force. The ship put into Freetown for the 

day to refuel, and this necessitated the taking of anti-malarial 

prophylaxis until the Falklands were reached, though there were 

no cases of malaria encountered. The Canberra reached 

Ascension Island after about ten days at sea, and there we stayed 

for about two weeks until the other ships of the task force 

caught up with the forward elements. The island provided a 

much needed break ashore, but took its toll. Many went down 

with foot problems; the combination of wearing light training 

shoes on the ship, and the extreme dry heat of the tropical 

island ripped the feet to shreds, and some of these problems 

were only just cured by the time we reached our destination. 

It would be wrong to think that life at this time was serious 

quite the reverse. Most felt that while we were at Ascension 

Island, the talking was taking place and we were only out on a 

very pleasant cruise. There was much to do, whether it was 

lying in the sun, watching films or improving the profits in the 

bars. At one stage there was a threat of a submarine attack and 

the ship sailed the ocean around the island. No one objected as 

it improved the airflow in the ship. The ‘Canberra Medical 

Society’ was formed from the doctors of the services and the P 

and O staff, and this organisation arranged talks of various 

degrees of seriousness. 

Shortly, however, this fun was to stop. Notice was given that 

the Canberra was due to set sail, and in a southerly direction. 

This was the signal for life to become more serious. The lights 

were dimmed properly and all became aware that war was 

imminent. By day one could see 19 ships around the Canberra, 

but it was also appreciated that there were plenty more beneath 

the horizon and the surface. Most noticeable was the Elk, the 

ferry that contained all of our larger cargo items and which had 

been with us since the start of the voyage. The Norland was also 

there carrying our sister battalion 2 Para. HMS Fearless, HMS 

Intrepid and countless others protected us. A blood donor 

session was arranged, taking 360 units from the battalion, and 

about 1000 in all. The date of the session was so keyed as to 

allow full recovery of the soldiers, yet the blood be suitable for 

the expected date of the battle. On leaving Ascension Island 

plans for the military operation came into the open. The 

Commanding Officer, Lt. Col. Pike briefed us on the detailed 

plan to land at Port San Carlos. The medical staffing was altered 

as well as getting the team of stretcher bearers. We gained CSgt 

Faulkner who had been in the RAP in Northern Ireland, and 

who was currently out of a job, being on the air staff arranging 

parachute manifests. This enabled us to double up on the 

numbers in the rifle companies from one medical assistant to 

two per company. The RAP was then going to consist of 

Captain Burgess, Padre Heaver, CSgt Faulkner, Sgt Bradley and 

Pete Kennedy. 

At the earliest ‘O’ Groups we were told that we would be 

going ashore in Landing Craft (LCU) from the sides of the 

Canberra in the dark, and this procedure had been practised 

while at Ascension, but two days from the planned landing it 

was changed, the thought being that there were too many 

troops on the one ship. Consequently 3 Para were transferred to 


HMS Intrepid by means of LCU. Here we got our first 

impressions of the conditions that the sailors had to endure 

with a ship sailing with a far greater complement than it had 

been built for. Even so the reception we received was superb in 

view of the difficulties of having to house an extra Battalion 

Group. It was while we were on this ship that a tragedy 

happened. One of the Sea King helicopters flying with 

members of the SAS on board came down at night after hitting 

an albatross. The loss of these 21 experienced soldiers was a 

hard blow especially as they were personally known to many on 

board. It was a greater shock than the loss of HMS Sheffield. 

Meanwhile the operation of the SAS to capture Fanning Head 

still went ahead as planned. The night of D-1 was a long night 

to remember. Since arriving on HMS Intrepid we had been 

ready to go into action, and now was the period of attempting 

to get some sleep while waiting for the time to go ashore and 

face the unknown. We were sitting in the Wardroom, reading, 

waiting, knowing that it was foggy outside, but that the fog 

could lift at any moment and give our position away; 

continually waiting for the bombs or torpedo to come at any 

second as we slipped into the sound. 

Eventually it was time to move and pick up one’s heavy 

Bergen and proceed down to the Tank Deck and be loaded 

aboard one of the LCUs. There was a slight hold up with 2 Para, 

and their unloading of the Norland with her narrow gangways 

and this resulted in 3 Para being further delayed. The company 

medics went with their respective companies, and the RAP 

followed up a few minutes later. By the time our boat floated 

out of the stern of HMS Intrepid it was broad daylight. Apart 

from the noise of the engine all was silent. It was a distinctly 

eerie feeling as we sailed past other ships in the sound and made 

our way up to the beach head about 3km from the settlement 

of Port San Carlos. Birds hovered overhead, but there were no 

aircraft. 

Our landing craft reached the shore with no difficulty and the 

RAP regrouped on the land just as the guns of a frigate opened 

up on the enemy position on Fanning Head where there was 

still resistance. A Pucara suddenly came from the East and 

attempted to gun our positions but without damage. The Royal 

Artillery and their Blowpipe returned the fire, but the effect at 

that stage was more devastating on 3 Para than on the enemy. 

Luckily no one was injured in the fighting. Our objective was 

to move into the settlement and this was quickly achieved, the 

40 enemy present in the village rapidly fleeing. However, they 

brought down two Gazelle helicopters who were escorting a Sea 

King with an underslung load; there was no explanation as to 

why the helicopters were so far forward over enemy held 

territory. After one pilot was brought down the enemy opened 

fire on him in the water with a machine gun as he tried to swim 

ashore. He was dragged out by the locals and taken to the bunk 

house – the site designated to be the RAP but he died before 

medical help could arrive. Meanwhile the mortars kept firing 

on to the fleeing Argentinians. Later that day the battalion 

established itself on the higher ground around the settlement, 

and the RAP took up residence in the bunk houses with four 

members of the press. 

This building proved ideal in many respects, in that it 

provided shelter and good clean facilities, but its main 

disadvantage was that it was on the seafront and clearly visible 

to any attacking Mirage and Etendard bombers. Air raids 

continued that day, and for the next week, although no damage 

was done. 

On Sunday 23 May 3 Para sustained the first of its casualties 

when there was an incident involving ‘A’ and ‘C’ Companies 

and a map reading error. The end result was that 8 soldiers were 

wounded, two receiving 7.62 rounds to the head, one serious 

abdominal wound and the other limb injuries, some serious. 

After it became clear that the enemy were not in the area, a Sea 

King helicopter arrived in Port Sam Carlos and flew the CO 

and half the RAP and stretcher team to the scene. The aircraft 

was full, and the pilot presumably tired. To avoid Argentinian 

detection he flew extremely low and as he approached the 

casualties behind a slight rise the tail of the plane hit the 

ground. This immediately caused the aircraft to lose control; it 

took off again and began to spin before crashing to earth once 

again. Luckily no one was injured in the crash and the 

helicopter did not catch fire. The wounded were then given 

further treatment and evacuated on other helicopters. They all 

survived although the two with head injuries are left with severe 

disability. The RMO and stretcher bearers were then flown back 

to the bunk house in Port San Carlos where we were then 

bombed, this time the bombs only just missing the house. It 

was a day to remember! 

The rest of the time in Port San Carlos went off really 

without incident, apart from the bombing raids. The next move 

for the battalion was to be a foot march across the island to the 

East. The Company medics went with their companies and the 

medical sergeant accompanied battalion headquarters; apart 

from many foot problems encountered with the cold and wet 

conditions there were few medical emergencies, the only 

incident of note was an accidental discharge when the culprit 

managed to shoot through his left shoulder with an SLR. As 

soon as the battalion went firm in the settlement of Teale Inlet 

the RMO flew in to treat some of the foot problems. He arrived 

as the last of the enemy were fleeing to the East. Here the RAP 

was set up in the bunk house and it was shared with a section 

of the Special Boat Service who were mounting operations 

throughout the time of our stay. The only problems were the 

intense cold as it had started to snow hard that night, a number 

of minor leg wounds caused by a sub machine gun and the local 

population who had not seen a doctor for some weeks. 

It initially seemed that we would be staying in the location for 

a number of days to sort out the foot damage, but that evening 

word came through from Brigade Headquarters that we were to 

proceed onwards with all speed to Estancia House. The soldiers 

marched onwards, often in agony. At Estancia House there was 

a far smaller settlement consisting of one house and a large 

barn. Part of the house became the RAP, and the barn an admin 

shelter. It was here that we received news of the losses at Bluff 

Cove which would mean inevitable delays. We were bombed at 

night, but it was ineffective except in scaring the civilian 

population, especially the children. 

Estancia House brought changes to the medical organisation 

of the battalion, and Captain Michael Von Bertele arrived with 

two extra medics from 16 Field Ambulance. These were to 

prove invaluable on Mount Longdon. Little happened in the 

wait before the battle. There were visits by General Moore, 

Brigadier Thompson, and the CO of the SAS; but this period 

was used as a time to prepare the battalion for the rigours ahead. 

There was a great delay, initially to await the arrival of two 

Royal Marine units; and then to let 5 Infantry Brigade catch up 

on their route from the South. The time was also used for 

aggressive patrolling behind the enemy lines on the hill, and 

attempting to find a way up the cliffs that buttressed the 

mountain. 

Eventually a medical plan was evolved which essentially made 

two RAPs. Captain Burgess with his own staff would march on 

the hill under the direction of Major Dennison the OC SP Coy. 

As much medical equipment was to be taken as possible, and 

personal items were excluded. The stretcher bearers would also 

come with the first wave on foot, carrying some medical stores 

and stretchers of the folding airborne type, and also a large 


quantity of belt ammunition for the machine guns. No Red 

Cross markers were used by anyone in 3 Para. The rearward 

RAP would follow up behind in Volvo BV tracked vehicles with 

further stores and would have the capability to move through 

the first RAP and set up independently if the advance 

proceeded down Wireless Ridge. 

After extensive medical briefings the various sections were 

moved up from Estancia House to an area occupied by ‘A’ Coy. 

This move was by BV, and during the deployment news came 

through of one minor injury as a result of a shrapnel wound. 

The form up area was about 8 km from the objective, and at 

this point most of the battalion gathered, and here were also 

included a large number of civilians who had agreed to help the 

operation by providing their own tractors to transport items 

such as mortar ammunition. It was a glorious evening as the sun 

slowly set, and all enjoyed a last hot meal in the comfort of a 

dug in position. Major Dennison gave a short talk to those 

under his command, and as he did so shells started falling close, 

but soon all fell silent once again. The still air was disturbed by 

the arrival of a helicopter with a secret signal stating that on the 

latest intelligence the objective had now been occupied by a 

battalion of the very best Argentinian Marines, instead of the 

company strength that we had all been expecting. The outcome 

of this was a resolute ‘No Change.’ 

At 2030 Zulu timing the RAP formed up and took its place 

in the march towards Mount Longdon. 

Shortly after leaving ‘A’ Coy position the RAP was in dead 

ground from Two Sisters which provided some protection from 

enemy OP and detection. The march moved on steadily until 

the Murrell River was reached which was crossed with little 

difficulty and then continued eastwards. The stretcher bearers 

with their difficult loads suffered more than most on the march, 

but at about 0100 on the 12 June the RAP reached the first of 

the objectives about 1½ km from the western edge of the 

mountain. 

It had been a dark night up until then, but the moon slowly 

rose above the eastern edge of the mountain silhouetting the 

objective. Suddenly the peace was shattered as ‘B’ Coy 

approached the mountain from the western edge, hit a 

minefield and gave away their presence. The attack then began 

to close in from the west, and as the support weapons were 

unable to give effective fire from 1500m out, SP Coy and the 

forward RAP then prepared to move up the slope to the rocks 

at the western edge of the mountain. 

The small arms fire by this time had begun to get intense, 

with tracer and parachute illuminant lighting up the sky from 

all directions. The RAP closed in to its position, a location 

where it would remain until the end of the battle. It took some 

time to regroup all the stretcher bearers, and they were required 

at once to collect the wounded from the minefield to the north. 

Very shortly after arriving the first two casualties were brought 

in. The first was one of ‘B’ Company medics Private 

Dodsworth. He had been going forward to help the wounded 

when he was hit in the pelvis and legs by small arms fire. He 

went into unconsciousness at the RAP and was soon placed on 

the first BV to be transported back to the helipad for further 

evacuation. He died shortly after leaving the RAP. 

The BV borne RAP came up the hill after this incident and 

provided extra necessary help with the second doctor. On their 

arrival the casualties began to be brought down in a steady 

stream. Many were seriously injured, having had limbs 

amputated in the minefields, and these were dressed further and 

then evacuated in the next vehicle for the six hour journey back 

to surgery. Some of the injured had been trapped in the 

minefields and due to the sniping at night they could not be 

evacuated as the attempts were beaten back repeatedly. News 

came through that another of the medics had been killed by a 

shell. LCpl Lovett from ‘A’ Coy, and that another was trapped 

in a minefield and was being mortared, and had possibly been 

killed. The stretcher team leader approached me and asked if he 

should make a further attempt to retrieve the injured from the 

minefield, but I replied that as the injured had already been 

treated by the medic it would be foolish to waste further lives in 

repeated attempts. Having had two killed and one missing I had 

to preserve my medical strength. The injured were soon 

removed when the snipers had been cleared from the hill, 

luckily none were too badly injured. The battle then took 

another phase as we won control of the hill except for a few 

small pockets of resistance dug into the rocks. A very heavy 

mortar and artillery barrage then commenced, the rounds 

landing amongst the vacated Argentinian positions. These 

claimed many lives, and seriously put at risk the viability of the 

RAP. 

One Argentinian, in attempting to escape ran through the 

RAP, indeed came between the area of the mortuary and where 

the RMO was attempting to treat the injured. He was shot by 

one of the sergeants who was standing by, and dropped dead in 

the middle of the RAP. The following day prisoners were to 

bury him in a makeshift grave, and while the Padre was saying 

a few words over the grave he was fired upon by a sentry 

escorting further prisoners down the hill. This led to a counter 

attack, as we looked in the direction of the shots, there were 

twenty of the enemy to be seen. Although a large quantity of 

ammunition was expended, no further casualties were reported. 

During the whole of the daylight casualties continued to 

arrive and these were evacuated as soon as possible by 

helicopter, although for some there was a very considerable 

delay. Every time a large helicopter arrived the position was 

immediately mortared again, so it meant that only the Scouts 

and Gazelles could be used. That night the shelling of the 

position continued with air-bursts lighting the sky and shower 

shrapnel around the rocks. One shell blew a medical assistant 

off a rock with slight injury, but an even closer burst knocked 

out the CSgt and he could not be found for six hours. A radio 

message asked that the medical team pick up a patient who had 

been injured and who was lying on the southern slopes of the 

hill about 500 metres from the RAP. It was decided that the 

medical sergeant should go out in one of the BVs to retrieve 

him. On the way out they struck an anti-personnel mine doing 

slight damage to the vehicle. On trying to reverse out another 

exploded. The vehicle returned without the casualty, but the 

medical sergeant was so badly shaken by these events and the 

shelling that he had to be evacuated as a battle casualty. The 

medical staff was now critical with two dead, one other case 

evacuated and two hurt by shell fire. 

That night an armourer passed through the RAP going to the 

top of the hill when he was hit by mortar fire, lacerating one 

femoral artery and fracturing the opposite femur. Two others 

went to his aid but these were also hit by mortar fire, resulting 

in both sustaining bilateral fractured femora. They were in close 

proximity to the RAP when they arrived, but the first died very 

shortly afterwards, and another in a helicopter as he was being 

evacuated. The third survived with one amputation, and the 

other leg severely damaged. 

The following morning saw advances by 2 Para who had 

passed through our position the previous day, and this took the 

pressure off 3 Para RAP. That morning an air raid passed over 

the position to strike at Brigade Headquarters, and then it all 

began to quieten, the shelling becoming less frequent and 

certainly less accurate as the enemy OPs were destroyed. The 

CO then began to brief his officers on the attack on Moody 

Brook, and the advance into Stanley itself, at least as far as the 

racecourse. During this ‘O’ Group on the side of the mountain 

the snow continued to fall, and everyone wondered how the 


attack on Stanley would result as regards casualties. As the RAP 

was waiting, news came through from 2 Para that they were 

pushing forward into Moody Brook and large numbers of the 

enemy were to be seen fleeing in the direction of Stanley. 

Minutes later came the order to advance with full speed to 

Stanley. 

The medical orbit of the move altered in that the RMO rode 

in the BV with his usual team, while Captain Von Bertele 

moved off before on foot. During the move it was learned that 

there were white flags to be seen over Stanley, and all rushed 

forward down the slope into Moody Brook. The snow had 

melted by this time, the sun was shining, but clouds of smoke 

were clearly visible coming from the western edge of the city, 

and from Moody Brook itself. The RAP vehicle being the first 

of the BVs to get into Stanley was stopped by a helicopter 

carrying the 3 Para flat, and this was attached to a Bangalore 

torpedo and carried high, victorious into the city. 

The city was a mess, with no sewage, water or electricity; the 

battalion was forced to live in squalor with no food provided 

either. Looting Argentinian sources was the only way out until 

further supplies could catch up with the advance. Luckily there 

was no shortage of Argentinian food in Stanley itself, the frozen 

steak being a favourite of 3 Para. Unfortunately with all the 

inadequate sanitation most of the battalion went down with 

diarrhoea and vomiting, and there was little that could be done 

to prevent this without a proper water supply provided by the 

Royal Engineers. 

On the first evening in Stanley the RMO and Captain Von 

Bertele along with two guards crossed the ‘White Line’ that 

separated the opposing forces in the city, by showing their 

Geneva ID cards, and then went up the road to King Edward 

VII Hospital. They were the first British soldiers into that area, 

and the welcome bestowed will always be remembered. It was 

one of the proudest moments of being a member of 3 Para. It 

is impossible to convey in words those embraces and messages 

of thanks from the medical staff and other civilians sheltering in 

the hospital. 

The Third Battalion the Parachute Regiment lost 23 killed 

and 48 wounded in the battle for Mount Longdon plus 12 

wounded before the assault, and countless who suffered with 

their feet and will continue to suffer; but to liberate those 

islanders in the hospital did seem to make it all worthwhile. 



My thoughts on the Falkland Campaign 

WSP McGregor, OBE FRCS (Ed), Lt Colonel RAMC Consultant Surgeon 

The regular soldier spends much of his time training for war. It 

is curious that the more training he undergoes, the less he 

savours the thought of going to war because the greater is his 

knowledge of the terrible destructive capability of modern war 

weapons. 

My call came as a member of the Parachute Clearing Troop – 

16 Field Ambulance, not unexpectedly because I had followed 

the build up in the national press consequent on the invasion of 

the Falkland Islands by the Argentinian Forces. I had just 

finished a busy Outpatient Clinic and sat in my office 

completely drained of all compassion for the wives of majors, 

corporals and the rest of humanity when the ‘phone rang. 

“Come and join us” was the call, so off I went to war. We all 

knew that we were going to sail to war but we also knew that 

this was going to be a limited cruise. We should meet in 

Aldershot, parade, embark and sail and that somewhere around 

Ascension Island, the politicians would sort it all out and we 

would all turn around and sail back again. With a bit of luck I 

thought I might miss out on about two weeks of outpatients 

clinics. 

We duly paraded in Aldershot and for the first time in my 

long association with the Airborne forces, the unit P.C.T. was 

up to strength and had been completely equipped with all the 

paraphernalia of war that we had been trying to fight off for at 

least 10 years. After several false starts, we actually set off in a 

convoy of coaches and reached that most admirable port, 

Portsmouth. Much more, we were actually allowed to board the 

ship as part of the 2nd Para Brigade Troop. The ship itself had 

been recently acquired and converted from a North Sea Ferry – 

the Norland. Built for the holiday trade, with accommodation 

for 1,000 passengers, it suddenly had to accommodate 1,500 

fairly carefree Paras, with all, if not more, of their equipment. 

Amid scenes reminiscent of the Hollywood films showing the 

departure of Kitchener’s force for the Sudan portrayed so well 

in the original film Four Feathers, the Norland sailed. I cannot 

say that I was unaffected. It was an emotional occasion. The 

crowds cheered, the band of 2 Para played such stirring music 

as “Don’t cry for me Argentina” and the RSM of 2 Para 

marched along the deck saying “If you lean on the rails, I’ll 

break your arms – stand up”. The Navy were particularly good. 

Ships in the dockyard sounded their sirens, Naval shore 

establishments lined the banks and cheered and the dockyard 

labourers showed a pride in the work they had put into these 

ships over the past two or three days. 

The journey south was accomplished with surprising ease. 

The holiday air persisted and as the climatic conditions 

improved, the holiday atmosphere became even more marked. 

The 2 Para group entertained the ship’s officers; the ship’s 

officers entertained 2 Para group and eventually we both 

entertained one another, but suddenly we found ourselves at 

Ascension Island. The war climate had not improved. The 

politicians had not resolved the problem. Suddenly there was a 

vast increase in traffic signals, cross decking of the supplies 

between ships became more urgent. Essential supplies such as 

ammunition were suddenly dug out from the bottom of the 

hold where they had been buried under piles of arctic 

equipment and rations. The holiday atmosphere evaporated 

quickly and very impressively. It changed to one of sheer 

professionalism. Training became more popular and more 

universal. Personnel began board drills with a more serious and 

interested attitude. The lifeboats of Norland were swung out 

and lowered, much to the amazement of the Captain who in his 

seven years in command, had never seen them move from the 

chocks. Much to the gratification of the Medical Services 

suddenly the big Army began to take us seriously. First Aid 

lectures became very much better attended and certainly the 

officers in the bar of an evening began to cultivate the company 

of the medical officers with rather searching questions. 

The Medical Services, to their great credit, carried on as 

usual. Trained as they were to a superb level, they tried to pass 

this knowledge on to the people whom before had been too 

busy to take any notice. When it became obvious that due to 

our combination of postings, circumstances and bad planning, 

medical potential of the 2nd Battalion Parachute Regiment was 

less than adequate - an intensive training programme was 

instituted. Much of the emphasis of this was on the setting up 

of intravenous infusions. We had provided, thanks to the preplanning 

of Major Malcolm Jowitt, RAMC, a plastic arm in 

which the insertion of intravenous infusions could be practised. 

It was after one such session when a member of 2 Para turned 

to his Regimental Medical Officer and said, “For all the good 

I’m doing Sir, I might well be sticking it up his ------”. This led 

to a short time vogue for rectal intravenous infusions. I would 

like here and now to condemn this practice, if only that in the 

Falklands, it would have led to a spate of frost bitten bums, 

comp saturated colons, unfixable drips, and dead soldiers. 

With this and many other merry japes, we eventually made or 

way south and suddenly the merriment went out of the 

situation. Following a training lecture by the Royal Naval 

personnel on the invincibility of the Royal Navy ships, came the 

news of the sinking of HMS Coventry. If this put a damper on 

the situation, it also concentrated the attitudes towards training 

even more. The actual run into the Falklands was, to say the 

least, sporting, with false sonar alarms about submarines which 

turned out to be whales, sleeping in lifejackets, sailing through 

minefields and making the arrival at the shore somewhat of a 

relief. There is no doubt that by the time disembarkation from 

Norland for the beachhead on rather flimsy landing craft, in 

pitch darkness and under fairly adverse weather conditions took 

place, the professionalism of 2 Para group had reached its peak. 

I have nothing but admiration for the soldiers of the Parachute 

Battalion, for the Royal Navy and for the Merchant Navy 

personnel who risked much to get us there. 

The arrival in San Carlos water of the M.V Norland 

highlighted the lack of communication between the different 

branches of the regular soldiers. While 2 Para disembarked and 

landed without incident, the first task of the P.C.T. was to 

establish aboard the Norland a mini-field hospital. This was 

done with the alacrity and expertise which one would expect of 

the unit. After a day spent in consistent air attack, it became 

obvious that the big ships would have to be withdrawn from 

San Carlos water during daylight and finally the message we 

had been trying to give to the Navy for some time got through 

– if there were troops ashore, the medical expertise should also 

be ashore. Besides, ships were dangerous. So, with a little 

difficulty, Parachute Clearing Troop arrived at Ajax Bay – the 


first surgical teams ashore. Again it is a tribute to the Airborne 

soldiers that within an hour of landing, a surgical facility had 

been set up. This formed the basis of the field hospital which 

was eventually established at the old Refrigeration Plant at Ajax 

Bay of the Parachute Clearing Troop plus a marine medical 

support troop plus two surgical teams from the Royal Navy. 

This is the unit which bore the main bulk of the surgical load 

in the Falkland Campaign. 

The time spent at Ajax Bay had its moments. quite apart 

from the large casualty load, there came a time when the 

Argentinian Air Force decide to remove the field hospital from 

the order. Had their bombs had the right fusing, they would 

have done this most successfully. However, the unit survived. 

As the fighting advanced towards Port Stanley, it became 

obvious that surgical support was necessary nearer the front 

line. The only surgical teams whose equipment scales and 

general training fitted them for this task were 5 and 6 surgical 

teams of P.C.T. 5 F.S.T. were despatched to Teale Inlet, 6 F.S.T. 

were despatched to Fitzroy and in these locations, they carried 

on the treatment of battle casualties for the rest of the 

campaign. It fell upon 5 F.S.T to be the first to enter Stanley 

where they set up in the local hospital. They were followed 

quite shortly by 6 F.S.T. It is interesting that while at Ajax Bay 

and in support of 2 Para elements of the P.C.T. were deployed 

to reinforce 2 Para medical elements in the attack on Goose 

Green. The attack went in against superior numbers and that 

success has now entered the history of the British Army. Not 

only were 2 Para outnumbered but they had to endure severe 

mortar and artillery bombardment and the ever persistent 

attention of the Argentinian Air Force. Towards the end of the 

engagement, a party of airborne medics were carrying a 

wounded man from 2 Para on a stretcher when they were 

spotted by an Argentinian Pucara aircraft. As it prepared to 

attack, the men carefully laid down the stretcher, cocked their 

weapons and put up a very intense fire against the attacking 

aircraft. It is perhaps one of the inconsequentialities of war that 

the casualty on the stretcher is reported as saying “Don’t shoot 

at it fellows, you might make him angry.” I cannot help feeling 

that it was the anger of airborne forces which brought this 

conflict to a quick and successful conclusion. I cannot also help 

thinking that it was the expertise of the airborne medical service 

which resulted in the remarkably low casualty figures. 



War stores San Carlos settlement 

Burn victims from Sir Galahad in Ajax Bay 



Bill McGregor operating at Ajax 

Sea King over Ajax Bay refrigeration plant 



Medics treating wounded in the field Darwin Goose Green Battle 

Bill McGregor & team operating at Fitzroy settlement 



WO2 Les Viner treating a Galahad casualty on the ground at Fitzroy 

Medics at the Battle for Darwin/Goose Green 



Main entrance Red & Green Life Maching at Ajax Bay - Note fridge door 

Charles Batty & FST at Ajax 



Sea King over San Carlos Settlement 



King Edward VII Memorial hospital Stanley - later burnt down 

Bill McGregor operating in a KF shirt 



Charles Batty operating 

Post op Recovery area at Ajax 



Galahad survivors coming ashore at Fitzroy 

Sir Galahad burning 



Sir Galahad abandoned 



OPERATION CORPORATE – THE SIR GALAHAD BOMBINGS 

Woolwich Burns Unit Experience 

P Chapman 

Summary 

During Military Operations in the South Atlantic to recover the Falkland Islands in 1982, the troopship Sir Galahad was 

bombed. Initial treatment of the injured in field medical units was followed by transfer to the hospital ship SS Uganda and 

evacuation to the United Kingdom where 48 patients were treated in the Burns and Plastics Unit, Queen Elizabeth Military 

Hospital, Woolwich. The treatment of these patients is described and the management of war burns discussed. 

Introduction 

On 8 June the Royal Fleet Auxiliary SIR GALAHAD was at 

anchor in Fitzroy Bay. The 1st Battalion Welsh Guards, support 

troops, their equipment and munitions were on board. They were 

awaiting disembarkation from Bluff Cove as part of the force 

involved in the coming assault on Port Stanley when, at 

approximately 1700 hours local time, the ship was bombed by 

Argentinian Sky Hawk jets. At least one bomb exploded at the 

rear end of the tank deck which was the main assembly point for 

troops and their equipment ready to leave ship. The blast caused 

secondary detonation of a considerable amount of munitions, 

including mortar ammunition stored directly below the ship’s 

main hatch forward of the superstructure. Troops were killed or 

injured by flash, blast and secondary missiles from multiple 

explosions. A total of 78 soldiers were burnt. Within minutes of 

the attack a massive evacuation of the ship was started, using 

helicopters, lifeboats, landing craft and inflatable rafts. Many 

wounded troops were successfully carried ashore, although all 

their equipment was lost. 

Medical facilities at Fitzroy were limited, as all the Field 

Ambulance equipment had been lost on board the SIR 

GALAHAD during the bombing. First aid was given and the 

wounded evacuated as soon as possible by helicopter to Ajax Bay 

where the main shore-based medical facilities were stationed in a 

disused refrigeration plant. Some of the injured were transferred 

directly to ships in San Carlos Water. All were ultimately 

evacuated to the hospital ship SS UGANDA which itself was 

under pressure to evacuate as many wounded as possible, to make 

room for the large numbers of casualties expected from the 

planned attack on Port Stanley 1 . Those fit enough were therefore 

transferred from UGANDA to the smaller hospital transport 

ships, HECLA, HERALD and HYDRA for passage to 

Montevideo and onward flight in RAF VC 10 aircraft to the UK 

via Ascension Island. On arrival in UK, wounded were held 

overnight at the Princess Alexandra’s Hospital, Wroughton, and 

then dispersed to other military hospitals in England. 

Management 

Of the burnt soldiers who reached the UK, 27 were considered 

sufficiently healed to be sent home on sick leave, three were 

transferred to the RAF Hospital, Halton, and 48 were transferred 

to the Burns and Plastics Unit at the Queen Elizabeth Hospital, 

Woolwich. 

The field medical documentation and hospital case notes of 

those patients treated at Woolwich were retrospectively analysed. 

Each soldier was interviewed to make good any omissions in the 

The Sir Galahad on fire in Fitzroy 

necessarily brief field records and to provide background 

information for construction of the historical picture. 

In the South Atlantic 

Immediate first aid at Fitzroy included hosing down of burnt areas 

with cold water and application of basic field dressings 2 . As all 

medical stores had been lost in the ship, the two field surgical 

teams from 2 Field Hospital, supported by 16 Field Ambulance, 

had an extremely limited capacity 3 . However, shore-based infantry 

units, already established and equipped, were on hand to provide 

intravenous fluids, drip-giving sets and further field dressings. 

After receiving their basic first aid, casualties were transported 

by helicopter as quickly as possible, many within half an hour, to 

the medical unit at Ajax Bay. Space and resources at the 

refrigeration plant in Ajax Bay were also limited, so about half the 

patients were transferred to medical holding facilities prepared 

aboard FEARLESS, INTREPID and ATLANTIC CAUSEWAY. 

At Ajax Bay patients were routinely given intramuscular 

penicillin and booster doses of tetanus toxoid 4 . Morphine was 

available for pain relief. Hand burns were cleaned with cetrimide 

solution and put into plastic bags containing silver sulphadiazine 

cream until the supply of bags ran out. The remaining patients 

were given saline-soaked field dressings until plastic bags were 

again available on the Uganda. Other areas were treated with 

saline soaks which were replaced with occlusive silver 

sulphadiaxine dressings on UGANDA. Faces were left exposed 

after cleansing. Other injuries such as shrapnel wounds were 

debrided and treated as required. 

Fourteen patients with greater than 10% burns were 

resuscitated with intravenous fluid drips begun either at Fitzroy or 

later at Ajax Bay. Eight of these were catheterised. Of a further 19 


patients with 6-10% burns, nine required intravenous drips, and 

two of these were also given a urinary catheter. A total of 10 

patients required catheters, three of which were inserted at Ajax 

Bay and the rest on board the hospital ship UGANDA. The main 

fluids used at Fitzroy and Ajax were sodium lactate and Polygeline. 

As most had been exposed to flash and smoke in the confines of 

the ship, steroids were administered, before transfer to the 

UGANDA, to 29 patients, roughly half of whom had one dose of 

hydrocortisone 100mg intramuscularly, the rest having 1 gram of 

Methylprednisolone intravenously six hourly. 

Most patients were transferred by helicopter to the hospital ship 

UGANDA within 24 hours. Here intravenous resuscitation was 

continued using Dextran 70 in those still with high haematocrit 

levels many hours after injury. The drip rate was controlled by 

reference to hourly haematocrit levels measured on a hand-held 

battery-powered centrifuge, using a regime now known as the 

“Uganda Rule” (Table 1) 1 . 

Hourly Haematocrit 

Rate of infusion for 

500 mls Dextran 70 

>60 2 hourly 

50-60 4 hourly 

From the group in which Kirschner wires were used, two 

remained hospital inpatients to allow their axial pattern flaps to 

mature. The other three were transferred, after grafting was 

complete, to the Joint Service Rehabilitation Unit at 

Chessington, for active full-time physiotherapy. At the end of 

1982 one of these was back at work as a heavy goods vehicle 

driver and the other two were awaiting re-admission for further 

corrective surgery. 

None of the patients interviewed many months after the event 

admitted to any respiratory trouble either at the time of smoke 

inhalation or later, whether or not they had been treated with 

steroids. 

Continued use of pressure garments has been required to 

counteract hypertrophic scarring and web space contractures in 

24 hands (15 patients). In this group only one pair of hands was 

treated conservatively. Hypertrophic scarring requiring similar 

treatment occurred in three other burnt areas, all treated 

conservatively. 

By the end of 1982 64 operations on 27 patients under general 

anaesthetic had been performed by the Unit. 

Discussion 

Distance: Casualty evacuation over a distance of 8,000 miles 

presents enormous problems administratively, logistically and for 

the patient. With many transfers from ship to ship, ship to 

aeroplane and hospital to hospital in the UK, the journey from the 

SS UGANDA to the Queen Elizabeth Military Hospital, 

Woolwich, took an average of six days. The nearest usable air base 

to the combat zone in the Falklands was 1,100 miles away at 

Montevideo. Patients stabilised on UGANDA were transferred to 

hospital transport vessels, which had been converted from survey 

ships, for the journey to Montevideo. From there they were flown 

to the United Kingdom via Ascension Island. This was a 

substantial achievement; the American forces in Vietnam used 

permanent air bases relatively close to the fighting and were able 

to use large jets, taking 20½ hours for a journey similar to that 

between the Falklands and the United Kingdom to evacuate 

patients in large numbers direct to the United States 6 . In the early 

stages of the Vietnam war most of the serious cases were evacuated 

rapidly, sometimes within 24 hours of wounding, but as larger 

more specialised medical facilities were established in the war 

zone, transfer of these patients was delayed and definitive 

treatment started immediately 7 . British soldiers arrived in England 

tired, confused and some in great pain. The length of the casualty 

evacuation chain precluded any reconstructive surgery in the 

South Atlantic for burn cases. Emergency surgery included 

amputations, escharotomies and tarsorrhaphies which were 

carried out as indicated, but no definitive grafting was started until 

arrival in the UK two weeks after injury. 

Early Treatment: In order to cope with a large number of 

casualties in a short period of time there needs to be an established 

well rehearsed regime for burns treatment on the battle field. 

Intravenous fluid replacement in the shock phase for large 

numbers can be adequately controlled by following Sorenson’s 

Dextran formula as adopted by the Army 8,9 . Experience on the 

hospital ship has demonstrated that large numbers of patients in 

the shock phase can be adequately monitored by hourly 

haematocrit levels using the ‘Uganda Rule’. Despite this, some will 

still be either under or over-resuscitated, but this is compensated 

for by the fitness, age and morale of professional soldiers in a 

regular army. Superficial burns of hands dressed conventionally 

with bulky bandages make otherwise fit patients dependant on 

others. However, plastic bag occlusion allows the patient a degree 

of mobility and self help, relieving overworked nursing and 

auxiliary staff for the more extensively injured 10 . The exposure 

treatment of burns is well documented 11 and this applies 

particularly to superficial burns of the face which require virtually 

no maintenance, a factor of importance when dealing with large 

numbers. 

Protective Clothing: To a limited degree clothing can give 

protection from burn injuries. The SIR GALAHAD victims were 

dressed for cold wet conditions with many layers of combat 

clothing, although the hands and head were uncovered. Two 

soldiers who were wearing gloves suffered only minor superficial 

blistering to the hands. Some wore plastic waterproof outer 

clothing with a hood, which was typically bunched up behind the 

head. This caused deep burns where it ignited and fused to the 

scalp. Others wore thick arctic parkas which gave a good degree of 

protection, particularly when the face was protected with the 

hood, as demonstrated by one quick-witted soldier who, although 

losing a leg, had no facial burns. Except for those close to the blast, 

multiple layers of clothing gave considerable protection. Analysis 

of this incident shows that despite the large numbers of casualties 

involved, many were of a relatively minor nature and might have 

been prevented. Flash protective clothing, as worn by the Royal 

Navy crews, could protect many hands and faces although both 

availability and troop compliance are likely to cause difficulties. 

Acknowledgements 

I wish to thank Col BC McDermott CBE FRCS L/RAMC for 

his encouragement and permission to report on his patients, and 

Col R Scott FRCS L/RAMC for his advice on preparation of 

this article. 

References 

1. Chapman CW Burns and plastic surgery in the South Atlantic campaign. 

JR Nav Med Ser 1983; 69: 71-79. 

2. Jackson DS 1983; Personal communication. 

3. Jackson DS et al. The Falkland War arm field surgical experience. Ann R 

Coll Surg Engl 1983; 65: 281-285. 

4. Williams JG, Riley TRD and Morley RA, Resuscitation experience in the 

Falkland Islands campaign. Br Med J 1983; 286: 775-777 

5. McGregor IA and Jackson IT. The groin flap. Br J Plast Surg, 1972; 25: 3- 

16. 

6. Funsch HF Jet age evacuation of Vietnam casualties. Med Times 1966; 94: 

1022-1029. 

7. White MS et al. Results of early aeromedical evacuation of Vietnam 

casualties. Aerospace Med 1971; 42(7): 780-784. 

8. Sorensen B, Seirsen P and Thomsen M. Dextran solutions in the treatment 

of burn shock. Scan J Plas Reconstr Surg 1967; 1: 68-73. 

9. Kirby NG and Blackbury E. Field Surgery Pocket Book. London HMSO 

1981. 

10. Slater RM and Hughes NC. A simplified method of treating burns of the 

hands. Br J Plas Surg 1971; 24: 296-300. 

11. Wallace AB. The exposure treatment of burns. Lancet 1951; 501-504. 



Commentary on 

Operation Corporate – The Sir Galahad Bombings 

Woolwich Burns Unit Experience 

Lt Col Alan Kay FRCS FRCS(Plast) RAMC Consultant Adviser to DGAMS, 

Burns & Plastic Surgery 16 Close Support Medical Regiment 

The Falklands Conflict produced some iconic images of burn 

injury in modern warfare; the skin hanging off the burnt sailors 

getting off helicopters, the rescue attempts around the blazing Sir 

Galahad, the smiling burnt faces of the casualties on SS 

UGANDA lying on the floor in their makeshift ward with their 

hands in plastic bags, the scarred Simon Weston. This paper 

should be part of the iconography of medical planners as it is a 

clear condensation of the issues around several key aspects of 

military burn injury. 

Much of the information presented in this paper confirms what 

was already known. Ships engaged in war fighting are a significant 

potential source of mass burn casualties, most casualties will have 

small burns, some will have other non-burn injuries, burn 

casualties (even small burns) place a huge strain on logistic 

support, burn casualties can do well in extended evacuation chains 

if moved early and initial management is good. These headline 

messages are still valid. That said, some things would have been 

done differently today. 

There has been a shift in what is considered “best practice” in 

burn care. Early excision (certainly within 48 hrs) of a burn 

wound is now seen as a life saving measure in large burns. As in 

1982, it is still considered impractical to perform such surgery 

forward of Role 4. Only four burns greater than 20% entered the 

evacuation chain after this incident and more recent conflicts have 

also yielded very small numbers of large burns. It is, therefore, 

difficult to test statistically whether our doctrine of not excising 

large burns prior to evacuation is an unacceptable compromise of 

care. Repeated anecdotal evidence from UK forces and 

observation of the larger US figures has so far produced no 

evidence to suggest we may be getting it wrong. 

Aspects of the initial management highlighted in this paper 

would be criticised now but we should not view matters outside 

of the context of what was seen as best practice then. Most of burn 

care has evolved through personal anecdote and prejudice rather 

than being evidence based. There would have been no “National 

standard” for a burn fluid resuscitation regime. The exposure 

method of burn management would be deemed negligent by 

many Burn Surgeons today. Here we must put ourselves in the 

shoes of those who, adapting the knowledge of best practice at the 

time, produced pragmatic solutions to a resource limited 

environment. Adaptive thinking produces concepts such as “The 

Uganda Rule”. Does this ‘making it up as you go along’ lead to 

outcomes that are any worse than rigid pre-planned protocols 

The patients who are seen during the learning phase of adaptive 

thinking may well be in receipt of sub-optimal treatment. Again, 

though, we cannot answer the question “did they get it right”. A 

simple glance at the reported end-points does not inform the 

debate about whether outcomes improved or worsened by what 

was done or not done. 

The liberal use of steroids for inhalation injury in the Falklands 

Conflict is a clear example on non-scientific medicine; there being 

then, as now, no evidence of benefit. The mechanism of injury on 

the Sir Galahad should have produced casualties with inhalation 

injury. The fact that none of the casualties required intubation nor 

had long term respiratory sequelae was, particularly within Naval 

circles, the evidence used to advocate prophylactic steroids as an 

essential intervention for several years. I cannot help but feel that 

one or two of the casualties would today have been intubated and 

ventilated. One of the casualties with 48% burns arrived in the 

Burn Unit a month after injury and this would now be regarded 

at unacceptable. We should be asking ourselves the awkward 

question that, did these casualties do so well because of the 

omission of early aggressive treatment For example, it is now well 

recognised that the pulmonary insult of ventilation in inhalation 

injury is in itself harmful. 

The complexity of the evacuation chain from point of 

wounding to definitive care is clearly highlighted. Without more 

detail it is difficult to know, in retrospect, if any part of that chain 

could have been improved on. In particular, the delayed arrival of 

the most severely burnt casualty because of septicaemia is not 

expanded on. Where in the chain was he held Leading up to 

1982, it was considered inconceivable that the UK would embark 

on such a mission. There is nothing today that should allow our 

strategists to be allowed to think that a similarly complex scenario 

could not again be a reality. We must have in our system the ability 

to evacuate severely injured casualties from all environments. 

The four larger burns from this incident would in itself generate 

a very heavy workload in any modern Burn Unit. Added to this 

was the greater number of smaller but functionally significant 

burns. Surgery to heal and reconstruct hand burns is demanding 

and time consuming. The on-going rehabilitation and scar 

management even more so. This total workload would today, I am 

certain, have such an effect on any single unit that the patients 

would be distributed to a number of burn services. This would 

have been an excellent cohort to follow up and report on the long 

term outcomes of hand function as they would represent about a 

decades worth of experience for the average UK Burn Surgeon. 

Personal protective equipment (PPE) issues are still with us. The 

wearing of body armour to protect against chest penetration is 

almost universal. Anti-primary blast wave technology is available 

but, for conventional explosives, of uncertain value. Anti-burn 

PPE has been around for decades but is not popular with 

dismounted infantry. The time of maximum danger for burns is 

when such troops use ships, aircraft and armoured vehicles for 

mobility. Finding appropriate anti-burn protection for the 

infantry is an area of on-going research. 

This paper adds to our collective anecdote about military burn 

injury. Its descriptive style makes it difficult to extract useful data 

for analysis and it would certainly have been inappropriate to base 

any doctrinal change in clinical practice on what it presents. It 

does provide a good overview of the scale of the problem and gives 

an insight into the pragmatic approaches adopted. It is a “must 

read” for medical planners. 



Army Amputees from the Falklands - a review 

AFG Groom, JT Coull 


Two years after the war in the South Atlantic the 23 major Army 

amputees out of a total of 38 Service amputees resulting from 

hostilities and their aftermath are reviewed. Of the total of 38 

cases, 32 were major and six minor. It is noteworthy that, of the 

major Army amputees, 11 (48%) occurred as a result of injury 

sustained after the ceasefire. Minor amputations have not been 

included. They do not, of themselves, pose the same problems of 

management, nor was the eventual medical grading effected in 

any of the four Army cases. The figures are not complete in that 

they do not include amputations of digits secondary to burns. The 

amputees present an opportunity to review the management of a 

small group of severely injured treated under the most difficult of 

circumstances. 

Total casualties were 255 killed and 777 wounded. The 32 

major Service amputees would, therefore, give an amputation rate 

of 4% but if the 11 cases wounded after the ceasefire are excluded 

the amputation rate falls to approximately 2.5%. Data on 

amputation rate from other conflicts are not readily available. 

Wiles 1 reported an amputation rate of 3.5% among 29,000 battle 

casualties admitted to Middle East hospitals in one year from April 

1942 to March 1943 and similarly the amputation rate in the 

European theatres in one US evacuation hospital for 12 months 

from 1944-45 was 3.7% 2 . Incidentally, in this latter group, 

clostridial myositis was the indication for amputation in 11% and 

overall mortality was 6.4%. In the Falkland series no patient who 

survived to reach primary surgical care subsequently died and in 

no case was clostridial infection an indication for amputation. 

Wounds of the extremities constituted 67.5% of injuries 

operated on by the Army surgical teams 3 . This is similar to the 

proportions encountered in a number of previous conflicts even 

though the nature of warfare may have differed significantly. 

The distribution of amputation levels is given in Table 1. 

Above Knee 7 (2) 

Through Knee 1 

Below Knee 11 (7) 

Above Elbow 2 

Below Elbow 2 (2) 

Totals 23 (11) 

Table 1. Major Amputees – Army 

The figures in brackets indicate those sustained after ceasefire. 

Pattern of Wounding: Table 2 lists the relative importance of 

wounding agents. It is sadly ironic that accidents during 

garrison duties, even excluding those associated with mine-field 

clearance, resulted in as many amputees as the bloodiest action 

of the war, namely the battle for Mount Longdon. It is also 

remarkable that anti-personnel mines were responsible for fewer 

amputees during hostilities than after the ceasefire, especially so 

since each battalion action involved direct assault against 

prepared defences including extensive mine fields. 

Anti-personnel Mine 9 (5) 

Mortar/Artillery 3 

Gun Shot 3 

Bomb 2 

Sidewinder - (4) 

Booby Trap - (1) 

High Explosives - (1) 

Table 2. Wounding Agent 

The figures in brackets indicate those sustained after ceasefire. 

Wound Management: First Aid. This was invariably given by 

comrades on the spot. Such treatment in itself was hazardous and 

indeed 2 cases were wounded while rendering first aid. 

Wound Dressing: all cases had “shell” dressings applied. One 

required seven such dressings. Tourniquets were used in only three 

of 32 cases during hostilities. In none of those three did 

inappropriate use of a tourniquet contribute to the indications for 

amputation. 

Evacuation: Methods were invariably improvised, often under 

conditions of extreme difficulty and danger. Most cases were 

manhandled to Regimental Aid Posts. One was dragged on a 

ground-sheet more than 3 kilometres. Two cases were carried 

similar distances on stretchers and three cases were carried by 

stretcher but for shorter distances. Three were moved from their 

site of wounding in a mine-field to a Field Surgical Unit by Volvo 

BV202 (an articulated, rubber-tracked vehicle exerting extremely 

low ground pressure) and one case was transferred by landing craft 

direct to a surgical team. In all other cases rearward evacuation 

from the Regimental Aid Post was by helicopter. 

Analgesia: All cases were given “on the spot” intra-muscular 

Omnopon (30mg syrette). Those in whom evacuation was 

unavoidably delayed received two doses but two of the amputees 

found the analgesia totally ineffective. 

Resuscitation: Anti-tetanus – All 23 cases received a tetanus toxoid 

booster 0.5 ml intramuscularly during the resuscitation phase. 

Antibiotics: In the first 24 hours nine cases received Benzyl 

Penicillin alone in accordance with normal policy whereas five 

received Benzyl Penicillin in combination with other Penicillins 

Benzyl Penicillin 9 

Benzyl Penicillin with other Penicillins 5 

Benzyl Penicillin with Metronidazole 1 

Triplopen with Metronidazole 1 

Other Penicillins alone 5 

Ampicillin and Metronidazole 1 

Tetracyclin/Erythomycine with Metronidazole 1 

Table 3. Antibiotic Administration in First 24 Hours 


Cases Average Range 

Requirement 

Hartmann’s solution (litres) 23 1.5 0.3-3 

Blood (units) 15 3.4 2-7 

Polygeline (Haemaccel) 

(500 ml) 13 1.7 1-3 

Table 4. Resuscitation – Intravenous Fluid Administration 

(variously Triplopen, Ampicillin, Cloaxillin and Flucloxacillin). 

Others received combinations including Metronidazole and one 

case of a known Penicillin allergy was treated with Tetracycline and 

later with a combination of Erythromycin and Metronidazole. 

The antibiotic administration during this phase is summarised in 

Table 3. No case had any other indication such as a penetrating 

abdominal injury to dictate an alternative antibiotic choice. 

Intravenous Fluids: Requirements varied with the severity of 

wounding and the time to first surgery. There were clear differences 

between the group wounded during hostilities and those wounded 

after ceasefire and predictably the latter group require smaller 

volumes of intravenous fluids for resuscitation. The fluid 

administration is summarised in Table 4. 

Complete traumatic amputation 13 

Gross disruption 7 

Primary vascular damage 2 

Secondary vascular insufficiency 1 

Table 5. Indications 

Indication for amputation 

This is summarised in Table 5. The commonest indication (13/23) 

was completion of a de facto traumatic amputation. 

In 12 cases the final level was the same as the level of traumatic 

amputation. In one case the traumatic below-knee amputation 

initially completed at that level was revised to through-knee. In 

seven cases the indication was gross disruption of bone and soft 

tissue and in only two cases was the indication primary vascular 

damage. They both involved the upper limb and although they 

were theoretically salvageable there was also a complete loss of the 

brachial plexus rendering attempts at salvage inappropriate. In only 

one case was secondary vascular insufficiency the indication for 

amputation where a gun-shot wound to the knee causing a severe 

compound upper tibial fracture raised the question of vascular 

damage. Two days later a below-knee amputation was performed, 

revised five days subsequently to an above-knee. 

It is noteworthy that, in spite of the conditions of combat, and 

occasionally long delays before surgery, in no case was the 

indication for amputation due to the presence of clostridial or any 

other infection. 

Operative treatment 

The optimal surgical treatment is two procedures, one to 

perform or complete the primary amputation with wound 

excision and a second for delayed primary closure, either by 

suture or graft. This was achieved in three out of nine cases of 

those wounded during hostilities requiring primary amputation 

and in six of 11 such cases wounded after ceasefire. 

Of the remaining six occurring during hostilities, five 

required an early revision prior to closure and two required 

dressing changes with general anaesthesia. Of the remaining 

five occurring after ceasefire, four required early revisions. 

Three cases required secondary amputation after initial 

justifiable efforts at conservation. 

Late stump revision was undertaken in only four cases and in 

two of these this amounted merely to trimming a bony spur. 

One case underwent formal stump shortening in an attempt to 

alleviate prosthetic discomfort but unfortunately healing was 

delayed and discomfort not ultimately relieved. One case 

elected to undergo forearm shortening to permit fitting of a 

functional prosthesis. Apart from these two cases the remaining 

21 have opted to retain their emergency amputation stumps 

although prosthetic advice was sought in every case at the first 

consultation regarding the need for and the advisability of early 

refashioning. 

Rehabilitation 

On return to the UK all amputees were referred at the earliest 

possible opportunity to the Limb Fitting Centre. The service 

offered was exceptionally good and temporary prostheses were 

supplied with great speed, many within 24 hours. Only one of 

12 below-knee amputees and five of eight above-knee amputees 

had stumps resembling the accepted standard length. 

Rehabilitation has, in some instances, been spectacular. Three 

of 12 below-knee amputees have passed the basic fitness test 

and a further three are likely to achieve this standard. One is 

still employed as a physical training instructor. Four of the BK 

group (including the double amputee) have been medically 

discharged. Predictably those discharged have been the younger, 

more junior soldiers for whom Army life depends almost 

entirely on physical skills and who have least to offer in 

technical or managerial roles. Among the eight above-knee 

amputees rehabilitation has been less dramatic and none, of 

course, can truly run. Six have been medically discharged. The 

two that have opted to continue are both exceptionally 

motivated and fit. Both were due for promotion at the time of 

wounding and it appears that this may still be possible. 

Of the upper limb amputees one has been discharged. While 

the fitness test is the challenge for the lower limb amputee the 

annual personal weapon test is the problem for the upper limb 

amputee. Of the three still serving two have passed and the 

third is likely to do so. 

Amputation is a mutilating operation following devastating 

injury. Many authors have stressed the importance of early and 

continued attention to psychological factors in the treatment of 

amputees. This falls largely into the responsibility of the doctors 

treating the wounds and of the voluntary and welfare 

organisations. The families also require considerable support. 

It is easier to identify where external psychological factors 

have delayed rehabilitation than where they have contributed to 

it. This series contains two distinct groups, namely those 

injured in battle or in dangerous but essential tasks (eg minefield 

clearance) and those injured by other instances, such as the 

Sidewinder missile and booby trap after the ceasefire. 

The latter group was injured accidentally in circumstances 

they could not regard as worthwhile. They were therefore at a 

psychological disadvantage and it was reflected in subsequent 

performance. 

The need for understanding, support and information to 

both amputee and family cannot be over stressed. Motivation 

must be fostered and energy channelled away from resentment 

and into rehabilitation. 

References 

1 Wiles P. Analysis of Battle Casualties admitted to Middle East Hospitals 

April 1 1942 to March 31 1943. Lancet April 1944; 523-525. 

2 Odom B reported in Coates J B. Surgery in World War II: Orthopaedic 

Surgery in the European theatre of Operations. 

3 Jackson D S et al. The Falklands War: Army Field Surgical Experience. Ann 

Roy Coll Surg Engl 1983; 65: 281. 



Commentary on 

Army Amputees from the Falklands - a review 

JR Army Med Corps 1984; 130: 114-6 

LT Col John Etherington 

Consultant in Rehabilitation, DMRC Headley Court 

It was both timely and fascinating to read the paper that LtCol 

Groom and Maj Gen Coull wrote on the management and 

subsequent rehabilitation of amputees from the Falklands War. 

Some of us can recall some of the legacy patients from that war 

in the military hospitals of the 80’s and 90’s. The paper reminds 

us of the constant of modern warfare, but also serves to 

highlight the differences in service provision since the Falklands 

conflict. 

In 1982, service amputees would have been referred to the 

local NHS Limb Fitting Centres. Since June 2006, the Armed 

Forces have had its own Limb Fitting Centre located at the 

Defence Medical Rehabilitation Centre (DMRC) at Headley 

Court. The service was developed in response to the inconsistent 

provision of limb fitting for the serving personnel. This paper 

states that the service provided was exceptionally good with 

rapid provision in prosthesis. With notable exceptions, such as 

the West Midlands Limb Fitting Centre, over subsequent years 

prosthetic provision was inconsistent, often slow and inevitably 

limited by local NHS financial pressures. This often led to 

frustratingly long periods waiting for limb refitting, with delays 

in rehabilitation. After prolonged staff-work at all levels in the 

DMS, money was made available to provide a service-wide 

Limb Fitting Centre. A private company is now contracted to 

provide prosthetic sevices, which are manufactured at DMRC 

and fitted to the individual there. This new service provides 

rapid prescription and adjustment of the prosthesis whilst at the 

same time allowing continued rehabilitation of the patient. 

This month will complete one year of prosthetic provision at 

Headley Court. We are subsequently auditing our throughput 

and early outcomes, which we hope will be a subject of a 

publication in this journal shortly. 

The current data indicates that there are currently 62 

amputees serving in the Armed Forces, many of whom have 

been in the Services for some years. There have been 42 cases 

treated at DMRC since June 2006 and we have records of 25 

aeromedically evacuated cases during the same time. The figures 

are comparable to those reported by Groom and Coull, with an 

almost identical distribution of amputation levels. 

From a rehabilitation perspective the authors make two very 

interesting points. Firstly, that the potential occupational 

outcome for soldiers with below knee amputations is very good. 

Higher amputation levels are associated with longer 

rehabilitation times and lower functional outcomes. The longterm 

vocational outcomes of these servicemen remains 

unknown but with the technical improvement in prosthetic 

provision functional capability is likely to be higher than 1982. 

Consequently, I believe, we may need to review our concept of 

medical grading for these patients, considering both functional 

potential and the aspirations of the individual. 

Secondly, the authors raise our attention to the psychological 

factors, which influence the rehabilitation outcome of 

amputees. Interestingly, they state that management of this is 

the responsibility of the doctors treating the wounds and of 

voluntary and welfare organisations. The necessity of support to 

families of injured service personnel is also stressed. Fortunately, 

I believe our provision in this area has improved considerably. 

There is widespread recognition of the influence of 

psychological factors on the outcome of recovery and every 

effort is made by the acute services and rehabilitation team to 

identify and ameliorate these issues, even from the point of 

wounding. All members of the rehabilitation team contribute to 

this, but particularly those from the mental health, occupational 

therapy and social work teams. I believe that group-therapy, led 

by a military remedial instructor within a rehabilitation unit 

with a Service ethos, together with similarly injured wounded 

service personnel, contributes to their psychological support and 

hopefully their long-term outcome. 

This paper illustrates that whereas the types of injuries 

sustained then and now are very similar, there has been 

significant progress in rehabilitation provision in the Defence 

Medical Services with the aim of returning the injured back to 

the maximum possible psychological and physical health. 



Army Field Surgical Experience 

DS Jackson, CG Batty, JM Ryan, WSP McGregor 

Keywords: Field Surgical Team, Advance Surgical Centre, High Velocity Missiles, Wound Excision 

Summary: In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. 

They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of 

wounding and the methods of casualty management are discussed and compared with other recent campaigns. 

Introduction 

During the recent conflict a Naval task force which included a 

land forces element, consisting of 3 Commando Brigade and 5 

Infantry Brigade was dispatched to the South Atlantic. The 

initial landing of these units on East Falkland took place on 

21st May 1982. Support for the land forces provided by the 

Army Medical Services consisted of: 

1. A Regimental Officer (RMO) assigned to each major unit. 

At a later stage some units were assigned a second Medical 

Officer. 

2. 16 Field Ambulance RAMC providing second line medical 

support for the land force. 

3. Surgical teams drawn from 16 Field Ambulance (Parachute 

Clearing Troop) and 2 Field Hospital RAMC. 

Additional support was given by a Royal Navy Ship’s Surgical 

Team of the Marine Commando Medical Squadron whose 

experience will be reported separately. 

A Task Force of this magnitude has not been deployed since 

World War II. The conflict took place at a distance from base 

of 8,000 miles, and with such long lines of communication and 

a relative lack of surface transport, obvious difficulties with resupply 

of medical stores and rearward evacuation of casualties 

to base hospitals was envisaged. The medical support, therefore, 

had to be self sufficient to a degree not previously experienced. 

Four Army surgical teams were deployed during this period. 

They had to work under hostile conditions, often very close to 

the battlefield, and were bombed by the Argentinian Airforce 

on a number of occasions. 

The lack of suitable buildings, the virtual absence of roads, 

the often impassable terrain, and the appaling weather 

conditions, all influenced the collection, treatment and 

evacuation of casualties. These features also influence the 

surgical management of the wounded. 

The Campaign 

From the surgical point of view the campaign can be regarded as 

having occurred in two phases. 

Phase One 

On the morning of 21st May 1982 a number of beach-heads 

were established on East Falkland in the area of Port San Carlos, 

San Carlos and Ajax Bay (Fig 1). 

Marine Commandos and Paratroopers were landed, largely 

unopposed. Field Surgical support for these units was provided 

by the two Field Surgical Teams of the Parachute Clearing 

This article first appeared in the Annals of the Royal College 

Surgeons of England and is reproduced by kind permission of 

the editor 

Troop of 16 Field Ambulance, and a Royal Navy Ship’s Surgical 

Team (SST) drawn from the Commando Medical Squadron. 

An Advanced Surgical Centre was established in a disused 

refrigeration plant in Ajax Bay, and dealt with casualties 

resulting from the landings and the subsequent bombings of 

ships in the Falkland Sound and San Carlos Water. In addition, 

the wounded, following the celebrated battle for Darwin and 

Goose Green by the 2nd Battalion the Parachute Regiment, 

were treated at this Centre during 28th and 29th May. 

Phase Two 

With the arrival and deployment of 5 Infantry Brigade over 

the period 31st May – 2nd June, preparations were made for 

the next major land battles and the final assault on Port Stanley. 

Two Army Field Surgical Teams designated FST 1 and 2, and a 

Holding Section – vide infra – drawn from their parent unit 2 

Field Hospital in Great Britain, in company with 16 Field 

Ambulance, provided the Brigade medical support and were to 

reinforce the Parachute Field Surgical Teams designated FST 5 

and 6, and the Royal Navy Surgical Support Team on land. 

As plans were drawn up for battles to take the horse-shoe 

shaped perimeter of mountains surrounding Port Stanley, Field 

Surgical Teams 1 and 2, their Holding Sections and 16 Field 

Ambulance less their advance party, were embarked on Royal 

Fleet Auxillary Sir Galahad in company with the Welsh Guards. 

The object was to set-up a more proximal Advanced Surgical 

Centre (ASC) at Fitzroy Settlement from which the enemy had 

withdrawn (Fig. 2). In addition, FST 5 was moved to Teal Inlet 

and FST 6 remained at Ajax Bay. However, events altered the 

planning. With only elements of FST 1 ashore, Royal Fleet 

Auxillary Sir Galahad was bombed with the loss of all surgical 

equipment. Both teams were re-supplied with a variety of 

medical equipment gathered from the supporting fleet. FST 1 

was then sent back to Fitzroy with FST 6 forming a two table 

A.S.C. as originally planned. FST 2 having survived the 

bombing was established in the refrigeration plant at Ajax Bay, 

alongside the Royal Navy Surgical Team which remained static. 

The final deployment of the Field Surgical Teams is 

illustrated in Fig 2. 

Field Surgical Teams 

Field Surgical Teams (FSTs) are essentially highly mobile units 

capable of working independently in small groups. They can be 

rapidly deployed and become operational within 15 minutes of 

arriving at a location, subject to basic facilities being available, 

e.g. buildings, tentage, water, heat and light. 

Each team consists of a surgeon, anaesthetist, resuscitation 

officer, four operating theatre technicians, a blood transfusion 

technician and a clerk(1). 

The four Army Surgical Teams were organised as shown in 

Table 1. 


Fig 1 Map of East Falkland 

From PCT 

of 16 Field 

Ambulance 

From 2 

Field 

Ambulance 

FST 5 

FST 6 

FST 1 

FST 2 

Table 1. Organisation of Army Surgical Teams 

Surgical registrar (CGB) 

Consultant anaesthestist 

General duties medical officer 

Consultant surgeon (WSP McG) 

Anaesthetic registrar 

General duties medical officer 

Senior surgical registrar (DSJ) 


Dentist with resuscitation training 

Senior surgical registrar (JR) 


Dentist with resuscitation training 

Region Number of Cases Percentage 

Head and Neck 36 14 

Chest 18 7 

Abdomen and pelvis 30 11.5 

Upper limb 68 26.5 

Lower limb 106 41 

Table 2. Analysis of injuries treated by operation 

Fig 2 Deployment of Field Surgical Teams on East Falkland 

Holding Section 

Nursing and postoperative care were provided by holding 

sections consisting of trained male nurses and medical assistants, 

either from 16 Field Ambulance or 2 Field Hospital. 

Pattern of wounding 

We comment only on patients operated on on land by Army 

surgical teams. Two hundred and ten cases underwent surgery by 

the four teams during the campaign. In addition FST 2 and FST 

5 both utilised the civilian hospital in Port Stanley after the 

ceasefire, and operated on a further 23 cases. These included 

neglected war wounds, mainly Argentinian, and sadly a 

considerable number of patients, Service and Civilian, injured by 

unstable ordnance, unchartered mines and booby-traps. 

Several casualties were injured by the accidental discharge of 

weapons which included the misfiring of a sidewinder air-to-air 

missile onto a group of soldiers on the airfield at Port Stanley on 

13th July 1982. Table 2 gives a breakdown by region of the 

surgical operations performed by the four teams. The figures do 

not include the many patients who passed through the units with 

a variety of conditions requiring treatment but no immediate 

surgery. These also included several types of cold injury 

(immersion foot, trench foot, and frost bite), a variety of medical 

problems and more significantly numerous burns cases, 

resuscitated before evacuation to the Burns Unit on SS Uganda. 

FST 1 and 2 and 16 Field Ambulance, as has already been 

mentioned, were involved with the immediate resuscitation of 

more than fifty burns cases resulting from the bombing at Bluff 

Cove. 

Table 3 provides an analysis of the wounding agents and the 

breakdown is as expected and correlates well with the results from 

more recent conventional wars (2-6). This analysis is quite unlike 

those reported from Northern Ireland where bullets cause a 

higher percentage of the wounds (7). 

Missile Number of Cases Percentage 

Bullet 74 31.8 

Fragment 105 45 

Mine 25 10.8 

*Unclassified 29 12.4 

Table 3. Wounding agents 

*Unclassified: includes secondary missiles, road traffic accidents, sidewinder missile. 

Priority One Priority Two Priority Three 

Require immediate Require resuscitation Require no 

resuscitation and/or and early surgery resuscitation and 

immediate surgery 

delayed surgery 

Table 4. Priority of treatment 

Casualty Management 

The vast majority of casualties were received by helicopters as the 

only effective method of transport(5-8). It is worth noting, 

however, that particularly after the Bluff Cove bombing, many 

casualties walked considerable distances. 

The mobility of Advanced Surgical Centres precludes a large 

holding capacity. Thus to avoid being overwhelmed with cases 

the ASC’s in the Falklands dealt mainly with the most severely 

injured. These priority One and Two Cases (Table 4) were 

immediately resuscitated, operated upon and quickly evacuated 

rearward, often within hours of surgery, by air onto the hospital 

ship SS Uganda which functioned in this case as a general 

hospital. 

The majority of wounds were caused by high velocity missiles. 

All wounds, therefore, were presumed to be heavily contaminated 

as a result of the cavitation effect of the wounding agent(9). 

Treatment was by accepted surgical techniques(1). 

On arrival at a centre patients were resuscitated using a variety 

of intravenous fluids, Hartmann’s, plasma expanders and whole 

blood. The airway was secured, endotracheal intubation being 

carried out if necessary. Tetanus toxoid booster and benzyl 

penicillin were given to all except cases of known hypersensitivity 

to the penicillin group of drugs. In addition, head wounds 

received sulphadimidine, and patients with abdominal and pelvic 

wounds were given metronidazole and either ampicillin or a 

cephalosporin. 


An operating list was compiled by the resuscitating officer, 

anaesthetist and surgeon working together, though each of the 

casualties was continuously reassessed in accordance with the 

dynamic nature of the triage system, leading to frequent 

alterations of the list, depending on their changing clinical 

conditions(1). The response of each casualty to resuscitation was 

carefully monitored, and on occasions, in cases of severe multiple 

injury, immediate surgery was used as part of the resuscitative 

procedure. 

In cases of limb injuries, entry and exit wounds were incised 

along the axis of the limb. Wide fasciotomy was practised, often 

including muscle compartments not seen to be involved. Skin 

was preserved as far as possible but subcutaneous tissues and dead 

muscle were widely excised, until the latter demonstrated healthy 

bleeding and contractility. Comminuted fractures were treated by 

lavage, removal of detached small fragments, approximate 

reduction and maintenance of bone length, and external POP 

splinting over well padded loose dressings. 

Damaged tendons and nerves were marked wherever possible 

by silk sutures for secondary repair. Only important arteries and 

veins were repaired or vein patched (femoral, popliteal, brachial). 

Limbs beyond salvage were immediately amputated at the lowest 

possible level through healthy and uninjured tissues. Skin flaps 

were left long and bone ends covered by myoplastic flaps loosely 

approximated. A guillotine method was used when time was 

short. All wounds were loosely dressed and left open for delayed 

primary closure on the hospital ship (3,9). 

Abdominal and pelvic penetrating wounds were all explored 

and presented major clinical problems; however, a number of 

abdominal wounds were tangential and did not enter the 

abdominal cavity. These patients did not have laparotomies at the 

advanced surgical centres, but were evacuated rearward with the 

knowledge that some might well come to laparotomy by virtue of 

the indirect injury to abdominal contents which may be caused 

by high velocity missiles (4). 

At laparotomy a long mid-line incision was employed for wide 

access and arrest of haemorrhage was the immediate priority. 

With injuries to the small bowel it was common to find multiple 

perforations and lacerations caused by a single missile, in addition 

to severe mesenteric haemorrhage (4,9). Small bowel perforations 

were dealt with by marginal excision and closure or by segmental 

resection and end to end anastomosis. Colonic injuries which 

reached the Advanced Surgical Centres were few in number. 

Those of the right colon were treated either by marginal excision 

with simple closure or hemicolectomy and anastomosis. Wounds 

of the left colon usually involved bowel resection and a colostomy 

with mucus fistula, or repair with proximal colostomy, combined 

with generous drainage, or exteriorization of the injured segment. 

Liver wounds were inevitably low velocity (3,9). One case of 

hepatic injury was treated by wound excision, laparotomy, 

marginal liver resection and haemostatic repair with drainage. 

The biliary tree was repaired and ducts splinted with drainage. 

Chest injuries presented few problems. Patients with chest 

wounds were largely self selecting (4). No patients with 

mediastinal involvement reached surgical help alive in this series. 

Most of the wounds were peripheral or tangential, and because of 

the lungs’ peculiar resistance to the cavitational effect of high 

velocity missiles did not require formal thoracotomy (3,9). 

Excision of the wounds along conventional lines, followed by 

tube drainage, was the standard treatment. Only 6 thoracotomies 

were carried out and these in cases of persistent haemorrhage and 

massive pulmonary injury. Also 1 of our chest wounds had a large 

defect posteriorly resulting in a sucking wound. Here 

thoracotomy was followed by swinging a large muscle flap to 

cover the defect. 

Casualties with serious wounds of the head and neck were few 

among the survivors. Almost all high velocity penetrating 

wounds are immediately fatal (9). 

Our cases on the whole suffered from low velocity injuries. the 

small number of survivors from high velocity missiles had 

tangential wounds resulting in compound skull fractures, severe 

soft tissue loss and brain destruction. Unlike other wounds, head 

wounds were closed, dural defects in particular being covered, 

and in one case a rotation flap was used. 

Maxillo-facial wounds were only dealt with by the Advanced 

Surgical centre when they presented an airway problem. 

Tracheostomy was carried out with minimal further attempts to 

deal definitively with the wound in 3 cases. No attempts were 

made to remove the wounding fragments if they were not 

obvious or easily accessible. 

It should be emphazied that only life and limb saving surgery 

was carried out at this level, and thus our work in a way was 

greatly simplified. The extensive problems that will follow, such 

as those of reconstructive surgery were not considered and are 

beyond the scope of this report. Post operatively casualties were 

held for as short a time as possible compatible with the nature of 

the surgical procedure and the availability of helicopter transport. 

Rearward evacuation took place from 1 to 36 hours after 

treatment and was to the hospital ship SS Uganda. The 

maximum flight time from the most forward surgery centre 

(Fitzroy) was approximately 40 minutes, and our casualties 

tolerated this extremely well. 

Agent Site of Cause of Time of 

injury death death 

Bomb blast Small intestine Haemorrhagic 14 Day post -op 

fragments Inferior vena pancreatitis on SS Uganda 

cava 

Gunshot Pancreas Gross brain 24 hours 

wound Head damage postoperative 

on SS Uganda 

Anti-tank Pelvis Perineum Uncontrollable Died on 

mine both legs bleeding operating table 

Massive tissue table at 

loss Fitzroy 

Table 5. Details of 3 deaths 

Results 

There were 3 deaths and details of the cases are given in Table 5. 

The figures only reflect the immediate mortality. It is beyond our 

scope to deal with the long term results though it is hoped to 

present there is a later study. We are, however, happy to record 

that no further deaths have occurred (to this date) following 

evacuation and repatriation. 

Discussion 

Sited as they were on East Falkland, the four army teams 

functioned as Advanced surgical centres. This was necessary 

because of the manner in which the battle was conducted and 

the difficult terrain. Surgical facilities further to the rear would 

have posed insurmountable problems in casualty evacuation as 

helicopters were in short supply, had a limited load carrying 

capacity and many had no night flying capability. 

Conventionally, casualties having been initially treated by 

their Regimental Medical Officer at the Regimental Aid Post, are 

evacuated rearward by road or air to a Field Ambulance. Here 

resuscitative measures are checked and continued and casualties 

sorted, such that the most seriously injured are preferentially 

further evacuated by air, road or rail to a well equipped Field 

Hospital. Advanced Surgical Centres short circuit the chain but 

are less than ideal in many respects. The equipment is basic, 

though adequate, and is geared only to life or limb saving 

surgery. 


It is tempting to draw comparisons with reports from other 

Campaigns (2,5,7,10-14). However, there were aspects of this 

was which makes direct comparison difficult. In Vietnam the 

American Surgical Services were all permanent installations, on 

a grander scale with sophisticated laboratory and diagnostic 

equipment available. Specialist teams were on hand to deal with 

regional injuries. Thus head wounds were dealt with by 

neurosurgeons and chest wounds by thoracic surgeons (3). 

The reports from the Yom-Kippur War show that the Israeli 

Armed Forces are provided with echelons of medical care similar 

to those planned by the British Army Medical Services, with 

surgical facilities usually well back at the 3rd echelon (15). 

However, their lines of communication were short with some 

civil base hospitals close to the fighting. This is also true of 

Northern Ireland. In the Falklands War the difficulties of 

logistics, transport, communications, terrain and bad weather 

necessitated the tactical advancement of the surgical facilities 

available, in order to provide adequate surgical treatment for the 

casualty as close to the point of wounding in both time and 

distance. 

Not since Anzio in 1944 have surgical teams worked in 

isolated groups on a beach-head with small advanced surgical 

centres close to the fighting, with only the basic equipment and 

the ships functioning as base hospitals (16). The concept of the 

ASC is not new (13). It worked well. It provides surgical care, 

basic at best, at a forward level and is aimed at those patients 

who would have otherwise died if the conventional approach to 

surgical support had been adopted. It is worth commenting that 

no insurmountable clinical problems were encounted by the 

surgeons, most of whom were of junior hospital doctor status. 

Only one consultant worked at an Advanced Surgical Centre 

(WSP McG). The training of surgeons in the British Army 

includes time spent in all major surgical specialities in addition 

to the normal training in general surgery. Most of us approached 

the conflict with a certain amount of apprehension concerning 

our ability to deal with the widespread range of clinical problems 

we would encounter, though previous service in Northern 

Ireland undoubtedly provided a framework of experience. In the 

event there were no particular difficulties. The thoracic problems 

we encountered should all be within the competence if a general 

surgeon, though neurosurgical injuries posed difficulties. 

However, we feel that a neurosurgeon, whilst needed in a field or 

Base Hospital has no place with a Field Surgical Team in an 

Advanced Surgical Centre. 

The extremely low mortality experienced by us deserves 

comment. With very few exceptions our patients were evacuated 

from close to the point of wounding by helicopter and taken 

directly to resuscitation and subsequently surgery, either at an 

Advanced Surgical Centre or to the Dressing Station of 16 Field 

Ambulance which had an advanced surgical centre co-located 

with it (FST 1 and 6). The Dressing Station provided a useful 

filter, treating the minor wounded and passing on Priority 1 

Casualties to the Surgical facilities. Evacuation times, however, 

from wounding to surgical care varied considerably from several 

minutes to several hours, and though most patients reached 

surgery quickly, there are many reported instances of 

considerable delays particularly following night battles because, 

as has already been mentioned, not all helicopters could fly at 

night. On several occasions casualties were brought to us who 

had been wounded at the start of the night battle, and had 

waited all night on the mountains for evacuation at first light. It 

is likely, therefore, that some of the more seriously injured died 

before evacuation was possible thus paradoxically improving our 

survival figures at the surgical centres. However, in contradistinction, 

a very short evacuation time presented us with a live 

patient who had received wounds which inevitably would and 

did prove fatal (Table 5, patient 3). 

Argentinian casualties presented a significant group and it is 

sad that we have no information on their fate. Most were 

transferred to Argentinian Hospital Ships from SS Uganda. 

The final common pathway for all our cases was to the 

hospital ship SS Uganda. We are very grateful to our colleagues 

of the Royal Navy who ran this floating hospital, and who 

absorbed casualties directly when the advanced surgical centres 

were overwhelmed, particularly for example with the burns cases 

after the Bluff Cove bombing. Without them the Advanced 

Centres would have been flooded and thus rendered relatively 

ineffective. 

The authors would like to thank Colonel R. Scott M Ch FRCS 

Professor of Military Surgery and Major General W. Pryn OBE 

FRCS Director of Army Surgery for their help in the preparation 

of this article and Mrs D Brockley for the preparation of the 

manuscript. 

References 

1. Kirby NG, Blackburn G. Field Surgery pocket book. London; HMSO, 

1981. 

2. Rich NM. Vietnam missile wounds evaluated in 750 patients. Milit med 

1968;133:9-22. 

3. Whelan TJ, Burkhalter WE, Gomez A. Management of war wounds; 

Advances in surgery; Vol 3, 227-350. 

4. Joshi HC. Abdominal injuries in the forward areas. Indian Journal of Surgery 

1974;36:350-5. 

5. Watts JC. Military surgery. Ann R Coll Engl 1960; 27:125-43. 

6. Hampton OP. Wounds of the extremities in military surgery. St Louis VC 

Mosby Company 1951. 

7. Boyd NA. A military surgical team in Belfast. Ann R Coll Surg Engl 1975; 

56:15-25. 

8. Dudley HAF. Some aspects of modern battle surgery. JR Coll Surg Edinb 

1973;18:67-75. 

9. Owen-Smith MS. High velocity missile injuries. In: Hadfield J Hobsley ed. 

Current surgical practice Vol 2 London. Edward Arnold 1978;204-9. 

10. Melsom MA, Farrar MD, Volkers KC. Battle casualties. Ann R Coll Surg 

Engl 1975; 56:289-303. 

11. Brown RF, Binns JH. Missile injuries in Aden. 1964-1967 Injury 

1970;1:293-302. 

12. Soul JO. War Casualties in Oman. JR Nav Med Serv 1977:63:85-91. 

13. Bruce J. Surgery in far eastern theatres of war. JR Army Med Corp 

1949;93:57-67. 

14. McDermott BC. A field surgical team in Borneo. JR Army Med Corp 1968; 

14:97-101. 

15. Michael D. Medicine on the battlefield. A review. JR Soc Med 1979;72:370- 

73. 

16. Estcourt HG, Clarke SHC, Ross JA et al. Abdominal wounds at a beachhead. 

A clinical review of 65 cases. Lancet 1944;12:38-41. 



Commentary on 

The Falklands War - Army Field Surgical Experence 

Ann R Coll Surg Engl 1983; 65: 281-5 

Professor JM Ryan 

Reviewing this paper, published nearly a quarter of century ago, 

the writer is immediately struck by how much has changed. 

Although those deploying did not realise, the war was to be a 

watershed, at least in medical terms. The Army (land based) 

surgical support elements were lightly equipped, lean and 

austere and would have been easily recognised by an earlier 

generation of surgeons deployed in support of troops fighting in 

the Boer War and World War 1. Even the field clothing worn 

by the surgical teams were a throw back to an earlier century – 

Long sleeved vests and KF pattern shirts worn with aprons. 

Never again would field surgical teams deploy in such manner. 

It was of course not meant to be this way. Carl Von 

Clausewitz’s observation that ‘the plan would not survive the 

first contact with the enemy’ proved prophetic. The initial plan 

envisioned that surgical support for the wounded would be 

afloat on the hospital ship SS Uganda and the liner SS 

Canberra. Field Surgical teams (FSTs) were to be held in reserve 

and few thought they would be needed. The Argentine air force 

put paid to that plan, necessitating the early deployment of 

Royal Navy, Royal Marine and Army personel ashore and into 

a disused refrigeration plant at Ajax Bay. 

Turning now to the paper – it is immediately obvious that 

only part of the story is told here. The paper relates the 

experience of the Army FSTS only and barely a mention is 

given to the considerable experience of the Royal Navy teams 

both ashore and alongside the Army FSTs, and those deployed 

on the hospital ship SS Uganda and on ships and liners 

throughout the fleet. Memories fade with time and it is difficult 

to recall why this was so. There was certainly no malice or 

jealousy, more likely a desire to be first in the race to publish. 

What a pity, as a paper describing the total experience would 

have left a more complete and better record. How invaluable 

the retrospectoscope! 

Jackson et al’s paper gives a vivid and raw account of surgery 

ashore under the most primitive and sometimes dangerous 

conditions. It will shock many reading it for the first time in the 

light of early 21st century advances. So many features are 

striking. The majority of the surgeons and anaesthetists were 

trainees with only one consultant surgeon and one consultant 

anaesthetist. Towards the end of the campaign a lone trainee 

surgeon was deployed forward to work single handed in Teal 

Inlet – something unthinkable in the modern climate of clinical 

governance. Yet there were no fatalities at Teal Inlet. The 

equipment scales were basic and limited. This was the age 

before field ventilators and oxygen generators. Paper towels 

were used due to the absence of any linen. Surgeons and their 

assistants worked in shirt sleeve order and with the bare 

minimum of instruments. Table lighting was appalling, 

sometimes with bare light bulbs in use. There was no imaging 

and laboratory support was confined to blood group typing. 

Another striking aspect of the campaign was the scarcity of 

helicopters for both evacuation of the wounded to the FSTs at 

Ajax and for evacuation to the Hospital Ship and other 

receiving ships. Most of the helicopters earmarked for casualty 

evacuation went down with SS Atlantic Conveyor destroyed by 

an Exocet missile early in the campaign. Another example of 

Von Clausewitz’s dictum on planning. Further difficulty was 

caused by Argentine air attacks over San Carlos Water. Such was 

the danger that the Hospital Ship could only anchor close to 

Ajax at night and then only for short periods. This further 

altered planning as the original intention was for the FSTs 

ashore to confine their operations to life and limb salvage. 

Evacuation delays now dictated that as much surgery as possible 

was to be performed to avoid potentially lethal wound infection 

in the majority of wounds. 

The paper provides an analysis of wounding agents and 

injuries by region. The preponderance of limb wounds is 

striking but not surprising. Lengthy delays in evacuation 

occurred due fighting at night and the lack of helicopters. 

Jackson et al report in the paper that some of the most seriously 

injured died before evacuation was possible which paradoxically 

lowered hospital mortality. It is sad to recall a note of bitterness 

here and it concerns the numbers operated upon by Army FSTs. 

Following the publication of the paper some senior Royal Navy 

colleagues questioned the numbers cited and felt that the Royal 

Navy teams had not been given credit for their contribution. 

Such disagreements are all too common, even in reports from 

civilian hospitals. Fortunately this has caused no lasting ill 

feeling. 

The war was to provide a sharp reminder of the danger of 

providing close in surgical support. The redeployment forward 

of two FSTs with a role 2 dressing station in support of 5 

Brigade’s daring assault at Fitzroy/Bluff Cove put surgical and 

medical teams at hazard in a most unexpected way. The FSTs 

and role 2 elements were boarded on the troop ship Sir Galahad 

alongside the Welsh Guards and other support personnel. With 

just elements of the dressing station and one FST ashore the 

ship was bombed with considerable loss of life. The author was 

aboard with his FST and saw at first hand the effects of the 

bombing and the chaos that followed. It is fair to say that for a 

considerable time few expected to get off the ship alive and 

uninjured. 

In the months and early years following the war individuals 

and some national organisations, notably the British Limbless 

Ex-servicemen’s Association (BLESMA), began to question the 

decision to send such junior surgeons to work under such 

adverse conditions. BLESMA questioned the apparently high 

amputation rate and the surgical techniques used. In fact the 

teams were better trained that might appear. All had been 

exposed to the surgery of war in Oman or Northern Ireland and 

all trainees were older and vastly more experienced than their 

counterparts today. A careful analysis of the available data 

supports early decisions to amputate and to carry that out at the 

lowest possible level to allow a ‘site of election’ amputation later. 

Further analysis of those who died of wounds (only three) 

suggests the injuries sustained were non-survivable even under 


optimal conditions. 

In conclusion this writer hopes that the current generation of 

military surgeons might find some valuable lessons in the paper 

under commentary. It might also cause them to reflect on the 

advances that have occurred in the last 25 years. What a joy it 

would have been to have had the field surgical facilities of today 

transported back through time to Ajax. One final comment – 

at least in Ajax Bay at the end of a long operating session the 

unit Commander – Surgeon Captain Rick Jolly produced 

copious quantities of best Navy rum before bed time. 



First and second line treatment - A Retrospective View 

DS Jackson 1 , MD Jowitt 2 , RJ Knight 3 

1 

Senior Specialist in Surgery, CMH, Aldershot, 2 Specialist in Anaesthesia, Parachute Field Surgery Team, 16 Field Ambulance, 

Aldershot, 3 Consultant Anaesthetist, BMH, Dharan 

Summary 

The case history of a single casualty is recorded. A critique of aspects of his treatment is presented. Some suggestions for 

modifying aspects of his treatment are considered. 

A factual account of the wounds received by a soldier during one of the land battles in the Falklands Campaign is presented 

together with an account of his initial (first and second line) and subsequent (third and fourth line) treatment. 

Comments and suggestions are offered on aspects of treatment given in the first and second line medical facilities as they 

existed during the Falklands Campaign. 

Case History 

During the battle for Mount Longdon, a 23 year old man 

sustained extensive injuries of the legs from a mortar blast. His 

left leg had been almost completely amputated at mid-thigh level 

and there were numerous injuries of the right. The incident 

occurred at about 20.00 hours and field dressings were applied to 

the wounds almost immediately, papaveretum 20mg, being given 

intramuscularly shortly afterwards. Although he was bleeding 

freely from his amputation site, no tourniquet was applied and 

no intravenous infusion commenced at that time. He was 

evacuated to the Fitzroy Field Surgical Facilities by helicopter, a 

flight of about 20 minutes. 

On his arrival in the resuscitation area, only 45 minutes after 

injury, his pulse was 100 and his systolic blood pressure less than 

60 mm Hg. 

He was semi-conscious and quite incoherent. An intravenous 

infusion was immediately set up and in spite of the rapid infusion 

of 1,000ml Compound Sodium Lactate Solution followed by 

two units of O Positive blood, his condition deteriorated. To 

control bleeding, an Esmarch Bandage was applied as a 

tourniquet to the left thigh. 

During the initial infusion, a full clinical examination was 

made which revealed multiple deep shrapnel wounds of the right 

leg. An Esmarch Bandage was then applied to the right thigh as 

a tourniquet and a second intravenous line was established. 

He was taken to theatre at about 21.15, i.e. about 75 minutes 

after injury. Anaesthesia was induced with ketamine and 

relaxation for intubation with suxamethonium bromide. 

Relaxation was maintained with alcuronium and the casualty was 

ventilated by hand using the Laerdal bag. However, his blood 

pressure remained unrecordable for the first 20 minutes of 

anaesthesia in spite of manually pumping the drip chambers and 

infusing a further two units of blood, 500mls of Polygeline and 

1,000mls of Compound Sodium Lactate and dropping the head 

of the table about 15 degrees. 

Slowly, his blood pressure and pulse returned to relatively 

normal values. 

Wide excision and debridement of his various wounds and 

completion of the amputation lasted about 90 minutes. Postoperatively 

his blood pressure and pulse remained stable at 110 

(systolic) and 85 respectively. The initial intravenous line was 

discontinued and he was given one litre of Dextrose Saline 12 

hourly by the second line. 

He was evacuated to our hospital ship, the M.V. Uganda, about 

12 hours after his initial surgery, where his haemoglobin was 

found to be 9.2 g/dl and a further two units of blood and 500 

mls of Polygeline were given. 

Once aboard the M.V. Uganda, he underwent a further eleven 

general anaesthetics employing a variety of techniques. An 

epidural cannula was also placed to provide post-operative 

analgesia. Most of his later anaesthetics were given to facilitate 

inspection and redressing of his wounds. Other procedures 

included fasciotomy of the right leg (two days post-injury), 

delayed primary suture and refashioning of his amputation 

stump (five days post-injury) and split skin grafting of the right 

leg (at three weeks). Evacuation to the United Kingdom, by ship 

and air, took place one month after injury. In the United 

Kingdom, he received two further general anaesthetics, both for 

manipulation of the right knee. 

Comment 

The Falklands Campaign is generally held to have been unusual 

in a number of ways and not altogether relevant to a N.W. 

European war, this latter being the contingency for which the 

principal training objectives of the RAMC are currently aimed. 

However, it is not disputed that the South Atlantic Campaign 

was the first occasion in recent years in which the RAMC, in any 

number, have provided first and second line medical support on 

the battlefield. It was undoubtedly the first occasion in which the 

RAMC had been involved in a large-scale battle utilising 

advanced electronic weapons systems similar to those which 

would be used in a European conflict. 

In the case described, the injuries were substantial though by 

no means unusual as mortar wounds have been a feature of 

military surgery for many years. These important points arise 

from the management of this patient, all of which relate to the 

severity of the wounds and the delay likely to ensue between 

injury and evacuation in the less favourable conditions which are 

likely to exist in a conflict in Europe. These points, blood loss, 

pain and infection will each be considered in this paper. 

The Buddy/Buddy system of primary care appears to have 

worked in this instance; field dressings were applied and analgesia 

given shortly after injury by his comrades. However, direct 

questioning by the authors of the casualty described and of others 

injured in the campaign revealed that self-help was often the only 

help available. When one considers the nature of the conflict, the 


terrain, the weather and, above all, the intensive fire which was so 

often a feature of the campaign, this is not so surprising. Perhaps 

this need for self-help would benefit from greater emphasis 

during training, which still tends to stress the mutual-aid aspects 

of primary care. 

Blood Loss 

Because of the extent of this casualty’s injuries, blood loss was 

enormous with the patient presenting almost exsanguinated. It is 

well-recognised that fit young men can withstand very severe 

injuries providing that blood loss is halted, or fluid replacement 

commenced quickly. With the conditions that existed on the 

battlefields of the Falklands and which are likely to apply to 

future conflicts, the placement and maintenance of intravenous 

infusions in hypothermic, hypovolaemic patients is almost 

impossible. The reception at the Field Surgical Team locations of 

a casualty who had received intravenous fluids was consequently 

the exception rather than the rule. In such circumstances and in 

view of the probable absence of immediate intravenous fluid 

replacement, attention must be drawn to the staunching of blood 

loss. Because of the usual inadequacy of field dressings applied to 

this type of injury, perhaps consideration should be given to the 

re-introduction of the tourniquet for selected cases such as this. 

Selected indications for the application of a tourniquet are 

traumatic amputations and limbs injured to such an extent as to 

make them unsalvageable 1 . Extending the use of the tourniquet 

to lesser limb injuries would expose the casualty to the many 

disadvantages and dangers of the tourniquet. However, most of 

the complications are the result of faulty application or 

management of the tourniquet rather than the tourniquet itself. 

It must be remembered that the particularly disastrous 

consequences of misuse of a tourniquet are likely to outweigh the 

benefits in unskilled or even semi-skilled hands. 

Current teaching in the RAMC to unit first aid instructors is 

that a tourniquet should only be used as a last resort and the 

reality is that this means never. In a peacetime situation, in a 

country where skilled medical attention is readily available, the 

use of a tourniquet is probably not as vital as in a battle situation. 

However, with the conditions which existed in the Falklands and 

which are likely to apply to an even greater extent in a conflict in 

Western Europe, it is likely to be a matter of several hours before 

a casualty receives any form of skilled medical aid, particularly if 

injured at the start of a night battle 2 . It is the experience of the 

authors that all casualties received in the surgical centres who had 

sustained a traumatic amputation or a wound that rendered a 

limb unsalvageable arrived in a state of considerable 

haemorrhagic shock and probably would not have survived 

extension of the evacuation line. From this, it must be concluded 

that casualties with similar injuries may have just simply bled to 

death in the absence of immediate evacuation and it is these losses 

which a tourniquet may well prevent. That this hypothesis is 

likely to be accurate is confirmed by several Regimental Medical 

Officers and Medical Officers of 16 Field Ambulance who took 

part in the first line management of the injured 3 . Certainly it is 

their opinion that serious consideration be given to the reintroduction 

of training in the use of the tourniquet at all levels 

of First Aid instruction. 

Pain 

Analgesia was given to casualties by the injection of 20 or 30 mg 

Papaveretum ‘intramuscularly’ from a syrette. Given the length 

of a needle atop a syrette, the extent of many of the injuries and 

the rapid onset of hypovolaemic shock, it is almost certain that 

insufficient quantities of the drug were absorbed to provide a 

serum concentration adequate to provide any measure of pain 

relief. 

In this case, no further analgesia was given until the patient 

was well into the post-anaesthetic phase of surgery; no more than 

six hours after injury and at a time when his intramuscular 

volume had been replaced. Other patients had received multiple 

doses of Papaveretum in a relatively short duration of time 

without any analgesia but achieving a large depot of opiate which 

was later absorbed during resuscitation, rewarming and 

anaesthesia, to provide profound respiratory depression at the 

end of surgery, often requiring massive doses of Naloxone to 

reverse. In these cases, poor peripheral perfusion was possibly, 

and paradoxically, life-saving. 

The authors suggest that the administration of an opiate by the 

‘intramuscular’ route to the severely injured on the battlefield is 

questionable and the dubious value of ‘intramuscular’ opiates in 

this context has been discussed at great length in the past 4 . The 

problem was identified by the F.S.T.s in Salalah in 1971 and very 

effectively controlled by the withdrawal of all syrettes from the 

troops 5 . This was discussed in a well-received paper in 

Edinburgh the following year. In addition, it is also the personal 

experience of one of the authors that the intramuscular 

administration of opiates gave no relief whatsoever to the pain of 

the injured after the bombing of R.F.A. Sir Galahad. 

Having made the case for withdrawing intramuscular opiates 

as first line analgesia, consideration must be given to a 

replacement. Recent work has shown that those shocked patients 

who require analgesia should receive it intravenously and 

incrementally. However, we must accept that the intravenous 

route, however desirable, is almost completely impractical in the 

field. 

Ideally to fulfil the role of a first line analgesic, a drug must 

have the following characteristics: 

1. It must be well absorbed in the shocked casualty. 

2. Overdosage must be unlikely 

3. It must be strong enough to provide pain relief in the severely 

multiply injured. 

4. In the self-help context discussed earlier, self administration 

should be simple and rapid. 

5. It should be relatively stable and retain its potency in extremes 

of climate 

It is suggested by the authors that Buprenorphine administered 

sublingually may well satisfy the criteria mentioned above. 

Sublingual absorption is reasonably rapid 6 and the possibility 

of overdosage by this route is remote. In the one reported case 7 

of overdosage where suicide was attempted by the sublingual 

dissolution of 35 to 40 400mcg tablets, no clinical effects were 

observed apart from slight drowsiness. One case of acute urinary 

retention in association with sublingual Buprenorphine has been 

observed 8 but this was in a 66 year old man. 

That it is potent enough is well-documented, comparing 

favourably with intramuscular morphine or intravenous 

pethidine 9 and the duration of pain relief from buprenorphine is 

substantially longer than with other analgesics 10 . though the 

incidence of sedation and nausea are slightly greater with 

buprenorphine, this should not present a clinical problem 11 . 

Buprenorphine has little effect on the direct endocrine and 

metabolic response to surgical insult 12 . 

It may be that reduced absorption will occur sublingually in 

the shocked casualty with the accompanying dry mouth. 

However, in the Falklands Campaign, wounded soldiers were 

anaesthetised by crash induction techniques 13 and therefore sips 

of liquid to aid dissolution of the tablet would make little 

difference to their subsequent management. 

To our knowledge, Buprenorphine has not been used as a 

front-line analgesic and therefore there are no reports of its safety 

in this context. However, it is our contention that there is now 


sufficient favourable evidence for this drug to be legitimately 

considered as a replacement for intramuscular opiates in the 

front-line and that it should be fully evaluated with this specific 

purpose in mind. 

Infection 

Recent experimental work 14 has shown that if antibiotics, 

particularly a penicillin derivative, are given immediately on 

receipt of a missile wound, then the extent of wound excision 

required is significantly reduced when delayed debridement is 

anticipated. Also, the infective complications are reduced 15 . it is 

the contention of the authors that consideration should be given 

to the issue, to each soldier, of an injectable antibiotic which may 

be administered by himself or his buddy at the time of wounding. 

The wounded soldier would not suffer if absorption were 

inadequate but would have everything to gain if adequate serum 

levels were achieved, either prior to peripheral shut-down or if the 

injury were not sufficient to evoke a full shock response. 

The drug should have a similar spectrum of activity to that of 

Benzylpenicillin and should be stable in liquid form in extremes 

of temperature – Gentamicin and Septrin are two possibilities. 

Perhaps the use of an auto-inject system, as used for the 

administration of Atropine to soldiers who are the victims of 

chemical attack, should be investigated. 

The patient in this case history was extremely fortunate in that 

he was evacuated by helicopter direct to the F.S.T. at Fitzroy, and 

it is not an exaggeration to state that his life was saved by the 

speed of his evacuation, as were the lives of many others. 

Undoubtedly, he would not have been saved had the terrain and 

weather not mitigated against the conventional use of wheeled 

and tracked vehicles as envisaged in a European was. If the 

advanced surgical centres are deployed to save the substantially 

injured with immediate resuscitation and surgery, then, in the 

light of the Falklands experience, perhaps the whole format of 

medical evacuation should be restructured to take into account 

the unquestioned excellence of helicopter transport with 

squadrons dedicated to the Medical Services as in other armies. 

Conclusion 

We feel that in the light of the Falklands experience, there are 

areas in the Medical Services which need to be improved or reevaluated, 

particularly in relation to the use of tourniquets, 

control of pain and the use of antibiotics. The solutions suggested 

in this paper are based on current views. 

It is only by raising questions and suggesting alternatives that 

the RAMC can continue to provide the teeth arms with the best 

medical support at all times and this has been the object of this 

paper. 

References 

1 Hamilton Bailey’s Emergency Surgery, 10th Edition, Dudley HAF ed, 

Bristol, John Wright and Sons Ltd. 1977 

2 Jackson D S et al. The Falklands War: Army Field Surgical Experience. Ann 

R Coll Eng 1983: 65: 281-5 

3 Willis M and Wagon R. Personal Communication. 

4 Beecher H K. 1945 

5 Mayes F B. Personal Communication. 

6 Crossland J. Lewis Pharmacaology, 5th Ed. Churchill Livingstone; 1980: P 

34 

7 New Zealand Med J 1979; 89: 633: 255-256. 

8 Br Med J March 1983; 286: 763-764 

9 Ellis R et al. Pain Relief After Abdominal Surgery – A Comparison of i.m. 

Morphine, Sublingual Buprenorphine and Self-Administered i.v. 

Pethidine. Br J Anaes 1982:54: 421-428 

10 Kay B. A Double Blind Comparison of Morphine and Buprenorphine in 

the Prevention of Pain After Operation. Br J Anaes 1978; 50: 605-609 

11 McQuay H J et al. Clinical Effects of Buprenorphine During and After 

Operation. Br J Anaes 1980; 1013-1019 

12 Fry E N S et al. Relief of Pain After Surgery. Anaesthesia 34: 549-551 

13 Jowitt M D and Knight R J. Anaesthesia During The Falklands Campaign 

– The Land Battles. Anaesthesia 1983; 38: 776-783 

14 Dhalgreen B et al. Local Effects of Antibiotic Therapy (Benyl-penicillin) 

on missile wound infection rate and tissue devitalisation when 

debridement is delayed for twelve hours. Acta Chir Scand Suppl 1982; 

508: 271-279. 

15 Jackson D S. Soft tissue limb injuries in the Falklands (awaiting 

publication). 

First and second line treatment in the 

Falklands Campaign 

From Col R Scott, L/RAMC, Professor of Military 

Surgery 

1. The case history presented in this issue of the Journal by Major 

Jackson, Major Jowitt and Lieutenant Colonel Knight, raises a 

number of issues for discussion. 

2. As the authors point out there are injuries, particularly 

traumatic amputations of the limbs, for which pressure dressing 

alone is insufficient to control bleeding. In such cases a 

tourniquet applied, as distally as possible, may be a necessary life 

saving measure. However, I believe that more limbs and more 

lives will be lost by the unskilled application of tourniquets, 

than by neglect of their use, and that our first aid training 

should continue to stress the value of direct pressure for the 

control of haemorrhage. Since we now have records of almost 

4,000 army casualties from the Falklands and from Northern 

Ireland held in the Department of Military Surgery, we will 

attempt to clothe the bare bones of this statement with some 

data. 

3. I entirely support the authors’ view of the dangers of 

intramuscular morphine in shocked patients, but I cannot 

accept that the intravenous route is almost completely 

impractical in the field. When the evacuation time is long and 

the need for analgesic greatest the patient will usually come into 

contact with a doctor soon after injury. When the evacuation 

time is short, as in this patient, control of haemorrhage and 

splintage of injured limbs may obviate the need for an analgesic. 

An oral analgesic which is absorbed and which is rapidly 

effective, would have obvious advantages especially if it were 

universally available. However, it has yet to be shown that 

Buprenorphine fulfils all the criteria necessary for an analgesic 

that is universally available to the soldier in action. Detailed 

study of its possible use in this situation is required. 

4. The prevention of infection in missile wounds has long been a 

subject of study in the Department of Military Surgery and 

some experimental work by my predecessor suggested that fatal 

gas gangrene from contaminated penetrating missile wounds 

could be prevented by intramuscular penicillin 1 . During the 

Borneo confrontation we set up a trial of oral tetracycline to be 

taken by soldiers immediately after wounding and found that it 

was not absorbed. There is, therefore, a good case for antibiotics 

given intramuscularly but a vast amount of clinical and 

experimental work has shown that wound contamination 

develops into wound infection after a lag period of some hours, 

and we would hope that in the usual military circumstances the 

casualty would receive treatment from medical personnel. 

5. The authors raise many questions of importance in the 

management of the injured. Their views underline the need for 

further research in this important field and a continuous 

revaluation of our own experience. 

R Scott 

Reference 

1. Owen-Smith, M S Antibiotics and anti-toxin therapy in the 

prophylaxis of experimental gas gangrene. Br J Surg 1968; 

55: 43-45 



Commentary on 

First and second line treatment - A Retrospective View 


PAF Hunt 

SpR in Emergency Medicine and Critical Care Medicine. Department of Academic Emergency Medicine, The James Cook 

University Hospital, Middlesbrough, TS4 3BW 

The original article by Jackson, Jowitt and Knight was first 

published in 1982 with a commentary by Col. Scott L/RAMC, 

Professor of Military Surgery at the time. The case report they 

describe involves significant lower limb traumatic injuries with 

a partial amputation secondary to blast. They present some 

interesting points worth reflecting upon again, particularly with 

the benefit of the subsequent 25 years of further experience in 

dealing with this group of casualties. Both the original authors, 

and Col. Scott in his later commentary, discuss a number of 

issues all of which are worthy of further consideration from a 

modern perspective. These points: haemorrhage control, 

analgesia and prevention of infection, will be discussed 

separately. 

Haemorrhage control 

The authors state that the casualty received effective ‘buddybuddy’ 

immediate care at the time of wounding, consisting of 

first field dressings and analgesia. Environmental and tactical 

considerations at the time inhibited the effective provision of 

‘buddy-buddy’ immediate care and the authors stressed the 

importance of ‘self-help’ systems of immediate care in such 

circumstances. Recently, modern training and equipment has 

been designed to better meet these aims, including self- and 

buddy-aid Battlefield Casualty Drills, Team Medic, BATLS 

knowledge and core skills training and the provision of the 

Combat Aid Tourniquet which can be applied by casualties 

themselves. The evacuation of the casualty is interesting in so 

far as a support helicopter was used as transport - an infrequent 

opportunity during the conflict. The time taken from the point 

of wounding to reach an appropriate resuscitation area was less 

than one hour, which is quite impressive even by modern 

standards. 

The authors specifically make note of the fact that no 

tourniquets were in place at the time of arrival in the 

resuscitation area, despite the presence of significant ongoing 

external haemorrhage, although they reflect on the fact that first 

aid teaching at the time of the conflict advised against the use 

of tourniquets other than as a last resort. They reiterate the 

contrast between peacetime and battle situations in cases where 

haemorrhage control is vital and recommend the reintroduction 

of tourniquets for cases of severe external 

haemorrhage, especially from traumatic amputations where the 

chance of limb salvage is slim. In his commentary, Col. Scott 

rightly re-emphasises the risks of injudicious use of tourniquets 

Correspondence to: Maj Paul Hunt RAMC 

Research Fellow, Department Academic Emergency Medicine, 

James Cook University Hospital, Middlesborough 

and discusses the importance of direct pressure for the control 

of external limb haemorrhage. 

The authors also stress the fact that no intravenous infusion 

had been commenced until the casualty arrived in the 

resuscitation area. This may have been due to inability to 

successfully site an intravenous line due to hypothermia and 

shock. The introduction of more effective and practical 

intraosseous devices provides the ability to administer 

resuscitative fluids to the casualty where previously unfeasible. 

The emphasis placed in the original article on the need to 

replace fluids aggressively in cases of severe or uncontrolled 

haemorrhage can now be considered inappropriate. Modern 

pre-hospital teaching recommends that the use of intravenous 

fluid in such cases should be limited to sustaining essential 

organ perfusion, especially cerebral, whilst permitting some 

degree of hypotension to reduce the risk of disrupting vital 

blood clot and exacerbating haemorrhage. The authors note 

that the casualty was “semi-conscious and quite incoherent” 

with a pulse rate of 100 and a systolic blood pressure less than 

60mmHg. This may have been due to the opioid analgesia 

given at the scene although it was arguably more likely to be 

due to hypovolaemic shock. A rapid infusion of 1000ml of 

crystalloid was initially administered in the resuscitation room 

followed by two units of whole blood. The authors note that the 

casualty’s condition deteriorated following this, requiring the 

application of tourniquets to both thighs in an effort to stem 

the continuing haemorrhage. They describe the use of the 

Esmarch Bandage (also known as an Esmarch Tourniquet), a 

narrow hard rubber band with a chain link that can allow the 

band to be tightened around the limb. It could be argued that 

the use of such a large volume of fluid before first ensuring 

adequate control of haemorrhage may have aggravated the 

clinical situation, although it is difficult to clarify this from the 

account given. The use of large volumes of fluid for 

resuscitation was routine practice at the time of the conflict 

although even current practice may have required the use of 

large volumes of fluid for resuscitation in the face of massive 

haemorrhage and critical hypoperfusion. While not stated 

explicitly in this case report, whole blood was generally used for 

emergency transfusion during the conflict and this may have 

had some advantages over the packed red cell units used today, 

especially in terms of providing some clotting factors as well as 

oxygen carrying capacity. 

From the description given, the total volume of fluid 

administered in the first 24 hours amounted to around 3000ml 

of crystalloid, 1000ml of colloid and 6 units of whole blood. 

There was no mention of the estimated volume of blood loss 

throughout the casualty’s initial resuscitation or surgery. Once 


evacuated to the hospital ship, the authors state that the patient 

was transfused a further 2 units of blood due to his 

haemoglobin level being 9.2 g/dl. It could be argued that a 23- 

year-old soldier would not require further blood transfusion 

with this level of haemoglobin and that the risks of a 

transfusion reaction or transmission of a blood-borne infection 

would outweigh the potential benefits, although no such 

complications were acknowledged in the case report. However 

it is fair to say that modern practise is to be far more cautious 

with blood transfusion than was the case twenty five years ago. 

Initial haemorrhage control may have benefited in this case 

from one modern-day intervention, namely the use of novel 

haemostatic agents such as QuikClot or HemCon, the use of 

improved pressure dressings and possibly from the earlier use of 

tourniquets. Avoiding the lethal triad of coagulopathy, 

hypothermia and acidosis requires significant attention to detail 

for cases such as these. Vital measures include ensuring the 

maintenance of core temperature as much as possible with 

warming devices, warmed fluids where needed and protection 

from the elements in the pre-hospital setting. Resuscitation 

efforts must be concentrated on the providing adequate tissue 

oxygenation and perfusion in order to minimise acidosis, 

although the balance must be set against the need to reduce 

exacerbation of haemorrhage by overzealous fluid 

administration. The use of fresh frozen plasma in conjunction 

with packed red cell transfusion is recommended to maintain 

adequate coagulation in the face of increased clotting factor 

consumption and continued blood loss. Finally, there may be a 

role for the more swift use of recombinant Factor VIIa in severe 

trauma cases where coagulation disorders are expected although 

its effectiveness is markedly reduced in circumstances where 

hypothermia and acidosis have already taken hold. 

Analgesia 

In the case report the casualty was given intramuscular 

papaveretum 20mg at the scene. Paraveretum (Omnopom), a 

mixture of hydrochloride salts of opium alkaloids, was a 

commonly used drug for pre-operative sedation and relief of 

moderate to severe pain until the early 1990’s. The authors offer 

the opinion that the design of the drug delivery device and 

presence of hypovolaemic shock would have resulted in 

inadequate tissue absorption and an ineffective serum 

concentration of the drug. Multiple doses of the drug were 

often given over a relatively short duration of time despite, or 

perhaps because of, the limited analgesic effect. Once the 

hypovolaemic state was being corrected there was a significant 

risk of the rapid redistribution of a large concentration of 

opioid into the systemic circulation leading to potential 

complications from cardiorespiratory depression. 

The original authors and Col. Scott both comment on the 

dangers of administering intramuscular opiates in shocked 

patients. The administration of analgesia by the intramuscular 

route in the pre-hospital setting has advantages and 

disadvantages. The equipment and training required is limited 

and the method is amenable to self-treatment. However, 

absorption from this route does not occur at a constant rate, is 

highly dependent on local tissue perfusion and is therefore 

particularly unreliable in shocked patients. 

In this article, sublingual buprenorphine was proposed as 

satisfying all the criteria for an ideal pre-hospital analgesic. 

Buprenorphine is a partial agonist with a long duration of 

action. Although the side effects are rare, such as nausea and 

respiratory depression, when they do occur they can be 

persistent and difficult to reverse. The search for a reliable, safe, 

effective, rapid, well-absorbed and stable alternative to 

intramuscular morphine continues and there is a lack of highquality 

evidence, such as randomised control trials, regarding 

pre-hospital analgesia. Considerable research is ongoing in this 

area and several options have been suggested including oral 

(transmucosal) fentanyl citrate, intranasal diamorphine and 

methoxyflurane. 

In his commentary, Col. Scott correctly emphasises the need 

for appropriate splintage of injured limbs for pain relief and 

disagrees that the intravenous route of drug administration is 

completely impractical in the field. However, with the recent 

advances in intraosseous access devices it is possible that these 

will replace the intravenous route in the field as a method for 

the administration of enhanced pain relief and other important 

drugs required in the pre-hospital setting. 

Prevention of infection 

The authors comment that early administration of antibiotics 

may be beneficial to outcome in circumstances where there is a 

significant delay to primary debridement of wounds caused by 

penetrating trauma. However, there is no firm evidence to 

support the use of empirical antibiotic therapy in penetrating 

trauma where casualty evacuation times are short. The potential 

risks of serious complications from empirical penicillin therapy 

are infrequent but significant, with an overall risk of 

anaphylaxis estimated to be around 1 in 5000 cases with a 

subsequent mortality rate of around 1 in 10 of these. However, 

evidence does suggest that there is a lag phase of a few hours 

between initial wound contamination and the onset of wound 

infection. In this case, it is not unreasonable to accept the delay 

until casualties reach a facility that can provide definitive care 

and ultimately wound debridement. In cases where this care is 

substantially delayed there may be a role for empirical antibiotic 

therapy, either by the intramuscular or perhaps intraosseous or 

intravenous route. The choice of which antibiotic to use, and 

one that would remain stable in the pre-hospital setting, is still 

the subject of further investigation and research. Current 

clinical guidelines should be consulted and reflect the best 

presently available evidence. 

Conclusion 

The authors present a case report describing a mechanism and 

pattern of injury all too familiar to UK military medical 

personnel with experience of current operational commitments. 

It serves to highlight a number of issues that are still as valid 

now as they were 25 years ago. A better understanding of the 

pathophysiology of severe trauma has provided potential 

therapeutic opportunities that were unavailable at the time the 

article was written. However, the problem of how essential 

clinical interventions for such casualties can be provided 

effectively in the field remains as much an issue now as it was 

then. 

The main issues continue to be the control of external 

haemorrhage, appropriate resuscitation to restore adequate 

tissue oxygenation, analgesia and secondary prevention 

measures. The most important of these measures include 

cerebral protection and the prevention of hypothermia. 

Finally, Col. Scott’s comments on the importance of further 

research and continuous revaluation of experience and practice 

(now considered central components of effective clinical 

governance) ring ever true with the increasing complexity of 

medical equipment, greater expectations and the ongoing 

challenges of modern warfare and operational environments. 



Soldiers Injured During the Falklands Campaign 1982 

Sepsis in Soft tissue Limb Wounds 

DS Jackson 

Summary 

The factors related to the development of sepsis in the soft tissue limb injuries sustained by soldiers during the Falkland 

Campaign have been assessed. Delay in surgery and delay in antibiotic administration are the most important factors, and 

where delay in surgery is inevitable, delay in antibiotic administration assumes an even greater importance. 

Introduction 

The principles of the management of battle casualties and the 

role of surgery in the treatment of missile injuries are well 

established 1,3 . Avoidance of septic complications with their 

associated increase in morbidity and mortality in the wounded 

has always been of paramount importance. This is achieved 

mainly by immediate antibiotic therapy, early debridement 

(within six hours) and delayed primary suture (DPS). 

Method 

Two hundred and thirty three soldiers were injured in the 

Falklands Campaign. Data were obtained from the field 

medical cards, case notes and Hostile Action Casualty System 

coding sheets, and the records of all soldiers who received soft 

tissue limb wounds were analysed. Burn injuries were excluded. 

There were 174 injuries to the limbs and of these 49 involved 

the soft tissues only, ie 28% did not damage bone. Twenty eight 

lower limb and 21 upper limb injuries were studied. 

Results 

The wounding agents covered the whole spectrum of weaponry 

(Table 1) and the range of tissue trauma varied from extensive, 

with tissue and skin loss and neurovascular injury, to minimal. 

9 mm 4 Shell 5 (2) 

Mine 5 HV. Unspec 2 

Shrapnel 4 (2) Helo Crash 1 

7.62 mm 8 (2) Sidewinder 1 

Grenade 4 Bomb Fragments 3 

Mortar 12 (3) TOTAL: 49 

Table 1 Wounding Agents 

The figures in brackets indicate the number of cases in which sepsis developed. 

The time intervals from wounding to first surgery and 

wounding to antibiotic administration are given in Table 2. 

Only 20 patients, 40%, underwent surgery before six hours had 

elapsed and nine patients, 18%, were delayed over 15 hours. A 

higher number of patients however, 28 (57%), received 

antibiotics before the six hour point. 

Table 3 gives the intervals at which delayed primary suture 

was carried out and most operations took place between five 

and seven days after initial surgery. Delay beyond this point was 

usually because of a dirty wound which required further 

dressings or further excision before safe closure. In this event 

skin grafts were used as a method of delayed closure. This 

technique was used for three legs and two arms. 

All the wounded in this series were given antibiotic cover 

(Table 4) and this was mostly one of the penicillins. In only one 

case was a combination used, Triplopen and Metronidazole, the 

Hours 0-3 4-6 7-9 10-11 13-15 >15 

Wounding to 

Surgery 11 9 8 10 2 9 

Septic cases 1 1 2 1 1 3 

Wounding to 

Antibiotics 17 11 7 5 2 7 

Septic cases 0 2 4 1 0 2 

Table 2. Intervals: Wounding to Surgery and Antibiotics 

Days 0-4 5-7 8-10 11-13 

Number 4 (3) 40 (6) 3 (0) 2 (0) 

Table 3. Intervals: Surgery to DPS 

Magnapen 2 

Crystapen 8 

Triplopen 26 

Penicillin (unspec) 10 

Tetracycline 2 

Metronidazole 1 

Erythromycin 1 

Table 4. Antibiotics used in limb wounds 

latter being employed to cover possible concomitant bowel 

injury. 

Of the 49 cases reviewed, three patients had septic wounds at 

delayed primary suture, ie frank pus in the wound, an incidence 

of only 6%: but subsequent infection after delayed primary 

suture developed in a further six cases making a total of nine or 

18%. Erythematous or moist wounds and very minor degrees 

of infection, have been excluded, as have those wounds which 

had primary closure delayed because of separating sloughs and 

were not overtly clinically infected. 

Examination of the time intervals between injury and first 

surgery in those casualties who developed sepsis (Table 2) 

reveals that seven of the nine cases occurred when wound 

excision was delayed beyond six hours. Twenty-one of the 49 

casualties were given antibiotics after six hours. 

Septic wounds also resulted in seven of the nine cases in 

whom the giving of antibiotics was delayed beyond six hours. 

Unfortunately there was insufficient time to prepare a fifth 

table showing the delay to surgery in those cases in which 

antibiotics were administered within three and six hours 

respectively. 

Table 1 also gives details of the wounding agents in the septic 

cases and does not suggest any link between the nature of the 

agent and the development of infection as the cases are evenly 

distributed. 


Delayed primary suture was used as a method of closure in all 

casualties in this series and Table 3 illustrates the intervals 

between initial surgery and closure in the septic cases. It is 

striking that no infection occurred after DPS when that interval 

was greater than seven days. 

Discussion 

The prevailing conditions in the Campaign led to erratic and 

often very delayed casualty evacuation, particularly as most of 

the battles commenced at night, and helicopter transport was in 

short supply 2 . 

Current military surgical teaching dictates that all operations 

should be performed within six hours of injury to reduce 

infective complications 1 . Twenty nine of the 49 casualties were 

treated after six hours had elapsed and this can readily be 

explained by the nature of the terrain and the consequent 

evacuation difficulties, coupled with the application of the 

triage system relegating these injuries to a lower priority when 

force of circumstances dictated it 1,3 . The infection rate in this 

group approached 25% and this high infection rate can be 

related to delay in the primary wound excision. 

There were no septic complications when antibiotics were 

administered within three hours of wounding and this confirms 

recent experimental work showing that early antibiotic therapy 

(benzyl penicillin) totally inhibits the usual growth of bacteria 

in missile wounds when excision is delayed for twelve hours 4 . 

It would appear that the antibiotic prevents the growth of the 

initial sparse mixed flora of contaminants derived from clothes 

and skin which, were they allowed to thrive, would have 

prevented the recovery of reversibly damaged tissue and led to 

super-infection with more pathogenic organisms. In addition, 

the recovery of tissue damaged on the periphery of the wound 

leads to a more limited primary excision. In another 

experimental study by the same authors with no antibiotic 

therapy, the conclusion is reached that infection can be 

overcome by wound excision within six hours but would be out 

of control by 12 hours 5 . 

Owen-Smith and Matheson demonstrated that 

benzylpenicillin totally protected clostridial-contaminated 

sheep thigh wounds from gas gangrene provided that antibiotics 

were given within nine hours of wounding 6 . No cases of gas 

gangrene were encountered in the limb injuries reviewed, but 

the infection rate in this series in that group of wounded who 

received antibiotics beyond six hours after injury was 33%. 

The extent of initial wound excision is an unknown quantity 

in this series, the patients having been operated upon by several 

different surgeons of varying experience in the management of 

these types of wounds 2 . However, inadequate or insufficient 

wound excision will substantially contribute to the 

development of sepsis if at delayed primary suture devitalised 

tissue is not recognised and closure is undertaken. It should be 

appreciated that the second operation in the treatment of a 

battle wound provides an opportunity to inspect it and re-excise 

it where necessary and not just to close it. Indeed, altering the 

emphasis of the second operation from closure to inspection 

may permit a more conservative initial excision. In this series six 

cases of sepsis developed after delayed primary suture suggesting 

that the wounds were closed inappropriately. Five cases were 

closed well beyond the seven day point because of wounds 

which were of doubtful cleanliness. None became septic. 


I would like to thank Col R Scott L/RAMC, Professor of 

Military Surgery, for his help in the preparation of this paper 

and Mrs. Vera Crawford for the typing of the manuscript. 

References 

1 Field Surgical Pocket Book, Kirby N G, Blackburn G. London HMSO 

1981. 

2 Jackson D S. et al. Falklands War: Army Field Surgical Experience. Ann R 

Coll Surg 1983; 65: 281-285. 

3 Owen-Smith, M S. High Velocity Missile Injuries in Hadfield J, J. Hobsley 

M. Ed Current Surgical Practice. Vol 2 London. Edward Arnold . 1978; 

204-229. 

4 Dahlgren B, et al. local Effects of Antibacterial Therapy (Benzylpenicillin) 

on Missile Wound Infection Rate and Tissue Devitalisation when 

Debridement is Delayed for Twelve Hours. Acta chir Scand Suppl 

1982;508: 271-279 

5 Dahlgren B, et al. Findings in the First Twelve Hours Following 

Experimental Missile Trauma. Acta Chir Scand. 1981; 147: 513-518 

6 Owen-Smith M S, Matheson J M. Successful Prophylaxis of Gas Gangrene 

of the high velocity missile Wound in Sheep. Br J Surg 1968; 55; I: 36-39. 



Commentary on 

Soldiers injured during the Falklands Campaign 1982- 

sepsis in soft tissue limb wounds 


Lt Col Paul Parker 

The major cause of preventable death in war-time has always 

been infection (1). One of the greatest medical lessons learnt in 

WW II was the prophylactic use of penicillin in the surgical 

units closest to the front (2). In the jungles of Burma, soldiers 

carried their own antibiotic tablets. Medical corpsmen gave 

antibiotics at point of wounding in Korea (3). In this small but 

significant series, there were no septic limb complications when 

antibiotics were administered within 3 hours of wounding. 

Septic wounds resulted in 7 of 9 cases where antibiotic 

administration was delayed beyond 6 hours(4). 

These simple yet important clinical observations were borne 

out by later experimental work at Porton Down: Intramuscular 

administration of Benzylpenicillin, begun within 1 hour of 

wounding, was effective in preventing streptococcal infections 

in a pig model of fragment wounds. When this administration 

was delayed until 6 hours after wounding, the medication was 

not effective (5). 

Two thirds of all war wounds are in the extremities and most 

are not immediately fatal(6). Yet we repeatedly forget the 

lessons of history and thus the eminently preventable morbidity 

and mortality associated with these complex open limb wounds 

still occurs. The US Military have recently (re)introduced a 

combat pill pack containing oral Moxifloxacin for pre-hospital 

self-administration in the field by the wounded soldier (7). 

Current UK military practice mandates iv Benzylpenicillin and 

Flucloxacillin on arrival at Role 2 for extremity wounds and iv 

Cefuroxime and Metronidazole for cavity wounds (8). These 

guidelines should still be followed pending a review of the 

available evidence. 

References 

1. Feltis JM. Surgical experience in a combat zone. Am J Surg 1970 119:275- 

8 

2. Poole LT. Army progress with penicillin. Br J Surg 1944 32:110-1. 

3. Scott R. Care of the battle casualty in advance of the aid station. 

Presentation at Walter Reed Army Medical Center Conference on 'Recent 

advances in Medicine and Surgery' based on professional medical 

experiences in Japan and Korea. April 19 1954. 

4. Jackson DS. Sepsis in soft tissue limb wounds in soldiers injured during the 

Falklands Campaign 1982. J R Army Med Corps 1984 130(2):97-9. 

5. Mellor SG, Cooper GJ, Bowyer GW. Effect of delayed administration of 

Benzylpenicillin in the control of infection in penetrating soft tissue 

injuries in war. J Trauma 1996 S128-34. 

6. Parker PJ. Bullet and Blast Injuries: Initial Medical and Surgical 

Management. 2006 Curr Orth 20:333-45. 

7. Tactical Combat Casualty Care: Tactics, Techniques and Procedure. Center 

for Army Lessons Learned. 2006 6-18. 

8. The British Military Surgery Pocket Book. 2004 UK: British Army 

Publication AC 12552. 



Rate of British Psychiatric Combat Casualties Compared to 

Recent American Wars 

HH Price 

Division Psychiatrist, Headquarters, 8th Infantry Division (Mechanised), US Army, Europe 

Summary 

This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the 

Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World 

War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars. 

The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of 

combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite 

and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands 

War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention 

rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of 

various diagnoses are also presented. 

The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of 

American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function 

in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular 

constellation of factors may not recur. 

Introduction 

The Falklands war is described by Surgeon Commander Scott- 

Brown, as one of the Navy psychiatrists involved, as a 20th 

century reincarnation of the Afghan Wars or the 1896 Sudan 

Expedition 1 . Despite the technological advances of naval and air 

warfare in this conflict such as Exocet missiles and Harrier jets, 

the land war was fought without many of the weapons used in 

recent wars. There was little use of heavy armour or helicopter 

gun ships. General Thompson, the land force commander, said 

“The only difference between Hannibal and us is that he went 

by elephant and we are going to walk” 2 . And walk they did, 

carrying most of their supplies, due to the poor road system on 

East Falkland. 

During the course of the war which lasted a total of 74 days 

with a 25 day land campaign from the landing at San Carlos 

Water to the capture of Stanley, the British lost 237 men killed, 

777 wounded with 446 receiving significant hospital treatment. 

The rate of evacuated psychiatric casualties was 2% of all 

wounded with 16 declared cases evacuated from the hospital 

ship, Uganda. This rate compares favourably to the American 

experience in recent wars i.e., 23% of medical evacuees were 

psychiatric casualties in WWII, 6% in Korea and 5% in the 

early stages of the Vietnam War, reaching a high of 60% during 

the drug epidemic of 1972 3,4 . The Falklands produced a low 

rate of psychiatric casualties. This paper will examine the factors 

which the American experience suggests affects psychiatric 

casualty rates, two of which were not present in the Falklands 

and six factors which were. 

Factors not Present 

The low psychiatric casualty rate in the Falklands is significant 

in that two factors believed to have decreased psychiatric 

casualties in American experiences were not present in this 

campaign, i.e. the presence of psychiatric personnel in line units 

and psychiatric screening of all evacuees. 

Due to the psychiatric disaster in the American Army during 

the Tunisian Campaign in 1943, psychiatrists were sent to corps 

level, then further forward to evacuation hospital level during 

the Sicily invasion. On 9 November 1943 the War Department 

re-established the position of division psychiatrist with the first 

division psychiatrist reaching a division at Anzio in March 

1944. The increasing forward assignment of psychiatrists 

during World War II coincided with, and perhaps led to, a 

decrease in psychiatric casualties. However, even as late as 

August 1945, only seven out of 17 divisions in the Southwest 

Pacific had division psychiatrists 5 . During Korea, within 6-8 

weeks of the onset of fighting, division psychiatry became 

operational 6 . By the time of Vietnam, there were more 

psychiatrists in the theatre per Army troop strength than in any 

previous war. 3 Though Abraham has written extensively on the 

treatment of battleshock (the British term for psychiatric 

combat casualties) and has proposed the development of 

Battleshock Rehabilitation Units at division level supported by 

Field Psychiatrist Teams, these have not yet been fully 

organised 6 . There are no behavioural science teams attached to 

British line units corresponding to the division psychiatrist, 

psychologist, social worker, and enlisted behavioural science 

technician (91G) in the U.S. Army. No Royal Army Medical 

Corps psychiatrists were invited to the Falklands. 

Psychiatric screening of medical evacuees has also been found 

to decrease rates of psychiatric casualties in the American Army. 

During the New Georgia Campaign in the Pacific during July 

and August 1943 no screening of evacuees occurred in the 43rd 

Infantry Division. This division had large numbers of 

psychiatric casualties as well as medical evacuees subsequently 

found to have psychiatric disorders at base hospitals 7 . This 

division lost 10% of its strength during one month to N-P 

casualties. It is reported that men actually “tagged” and 


medically evacuated themselves to rear bases. In another 

division, the 37th Infantry Division, also on New Georgia and 

taking the same amount of physical casualties, all psychiatric 

cases were screened by the division psychiatrist producing a 

negligible N-P evacuation rate 7 . During the Korean War and 

the Vietnam War all psychiatric evacuees were screened by 

psychiatrists except for drug abuse cases evacuated from 

Vietnam through Drug Rehabilitation Centers run for the most 

part by internists or general medical officers 4 . No psychiatric 

screening occurred in the Falklands because the two Royal Navy 

psychiatrists present were aboard ship for the duration of the 

conflict, one aboard the hospital ship Uganda and one aboard 

the Canberra, a troopship with a 50-bed hospital 8,9 . 

One was to have been placed in a mobile field hospital, but 

as all tents were lost in the sinking of the Atlantic Conveyor, the 

hospital was set up in a refrigeration plant at Ajax Bay primarily 

for surgical cases. All psychiatric casualties were evacuated to 

the Uganda. Though the British have a similar understanding 

of combat psychiatric casualties and their treatment 10 as 

American psychiatrists, the location of the psychiatrists was not 

optimal for the rapid return to duty of cases. The Geneva 

Convention prohibits return of troops to combat from a neutral 

territory and permits wounded to be taken prisoner from a 

hospital ship. Therefore casualties were sent by ambulance ship 

to the neutral port of Montevideo and then to Britain by 

aircraft. Once aboard the Uganda at San Carlos Water the 

evacuee was as good as home in Britain despite the 8,000 mile 

distance. 

The Canberra, on the other hand, was legally a troopship and 

thus a legitimate military target, by Geneva Convention rules. 

Consequently after offloading troops and equipment during the 

landings on 21st May and taking on some casualties it was sent 

the next day to the east of the Total Exclusion Zone out of range 

of land based Argentine aircraft. If the British had been able to 

obtain complete air superiority, the Canberra could have been 

kept closer to the land battle medical evacuation chain and used 

for the treatment of psychiatric casualties and their return 

directly to combat. 

Of the 16 psychiatric cases evacuated to the Uganda, Scott- 

Brown reported that four were battleshock cases, four had 

formal psychiatric illnesses, precipitated by combat all of whom 

were depressed, four were survivor reactions with bereavement 

and fear of minor trauma and four were cases of 

hyperventilation and depression without exposure to land 

combat 1 . The battleshock cases were treated with rest, warmth, 

food and small group therapy. The psychiatrist aboard took 

charge of a 250 bed low dependency ward and performed many 

consultation-liaison activities such as pain control consults and 

amputation counselling. 

Morgan O’Connell, the psychiatrist on the Canberra, 

consulted on eight cases. One was a case of bereavement, one 

had psychosomatic chest pain with family stresses, two were 

cases of alcohol abuse, one a case of acute paranoid 

schizophrenia with a previous history of hospitalisation, two 

homosexual civilian ship’s crew members with depression and a 

Senior NCO with disseminated sclerosis. He was also involved 

in preventative psychiatric group work with survivors of the 

Ardent after section, as well as the Special Air Service Squadron 

which lost 19 men in a helicopter crash. Only the bereavement 

case had been involved in the land combat; his helicopter 

crashed and the pilot died in his arms under heavy fire from 

Argentines 8 . 

Despite absence of psychiatrists ashore or in line units and 

the lack of psychiatric screening of evacuees all of which were 

removed from combat and sent to Britain, the Falklands 

Campaign still produced the remarkably low rate of 2% 

psychiatric cases of all medical cases. When viewed in the light 

of the American experience in the past three wars, this low rate 

represents a concentration of optimal factors leading to healthy 

functioning in combat. 

There are five optimal factors which appear important but 

first a look at an important factor which, while decreasing the 

rate of diagnosed psychiatric casualties, leads to their evacuation 

under other diagnoses. 

Occult Psychiatric Casualties 

Marlow (1979) pointed out that during World War II “severe 

combat that produced few people who were labelled by the 

Medical Department as combat psychiatric casualties, also 

produced compensatorily large numbers of personnel 

withdrawn from battle for frostbite, illness or light injury, as 

well as AWOL and self-inflicted wounds” 11 . The low number of 

psychiatric casualties in the British campaign may have been 

offset by the fact that 20% of all land casualties were due to 

immersion foot 12 . A number of exposure cases however, 

occurred when the landing ship Sir Galahad was bombed at 

Bluff Cove with no voluntary component to their condition. 

Therefore the number of occult psychiatric casualties may have 

been negligible. 

In a climate very similar to the Falklands, when the 7th 

Infantry Division invaded Attu in the Aleutians in May 1943, 

large numbers of cold casualties occurred in a campaign lasting 

21 days. This division, desert trained with neither proper 

training nor clothing for the cold wet weather, suffered 553 

KIA, 1,154 wounded, 2,205 diseased, of which 1,518 were 

frostbite and trenchfoot. The North Pacific theatre had the 

lowest overall psychiatric casualty rate of the war 13 . In the 

European theatre during World War II and again in Korea, 

frostbite was also noted to be an evacuation syndrome. 

Evacuation of psychiatric casualties has occurred under 

organic diagnosis such as “blast concussion”, and diarrhoea. In 

Italy after the invasion at Salerno in September 1943, the 

incidence of diarrhoea increased by one third in the 5th Army. 

“Most patients recovered promptly after three to five days 

regardless of whether sulfonamides, or bismuth or Paregoric 

were used” 14 . During this same period many patients who had 

bypassed evacuation hospitals and were evacuated to North 

Africa with diagnoses of “concussion” or other somatic disease 

were subsequently discovered to be neuropsychiatric 

casualties 14 . The ratio of diagnosed psychiatric casualties to 

battle casualties was one to eight. Later in the Italian campaign 

with more thorough evaluation the ratio rose to one out of four 

to five battle casualties 14 . At times command pressure 

influenced diagnosing of psychiatric casualties. On Guadalcanal 

in 1942 General Patch, commanding the American Division, 

insisted on court-martialing officers with neuropsychiatric 

diagnosis. The division psychiatrist, serving also as the division 

surgeon, circumvented this by labelling these cases as “blast 

concussion” 15 . During the Iwo Jima campaign a high incidence 

of “blast concussion” evacuees occurred in Marine units. It was 

suspected that this was an attempt to decrease incidence of 

“combat fatigue” 9 . 

Malaria during World War II was another example of an 

evacuation syndrome, preventable by taking Atabrine. On 

Guadalcanal in November 1942 so many men were lost due to 

malaria that all men with temperatures up to 103º were ordered 

to remain in combat. This caused much resentment towards 

“healthy” N-P casualties 5 . Again in the battle for Buna, New 

Guinea in 1942 the 32nd and 41st Infantry Divisions, both 

without psychiatrists, overwhelmed forward treatment centers 

with malaria and diarrhoea cases 5 . By December 1942 the 

Southwest Pacific theatre psychiatry consultant reported that 


42.7% of cases evacuated to the United States were psychiatric. 

In the past, when no possibility of evacuation existed, rates of 

psychiatric casualties and other evacuations syndromes were 

low. On Bataan in 1942 little psychiatric disease occurred 

despite heavy fighting, lack of food and inevitable defeat 18 . 

During the Vietnam War most psychiatric evacuees were 

screened by the “K-O” teams. “Drug abuse became a kind of 

evacuation syndrome with most of these patients becoming 

casualties only on the basis of the positive urine screening” 4 . 

This paper will now examine five optimal factors in the 

American experience which were present in the Falklands War. 

Elite Units 

The British troops involved were from elite units such as the 

Marine Battalions, Special Air Service Regiment, Parachute 

Regiment, Special Boat Service, Guards and Gurkhas. These 

units have been serving together for years, the majority having 

seen service in North Ireland. The men knew their leaders and 

vice versa; strong group cohesion existed. The units were not 

dispersed and they fought together. Similarly, low rates of 

psychiatric casualties have occurred in American elite units. 

During the breakout from the Anzio beachhead in Italy in 1944 

the 1st Special Service Force, a brigade of American and 

Canadian volunteers suffered a minimum of psychiatric 

casualties while taking heavy physical casualties 17 . Also in Italy, 

the 100th Infantry Battalion composed of Japanese-Americans 

from Hawaii suffered 109 battle casualties in a two week period 

with only one psychiatric casualty 17 . The 442nd Regimental 

Combat Team also made up of Japanese-Americans had a 

similar low rate 17 . The three Airborne Divisions fighting in 

Europe during World War II never had a neuropsychiatric 

casualty rate higher than 5.6% of battle casualties 18 . It should 

be noted, however, that in the Vietnam War the rate of 

psychiatric casualties did not increase when regular Army 

volunteer troops were replaced by draftees in 1967 4 . 

Duration of Combat 

The Falkland land campaign lasted only 25 days. Brief duration 

of combat exposure has, in American wars, been associated with 

low N-P casualty rates. During the invasion of Saipan, in a 

campaign of short duration from 19 June to 12 July 1944, the 

27th Infantry Division had relatively few cases of psychiatric 

illness consisting of 5.6% of all admissions despite intense 

combat and heavy physical casualties 19 . The low incidence of 

“combat exhaustion” type cases of World War II during the 

Korean conflict has been attributed to the rotation policy for 12 

months in the combat zone. 

This factor alone cannot always be relied upon to produce 

low rates. 24 hours after the newly arrived American Division 

went on the offensive at Guadalcanal, one third of the 350 

casualties at the clearing station were psychiatric 7 . Later during 

the New Georgia campaign 70% of the total N-P casualties 

occurred during the first month, 26% in the second and 4% in 

the third and final month 20 . This decreasing incidence was due 

to improved screening of casualties but also to the changing 

character of the combat as the island was cleared. On Okinawa, 

in April 1945, after an initial period of light combat and 

relatively unopposed landings the psychiatric casualty rate rose 

on the third day of intense combat 18 . Of 100 psychiatric cases 

evacuated to Saipan a large sub-group consisted of men with 

over 140 days combat in the theatre 18 . Psychiatric casualties can 

occur early in a campaign in men with previous combat. 

Indirect Fire 

In American wars the presence of indirect fire is associated with 

increased N-P rates. The British force experienced limited 

heavy bombardments, no intense counter-attacks, and 

intermittent air attack. Few psychiatric casualties occurred 

while the Task Force was at sea despite the threat from Exocets 

and Argentine fighters. Similarly, during the voyage to Okinawa 

no psychiatric problems arose in troops due to the heavy 

Kamikaze attacks 18 . However, once landed at Okinawa 13.3% 

of all admissions were psychiatric cases. This was attributed to 

concentrated heavy artillery fire 18 . At Anzio the rate of N-P 

casualties rose in support troops for the first time due to heavy 

continuous bombardment of the surrounded beachhead. 17 . 

Later in Italy, the 88th Infantry Division in 22 days of combat 

in the Voltera area was under severe artillery fire and the N-P 

casualty rate was 24% with an incidence of diarrhoea as well 17 . 

Lack of exposure to artillery barrages has been suggested as one 

factor in the low psychiatric casualty rate in American troops in 

Vietnam 3 . 

Unopposed Landing 

The most vulnerable moment for the British was the initial 

landing at San Carlos Water. The Argentines who had the 

opportunity to move in units to oppose the landing did not 

take the initiative. Heavy fighting at the beachhead as at Anzio 

and Salerno leads to heavy physical casualties and psychiatric 

casualties. When the 31st Infantry Division invaded Mindanao 

at the Parang beachhead in the Philippines, 25% of the initial 

400 casualties were psychiatric. 

Offensive vs Defensive Posture 

The British were constantly on the offensive in a mobile fluid 

advance primarily fighting with light infantry weapons. After 

the improvised battle at Goose Green in which the 600 men of 

2 Para Battalion captured 1,400 Argentines while losing their 

Commanding Officer, it was decided by the British command 

to fully prepare for the final assault on the defensive perimeter 

around Stanley where the Argentines had withdrawn. 

Rapidly advancing troops experience low psychiatric casualty 

rates. During 3rd Army’s sweep across France in August 1944, 

the rate of psychiatric casualties was 7.4% of non-fatal 

casualties 21 . In Italy during the pursuit to the Gothic line, the 

advancing 34th Infantry Division troops had low rates of 

psychiatric breakdown despite severe physical fatigue in four 

days of marked fighting alternating with periods of no fighting 

during which it took heavy physical casualties. Under 

favourable tactical circumstances, even in the presence of severe 

fatigue and wounded rates, low N-P rates tend to occur. 

In Vietnam as the posture changed from offensive operations 

to more defensive withdrawal the rate of psychiatric casualties 

increased despite the overall decrease in combat participation. 

Summary 

The low rate of British psychiatric casualties in the Falklands 

was due to a number of positive factors: the use of elite units, 

short duration of combat, little exposure to indirect fire, an 

unopposed landing and a consistently successful offensive 

posture, all of which influenced the rate of psychiatric casualties 

in past American wars. This low rate occurred despite the 

absence of any psychiatrists on land during the campaign and 

the absence of psychiatric screening of evacuees. The 

combination of favourable factors occurring in this conflict is 

not likely to occur in the most predictable future American 

conflict, a high intensity European war. The low rate of 

psychiatric casualties experienced by the British should not 

decrease planning and training for dealing with these casualties 

in any future conflict involving either the British or U.S. Army. 

References 

1 Scott-Brown A. Presentation, Symposium on Military Psychiatry. Royal Army 

Medical College, Millbank, Sept. 30, 1982 


2 Sunday Times of London Insight Team. War in the Falklands: The Full Story. 

Harper and Row, New York, 1982 

3 Tiffany, W J and Allerton, W S. Army Psychiatry in the mid-60’s. Amer J 

Psychiat 1967; 123: 812-813. 

4 Jones, F D and Johnson, A W. Medical and Psychiatric Treatment Policy and 

Practice in Vietnam. J Soc Issues 1975; 31 (4): 49-65. 

5 Challman, S A and Davidson, H A. Southwest Pacific Area, in Glass, A J AND 

Mullins, M S (eds). Neuropsychiatry in World War II, Vol II, Overseas 

Theatres. Washington DC, U.S. Government Printing Office 1973; 513-577. 

6 Glass, A J. Psychotherapy in the Combat Zone. Amer J. Psychiat April 1954; 

725-731. 

7 Billings, E G. South Pacific Base Command, in Glass, A J and Mullins, M S 

(eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington 

DC, U.S. Government Printing Office 1973; 473-512. 

8 O’Connell, M. Psychiatrists at War. Paper presented at Symposium on Military 

Psychiatry, Royal Army Medical College, Millbank Sept 30, 1982. 

9 Rottersman, W and Peltz, W. Western Pacific Base Command in Glass, A J and 

Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas 


10 Abraham, P. Training for Battleshock. J R Army Med Corps 1982; 128: 18-27. 

11 Marlow, D. Cohesion, Anticipated Breakdown, and Endurance in Battle. 

Considerations for Severe and High Intensity Combat. Unpublished, Dept. of 

Military Psychiatry, Walter Reed Army Institute of Research 1979; p14. 

12 Lessons of Falklands: Prepare for Surprises. U.S. Medicine Feb, 1, 1983; p3. 

13 Frank, R L. Alaska and the Aleutians (North Pacific Area), in Glass, A J and 



14 Drayer, C S and Glass, A J. Italian Campaign (9 September 1943 – 1 March 

1944), Psychiatry Established at Army Level, in Glass, A J and Mullins, M S 

(eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington 


15 Kaufman, M R and Beaton, L E. South Pacific Area in Glass, A J and Mullins, 

M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. 

Washington DC, U.S. Government Printing Office 1973; 429-471. 

16 Beaton, L E and Kaufman, M R. As We Remember It, in Glass, A J and 



17 Glass, A J and Drayer, C S. Italian Campaign (1 March 1944 – 2 March 1945), 

Psychiatry Established at Division Level, in Glass, A J and Mullins, M S (eds), 

Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, 

U.S. Government Printing Office 1973; 47-108. 

18 Markey, O B. Tenth U.S. Army, in GGlass, A J and Mullins, M S (eds), 

Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington 


19 Kaufman, M R. Central Pacific Area, in Glass, A J and Mullins, M S (eds), 



20 Hallam, F T. War Neurosis-Report by XIV Corps Surgeon, in Glass, A J 

and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas 

Theatres. Washington DC, U.S. Government Printing Office 1973; 1063- 

1069. 

21 Thompson, L J, Talkington, P L and Ludwig, A O. Neuropsychiatry at 

Army and Division Levels, in Glass, A J and Mullins, M S (eds), 



Footnote by: 

Col P Abraham L/RAMC FRCPsych 

Professor of Military Psychiatry 

Captain Price was obliged to refer to “the rate of evacuated 

psychiatric casualties” as “2% of all wounded” since these were 

the only data available to him. The true figure for incapacity for 

psychological reasons was approximately four times that 

number. 

The principal reason for this was that many were evacuated 

with a physical label, a case of hysterical deafness diagnosed 

subsequently in UK being fairly typical. 

Others avoided going through the evacuation chain by virtue 

of recovery before being caught up in it, or because the sudden 

armistice forestalled the need for transportation as a casualty. 

Concerning the possibility of occult psychiatric casualties 

occurring amongst those with cold injury, this was indeed not 

unknown, but the number may well have remained small 

because responses to cold stresses of one sort or another were 

managed within the unit wherever possible, which happens to 

be the correct procedure for overt psychiatric casualties as well. 



Commentary on 

Rate of British Psychiatric Combat Casualties compared to 

recent American Wars 


Morgan O Connell 

After twenty five years, in general this paper reads correctly, 

however it needs to be emphasised that there were psychiatric 

assets ashore in the form of two dual qualified nurses embedded 

in the Surgical Support Team in Ajax Bay. They had been 

extracted from the psychiatric departments in the Royal Naval 

Hospital Haslar and the Royal Naval Hospital Plymouth, not 

because of their psychiatric qualifications but because of their 

SRN qualifications. Nevertheless they did function in this dual 

capacity within the Surgical Support Team and provided 

support for the surgeons and physicians on the ground in their 

triage. 

It is not entirely correct to say that no Royal Army Medical 

Corps Psychiatrists were invited to the Falklands. I initiated the 

signal in the aftermath of the Battle at Goose Green when it 

became apparent that we were already beginning to experience 

psychiatric casualties amongst 2 Para. This signal requested the 

deployment of an Army Mental Health Team. My 

understanding is that this was over-ridden by more senior Staff 

Medical Officers who quite clearly failed to understand the 

importance of having mental health assets on the ground, and 

in particular Mental Health assets identified with the Units in 

question, i.e. with the Army as opposed to the Navy/Royal 

Marines. I believe this had a long term effect on the subsequent 

failure/unwillingness/difficulty in recognising psychiatric 

casualties amongst the returned combatants. 

Whilst the Paper is entitled Rate of British Psychiatric 

Combat Casualties Compared to recent American Wars and by 

implication is addressing psychiatric casualties during combat, 

it needs to be emphasised that just because the shooting has 

finished, it does not mean that psychiatric casualties do not 

continue to present. This is amply born out by the number of 

Veterans on the Books of Combat Stress, the Ex-Services 

Mental Welfare Society (some 400) whose traumatic experience 

is identified as being the Falklands. It was certainly my 

experience before I left the Navy in 1996 that we continued to 

see casualties presenting from that conflict on a regular basis 

and indeed it was because of this that we set up the first PTSD 

treatment programme in the country in the Royal Naval 

Hospital Haslar in 1987, to which Army casualties were 

referred who were suffering as a consequence of 1982. 

It has been suggested that amongst the occult psychiatric 

casualties were a number of non freezing cold injury/trench foot 

cases. I have discussed this with Rick Jolly who was the MOIC 

in Ajax Bay, in addition to which I saw some of these cases 

myself on board Canberra and there was no doubt in my mind 

that whilst they may well have had some form of psychological 

symptomathology, their primary disorder was that of trench 

foot and to have retained them on the ground with the 

inadequate facilities experienced by the fighting units, would 

have added to the burden of those units. 

Why were the figures so low (and I believe the figures are 

valid). Well first and foremost of course, we won. Secondly the 

country was behind us as a whole as was witnessed by the send 

off which was exceeded only by the welcome on our return. 

Thirdly it was a relatively short conflict and there was virtually 

no record of atrocities. This was confirmed by the International 

Committee of the Red Cross who visited Canberra when it was 

hosting the 4,500 Argentinean prisoners of war who were 

returned to the Argentine. In addition there was virtually no 

night fighting other than in the final stages of the conflict and 

so the issue of combat exhaustion was a relatively minor 

problem. 

The breakdown of the psychiatric casualties currently on the 

Books of Combat Stress by unit, reflects what we have come to 

expect. i.e. where there are significant numbers of physical 

casualties including fatalities, then there are psychiatric 

casualties in proportion. 

Finally all are in agreement that the three week journey to the 

site of the conflict was a wonderful opportunity to complete 

preparation, if that can ever be completed, for going to war and 

by the same token the return journey, particularly for the 

sailors in their ships, even those which had sustained damage, 

gave all the opportunity for recovery. 



Military Cold Injury During the War in The Falkland Islands 

1982: An Evaluation of Possible Risk Factors 

Lt Col RP Craig 


Abstract 

Throughout the history of war, there have been many instances when the cold has ravaged armies more effectively than 

their enemies. Delineated risk factors are restricted to negro origins, previous cold injury, moderate but not heavy smoking 

and the possession of blood group O. No attention has been directed to the possibility that abnormal blood constituents 

could feasibly predispose to the development of local cold injury. This study considers this possibility and investigates the 

potential contribution of certain components of the circulating blood which might do so. 

Three groups of soldiers from two of the battalions who served during the war in the Falklands Islands in 1982 were 

investigated. The risk factors which were sought included the presence or absence of asymptomatic cryoglobulinaemia, 

abnormal total protein, albumin, individual gamma globulin or complement C3 or C4 levels, plasma hyperviscosity or 

evidence of chronic alcoholism manifesting as high haemoglobin, PCV, RBC, MCV or gamma glutamyl transpeptidase 

(GGT). 

No cases of cryoglobulinaemia were isolated and there was no haematological evidence to suggest that any of those men 

who had developed cold injury, one year before this study was performed, had abnormal circulating proteins, plasma 

hyperviscosity or indicators of alcohol abuse. Individual blood groups were not incriminated as a predisposing factor 

although the small numbers of negroes in this series fared badly. 

Although this investigation has excluded a range of potential risk factors which could contribute to the development of 

cold injury, the problem persists. 

Two areas of further study are needed: the first involves research into the production of better protective clothing in the 

form of effective cold weather boots and gloves and the second requires the delineation of those dietary and ethnic factors 

which allow certain communities to adapt successfully to the cold. A review of the literature in this latter area is presented. 

Introduction 

Local cold injury may greatly reduce effective combatant troops 

in war and can result in considerable morbidity during exercises 

in peacetime. Its significance and occurrence is underestimated 

and frequently under-diagnosed. Until the Falklands War of 

1982 the last occasion in which British servicemen fought in a 

cold climate was in Korea and the remaining medically 

qualified veterans of that conflict have nearly all retired. 

There are historical instances in which the cold has inflicted 

more battle casualties than the enemy. Larrey 1 reported the loss 

of 11650 out of 12000 men of the 12th division of Napoleon’s 

Grand Army during the Russian Campaign and Hitler’s 

advance into, and subsequent retreat from, the USS during 

World War II resulted in both sides losing catastrophic numbers 

of men from the cold 2 . The British Army documented 115,361 

cases of frostbite and trench foot in the official records of World 

War I but the majority of these occurred early in the conflict. 

With the introduction of duckboards, the issue of dry socks and 

strictly imposed foot and hygiene discipline the incidence 

dropped during the later years of the campaign 3 . The influence 

of these measures in combating cold injury was again manifest 

during World War II in North West Europe where British 

casualties were much lower than the 91000 suffered by the 

United States Army of whom some 87% were infanteers. There 

were times during the winter of 1944-1945 when the cold 

resulted in up to one-third of American battle casualties 4,5 . 

No accurate figures for the number of British and 

Argentinian troops who fought in the Falklands and sustained 

cold injury are available although symptoms were recorded in 

28.5% of 3 Para and 20-30% of 2 Scots Guards 6 . 

Non-freezing and freezing cold injury not only reduces 

fighting capability but also occurs sporadically in the United 

Kingdom and in North West Europe amongst soldiers either on 

exercises or as a result of sleeping rough whilst intoxicated. 

Any blood constituent which would impair flow at reduced 

temperature is likely to predispose to damage in a cold 

environment. Cryproteins are known to do so 7 . 

The digital necrosis seen in patients with cryoglobulinaemia 

is clinically indistinguishable from that produced by freezing 

and this appearance raised the possibility that there might be a 

group of otherwise asymptomatic individuals who had small 

quantities of cryoglobulins circulating in their blood which 

might predispose them to developing cold injury. The further 

possibility that there could be a number of Servicemen who 

were polycythaemic and hyperviscid due to the effects of 

chronic alcohol ingestion could explain why some but not all 

personnel who served in the Falklands campaign sustained cold 

injury whilst others subjected to similar conditions did not do 

so. 

This study examines these possibilities by comparing venous 

blood obtained from British Servicemen who had clinical cold 

injury during the campaign with a similar group who 

experienced the same environmental conditions but did not do 

so and a further group who did not participate. 


Subjects and Methods 

Six groups of soldiers, three from 3rd Battalion, The Parachute 

Regiment and three from 2nd Battalion, Scots Guards were 

studied. The first two groups (A) consisted of men from these 

battalions who were diagnosed as having sustained cold injury in 

the Falklands. Confirmation of this diagnosis has been 

substantiated in most cases by objective measurement of 

impaired nerve conduction and by abnormal vasomotor 

response to a cold stimulus observed by strain-gauge 

plethysmography 8,9 . The second two groups (B) consisted of 

men of similar age who had gone to the Falklands but who did 

not sustain injury despite being subjected to an identical 

environment. Selection of these subjects was made by the subunit 

commanders who had led them during the war. The third 

group (C) consisted of a similar number of soldiers who did not 

go to the Falklands and who had not previously suffered the 

effects of cold elsewhere in the world. 

All personnel gave informed written consent for venipuncture, 

which was performed two to three hours after a midday meal. 

Consent forms were numbered serially and allocated randomly. 

Thus the sampling and analysis was performed blind and the 

groupings constructed after the results were obtained from the 

lists provided by the units. 

Samples of 20ml venous blood were withdrawn from the 

antecubital fossa using a venous tourniquet into syringes and 

needles warmed to 37ºC. 10ml of this blood was immediately 

transferred to EDTA lined bottles previously warmed to 37ºC 

and replaced in a warmer at the same temperature. The warmed 

specimens were centrifuged at 37ºC for 10 minutes at 1000 rpm 

followed by 15 minutes at 200 rpm. Thereafter, the supernatant 

plasma was collected into plain bottles at room temperature and 

transferred for cryoglobulin, total protein, albumin, IgC, IgA, 

IgM, complement C3 and C4 estimation. These plasma samples 

were divided into three aliquots, one placed at 4ºC, one at 37ºC 

and the third retained at room temperature. Regular inspection 

was carried out for 72 hours but no cryoproteins were observed. 

Immunoglobulin (IgG, IgA, IgM, C3 and C4) levels were 

estimated by immuno-nephalometry on a Disc 120 laser 

nephalometer (Hyland Laboratories, USA) using goat antisera to 

IgG, C3 & C4 (Atlantic Antibodies, USA), IgA, IgM, (ICL, 

Scientific, USA). Total protein and albumin levels were obtained 

by standard laboratory techniques. 

The other specimens were analysed by routine methods on a 

Coulter S Senior, (Coulter Electronics, Linton, Beds.) for 

haemoglobin, packed cell volume, red cell count and MCV. 

Plasma viscosity was determined on a Harkness Coulter 

Viscometer 9 and gamma glutamyl transpeptidase levels were 

estimated by an automated method using the technique of 

Szasz10 on a Coulter Kem-o-mat autoanalyser. 

Reference ranges were: total protein, (55-79g/1), albumin, 

(30-42g/1), IgG, (5.4-16.1g/1), IgA, (0.9-3.4g/1), IgM (0.5- 

2g/1), C3, (0.7-1.7g/1), C4, (0.1-0.7g/1), plasma viscosity (1.5- 

1.72cp) and GGT (6-28iu/1). 

Quantitative data were compared between groups using an 

unpaired test and blood group data were analysed using a Chi 

Squared test with Yates correction where applicable. 

Results 

Although the mean ages of the groups in 2 SG were higher 

than those in 3 PARA, no statistical differences were evident. 

They are shown on Table 1. 

Table 1 

Subjects Studied 

3 Para 

Number 

Group A 14 

Age (Yrs) 

Group B 15 22.2 2.33* 

Group C 16 20.3 2.55 

2SG 

Group A 16 24.4 3.10 

Group B 16 23.8 4.02 

Group C 16 25.8 4.74 

* 1 SD 

Information was obtained from the RMO’s of the two battalions 6 

on the distribution of blood groups as was data on those soldiers 

who were studied. Tables 2(a) and 2(b) show these distributions. 

The variation in the proportions of blood group genotypes 

between the two battalions reflects regional differences in the 

distributions of blood groups. In this small series no protection due 

to the carriage of blood group A was found nor were there any 

statistical indicators suggesting an increased tendency to suffer cold 

injury in holders of blood group O. 

Blood 

Groups 

3 Para 

A B O AB 

Rh Pos. 178 41 183 25 

Rh Neg. 30 0 51 0 

Totals 

2 SG 

208 

(40.9%) 

41 

(8.1%) 

234 

(46.0%) 

25 

(4.9%) 

Rh Pos. 165 52 263 18 

Rh Neg. 17 9 19 2 

Totals 

Table 2(a) 

3 Para 

182 

(33.3%) 

61 

(11.2%) 

282 

(51.7%) 

20 

(3.64%) 

ABO and Rhesus Distribution between the Study Groups 

A B O AB Rh+ Rh- 

Group A 8 1 4 1 10 4 

Group B 6 1 8 0 13 2 

Group C 7 0 8 1 12 4 

2 SG 

Group A 5 0 9 2 15 1 

Group B 4 2 10 0 16 0 

Group C 5 2 9 0 14 2 

Table 2(b) 


Hb g/l PCV Red Cell Count MCV 

(10 –12 /1) (f1) 

3 Para 

Group A (n=14) 15.02±0.92 45.5±2.34 4.885±0.357 89.14±3.11 

Group B (n=15) 15.47±1.16 46.09±3.17 49.89±0.357 88.50±3.34 

Group C (n=16) 14.91±1.04✝ 45.38±3.00 4.912±0.351 88.56±2.52 

S Scots Guards 

Group A (n=16) 16.10±0.88 47.54±2.72 5.033±0.241 92.13±4.00 

Group B (n=16) 15.50±0.71 45.83±0.47 4.893±0.201 91.30±2.55 

Group C (n=16) 16.18±1.02✝ 47.774±3.02 4.998±0.290 93.25±4.16 

Table 3 Haematology Results ±ISD 

✝ P

whites implying a strong genetic effect, but they also maintained 

higher temperatures than the Indian children which would suggest 

a degree of adaptation during life. The influence of genetic mixing 

between Indians and Caucasians was studied by measuring the rate 

at which cold induced vaso-dilation (CIVD) occurred after hand 

immersion at 5ºC in two groups of Canadian Algonkian Indians 

from two villages 19 . They concluded that the onset of CIVD 

occurred later in the Indians with greater Caucasian admixture. 

In addition to these genetic factors there is a real possibility that 

diet may contribute to adaptation to environmental cold. Laursen 17 

(1983) has noted that the capacity of Alaskan Eskimos to cope with 

freezing conditions appears to be lost if they transfer their diet to 

that of Westerners and stop consuming seal blubber and fish. 

Sinclair 20 (1953) failed to find any cholesterol deposition in the 

corneas of Eskimos on a traditional diet which contains the highest 

known proportion of dietary fat. Coronary heart disease is not 

observed in these people 21 . Fish and blubber fat is rich in linolenic 

acid as is the dietary fat consumed by the Japanese in whom 

atherosclerosis is also rare. He extended his experiments by joining 

a community of long living Eskimos in Greenland in 1976 and 

subsequently consumed seal and fish as his sole nourishment for 

100 days 22 .This resulted in extension of his bleeding time from four 

minutes to in excess of 50 minutes and greatly decreased his platelet 

aggregation. He postulated that this effect was caused by the high 

intake of linolenic acids resulting in the production of prostacyclin, 

(PG13) and thromboxane (TXA3) rather than PG12 or TXA2 

which are derived from linoleic acid. Whereas PG12 and PG13 

both de-aggregate platelets, TXA2 promotes thrombosis whilst 

TXA3 has little or no effect upon platelets. These interesting 

findings do suggest that diet may be an important contributor to the 

circulation of blood in the extremities of Eskimos who consume 

traditional food and may reduce the likliehood of intravascular 

thrombosis during periods of impaired flow and hyperviscosity in a 

cold environment 20,22 . 

Rather more difficult to explain on either genetic or dietary 

grounds is the capacity to adapt to occupations involving the 

handling of cold objects or immersion of feet in cold water. 

Examples include Gaspe fishermen 23 , fish filleters 24 , and Canadian 

lumberjacks 25 whose feet remain immersed and cold for long 

periods without deleterious effect. A fish diet in the first instances 

and active movement and exercise in all examples may result in 

improved circulation in these cases along with an acquired capacity 

to vasodilate. 

Raynaud’s phenomenon whether it be idiopathic or secondary to 

peripheral vascular disease, thromboangiitis obliterans, vibration 

injury, previous cold injury or to mixed connective tissue disease 

greatly increase predisposition to the effects of the cold 26 . 

Other factors which have been delineated include moderate but 

not heavy cigarette smoking, fatigue, ethanol consumption, 

hyperhidrosis, reduced lean body mass, blood group O individuals, 

inadequate clothing and footwear, hygiene, rank and 

motivation 3,11,25 . 

With the exception of ABO blood groupings no attention has 

been paid in the literature to the possibility that the physical 

properties or composition of the blood itself could predispose to the 

development of cold injury. Nor is it clear whether the pathological 

effects of the cold upon the extremities is the direct result of 

intravascular thrombosis alone or due to an inflammatory response 

with endothelial damage and vascular destruction in addition. Eady 

et al 27 , (1981) in a study of cold induced urticaria and vasculitis, 

demonstrated the appearance of complement C3 in dermal blood 

vessels following a cold stimulus which preceded deposition of fibrin 

and immunoglobulin within the vessel wall and was associated with 

mast cell degranulation. There was later perivascular infiltration by 

inflammatory cells and later still vascular endothelial disruption. 

Controls showed no such response. 

Cryoglobulinaemia has been recognised since 1933 28 , and the 

conditions in which it has been observed include myelomatosis, 

lymphoma, mixed connective tissue disorders including rheumatoid 

arthritis, systemic lupus erythematosis, Sjogren’s disease, cirrhosis, 

Crohn’s disease and disseminated malignancy 29-33 . there were a 

number of cases reported above in whom the aetiology of 

cryoglobulinaemia was unknown and they were described as being 

essential or idiopathic. McGrath and Penny 7 (1978) demonstrated 

greatly increased blood and plasma viscosity in cases of 

cryoglobulinaemia with an associated increased red cell aggregation 

on cooling at low shear rates. They suggested that this finding 

explained at least in part the localisation of damage to the skin in 

those peripheral tissues of the extremities most exposed to cold. 

Dehydration due to the combined effects of excessive sweating 

within the clothing required in a cold environment along with a 

reduced intake of water also results in hyperviscosity 34 . Chronic 

alcolhol abuse is associated with a raised MCV and gamma glutamyl 

transpeptidase, (GGT) 35-38 . 

This study has investigated several components of the circulating 

blood in soldiers who served in the Falklands Campaign of 1982 

and has effectively excluded many of them as being aetiological 

factors in the development of non-freezing cold injury. Thus the 

reasons why some and not all individuals who are subjected to 

similar adverse environmental circumstances develop symptoms 

remains unanswered. 

The study was performed one year after the event. As no cases of 

cryoglobulinaemia were found in any of the soldiers in any of the 

three groups who were studied, it would seem most unlikely that 

small groups of individuals with asymptomatic cryoglobulinaemia 

exist. Whereas it is recognised that epinephrine release produces 

distal vasoconstriction in association with fear, the concomitant 

production of cryoglobulins in these circumstances has not been 

investigated. Perhaps venous sampling of parachutists prior to their 

first jump might confirm or refute this possibility. It is known that 

the circulation in the fingers can be reduced to 3% of control levels 

following immersion in water at 13ºC for two hours 39 or to zero at 

temperatures between 0ºC and 8ºC 40 . Associated with this 

diminution of flow is a tendency to sludging and microvascular 

occlusion. Thus, polycythaemia or hyperviscosity would tend to 

accentuate this phenomenon 41 . Although high haemoglobin levels 

have been recorded in chronic alcoholics 42 it is still disputed whether 

this is entirely due to the alcohol or whether it derives from the 

stimulus provided by consistently high levels of carbon monoxide 

found in heavy smokers who also drink. The possibility that certain 

soldiers might be found to have biochemical or haematological 

evidence of chronic alcohol abuse was explored bearing in mind that 

one year had elapsed between the exposure to cold and also that the 

alcohol intake was restricted to two cans of beer per day during the 

sea voyage between Ascension Island and the Falklands. This 

restriction, however, would not necessarily prevent a considerably 

greater intake by alcohol abusers who could have increased their 

consumption by certain forms of barter. 

The concept of hyperviscosity and an increased tendency to 

sludging associated with a high haematocrit and polycythaemia may 

contribute to the high proportions of chronic alcoholics who form 

the bulk of most of the civilian series of frostbite 43-45 . More likely is 

that these cases occur due to acute inebriation causing them to sleep 

rough in cold weather. It is nonetheless worthwhile to consider 

chronic alcoholism particularly in troops who are to be exposed to 

the extremes of cold either on exercise in peacetime or in war. 

The tendency for negroes to be more susceptible to the cold than 

Caucasians was confirmed in this study albeit with small numbers. 

The proportion of the population with Group A blood is higher 

in Scandinavia than in the rest of Europe and it has been postulated 

that this is associated with an evolutional capacity to withstand 

cold 46 . Group B blood becomes increasingly common through 

Eastern Europe and into Asia 46 . Group O American soldiers have 

been found to have 1.8 times increased chance of cold injury during 


training in Alaska. Whereas 3 Para have a pattern of blood groups 

which is in close parallel with England despite drawing from all 

areas of the nation, the 2 SG who recruit 60% of their troops from 

north of the border had a pattern of distribution which is identical 

to that found in SW Scotland with a Group A proportion of only 

33% and with 52% Group O. This would appear to reflect a Celtic 

rather than Scandinavian ancestry. There is no indication, however, 

to restrict soldiers’ employment because of their blood genotypes. 

Complement C3 and IgM deposition in the walls of dermal 

blood vessels has been shown to be an early finding in the 

development of vasculitis associated with cold urticaria 27 . In this 

series, immunoglobulins, complement C3 and C4 levels were all 

indistinguishable between groups and none of these proteins have 

been shown to be of aetiological importance in the development of 

non-freezing cold injury. 

It was not possible to obtain information on the smoking habits 

of the men from these two battalions who served in the Falklands. 

Information from the 93 who were investigated as regards smoking 

was not sought. Previous work carried out in Alaska 11,12,25 has 

revealed that light smokers (less than 20 per day) had a higher risk 

of sustaining frostbite than non-smokers or heavy smokers (more 

than 20 per day). 

Conclusions 

The cold produced considerable morbidity and loss of fighting 

strength during the Falklands Campaign as it has on numerable 

occasions throughout the history of war. This study has excluded 

some of the possible factors within the circulating blood which 

might have predisposed to its development. 

The following areas of research warrant further evaluation. 

Improvements in cold weather clothing and particularly foot and 

hand wear is a major priority. Further data on the microscopic, 

electron microscopic and biochemical nature of the effects of cold 

upon blood vessel walls, nerves and dermal cells is required. The 

possible contribution of diet and specifically those rich in omega 3 

polyunsaturated fatty acids similar to that consumed by Eskimos 

who have successfully adapted to their environment needs 

investigation. Ways in which the prolonged bleeding time 

produced by this diet could be rapidly corrected in the event of 

wounding should be sought. Evaluation of vasodilator drugs as 

prophylactics might prove a worthwhile avenue for study. 

Finally, standardisation and quantification of the effects of 

previous cold injury is required in order to assess prognosis, future 

employment standards and the possibility of improving late vasospastic 

symptoms of sympathectomy the value of which in the 

acute phases of frostbite remains questionable 45,45 . 


The efficiency and co-operation of 2 SG and 3 PARA in providing 

soldiers for this study is greatly appreciated. Both the ABSD and 

John Boyd Laboratory gave inestimable help with venous sampling 

and analyses. Particular thanks are due to Dr. Pamela Riches and the 

Protein Reference Library at the Westminster Hospital for advice 

and for the cryoglobulin, protein and complement estimations. 

This study was approved by AMS Research Executive Committee 

as Project No. 277. 

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Commentary on 

Military Cold Injury 


Surg Commander Jason Smith 

This paper, written a year following the Falklands War and 

published in the JRAMC in 1984, explores some of the reasons 

why some soldiers succumbed to cold injury during the 

campaign. It asks the question why some were affected while 

their comrades-in-arms, who were exposed to the same 

conditions, were not. 

In this day of publication bias (of positive studies) it is 

refreshingly negative in its results, as all the suggested 

haematological abnormalities the paper set to explore were not 

in fact present in the subjects. Although the modern day soldier 

is better equipped and less likely to sustain cold injury than 25 

years ago, it is still a very real risk in austere environments 

particularly when other hostile factors are present. 

There are parallels to be drawn with other forms of 

environmental illness, in particular heat-related illness. It is still 

not fully understood why one soldier is more likely to suffer one 

of these environmental medical problems than those around 

him. However, there have been advances in knowledge of how 

hypothermia affects other conditions, in particular the 

detrimental effects in multiple trauma patients with ongoing 

haemorrhage, and potentially beneficial effects following 

cardiac arrest. 

The disastrous effect of cold in trauma patients where there is 

ongoing haemorrhage contributes to the lethal triad of 

hypothermia, acidosis and coagulopathy. Mortality in patients 

who fall into this group is high. 

There is now reasonable evidence to suggest that whole body 

cooling following cardiac arrest improves survival, due to a 

reduction in cellular oxygen demand and metabolism. The 

same could be surmised from the anecdotes from the same 

period as this paper, of penetrating trauma victims during the 

Falklands conflict, where a self-selected group of patients 

survived in the cold of the South Atlantic winter for hours 

without formal resuscitation or critical care treatment. This 

group had presumably stopped bleeding through tamponade 

(or other mechanisms) and therefore the effects of the 

hypothermia were of benefit in slowing metabolism and tissue 

metabolism without causing continuing haemorrhage due to 

adverse effects on the coagulation cascade. 

However, we are now into the realms of conjecture. 

Returning to the topic of this paper, in 1984 we were no nearer 

to the truth about why some are affected by cold while others 

are not. I wonder if modern science has brought us any further 

to an answer. 

For an up to date summary of the topics of cold injury and 

hypothermia, I would recommend the special edition of this 

journal dedicated to Medicine in Hostile Environments 

(December 2005). As the title of one of these papers says, cold 

still kills. 

Jason Smith 

Surgeon Commander Royal Navy 

Consultant in Emergency Medicine 

Derrifield Hospital, Plymouth 



Resuscitation experience in the Falkland Islands campaign 

JG Williams, TRD Riley, RA Moody 

The recent campaign to retake the Falkland Islands was a novel 

military exercise from many points of view. This was 

particularly so for the medical support, which required much 

improvisation at all levels. Several surgical teams from the Royal 

Naval and the Royal Army Medical Corps were deployed in 

support of both the fleet and the troops on land. Two Royal 

Naval teams embarked in SS Canberra, and the journey south 

on board provided an opportunity to discuss and decide on a 

specific resuscitation policy for the casualties that might be 

encountered. We discuss the details of this policy and the results 

of using it. 

Resuscitation policy 

The essence of the resuscitation policy was that it should be 

simple and straightforward, using a minimum of procedures, 

drugs, and fluids. This would aid the speed at which large 

numbers of casualties could be resuscitated. Once formulated, 

it was taught to all personnel likely to be concerned in 

resuscitation. 

Airway – The airway was to be managed in the usual manner 

with clearance of all foreign material from the mouth and 

pharynx, support for the jaw, and insertion of a Guedel airway 

if necessary. Facilities for endotracheal intubation and assisted 

ventilation would be available in the resuscitation area. Patients 

with maxillofacial injuries would probably be nursed prone, but 

patients with other injuries would probably be supine when 

attended. Any penetrating injury of the chest or any clinical 

evidence of pneumothorax would require the insertion of an 

intercostal chest drain in the mid-axillary line between the 

fourth and fifth and six ribs and directed apically on the side of 

the injury. These patients would be nursed sitting up, if not 

contraindicated by shock. 

Analgesia – Intravenous morphine was to be used, diluted 15 

mg in 5 ml of water, and given in small doses (3 mg) often, 

titrated according to pain. The importance of checking the dose 

and time of any analgesia given previously was emphasised. For 

chest injuries it was planned to given buprenorphine 

hydrochloride 0.3-0.6 mg or, if unavailable, pentazocine 30-60 

mg intravenously. Inhalational Entonox (50% nitrous 

oxide/50% oxygen) would also be available. 

Antibiotics – All patients with open wounds were to be given 

benzyl-penicillin intravenously, one megaunit immediately and 

repeated every six hours for 24 hours. Patients with penetrating 

head wounds were to be given sulphadimidine 1 g four times a 

day intramuscularly in addition. Those with abdominal wounds 

were to be given immediately gentamicin 80 mg intravenously 

and metronidazole 500 mg intravenously. With these more 

complicated injuries postoperative antibiotic treatment was to 

be defined by the operating surgeon. It was decided not to 

attempt to exclude penicillin hypersensitivity in view of the 

difficulties in obtaining an accurate history. 

Antitetanus – It was decided not to attempt to administer 

This paper first appeared in the British Medical Journal and is 

reproduced by kind permission of the editor 

tetanus toxoid vaccine to all troops before the expected battles 

as their basic level of immunity would have been high due to 

normal service vaccination programmes, and the wide 

distribution of troops among the ships of the Task Force would 

have made it impossible to cover all the combatants with this 

policy. Thus postinjury boosters would still need to be given 

and in some areas would have resulted in three antitetanus 

injections over only a few months. It was therefore decided to 

limit active antitetanus immunisation to booster injections 

given during the resuscitation of all casualties with penetrating 

injuries or burns. Human antitetanus immunoglobulin was 

available for use at the discretion of the surgeon. 

Other drugs – Diazepam 10 mg in 2 ml was to be given for 

excess anxiety persisting when pain had been controlled by 

morphine. Naloxone 0.4 mg diluted to 2 ml was available to 

reverse opiate overdosage. Methylprednisolone 1 g immediately 

followed by 0.5 g every six hours was to be given for any lung 

injury whether caused by trauma, blast, smoke inhalation, or 

drowning. It was not planned to give steroids routinely for 

shocked patients except for irreversible shock. Adrenaline 1 mg 

in 500 ml 5% dextrose was set up in the resuscitation area daily 

for the treatment of anaphylactic shock. 

Oxygen was to be given to all shocked patients through a 

moderate concentration Venturi mask. 

Fluid replacement – Intravenous infusions were to start after 

a blood sample had been taken for cross match through a large 

bore intravenous cannula sited in a forearm vein as soon as 

possible after admission. If vasoconstriction precluded 

peripheral venepuncture a cut down or central line was to be 

inserted. Initial infusion would be with one litre of compound 

sodium lactate solution followed by 500 ml of polygeline. 

Polygeline was chosen in preference to other colloids because of 

its unbreakable bottle, light weight, temperature stability, and 

because it would not interfere with blood cross match. The 

speed of infusion was to depend on clinical judgment. The 

sequence of compound sodium lactate followed by polygeline 

would be repeated if clinically indicated. Cross matched blood 

would be given, if indicated, when available. Cross match times 

would be half an hour for an urgent cross match and two hours 

for a routine cross match, though a small stock of O-negative 

blood was to be held in the resuscitation area for lifesaving 

urgent transfusion. 

Burns – Burns cases were to be treated with attention to the 

airway, analgesia, penicillin, and tetanus toxoid as already 

described. Intravenous fluids would be given at 120 ml per 1% 

of burn over the 24 hours after the time of the burn, using 

crystalloid (compound sodium lactate) and colloid (polygeline) 

in equal proportions plus additional crystalloid for normal daily 

requirements. It was not planned to give intravenous treatment 

unless the burnt area was 15% of the total body surface area, or 

greater. Silver suphadiazine cream was to be used topically with 

polyethylene bag occlusion for hands and feet. Any evidence of 

blast or smoke inhalation injury to the lung would be an 

indication for methylprednisolone 1 g immediately followed by 


0.5 g every six hours. 

Monitoring – The usual measurements of pulse, blood 

pressure respiratory rate, and level of consciousness would be 

used. It was not planned to use central venous lines for 

measuring venous pressure. 

Clinical results 

The main reception areas for treating casualties from time to 

time of the landings on 21 May to the surrender were first SS 

Canberra and then a disused refrigeration plant at Ajax Bay, 

which was later supplemented by forward surgical stations at 

Teal Inlet and Fitzroy. We were present and responsible for the 

resuscitation at all of these sites except Fitzroy, and the policy as 

described was used in these areas where over 500 battle 

casualties were treated. Overall, the simplicity of the policy and 

the planning and rehearsal that went into it paid dividends. 

Resuscitation proved to be rapid, efficient, and effective. Only 

three patients died at this stage of their management. One 

reached Ajax Bay irreversibly shocked, having lost both legs 

when an ammunition dump exploded at Goose Green, and 

could not be resuscitated, and two were admitted to Teal Inlet 

moribund from severe penetrating high velocity gunshot 

wounds to the head. 

Specific aspects of resuscitation deserve the following 

comments: 

Airway – No upper airway problems were encountered, and 

no patients required endotracheal intubation before surgery. 

This included several admissions with wounds to the head, face 

or neck who were nursed prone to maintain their airway, but 

even these patients appeared to have travelled well in a variety 

of positions without problems. All penetrating wounds of the 

chest were treated with intercostal drainage with, in many cases, 

relief of respiratory embarrassment by the drainage of 

substantial volumes of blood. Heimlich valves were used to 

provide a one way seal to these drains and these often became 

blocked if blood was draining. The only solution was to change 

the valves frequently but a non-blocking seal would have been 

an advantage. Several patients who had been exposed to blast 

had pneumothoraces without external evidence of injury and 

these also received intercostal drains. Sucking chest wounds 

were occluded with airtight dressings. With these measures, 

nursing in the sitting position, and giving oxygen to those who 

were clinically cyanosed or in whom restlessness suggested 

hypoxia, all chest wounds were managed in slow time, and no 

patient required immediate emergency surgery. 

Analgesia – Morphine given in small doses intravenously at 

frequent intervals was very effective in controlling pain and 

relieving anxiety. No problems were encountered with 

respiratory depression and in the event non-opiates were not 

used as an alternative to morphine for chest injuries. 

Antibiotics – No specific figures can be given, but infection 

did not prove to be a problem provided that the surgical 

principles of extensive wound debridement and delayed 

primary suture were followed. Antibiotic policy as planned was 

followed with the exception of penetrating head wounds when 

metronidazole was given in addition to penicillin and 

sulphadimidine when it was learnt that some patients with head 

injuries evacuated to the hospital ship SS Uganda had improved 

when metronidazole was added to their treatment. No cases of 

tetanus, gas gangrene, or hypersensitivity to penicillin were 

seen. 

Other drugs – Diazepam was use in small doses in a few 

patients who remained agitated, noisy, and disruptive to other 

patients despite adequate pain relief with morphine. These were 

all patients who had suffered painful superficial facial and hand 

burns. Diazepam 5 mg with most effective in controlling this 

agitated behaviour without harmful synergism with morphine. 

No patients required inotropic cardiac support in the 

resuscitation areas. 

Steroids – Methylprenisolone was given to all cases of near 

drowning, blast lung, or smoke inhalation. Treatment was 

started as soon as possible and continued for 24 hours. Three 

cases of severe blast lung were seen: in all these clinical evidence 

for pulmonary oedema was apparent at admission and before 

treatment with methylprednisolone had been started. 

Nevertheless, all were managed with high doses of 

methylprednisolone (1 g immediately followed by 1 g every six 

hours) plus frusemide as necessary and oxygen. Despite severe 

pulmonary oedema and profound hypoxia these patients all 

survived. One required intubation and mechanical ventilation, 

though this could not be started until 24 hours after injury 

when he was transferred to SS Uganda. Methylprenisolone (1 g 

immediately, 0.5 g every six hours for 24 hours) was given to 57 

patients with burns from the Sir Galahad who were treated at 

Ajax Bay. None of these patients developed respiratory 

complications despite exposure to blast and smoke. 

Methylprednisolone was not given to patients with gunshot 

wounds to the chest, and no problems were encountered. 

Intravenous cannulation – In most patients it was possible to 

site a large bore cannula into a forearm on arrival. Central lines 

through the internal jugular or subclavian approach were used 

in several patients who were severely shocked on arrival but 

these seemed to confer no specific advantage over finding and 

cannulating a forearm vein. Several patients had received initial 

fluid replacement in the field from a forward regimental aid 

post, but cold and movement in transit almost invariably meant 

that these venous lines had ceased to function by the time the 

patients reached the surgical stations. 

Fluid replacement – Many patients were severely peripherally 

vaso-constricted when admitted to the surgical stations but this 

was related to cold as much as to blood loss. In a fit young 

population circulatory resuscitation proved very effective, with 

only one patient, already described, in irreversible shock. Most 

patients with simple gunshot wounds required only a litre of 

compound sodium lactate followed by 500 ml of polygeline 

before surgery. In those in whom blood loss had been serious 

blood was given as soon as available. On board the Canberra 

cross matched blood was used but ashore cross match was 

impractical for lack of both time and facilities and group 

compatible blood was given. No transfusion reactions were seen 

in either location. 

Burns – After the bombing of the Sir Galahad 130 patients 

were admitted to Ajax Bay in one hour. Seventy three of these 

casualties were suffering from relatively minor trauma or burns 

and were transferred immediately to ships in San Carlos Water. 

Most of the remaining 57 were suffering from burns to the face 

and hands. Sheer weight of numbers meant that a standard 

intravenous replacement regimen had to be adopted, and all 

patients with greater than 10% burns received intravenous 

fluids – about three litres compound sodium lactate and one 

and a half litres polygeline – over the next 20 hours, before 

transfer to the Uganda. This resuscitation proved necessary but 

satisfactory for all except a few patients with more extensive 

burns (20-30%) who were underinfused as judged by 

haematocrit estimation performed the next day. Pain relief was 

good with morphine, though several agitated patients required 

a small dose of diazepam (5 mg) in addition. Burns were treated 

with silver sulphadiazine cream and exposure, except for the 

hands which were enclosed in polyethylene bags. 

Discussion 

The resuscitation policy as described was simple and 

conventional, 1 and no new lessons were learnt when using it in 

the resuscitation of over 500 patients. Although the injuries 


were often severe and multiple, the injured on the British side 

were highly trained, fit men with a strong will to survive. About 

20% of the casualties treated were Argentines and the fitness of 

these cannot be gauged nor their will to survive, though many 

of them were clearly profoundly relieved to be out of the battle 

and out of the cold. Language difficulties and fear made pain 

relief and sedation more difficult to achieve but there were no 

other specific problems. 

The high success rate achieved in the resuscitation of a large 

number of casualties, some with severe injuries and many who 

had remained in the field for some hours before evacuation, is 

a testament to this fitness and morale, and also to the skill and 

training of the personnel concerned. The results may also reflect 

some degree of selection in that those patients with the most 

severe injuries or obstructed airways may have died before 

evacuation. Intensive rehearsal before the invasion enabled 

paramedical personnel to help with resuscitation so that no 

delays occurred once patients were admitted, even at time of 

mass casualty reception. The 57 patients admitted after the 

bombing of the Sir Galahad were all received at Ajax Bay within 

one hour, and none had to wait a considerable or dangerous 

length of time for treatment. The standardisation of 

resuscitation procedure and the elimination of choice in the use 

of fluids and drugs contributed greatly to the speed of this 

treatment. 

The availability of blood also contributed greatly to the 

effective resuscitation of the more severely wounded. Ashore, 

blood was given without cross match but with confirmation of 

the patient’s group by serology, and the time gained outweighed 

the dangers of possible mismatch. In the event no transfusion 

reactions were seen, though the possibility of sensitisation to 

future transfusion remains. 

The only other fluids used for intravenous infusion for 

resuscitation were compound sodium lactate and polygeline. 

Other crystalloid solutions such as saline, dextrosesaline, or 

dextrose, and colloid such as dextran or plasma were not used 

and not missed. Similarly, only penicillin was used to treat 

wounds, apart from the special conditions described, and this 

was effective and safe. the possibility of anaphylactic reactions 

was considered, but it was thought impractical and too time 

consuming to try to elicit a history of this, particularly when 

such a history would probably be unreliable. Adrenaline was 

available for the treatment of any anaphylactic reaction but 

there was none, justifying the selection of this policy. 

We acknowledge with thanks the many medical staff, RN, 

RAMC, and P and O, in SS Canberra and ashore who 

contributed to the formulation and to the execution of this 

resuscitation policy. We also thank Mrs Janice Saul for typing 

the manuscript. We are grateful to the Medical Director 

General (Navy) for permission to publish this article. 

Reference 

1. Kirby NG, Blackburn G, Field surgery pocket book. London: HMSO 

1981. (Accepted 18 January 1983). 



Commentary on 

Resuscitation experience in the Falklands Islands 

Campaign 

Br Med J 1983; 286: 775-7 

Keith Porter 

Each major military campaign leaves a legacy and in the case of 

medicine this may be clinical, policy or operational. Perhaps 

the most famous quotation in relation to trauma is that by 

Cannon, an American Surgeon practicing during the first 

world war, who reported in 1918 “shock may hinder bleeding”. 

The Falkland Islands campaign was no exception. 

In a pre ATLS era Williams et al reported devising a 

resuscitation policy very similar to an ABCD primary survey. 

Their desire was to create a system which was “simple and 

straightforward using a minimum of procedures, drugs and 

fluids” – principles similar to those used at the Birmingham 

Accident Hospital (“simple things should be done well always” 

Peter London, Senior Surgeon). 

Contemporary care remains similar albeit with some 

advances in assessment and resuscitation techniques. In 

relation to airway care there has been the addition of naso 

pharangeal airways and rapid sequence induction of 

anaesthesia frequently delivered in a forward position as part of 

the MERT teams. Oxygen can now be delivered in higher 

concentrations with the use of the trauma mask. Non 

operative management of penetrating chest trauma, where 

indicated, remains unchanged as does the use (at the moment) 

of titrated opiates. Early blood transfusion led to more 

effective resuscitation in the severely injured, a lesson 

reinforced by the current conflict. 

In relation to major incidents the successful management of 

the multiple burn victims from the Sir Galahad was an 

illustration of “doing the most for the most” with the adoption 

of a generic fluid replacement policy for all patients with burns 

>10% - applying principles ahead of the creation of the 

MIMMS course. 

Lessons from the Falkland Islands campaign have advanced 

medical education but so often history repeats itself. How will 

the current campaigns in Afghanistan and Iraq may be 

remembered - for the use of hypotensive resuscitation 

strategies (remember Cannon), tourniquets, haemostatic 

dressings and damage limitation surgery with early blood 

transfusion (remember the Falklands), FFP and platelets. 

Correspondence to: Keith Porter 

Professor of Clinical Traumatology, Royal Centre for Defence 

Medicine, Selly Oak Hospital Birmingham 

R Army Med Corps 153(S1): 73 73


Lessons from the Falklands Campaign 

“The tumult and the shouting dies; 

The Captains and the Kings depart: 

…Lest we forget – lest we forget!” 

Rudyard Kipling 

Although he wrote in another context, Kipling’s words from his 

renowned Recessional hold a prophetic warning for the Army 

Medical Services and, more important for their masters, lest they 

forget the hard-learned lessons of the land battle for the Falklands. 

On many occasions in the history of warfare the lessons of earlier 

campaigns have had to be relearned anew and it is sad but salutary 

to confirm the validity of the truism that history teaches that we do 

not learn from history. The purpose of this editorial is to stem the 

drift to oblivion of the object lessons adduced. As the drama and 

activity of the brief land campaign start to recede into the mists of 

memory it is important to collect and collate the medical 

information, to identify shortcomings as well as successes, and to 

define the doctrines on which future teaching policy may be based. 

To this end the five professors of the Royal Army Medical College, 

none of whom was a member of the Task Force, have been asked 

to write a brief and preliminary appraisal of the medical problems 

encountered in the areas of their particular specialism. 

In such operations as the recapture of the Falklands the public 

gaze not unnaturally concentrates on the work of the surgeons, and 

certainly the rapid and effective treatment of surgical casualties is of 

paramount importance not only for the saving and conservation of 

manpower but also for the maintenance of morale among troops 

in the field. However, no one should doubt the significant 

contribution made by all the component parts of the Army 

Medical Services and amongst those perhaps the most relevant is 

preventative medicine. The effective mental and physical 

preparation of troops committed to battle in one of the most 

hostile environments known to man is clearly a key factor in 

determining a successful outcome. 

The series of reviews that follow must be regarded as provisional 

and preliminary in terms of the opinions expressed. It may be that 

some of what is said now by the professors will turn out to be 

wrong when analysed by the more scientific and critical appraisals 

that will follow, but that does not mean that these things should 

not be said. It is right that they should be said and discussed so that 

ultimately, truth will emerge. 

Preventative Medicine 

Col I P Crawford, GM, FFCM 

It is without question that our troops involved in the Falkland 

Islands campaign suffered from medical conditions which might be 

considered preventable. What we need now is to look at the 

conduct of the campaign and consider how well we anticipated 

problems and how successful we were in overcoming them. It is of 

particular importance to identify those areas where execution fell 

short of intention and to seek reasons for the discrepancies. 

In any campaign there are two types of casualty, those that are 

the direct result of enemy action and those resulting from a hostile 

environment, the latter encompassing not only the physical 

environment but also the prevailing health circumstances. 

It behoves us therefore to consider the environment of the 

Falkland Islands and review the health risks pertaining. We had 

available at the outset a reasonable amount of information upon 

which to base our appreciation. The presence in the United 

Kingdom of senior medical and other islanders helped in this task. 

From the purely “medical” point of view it appeared that the 

only conditions of note causing problems in the local population 

were upper respiratory tract infections, bronchitis and a small 

amount of tuberculosis; no exotica that one could ascertain. Such 

complaints did not pose a direct threat to our troops but pointed 

to problems we were likely to encounter. 

The physical environment on the other hand did pose problems. 

The South Atlantic in winter is no place to be by choice and a long 

sea voyage with worsening weather is not a happy prospect. 

Presuming that motion sickness had not taken too great a toll of 

the Force, and there is not much that can be done to reduce the 

incidence, we needed to know what conditions of weather and 

terrain would confront our troops on arrival at the Islands. 

The answer, extremes of heat and cold apart was the worst 

possible environment in which to survive irrespective of carrying 

out military activities. The climate wet, cold and extremely windy, 

the terrain wet, boggy in places, rocky elsewhere, some small 

mountains, minimal roads or tracks and generally ground 

impassable to vehicular movement. Outside the main settlement 

no shelter to be found and no protection from the weather. In short 

hostile in the extreme. The one essential of which there was no 

shortage, indeed an excess, was water in its natural state. 

With a population of the order of eighteen hundred and 

sanitation appropriate to local circumstances it was clear that the 

addition of the Task Force would overload the local system apart 

from any disruption caused by the presence of the enemy or by 

military action. The nature of the terrain in part dictating the style 

of warfare indicated that the troops would have to be self sufficient 

with regard to food and that individual ration packs would be the 

order of the day. 

With these thoughts in mind what could be done to reduce the 

toll the ‘environment’ would exact upon the Task Force For once, 

time, in a curious way, was on our side. The long journey to the 

South Atlantic made possible adequate preparation and training in 

terms of further education and practice in first aid, primary 

medical care, basic hygiene and instruction in the use of protective 

clothing. Time was also well spent in building upon the ‘Fit to 

Fight’ programme so that on arrival in the war zone the troops 

would be able to accomplish the extremely demanding operation 

required of them. Was the appreciation of the situation accurate, 


did the preventative measures taken succeed in their aim and was 

there any oversight 

In general terms the measures outlined above, together with the 

enhanced state of fitness and training of the troops, helped to 

ensure the successful outcome. However, not all went well and in 

particular the climate took a more fearsome toll than was 

anticipated. The incidence of non-freezing cold injury to the feet, 

trench foot, was high and presented a continuous drain on 

manpower. Factors contributing to this incidence: firstly the 

unavoidable immersion during landing, continuous wet weather, 

boggy ground, river crossings and lack of shelter; secondly those 

possible avoidable, inappropriate footwear (no marching boot was 

equal to the conditions), poor foot hygiene, no facilities for drying 

gear, and in some cases previous cold injury. In short, conditions 

were optimal for this debilitating condition and the incidence 

reflected it. In the event only a proportion of those affected came 

into medical care, many pressed on regardless. How much longer 

they could have continued is an open question which fortunately 

was not put to the test. Probably associated with good preparation 

on the voyage was a very low incidence of hypothermia; those 

concerned recovered quickly and did not require evacuation. In a 

campaign where if it was needed it had to be carried on the man, 

shortcomings in the equipment for load carriage rapidly came to 

the fore and in particular the excessive loads carried by many 

accelerated the onset of fatigue to an unacceptable degree. 

During hostilities the main food supply was either the Arctic or 

the General Service 24 hour ration pack; a significant number of 

troops did not eat all their rations with a consequent loss of weight 

and possible loss of efficiency. Reasons given for this failure ranged 

from “unappetising” foods, shortage of time, nature of operations 

Field Psychiatry 

Col P Abraham, FRCPsych 

It is difficult for those who, like the writer, did not take part in the 

land battle to recover the Falklands to realize how ferociously each 

engagement was fought. These encounters, and the battle of 

which they formed part, were mercifully curtailed. 

Had they lasted longer the number of those whose inability to 

fight was not attributable to injury or sickness would have 

escalated alarmingly. The chief reason for this assertion is that the 

number of such battleshock cases is inexorably linked to the 

number of wounded, and as the fabric of the unit is eroded by 

casualties, both physical and psychological, so does it become 

harder for the remainder to sustain themselves and each other in 

the face of bombardment and bereavement. Fortunately the same 

arithmetic applied with even more force to the enemy. 

In order to support this claim that the number of battleshock 

cases was about to achieve significant proportions it is necessary to 

show that the law linking the incidence of battleshock to the 

incidence of wounding did in fact hold in this particular force and 

that the number of stress reactions was rising. 

The battalions under study are three of the finest fighting units 

to be found anywhere. Training is tough, cohesion tight, 

leadership strong. Motivation and morale were acknowledged to 

be good. Commanders held the initiative and understood well the 

need to ensure respite for their own troops while denying it to the 

enemy. It is chastening to record that the ratio of battleshock to 

wounded still amounted to between five and ten per cent. 

It may be argued that with single figure numbers it matters not 

militarily and little from the humanitarian point of view whether 

the cases were managed successfully or not. This overlooks the fact 

that changing any one of the favourable factors mentioned, 

including the shortness of the war and the limited number of 

to lack of potable water with which to prepare the meal – 

particularly the Arctic ration. 

Supplies of appropriate clothing, always a problem in cold/wet 

conditions, were somewhat limited and drying of clothes was 

usually difficult if not impossible. 

Such were the problems of the hostile environment; encounters 

with the enemy added two further stresses apart from direct 

weapon casualties. The first, noise induced hearing loss, was a 

hazard to which all were exposed both during preparatory training 

and during operations. We shall not know the magnitude of this 

injury for some time to come. The other condition of note was 

gastro-enteritis. During the campaign the incidence of enteritis was 

of insignificant proportions but the disease began to make its 

presence felt with the cessation of hostilities and the liberation of 

Port Stanley. This development, surprising to some, was probably 

due to the more widespread adoption of communal cooking, the 

gross contamination of all accommodation and surrounding areas 

by enemy troops, and damage sustained by the water supply plant, 

mains and sewage disposal system such as it was. Here as elsewhere 

the sterling efforts of the environmental health personnel saved the 

day. 

In summary it can be said that provisional comment from the 

preventative medicine aspect is that there is room for improvement 

but that much of the effort directed by the Army Medical Services 

into improving the fitness of the soldier, his awareness of hostile 

environments, his training in first aid, and attempts to improve his 

equipment paid off in this campaign. 

As a last word it must be added that it was fortunate that there 

was time on the voyage south to make good some of the 

deficiencies in unit preparedness. 

wounded, would have dramatically altered the picture. With 

perhaps a third of the battalion out of action, whether or not a 

section or two of physically fit men get back to effective duty 

begins to matter. Furthermore, some of the casualties were key 

men, the successful return to their original role of any one of 

whom would have justified the precious place in the land force of 

a man whose skills were devoted to this task. 

There were no such specialized medical personnel ashore. In 

addition communications were difficult, a situation compounded 

by the peculiar arrangements of the Geneva Convention whereby 

once a casualty reached a Hospital Ship he was forbidden to return 

to the war. These circumstances negated the fundamental 

principles of early forward intervention and rapid return to duty. 

In the Falklands, battleshock casualties who left their units did not 

return to active duty. It is probably also fair to say that some of 

those occurring within the battalions could have been better 

managed, even though some previous knowledge of the subject 

was hurriedly amplified on the journey South. (One CO, to his 

credit, even read carefully an article on the subject published in 

this Journal!) 

Would there always be time to do this It is contended that the 

management of psychological problems in battle should be an 

integral part of First Aid Training of all medical personnel and all 

junior leaders, officers and NCOs. It is further contended that 

there should be a specialised presence forward with a field medical 

unit. The Israelis have recently proved yet again the efficiency of 

this policy in Lebanon, but only because they had organized and 

trained for it in peacetime. 

If we do not adopt these twin measures we might not be so 

lucky next time. 


Medicine 

Brig M Brown, FRCP 

In his general preface to the History of the Second World War, Sir 

Arthur MacNulty 1 emphasises the value of medical histories of war 

to record discoveries and progress in medicine and surgery under 

the stimulus of warfare, to relate how problems of medical 

administration in theatres of war were met and solved, and to detail 

mistakes and errors for the profit of those who come after. 

In the short Falklands Islands campaign the main problems were 

those of logistics, and medically, apart from cold injuries, there 

were no new or old diseases to diagnose and treat. The small 

healthy civilian population meant there were no serious demands 

on the physician, and the rapid repatriation of the Argentinean 

prisoners of war prevented a potential serious epidemic situation. 

The emphasis lay on fitness, selection of personnel and the 

elimination of the unfit. The correct application of the Pulheems 

system and its Employment Standards was again highlighted in 

those cases requiring evacuation for medical reasons. These 

included peptic ulcer, asthma, recurrent bronchitis and one case of 

hypertension. Too often in peacetime the officer with well 

controlled hypertension on treatment is not downgraded. Selection 

of recruits with recent asthma or even intermittent therapy without 

proper screening tests still occurs. 

In the Falkland Islands campaign the supply of drugs was 

limited, there was no return to duty if case-evacuated to a hospital 

ship, and therefore there was no “line of communication” medical 

category. Since the Second World War there has been a new trend 

in therapy – the use of drugs to prevent long term effects or relapses 

on such conditions as hypertension, peptic ulcer, asthma and gout. 

In the Services, these people are otherwise fit, pass their BFT, are 

often employed in highly specialised jobs, and have considerable 

service and experience. But as in the present campaign, medical 

Pathology 

Col J B Stewart FRCPath 

The Army Medical Services played a distinguished part in the 

Falklands Islands campaign and the courage and self-sacrifice of 

the Field Ambulances and Field Surgical Teams have been 

rightfully recognised and honoured. Less glamorous but 

nonetheless valiant contributions were made by other medical 

units. These contributed significantly to the success of the 

medical operation and added lustre to the reputation of the 

Corps. Army Pathology notably played its part throughout the 

hostilities and continues to provide an essential laboratory 

service to the Islands in the aftermath of the fighting. The 

operational readiness of the pathology services was well 

illustrated by the specialist sub-units, particularly Army Blood 

Supply Depot (ABSD) and The David Bruce Laboratories 

(DBL) – units established during the Second World War for 

just such contingencies. On mobilisation of the Task Force 

DBL were able to issue large stocks of vaccine and smoothly 

gear their increased vaccine production to provide adequate 

emergency stocks. ABSD was heavily committed throughout 

the campaign and 1600 units of fresh blood were urgently 

collected and in four separate lots, each accompanied by a 

courier, delivered by air to Ascension Island. From Ascension 

individual deliveries were made by helicopter to passing 

hospital ships of the Task Force. 

The blood was issued in new CPD-adenine preservative 

giving extended shelf life of 42 days (previously 28 days). The 

blood packs were transported in Ordnance Cardboard 

drugs are not a first priority, and so regular therapy cannot be 

guaranteed. A review of this problem, the numbers involved, the 

effect on careers and the cost from wastage is needed in the light of 

these experiences. Certainly in the selection of recruits, or at their 

final medical, there is no place for any doubtful cases. Continued 

research into better selection methods and functional testing as in 

the Exercise Liability Test 2 for asthma is essential. 

In this short campaign there were no epidemics, no exotic 

diseases, and no major civilian problems as seen in the Second 

World War. The potential risk situation of the large number of 

prisoners of war, in a poor state of hygiene, with little 

accommodation was prevented by early repatriation. Should an 

epidemic have occurred, there were grave doubts expressed by the 

Consultant Physician, who arrived after the ceasefire, as to whether 

the required medical supplies would have been available. The 

medical drugs are limited in the Field ambulance and Field 

Hospital equipment for War. Research is required into the newer 

drugs, their shelf life, modular packing, and use in the field so that 

in the future, these are quickly available to meet specific 

circumstances and changing situations. Contrast the requirements, 

for example, of Camp Foxtrot in Zimbabwe, with a Field 

Ambulance in Jordan helping a United Nations force, and the 

Falklands Islands campaign. 

To quote Major General Sir Henry Tidy 3 – “The traditional and 

essential function of military medical services is the maintenance of 

manpower in a state of fighting efficiency. Such function involves 

two separate factors, first the selection of the fit and suitable and 

elimination of the unfit, and secondly the prevention and 

treatment of disease. As physicians we have an important role in all 

three.” 

Polystyrene boxes. The latter containers and the increased blood 

preservation had both been the successful outcome of research 

and trials carried out at ABSD during the previous two years 

and both developments proved highly successful under field 

conditions. The entire blood supply operation demanded and 

received great co-operation from UKLF, local military units and 

the staff of ABSD. Signal traffic and the various logistic 

exercises worked smoothly throughout and reflected realistic 

training in the past. The Commanding Officer ABSD records 

with pride the outstandingly loyal support of his civilian staff 

who worked long hours collecting and processing blood; one all 

day session was completed the following morning at 0500 

hours. Before the Hercules transport aircraft could land at Port 

Stanley blood was dropped by parachute on the disused end of 

the runway – and delivery successfully completed without the 

loss of a single unit of blood! ABSD continues to supply the 

Falkland Islands from Aldershot with a regular monthly 

delivery of fresh blood by air. 

In addition to the smooth blood supply organisation 

members of the Parachute Field Ambulance, who had 

undergone previous training at ABSD, instructed other 

personnel on the ships travelling down to the South Atlantic in 

blood collection and resuscitation. These men demonstrated 

splendid improvisation in blood storage on the ground and also 

supervised the bleeding of Argentine prisoners at the height of 

the fighting. This valuable contribution highlighted the 


additional role of ABSD, namely its commitment to regular 

training in resuscitation procedures. 

A Laboratory Technician Class 1 accompanied 2 Field 

Hospital and at the end of hostilities was responsible for setting 

up a laboratory service in the small civilian hospital in Port 

Stanley in liaison with the local civilian general technician. A 

basic diagnostic service was quickly established using the fully 

serviceable field laboratory equipment. Many of the early 

problems involved basic field hygiene and public health checks, 

including control of water and milk supplies and highlighted 

the need for experienced Army technicians with broad general 

training in all laboratory disciplines – versatile all rounders. A 

senior laboratory technician is now posted to the Falklands on 

a five months rotation. The reference laboratories at Royal 

Army Medical College are the regular destination for specimens 

from outstations abroad and it was not long before interesting 

material, including surgical biopsies, cytological specimens and 

specimens for clinical chemistry and serological tests were 

Surgery 

Col R Scott FRCS 

Although surgeons and anaesthetists of the Army Medical Services 

have been continuously deployed with field surgical teams in 

support of military operations worldwide since the end of World 

War II, there has been no experience since then of the problems of 

surgical support of a Naval Task Force. Although surgical teams 

have often been situated some thousands of miles from a main 

base, the daily rate of casualties has seldom exceeded the capacity 

of the teams and casualty evacuation by air from the point of 

wounding to the field surgical team, and then rearward to a main 

hospital at base, has always been possible. The experience of the 

surgical teams in the Falklands has emphasised the lessons learnt 

from previous experience but has also raised possibilities for 

improvement in the future. 

Although the Task Force contained elements from all three 

armed services, initial planning was the responsibility of the Royal 

Navy. With the necessity for tri-service co-operation, it is essential 

that the Medical Officers of all three services understand fully the 

responsibilities and capabilities of the other two. Experience in the 

South Atlantic strengthened the case for tri-service co-operation in 

the education of surgeons and anaesthetists and in the training 

exercises of forward surgical units. Difficult though they may be 

to achieve, the value of realistic training exercises has been 

repeatedly stressed by those involved in the South Atlantic 

operations, who emphasise the importance of familiarity with the 

equipment, the value of team training, the necessity of training 

with their host medical units, and the importance of simple 

military fieldcraft which can become as important for the survival 

of surgeons and anaesthetists as it is for combatants. 

Forward anaesthetists must be completely familiar with field 

equipment and its potential. Anaesthetic experience based on the 

district general hospital is insufficient to equip an Anaesthetist to 

function effectively in an advanced surgical centre. He must be 

fully prepared to utilise his robust equipment to its full potential 

and be prepared to improvise as a changing military situation may 

demand. The simplest method of anaesthesia is often the safest 

and best in these circumstances. He must be supported by 

competent, well-trained operating theatre technicians who have 

trained with the team. 

The Surgeon also needs the support of a well-trained team of 

operating theatre technicians who know their equipment, know 

their fieldcraft and have trained with other members of the team. 

Whereas at present the scales of equipment meet the need for 

arriving at Millbank. A steady stream of interesting case 

material arrives regularly from the Falklands. Consultant 

Pathologists have made the long journey to Port Stanley to 

conduct autopsies and review the laboratory facilities. 

There are still many lessons to be learned from the Falklands 

conflict. The Army Pathology Service clearly demonstrated an 

excellent state of preparedness for its war role. The need for 

continuing energetic research and development in areas such as 

blood supply in war were underscored. In these days of ever 

threatening financial and staff cuts it is important that such 

vital tasks are fully recognised and given maximum support in 

terms of resources and skilled manpower in order that we 

remain prepared for any future conflict. The need for 

experienced all round technicians also vindicates the Army’s 

policy of a broad general training at RAM College. It is hoped 

that in the final analysis of all medical aspects of the Falklands 

campaign the contribution of Army Pathology will be fully 

realised and supported. 

going to war, they are capable of improvement and individual 

items must be repeatedly subjected to detailed scrutiny to effect 

these improvements. 

The surgeons and anaesthetists must be physically fit and 

psychologically capable of continuing to function under extreme 

physical and emotional stress. The surgeon must be capable of 

rapid decision and rapid surgery. He must be trained and capable 

of operating on the head, chest and abdomen, as well as the limbs. 

Although limb injuries constitute the majority, injuries of the head 

and trunk provide the most taxing surgical problems. If lives are 

to be saved by forward surgery, the military surgeon must be a 

truly general surgeon. 

Rapid evacuation from point of wounding to surgery is the 

most important factor in the saving of lives. Lives are also saved by 

effective first-aid and resuscitation, but in this campaign it is 

difficult in a retrospective study to assess their value. The 

appointment of a consultant surgeon to the force, with a specific 

duty to monitor treatment and assess its value at each point in the 

evacuation chain, could have provided much information that is 

unfortunately now lost. Regrettably, also lost is the opportunity to 

assess the impact of new weapon systems on personnel and the 

exact cause of a large number of superficial burns sustained by 

some soldiers in one notable incident. 

The value of a specialised team for the treatment of burns in the 

base hospital, in this case a hospital ship, was proven. The maxillo 

facial Team was also usefully employed at base but it was 

interesting to note that other injured soldiers survived the long 

journey back to the United Kingdom for specialist treatment, 

without apparent ill-effect. The speed of evacuation by air 

undoubtedly contributes to the successful management of 

specialised surgical problems. 

The last, and possibly most important lesson, is that a 

professional army needs its own professional surgical teams as part 

of its medical support for operations worldwide. 

References 

1 MacNulty A S History of the Second World War - Medicine and Pathology 

HMSO London 1952 

2 Carson J and Winfield C Exercise testing in servicemen with asthma. J R 

Army Med Corps 1982 

3 Tidy H History of the Second World War - Medicine and Pathology 

HSMO London 1952 



Port Stanley Airport after being bombed by RAF Vulcan 

bombers as part of the Black Buck missions in May 1982 

Argentine marines outside Government House, Port Stanley 

on 2nd April 1982 

RAF Sea Harriers over the south Atlantic 

Vulcans, Victors and Nimrods at Wideawake airfield, 

Ascension Island 

Royal Marine Commandos march towards Port Stanley 

Maintenance men working on a Sea Harrier aboard HMS 

Invincible 



One of the Vulcan bombers responsible for operation Black 

Buck, then the longest bombing mission ever attempted 

A casualty from HMS Sheffield being carried to the sick bay 

on HMS Hermes 

An Argentine soldier cooking in a sheep shearing shed at 

Goose Green 

HMS Sheffield on fire after being struck by an Exocet missile 

HMS Ardent sinks on May 21st 1982 

HMS Ardent sinks on 23rd May 1982 after being hit by 

Argentinian 500lb bombs 



A British military funeral on the Falklands 

Argentine rifles piled beside the road to Port Stanley Airport 

Teniente de Naviro (Lieutenant) Alfredo Astiz signs the 

instrument of surrender of South Georgia on board HMS 

Plymouth 

Argentinian prisoners of war 

Royal Marines escorting Argentine prisoners 

Argentine prisoners under guard outside Port Stanley 



Naval Party 8901, the Royal Marine Garrison evicted by the Argentines, outside Government House Port Stanley after the 

surrender 

HMS Exeter, the only Falklands ship still in commission 

The task force returns home 

The Parachute Regiment remembers the fallen 



Port Stanley cathedral. The whalebone arch is a reminder of a 

long dead industry 

25 years on……. cruise ship visitors are welcomed to Port 

Stanley 

Falklands wildlife 


J O U R N A L O F T H E 

R O Y A L A R M Y 

M E D I C A L C O R P S 

F A L K L A N D S C O N F L I C T 

C O M M E M O R A T I V E I S S U E 

Volume 153, Supplement 1 

Map of Falkland Islands (Frontispiece) 

i Chronology of Events 

2 From the Editor 

3 Editorial M von Bertele 

5 Fighting for the Falklands P R J Page 

13 Roll of Honour 

16 Introduction to original papers 

17 The Eve of the Sinking of the Sir Galahad J Crummic 

18 The Battle for Goose Green SJ Hughes 

20 2 Para Memorial, Goose Green 

21 My Experiences in the Falkland Islands War J Burgess 

25 My Thoughts on the Falklands Campaign WSP McGregor 

27 Photographs Section 1 

37 Operation Corporate - the Sir Galahad Bombings P Chapman 

40 Commentary A Kay 

41 Army Amputees in the Falklands - a review AFG Groom JT Coull 

43 Commentary J Etherington 

44 Army Field Surgical Experience DS Jackson CG BattyJM Ryan WSP McGregor 

48 Commentary JM Ryan 

50 First and Second Line Treatment – a retrospective view DS Jackson MD Jowitt RJ Knight 

53 Commentary PAF Hunt 

55 Soldiers Injured During The Falklands Campaign 1982 DS Jackson 

57 Commentary P Parker 

58 Rate of British Psychiatric Combat Casualties Compared to Recent American Wars HH Price 

62 Commentary M O’Connell 

63 Military Cold Injury During the War in the Falkland Islands 1982: 

an evaluation of possible risk factors RP Craig 

69 Commentary J Smith 

70 Resuscitation Experience in the Falkland Islands Campaign 

JG Williams TRD Riley RA Moody 

73 Commentary K Porter 

74 Lessons from the Falklands Campaign 

IP Crawford P Abraham M Brown JB Stewart R Scott 

78 Photographs Section 2 

83 Retention Positive What I can remember 25 years on. M von Bertele 

86 Looking Back 25 years: a naval perspective AJ Walker 

88 A Personal Reflection on the Falkland Islands War of 1982 JM Ryan 

92 Campaign Medals: The South Atlantic Medal 

93 Original Contributors 

94 The 1982 War Memorial 

Views and opinions expressed in this Journal are those of the authors 

and imply no relationship to MOD or AMS policy, present or future. 



Retention positive What I can remember 25 years on 

Major General M von Bertele, Chief Executive Medical Education and Training 

Agency (DMETA) 

Was the Falklands War a good war Not in the sense of a just 

war, but for those involved Certainly for me it was. The seeds 

were sown a year earlier. The Parachute Clearing Troop of 16 

Field Ambulance, was on Exercise POND JUMP in Canada 

with the 3rd battalion The Parachute Regiment, 3 Para. We 

rounded off 3 weeks of training with a live firing attack on a 

small hill, and suffered a single casualty, a soldier injured by a 

grenade fragment thrown too close to the advancing line of 

troops. It was daylight. At the wash up, the CO Lt Col Hew 

Pike, noted the accident and that it shouldn’t have happened, 

and then made a fateful comment. He referred to soldiering, 

and what we had achieved over the past 3 weeks, and hoped we 

had enjoyed the final assault, for it would never again happen 

for real. Warfare had changed. That evening Sphinx Battery 26 

Regt RA took on the battalion in a post exercise brawl, 

hospitalizing about 30 paras and gunners. All agreed it was a 

good fight, reinforcing the rivalry and camaraderie of the green 

and blue. It was a busy night for the RAP, and the RMO, 

Captain John Burgess. 

I left Canada via Vancouver and Seattle, joined my unit for a 

more traditional exercise in Denmark fighting the red forces on 

the northern flank, spent 5 months including Christmas, on 

Op BANNER, Musgrave Park and Armagh, and then joined 

the PWO in Norway for my second winter with the AMF(L). 

It was what the field ambulance doctors did; a round of 

exercises and live medical support. 

On my return in late March I prepared for a skiing 

expedition. We were due to leave on the 3rd of April, and 

despite the belligerent tone of diplomacy in the South Atlantic, 

and the fact that we were the Spearhead surgical team, my CO 

said we could go if we left a phone number – good news to me 

since we planned to be out of contact for 10 days. By Monday 

morning, after a great day’s skiing, and having ignored several 

calls, I was ordered back to Aldershot, and, in hot water with 

WO2 Fritz Sterber, the Warrant Officer on my surgical team. I 

paraded the following day, Bergen packed. 

A full 2 weeks later I found myself in Southampton Water, 

hastily assigned to the Townsend Thoresen Europic Ferry as 

ship’s doctor, to accompany the light guns and scout helicopters 

for the Task Force, and about 60 soldiers. The 4 officers on 

board shared the bridal suite of this curious vessel, a throwback 

to the 1950s. The hold carried 1,000 tons of ammunition, and 

three 105mm light guns and on the deck, 3 scout helicopters. 

The bursar was busy filling all available space with fresh 

victuals, steak, potatoes, and beer. 

What did I know I had qualified 3 years earlier, completed 2 

house jobs in the NHS and then I had attended the PGMO 

course, discovered that I quite liked running and tabbing, hated 

marching, learned about general war in Germany and linear 

flows of casualties, NBC and re-supply by boxes 1-4. Within 

weeks of joining my first unit I was in Norway, running a sick 

parade each morning before skiing and learning about arctic 

warfare and the problems of providing medical support in 

hostile climates. I knew then that the MOs boxes contained 

hardly anything of any use for managing routine illness, but 

that the MO down in Voss had a well stocked dispensary and 

that it was always worth a visit with a patient, and the prospect 

of a day on the slopes. I was soon adept at knocking up hot 

meals, could manage on menu D for several days, recognise and 

treat scrot rot and frostbite, plus a host of minor breaks and 

sprains. A year followed of P company, parachute training, 

medical centre duties, exercises and detached duty. I saw my 

first gunshot wounds, blast injuries and the first use of the 

RPG7 against troops in a landrover. Life was reasonably 

predictable, it was fun, and while not clinically demanding, 

being a spare doctor offered enormous variety. I even persuaded 

a dental colleague to show me how to extract teeth and 

administer an inferior dental block. The PFA exercises were 

always instructive, we had solid and experienced NCOs, and 

although we rarely saw our surgical teams we could always pop 

in to the Cambridge and assist on a list, since that is where our 

clinicians worked. 

By the time we reached the Southern Hemisphere it was still 

not clear that we would go the whole way. We had done lots of 

weapons training, flown multiple sorties over water in our 

single engine scouts, visited the Canberra several times, and I 

had sorted out the rather good sick bay kit provided by the 

Navy, including my dental satchel. I even felt confident enough 

to extract a molar with a pea sized abscess on it, which had 

failed to respond to antibiotics. We had settled in to a satisfying 

routine, exercise, sick parade, reading, pre-dinner drinks, 

dinner, and a game of cards in the evening. The peace was 

briefly shattered when a soldier, on fire picket duty at night in 

the hold, decided to prime a couple of grenades to see how they 

fitted together. He appeared in our cabin at about one in the 

morning, hands cupped round his mouth with blood pouring 

on to the floor, and looking up from my cards I assumed he had 

a nose bleed, so I laid the cards down, picked up the sick bay 

key, and told him to follow me. My cabin mates were 

impressed, for they had all spotted that he was missing 2 fingers 

but it was only when we reached the sick bay that I saw the full 

extent of the damage. My reputation was made, cool under fire, 

and 2 weeks later when the helicopter brought back a comatose 

platoon commander from Goose Green, a bullet in his liver, 18 

hours after injury, the pilot, my cabin mate, wept with relief 

when he saw me. He had been flying non stop for 18 hours. 

We went ashore at Ajax Bay on the evening of the first day of 

the landings. The plan to provide surgical support from afloat 

failed at first contact with the enemy, and we hastily repacked 

our kit and huddled in the bottom of a landing craft. Within an 

hour of landing we had knocked a hole in the wall of the old 

refrigeration plant for the generator exhaust, and set up our first 

table. This was familiar territory. Soon we were receiving 

casualties from the sea, flown or shipped ashore. At first light we 

trooped outside to watch the Skyhawks resume their attack, and 

were informed that we were now part of the Red and Green Life 

Machine, in a stirring address delivered by Surgeon 

Commander Rick Jolly. We dug shell scrapes as a precaution, 

but found warmer drier sleeping spaces in the old cold store, 

and continued operating. The casualties were seamen, and 

Chinese laundrymen in bri-nylon shirts that had melted into 

their skin. We watched the planes being shot down, the 


eachhead building all the time, and saw the Ardent towed, on 

fire, into the sound. We listened to the commentary on the ops 

room radio, and watched open mouthed when the bomb 

exploded in a forward compartment. Thirty minutes later the 

bomb disposal warrant officer was brought ashore, his arm 

hanging on by a thread, his colleague lost in the detonation. 

The first serious land casualties we saw were blue on blue, paras 

who had successfully engaged their colleagues in the confusion 

of patrolling the opposite shore. We were still operating when a 

Skyhawk dropped two 500lb Matra bombs on the building. 

One exploded in the mess hall next door killing and injuring 

several marines. It set fire to the ammunition dump, and for the 

next 6 hours our shell scrapes were ablaze with white 

phosphorus as mortars and shells detonated in the blaze. We 

carried on operating. The other one landed 10 feet away in our 

sleeping accommodation. It did not detonate. We finished our 

list and went outside while the bomb disposal team took stock. 

A RAF sergeant was scratching his head when I went in to 

recover my Bergen with the spare anaesthetic kit. We were 

going to set up an alternate FST. He explained that these bombs 

could be set to delay detonation, but the plans were in French 

and he could not read them. Armed with an O level and a long 

summer holiday in St Raphael 2 years earlier I sat down to 

search for that elusive phrase that might mean time delay. 

Ninety minutes later it has not gone off so we re-entered the 

building and just got used to our French lodger. 

For the next few days we settled into a sort of routine. Food 

and fresh water were in short supply, field sanitation was poor, 

but the hospital was working. Post operative casualties built up, 

but when we could, we flew them out to SS Uganda, the 

hospital ship. It was a good trip to go on as the medical escort. 

There were no flight nurses ashore. The prospect of a meal on 

board made up for the risk of being shot down. Once we flew 

out to sea for two hours in low fog before admitting defeat and 

turning for shore, low on fuel, until we landed on Hermes and 

had to unload all of our stretchers as we came under threat of 

attack again. Food supplies were running low and we were on 

half rations for a while, and were starting to get tired. The 

surgical teams often operated through the night, and the strain 

was showing in the faces of some of the team. It was hitting the 

older married men harder. Our first Argentinean casualty was 

Ossie Ardilles, named after the footballer, who had dislocated 

his knee ejecting from his Skyhawk over the sound. He was 

shocked when he saw the impact of their bombs on the 

hospital. 

The battle for Goose Green came as a surprise, the passage of 

information being a bit thin, but we heard it on the World 

Service just before the casualties started arriving. The shock of 

the RSM turning up to announce that “H” was dead, the 

adjutant too, hit us all. We knew these people. The casualties 

kept coming and our triage was tested to the full. Colonel Bill 

Macgregor continually reassessed priorities, appearing 

throughout the night in his green apron to take stock. He was 

furious to discover that a patient with a head wound and open 

brain injury had been left in a corner labelled “expectant”. He 

operated, and the soldier, properly treated made a reasonable 

recovery, although when I saw him 6 months later in Woolwich 

he had considerable functional impairment. My opposite 

number on the other team, Captain Rory Wagon, had gone 

forward with 2 Para’s RAP, and I alternated between 

resuscitation officer and surgical assistant, with the medics 

putting up drips, administering analgesia, and antibiotics. We 

ran low on penicillin as the numbers of Argentinean casualties 

rose, and on one memorable occasion a casualty was given IM 

penicillin, IV, by mistake. He had a short fit, but recovered 

quickly with diazepam, convinced that he had been given truth 

serum. Then we ran low on induction agents and started to use 

ketamine for the minor debridements. This was left to us 

juniors, and caused some interesting recovery phenomena. One 

SF soldier entertained us to half an hour of bawdy songs before 

sinking into deep sleep. We were bleeding troops to provide 

fresh blood, and we had all given a pint. Then the Argentinean 

casualties exhausted our supply so I was dispatched to the PW 

holding cage to ask for volunteers. They were very reluctant 

until we showed the senior officer how many casualties we had 

inside, and then the blood supply problem was resolved, 

although it was not used on our casualties – hepatitis screening 

was not possible. 

For several days we continued to receive Argentinean 

casualties from the battlefield, the last one some 4 days after the 

battle. Left for dead in a trench, he survived despite a serious 

wound to his buttock and the loss of one eye. The first funeral 

was a sombre affair. A mass grave dug by an engineer tractor, 

and the bodies laid one by one, wrapped up in body bags. I can 

still hear the voice of Padre David Cooper, and every time the 

footage is shown on the television I am transported back to that 

moment. One month earlier it had been beyond the 

imagination of us all. 

We followed the progress of the force as they tabbed and 

yomped across the island. Rivalry was always present, but the 

teams by then were well integrated and clinically they deferred 

to Colonel Bill, by far the most experienced clinician. Rick Jolly 

was a dynamo, charging around everywhere, but every other 

evening he would appear with a bottle of whisky or rum that he 

had razzed from some ship, and give us a small tot to bolster 

morale. We fell out once or twice over re-supply and rosters, 

and it was with some relief that I found myself despatched one 

night to embark on the Sir Tristram for a night trip to Teal Inlet 

to join the RAP of 3 Para, before they moved up to Estancia 

House. The RMO, Captain John Burgess, had already been 

blooded at San Carlos Sound, and was glad to see me and my 

two medics, Cpl Parkin and Private Davey Wilson, although we 

doubted that it constituted a doctrinally pure collecting section. 

We spent the next few days looking after the troops who were 

suffering badly from the wet and cold. The march over the 

island had left many with cold and painful soggy feet, and 

although the CO rotated them back to the barn attached to the 

Estancia farmhouse to dry out and get a decent meal, many 

were still dug in under ponchos in forward positions. We went 

out with medical supplies and spent a few nights with the 2 

forward companies and the artillery battery up on a hill above 

Estancia House. Water was being flown up by helicopter in 

jerry cans. It was a laborious process, and the battery was 

camped 50 yards from a peaty pond. I was intrigued to see a 

small stone sump near the outlet of this pond, with a pipe 

leading down the hill, so we walked down beside it for 2 miles 

to find the other end attached to the side of Estancia House, 

where the patient water-duties man was filling jerry cans from 

the tap. 

John Burgess described the battle on Mount Longdon in the 

Corps Journal 25 years ago, but my recollection is still vivid. 

The moment when Cpl Mills trod on a landmine and the sky 

gradually filled with flares and tracer, and the artillery and 

mortars started, was dramatic, but the noise was barely different 

from our exercise in Canada 9 months earlier. This time we had 

to go through it to reach the RAP, by now set up between the 

rocks on the reverse side of the hill. There was not much we 

could do. Casualties were brought down to us or made their 

own way, and we revised dressings, gave morphine and 

antibiotics as best we could. The use of lights was out of the 

question with constant sniping for most of the night, and only 

when dawn started to break could we refine treatment and start 


to put up drips. It was raining slushy snow and everyone was 

cold. Evacuation by vehicle was no longer possible, enemy 

artillery was still falling on the slopes below us, and it was 

several hours before the first helicopter reached us. By then we 

had about 40 casualties in the RAP, and more arriving every 

hour. The first helicopters to arrive were Scouts and evacuation 

was painfully slow, but eventually a Sea King arrived and they 

started to go more quickly. A burial party was arranged and 

many of the Argentinean dead were interred that day. For two 

and a half days we stayed there on the hill, harassing fire 

whizzing overhead, first 105mm and then big guns, 155mm air 

burst, which sent shrapnel pinging around the rocks. The roar 

of the shell overhead and the rush of air following was 

misleading because the shell had by then already exploded a 

hundred yards down the hill. The odd round fell above us, 

extracting a steady toll on people moving around, most 

devastatingly in the incident described by John Burgess, when 

my memory is of a single round falling between 3 men, killing 

2 of them and amputating the legs of the third. They were only 

about 50 yards from us and still alive when we reached them, 

exsanguinating within seconds. I can’t remember applying a 

tourniquet to the survivor, but we tried to apply pressure to his 

wound, and failed to get a drip into him. By the time we had 

carried him to the safety of the rocks it was too late. 

The following night, artillery changed to mortars, and rounds 

started to fall around us. We could not dig in as the soil was 4 

inches deep on solid rock, and so we huddled under a large 

boulder and prayed, until the cry went up “Medic”. A soldier 

had been blown through the air by the blast from an exploding 

round and was unconscious. John and I debated whose turn it 

was to go. I lost, and ran terrified across the open ground to pull 

the casualty under cover. By now it was safe to use a torch but 

a detailed examination revealed no injury, and we concluded 

that the blast had literally knocked the breath out of him. Sure 

enough he slowly came round, deaf, but otherwise unhurt apart 

from a very sore back where he had landed on a rock. Within 

minutes the mortars had been silenced, but it was hard to get 

any sleep while adrenaline was running high. The following 

morning, clear and cold, saw us moving up for the final assault 

on Port Stanley, but as everyone will now know, the fighting 

was over. My section and I took off our helmets, put our berets 

on, and walked with the lead company into Stanley. We left 

them at the racecourse and on a whim, and because the 

islanders had been told to congregate at the hospital, walked 

through the Argentinean military police roadblock, and made 

our way to the King Edward VII Hospital. We were given a 

rapturous welcome. The islanders had been listening to the 

radio, and knew that a ceasefire had been called. The hospital 

had been commandeered by Argentinean doctors and there 

were several hundred patients in it. I went to talk to their CO, 

a youngish surgeon who had trained in Germany, and who 

spoke good English. I explained that the war was over and asked 

him to hand over all weapons and evacuate the hospital. 

Without argument he produced a brand new and un-fired 

Browning 9mm pistol and handed it to me. The others did the 

same, and then for half an hour we discussed the war, his 

patients, and how to move them. They were remarkably open, 

and expressed sadness that the British had felt it was necessary 

to fight for the islands. They told us that from the moment the 

Belgrano was sunk they knew that they would lose, as we were, 

after all, still a significant military power, but they, like us were 

caught up in events. We discussed the casualties we had treated, 

and they expressed gratitude for the care we had given to their 

people, word had somehow got back to them, and then they set 

about moving their patients to a ship in the harbour. Within 3 

hours the hospital was empty, and in the lull we decided to have 

a bath. As darkness fell there were scattered disturbances, a few 

shots were fired and buildings set on fire, but no-one came near 

the hospital. Judging it too dangerous to venture outside we 

accepted a can of beer from the staff, and settled down to talk 

about their experience of occupation. Our uniforms had been 

taken to be cleaned, by then we stank, and so we were clad in 

theatre greens. Thus it was that General Jeremy Moore found 

us, the collecting section of the PFA, slightly drunk, at 

midnight, when he came to tell the hospital that the war was 

over. 



Looking back 25 years - a naval perspective 

Surg Capt A J Walker 

ex Surg Lt HMS Plymouth 1982 

As a young Surgeon Lieutenant, being sent to sea as Squadron 

MO and deploying to the West Indies in HMS Plymouth was 

to be the highlight of GDMO time. However, all was not to 

turn out quite as expected. Nobody anticipated sailing to war as 

we left Rosyth in mid March 1982. In fact we were to 

participate in major fleet exercises off Gibraltar, replenish and 

head off across the Atlantic to a five-month tour of Caribbean 

islands, Florida and Belize. 

How quickly life can change! We were not to see Gibraltar 

again for some months and by 1 April were heading south with 

a Task Group. Rumours abounded: would we be the Acension 

Island guard ship or the fleet mail ship – after all we were a 21 

year old frigate – a fine old lady, but somewhat dated compared 

with those shiny Type 21, 22 and 42 ships. Life on board 

changed quickly, although we all had a secret hope that a 

diplomatic solution to the crisis (and invasion by 2 April) 

would result and allow us to proceed on our Caribbean tour. 

Firstly, food was rationed to allow a 70-day reserve (in effect the 

choices reduced and the quantity was more portioned), and 

then we began to train hard with fire, NBCD, damage control 

and first aid exercises. Little did we know how important all of 

these were going to be. 

The balmy tropical weather at Ascension saw us in shorts 

rapidly loading war levels of stores and ammunition, before 

detaching south in the van of the Force heading for S Georgia. 

We embarked D Sqn 22 SAS and a Naval Gunnery Spotter 

(NGS), the wardroom lost anything precious and was now full 

of medical stores and F Ident 107’s and 106’s were issued to the 

medical staff. One of the senior rates said that he knew we were 

really going to war when the medical staff began issuing 

individual morphine autojets – items normally kept very 

securely under lock and key and mustered regularly! 

On 14 April, we rendezvoused with the red-hulled HMS 

Endurance who had been hiding around S Georgia. The task 

group ships lined the side to cheer her in quite an emotional 

meeting, and I think her ship’s company were quite glad to be 

once again in company with grey warships. As the weather 

cooled, we neared the danger area and the MO’s from HMS 

Antrim, Plymouth, Endurance, 45 Cdo and RFA Tidespring 

met to discuss the medical plan for action. Tidespring with a 

surgical team on board was to be the Role 2 facility and Antrim 

with her larger sickbay to be the main receiving facility. Blood 

donors were identified and bled to produce a small pool for the 

group as we assessed that we were far enough away from action 

to allow them to recuperate. 

By the 19 April we were at action stations, concerned about 

the submarine threat, and beginning to see icebergs and getting 

used to the southern ocean long swell and high winds. Two days 

later we were off S Georgia. SAS insertions to the Fortuna 

Glacier were hampered by weather and helicopter crashes, but 

Surgeon Capt A J Walker, Defence Consultant Advisor in 

Surgery, Derriford Hospital, Plymouth, PL6 8DH 

suddenly on 25 April we were in action with helicopters firing 

on a surfaced Argentinean submarine. At 14:15 we opened fire 

on S Georgia – the long-awaited war had begun in earnest. 

S Georgia capitulated with only one casualty – a submariner 

who lost a leg when his boat was hit. Lt Cdr Astiz surrendered 

the garrison at Leith in Plymouth’s wardroom and the Union 

Jack and White Ensign were once again flying on sovereign 

British territory. 

The next period was taken up by joining the main Task Force, 

hearing of Vulcan raids on Stanley airfield, being elated that the 

threat from the General Belgrano was neutralised yet devastated 

that HMS Sheffield was hit, burned out and abandoned to sink. 

Finally there were preparations for the landings. Life at sea had 

settled into a pattern and having been blooded at S Georgia, the 

ship was fully prepared and ready. When the mist allowed, the 

sight of the Task Force in convoy – warships, RFA’s and civilian 

Ships Taken Up From Trade (STUFT) was impressive. 

D Day was 21 May. We crept in poor visibility towards the N 

Falkland coast. HMS Antrim opened fire on Fanning Head 

about 01:00 and in what was now a clear, starry night we could 

see the flashes of the fall of her shot. By dawn the first waves of 

Commandos and Paras were ashore and we were in San Carlos 

protecting the huge white liner Canberra, while offering NGS 

support to the landings. The first Argentinian planes appeared 

about 08:45, but it was during the afternoon that the ships in 

the sound came under most intense attack. Having circled 

Canberra with all guns blazing, as her protection, we were sent 

to tow the immobilised HMS Argonaut into the relative safety 

of San Carlos, bringing their battle-weary crew some 

sustenance, support and power (we were later to bury their dead 

at sea in the solemn, highly emotional but very traditional naval 

manner). Later that night, once again on patrol in the Sound, 

we watched HMS Ardent blaze like a large Guy Fawkes beacon 

as ammunition exploded. This was true war – unpleasant and 

hard, but we were steeled to it. 

San Carlos Water was to be our daytime anchorage and we 

came to be comfortable there – we knew the direction of air 

attack and besides out at sea there was the worrying potential 

for Exocet attack! Night-time sorties to land Special Forces 

combined with gunnery serials on Argentinean positions and 

convoy duties for STUFT entering and leaving San Carlos. We 

were able to follow the battle for Goose Green and the land 

advance to ring Stanley closely. Air raids had become routine 

and all was going well. However, on 8 June we were ordered to 

fire on an Argentinian lookout post on Mt Rosalie overlooking 

San Carlos from W Falkland. A raid attacked us just before 

17:00 causing damage to the funnel, turret, after PO’s mess and 

mortar handling room. A fire broke out when a depth charge 

exploded and fires raged in the after portion of the ship 

engulfing the junior rates’ dining hall and the PO’s mess. The 

sickbay had to be evacuated forwards to the wardroom, and 

there we dealt with 5 casualties, including severe smoke 

inhalation and a major penetrating injury to the temporal lobe. 

All the casualties were evacuated to the Red & Green Life 


Machine at Ajax Bay, where I was later to see the host of burns 

casualties from the attack on RFA’s Sir Galahad and Sir Tristam 

the same day. 

Contemporaneous photographs, seen subsequently, make our 

plight look worse than it seemed aboard. We had survived battle 

damage, including a major fire aboard, but power, weapons and 

propulsion were all intact. Superficially we looked very battered 

and required patching up at anchor before sailing for repairs at 

Stena Seaspread where we met with HMS Glamorgan licking 

her more serious wounds from an Exocet hit. Suffice to say, we 

were sufficiently patched up to be back on the gun line by 14 

June and to hear of the surrender in Stanley. The next 48 hours 

were stormy at sea and we rode this uncomfortably – 

accommodation and messing being limited by our internal 

damage. We were honoured to be the first frigate to enter the 

inner Stanley harbour from Berkeley Sound and to be able to 

see Stanley itself for the first time. 

Our return via Ascension Island and Gibraltar was 

uneventful, but allowed a period of de-stressing, tidying of the 

ship as far as possible and a return to more relaxed cruising. Our 

welcome back at Rosyth was overwhelming, arriving under the 

Forth Bridges to the stains of a piper and the Band of the Royal 

Marines, and of course to the masses of families and friends. It 

had been an unexpected, short and intense war from which 

many lessons were learnt, and from which we were lucky to 

return relatively unscathed. 

…and yes I did return to the Caribbean later that year with 

another ship of the Squadron! 

HMS Plymouth following Argentine air strikes 



A personal reflection on the Falklands Islands War of 1982 

JM Ryan OStJ, FRCS, MCh, DMCC, Hon FCEM, Col L/RAMC(V) 

Emeritus Professor of Conflict Recovery, UCL, UK & International Professor of Surgery, USUHS, Bethesda, MD, USA 

Introduction 

On April 2nd 1982 Argentine troops invaded the Falkland 

Islands by sea and air. By April 5th the first ships of the British 

task force had put to sea. Civilian liners and ferries were 

requisitioned as troop ships, and a 200 mile exclusion zone was 

declared on April 12th. In seven weeks a task force of 28,000 

men and over 100 ships was assembled and sailed 8,000 miles. 

The invasion to re-take the islands took place on the 21st May 

– war was joined. 10,000 men were landed on a barren shore 

and within three and a half weeks the Islands were re-taken and 

the war was over. 

The war would create novel problems for the Defence 

Medical Services. Lines of communication and re-supply lines 

were over 8,000 miles. The war would take place in winter with 

virtually no usable buildings or other infrastructure in which to 

locate medical assets, including field surgical teams. 

Personal Background 

In 1982 the author was a 37 year old Senior Specialist in 

Surgery (in modern parlance – a Specialist Registrar) in the 

sixth and final year of higher professional training programme 

and seconded to St Peter’s Hospital in Chertsey. It is worth 

pausing for a moment to reflect on this old and discarded 

training programme. Three years of general professional 

training, followed by six years of higher training had resulted in 

exposure to the generality of surgery. It included postings to 

nine separate hospitals including three NHS secondments to St 

Bartholomew’s, Hackney and St Peters Hospitals with training 

in general, orthopaedic, plastic, neurosurgical, thoracic and 

vascular surgery – an unimaginable variety today. All military 

surgeons in training at that time had very similar training 

programmes. The aim was to produce a surgeon trained in the 

generality of surgery ready to work alone or in small groups in 

field surgical facilities. This system of training probably gave the 

surgeons who would deploy a training edge not available to 

civilian trainees of the period 

This was also the age before war surgery workshops, 

Definitive Surgical Trauma Skills (DSTS) courses and the 

myriad of other training opportunities, including overseas 

secondments, available to today’s military surgeons and their 

teams. Training in the art and science of war surgery prior to 

1982 was not easy. Military surgeons ‘cut their teeth’ during 

secondments to the Military Wing, Musgrave Park hospital in 

Northern Ireland. The ‘Troubles’ were in full swing and a 

generation of surgical trainees worked with an earlier generation 

of military surgery consultants such as Bill McGregor, Bill 

Thompson and Brian Mayes who had learnt their trade during 

a myriad of post colonial conflicts in far flung places like 

Cyprus, Aden, Malaya and Borneo. There was, in short, an 

institutional memory for the surgery of war which would 

become evident as the Falkland Islands war progressed. The 

military surgeon’s bible and almanac at that time was the latest 

edition of the Field Surgery Pocket book edited by Kirby and 

Blackburn and which became essential reading for all deployed 

military surgeons, irrespective of previous experience or colour 

of cloth. 

Medical Support 

Before turning to the main body of this paper – a reflection on 

events - it is worth giving an overview of the medical support 

for the task force which includes the Fleet at sea and the ground 

invasion force. The Medical Branch of the Royal Navy was 

doubly tasked and had the greatest impact on medical 

operations. They had to provide medical support, not only for 

the Fleet, but had the additional responsibility of providing 

comprehensive care ashore for the Marines of 3 Commando 

Brigade, 2 Battalions of the Parachute Regiment and the 

Brigade support elements including special forces and air assets. 

At sea the Royal Navy Medical branch provided what would 

now be described as 1st Role and enhanced 2nd Role assets 

throughout the Fleet and had the additional tasking of 

manning the only hospital ship – the SS Uganda and its 

support ambulance ships tasked with medical evacuation by sea. 

On land each Commando Battalion was provided with 2 

Commando Medical Officers RN and supporting medical 

elements. On the beach head at Ajax bay they deployed the 

Marine Commando Medical Squadron with two Royal Navy 

Surgical Support Teams (SSTs) with their supporting elements 

acting as an Advanced Surgical Centre (ASC). 

The Royal Army Medical Corps provided Regimental 

Medical Officers (Army) to each major field unit (2 to the 

Parachute Battalions) and manning for Regimental Aid Posts 

(RAPs). Surgical support was also provided. Initially this 

consisted of 2 FSTs from the Parachute Clearing Troop of 16 

Field Ambulance RAMC to reinforce the ASC. Later 16 Field 

Ambulance deployed 2 independent surgical teams designated 

55 FST. Shortly afterwards the main body of 16 Field 

Ambulance deployed to provide definitive 2nd Role medical 

support for the forces ashore. 

The Royal Air Force Medical Branch was tasked with aero 

medical evacuation from the theatre of operations – initially 

from the air head at Montevideo and later from the islands. 

While not deploying FSTs the RAF provided comprehensive 

medical support in the air, particularly critical and intensive 

care en route. Their achievements were outstanding – all 

evacuated wounded service personnel survived to reach the 

home base and were received into UK based military hospitals 

– now, sadly, consigned to history. 

A Personal Reflection 

It is strange to look back over a quarter of a century to a war 

that we never anticipated. In 1982 the Cold War still occupied 

our thoughts – and planning. The RAMC were exercised for a 

major conventional, and possibly a nuclear and chemical war, in 

Europe. All worked to a strict military doctrine, which defined 

how medical support would unfold and was based around mass 


casualties and numerous huge Field and General Hospitals. 

There was little flexibility in our thinking. Principles of War 

Courses, run annually, were run by the book. Directors and 

Professors of Military Medicine and Surgery would tolerate no 

discussions. These courses were exercises in Doctrine and 

debate was not encouraged. This author remembers discussion 

concerning Field Hospital with upwards of 600 beds – unheard 

of today. Doctrine defined what would be attempted at each 

Role – then called echelons. Mortality would have been 

appalling and the approach would have been ‘the most for the 

most’, hoping to get as many as possible home to UK based 

hospitals using all means including cross channel ferries. 

What was faced in 1982 was unexpected and appeared to be 

outside planning. This was the first campaign of what would 

become the norm – expeditionary warfare with new doctrines 

and new methods of working – and new expectations. Mrs 

Thatcher’s statement in the House of Commons some years 

later that wounded soldiers in war would get the same 

treatment as the injured in NHS hospitals had not yet been 

voiced. The first Gulf war was undreamt of and later 

expeditionary wars in the Balkans, Iraq and Afghanistan beyond 

our wildest imagination. 

To War on the QE2 

Mobilisation was fast and frenetic, however it was characterised 

by what many medics would still recognise today – an ‘off the 

truck, on the truck’ mentality, shrouded in a fog of uncertainty 

and chaos. The author was assigned to table 2 of 55 FST, 

mobilised in Aldershot. The first named anaesthetist was one 

Major H Hannah. That is until it was realised that this was 

Helen Hannah – a woman. Not just any woman, but the widely 

admired and redoubtable Major Helen Hannah RAMC. This 

caused consternation. The British Armed Forces were not yet 

ready for a woman on their battlefields and she was quickly 

replaced by the equally well known and redoubtable Lt Col Jim 

Anderson RAMC who would soon be appointed OC 55 FST 

with two surgical teams – FST 1 commanded by Major David 

Jackson and FST 2 commanded by the author. 55 FST had its 

origins in the Western Desert and it was a privilege to be part 

of it. The author is sure that other mobilising medical teams 

will have encountered similar headaches. His diary reveals that 

55FST departed Aldershot on the 12th May at 0430 under 

command of Jim Anderson and two hours later embarked on 

the QE2 in Southampton. Work was still under way on the 

helipad and elsewhere. At our first O Group we were told 

without humour that the ship had been re-designated LPLL – 

Landing Platform – Luxury Liner. She put to sea at 1600 hrs 

with no one believing that the team would get much past the 

English Channel. 

The author kept a diary throughout the campaign and it 

helps to illustrate the surreal atmosphere on board. It seemed 

bizarre to go to war on the world’s finest luxury liner. A few 

diary entries reflect the mood on board. 12 May …retired to 

the 1st class bar for large gins at 2100 hrs – retired to bed at 

2330 hrs! 13 May….Lifeboat drill ad nauseum. 15 may …. 

Superb lunches – fresh salmon yesterday – fresh crab today - 

and wonderful wines. 15 May…My first operation at sea – an 

appendicectomy on a young combat engineer – in the QE2’s 

operating theatre. 17 May ….Captain’s cocktail party! It 

became increasingly easy to imagine that all were on a holiday 

cruise, at least for the officers. 

Reality checked in on the when active service conditions were 

declared. The QE2, initially bound for the Falkland Islands, 

now turned away and headed for South Georgia. Why The 

given explanation was a threat from submarines. This would 

lead later to a spectacular insult by the crew of the P&O vessel 

SS Canberra which went directly to the Falkland Islands to off 

load her troops – some time later her crew hung a sheet over the 

side with the ditty – P&O cruises where Cunard refuses! 

Whether Cunnard’s QE2 was not to be risked or whether 

there was a genuine submarine threat is for historians to decide. 

All who cruised on the QE2 retain an enormous affection for 

her (in 1985 while on tour in Hong King the author had a 

chance to reboard the ship and explore familiar surroundings) 

ASC at Ajax Bay 

As one who never left the safety of the ASC (apart from an illfated 

sea journey on Sir Galahad and discussed later) the author 

will confine remarks to the surgical support for the wounded at 

the ASC at Ajax Bay. A Time traveller from the Boer War or the 

First World War would have recognised the ASC at Ajax Bay. It 

was situated in a meat refrigeration factory facing the San 

Carlos Water near San Carlos settlement. It was ideal in many 

respects – vast and open and lending itself to 

compartmentalisation into operating theatres, wards, primitive 

laboratory and living accommodation for staff and supplies. A 

nearby area of open ground facilitated landing by helicopters 

delivering wounded from the battlefields. On the down side the 

ASC was filthy and dusty rendering efforts at cleanliness nigh 

impossible. There were no windows and no air conditioning. 

The building was heated by air pumps delivering hot air. The 

author was still at sea during the initial landings and the 

subsequent battle for Darwin – Goose Green. However, Rick 

Jolly has left a memorable account in the Red and Green Life 

Machine of the outstanding work performed by the Marine 

Commando SSTs and the Parachute Clearing Troop’s FSTs. 

Sir Galahad and The Bombings at Fitzroy/Bluff 

Cove 

A personal reflection from this author must include the 

bombing of the RFA logistic ships RFA Sir Tristram and Sir 

Galahad which took place on the morning of the 8th of June. 

Sir Galahad, carrying Welsh Guards rifle companies and 

elements of 16 Field Ambulance including the two surgical 

teams of 55 FST, arrived off Fitzroy settlement. The ship 

should have anchored in Bluff cove some 5 miles away but 

could not get up the narrow channel to the planned 

disembarkation beach. For reasons beyond this review 

disembarkation at Fitzroy was delayed. Some elements of 16 

Field Ambulance including No 1 team of 55 FST (Major 

Jackson’s team) had got ashore but the remaining troops 

including the author’s team (No 2 team 55 FST) stayed 

aboard. It seems surreal now with the passage of 25 years. With 

the departure of 16 Field Ambulance and David Jackson’s team 

the author and a group of other Officers retired to the 

Wardroom. Lunch was taken and the group stayed in the ward 

room comforted by tots of whiskey, hot coffee and a dubious 

movie on the ward room TV monitor. Sometime later and 

without warning (and the author is still uncertain about 

timings) Sir Galahad and Sir Tristram were bombed by a flight 

of Argentinean fighter bombers. Chaos ensued – those of us in 

the ward room were thrown from our seats by the explosions, 

we were uninjured but were now trapped in a blacked out and 

smoked filled room. We were quickly rescued by a young 

unnamed 2nd Lieutenant in the Welsh Guards who found a 

hatch behind the bar which led out to a passageway going 

forward and out onto the open deck which resembled a melee. 

We quickly realised that a very large number of our comrades 

had been killed and a greater number wounded – most of them 

on the tank deck which had taken a direct hit. Others taking 

the air out in the open were also killed. Among the dead was 


Major Roger Nutbeam, second in command of 16 Field 

Ambulance. Lt Col Jim Anderson, officer commanding 55 

FST and anaesthetist with no 2 team had also been outside and 

was badly injured. All the FST equipment, along with much of 

16 Field Ambulance’s stores was destroyed. The ship was 

abandoned, many, including the author, clambered into 

dinghies and life boats. Others were winched directly off the 

ship by helicopters hovering over the deck. These pilots and 

crews displayed extreme gallantry – the ship was on fire and 

exploding ammunition was propelled skywards towards the 

rescuing helicopters. The survivors came ashore at Fitzroy and 

were cared for by those already ashore. The author well 

remembers being sheltered by WO2 Les Viner RAMC under a 

mound of peat smoking his cigarettes and drinking whiskey 

from his water bottle. For a time at least, the author while safe 

and well was incapable of direct assistance to the on-going 

rescue effort. 

In concluding this episode it is interesting to reflect on the 

accuracy of books reporting historical events even those 

written during or shortly after the event. The author has a 

book entitled “The Scars of War” by Hugh McManners, a 

friend from the conflict. In describing the Sir Galahad episode 

(which was related to him by someone who was in the USA at 

the time of the attack!) Hugh switches David Jackson’s team 

and the author’s – placing the author ashore during the attack 

and with Jackson still on board at the time – the reverse of 

what actually happened. It makes one cautious about veracity 

and accuracy when perusing historical works. 

Return to Ajax Bay 

16 Field Ambulance would stay at Fitzroy settlement with two 

co-located FSTs. One commanded by Bill McGregor who had 

moved forward from Ajax Bay, the other was David Jackson’s 

team from 55 FST. The other 55 FST team (the author’s) were 

on Sir Galahad and lost all their personal and unit equipment. 

They survived and were returned to San Carlos to be reequipped 

and re-positioned in Ajax alongside Royal Marine 

Medical Squadron’s SSTs. The other PCT FST, commanded by 

Charles Batty, was deployed forward to Teal Inlet to support 

operations in that area. Six FST/SST units were now in position 

on land to support the land battles - three at Ajax (two RN, one 

Army), two at Army FSTs at Fitzroy and one at Teal inlet. At sea 

surgical support was in place on the Hospital ship SS Uganda, 

SS Canberra, HMS Fearless and Intrepid. Further surgical 

support was in place on both aircraft carriers. In addition every 

major RN unit at sea had comprehensive on board medical 

support including further SSTs. Thus the scene was set 

medically for the forthcoming land battles. 

Medical Support for the Final Land Battles 

The author’s diary recalls that the final land battles to take Port 

Stanley and force an Argentine general surrender commenced at 

0200 on Saturday 12 June - the entry states tersely “The attacks 

start at 0200hrs – we will be busy by morning.” It would indeed 

be a busy day – the author’s team operated on 16 cases 

commencing at 1030 hrs and ending at 2200. Overall the diary 

records that the three teams (2 RN and 1 Army) carried out in 

excess of 30 procedures without fatality. 12 June was the 

Queen’s official birthday but also the day that HMS Glamorgan 

was struck by a shore based exocet missile – the first time such 

an attack had taken place. The ship survived the attack – an 

evening briefing reported that she was ‘steaming and fighting 

but had sustained serious damage and casualties were heavy’. 

The pattern was now set for the next 4 days – battles for the 

mountains were fought by night with casualties arriving by 

helicopter at the surgical centres at first light. The consequence 

for the wounded was very long delays before evacuation – all 

were hypothermic to a greater or lesser degree on arrival at the 

surgical centres. Anecdotally few were bleeding heavily on 

arrival but warming and fluid resuscitation produced dramatic 

and unexpected recurrence of bleeding. Each day was 

characterised by lengthy lists followed by early to bed with a 

mug of rum and tobacco supplied by Surg Capt Rick Jolly. 

By Wednesday 16 June the land battles were over and Port 

Stanley liberated although it would be a further day before an 

islands wide surrender was signed. Thus began a long wait for 

medical teams – the usual outcome and an example of the 

“hurry up and wait” mentality that will be familiar to readers. 

It was not until Saturday 19 June that personnel were briefed 

leading to low morale and disgust – the army FST personnel at 

Ajax were all Galahad survivors and had been living and 

working in the same clothes for nearly 2 weeks and were now 

stinking. To compound matters the FST was moved from Ajax 

Bay onto the hold of a ship – the Elk – and told to wait in the 

hold. A move to Port Stanley after 24 hours probably prevented 

violence – the FST still held their weapons and ammunition. It 

is curious to reflect on such careless and thoughtless behaviour 

by movements staff – a briefing, even when there are no hard 

facts, still inspires trust and goodwill. It is interesting to hear 

similar reports by medical teams deployed on later missions in 

the Balkans, Middle East and Afghanistan – Plus ce change! 

The Aftermath 

Most medical personnel were quickly back loaded to UK by 

Ship to UK as indeed were most of the fighting troops. This 

cleared the way for fresh units, arriving daily to embark and 

begin garrison duties. The author’s FST drew the short straw 

and stayed pending the arrival of 22 Field Hospital. It was a 

busy period – the FST was the only surgical resource ashore, 

and after the departure of SS Uganda – the only surgical 

resource for the population and garrison on land and at sea. It 

was a busy period - the local population had been virtually 

without hospital medicine since the invasion. In addition a 

number of incidents with mines and missiles kept the casualties 

coming. 

As elements of 22 Field Hospital arrived in small packets – so 

the FST slowly disintegrated. It was quite sad not to have been 

stood down as a unit and to have returned to UK together. On 

a positive note the slow draw down did allow the group time to 

readjust to peace, to travel a little and to see the beauty of our 

surroundings – something not possible during the conflict. 

Conclusion 

The war in the Falklands was a watershed. It had more in 

common with the past than with wars and conflict of the 1990s 

and the 21st century. It harked back to the Great War and even 

the Boer war. Medical support was austere and minimalist. 

Never again would surgical teams operate in disused factories 


dressed in KF shirts with no gowns or theatre linen. Ashore 

there were no imaging, ITU, and less laboratory support than 

was available during World War 2. Yet it worked. Rick Jolly 

reported that only two people who arrived alive at surgical 

centres subsequently died. It is worth considering how different 

things might have been if the support ship Atlantic Conveyer 

had not been lost with a tented field hospital, support vehicles, 

heavy medical equipment and dedicated medical helicopters. 

Casualties would have been lifted off the battlefield much 

earlier and many, with very severe injury, would probably have 

survived to reach surgery. The effect might have been to reduce 

the killed in action (KIA) rate but it is sobering to reflect that 

this would likely have driven up to died of wounds (DOW) rate 

in the forward hospitals. 

References 

Jackson DS, Batty CG, Ryan JM, McGregor WSP. The Falklands war:Army 

Field Surgical experience. Ann R Coll Surg Engl 1983;65:281-285 

Marsh AR. A short but distant war- the Falklands Campaign. J R Soc Med 

1983;76:972 

Shouler PJ, Leicester RF, Mellor S. Management of infections and 

complications during the Falkland Islands campaign. In: Gruber D et al, Eds. 

The pathophysiology of Combined Injury and Trauma. London: Academic 

press Inc(London) Ltd, 1987:43-51. 


CAMPAIGN MEDALS 

South Atlantic Medal 

Obverse 

Reverse 

Size 

Metal 

Ribbon 

The crowned head of the Queen facing right surrounded by 

Elizabeth II DEI GRATIA REGINA FID. DEF 

Armorial bearings of the Crown Colony of the Falkland Islands 

and its dependencies, encompassed by the legend, SOUTH 

ATLANTIC MEDAL and sprigs of laurel. 

36mm diameter 

Cupro-nickel 

32mm wide, shaded and watered bands of blue, white, green, 

white Blue. 

The small white metal rosette signifies that personnel served ashore or afloat below 

35 degrees south or who flew operationally below Ascension Island. 


The 1982 War Memorial

Falklands war 25TH anniversarY - Boekje Pienter

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