Falklands war 25TH anniversarY - Boekje Pienter

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THE FALKLANDS WAR 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
FALKLANDS WAR 25th ANNIVERSARY 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, 74 JR Army Med Corps 153(S1): 74-77
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training of trauma surgeons within
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FROM THE EDITOR In 1982, the editor
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Pebble Island - 14 May Boat troop,
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