Report - 13th December 2011

Professor Jeremy Owen: The Chain of Care - what happens after something goes ‘Bang’!?

Professor Jeremy Owen is the Deputy Defence Postgraduate Dean, Defence Medical Corps, and Consultant Advisor in Occupational Medicine (Army). He gave a graphic account of the cost of war in Afghanistan for UK Military Operations, not just in financial terms, but in lives lost and wounded. His talk was illustrated by many pictures of action in the field in Afghanistan, and the dangers and working conditions faced by British soldiers out there. In particular he focussed on the devastating effect of land mines, for those both killed and maimed. The Chain of Care described the ‘Platinum 10 minutes’ when rapid action could save lives and limbs following an explosion, the ‘Golden hour’ when medical emergency response teams were called in, and the following events in Camp Bastion Hospital. The importance of judicious use of tourniquets (he brough along an example) in saving limbs was paramount to later clinical outcomes.

Later repatriation was to the Royal Centre for Defence Medicine in Birmingham and the Queen Elizabeth Hospital, and the Defence Medical Rehabilitation Centre at Headley Court. The latter has about 120 new admissions/ year, but increasing re-admissions for patients with very complex trauma. Improved medical rescue has meant that there are many more unexpected survivors with very severe injuries - for example in 2011 they had 22 triple amputees. Professor Owen described how the DMRC slowly got patients back on track and back to work in a large number of cases - for example, the medial time for a return to work is 6-9 months, although the average time before a patient was discharged from DMRC following wounding was 3 years. He gave inspirational stories of people’s courage and determination to lead normal lives, and even to go on to take part in sport at national and international levels. Finally, he left us with the thoughts of what happens to the Afghans themselves - many more are killed and wounded, and they do not have the same level of rescue resource available to them.