Changes in the care of the battle casualty: Lessons learned from the Falklands campaign

Military Medicine,  May 1999  by Batty, Charles G

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In the Falklands War, advanced surgical centers were set up and 241 patients underwent surgery. There were three deaths. The patterns of wounding, method of casualty management, and lessons learned are discussed.

Introduction

The necessity to maintain the fighting strength and morale of an army by removing the dead and wounded from the battlefield has been recognized by good military commanders for nearly 2,000 years. The German military strategist von Clausewitz described the battlefield as the realm of danger, with soldiers affected by what he described as its "four elements": danger, exhaustion, uncertainty, and chance. Medical officers and their teams are not immune. Indeed, during the recent Persian Gulf conflict, a senior U.S. military doctor amusingly remarked, "What our city slicker medical friends have got to realize is that in war it is not the four or five doctors and one patient in a modern resuscitation room, it is more likely to be four or five casualties and one doctor working under arduous field conditions." So it was in the Falklands War. Many of the practices used then are just as important today.

"Those who cannot remember the past are condemned to repeat it"1 is an often quoted dictum that remains pertinent today. We in the Royal Army Medical Corps have the "advantage" of an ongoing terrorist campaign in Northern Ireland to remind us of these early lessons.

In May 1982, U.K. doctrine and training had been with the cold war in mind and Europe as the battlefield. The Falkland Islands were some 8,000 miles away, with such a distance's problems of casualty evacuation and resupply, with long lines of communication, and relative lack of surface transport. The medical support, therefore, had to be self-sufficient.

The Task Force set off carrying 3rd Bn The Parachute Regiment and Royal Marine Commando, and a few weeks later a converted North Sea ferry sailed from Portsmouth with 2nd Bn The Parachute Regiment and the Parachute Clearing Troop. This latter unit comprised 36 parachute-trained men: two field surgical teams (FSTs) of 9 men each and a holding section of 18 men, which included male registered general nurses, combat medical technicians, clerks, and radio operators. In addition to their personal kits, they carried between them, in their bergans, enough equipment to perform 10 major surgical procedures and look after the patients. The remainder of their equipment was secured on pallets, and with that another 50 patients could be treated before resupply was required. This unit could be deployed rapidly to buildings or tents, where they could quickly set up and start work.

On the way south, in preparation for what lay ahead, physical and military training were carried out; the former was undertaken at every opportunity around the decks, with the troops carrying realistic loads so that they were physically fit and strong. Because Advanced Trauma Life Support techniques were not universally taught, an intensive first aid training program was instituted to increase the soldiers' knowledge and skills, with the emphasis being on self-aid rather than on buddy aid if wounded. It was important that the soldiers understood that the attack had to be completed and not falter through a lack of momentum.

Ajax Bay Advanced Surgical Center

On the May 21, 1982, an unused slaughterhouse and meatprocessing plant was taken over at Ajax Bay on the southern shore of San Carlos Water. The building was well insulated with cork and concrete walls but was devoid of heating, water, electricity, and ventilation. Access into it was limited to two doors, one at either end of the building. This was to become the advanced surgical center (ASC).

Surrounding the building was a rough, sloping, marshy terrain extending from the nearby hills to the water's edge. Helicopters were able to land at various sites at this location. This whole area became the brigade maintenance area, into which the ammunition and other stores of war were offloaded before being moved to the front line. For this reason, no red crosses were displayed on the building or by the medical personnel. For our own protection from air raids and possible exploding ammunition in the event of a successful strike, foxholes were dug.

On arrival, the surgical teams set up the MacVicar operating table-a light, robust tubular structure-along with its lights, which were powered by a small generator. The stores were brought up from the beach and put readily to hand. Soon afterward, the Royal Naval surgical support team arrived and similarly set up. The building had a number of cavernous rooms into which were organized areas for reception, triage and major resuscitation, minor treatments, wards, and living accommodations.

In the middle of the building were two smaller rooms containing many girders and rails from which the animal carcasses used to hang. These rooms were considered to be the safest and so became the operating theaters: one housed the two Parachute FSTs and the other housed the Royal Naval team. Despite all efforts to clean the place, the building was incredibly filthy from the concrete dust and dirt. In the two theaters, the meathanging rails were just at the right height to be knocked, and a shower of rusty flakes would fall into the operating field. Polyethylene sheeting was wrapped around those parts of the rails that overhung the tables to minimize further wound contamination.