Trauma Medicine

In the first of two programmes Dr Kevin Fong looks at how wars and conflicts have helped to drive emergency medicine in the 21st century, both on and off the battlefield. Drawing on his own experiences as a junior doctor at the scene of a terrorist bombing in 1999, through to his current job, flying on the UK's air ambulance service, Kevin discovers how the challenges of the past continue to shape the future.

Kevin meets one of the fathers of emergency medicine - James Styner, an American orthopaedic surgeon, now in his 80s. His realisation - in the 1970's - that trauma care was in desperate need of revolution didn't come out of research or clinical trials, but in the wake of tragic and terrifying events. It began with a plane crash: Jim as pilot, his wife beside him and his four young children sleeping in the rear. When bad weather caused him to lose altitude, the plane crashed into trees at 168 miles per hour. The resulting scene was horrific: His wife was killed on impact, three of his four children lay unconscious and Jim himself was badly injured. In the dark and with temperatures dropping rapidly, Jim dragged his kids out of the plane, searched for his wife's body and then made his way through the woods to the road where he eventually flagged down a passing car.

However, as Randy and James explain, once at the local hospital, their problems continued. Horrified to discover that the local doctors were largely unprepared to deal effectively with the traumatic injuries his children had suffered he vowed there and then to make amends. "When I can provide better care in the field with limited resources than my children and I received at the primary facility, there is something wrong with the system and the system has to be changed". James Styner went onto develop the first systematic approach for dealing with severe injuries - ATLS or Advanced Trauma Life Support. This approach has transformed trauma medicine and is now taught in over 50 countries. It has undoubtedly saved countless lives and was what Kevin, as a junior doctor, relied upon to get him through the shock of attending the scene of the London Soho pub bombing, 15 years ago.

It was those experiences that again came to mind when Kevin met medical workers in Boston who attended to the victims of the marathon bombing in 2013. One of those on duty that day was Ricky Kue of Boston Medical Center: "After the blast, I had this gut-wrenching moment where everything just sank in my body and I realised what we'd always trained for and what we thought would never happen, just did".

In the course of the programme, Kevin speaks to other trauma specialists who have attended horrific events, such as terrorist bombings or major railway disasters. What becomes clear is that whilst these incidents as awful as they are, don't always drive the evolution of trauma care as in Styner's case, they do nevertheless, serve a purpose. They benchmark the system, revealing its strengths and weaknesses, showing us from a medical standpoint, what the state of the art in trauma care at that time is capable of and asking whether we have learnt the difficult lessons of the past.

Please note: both programmes in this series have been re-versioned and were originally broadcast on the BBC World Service earlier this year.

Kevin Fong explores the development of trauma medicine through conflict and catastrophe.

Dr Kevin Fong explores the development of modern trauma medicine.

In the second of two programmes exploring the evolution of trauma medicine, Dr Kevin Fong travels to Afghanistan to meet the medical teams in Camp Bastion and discovers how the hospital there has become the most successful trauma centre in the world - saving the lives of servicemen and women who, in the past, would never have survived their horrific injuries.

They call them "The Unexpected Survivors". The casualties from the war in Afghanistan whose injuries were so severe that they weren't expected to survive, but who survived nevertheless. And since 2009, the number of those survivors has increased to such a level that the standard tools for measuring or scoring trauma injuries as a means of predicting survival, no longer apply. This is part of the medical legacy of ten years in Afghanistan. But how did that come about? And what lessons can be passed on to help casualties in civilian hospitals in the UK and around the world?

Kevin Fong begins at RAF Brize Norton, in Oxfordshire, where, with unique access, he joins medical teams on a week-long training course for MERT - the Medical Emergency Response Team service that operates from a Chinook helicopter in Camp Bastion. More than just an air ambulance, the MERT is a mobile resuscitation unit, flying nurses, paramedics and for the first time in modern warfare, doctors right into the heart of battle to rescue and treat casualties soon after injury.

One of those is doctors is Surgeon Commander Dr Kate Prior who first trained to go ou to Afghanistan in 2009 when the fighting was at its fiercest: "it was busy, we knew it was busy and the MERT was going out several times a day. We we were seeing an awful lot of amputations, patients who'd lost one leg, two legs, sometimes two legs and an arm. And so I knew what to expect. But nothing prepares you for the first real casualty that you see".

MERT is impressive but it is only one link in the chain of care so to discover how the system operates as a whole, earlier this year Kevin travelled to Camp Bastion in Afghanistan with one of the last medical teams to deploy out there on Operation Herrick 19. Now as military medics return to the UK, can success on the front line translate to the emergency departments on the home front?

Dr Kevin Fong travels to Afghanistan to meet the medical teams in Camp Bastion.

Dr Kevin Fong explores the development of modern trauma medicine.