Liverpool Medical Institute Event “Then & Now” This took place last week and a few of us were able to attend. This event was in collaboration with 208 Field Hospital (Volunteers) and the lectures were delivered by them.
The car park had two field hospitals installed, the first being a recreation of a WW1 Field Unit with a tunnel leading to the second unit which was present day. As a nurse it was fascinating to hear the soldiers in each give graphic descriptions of treatment options of their times. I made notes but was so absorbed that some of them don’t make sense when I read them back!
Here are a few items for each era
1914-Typhus was the biggest killer in the trenches. 60% of wounds were caused by shrapnel (there were 200 lead balls in each shell), 35% by gunshot wounds. The remaining 5% were from small weapons such as grenades and bayonets.
In 1914 a soldier receiving a leg wound had a 20% chance of surviving. In 2014 the survival rate is 98%. The Thomas splint was the most influential treatment introduced but unfortunately it was not available to the army until 1917. There were 3 tallys a patient could be given on reception at the 1914 field hospital.
1). For Surgery 2). Resuscitation > blankets, brandy and warm fluids rectally. 3). Moribund> taken to a quiet tent and given comfort until they died.
Experience in wound management was most recent from the Boer war which was in the veldt with dry soil and hot conditions but wounds did not become infected to the same degree. The WW1 trenches were in muddy, manure rich soils full of bacteria which penetrated the wounds and gave rise to anaerobic infections which of course could not be treated with antibiotics at that time.
In 2014 there is delayed primary closure technique to avoid infections, also negative pressure machines which suck out exudate. Also, there are tailormade dressings and silver lined dressings.
In 1915 one base hospital could have 14.000 beds. Patients were evacuated by field ambulances, barges, trains and boats, all of which were uncomfortable and took some time to return to the UK. Locally there were 4,500 beds in Fazakerley, 16,000 in Manchester and Lord Derby had 3313 beds in Winwick.
In 2014 all soldiers carry a tourniquet in a pocket on their sleeve, in each patrol there is a soldier with additional first aid training. Medical Emergency Response Team (MERT) are the first line, if necessary evacuation is by Apache helicopter to the hospital at Camp Bastion and Hercules plane back to Birmingham to the specialist military hospital.
The biggest challenge is to power all the electrical equipment in Camp Bastion, there are two CT scanners and every patient has a scan, but they can only run one at a time because of the power needed. I was amazed to find the army has only been using GPS since 2007 when they went to Afghanistan.
In 1914 most of the injured were soldiers. Now many of the injured are local, including children. This presents ethical challenges and very difficult situations.
In the future it is possible that supplying base hospitals will be very different as with 3D printing limb casts etc. could be created individually, as an example. Truly mind-blowing!
The last word I felt had to go to Major Andrew Parry, a nurse who was second in charge of the Emergency Dept. at Camp Bastion in 2007 , 2011, when he reminded us of the inscription on a Belgian medal issued to nurses who served at La Panne in WW1.
“Sometimes cure, console, always comfort.”