Medics deal with frontline bomb and gunshot wounds

LEAVING the comfort and safety of their own homes for the dangers and cold of Afghanistan a team of nurses, doctors and surgeons are on hand 24 hours seven days a week ready to administer life-saving care to the wounded.

Manning Camp Bastion's Role 3 Hospital is 243 Field Hospital – a volunteer regiment made up of medics from across the South West, a large selection coming from Plymouth.

Some of those working in the state-of-the-art facility are Plymouth medics Corporal Simon Marshall, Captain Ian Inch, Corporal Kate Pomeroy, Warrant Officer Kevin Cross, Sargeant Debbie Evans and Major Rose Chapman.

The team have been in Afghanistan since October after being mobilised by the Territorial Army (TA), missing Christmas and New Year.

Although Christmas was another routine working day, personnel had the chance to enjoy some festivities including a carol concert and karaoke.

It was swiftly back to work for the team, and many of 243 Field Hospital will begin transiting home in the next three weeks having finished their stint in Camp Bastion.

In this last week they have had casualties with double amputations to the legs after treading on Improvised Explosive Devices, gunshot wounds to the head and pelvis, as well as suspected 'Helmand fever' and gastroenteritis.

Since October the team have had more than 680 casualties through the doors. When a British casualty comes into the hospital it's one of Capt Ian Inch's jobs to begin the notification of the casualty process.

Capt Inch, from Laira, who ordinarily is the manager at Drill Cut Ltd, explains: "When we get a seriously injured UK soldier we really need to be trying to tell the family within two hours of him coming in."

When a UK soldier is injured or killed Op Minimise comes into place. This protects the family of the individual from finding out by means other than a notification officer coming to their home.

Whilst this is in place Capt Inch starts the process by informing the Joint Casualty Compassion and Control Centre. From here he is expected to update them on the casualty's condition and prognosis whilst writing a report for the family. It's his role to ensure all of the medical terminology is put into simpler English so when reading the report the family can be well-informed of their loved one's condition.

"With certain casualties we let them tell their families themselves instead," he explains. With conditions such as fractures, simple flesh wounds and single trauma the casualty can often be best placed to tell their loved ones. The married father-of-two, who has been in the TA for 29 years, is often with the casualty when this is done.

He added: "When they come out of theatre they can call home. They tend to say 'mum I've been shot', and then mum is really upset but then they say 'but mum I'm talking to you'. The casualties can quite often be in an emotional state as they come to terms with what's happened."

Corporal Simon Marshall, from Mainstone, is one the hospital's Operating Department Practitioners. He supports the surgeons in theatre and also during the initial treatment when casualties come in.

The 46-year-old TA soldier works at Derriford Hospital when he's not mobilised on military operations.

He describes his role as similar to a theatre nurse. He said: "Here we also help assisting the anaesthetist and support airway management working at the head end of the patient.

Gunshot wounds

"Major trauma is the main thing we deal with. We get gunshot wounds, IED blast and shrapnel injuries and road traffic accidents. At home in Derriford I don't normally deal with trauma."

Cpl Marshall first joined the TA as a combat medic before training at Plymouth University to be an operating department practitioner.

As the hospital is much smaller than Derriford it is easier to track progress of the casualties that come in.

"We are quite a close hospital and we get to find out how patients get on – there is quite a lot of satisfaction knowing you have been involved in saving the patient's life," he added.

The father-of-one said he often thinks about one British soldier the team couldn't save despite their very best efforts. "He came into theatre and despite everyone working on him for a long time there wasn't anything else we could do to save him. I thought about it after and reflected on it, but the following day we just had to carry on. When things like this happen it can often affect the whole hospital."

But it's not just soldiers and civilians the hospital team fight to save.

Cpl Marshall explained: "We were expecting a casualty to come in, there was a team on the door and all we knew is the patient had been involved in an explosion. When the casualty arrived it was one of the working dogs. I was again at the head end giving it oxygen as the rest of the team worked to save it.

"It's been an amazing experience, I've learnt a lot but I'm looking forward to getting home and seeing my daughter Lia."

Operating in a warzone as an arms instructor and operations ward master is a far stretch from Kevin Cross' day job as the man who schedules the First buses in and around the city.

The Warrant Officer from Saltash deployed to Afghanistan with 243 Field Hospital to take on the running of Camp Bastion's main hospital facility.

He and around 50 others were mobilised by the Territorial Army in August to begin preparations to leave in October.

Married with three children, a step-daughter and a step-grandchild, he has swapped his 9-5 job for seven days a week working 6am to 7pm.

He said: "I've enjoyed my career with the TA – it's not often you get the chance to have a second career."

Helicopter 'nine-liners'

One of his roles includes putting the information of incoming casualties into the hospital computer systems from helicopter nine-liners – snippets of vital details about the patient.

"When we get a nine-liner for a medical case on the ground I start entering the details into the computer system to HR and the Emergency Department so they can start pulling the team together – for instance if we get a Category A casualty they can then send for the trauma team." Another of his roles in theatre includes keeping higher command aware of the types of injuries coming in and statistics for the numbers of injuries. He also informs the Red Cross who run a hospital in Kabul of the issues on the ground that they may need to be aware of.

WO2 Cross said: "I've recently been asked to prepare some figures looking to advising the Afghans what sort of medical facilities they require as we begin to draw down our involvement here."

Just before Christmas the Prime Minister announced troop levels would be dropped from 9,000 to 3,800 as the Afghan security forces begin to take further responsibility for security in Helmand province. By the end of next year it is intended all UK combat troops will be removed.

But with the current hospital facilities providing some of the best trauma care in the world it's important the Afghans are prepared for carrying on the emergency care their forces and civilians will need in the future.

Deployed Medical Director of 243 Field Hospital, Colonel Rob Russell, said the training and mentoring of the Afghan medical services has been a key element of the hospital's work this time. He explained: "It's one of the things we have majored on here in the last three months. We have nurses and doctors over to the medical centre at Shorabak , the Afghan camp next to Bastion twice a week. The previous deployments have done a good job starting it but we've really built on it.

"We are now starting to get some of the [Shorabak's] guys back here to do some further mentoring but it's difficult showing them in the context of what they can do – clearly they don't have advanced technology like CT scanners and won't have for a long time."