Front-line medicine: The battle zone innovations helping to save lives in Iraq and Australia

General surgeon and burns specialist Michael Rudd and orthopedic surgeon Major Jay Dave are both based at the medical facility at Camp Taji, Iraq. Photo: Gary Ramage Prime Minister Malcolm Turnbull during his visit to Taji Military Complex to visit troops from Task Group Taji, on Saturday. Photo: Alex Ellinghausen

Dr Rudd and Dr Dave are specialist reservists. Photo: Gary Ramage

Australia has ‘stepped up’ the fight: US

Camp Taji, Iraq: “This is another thing that’s different about working here,” says orthopedic surgeon Jay Dave.

He points to a bullet hole in the wall of the mobile hospital. On New Year’s Eve, a stray round from celebratory gunfire somewhere outside the camp where Australian soldiers are based pierced the tent wall. By spectacular chance it landed not just in the operating theatre but on the room’s sole bed.

Fortunately there was no one there at the time, but it highlighted just how unpredictable a place like Iraq is for medical staff to work in.

Dr Dave, who usually works at the Liverpool Hospital, works alongside Michael Rudd, a general surgeon and burns specialist from the Royal Brisbane.

Both reservists, they form part of the team that stands by to treat the shocking injuries that happen on the modern battlefield – gunshot wounds, burns, lost limbs from “improvised explosive device” or IED blasts. Medicine in war zones has advanced to extraordinary levels, such that the hospital at Kandahar base in Afghanistan – where Dr Rudd has previously worked – offered wounded soldiers who arrive with a pulse a better than 98 per cent chance of survival, whatever their injuries.

The trauma ward for Task Group Taji, made up of about 300 Australian and 100 Kiwi soldiers, is smaller and a little more basic, but it is finely calibrated to tackle the kinds of injuries expected on the mission to train Iraqi counterparts. As well as the operating theatre, it has a two-bed intensive care unit, some diagnostic equipment such as X-rays and a reliable supply of donor blood.

Last week, the doctors treated the young soldier who accidentally shot himself through the leg, causing serious injuries. He was stabilised and then flown to Landstuhl hospital in Germany.

The trauma ward is housed in a tent that can be erected and equipped from shipping containers in less than a day.

“What we do now is a product of being at war for the last 14 years,” Dr Rudd said. “The management of the injured on the battlefield with the tourniquets, the system that we use to evacuate wounded from the battlefield, the way we resuscitate patients with whole blood or reconstituted whole blood, the types of surgery that we do, the whole philosophy of what we call ‘damage control surgery’.

“It’s the sum of all of those improvements that have reduced the rate of preventable deaths on the battlefield by a couple of hundred per cent. Everything we do now is based on evidence gleaned from the decade of experience.”

In fact military medicine innovations – such as resuscitating patients with blood rather than water-based fluids, the length of surgery times, the importance of patient temperature and circulation – have started to be adopted in civilian care, Dr Rudd said.

The carefully studied way of treating soldiers stretches from the immediate moments after injuries happen, through damage control surgery and stabilisation in a place like the Taji hospital, to being transported to a major hospital such as Landstuhl.

In an age where IEDs are a favoured weapon of insurgents, the humble tourniquet has proved singularly effective. Every Australian soldier goes through refresher first aid training before they arrive in a conflict zone such as Iraq or Afghanistan, and much of the time is spent on how to use the tourniquet. Every soldier carries one strapped to the front of their body armour vest.

“In terms of saving lives and limbs, it’s the biggest innovation,” Dr Rudd said.

Dr Dave said that one advantage of treating young fit men is that they are more robust and quicker to heal.

“They can endure a little bit more blood loss, they can endure a little bit more hypothermia, which often happens as they’ve been transported from the field. They do bounce back very quickly. They are very keen in their rehabilitation, they want to get back on their feet as soon as they can. They do bounce back.”

Over in the ICU, Major John Skipp, who heads the unit, cites the endless battle with dust as one of his many challenges.

“If it starts building up, you have issues with infection control,” he said. “You can’t keep it out. So it’s just a matter of cleaning a lot.”

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