In the darkness, the paramedics can just make out the bulky silhouette of an RAF C-17 Globemaster, its wing lights flashing as it touches down.
The C-17 brings home injured servicemen and women, including those critically wounded, from the world’s most dangerous war zone.
During the 14-hour flight from Camp Bastion in Afghanistan a team of RAF medical staff works non-stop to keep critically wounded soldiers alive.
The medical crew waiting on the tarmac at Birmingham International Airport is a mix of military and NHS staff. They quickly take the soldiers to Queen Elizabeth Hospital (QEH) escorted by police.
From the moment notification is received that armed forces personnel are being airlifted home to the UK for emergency treatment, a carefully co-ordinated procedure begins.
By the time a severely wounded soldier arrives at the intensive care unit in Birmingham, a team of consultants from different medical fields is in place, ready to begin life-saving treatment.
The evacuation process involves a smooth transition of care between military medics and their NHS colleagues with the support of the police and the airport authorities.
“The transition is incredibly efficient,” says Group Captain Wendy Williams, head of the Royal Centre for Defence Medicine (RCDM), which is based at QEH.
“The medical teams have fantastic support from the airport authorities, the West Midlands Ambulance Trust and the West Midlands Police, who escort the ambulances through traffic.
“I’m proud of the roles that military and NHS staff play in saving the lives of service personnel.”
Severe injuries
Since 2001, University Hospitals Birmingham (UHB), which includes QEH, has been the main receiving centre for UK military casualties wounded in overseas operations including Afghanistan.
“Care on the battlefield has improved so dramatically that soldiers now survive injuries they could not have previously,” says Group Captain Williams. “Birmingham deals with some extremely complex and challenging injuries.”
She says the decision for acute care to be provided by the NHS was taken because it made sense both for military medical staff and military patients.
“Military medical staff gain far more experience and maintain their skills better by working in busy NHS hospitals,” she says.
“Patients also do better when treated by clinical teams who have experience in dealing with their particular problems. The old military hospitals were too quiet for clinical teams to gain this experience.”
Severe injuries include multiple fractures, amputations, loss of sight or hearing, brain injury and sometimes a combination of all of these.
“Patients' medical needs are best served by having access to a busy acute care hospital that deals with severe trauma on a daily basis,” says Group Captain Williams.” We would never have been able to deal with the level of trauma in our old military hospitals.”
“We’re in the best place to make sure that our patients get world-class care. The combination of military and civilian staff working in partnership is the right model of care.”
Complex treatments have better results if they are performed by healthcare professionals who do that procedure regularly. UHB and RCDM have surgical specialists who are skilled in treating every type of injury.
An independent report in 2008 by Parliament’s Defence Committee concluded that, together, the RCDM and the NHS trust were providing “world-class care”.
Military atmosphere
In response to those who feel the loss of the military environment, the RCDM has introduced measures to promote an armed forces atmosphere.
Depending on the type of treatment they're receiving, most military patients are grouped together in the same trauma ward, which is staffed by both NHS and military medics.
Patients get regular visits from military liaison officers, whose duties include dealing with their day-to-day needs and maintaining links with the patients’ units.
Group Captain Williams says recognising the specific needs of military battle casualties and their families has been crucial in making the partnership with the NHS a success.
A medical file is created for every military patient injured on overseas operations and their progress is closely monitored until the completion of their treatment, using a system called the Defence Patient Tracking System (DPTS).
“Treatment can take several months and involve several stages, including follow-up hospital appointments and rehabilitation,” says Group Captain Williams. ”DPTS ensures that the different stages of patient’s treatment is seamless.
“The system ensures that no patient falls through the cracks and that they don’t feel like they’re being abandoned at any point during their treatment.”
A rigorous handover process between the military and the NHS is in place for patients whose injuries mean they are no longer fit for military life. The Seriously Injured Leavers Protocol (SILP) aims to ensure that the transition from military to civilian healthcare is as smooth as possible.
For Group Captain Williams, one of the strengths of military medicine is the teamwork. All three services (the Royal Navy, British Army and Royal Air Force) work together for the benefit of the patient.
“Our NHS colleagues have joined this team effort in a continuing effort to build on our mutual strengths,” she says.
