Waking up in intensive care

Waking up in intensive care can be a very disorientating experience for a soldier, whose last memory may be of coming under enemy fire.

Unconscious or under heavy sedation in their beds, some soldiers have flashbacks of their attack and can be heard shouting and tossing about in their sleep.

Their immediate reaction upon waking is to think they're still in the danger zone on the battlefield.

“A lot of them wake up asking where their rifle is," says Erica Perkins, manager of the critical care unit at Queen Elizabeth Hospital Birmingham (QEH), part of University Hospitals Birmingham (UHB).

This article was part of a special report on military healthcare.

"They think they're still out there. If they see relatives, they warn them to stay away, saying they’re not safe.”

After regaining consciousness, it can take up to 24 hours for them to accept that they’re back in the UK and away from enemy fire.

By that time they will have spent days or sometimes weeks shifting in and out of consciousness, oblivious to their surroundings, medical staff and visiting family.

Patient diaries

To help fill in the blanks, nurses have begun to keep patient diaries for the soldiers, recording details of their time spent in intensive care.

“Seriously wounded patients are usually unconscious or sedated when they arrive at QEH and become disorientated when they wake up,” says Perkins.

Some may have little or no recollection of what has happened to them following their injury on the battlefield.

“They struggle with having lost this time from their lives,” says Perkins. “The last thing they remember is being under attack.”

The diaries, which have been used with good results in critical care settings throughout the NHS, were introduced for injured armed forces personnel in 2008.

The entries record the different stages of their care, from their initial treatment at a field hospital to the flight back home and their time in critical care.

“We don’t put in anything medical, only simple things such as whether they’ve had a good day or a bad day, who’s cared for them and who’s come to visit them,” says Perkins.

“We ask family members to contribute as well. Soldiers read them over and over again. It helps to put their experience into perspective. It fills the gaps for them.”

Waking up in unfamiliar surroundings is hard enough but often patients must also come to terms with life-changing injuries and survivor’s guilt.

“When they wake up some will slowly remember what happened to their mates,” says Perkins. “When it sinks in they can become withdrawn.”

Patients will go through a variety of emotions on the ward and have good days and bad days.

Once they're stable and no longer require breathing assistance they are transferred to the most appropriate ward for their ongoing treatment and the start of their rehabilitation.

Healing process

The military ward at QEH is a busy trauma ward with restricted access, where NHS and military nurses work side by side caring for both civilian and armed forces personnel.

Military patients are grouped together, when clinically appropriate, in one section of the ward, where there are up to 30 beds at their disposal.

Staff try to create a military atmosphere for armed forces patients, which is believed to help with the healing process.

Military ward manager Squadron Leader Lesley Adcock says armed forces patients feel more comfortable in a military environment.

"That way they don't feel lost," she says. "They've come from places like Afghanistan onto a hospital ward and they see military staff again."

Kelly Parslow, a trauma nurse, agrees. “What helps is that they're in a place where there are other patients who have been through similar experiences.”

The benefits to the patient of being able to engage in typical army banter can't be underestimated. “They bounce off each other,” says Parslow. “They can talk about what they've gone through and it helps them get over it.”

Sergeant Mark Sutcliffe, who spent four months at UHB after losing his lower left leg in Iraq in 2006, says the banter “was what helped us get through each day”.

Sergeant Sutcliffe is full of praise for the nurses at UHB. “They looked after me very, very well. There was never a point when the clinical care wasn’t good enough.

“I have to thank them for saving as much of my leg as they did,” he says.

Physiotherapy

On a typical day patients are woken at 7am and given their morning drugs before breakfast.

Then they get washed. As armed forces members, they're expected to maintain high standards of personal hygiene, which includes shaving.

They may have a physiotherapy session before or after lunch. During the afternoons they’re usually free to receive visitors or go on accompanied group trips into town.

“We start their physiotherapy as soon as possible,” says Parslow. “We have to get them moving to limit muscle wastage.”

Early rehabilitation also lifts their mood. “It shows them that they’re making progress and it makes them more determined.”

For the nurses, whether military or NHS, there is great personal satisfaction in helping military patients recover.

“Seeing them brought in on a bed and unable to move and then seeing them walking out of here unaided is really rewarding,” says Parslow.

Sergeant Sutcliffe says the nurses are great morale boosters. “At no point do they feel sorry for us. They are all about encouraging us.

“All military patients are determined to get their lives back. My ultimate goal was to walk again.”

There was no room for self-doubt. “I would not give my attackers that satisfaction,” he says. “It would be like letting them win.”

Page last reviewed: 16/06/2013

Next review due: 16/06/2015

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