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Nursing, Trauma and War

'For Queen and Country'

Traumatic injuries and disease are an inevitable threat in war. Even the armies of antiquity understood the value of diet, exercise and the need for a medical service to support them in battle.

Over the centuries each conflict has provided a unique injury pattern and new medical challenges. In 216 BC at Cannae, 50,000 Roman soldiers died from sword, spear or arrow wounds within 1000 yards of battle. Gunpowder discovery in the 14th century and the invention of firearms in the 15th century caused ballistic and blast injuries. Improvised explosive devices (IEDs) used in Iraq and Afghanistan caused extensive blast injuries to lower limbs. Nursing the wounded has been shaped by this evolution of weaponry.

Yet throughout history more military personnel have been admitted to hospital due to disease than trauma. In the Second World War, malaria and venereal diseases showed that environmental threats can debilitate armies as easily as the battlefield. 
 
Defence nurses doing their duty for ‘Queen and Country’ have provided skilled, compassionate care to anyone in need during war and conflict. This is their story.

Detail of plaque awarded to Nurse Cathlin DuSautoy

Image 快猫视频 Archive: Detail of plaque awarded to Nurse Cathlin DuSautoy, 1921. This unusual brass plaque was awarded to Cathlin for her organisation of a District Nursing Service in Reims, France. It shows the figures of Justice and Marianne pursuing a German soldier, with Reims Cathedral engulfed in flames.

From gunpowder to the Improvised Explosive Device

The first stage of nursing care is prevention of injury and illness.  From the 鈥楤rodie Helmet鈥� for British Troops in WW1 to pelvic protection in Afghanistan, body armour has been designed to prevent life threatening injuries.  When prevention measures fail, the nursing service is key in saving lives and restoring health and fitness.   

First World War care on the battlefield was often provided by medical officers and orderlies with varying degrees of training. Nursing care began at casualty clearing stations before the wounded were sent through a lengthy evacuation chain. The journey from the battlefield to base hospitals and back to Britain resulted in large numbers of avoidable deaths and injuries. It was soon learned that early intervention could save lives. New treatments performed by nurses such as the tetanus vaccine and wound irrigation techniques saved even more. 

By the Second World War increasing numbers of orderlies were trained and posted to advanced first aid units.  For the first time, female nurses of the British Armed Forces were sent into battle zones to provide expert care for troops. The discovery of penicillin and improvements in pre-hospital blood transfusions vastly increased survival and rehabilitation rates.

By the time of the Iraq and Afghanistan conflicts, all UK soldiers were trained in battlefield first aid. Nurses, medics and advanced surgical teams with specialist skills were posted close to areas of operation. Rapid aeromedical evacuation, including return to the UK has sped up the nursing care for reconstructive surgical procedures, prosthesis and rehabilitation. The development of flight nursing in the Second World War was critical to this success.

Canvas and peg tourniquet with belt A black strip of thick fabric with a plastic pin.

Homeward bound

Defence personnel are deployed across the globe. Whilst immediate care can be provided in field hospitals on land or sea, the ongoing complex care and rehabilitation for British personnel can only be provided in the UK. 

Previously medical evacuation was long and involved travel by trains, ships and ambulances before finally arriving at a military hospital. First World War nursing care began at casualty clearing stations, before the wounded were sent  through a lengthy evacuation chain. The journey from the battlefield to base hospitals and back to Britain resulted in large numbers of avoidable deaths and injuries, and it was soon learned that early intervention could save lives.

Aeromedical transfer was first introduced in 1915 and significantly reduced this journey. By the Second World War, nurses of the British Armed Forces were sent into battle zones to provide expert care for troops. 

Today, Royal Air Force nurses in the Aeromedical and Critical Care Air Support Team (CCAST) continue to transfer patients from deployed areas direct to the UK. By the time of the Iraq and Afghanistan conflicts, nurses, medics and advanced surgical teams were posted close to areas of operation. Rapid aeromedical evacuation has sped up the nursing care for reconstructive surgical procedures, prosthesis and rehabilitation.

Military hospitals have since been abolished. Acute care is provided within dedicated military units attached to National Health Service hospitals. 

And ambulance truck with a red cross printed the side parked next to a Chinook helicopter

Image courtesy www.defenceimagery.mod.uk: An ambulance waits to receive a casualty from a Chinook helicopter at Camp Bastion, Afghanistan, 2011. The Medical Emergency Response Team (MERT) consists of a doctor, an emergency department nurse and two paramedics. 
Black and white photograph of people in uniform in casual poses, standing outside 3 white tents. Black and white image with 2 nurses and a man in uniform standing between 2 rows of beds on either side of a carriage. Black and white photograph of a room taken from aerial view filled with patients in beds, nurses and a chandelier wrapped in a sheet hanging from the ceiling. Black and white image of a group nurses wounded soldiers sitting on a flight of stairs. Black and white photograph of a ward with a row of patients in beds with various limbs suspended from pulleys on the left and a nurse in the foreground on the right