Wounded soldiers today have a far better chance of surviving serious injury than their counterparts in previous conflicts. Developments in medical treatment and technology mean that catastrophic injuries can be treated more quickly and effectively.
For the UK military, the war in Afghanistan was a particularly formative experience. This conflict involved 456 deaths and the serious injury of many more. The nature of the fighting meant that gunshot wounds and blast injuries caused by Improvised Explosive Devices (IEDs) were particularly common.
Medical support rapidly evolved during this conflict. Soldiers were equipped with easy-to-use first aid kit, emphasis was placed on rapid treatment and evacuation and high level care was provided at the hospital at Camp Bastion, the main British base in Afghanistan. More specialist surgical provision was concentrated at the Royal Centre for Defence Medicine in Birmingham, with further facilities for rehabilitation.
Here we give an overview of what happened when a soldier was seriously wounded in Afghanistan – from the moment of injury to coming to terms with the consequences – through the experiences of soldiers and medics themselves.
Corporal Andy Reid: "I’ve kind of got a vague recollection of spinning round in the air. I’m not sure if I did or not but it’s something I keep thinking back that I did, I remember looking down, I lay on my back, looked down I couldn’t see my legs at that stage, a big dust cloud all round. I couldn’t see anything and I couldn’t hear anything neither. I weren’t in any pain at that particular time I just felt like shock and numbness as if I’d walked into a door or ran into a big prop forward playing rugby or something like that and I looked across to this left hand thinking I need to get some first aid kit out here, because your training kicks in right away, in your right hand pouch there you’ve got your tourniquets and your first field dressing and your morphine and that so I was looking to get a bit of first aid because even though I didn’t feel any pain I knew something violent had just happened. And looked across and this finger was hanging off, so I kind of kept hold of that I thought I’m not losing that as well, keep that, and then looked across at my right arm and it was twisted up behind my back so then I shouted for a medic, but obviously I shouted but I couldn’t hear myself shout, which was quite strange because I knew I was shouting but then, I couldn’t hear anything. The Vallon guy had been thrown forward in the blast he took some shrapnel to the behind. He crawled back towards me obviously risking his own life really on uncleared ground and he gave me some morphine and started putting tourniquets on. He put a tourniquet on my arm pulled it obviously really tight to stop the blood flow and that, but I felt it pinch my skin for some reason that felt quite painful but I couldn’t really feel anything else so I told him not very politely to calm down a bit because it was pinching my skin and then I just remember being in and out of consciousness a bit."
Being Wounded
Corporal Andy Reid was serving in Helmand Province, Afghanistan with 3rd Battalion, The Yorkshire Regiment when he was involved in an IED blast on 13 October 2009. His injuries resulted in the amputation of both his legs and his right arm. In this film interview clip, Andy describes the moment he was wounded and the bravery of a fellow soldier in providing first aid.
Evacuation
When a soldier is wounded, time is of the essence. In Afghanistan, the UK military placed enormous emphasis on providing instant first aid within the ‘platinum ten minutes’ and onward evacuation by helicopter to the medical facilities of Camp Bastion within the ‘golden hour’ after injury.
When casualties were stable enough, or if their injuries required urgent specialist care, they were flown back to the UK. This stage in the medical chain is explored in this photograph by artist David Cotterrell, who spent time in Afghanistan in 2009 observing aspects of British military medical care. His images atmospherically convey that, for the sedated and unconscious casualty, this journey is often a hazy memory.
This haziness is described in the audio clip by Lance Corporal Nick Davis, who lost a leg and sustained serious injuries to his hip in an IED explosion in Afghanistan in 2009, when serving with 1st Battalion, Grenadier Guards.
'I slightly came round a bit, I couldn’t open my eyes'
“The next thing I can remember was when they landed at Camp Bastion, I can remember, I sort of, I slightly come round a bit, I couldn't open my eyes for whatever reason, and they probably taped them or whatever, I don't know. I come round but I can remember feeling being carried off and hearing everybody talking and being carried off and put in the back, on the back of the ambulance and then the ambulance driving off and then, yet again, nothing. And then the next thing I knew after that I was in Birmingham 36 hours later and I was waking up in intensive care at Solihull Hospital. Obviously at Camp Bastion they did all the surgery, they made me fit enough to fly. Died at one point, got brought back around, thank God. I just had the one big operation where they sort of, they removed the rest of the leg or the dead tissue, all that sort of stuff.”
Wing Commander Teresa Griffiths: "When the hospitals closed, military hospitals closed, basically military personnel were moved to the five or six different locations around the country so you have got a unit in Derriford, in Northallerton, in Frimley Park, in Peterborough and Portsmouth so the nurses and medical staff are integrated into that hospital to get the appropriate medical training for their operational role. Now Birmingham does do that, that’s one of its roles but the significant role that Birmingham does that differs from the others is that is called the role 4 and role 4 is the end of the evacuation chain for our casualties from operational theatres and that we actually deliver care that cannot be delivered in an operational theatre because it is going to take too much time or that the injuries are so significant that they are going to need more specialities that they don’t have in places like Afghanistan and Iraq so Birmingham is half of it and its the acute care clinical unit and Headley Court provides the rehabilitation focus. So whilst we have patients coming back from Afghanistan and other operations, we are also the hub and spoke for all aeromed [aeromedical] activity wherever military personnel are deployed across the world so if you are on a ship in the Caribbean and you are injured and need to come home you will first come back to RCDM [Royal Centre for Defence Medicine] in Birmingham."
Hospital: Wing Commander Teresa Griffiths
British casualties needing further care after injury in Afghanistan were evacuated to the Royal Centre for Defence Medicine (RCDM) in Birmingham. This is the main specialist medical hub for the British armed forces in the UK, providing a level of surgical and general care not possible in a war zone.
In this interview clip, Wing Commander Teresa Griffiths describes the role of the RCDM in Birmingham, where she served as the officer in command of nursing between 2010 and 2013.
Corporal Andy Reid: "So the first one I got it’s called a KX06, it’s a pretty basic leg, it’s got like a mountain bike shock absorber where the knee is, you’ve got to be constantly pushing back on your thigh with your thigh muscle to keep it straight. If you relax for a second then it just gives way. I didn’t really get on with it that well so I said can I get one of these, which is the C-Leg. This is C-Leg 2 this one, so it’s got like blue tooth technology in it and it knows how much weight you put on the toe, that’s what makes the knee bend and they do it all on like a computer. It’s just a lot more stable, you can walk down ramps with it and walk down stairs and you can make the knee yield you can half sit down and then change your mind and stand up again whereas with the KX06 once it’s bent that’s it, you’d have to sit down and then stand up all the way, you can’t just change your mind halfway through. This is below knee this is just a basic normal socket leg there and then this ankle I’ve tried all different ones. You can get some where the ankle moves a little bit, but I find them quite hard to stand up still on because as you lean forward the ankle’s bending, I would rather have it quite stiff then it stays this ankle will flex on any kind of, so if you put the heel down it’ll flex but if you land on the toe as well it’ll flex. I think it’s a lot of trying out different ankles and seeing which one suits you."
Rehabilitation
For serious casualties, the next stage in their journey is rehabilitation. In recent times, the Defence Medical Rehabilitation Centre (DMRC) at Headley Court in Surrey has been the UK military’s main facility for providing follow-up care to casualties. It has become particularly associated with British soldiers who have suffered life-changing injuries in IED explosions in Iraq and Afghanistan. In 2018, the main UK military rehabilitation centre will relocate to Loughborough.
In this film interview clip, Corporal Andy Reid talks about the prosthetic legs he was given at Headley Court after injuries sustained as a result of an IED blast in Afghanistan in 2009.
Coming to terms with injury
Medical advances have meant soldiers have survived catastrophic injuries that previously may have been fatal. Yet there are still huge challenges, both for the soldiers coming to terms with life-changing injuries and for military and civilian medicine in providing long-term care and support.
Lance Corporal Nick Davis was seriously wounded in an IED explosion in Afghanistan in 2007. As a result of the blast he lost his right leg at the knee and he sustained serious injuries to his right hip. During his rehabilitation, he agreed to sit for a portrait that fully revealed the extent of the damage to his body.
In this audio clip, Nick reflects on the nature of his injuries, his feelings about the painting and what he hopes it will achieve.
'It’s striking and it’s thought provoking and that’s what it’s got to be'
“You can see a prosthetic on somebody, but it doesn't tell the whole picture, doesn't tell the whole story. What's happened to that bloke. Like for myself, all my injuries are hidden by my clothes and you can't see them, so to a normal person, all that's happened to me is I've lost my leg. That's not true, that's not my worst injury. I've got an injury that's worse than my amputation, which affects me far more than my amputation. But your normal average civilian cannot see that injury. But for me, it was raising that awareness of almost don't judge a book by its cover because you can't see the contents of what's happened to that bloke. The painting it's, it's striking, and it's thought provoking and that's what it's gotta be, it's gotta be thought provoking, you know. But for somebody to stand there, you look at that picture and it just makes them realise and they look at the scars and that and the whole, the whole idea behind it is to make them think that. It is the challenge their thought process and then to think, “Shit, what happened to him?” sort of thing. And then it starts playing in their mind. “Well, what actually did happen to him?” sort of thing, you know. And then, then they start wondering on the story of it and, and that's how it's gonna raise awareness I think.”
