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A revolution in combat casualty care

Recent PhD graduate Colonel Tim Hodgetts outlines the dramatic changes that have occurred in military combat care over the last ten years.
by Ben Sawtell

Students at City Univernullsity London come from all corners of the world and have a diverse range of life experiences. However, there haven't been too many that have been on the front line in Afghanistan, Iraq and Kosovo. It's fair to say that Tim Hodgetts isn't a typical student.

Colonel Timothy J. Hodgetts completed his PhD at City last year and returned to Northampton Square yesterday to discuss the topic of his thesis in which he outlined the revolution that he believes has taken place in combat casualty care over the last ten years.

In 1998 the Ministry of Defence published a report that described the practices within the Defence Military Services as being well below that of the NHS. Ten years later a comprehensive review by the Healthcare Commission (HCC), the forerunner for the Care Quality Commission, found 'exemplary' standards in the quality of combat trauma care and recognised that 'there is much that could be learned by similar services within the NHS.'

The ten year journey toward these changes in combat casualty care was the focus of Hodgetts' thesis - and his lecture last night - in which he argued that the changes he has introduced are a quantifiable revolution.

Hodgetts believes that the tipping point for his revolution are was the reassessment of the fundamental principles of resuscitation - 'ABC', or 'Airway, Breathing and Circulation'. 

In military terms the ABC mantra is not fit for purpose, so Hodgetts introduced <C> ABC where the first 'C' stands for 'catastrophic haemorrhage'. In his thesis he argues, "For the soldier who has lost his legs to an improvised explosive device (IED), is conscious and is in severe pain, the highest priority is to immediately stop further bleeding-otherwise he will rapidly succumb to massive blood loss." 

During his hour long talk - which fittingly for an army officer ran exactly to time - Hodgetts cited other indicators of revolution such as adoption of new doctrines, organisational concepts, and technological innovation.

nullHodgetts also touched on the ethical implications of this revolution. He noted that some may argue that consideration should be given to the quality of life an 'unexpected survivor' might have.

Some, especially those with the profound injuries, may decide that a life with severe disability isn't one worth living and while that is beyond the scope of his research but cited the heroic performances of the paralympians in London last year as one example of the power of the human spirit to overcome such challenges.

The gap between the NHS and combat casualty care was demonstrated with a startling statistic; between 2006 and 2009 25% of seriously injured patients were categorised as 'unexpected survivors'; in comparison, the rate of unexpected survivors in NHS hospitals was, at best, 6%.

Hodgetts firmly believes that, in relation to trauma medicine, the organisation, facilities and outcomes in a British field hospital during an extended campaign now exceed NHS best practice. And while there are signs of change the 'predictable barriers to innovation and adoption' of these of these changes are a large hurdle to overcome if a comparable revolution is to occur within the NHS.

"For the sake of the sacrifice of our fallen and injured soldiers, an obligation rests with the NHS to overcome the known barriers to innovation adoption to benefit the injured of the future." Colonel Timothy Hodgetts.

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