WSM LONDON 2015
CITATIONS
Pask Award
Members of Defence Anaesthesia who served in
Afghanistan
Regular and Reserve Defence Anaesthetists from the Royal Navy,
the Royal Army Medical Corps and the Royal Air Force have been
serving in Afghanistan since the beginning of the conflict there in
October 2001. Operations in Afghanistan were commenced as a
direct result of the 11th September 2001 attacks on the USA. Initially
a small number of Defence Anaesthetists worked to support Special
Forces during the commencement of Operation Enduring Freedom
with forward resuscitation and critical care evacuation. Since early
2002 they have been part of the coalition of up to 42 nations who
have contributed to the International Stabilisation Assistance Force.
Consultants and, later in the mission, trainees, have been deployed
to provide medical support to combat and security operations.
Defence Anaesthetists have been outstanding members of the
medical team, leading advances in care, which have seen a great
many unexpected survivors from trauma. This has heralded the
lowest mortality amongst casualties in any conflict to date. Key to
that has been the involvement of the anaesthetist at every stage of the
evacuation chain from pre-hospital care, resuscitation, anaesthesia,
intensive care, pain management and aeromedical evacuation,
through to command roles as Deployed Medical Directors.
Conditions at the commencement of the conflict during entry
operations were extremely harsh and fraught with personal danger
and though the threat to personal safety has declined over the 11
years of the conflict, it will be ever-present. Personal risk has been a
constant accompaniment over many tours of duty for some and they
deserve particular mention. Before specific groups are identified
it is important to recognise the dedication and personal resolve
demonstrated by those volunteers who repeatedly return for these
extremely taxing duties on operational deployments. The stress of
working daily with critically injured young UK and coalition service
personnel and local civilians, including many children, cannot be
overstated. This outstanding commitment has never faltered and has
been carried out with unflagging professionalism which should be an
example to all.
Many Defence Anaesthetists have seen more severe trauma in a
single day than many civilian anaesthetists will see in an entire career,
with as many as three major incidents in a 24 hour period being
experienced on occasions. The level of trauma and the ensuing
resuscitation continuing long into surgery, subsequent intensive care
and even into tactical and strategic evacuation has been demanding
in the extreme. It has often required two or more anaesthetists to
manage up to six surgical teams operating on a single patient.
Transfusions of blood and blood products of as much as 1 unit every
50 seconds and 50 units of blood per hour have not been unusual.
When considering courage and commitment a special mention must
be made of those individuals, from all three services, undertaking
duties with the Medical Emergency Response Teams (Enhanced).
These individuals have carried out remarkable feats of resuscitation
taking advanced airway techniques, rapid sequence induction,
therapeutic thoracotomy, interosseous vascular access, blood and
blood products onto the battlefield, more often in pitching helicopters
and regularly under enemy fire. They have undertaken mission
after mission in the knowledge that everyone is a potential lure into
ambush, but for the sake of the injured they have not flinched from
their duty.
Likewise, particular consideration is due for Royal Air Force
Anaesthetists who have been deployed in Tactical Critical Care Air
Support teams (T-CCAST). A number have undertaken particularly
hazardous missions where they have experienced constant
exposure to danger above that normally experienced when flying
over and landing in hostile territory. Tactical flying at night through
mountain passes in helicopters or fixed wing aircraft, while striving
to save the lives of critically injured service personnel, is not for the
fainthearted.
68
T-CCAST have transferred and evacuated hundreds of patients over
thousands of miles. These patients have been saved from death by
the skill and resolve of their triservice anaesthesia and intensive care
colleagues, working tirelessly with the rest of the multidisciplinary
team. Many patients have been so critically ill, that even moving
them within a fixed facility in the UK would have been a severe
challenge and perhaps not even attempted. During these missions
not a single patient has been lost and quoting Professor Sir Keith
Porter (University Hospitals Birmingham Foundation Trust) these
multiple-injury patients have been delivered to critical care, in his
Trust, in better condition than patients transferred in from a few miles
away and who have had much less trauma. This in itself speaks
volumes of the ability and dedication of Defence Anaesthetists.
This conflict has seen an unprecedented improvement in care
of the war wounded. This has been backed by continuing world
class research and development, which in many cases has been
undertaken by Defence Anaesthetists while deployed. This level of
exceptional care has led to the description of the UK led hospital
in Camp Bastion, as being the “best trauma hospital in the world”.
Both the National Audit Office and the Healthcare Commission
have praised the DMS trauma care most highly, but Defence
Anaesthetists who have been part of this trauma system deserve
their own recognition for the exemplary job they have done. This and
other acknowledgments are a huge tribute to the skill and dedication
of the entire evacuation chain from point of wounding to repatriation
to the NHS. The integrity of this chain is entirely dependent for the
provision and maintenance of its links on Defence Anaesthesia.
Advances in analgesia provision throughout the chain of care are
also worthy of mention. Dedicated members of Defence Anaesthesia
have forged a comprehensive and effective system for providing
analgesia to the highest standard possible and this work continues.
Royal Air Force Defence Anaesthetist trainees have also been the
backbone of advanced analgesia support to the many thousands
of war wounded who have been transferred by the Royal Air Force
Aeromedical Evacuation Service. In the UK, Defence Anaesthesia
provides support to those war wounded in rehabilitation with
outreach clinics and multidisciplinary teams.
Recognition must also be extended to the families of Defence
Anaesthetists, who are, for the most part, unrecognised. Without
their encouragement, support, sacrifice and backing, many of those
deploying would not have, so readily, undertaken the missions that
they have, nor would they have felt as secure as they undertook the
great challenges which faced them.
When the AAGBI awarded the Pask Certificate for service in Iraq,
the citation stated that “It is a great tribute to Service Anaesthetists’
dedication, courage and professionalism that they were able to
produce a consistent, high quality and enduring clinical effect in
the most difficult of circumstances, in order to treat their patients
and support the overall medical effort during the campaign”. This
sentiment applies just as truly to service in Afghanistan. It remains
true that these individuals have served and continue to serve their
patients, Defence Anaesthesia, the Defence Medical Services and
their country with loyalty, dedication and honour. It is, likewise, right
that they are recognised for that. The Council of the AAGBI takes
great pride in awarding the Pask Certificate of Honour to Defence
Anaesthetists who have served in Afghanistan.
This is the original citation written by Group Captain Neil McGuire
in 2012.
Since the AAGBI originally gave Pask Awards to military anaesthetists,
a further 21 have served in Afghanistan up to the cessation of
offensive ground operations. These individuals are just as deserving
of our recognition. The AAGBI recognises the increased role and
dedication of Medical Officers in the Reserves as we move beyond
ground combat operations in Afghanistan.
Dr Andrew J Hartle
President, AAGBI