BBC: Frontline Medicine

This programme contains some scenes which some viewers may find upsetting

This programme contains some strong language

Five litres of blood in the human body, five litres.

It can be gone in three to four minutes. Gunshot wound, heavy bleeding.

Really brilliant surgery. His life was definitely saved this morning.

The survival rate amongst wounded troops in Afghanistan

is the highest in the history of warfare.

War has always driven innovation. And this one is no exception.

Do you have any evidence that this is effective?

Just by the level of injuries that people are now surviving.

Posterior tibial pulse is present to both feet.

We've got people who are alive

who, five years ago, would not have survived.

I want to find out what medics and surgeons have learnt

from the last ten years of bloodshed.

What are the advances that are making

the difference between life and death?

And how could they help us all?

It's early in the morning and we're going off to war, to Afghanistan.

Now, the reason I want to go is because the medics there

are somehow managing to keep up to 90% of casualties alive

and that is a truly awesome statistic.

The highest success rate that has ever been achieved.

I'm also feeling a little bit apprehensive,

because I have never been to a war zone before.

I get a taste of what's to come sooner than I expect.

Wow, this is not what you see on your average aircraft.

All these stretchers.

Now, I trained as a doctor and I've seen a lot of trauma,

but I suspect nothing like what I'm going to see in Afghanistan.

I was thinking, as we came on the aeroplane -

I saw those young men going up the steps -

I was thinking if the war is as fierce this year as it was

last year then, statistically speaking at least,

one of those guys back there is going to be killed

or severely injured in the next six months

and, if so, they're going to be coming home on one of these.

This is Camp Bastion,

headquarters of the British Forces in Afghanistan.

It's also home to the main hospital for battlefield casualties.

And just a few hours after landing, that's where I'm heading.

I'm told that Camp Bastion is the size of Reading.

It's certainly an awful lot dustier.

Hi, guys, is this the hospital? Yes. Thank you.

So...something busy is going on.

I've arrived outside the hospital and suddenly it's all kicking off.

They're all heading off in that direction.

I've only been here a few moments

and already I'm seeing casualties brought in from the battlefield.

So I've seen one person being carried off the helicopter

and it looks serious.

SIREN WAILS

Nice and gentle.

This hospital deals with some of the most severe injuries

you'll see anywhere in the world.

In three, two, one. Clear.

It's run by British military medics.

When they're not on tour, they work in the NHS.

They're both described as going in and out of consciousness.

Colonel Jeremy Henning is the clinical director.

So what's wrong with this guy?

So he's been shot through the pelvis.

He was up doing guard duty in an elevated tower.

He was shot, he's fallen back. He's Afghan Army.

Normal expansion chest.

Is this is a typical sort of injury you'd see?

Yeah, we see two main types of injuries.

One is the gunshot wounds. They come in very regularly,

and the other major one we see are the improvised explosive devices.

He's moving his right foot.

He's stable enough. He's now gone for a CT scan.

That is just over ten minutes and he's in...

We've got another four casualties coming in. How many?

Another four. Another four, right.

Posterior tibia pulse is present.

What is really impressive, I have to say, is the speed at which

they're moving because there was a guy who was just over there,

he came in maybe...ten minutes ago and he's already been dealt with.

They've begun their investigations and he's off having a CT scan.

This guy came in about five minutes afterwards

and he's also just about ready. They've already X-rayed him

and they're about to whisk him off to CT scan as well.

He's got blast pants on.

The commonest cause of death amongst casualties out here

is massive blood loss.

But they've recently developed ways of dealing with it

that's had a huge impact on survival rates.

That one's 11.20 that one's 11.30. 'Lieutenant Colonel Steve Lord

'is a consultant in the Emergency Department.'

So what have you got? An IED blast and he's apparently got amputations

of both legs. So he's stood on a mine

and it's been big enough to blow off both his feet?

We generally don't get given the level.

They may say it's just a foot, but if they say legs,

it could be anywhere from the ankle up to the groin

and we will not know till we see him.

They've called "hot vampire", which means they give him blood

in-flight, so we make sure we've got blood available.

'They found that by changing how they replace blood

'they can cut death rates by up to a half.

'The NHS are interested

'because 40% of trauma deaths in the UK are caused by blood loss.'

Just want to go to the blood lab and find out what's going on.

Hello. 'There's 20 minutes until the casualty arrives

'and Chief Petty Officer Andy Murphy is getting blood ready.'

We've got one guy with a head injury, one with a double amp.

The double amp is obviously the main concern.

Effectively, any trauma patients, we assign them universal donor blood.

And each of those people could need 30, 40 units, or what?

And the rest, potentially. More? In some cases.

There have been cases of patients having upwards of 150 units.

You're talking up to 50 litres of blood?

I mean, that is a bathful of blood, isn't it? Yes.

'Amazing, considering the average body only holds five litres.

'As usual, blood for transfusions is separated into different parts.'

'Red blood cells that carry oxygen,

'and plasma, a yellowy fluid which helps blood clot.

'In the past, they'd give four times more red cells than plasma.'

When they used to give four of these to one of these, they weren't

giving back enough clotting factors

for the patient to stop bleeding and that's why they would bleed out.

'So the military recently increased the amount of plasma they give.'

They actually now give equal volumes. One of this to one of this.

And that helps to provide...top up the patient's own clotting factors.

Do you have any evidence that this is effective?

Just by the survival rate and the level of injuries that people are now surviving.

Number 1891. 4-5-4-7.

Four litres of blood are rushed to the Emergency Department.

The new casualty is only moments away.

He's been flown in from the frontline by the MERT,

the Medical Emergency Response Team.

SIREN WAILS

United States marine. Mechanism is IED versus foot soldier.

Injuries are left below knee, right below knee,

with tissue damage up to the groin.

Lance Corporal Ronald Barnes is just 20-years-old.

He's been blown up by an IED.

That's ADT two. 22? 22.

Oh, dear, it's really distressing.

No major obvious wounds on the back.

One, two, slide. Thank you.

Although heavily bandaged, he may still be losing a lot of blood.

4.1.

High wound to right thigh.

It's a massive wound on the right thigh, OK?

You want this down?

And, as you say, above knee on the right and below knee amputation

on the left. Can we make room for a chest X-ray?

In three, two, one.

Has he lost a lot of blood? Well, we have to assume that he has.

The fact that he received blood on the ground via MERT

would imply that he has significant blood loss. Right.

What they're really worried about is the lethal triad -

blood loss, a build-up of acid and hypothermia.

The blue blanket is going on the top to make sure that he stays warm.

You get cold really quickly.

Ronald's getting cold because he's lost so much blood.

Not enough oxygen is reaching his tissues to generate heat.

That lack of oxygen also causes a build-up of lactic acid.

The cold and increased acid make his blood less able to clot.

Untreated, he would bleed to death.

The new way they give blood, adding more plasma,

should reduce the risk of this happening.

He does have a weak radial pulse in the right.

They've got red cells and they've also got plasma

and he needs that in order to clot and stop a catastrophic haemorrhage,

bleeding, that may be going on.

And two mils of... No blood on blood.

They've got a line going into his arm

and they're pumping blood through there,

but they also want to get to the veins in the neck

cos then they can really pour it in.

They want to get as much blood into him as they can.

Everything here is set up for speed of diagnosis and treatment.

OK, so what have you got there?

This is a hand-held ultrasound unit that we use to quickly assess

the abdomen for free fluid and free fluid equals blood.

If there's any sign of internal bleeding, he'll be taken straight to surgery.

If not, they'll do a CT scan to get a clearer idea of his injuries.

Negative.

None that we've found so far. No internal bleeding?

None that we've seen.

Surgeon Commander Peter Small is waiting in the Emergency Department,

ready to operate as soon as he can.

He has a good blood pressure, he's not tachycardic

he's getting blood transfused. I think he's stable.

CT? CT.

Is blood loss a big factor?

Do you know how many units they poured in?

He had three and three on the helicopter and we've given him

some more in here, at least two units.

They've already replaced all the blood in Ronald's body.

And he still needs more.

He needs six units. For theatre, they need six units of blood.

But first, Ronald is taken to the scanner.

He's got a femoral fracture just above...

They're getting together detailed information about his injuries.

They're also looking for any hidden internal bleeding.

There's a large soft tissue defect anterior thigh.

They've had a dedicated radiologist for emergency cases here since 2009.