From Bastion to Birmingham

Military medical innovation has significantly improved battlefield casualty survival. In recent warfare, we observed higher rates of survival than expected. In fact, a quarter of those severely injured were not expected to survive at all.  In Afghanistan and Iraq medical teams had to adapt to changing mechanisms of injury, notably the improvised explosive device, which often resulted in major haemorrhage. The lessons learnt during recent deployments has altered how we manage civilian major trauma here in England, which comprises a trauma network of 24 level 3 centres. These networks are supported by robust pre-hospital care, diagnostics, senior doctor input and service evaluation. We discuss the key logistical and medical innovations that have transitioned into civilian trauma systems with a focus on haemorrhage control and damage control resuscitation and surgery.