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Sharing the experience, building the knowledge

If people are getting hurt, you need to be there to pick up the pieces,” says Major Andrew Kirkpatrick, recalling his time at the Role 3 Multi-National Medical Facility in Afghanistan. This was only one of the messages he delivered at the Canadian Association of General Surgeons Forum in Victoria earlier this month, when he and seven other military doctors spoke at a course on catastrophe surgery for victims of disaster, terrorism or war.

The course was designed to allow the civilian surgeons attending to benefit from the lessons learned overseas by the military surgeons, all of whom had served in Afghanistan. “The course was designed to deal with as many aspects of CF surgery as possible including vascular, orthopaedic and maxillofacial surgery,” says Maj Vivian McAlister, a surgeon in London, Ont. He joined the CF immediately after serving in Afghanistan as a civilian.

Catastrophe surgery is the norm at the Role 3, and Maj McAlister, the driving force behind the course, says it can be the surgical response either to multiple casualties of a catastrophe or to catastrophic injuries in a single patient. Although the presenting doctors honed their skills in Afghanistan, a theatre of war is not the only place those skills can be useful.

“While we were there,” Maj McAlister says, “we learned ways of looking after severely injured patients or multiple patients with injuries that we can apply to rare but not impossible events that happen in Canada, such as bus crashes or shootings.”

As well as being helpful in emergency situations in Canada, the information presented in the course will be useful to surgeons planning to go overseas with organizations such as the Red Cross and DoctorsWithout Borders.

The course also provided an opportunity for CF surgeons to highlight some of their contributions to the larger medical community.“Most of the major centres in Canada are now using massive transfusion protocols to resuscitate people,” says Colonel Ron Brisebois, senior surgical advisor to the Surgeon General, “and those protocols, which have only come out in the last year and a half, are based on our experiences overseas.”

Maj McAlister concurs, adding that this policy has saved many lives in Afghanistan and, ironically, brought about a lower blood transfusion requirement.

Col Brisebois was pleasantly surprised by the number of attendees, about 40, all of whom stayed for the entire course.“I’m certain, based on the number of questions and the number of interactions that we had during the breaks with different participants, that there was a significant body of knowledge that was passed on,” he says.“I think the CF gains a lot of prestige when civilian surgeons see the type of medical care that we’re able to provide overseas, and what we can accomplish.”

Offering this course and sharing the knowledge garnered at the Role 3 is an important part of making sure that knowledge is not lost, Maj Kirkpatrick says.“It’s a unique time for military trauma surgery in Canada because there are more people now who have actual experience than there have been sinceWorldWar II and the KoreanWar,” he says.“This whole course was an attempt to keep that body of knowledge relevant and alive and, hopefully, pass it on to other surgeons in case we ever need it for conflict or terrorist action, and to avoid having to relearn it later at the expense of the injured soldier.”