Bringing war surgery back home

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By Paul Mayne
Thursday, May 7, 2009
Imagine if University Hospital had to increase its activity 10-fold immediately.



Dr. Vivian McAlister receives the General Service Medal and Citation from Brig.-Gen. Hilary Jaeger at the Kandahar Air Field.   Photo by Kirk Sundby.

The work of the Canadian Forces Medical Service (CFMS) in war-torn Afghanistan  may have the solution.
 
Schulich School of Medicine & Dentistry professor Dr. Vivian McAlister (Department of Surgery), just home from the his second tour of duty where he worked at the Canadian Field Hospital, says dealing with multiple severely injured patients is the daily reality for the Canadian-run military hospital in Kandahar.
 
While war surgery deals with patients injured by bullets or bombs, an urban emergency room may not be that different at times with gunshot wounds becoming more common.
 
“The principles of care are similar to those applied to any severely injured patient,” says McAlister. “War surgery has taught us how to complete life-saving surgery very rapidly and then to allow the patient to regain their normal physiological status before proceeding to definitive surgery.
 
“We have learned how to do emergency shunts to save limbs when blood vessels are damaged so that a complete repair can be done later. War surgery has developed ways to handle mass casualties, when many severely injured patients arrive at the hospital at the same time.”
 
McAlister adds this skill could benefit Canadians in the event of a major catastrophe such as school bus accident, train derailment or explosion.
 
This was the challenge facing CFMS in 2004 when it was asked to take over the hospital in Kandahar. It did so by running exercises training the entire hospital together in a field hospital set up in Canada.
 
This tradition of training by rehearsing in field-like conditions is almost 100 years old, having started when the Canadian Army Medical Corps met here in London in 1911. The training continued through both World Wars.
 
“We will be training the eighth group next month so eight full hospital teams, technicians, nurses, administrators and doctors will be available to Canada for disaster response or to contribute to care provided locally,” says McAlister.
 
His latest tour in Afghanistan, while dealing with more wounded soldiers and civilians, ran much more smoothly than his first deployment.
 
“Overall the tour felt the same to me but there were differences. There were more casualties this time but our staff and equipment were even better than the last time,” says McAlister, who like other members of the Canadian Forces at Western (Drs. Raymond Kao and Brian Church) will head back to Afghanistan every year until Canada completes its commitment - probably until 2011.
 
“In addition Afghan medical services provided by the civilian hospital, Mir Wais, and by the Afghan National Army were much better than last year. This was very encouraging as it is possible to see a time now when the Afghans will take over medical services completely.”
 
Reviews of activity at the hospital at Kandahar have contributed to knowledge in areas of trauma surgery, from the additional training required by general surgeons to serve victims of conflict to the learning role of pre-hospital care.
 
This September, at the Canadian Surgery Forum in British Columbia, McAlister will lead a postgraduate course in catastrophe surgery with a faculty consisting of civilian and military surgeons who have served in the Kandahar hospital.
 
The application of military techniques such as triage, evacuation, damage control resuscitation and damage control surgery to civilian disaster will be discussed, as will be vascular, orthopedic, facial and skull surgical skills.
 
In an upcoming article to appear in the Canadian Journal of Surgery, McAlister says the tradition of turning adversity to advantage continues with CFMS in Afghanistan. As before, the cost has not only been financial but also of individual sacrifice. Six members of the medical branch have lost their lives in Afghanistan.
 
“By increasing its surgical capacity in time of war, Canadian military surgery is not only meeting its commitment to victims of the conflict, but also contributing substantially to Canada’s capacity for dealing with civilian catastrophe,” says McAlister.
 
 
Dr. Vivian McAlister (right) takes shelter during a rocket attack on the base at Kandahar Air Field with Western graduate Peter Collins, a Toronto psychiatrist.  Photo by Bethann Meunier.
 
 
 

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