Although Military Intensive Care can probably trace its roots back to the Crimea War when Florence Nightingale cohorted the sickest patients together near the nursing station so they received a higher level of care, the first time a specifically equipped ICU was deployed to the Field was the Second Gulf war in 2003. The UK military has been manning a deployed ICU somewhere in the work ever since.
In this time, military Intensivists have become experts in the care of gun-shot wounds (Iraq), blast injury (Afghanistan) and most recently infectious diseases (Sierra Leone). As the initial care and resuscitation of these patients has improved, the severity of injury and illness presented to the ICU has increased expontentially. A casualty with bilateral traumatic amputations is now retuned to the ward after their initial surgery in Field, hence the patient who comes to ICU has physiology on presentation that was previously thought unsurvivable. A patient with an infectious disease that was thought to have a greater than 80% chance of dying, can have a 70% chance of surviving given reasonable therapy. This presents unique clinical, ethical and moral issues.
Much has been written about the utility of 1:1:1 transfusion in acute blood loss, especially in the context of trauma. However, less is known about what to do after the ‘big’ bleeding has stopped and the patient is oozing on the ICU. The benefit of a pre-hospital team on early intubation of the IED victim has been described, but the issues of looking after the blasted brain, lung, heart and abdomen are less well known.
We now, for the first time since military Intensive Care was officially recognised, have all our ICM personnel in the UK. This is however not a time of rest. Not only do we have to prepare to respond to whatever the next emergency may be, we owe to it to our patients (those that survived and those that did not) to communicate our lessons learnt to anyone prepared to listen. They are lessons hard learnt, and history tells us we will learnt them again in the next conflict as we forget them in times of peace. However, this time it is different, conflict has the potential to affect us all. We remain lucky that a pandemic infectious disease has not hit this country. Maybe by making sure the whole ICM community hears our lessons, we can keep them alive to the benefit of both civilians and military. As the Royal Army Medical Corps Grace says:
Keep us forever mindful, it is not for ourselves, but for others we serve.