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Military Medicine in Iraq and Afghanistan

A Comprehensive Review

Greaves I, ed. Military Medicine in Iraq and Afghanistan: A Comprehensive Review. Taylor & Francis Group, LLC, CRC Press,
2019. Paperback, 687 pp. ISBN 13: 978-0-8153-7759-7. Available in paperback, hardback, eBook, and eBook rental.
Reviewed by John M. Quinn V, MD, PhD

or centuries, providers and clinicians have provided care Surgical Care (FRC/FSC) US and NATO military medical
for the warrior on the battlefield. The clinical specialty of doctrine.
Fmilitary medicine has become more organized and more
rooted in evidence-based medicine. Focus has also moved from Each chapter provides expert clinical analysis and detailed
trauma to prevention, internal medicine, infectious disease breakdown for the anatomical regions and other specific top-
and nonbattle injury, hygiene, mental health, rehabilitation, ics and integrates where DCR/DCS has advanced and which
ethics, pediatrics, and many other disciplines related to health challenges were overcome and which remain for future re-
and security. The constant pursuit of best practices requires search. These are indeed excellent lessons learned and shared.
not only this evidence base but also the sharing of lessons Of note, the discussion of the organization framework of the
learned to be applied to future conflicts—before these lessons patient care pathway with integrated health service network
are lost to time. Military Medicine in Iraq and Afghanistan: provides best practices for patient movement. And notes on
A Comprehensive Review serves as a compendium and com- trauma risk management and the prehospital medical emer-
prehensive review of the United Kingdom’s gency response teams operating from point
Defence Medical Services military medicine of injury and Role I to that of Role IV pro-
from the wars in Iraq and Afghanistan. It is vide a comprehensive account of patient
completed by colleagues and multiple UK- movement and interventions in support of
based authors and provides expert analysis the evacuation chain at all echelons of care.
and lessons to save life on the battlefield. Blood and transfusion medicine is discussed
As NATO and NATO partner forces pre- at length with focus on blood being admin-
pare for the next battle over the land, sea, istered far forward with accounts from not
air, space, and cyber multidomain battle- only the military experience but also that of
field, this comprehensive book offers the British civilian prehospital care providers as
policy and decision maker, the practitioner, well, highlighting interoperability. This is an
and, most importantly, the warfighter les- area of research and operational medicine
sons learned from the British military med- that is expanding rapidly, and the lessons
icine experience with meticulous detail and here provide data not presented elsewhere.
account.
An interesting comparison relates to training
The British Defence Medical Services have and standards, the British have developed
been recognized as providers of exemplary the BATLS course (Battlefield Advanced
health care, and this review of the military experience in these Trauma Life Support) mandatory for deployed personnel, en-
conflicts from the United Kingdom is truly multidisciplinary. forcing a team approach to trauma. No line-by-line curricu-
This approach includes comment on best practices in the field lum analysis was undertaken for this review, but this course
from a global level from across the UK and includes partners and others described in support of all phases of care likely
such at the Trauma, Oxygenation and Research Network correlate to the TCCC military provider and other prehospital
(THOR) and US Armed Forces medical services, among myr- standards deployed by the Department of Defense across all
iad others. Indeed, this book offers evidence that will impact branches of military service.
military medical systems across the NATO alliance and its
partners for the better. Of special note, the UK Joint Theatre Trauma Registry (UK-
JTTR) is the British equivalent to the Joint Trauma Registry
Description of the run-up and lead into the Afghanistan and (i.e., Joint Trauma System), which was developed to improve
Iraq wars in diligent detail helps set the stage and provides trauma readiness and outcomes through evidence-driven per-
copious account with data, the lives lost, and milestone events formance improvement. The data presented throughout this
throughout these theaters and military campaigns. Upon huge body of evidence and analysis support factors mitigat-
merger with NATO military medical doctrine, the British ap- ing the lethal triad of coagulopathy, hypothermia, and acido-
proach describes the organizational framework that follows sis, indeed the nexus of all battlefield medical research. The
the levels of care from point of injury, care under fire, tactical UK-JTTR also supported the novel illustration and recom-
evacuation care, prolonged field care, and damage control re- mendations on DCR/DCS from the British experience with a
suscitation (DCR) and surgery (DCS) as described in the Tac- broad range of medical innovation. A recurring theme in this
tical Combat Casualty Care (TCCC), Forward Resuscitative/ book is that of medical command and control and deployed

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