ABSTRACT
Improvised explosive devices (IEDs) were responsible for the majority of injuries and fatalities in the combat casualty during the conflicts in Iraq and Afghanistan. The chapter focuses on the clinical improvements, and the organisational structure, workload, and lessons learned by Defence Medical Services (DMS) anaesthetists during these conflicts. During the course of these conflicts, the anaesthetic teams had to adapt and evolve to provide high-quality medical care despite the location, local threats, skill mix of staff and complexity of injuries in the received casualties. To achieve this aim, changes were made to the layout and location of operating theatres, the number of anaesthetists in theatre, anaesthetic techniques, the management of major haemorrhage- and trauma-related morbidity, drugs and equipment and by the introduction of damage control resuscitation/Damage control surgery and new pain management protocols. During Operations Telic and Herrick, the US military deployed several dedicated research teams to their knowledge on subjects such as traumatic brain injury, haemorrhage and coagulopathy.
