Defence Anaesthetists knocked out to win outstanding certificate of honour

One hundred and thirty-eight Regular and Reserve Defence Anaesthetists from the Royal Navy, the Royal Army Medical Corps and the Royal Air Force have won the prestigious Pask Certificate of Honour for their services in Afghanistan since the beginning of the conflict in October 2001.

Defence Anaesthetists are a crucial part of the medical teams in Afghanistan. Initially, a small number worked to support Special Forces personnel, providing forward resuscitation and critical care evacuation.

Since early 2002 they have been part of the coalition of up to 42 nations who contribute to the International Security Assistance Force.

Consultants, and later in the mission, trainees, have been deployed to provide medical support to combat and security operations. These teams have led advances in care which have seen a great many unexpected survivors of severe trauma. This has resulted in the lowest mortality rate among casualties in any conflict.

Key to success has been the involvement of the anaesthetist at every stage of the evacuation chain, from pre-hospital care, resuscitation, anaesthesia, intensive care and pain management through to command roles as deployed medical directors.

Group Captain Neil McGuire, the Defence Consultant Adviser in Anaesthesia, co-opted to the Council of the Association of Anaesthetists of Great Britain and Ireland (AAGBI), said:

"Many Defence Anaesthetists have seen more severe trauma in a single day than many civilian anaesthetists see in an entire career."

The outstanding dedication, courage and professionalism of this group of anaesthetists led to this prestigious award. But why are Defence Anaesthetists so important in Afghanistan?

"Anaesthetists are the glue that holds it all together," said Group Captain McGuire.

Serving in Afghanistan, it has not been unusual for this highly select group of medical professionals to find themselves at the heart of three major incidents in a single day - involving the treatment of more than 15 seriously injured patients on occasion:

"In an NHS hospital, two or three patients who are seriously ill arriving in an Emergency Department would potentially constitute a 'major incident' where resources are severely stretched," explained Group Captain McGuire.

"In the Role 3 Hospital at Camp Bastion we have had incidents where ten patients are wheeled in, then, a few hours later, another incident could produce four or five more, followed by a third incident later with the equivalent again. We just don't know what is set to come through the door at any one time."

Typically, anaesthetists serve two- to three-month tours in Afghanistan, relatively short by military standards because the work is so 'incredibly demanding' explained Group Captain McGuire:

"People often don't realise that, unlike some personnel, we come back and return to our other job in the NHS, which is another full-time job with all of the pressures of patient care."

Unsurprisingly, the job of an Armed Forces anaesthetist can be enormously stressful, but dealing with that reflects their extraordinary character:

"To begin with, they are a self-selecting bunch of people," said Group Captain McGuire. "This is backed up by training to the highest possible standard that we can provide, and on top of that they derive essential additional skills from officer training in Sandhurst, Cranwell or Dartmouth."

All Defence Anaesthetists undergo the required military training, learning leadership skills, weapon handling, firefighting and first aid, reinforced by pre-deployment training and refresher clinical training to prepare them for working in the field environment.

On top of that, every anaesthetist undergoes Military Operational Surgical Training at the Royal College of Surgeons of England training facility, to brush up on military clinical techniques, followed by a further ten days devoted to hospital exercises and equipment training.

This means they are ready to be part of and also lead elements of the exceptional UK defence medical capability.

Defence Anaesthetists also spend clinical time in the NHS to maintain their specialist competences so that they can keep their registration and licence with the General Medical Council.

Regarding being awarded the Pask Certificate of Honour, Group Captain McGuire said:

"It's one of the highest awards that the AAGBI can give. It is awarded for bravery, valour and outstanding commitment to anaesthesia."

What is particularly impressive is that the Pask Certificate of Honour makes it a unique hat-trick of titles for the Defence Medical Services. First awarded to the Tri-Service Anaesthestic Society and then to those who served in Iraq, it now honours those who serve in Afghanistan.

The award was made by the AAGBI at their Winter Scientific Meeting held in London last week. A copy of the scroll will be personally awarded to each Defence Anaesthetist who has served in Afghanistan. Group Captain McGuire sees this as a tribute to the dedication of both Regular and Reserve anaesthetists who integrate seamlessly with medical teams in Afghanistan:

"At one time reservists used to go away on deployment and, when they came home, people would say 'you need to do a refresher course to catch up because you've been on holiday!'

"It's completely different now; these people are valued hugely for what they've done and they have a vital contribution to the NHS and changing NHS practice, as do all Defence Anaesthetists. In reality, there is not a cigarette paper you can put between us."

Perhaps the real benchmark of success of Defence Anaesthesia is that the anaesthetists are always ready to volunteer to step up to the mark and do their duty.

Group Captain McGuire is deeply proud of the 'huge honour' bestowed on Defence Anaesthetists whom he cannot praise enough:

"I'd just like to reinforce what a dedicated, loyal and professional bunch they are. It's been a great privilege to serve them and serve with them and I just cannot describe what a fantastic feeling it is. We are part of something that is truly great."