Lessons in Critical Care from the Battlefield: Kate Prior

Kate Prior conveys the lessons she has learnt working as a doctor as part of the Medical Emergency Response Team (MERT) in Afghanistan.

“Unexpected survivors” are those patients who, according to their injury severity score, should die of their injuries but they survive against the odds.

The years of conflict in Afghanistan saw increasing numbers of these grievously injured patients surviving to live a fulfilling life. How was this achieved?

As Kate explains, it is sometimes necessary to reorder the ABCDE.

In the case of a major trauma with catastrophic bleeding, stopping the bleeding needs to be prioritised above all else. Kate describes the methods she used.

Secondly, she discusses the importance of taking the hospital to the patient. Kate talks about the capability of the Chinook helicopters she worked in.

In her words ‘helicopters become flying Emergency Departments’. This enables advanced assessment and interventions to be delivered on scene. This includes IO access, blood transfusion, RSI and high-quality analgesia.

Kate goes on to discuss the important of training and rehearsal. For her role, many months of training are essential, to prepare for the unpredictable nature of a warzone.

This extends to being extremely familiar with all protocols, equipment, and machines, so that it becomes second nature in all situations.

Finally, Kate touches on the human impact of the patients she treated. Although you cannot save everyone, there is a need to learn a lesson from every patient.

Learn from them and disseminate the knowledge. In this way, you can continue to get better. This is highlighted by the improved mortality rates in Afghanistan.

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