Battlefield Advanced Trauma Life Support

History of Battlefield Advanced Trauma Life Support

Following the attendance on one of the American courses by the late Brigadier Ian Haywood, a former Professor of Military Surgery, the need was identified for a similar course modified for military requirements. The Department of Military Surgery at the Royal Army Medical College [now the Royal Defence Medical College (RDMC)] and the Army Medical Services Training Group [now the Defence Medical Services Training Centre (DMSTC)] were tasked with devising a course for the British Army.

Although the Battlefield Advanced Trauma Life Support (BATLS) Course is about training doctors for war, there is nothing new in this. Medical officers in former times had to deal with the injuries of the day - contusions, lacerations, penetrating wounds and broken bones - and under the primitive conditions prevailing at the time.

The Modern Era

Today’s medical services still have to deal with similar wounds, but they also have to contend with injuries produced by modern weapons - including not only gunshot wounds, but more importantly,multiple injuries produced by fragments with relatively high velocities and capable of

J R Army Med Corps 2000; 146: 110-114

BATLS Battlefield Advanced Trauma Life Support (BATLS)

Fragments and bullets

Bombs, shells, grenades and other explosive devices, cause death and injury due to victims being hit by primary and secondary fragments and due to the effects of blast. In older weapons, primary fragments were derived from the weapon casing and, as such, had wide variation in size, shape and weight. These weapons produced Random fragmentation and producing high energy-transfer wounds. They also have the problems of the effects of blast and the horrors of extensive burns.

Modern fragmentation amunitions are designed to deliver many hundreds of preformed fragments of different types. These fragments are much more uniform in size, shape and weight. Examples include, the pre-notched wire in a hand grenade, flechets in bomblets and etched plates in shells and mortar bombs. These weapons are referred to as improved (pre-formed) fragmentation devices Improved fragmentation devices are designed not to increase lethality but, to increase the likelihood of a hit. In fact, the lethality has fallen. The concept of the use of these weapons is a simple one: increase the likelihood of a hit, generate more enemy casualties and choke his logistic evacuation chain. The same concept also applies when these weapons are used by the enemy against friendly forces!

Table 1-1 Lethality of penetrating missiles

Type Lethality

Random fragmentation 1 in 5 (Shell)

devices 1 in 10 (Grenade)

Improved (Pre-formed) 1 in 7 (Shell)

Fragmentation devices 1 in 20 (Grenade)

Military bullet 1 in 3

Early rifle bullets depended on their mass and shape in order to produce injury, velocity was less important. For modern rifle and machine gun bullets, mass has fallen considerably but velocity risen dramatically. Given that the energy of a missile is derived from the formula 1/2JMV2 [M = mass, V =

velocity], this means the available energy in a modern military bullet has risen several fold.