Originally published on AspectofHistory.com
In October 2001 the United States led a coalition of nations into Afghanistan with the aim of overthrowing the repressive Taliban regime. The coalition forces advanced rapidly, Taliban forces were simply unable to withstand the onslaught of better trained, better equipped and better led armies.
Unable to compete with the coalition in conventional warfare, the Taliban soon became an insurgency, moving covertly amongst the Afghan population and employing guerrilla tactics. Nowhere was this more so than in Helmand Province, where British forces were most active, as Helmand was the historic heartland of the Taliban movement.
Key to Taliban tactics was the use of Improvised Explosive devices, or IEDs. Expert bomb makers were able to manufacture devices that could be initiated by pressure plate, trip wire, or remote control, or carried by suicide bombers travelling by foot or in vehicles. These devices allowed small numbers of Taliban fighters to inflict significant damage on the larger coalition forces. The devices were used not only to kill and wound, but also to control the movement of soldiers – IEDs could be placed to block routes or divert patrols into pre-prepared kill zones.
The IED threat led to a race of tactics and counter-tactics. For every solution coalition forces produced to combat the threat, the bomb makers would employ their malicious ingenuity to keep the threat potent. Metal detectors were countered by the production of low or no-metal content devices. Soldiers who became adept at spotting ‘ground sign’ soon had to contend with bombs put in trees or buried into walls.
The bomb makers seemed to take a perverse pleasure in using items discarded by British soldiers against them. Empty plastic water bottles could be crushed and used as a no-metal pressure plate. When the innocuous looking bottle was stepped on, two fine filaments within would make contact and trigger the bomb. Discarded batteries from the very metal detectors used to find IEDs were recovered by the Taliban and strung together to provide enough charge to initiate explosive devices.
The injuries caused by IEDs were very often horrific; the loss of two or three limbs was not uncommon. This was often their purpose because a severely wounded soldier could be more of a hindrance in a firefight than a dead one.
Because of these severe injuries, not only did the British have to rapidly develop tactics and techniques to avoid IEDs, but the way medical care was delivered to soldiers also had to evolve rapidly. In the 20 years during which the British were active in Afghanistan, 454 personnel were killed. This number is surprisingly low given the violence of the conflict, but many multiples of this number were severely wounded. In many cases, those who survived their injuries would not have done so in previous conflicts.
There are numerous reasons for the high survival rate of people with life changing injuries and these range from the cutting edge, to the extremely basic. At one end of the spectrum was the evolution of ultra-efficient evacuation chains. A soldier might be on an operating table receiving the attention of up to six consultants less than an hour after the explosion that wounded him or her. Those consultants would make use of innovative trauma management techniques such as the transfusion of specific ratios of different types of blood product. The lessons learnt from the experiences of the wars in both Afghanistan and Iraq were put into practice with extraordinary speed.
But the arrival of a casualty into that rarefied environment was only possible because of the re-learning of techniques that would have been familiar to medics working in the First World War, and the teaching of those techniques to ordinary soldiers. This included practices such as the application of direct pressure onto bleeding wounds, and the use of basic airway manoeuvres to keep people breathing but, perhaps above all, it was the widespread and effective use of tourniquets that saved lives.
All soldiers patrolled carrying tourniquets and it was intended that their own tourniquets would be used to save them in the event of a traumatic amputation. In fact, many wounded soldiers applied the tourniquets to themselves even as the dust of the explosion settled around them.
When it came to saving lives, it was not the highly advanced skills of the surgeons, nor the positioning of trauma-trained doctors in front line bases that made the difference. It was ordinary soldiers keeping calm under pressure and employing basic first aid that kept people alive.
Adam Staten is the author of the novel Steadfast: Band of Brothers based on his time serving as a medical officer in Helmand Province, Afghanistan.
