Conclusions

 

The origins of the International Red Cross and Red Crescent Movement lay in the humanitarian desire of Henri Dunant to aid the military medical services in caring for war wounded. Now, ironically, the hospitals of the ICRC daily deal with more victims of war than many military surgeons see in a lifetime of practice.

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The author therefore advocates that it is time for the military medical services around the world to repay their debt to the Red Cross by actively encouraging their surgeons, anaesthetists and other theatre personnel to volunteer for temporary secondment with the ICRC.

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At a time when realistic peacetime military training is increasingly difficult to achieve, and when the few suitably experienced military surgeons are leaving the services, such postings would also have the obvious benefits to the military medical services of excellent training, of enlarging the pool of experienced personnel, and of encouraging such personnel to remain in the Services.

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The author suggests that the ICRC video on Anti-Personnel Mine Injuries should be shown to all military medical personnel. Whilst there are some differences in doctrine between the ICRC and the military medical services, e.g. on evacuation policy, there is such unanimity on basic management principles that the ICRC field book "Surgery for Victims of War" and the book "War Wounds of Limbs - Surgical Management" should be standard issue to all military surgeons (alongside the Field Surgery Pocket Book which is currently the only surgical text issued to RAMC doctors). Lastly, the Red Cross wound classification could profitably be adopted by the military medical services. This would help to standardise the recording of wounds from different conflicts, and aid ballistic and wound research.

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ICRC surgical doctrine and practice, as exemplified in these books and its hospitals, may well soon become even more relevant to the military medical services. This is because the current trend would appear to be away from working within a system of structured evacuation chains and more and more towards working in humanitarian missions with the United Nations, with emphasis on providing and teaching adequate first aid and nonoperative management, and devoting the limited surgical resources to those who require semi-urgent surgery for survival or for improved quality of survival (68).

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Only by regularly dealing with a full spectrum of war wounds can military medical personnel hope to acquire and maintain their skills in war surgery.

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Acknowledgements

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I would like to express my gratitude to Lt General Sir Cameron Moffat KBE, FRCS, Chief Medical Adviser to the British Red Cross, to Robin Coupland FRCS, Surgeon with the Medical Division ICRC, to Bertrand Kern, External Resources Division ICRC, to Colonel J M Ryan MCh FRCS, Late RAMC, Professor of Military Surgery, and to Major A M 0 Miller RE, my brother-in-law, for their generous help with constructive criticism of this article.

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