Military medicine is medicine in less than ideal circumstances and military medicine is much, but not exclusively, involved with trauma.

Knowledge of and insights in trauma, its mechanisms and treatment are not static; they are constantly developing. Information on the subject is readily available in the literature, both civilian and military.

Trauma is an everyday-event in civilian life, and for that reason developments are on-going; trauma in the military environment is to a degree dependent on the frequency with which Armed Forces are involved in conflicts, and on the type of those conflicts.

Ideally, developments in the civilian arena should be incorporated, once they’ve proven their value, in military medicine; in the same vein, medical “experiences” from armed conflict should be studied as regards their applicability in civilian trauma care.

That this is not necessarily always the case can be illustrated by what has happened over the last forty years in the Netherlands. In the seventies of the last century, the height of the Cold War, preparations were on-going for “the big clash with the enemy from the east”, but after the actions in the former Dutch East Indies (1945-1949), the Armed Forces had almost no “fighting experience”. Equipment and doctrine in the seventies had become out-dated, also because of the political climate: a strong opposition to the Vietnam conflict had made all things military suspect. As a consequence, a big divide had developed between civilian and military medicine, in the sense that there was little communication, scientific and otherwise, between the two.

Fortunately, this unhappy state of affairs was not permanent. After the disappearance of the Iron Curtain, when the Armed Forces were transformed into an all-volunteer, expeditionary Force, experiences during deployments made it clear that both doctrine and equipment should be reviewed and be brought up-to-date.

That process was done as it should be: with input from both civilian experts and other NATO military medical services.

And that brings us back to the question: who’s leading in the development of traumatology: military or civilian medicine? Obviously: neither or both! It is, and should be a joint effort, or, if you wish: two-way traffic.

A couple of examples: the tourniquet which according to civilian medicine should “never” be used, but which proved its worth in Iraq and Afghanistan, and now is making its comeback (albeit only in very specific circumstances) in civilian trauma care; likewise the technique of deep-freezing platelets: a civilian development that has proven to be very effective and efficacious in Afghanistan.

Finally a remark from a reservist’s point of view: the reservist, having a foot in both camps, is very well suited for facilitating that two-way traffic !

Colonel Walter HENNY MD, Royal Netherlands Army Reserve