Military anaesthesia

War and conflict have long been associated with improvements in medical care. The recent conflicts in Afghanistan and Iraq have been no exception. The high tempo of operations has presented the United Kingdom’s Defence Medical Services (DMS) with the need to care for injured service personnel and local nationals with highly complex patterns of injury. Patients have presented to the DMS with injuries not commonly encountered in civilian practice—typically the result of blast and ballistic mechanisms. The deployed anaesthetist is involved in all stages of the patient pathway from point of wounding to the emergency department, through the resuscitative period encompassed by the damage control construct; to the critical care delivered on the ground and in the air and finally back in the United Kingdom at the interface with the civilian National Health Service. The high quality of care delivered in association with rigorous clinical audit and research including laboratory physical science, has produced developments that not only impact on military outcomes, but which are being introduced in wider civilian practice. This chapter covers all these areas from first principles to the management of pain and advances in the understanding of coagulopathy.