Medical Support to Operation CORPORATE J G Penn-Barwell, R Jolly, R Rickard
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Falklands 35 93 Medical support to Operation CORPORATE J G Penn-Barwell, R Jolly, R Rickard Abstract This article describes the medical support to Operation CORPORATE, and is derived from a range of sources, including sur- gical operative logbooks, journals and contemporaneous official reports.Eight hundred and fifty-five surgical procedures were performed by deployed medical units between 14 May and 13 July 1982 in support of Op CORPORATE. The rate peaked on the busiest day, 12 June 1982, when 86 operations were performed. The vast majority of operations were wound management procedures, although 20 laparotomies, four thoracotomies and six craniotomies were also performed. The four forward Role 2 (R2) surgical facilities at Ajax Bay, Teal Inlet, Fitzroy and on board SS CANBERRA collectively performed 354 operations.Ar- gentine and British casualties were evacuated from the area of operations on board three Argentine vessels and three British HECLA-class survey ships. Between them, HMSs HECLA, HYDRA and HERALD made a total of nine 1000-NM journeys between the Falkland Islands and Montevideo, Uruguay, caring for a total of 601 patients. From Montevideo, British casualties were transferred by RAF VC-10 back to the UK. Reflection on how a previous generation supported this operation may inform decision-making when similar challenges are faced in the future. Penn-Barwell JG et al. J R Nav Med Serv 2017;103(2):93–97 Introduction Detailed analysis of the operative surgical workload of the Thirty-five years ago, on Friday, 2 April 1982, the Argentine R2 MTFs was possible, and the overall number of opera- Armed Forces invaded and occupied the Falkland Islands. In tions performed on board HMHS UGANDA and their broad response, the British Government rapidly dispatched a Naval nature is available. No details of the surgical procedures Task Force charged with liberating the islanders and restoring performed on board HMS HERMES or HMS INVINCIBLE British sovereignty. There was no contingent military plan for have been found. the re-capture of the Islands.1 Similarly, the medical plan to support the operation was hastily developed in the first week Results of April and continued to evolve throughout the conflict. A total of 855 surgical procedures were performed in British MTFs described during Op CORPORATE. The greatest surgi- Organic Role 1 (R1) medical assets were already embedded cal workload was on 12 June 1982 when 86 operations were throughout 3 Commando Brigade, the fleet, and the manoeu- performed in R2 and R3 units, with a majority (56, 65%) being vre elements of the Field Army. The challenge for senior med- performed by Royal Navy (RN) and British Army R2 surgical ical planners was to establish forward or Role 2 (R2) and more teams ashore. Those operated on were predominantly casual- definitive Role 3 (R3) medical treatment facilities (MTF), as ties resulting from assaults on elevated positions around Stan- well as a strategic medical evacuation (StratEvac) chain to re- ley, namely Mount Harriet, Two Sisters and Mount Longdon. turn casualties to Role 4 (R4) care in the UK. The surgical workload of the R2 and R3 units over the course of the campaign is shown in Figure 1. This study reports a systematic analysis of the surgical support to Operation CORPORATE, aiming to inform on the challeng- Role 2 Surgical Teams es that exist in providing medical support to military opera- The composition of surgical teams at the R2 level varied con- tions with extended lines of logistical supply. It combines a siderably, as shown in Table 1. The Army deployed Forward narrative account of the disposition of medical assets with an Surgical Teams (FSTs) consisting of a single surgeon, a single analysis of the surgical workload and case mix. anaesthetist and a general duties MO. Across the four FSTs there was only one surgeon and one anaesthetist of consultant Methods grade. The RN Surgical Support Teams (SST) were larger but Data were derived from a range of sources, including the op- similarly comprised both trainees and consultants, although erative surgical logbooks from the four land-based surgical their size and composition fluctuated throughout the conflict. teams and those on board SS Canberra, making up the R2 surgical units (Table 1). A summary of operative output from Of the 354 surgical procedures performed at R2 facilities, HMHS UGANDA, the R3 medical treatment facility, was de- only 79 (22%) were performed by consultant surgeons, with rived from the report of the Medical Officer in Charge. Finally, the remainder being performed by surgical registrars, often in some limited data were collected from the journals of Medical isolation from consultant supervision. Similarly, only 122/354 Officers (MOs) in the fleet, contemporaneous official reports (34%) procedures for which logs are available were performed and administrative paperwork. under an anaesthetic delivered by a consultant anaesthetist. 94 Journal of the Royal Naval Medical Service 2017; 103(2) Figure 1: Surgical workload of Role 2 and 3 surgical teams over the course of the conflict. SST: Surgical Support Team, FST: Forward Surgical Team. Nine surgical procedures performed at King Edward VII Memorial Hospital in Stanley are not plotted separately Senior Senior Operations Surgical Grade Anaesthetic Grade performed Movements Royal Navy RN SST 2 Reg Reg 116 Ajax Bay 21 May-16 June RN SST 3 Cons Cons 66 SS CANBERRA HMS HERMES (SST 1) Cons Reg Unknown HMS INVINCIBLE Cons Reg Unknown HMHS UGANDA Cons Cons 501 Predominantly in the “Red Cross box”, closing to Falkland Sound daily during daylight hours from 29 May RAMC FST 1 (2 FH) Reg Reg 14 Bluff Cove/Fitzroy 11-14 June. FST 2 (2 FH) Reg Reg 25 Ajax Bay 12-14 June FST 5 (PCT) Reg Cons 79 Ajax Bay from 21 May, then Teal Inlet 8 June 16, moving to Stanley 16 June FST 6 (PCT) Cons Reg 56 Ajax Bay from 21 May, then moving to Bluff Cove/Fitzroy from 11 June. Table 1: Composition and position of surgical teams during Op CORPORATE. SST = Surgical Support Team; FST = Forward Surgical Team; PCT = Parachute Clearing Troop; FH = Field Hospital. [Collectively, the aircraft carriers HMS HERMES and HMS INVINCIBLE received 57 casualties, but further detail is not known.] Argentine casualties comprised 111 of the 354 (31%) of the It was later augmented by FST 2 from 2 Field Hospital as part surgical procedures performed at Role 2 facilities. of 5 Infantry Brigade. The first land-based Role 2 MTF was established in an aban- In preparation for the battles to secure the high ground doned meat packing plant in Ajax Bay on 21 May 1982 as surrounding Stanley (Mount Harriet, Two Sisters, Mount shown in Figure 2. This was manned initially by RN SST 2 Longdon, Wireless Ridge and Tumbledown), the two PCT and the two FSTs from the Parachute Clearing Troop (PCT). FSTs, together with FST 1, were moved forwards to the north Falklands 35 95 Figure 2: The abandoned meat packing plant at Ajax Bay, with helicopter landing site and Wessex 4 helicopter used for casualty evacua- tion in top left of picture. Photograph reproduced with kind permission of Surg Capt Rick Jolly OBE RN (Rtd). and south coasts of East Falkland to be in better positions to the troops she had transported to the Falklands. In the event, some receive casualties (Figure 3). After the Argentine surrender, of the surgical personnel and resources were transferred to the FST 5 was established in the King Edward VII Memorial Hos- facility at Ajax Bay, which was found to be an unexpectedly suit- pital in Stanley from 16 June onwards. able location with hard standing and environmental protection. Initial planning intended that SS CANBERRA would provide a SS CANBERRA was used to transport several thousand Ar- significant forward surgical capability after the disembarkation of gentine prisoners of war from Stanley to Montevideo, Uruguay Ajax Bay ‘Red Cross Box’ RN SST 2 21 May–16 June 40-miles North FST 5 21 May–8 June Teal Inlet UGANDA (R3) & FST 2 21–14 June FST 5 8–16 June 3 HECLA class FST 6 21 May–11 June ambulance ships Stanley San Carlos Water SS Canberra (R2) , Bluff Cove from 21st May & Fitzroy FST 1 & 6 11–14 June Grantham Sound UGANDA (R3), from 29 May (Daylight hours) Figure 3: Disposition of surgical teams across the Falkland Islands. 96 Journal of the Royal Naval Medical Service 2017; 103(2) prior to eventual repatriation to Argentina. Almost half of the 69 surgical procedures performed on SS CANBERRA were Dates Ship Casualties performed on Argentine POWs (31/69, 45%). 28 May - 2 June HMS HECLA 42 Role 3 Surgical Team 2-6 June HMS HYDRA 60 The R3 medical treatment facility was based on HMHS 10-13 June HMS HERALD 60 UGANDA, which was registered as a hospital ship with the In- ternational Committee of the Red Cross (ICRC). As such, she 12-16 June HMS HECLA 61 had to be illuminated and her position registered with ICRC. 14-18 June HMS HYDRA 80 She was equipped with a range of more specialised surgical capabilities including orthopaedics, burns and plastic surgery 20-25 June HMS HECLA 76 and ophthalmology as well as a 20-bed intensive care unit. 21-24 June HMS HERALD 100 Initially, UGANDA was located in a “Red Cross Box”, an area 24 June - 1 July HMS HYDRA 66 agreed with the ICRC, approximately 40 miles north of the Falklands, until 29 May when she sailed into Grantham Sound 7 July - 12 July HMS HYDRA 56 in East Falkland in daylight hours, returning at night to the 601 Red Cross Box. This arrangement was repeated on subsequent days.