J R Army Med Corps: first published as 10.1136/jramc-130-02-04 on 1 January 1984. Downloaded from

) R Arm.r Mlu/ Corps 19804; 130: K4-8 8

Operation Corporate-The Sir Galahad Bombing Woolwich Burns Unit Experience

Maj PChapman FRCS lEd) RAMC Senior House Officer in Burns and Pfast;o' Queen Elizaheth Military Hospital. Woolwich

SUMMARY: During Military Operations in the South Atlantic to recover the Falkland Islands in 19H2. the troopship Sir Galahad was bombed. Initial treat ment of the injured in field medical units was followed by transfer to the SS and evacuation to the where 48 patients were treated in the Burns and Pla.!ttics Unit, Queen Elizabeth Military Hospital. Woolwich. The treatment of these Ilutients is described and the mana"emcnt of war hurns discussed.

Introduction

On 8 June the Royal F leet Auxiliary SI R guest. Protected by copyright. GALAHAD was at anchor in Fitzroy Bay . The ISL Battalion Welsh Guards, support troops, their equipment and munitions were on board. They were awaiting disemba rkation for BlutT Cove as part of the force involved in the coming assault on Port Stanley when, at approximately 1700 hours local time, the ship was bombed by Argentinian Sky Hawk jets. At least one bomb exploded at the rear end of the tank deck which was the main assembly point for troops and their equipment ready to leave shi p. T he blast caused secondary detonation of a considerable amount of munitions, including mortar ammunition stored directly below the ship's main hatch forward of the superstructure. Troops were The Sir Galahad on fire in Fitzroy. killed or injured by flash, blast and secondary mis­ si les from multiple explosions. A total of 78 soldiers HECLA, HERALD and HYDRA for passage to http://militaryhealth.bmj.com/ were burnt. Within minutes of the attack a massive Montevideo and onward flight in RAF VC 10 air w evacuation of the ship was started, usi ng hel icopters. craft to the UK via . On arrival lifeboats, landing craft and inflatable rafts. Many in UK, wounded were held overnight at the Princess wounded troops were successfully carried ashore. Alexandra's H ospital, Wroughton. and then dispersed although all their equipment was lost. to other military hospitals in England. Medical facilities at Fitzroy were Jimited, as a ll the Field Ambulance equ.ipment had been lost On Management board the SI R GALAHAD during the bombing. Of the burnt soldiers who reached the UK, 27 First aid was given and the wounded evacuated as were considered sufficiently healed to be sent home soon as possible by helicopter to Ajax Bay where on sick leave, th ree were transferred to the RA F (he main shore-based medical facilities were stationed Hospital, Halton, and 48 were transferred to the

in a disused refrigeration plant. Some of the injured Burns and Plastics Unit at the Queen Eli zabeth on October 6, 2021 by were transferrc:d directly to ships in San Carlos Military Hospital, Woolwich. Water. All were ultimately evacuated to the hospital The field medical documentation and hospital ship SS UGA N DA which itself was under pressure case notes of those patients treated at Woolwich to evacuate as many wounded as possible, to make were retrospectively analysed. Each soldier was inter­ room for the large numbers of casualties expected viewed to make good any omissions in the neces­ from the planned attack on Port Stanley'. T hose sarily brief field records and to provide background fit enough were therefore transferred from information for construction of the histori cal UGANDA to the smaller hospital transport ships, picture. It J R Army Med Corps: first published as 10.1136/jramc-130-02-04 on 1 January 1984. Downloaded from

P Chapman 85

In the South A rlanrie measured on a hand-held battery-powered centri­ Immediate first aid at Fitzroy including hosing fuge, using a regime now known as the "Uganda down of burnt areas with cold water and applica­ Rule" (Table I)' . tion of basic field dressings2 • As all medical stores had been Jost in the ship. the two field surgical Table I teams from 2 Field Hospital, supported by 16 Field "The Uganda Rule" AmbuJance, had an extremely limited capacity ~ . Hourly haemalOcril Rate of infusion for However, shore-based infantry units, already estab­ 500 mls Dextran 70 lished and equipped, were on hand to provide intra­ > 60 2 hourly venous fluids, drip-giving sets and further field dressings. 50 - 60 4 hourly After receiving their basic first aid, casualties were <. 5U 6 hourly transported by helicopter as quickly as possible, many within half an hour, to the medical unit at Ajax Bay. Space and resources at the refrigeration Surgery on the UGA NOA was necessarily kept plant in Ajax Bay were also limited, so about half 10 a minimum. The most severe facial burns were the patients were transferred to medical holding treated with eyelid split-skin grafts and tarsorraphies facilities prepared aboard FEARLESS, INTREPID for corneal protection. A few escharotomies were and ATLANTIC CAUSEWAY. carried out, as well as emergency surgery for other injuries. Parenteral prophylactic antibiotics, started At Ajax Bay patients were routinely given intra­ guest. Protected by copyright. muscular penicillin and booster doses of tetanus at Fitzroy jf available, or otherwise at Ajax Bay. 4 were continued orally for five days. toxoid • Morphine was available for pain relief. Hand burns were cleaned with cetrimide solution and put into plastic bags containing silver sulpha­ diazine cream until the supply of bags ran out. The remaining patients were given saline-soaked field dressings until plastic bags were again available on the Uganda. Other areas were treated with saline soaks which were replaced with occlusive silver sulphadiazine dressings on UGANDA. Faces were left exposed after cleansing. Other injuries such as shrapnel wounds were debrided and treated as required. Fourteen patients with greater than 10% burns were resuscitated with intravenous fluid drips begun either at Fitzroy or later at Ajax Bay. Eight of these were catheterised. Of a further 19 patients with 6- http://militaryhealth.bmj.com/ 10 % burns, nine required intravenous drips, and two of these were also given a urinary catheter. A fig. 2 Skin grafting in South Atlantic total of 10 patients required catheters, three of which were inserted at Ajax Bay and the rest on board the hospital ship UGANDA. The main fluids Two patients, one who developed a haemo­ used at Fitzroy and Ajax were sodium lactate ami pneumothorax, and the other who required revision Polygeline. of a traumatic below-knee amputation. received As most had been exposed to flash and smoke ion blood transfusion at Ajax Bay_ Blood was given to the confines of the ship, steroids were administered. two other patients on the UGANDA with 26% and before transfer to the UGANDA, to 29 patients. 45 % burns respectively. In the relatively calm condi­

roughly half of whom had one dose of hydrocorti­ tions of the SS UGANDA, blood was cross matched on October 6, 2021 by sone 100mg intramuscularly, the rest having I gram before transfusion, although at Ajax Bay group of Methylprednisolone intravenously six hourly_ compatible blood was used without waiting for the Most patients were transferred by helicopter to result of emergency cross match. No transfusion the hospital ship UGANDA within 24 hours. Here reactions have been reported so far. intravenous resuscitation was continued using Dex­ tran 70 in those still with high haematocrit levels In the United Kingdom many hours after injury. The drip rate was con- The Queen Elizabeth Military Hospital, Woolwich • trolled by reference to hourly haematocrit levels received 48 burns cases from the SIR GALAHAD, J R Army Med Corps: first published as 10.1136/jramc-130-02-04 on 1 January 1984. Downloaded from

Operarion Corporate- The Sir Gafahad HomiJifl g

amongst other casualties from the South Atlantil.:. rc-grafting. Surgery was carried out to other areas as The Burns and Plastics Un it at Woolwich has 28 shown in Table Ill. Kirschner wires were used on ordinary beds a nd six high care beds in a self­ five patients to prevent finger joint contracture. Of contained burns ward. At the first indication of the the faces only two required any grafting. the re­ expected casualtie.."i all routine plastics patients were maining superficial Hash burns ht=aling conservatively moved from th~ Unit and booked operations were with exposure. Twt=nty-five patients had superficial postponed. Spare beds \vere made available on a hand burns which healed sufficiently with conserva­ general surgical ward for overflow of the less severe tive management to allow them to be sent home cases, and extra nursing staff were transferred from on sick leave within three weeks of injury. other parts of the hospital. The day-to-day run · In early July the last two patients arrived, delayed ning of the Unit was carried out by the Army Con· in one case by septicaemia in a 45 % body surface sultant in Burns and Plastic Surgery assisted by one area burn, and in the other by revisionary surgery junior doctor. On days when large numbers of to a traumatic amputation of the leg. The former casualties arrived together, junior doctors from other underwent an extensive series of re(.;onstrLlctive surgical departments were encouraged to help In operations, including bilateral tarsorraphy, bilateral the initial reception and clerking of patients. split skin grafts to upper and lower eyelids followed A total of 48 male patients. aged between 18 by Wolfe grafts to the same areas. and split skin and 41 , all injured on 8 June 1982, were admitted to grafts to other parts including the hands, arms and the Queen Elizabeth Military 'Hospital from 18 June scalp. He required nine gent!ral anaeslhclics before to 2 July (fable Jl). Twenty-five arrived on the first the cnd of September. day and 46 had arrived by the end of the first week . guest. Protected by copyright. Rc..'mits Table 11 By the end of 1982. 21 soldiers had returned to Body Surrace Area Burn of Sir Galahad victims normal employment. Of these 18 had been treated % body su rface area burn No. of Patients conservati vely. A further 22 patients were employed (Range I · 45 %) in a limited capacity. They had varying degrees of web space contracture. scar hypertrophy and skin <: 5 15 breakdown. and were being treated as Out Patients 6 - 10 19 with pressure garments, while three were admitted 11 - 15 4 in December for further grafts. Of this group in 16 - 20 6 limited employment. only two were treated con­ > 20 4 serva ti ve ly. Five soldiers remained in hospital. Total 4R Table lV Employment SIa1us related to Mlm:igemcnl (As al December 1982)

All had burns of varying degrees to their hands. http://militaryhealth.bmj.com/ Forty.two patients had burnt faces, 33 had burns Conservative Surgical Toul l on other parts of the body and eight had associated Fu ll I!ll1ploymcnt 18 -, 2 1 non-thermal injuries (Table Ill ). Lim ited employment 2 20 22 Hospital in paticms I ' 4 5 Table III *' Due 10 non thermal injury Burn Woundiu/o: by Region and Treatment Method used Cunservalive Surgical TOlal Two patients, after early repeated srlil skin graft· Hands 49 44 93 ing, required full thickness cover to deep burns over Faces 40 2 42 lhe dorsum of finger joints. Axial paltern groin Scalps 0 6 (, flaps .:l were successfulJy fashioned in both cases. on October 6, 2021 by a lthough thermal damage was so extensive that joint Trunkc 6 7 implants and tendon transplants will be required. 17 20 Limbs -, Late breakdown of extensor skin over finger joints occurred in two of the conservatively managed By the end of June dc-slough and spl it skin group and four of those initiaJly grafted. Apart from grafling had been carried out on 40 hands among one who required a full thickness cross arm flap. all 23 soldiers. Due either to incomplete de-s lough or underwent thick split skin grafts. graft failure, 12 hands (seven patients) required early From the group in which Kirschner wires were • J R Army Med Corps: first published as 10.1136/jramc-130-02-04 on 1 January 1984. Downloaded from

l' Chapman 87

used, two remained hospital inpatients to allow their was started until arrival in the UK two weeks after axial pattern flaps to mature. The other three were injury. transferred, after grafting was complete, to the Joint Early Treatment: In order to cope with a large Service Rehabilitation Unit at Chessington, for number of casualties in a short period of time there active full-time physiotherapy. At the end of 1982 needs to be an established well rehearsed regime for one of these was back at work as a heavy goods burns treatment on the battle field. Intravenous fluid vehicle driver and the other two were awaiting re­ replacement in the shock phase for large numbers admission for further corrective surgery. can be adequately controlled by following Sorenson's None of the patients interviewed many months Dextran formula as adopted by the Army8,9. Experi­ after the event admitted to any respiratory trouble ence on the hospital ship has demonstrated that either at the time of smoke inhalation or later, large numbers of patients in the shock phase can whether or not they had been treated with steroids. be adequately monitored by hourly haematocrit levels Continued use of pressure garments has been using the 'Uganda Rule'. Despite this, some will still required to counteract hypertrophic scarring and be either under- or over-resuscitated, but this is web space contractures in 24 hands (15 patients). In compensated for by the fitness, age and morale of this group only one pair of hands was treated con- professional soldiers in a regular army. Superficial I servatively. Hypertrophic scarring requiring similar burns of hands dressed conventionally with bulky treatment occurred in three other burnt areas, all bandages make otherwise fit patients dependant on treated conservatively. others. However, plastic bag occlusion allows the By the end of 1982 64 operations on 27 patients patient a degree of mobility and self help, relieving guest. Protected by copyright. under general anaesthetic had been performed by overworked nursing and auxiliary staff for the more the Unit. extensively injured!o. The exposure treatment of burns is well documentated" and this applies par­ Discussion ticularly to superficial burns of the face which Distance: Casualty evacuation over a distance of require virtually no maintenance, a factor of impor· 8,000 miles presents enormous problems administra­ tance when dealing with large numbers. tively, logistically and for the patient. With many Protective Clothing: To a limited degree clothing transfers from ship to ship, ship to aeroplane and can give protection from burn injuries. The SIR hospital to hospital in the UK, the journey from the GALAHAD victims were dressed for cold wet con­ SS UGANDA to the Queen Elizabeth Military Hos­ ditions with many layers of combat clothing. pital, Woolwich, took an average of six days. The although the hands and head were uncovered. Two nearest usable air base to the combat zone in the soldiers who were wearing gloves suffered only minor Falklands was 1,100 miles away at Montevideo. superficial blistering to the hands. Some wore plastic Patients stabilised on UGANDA were transferred to waterproof outer clothing with a hood, which was hospital transport vessels, which had been converted typically bunched up behind the head. This caused from survey ships, for the journey to Montevideo. deep burns where it ignited and fused to ·the scalp. From there they were flown to the United Kingdom Others wore thick arctic parkas which gave a good http://militaryhealth.bmj.com/ via Ascension Island. This was a substantial achieve­ degree of protection, particularly when the face ment; the American forces in Vietnam used perma­ was protected with the hood, as demonstrated by nent air bases relatively close to the fighting and one quick-wiHed soldier who, although losing a leg, were able to use large Jets, taking 20t hours for a had no facial burns. Except for those close to the journey similar to that between the Falklands and blast, multiple layers of clothing gave considerable the United Kingdom to evacuate patients in large protection. Analysis of this incident shows that numbers direct to the United States". In the early despite the large numbers of casualties involved. stages of the Vietnam war most of the serious cases many were of a relatively minor nature and might were evacuated rapidly, sometimes within 24 hours have been prevented. Flash protectiVe clothing, as of wounding, but as larger more specialised medical worn by the crews, could protect many hands and faces although both availability and troop facilities were established in the war zone, transfer on October 6, 2021 by of these patients was delayed and definitive treat­ compliance are likely to cause difficulties. ment started immediately7. British soldiers arrived • in England tired, confused and some in great pain. Acknowledgements The length of the casualty evacuation chain preclu­ I wish to thank Colonel B C McDermott CBE ded any reconstructive surgery in the South Atlantic FRCS L/RAMC for the encouragement and permis­ for burn cases. Emergency surgery included amputa­ sion to report on his patients, and Colonel R Scott tions, escharotomies and tarsorrhaphies which were FRCS L/RAMC for his advice on preparation of • carried out as indicated, but no definitive grafting this article. J R Army Med Corps: first published as 10.1136/jramc-130-02-04 on 1 January 1984. Downloaded from

88 Operation Corporate-The Sir Galahad Bombing

REFERENCES 1 CHAPMAN C W. Burns and plastic surgery in th

NEW YEARS HONOURS LIST 1984 Additional Qualifications CB Major-General J P Crowdy, QHP, L/RAMC. Col. W A Dalgleish, LRCP, LRCS, LRFPS, OBE Lieutenant Colonel C G Callow, RAMC. DTM&H, MRCPsych, DPM, L/RAMC has been MBE W02 A L Viner, RAMC. elected to a Fellowship of the Royal College of Psy­ chiatrists.

ACADEMIC ACHIEVEMENTS http://militaryhealth.bmj.com/ MD (Glas) Lt Col P Lynch, MB, ChB, MRCP, DObstRCOG, RAMC. Honorary Consultants to the Anny MRCGP Capt B J Bates, BSc, MB, ChB, RAMC, Professor N L Browse, MD, MB, BS, FRCS, was Maj I J Lambert, BSc, MB BS, RAMC, Capt Sir R appointed Honorary Consultant in Vascular Surgery H Lynch-Blosse, MB BS, RAMC, Capt R S Hur­ to the Army with effect from 19 December 1983. wood, MB BS, RAMC, Capt MJ Stone, MB, ChB, RAMC, Maj A J Waring, MB, ChB, RAMC, Maj A Dr A D Cox, MA, MRCP, MPHil, FRCPsych, was J Waring, MB, ChB, RAMC. appointed Honorary Consultant in Child and Adoles­ cent Psychiatry to the Army with effect from 3 April DTM&H Maj A Sharma" MB, ChB, RAMC. 1984. on October 6, 2021 by •

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