"I'm taking all the things I learned in Afghanistan and bringing them to the trauma bay at St. Mike's. So with the recent gun shots we have had here in Toronto, I can bring those processes I learned in Kandahar back to Canada."
"The first time you see somebody from a major IED blast, it can be fairly overwhelming to look at; you've just never seen an injury pattern like that before. But with some guidance and mentoring, it generally becomes routine."
Dr. Andrew Beckett, trauma surgeon, St. Michael's Hospital, Toronto

Brian Hutchinson / Postmedia News Files      Doctors perform surgery at the Role 3 hospital at Kandahar Air Field, where the lives of Afghan civilians are among those saved.

When Canada had committed itself to a military role in Afghanistan - through its membership in NATO - in Kandahar Province, one of the most brutally conflicted parts of the country, it experienced the anguish of losing more of its soldiers to death through the Taliban use of IEDs proportionately than any of its NATO counterparts. And it was not just Canadian soldiers that were being blown up, but Afghan civilians as well.

Canada operated a field hospital, and it is the lessons learned at that operating theatre that have been brought back to Canada, to establish a best-practices hospital treatment scenario when being faced with trauma to the human body. Canada's busiest regional trauma centre - Sunnybrook Health Sciences Centre in Toronto, sees about a thousand trauma cases a year, and St. Michael's about 500.

At Canada's Kandahar-based Role-3 hospital, operated for four years by the Canadian Forces, a flood of 2,600 trauma patients surged through the hospital.  "It's amazing that we could then pull off that very low in-hospital mortality rate", said army major Dr. Beckett. "You're essentially bringing first-world medicine over to Afghanistan, which is really an incredible feat."

For at the Kandahar clinic, less than one in 20 patients succumbed to their extreme wounds, according to a study recently published in the journal Injury, of which Dr. Beckett was the lead author. That represents a 4.4% mortality rate, compared to a 12% rate experienced through the Ontario Trauma Registry for 2009-10.

Dr. Becket worked at the Kandahar facility in 2010 for a three-month period. A NATO award honoured the work of the hospital from 2006 to 2009, in saving lives. The published study covered October 2009 to December 2010, when the U.S. took over operations with Canada's military departure from the area. Canadian doctors, nurses and other health professionals continued to make up about a third of the staff.

Although IED explosions resulted in the most common source of injury, gunshot wounds, vehicle crashes and wounds sustained from artillery, mortars or rockets were additional sources of injury. During the time of the study there were 19 triple amputations. By then the hospital staff included trauma-team leaders, anaesthetists, orthopedic surgeons, general surgeons, critical care specialists, family doctors, neurologists, ophthalmologists and oral-maxillofacial surgeons.

The entire point of this teamwork approach was to maximize surgical effectiveness and eventual health outcomes in a multi-disciplinary approach to the healing arts. An "assembly line" protocol was established making use of two CT scanners and additional diagnostic-imaging gear to lead the team members in their initial assessment and subsequent treatment of patients.

The successes that were realized at the Kandahar field hospital have motivated transferring the very same protocol in treatment effectiveness to civilian hospitals in Canada where first-world treatment is catching up to the successful process of overcoming third-world conditions, if that doesn't sound too convoluted and incredible.