Falklands war 25TH anniversarY - Boekje Pienter

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Vol. 153 Supplement 1

Fa l k l a n d s wa r 25 anniversarY TH

JOURNAL OF THE RAMC

RAMC Journal Publications HQ AMS, FASC, Slim Road, Camberley, Surrey GU15 4NP Telephone 01276 412790

JOURNAL OF THE RAMC VOLUME 153 SUPPLEMENT 1

FALKLANDS WAR 25th ANNIVERSARY

Editorial Major General M von Bertele, Chief Executive DMETA 30 years ago when this author joined the RAMC he was told by colleagues that it would be a short and dull career. Wars were a thing of the past and a life stationed on the Inner German Plain would soon pale. The Falklands war almost confirmed that. It was a conflict fought by foot soldiers, in a hostile environment against an enemy of unknown capability who nevertheless proved capable of inflicting high casualties. Never again we were told. Future wars would employ overwhelming force to minimise casualties. The easy victory in the first Gulf war when a large complement of hospital beds had been deployed, followed by relatively bloodless peace-keeping missions in Africa and the Balkans, all conspired to reassure political and military planners alike that risks could be taken with their medical Services. Following the collapse of the Soviet Union there was review after review, but the net effect, when the logic was stripped away, was a reduction in capability, culminating in the closure of military hospitals and a focussing of attention on deployable capability. Yet now casualties have returned in earnest and the capabilities of the Medical Services are being stretched to the limit coping with them, so it is worth asking in this anniversary edition of the Journal of the RAMC, what has changed and what still needs to be done ? The first point to be made is that the problems are largely unchanged. The patient is the same, the environmental and weapon threats vary from theatre to theatre, but disease and wounding mechanisms are the same, despite the impact of body armour and altered patterns of trauma, and the medical mission is the same. Despite the controversy about military hospitals and care of casualties in the UK, there are encouraging trends in almost all areas of deployed capability and considerable successes in a few: but fundamental problems remain in others. They will be considered in turn; medical advances, resource challenges, and most importantly perhaps, the people problem. In 1982 we had a good understanding of war surgery. If the patient got to a surgical facility we had surgeons who knew what to do. Their daily practise was generalist, they had memories, if faint, of service in small wars, and more recently in Northern Ireland, and they worked in military hospitals with the colleagues with whom they would deploy. They exercised together at least annually, and they still reigned supreme in a Corps that was focussed in large part on the doctrine of General War, where the best would be done for the most, but where resources would be overwhelmed and mortality was expected to be high. The challenge then, as now, was in getting the casualty to the surgeon. Most would be expected to die either in the immediate period following injury – they were then, and are now, largely unsalvageable, or died from haemorrhage over the next few hours, or died later from complications. With fewer casualties, attention has focussed on providing better resuscitation earlier for everyone, arresting non-compressible haemorrhage, and getting the patient to surgery earlier. The surgical team of general and orthopaedic surgeon. with consultant anaesthetic support, introduced in the 1990’s, has delivered outstanding success, and the provision of skilled aeromedical evacuation for even the most critically injured patients has enabled rapid return of casualties to the full spectrum of specialist services that the NHS can offer. There has finally, been a recognition that military casualties require more than just treatment on the NHS, and the confirmation that a formal role 4 capability is required as JR Army Med Corps 153(S1): 3-5

the final component of a comprehensive military medical capability that will be able to deliver a seamless patient care pathway. Our medical assistants are better trained and better equipped. Significant advances in development of haemostatic agents and revision of doctrine on the use, and provision, of new tourniquets has enabled haemorrhage to be better controlled. Better understanding of fluid replacement means that resuscitation can be tailored to give the patient the best chance of resuscitation and surgery at the earliest opportunity. In the Falklands the focus was on dressings, compression, and getting as much fluid as possible into the patient. Tourniquets were almost a dirty word. Many patients remained on the battlefield for hours, and by the time they reached the surgical facility they were significantly hypothermic. Coagulopathies were rare suggesting that the amount of blood lost in survivors might have been small. Oxygen was not carried, and was not even available during surgery. Now, the monitoring of vital signs, including oximetry, is considered essential. Pain relief was administered by morphine syrettes which were inadequate for the task, and there was a problem of overdosing with subcutaneous morphine, released later when a patient was being resuscitated. Other agents were tried, sub-lingual buprenorphine was popular at the time, and ketamine was used for the first time as both an analgesic and short acting anaesthetic, but only now are we really starting to address the problems and epidemiology of many different types of pain. Battle injuries were not the only cause and the management of pain from non-freezing cold injury (trench foot) proved challenging even for the anaesthetist. Evacuation in the Falklands was problematic Vehicles were almost non-existent and helicopters were barely up to the task and in short supply. But distances and therefore journey times, were short. Escorts were not present on battlefield helicopters. Now we agree that every casualty requires a comprehensive response, often including a medical team to provide resuscitation and a helicopter to ensure rapid evacuation. However, with finite resources we must not lose sight of the need to reduce risk to the responders and the aircraft, particularly as the more dispersed battlefield places increasing demands to evacuate over greater distances. Better decision making at the scene may reduce urgency and increase flexibility, but we must now focus on training more paramedics to perform this task and carry out research that will enable us to understand the prognostic indicators in order to focus resources on those who need them. The survival rates of those reaching surgery in 1982 were high, but the question has never been satisfactorily answered, were they the ones destined to survive? Current research is aiming to answer some of these questions, so that medical commanders can make more informed decisions and deploy the right resources, in the right time scale, to give optimal care to the casualty, and optimal support to the operational commander that will increase his freedom to manouevre. In the deployed surgical facility, a battery of tests is now possible; then there was only a simple cross match, but the essence of surgery is the same, and the challenge now is to train a surgeon to be competent in trauma surgery when in peacetime practice the emphasis is on ever greater specialisation. The competencies expected of the war surgeon cannot be delivered in routine practise in the NHS and we shall have to look either at taking a lead in the 3

training of trauma surgeons within the NHS, or continue to rely on additional training, much of which can only be obtained in other countries. The loss of training places in South Africa has been a significant loss to our ability to train trauma surgeons and although simulation has been heralded for many years as the answer to filling the skills gap, it is not yet sufficiently developed to deliver this. In 1982 the first surgical teams deployed had only one consultant ashore, a truly general and experienced surgeon, and he had to oversee a number of senior registrars. That generation of general surgeons is rapidly approaching retirement. Recently we have been reluctant to deploy surgeons below consultant grade, largely because of the impact on training programmes, but the training opportunities available on current deployments under consultant supervision may make us reconsider that stance. We have been fortunate over the past few years, in that the rate and complexity of casualties have increased slowly, giving us time to learn from American experience, and develop our techniques. Surgical facilities are well established, and our teams have an opportunity to rehearse before deployment; in future they may have to start again from scratch. As with our surgeons, the dash to specialisation in the nursing cadre is in danger of distracting from the training of generalist military nurses, but we have inadequate data to prove whether the quality of care has suffered or benefited from that trend. In the meantime we follow accepted wisdom but risk over-qualifying some of our personnel at the expense of delivering the right competencies to all of them. Data collection in 1982 was largely based on the field medical card and a retrospective interview survey of casualties was conducted by medical officers in an attempt to inform work being led by the Professor of Military Surgery. It was hardly systematic but since then many advances have come about through application of simple audit and the adoption of the principles of clinical governance. For many years however we have struggled to define and collect the comprehensive data sets that inform that audit. The promise of information systems that would facilitate and automate data collection and retrieval has distracted from practise but the imminent roll out of DMICP will produce a step change in capability, initially in the peacetime environment. The momentum must be maintained into the deployed environment and progress from being an electronic patient record to a functional operational medical decision support tool. That will have to be supported by a new organisation that will integrate data collection, storage, retrieval and analysis, and that will inform epidemiological analysis and decision making across Defence. In considering equipment, logistic support, and sustainability, we have probably turned the corner. In 1982 the scales were adequate, but old; re-supply was geared towards General War, and was woefully inadequate for light mobile forces. A RAP requiring 20 litres of Hartman’s would receive 2 or 3 large tri-wall boxes, which collapsed in the rain and spewed their contents over the mountainside. Now we have finally started to sort out scales in modules, re-supply by single line item, rapid response to UORs [urgent operational requirements], an understanding of the acquisition process, and a supply chain that is responsive and improving all the time. Further improvements will only be made, however, if we start to place medical support officers into logistic staff appointments at every level. The debate about evacuation continues, but structures are still geared to evacuation of the majority of land casualties by vehicle, with the attendant escorts, and yet experience has shown that the majority of serious casualties over the past 20 years have been evacuated by helicopter. Coupled with strategic aeromedical evacuation this has enabled progressive reductions in the deployed medical footprint but without assurances on how helicopters will be employed in future conflicts we risk moving out of step with other acquisition strategies. We must fight, not for dedicated helicopters which would restrict flexibility, but for better 4

equipment in assigned aircraft, and better training for all medical personnel who are likely to deploy. The debate about who should be on the helicopter has been clouded again by inter-Service rivalry, but articulation of clear doctrine and the delivery of the competencies required to deliver the capability must be delivered urgently. Organisational change has been driven by many factors, but not always by design. In 1982 control of the medical services was dominated by secondary care clinicians, but they have now been almost totally removed from the decision making process. The gap has been filled by a small cadre of medically trained staff officers, predominantly from the occupational and public health cadres, and by a rapid increase in the number of direct entry medical support officers. Despite improvements in staff training there is still a long way to go, and there is an increasing need for clinicians to return to the staff and policy forum. Promotion rules, changed to introduce common terms of service for professional officers and enable professional pay spines, now discriminate against the able in favour of the eligible, and are an increasing source of irritation. We serve and compete in an increasingly joint environment, alongside and against officers of the other Services, who, while intellectually and clinically gifted, are often operationally inexperienced and untested in command. As Yellowleas noted 30 years ago, the single greatest impediment to progress and rationalisation is the influence of the single Service medical directorates, and that remains true today. We must of course retain the best of single Service identity but must accept that cooperation and joint effort is essential if we are to overcome the challenges of the future. Each Service is too small to sustain their current posture, and this insularity has meant that too much time has been wasted fighting internal battles. In each Service there is still reluctance to allow able officers to compete against their Service colleagues for staff appointments outside of the medical services. Under intense media pressure there is also a danger that attention will be focussed on today’s tactical issues and insufficient attention given to the operational challenges of tomorrow. A strategic vision is required for the next 20 years and that must recognise the move from a tri-Service DMS to a truly joint DMS, recruited through the single Services but delivered jointly. Where a common standard can be applied to a capability, it should be delivered jointly. We must train more officers and NCOs at every level who will be able to sustain current levels of operational capability, train the next generation, and provide the leadership to deliver that vision. That training should be delivered through joint structures where sensible, and when specific to the medical services it should be designed and delivered to a joint audience, supplemented by environmental differences only when essential. We are moving in the right direction. Operations are increasingly joint; clinicians from all 3 Services work together, predominantly in a land environment; and there are moves to manage them more strategically, optimising their training and employment. . Paradoxically the only reason we are so strong today is because of the operational challenges of the past 5 years. Should conflict cease, because of our geographical dispersion, we risk being fragmented, with too many clinicians focussing on their immediate clinical practice in MDHUs, medically qualified staff officers concentrating on clinical governance and policy in headquarters, and medical support officers concentrating on the field medical services. Much work is required to bring them together in new peacetime organsiations. Ultimately it is our people who deliver medical capability, and it is hard to predict how we will fare over the next few years. In 1982 the NHS looked stable. You chose either a military career or a civilian one; you could transfer one way but rarely the other; and the routine practice of military medicine was satisfying, if not always too demanding. Now we are fully embedded in the rapidly changing training pathways of our NHS colleagues, and practice in JR Army Med Corps 153(S1): 3-5

an increasingly specialised world. The requirement to receive knee surgery from someone who only operates on knees may hold good in peacetime specialist centres, but is not the environment in which to train a generalist trauma surgeon. We must continue to work together to agree on the competencies required by our staff, and secure placements where they can be achieved. Our people at every level tell us that they want to be trained to do the military clinical task, but it is still hard to achieve that training as we try to balance career needs, single Service demands, and the wider service need. DMETA currently responds only to customer demand, but in future should be placed to inform the customer of the requirement, design it, and deliver. More needs to be done to focus training on the military requirement, while acknowledging the need to place and employ people in the NHS. This can only be done if the 3 Services agree. Training overall must improve, not just clinical, but importantly in command, leadership and management, and focus on delivering a multi-disciplinary command and staff cadre, open to clinical and non-clinical officers, properly trained in medical planning.

JR Army Med Corps 153(S1): 3-5

The Royal Navy and the Royal Air Force should allow their people to work more closely with their Army colleagues, and develop early the right career profiles to allow better application of common terms of service. The Army must offer up some command appointments to the other Services, especially as opportunities expand with implementation of Improved Medical Support to the Brigade (IMSB). Single Service differences should be retained either out of necessity, for example at role 1, or to meet specific environmental needs, but as a source of strength, not protectionism. This will only be achieved in an organisation that has a clear purpose, is adequately resourced, and properly organised and managed, with a focus on the fundamental output – the delivery of a full range of military medical support to servicemen and women of all 3 Services. That is the essence and purpose of a Joint element in our medical Services. With greater acceptance than for many years of the need for a comprehensive and capable Defence Medical Service, now is the time to make the change.

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FROM THE EDITOR In 1982, the editor wrote “The purpose of this editorial is to stem the drift into oblivion of the object lessons adduced [from the war]”. This remains, in a more general sense, one of the aims of the RAMC Journal. Sadly, experience bears out the suspicion that history is composed of lessons forgotten as often as it is of lessons learnt. I remember watching film on the news of Sir Galahad burning whilst I was a medical student and realising that my belief that wars had become something that didn’t happen anymore was wrong. The Vietnam and Korean wars had been years previously and World War II had been more than thirty years earlier, talked about only by people of my parent’s and grandparent’s generations. Times have changed again, and we now live with a continuing backdrop of wars involving British service personnel. Barely a week goes by without news of another death in action, yet I still remember the emotional shock to the Nation of the human cost of the conflict twenty five years ago. What also marked out the conflict in the South Atlantic was the almost universal support for what was judged to be a “just war”. It is surely a matter of pride that the people of the Falklands are as proud of and grateful to the Armed Forces now as they were all those years ago and that the Islands are more populated and more prosperous than ever before. And still British as their inhabitants wish. It is right, therefore, that we take this opportunity to mark the anniversary of the Falklands War and to pay tribute to those who served and to those who died. It is also important that we draw on their experiences in any way we can to ensure that the

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“object lessons” are not forgotten. Anyone reading the articles in this issue will readily realise that in many respects the challenges facing the medic at war have changed little since, just as they had changed relatively little in the years before. Much of this special issue consists of articles originally published in the Journal in the immediate aftermath of the War. Where necessary, I have included commentaries placing the articles in a modern context. Brief biographies of the original authors are also included. I am most grateful to Surg Capt Walker and Col Jim Ryan for their recollections of their service during the War, one on board ship, the other in the Field Hospital at Ajax Bay. The Army Medical Services are extremely lucky to have someone as enthusiastic and knowledgeable as Capt Peter Starling as their museum curator and I am immensely grateful to him for his patient responses to my many queries regarding this issue. In conclusion, the Royal Army Medical Corps lost four of its members in the Falklands Conflict and it is to them in particular that this issue is dedicated:

Major Roger Nutbeem S. Sgt Phillip Currass QGM L/Cpl IR Farrell Pte K Preston

JR Army Med Corps 153(S1): 2

FALKLANDS WAR 25th ANNIVERSARY

Fighting for the Falklands Capt. Piers R. J. Page "They landed approx 0930 GMT this morning in landing craft and stormed the capital Port Stanley and have taken over the government office - they landed with heavy armoured vehicles. We're now under their control. They are broadcasting that all local people will be treated as normal. Fairly peaceful in Stanley at present time." With these words, transmitted by Bob McLeod broadcasting as VP8LP from Goose Green, the UK discovered at 1600 hrs London time on 2nd April 1982 that the Falkland Islands had been invaded by Argentine forces.

industrial base for the South Atlantic whaling industry. By the mid 1960s, however, maritime engineering had produced the factory ship and there was no use for the giant factories on the shores of the island.

Background The roots of the conflict (war never officially being declared by either side) lay several hundred years previously, in the rapid expansion of the empires of several European nations. In the 1690s the body of water between the islands was named after 5th Viscount Falkland, a future First Lord of the Admiralty, by John Strong as he sailed between them. In 1765, the western region was claimed for Britain by John Byron, on the grounds of their prior discovery. Unfortunately, the eastern reaches had been settled the year before by the French, who took exception to the British claim before selling the settlement to Spain a year later. Spain promptly took the British settlement in 1771, returning it shortly after. In 1774, the British left, assuring continued possession by means of a brass plaque asserting the fact. Spanish government continued from Buenos Aires until 1816, when Argentina became independent and claimed inherited rights from Spain. A brief but catastrophic period of Argentine rule, which included a spat with the USA culminating in an armed visit from the USS Lexington and a failed penal colony whose soldiers mutinied and killed its governor prompted a British return in 1833. Over the following years, a British colony was established, which thrived throughout the colonial era. Much later, at the time of independence for many colonies, Lord Shackleton (grandson of explorer Ernest) was commissioned to explore the potential for viability and economic growth in the Falklands (during which his ship was fired upon by the Argentine navy). This inquiry found the islands to be net producers of wealth in British public purse terms, and to be stable, settled and selfmanaging. This was not the answer the Argentine government wanted to hear; when HMS Endurance, the naval exploration vessel was listed for withdrawal by May 1982 and the “Kelpers” of the Falklands were denied full British citizenship in 1981, the junta saw its opportunity.

South Georgia First landed on by Captain James Cook, the barren island of South Georgia experienced an intense half century as an Corresponding Author: Capt Piers RJ Page RAMC, Academic Department of Emergency Medicine, James Cook University Hospital, Marton Road, Middlesborough, Teeside, TS4 3BW Queen Elizabeth Military Hospital, Woolwich Email: [email protected] 6

HMS Chatham off South Georgia

On 19th March 1982 an Argentine flag was seen flying at Leith, the centre of the old whaling station. It had been run up by Constantino Davidoff, a scrap merchant who had decided to dismantle the station. The flag was run down after immediate British diplomatic action, but a further 7 days yielded no further co-operation; Davidoff had been ordered to present himself and his permit for the expedition to the British Antarctic Survey delegation on the island. He continued to resist this and by the 27th this Steptoe situation had escalated to the dispatch of a troop of British marines aboard Endurance, countered by the Argentine removal of nearly all the scrap men and replacement with their own marines. On the 27th, the writing was on the wall when two further missile boats arrived to support the Argentine marines and aircraft from the mainland remained almost constantly in the sky over Port Stanley. What has never been clarified is the degree of orchestration of this event by Buenos Aries. It seems quite possible that the initial action was in fact spontaneous, but offered an ideal opportunity for the junta to escalate its provocation of Britain.

Britain awakes On Wednesday 31st March John Nott, Margaret Thatcher’s defence minister, visited her to tell her that signals intelligence confirmed preparations by the Argentine fleet for invasion of the Falklands. This would be news to very few, as the entire fleet were at sea and had deviated from the course of their normal spring exercise. By Thursday evening, the Navy had committed a task force based around Hermes and Invincible, which it had vowed to put to sea by the Monday morning. Land forces were put on standby for immediate deployment and further ships set sail from Gibraltar to meet the force on its way south.

Contact! – 2 April At 0230 contact was called amongst the waiting marines; a fleet could be seen assembling off Cape Pembroke, as intelligence JR Army Med Corps 153(S1): 6-12

had predicted. What was not predicted, however, was the arrival at 0430 of Argentine special forces by Puma helicopter at Mullet Creek, south-west of their expected approach on Port Stanley. They landed here unopposed and began their infiltration. Within two hours their fierce assault on the thankfully empty British marines’ accommodation at Moody Brook demonstrated their will to win and destroyed any credibility the argument that they had aimed to take the islands without unnecessary losses might have had. Simultaneously, a large force of Amtrack LVTP-7 armoured personnel carriers was reported to be coming ashore by the OP above Yorke Bay – already, 18 were rolling across the island. Shortly after, assaults began on Government House, defended by the marines who had not formed the initial OP parties. Rex Hunt, Governor of the islands, called a meeting with Admiral Busser (leader of the invasion) and requested immediate Argentine withdrawal of forces. Busser replied that he felt with nearly 3000 men on the island and 2000 more in reserve at sea, he was unlikely to be made to leave. At 0925, the miniscule force of marines surrendered to the 600 Argentine special forces who they had held at bay through the early morning. Argentina had the Falklands. Within a day, South Georgia fell after a similarly heroic defence. Lt Mills of the Naval Party garrisoned at Stanley previously and due for replacement had taken 12 marines to the island after the escalation of the scrap metal affair. On 3rd April, an Argentine icebreaker ship hove into view, accompanied by one of the missile corvettes sent to reinforce the landed marines. As he watched the jetty he had boobytrapped awaiting further incursions, a Puma brought Argentine special forces to the island and discharged them in front of his face, whilst the missile boat brought fire down on the position. Mills immediately opened fire on the helicopter and one of his marines scored a waterline hit on the missile corvette with a Carl Gustav launcher. After ninety minutes of spirited defence, the inevitable was accepted and surrender agreed. As Operation Corporate began, careers were ending. Lord Carrington had grossly underestimated Argentine will for the invasion and as such his diplomatic efforts as Foreign Secretary were far too little too late. He resigned, describing the invasion as “a humiliating affront to this country.” John Nott also tendered his resignation as Defence Secretary but Mrs. Thatcher, concerned that the outbreak of war was no time to be losing a cabinet, did not accept it.

become the less favoured of the two (the other being a sundeck), due to its alarming tendency to move with a helicopter in the hover above it.

Due South

As April wore on and the task force elements steamed south, other elements of the plan continued. Ascension “Wideawake” Island, over 1000 miles west of Africa, was to be used as a staging post and therefore had to be reinforced. An RAF deployable Marconi radar was quickly installed, giving a tactical perimeter to the island, and a fuel farm established. Wideawake had a vast runway for the American satellite station there, and with extra logistic support was the ideal outpost to support the operation. Despite its excellent facilities, the British force still put great pressure on the infrastructure and visits were strictly limited, with several ships receiving their resupply by helicopter rather than putting ashore. The assembled land forces on their respective ships put the cruising time to good use. Weapons were inspected, fired and stripped daily, the decks of Canberra reverberated to the sound of regimental PT and ceremonial bandsmen refreshed their skills as combat medics. Despite wearing conditions and frayed tempers, the British land forces were going to arrive ready to fight. Back in the UK, a diplomatic effort slowly gathered momentum. Al Haig, the US ambassador to Britain, spotted

The assembly of the task force saw the initiation of a measure last implemented in the second world war – “take up from trade” of merchant ships. It was on this basis that that P&O’s flagship cruise vessel the SS Canberra sailed its final leg from Naples to Southampton for conversion to a giant troop ship. As Canberra sailed home to its renaissance as the floating home of the land force, the rest of the task force set sail on the morning of Monday 5th April. Hermes and Invincible left Portsmouth with Fearless, an amphibious assault vessel with 8 landing craft in its wake. Sir Galahad and Sir Geraint, both logistics craft escorted by Antelope, steamed to join from Plymouth sound and await the arrival of their partner ship Sir Tristam from Canada. Arrow and Plymouth joined the carrier group in the channel as their escorts. Another key vessel was Glamorgan, a missile-destroyer carrying Admiral Woodward, commanding the task force. While the impressively rapidly assembled task force sailed on towards the Falklands, Canberra metamorphosed from luxury liner to high-capacity troop ship. Its living quarters were chopped into tiny cabins and the swimming pool was drained to be fitted with a helicopter deck. This helipad would in time JR Army Med Corps 153(S1): 6-12

Total recall Having found the floating contingent, land forces were now needed. Brig Julian Thompson, commanding 3 Commando Brigade had been warned off 5 hours before the invasion; his brigade was now feverishly reassembling itself for war, just days after many units had returned from NATO exercises. 42 Cdo was based locally but on leave, so recall notices were issued and policemen sent to relatives’ houses all over Britain to deliver the news to relaxing marines. 40 Cdo in the North-West and 45 Cdo in Arbroath began their preparations as 42 personnel streamed from all over Britain back to the South-West. Further strength was needed, preferably at high readiness. 2nd and 3rd battalions of the Parachute Regiment fitted the bill, but were also dispersed on leave (the later famous CO 2 PARA, Lt Col H Jones was skiing in the French Alps when he heard of his unit’s deployment). 2 and 3 PARA were recalled in a similar fashion – at one point, tannoy announcements could even be heard on London stations informing all Parachute Regiment personnel that they were to return to Aldershot immediately.

“H” Jones VC, Commanding Officer 2 Para

Background noise

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the diplomatic difficulties in the USA’s twin interests of Britain against the Eastern Bloc and hard-right South American states (amongst whom Argentina was one of the foremost) against the central American Marxists. He volunteered himself to conduct negotiations personally, and consequently spent much of April in the air. Unfortunately, his fellow ambassador to the UN was not of a similar inclination and set a frosty backdrop to negotiation by attending an Argentine banquet on the night of the invasion and declaring that she could see no problem in Argentina repossessing its own islands. To Galtieri and his colleagues in power, a scantily opposed invasion of the islands followed by a senior US diplomat apparently showing support for their actions, suggested things were going very well indeed. Over the first few days, though, some progress was made. The EEC nations showed surprising solidarity; several put in place immediate import sanctions (symbolically if not economically significant), with an EEC-wide order being put in place on 9th April. On 3rd April, the UN had passed resolution 502, permitting use of force to regain the sovereignty of the islands. The USSR had made objections but stopped short of using its veto, sensing an ultimate battle it did not wish to be on the losing side of.

Black Buck – 1 May This was the name given to the nothing short of spectacular feat of delivering bombs onto (around, in the event) Port Stanley airfield by RAF Vulcan bomber. These behemoths of Cold War airpower were due retirement within weeks; this, their swansong, was a feat of logistics sadly unmatched by its tactical impact.

Wideawake before reaching home. When the bombs finally hit the airfield, some fell to the side causing minimal damage to the dispersal and parked aircraft, while some only cratered the runway. Just seconds after appearing, XM607 was on its way home, payload delivered. Although the tactical impact was short-lived with most damage repaired within the day, the impact on morale of Britain’s capability to strike the heart of the invasion force from such a distance must have been significant. Withers won the DFC for flying this mission, and Sqn Ldr Bob Tuxford, pilot of the underfuelled Victor who had risked his life for the mission the AFC. Follow-up sorties were made by the Sea Harriers of the task force, punching further holes in Argentine air capability and morale.

The Belgrano goes down – 2 May For more than a week, the crew of HMS Conqueror had been tracking the movements of the General Belgrano after a warning from Chilean intelligence that she had put to sea in the direction of the task force. Conqueror’s initial task was to watch and wait; as time wore on, however, it became obvious that the vessel was likely to be forming part of a pincer attack on the force. By the beginning of May, she was about to reach the shallower waters of the Total Exclusion Zone, into which Conqueror would not be able to follow her undetected. It was unthinkable that the group should come under direct threat, even with the inevitability of the global condemnation that would follow an act of aggression such as this. Conqueror was, therefore, ordered to engage Belgrano. Several Mk 8 torpedoes struck her as she turned, exposing a massive target. The damage was catastrophic, and within the hour she was sunk. Predictably, this caused outrage in many quarters – even the British press quickly quelled their riotous headlines such as “Gotcha!” as the extent of the disapproval became clear. One more step had been taken down the path to war, with consequences to be seen very quickly. On the same day, the Sea Harriers took their first loss when Flt Lt Paul Barton (on exchange to 801 NAS) engaged a Mirage at close quarters whilst on Combat Air Patrol around the group.

Belgrano is avenged – 4 May

A Vulcan bomber

Staging out of Wideawake, the formation of 2 bombers and supporting Victor air-air refuellers set out on 1st May. The first Vulcan was obliged to turn back rapidly due to a technical fault, leaving Flt Lt Martin Withers to make the lonely journey in XM607 to the airfield. A complex system of sequential refuelling by the Victors ensured viability of the mission – at each stage, one tanker would give all its fuel bar return and reserve quantities before turning for home. The final tankers gave more, in fact, than was safe, relying on calling a Victor back out from 8

At 1400 hours 2 days later, a plume of white smoke snaked towards HMS Sheffield as it protected Hermes and Invincible, the only sign of the Exocet missile about to bury itself deep in the ship. It had been fired by a low-flying Super Etendard, a class of aircraft flown by the most able of Argentine pilots. Although its warhead did not detonate, the ship was ablaze within a minute and direct hits had been taken to both the main engine and main generator. An unserviceable backup generator curtailed all smoke extraction facilities and the survivors struggled through acrid black smoke to reach safety. 20 were lost, as was the ship when it finally sank on tow 6 days later. A sombre mood prevailed back home when news of the loss broke, and delight at early successes forgotten. Loved ones would not be returning, and the fight had barely begun.

5 Brigade put to sea – 12 May The Cunard liner QE2 left Southampton on 12th May, carrying 5 Inf Bde, commanded by Brig Tony Wilson in chipboard-lined splendour. The 3000 strong brigade consisted chiefly of the Welsh and Scots Guards, in addition to a Ghurkha battalion. Their routine was much the same as those who had sailed before them – weapons handling, PT and boredom.

JR Army Med Corps 153(S1): 6-12

Pebble Island – 14 May Boat troop, D Sqn 22 SAS recreated the regiment’s North African successes in this raid on the main Argentine air asset. It had been adopted due to its proximity to the mainland and distance from the hazards of constant bombardment which its sister airfield at Stanley was suffering. The invaders had thus far used this strip unopposed – resupplying at leisure and flying frequent harassment sorties at the task force. A previously placed OP instructed that numerous aircraft were seen at the location, which they advised should be attacked overnight. After the patrols were reinforced by Sea King, the attached Naval Gunfire Officer called in support from Glamorgan which enabled attachment of plastic explosive to equipment whilst the garrison was pinned down. The total Argentine losses numbered 11 aircraft, the fuel dump and radar facilities. The cost of this was 2 minor injuries to SAS raiders, all of whom were successfully exfiltrated by helicopter. Events continued apace.

San Carlos – 21 May The time at sea had been productive for the command element of 3 Commando Brigade. The key question was where to come ashore; Julian Thompson favoured a direct attack into Stanley, various SF elements proposed disparate “softening” raids, but one voice, and a relatively junior one at that, was heard above all others. Major Ewen Southby-Tailyour had previously commanded the marine party in the Falklands, and as a keen sailor had spent a great deal of spare time exploring the coastline. He had kept a sketch-book; this added a great deal of weight to his opinion that San Carlos offered a sheltered, navigable approach. The only problem was that it was on the wrong side of the island. There was no better fighting composition in the world for long-distance terrain coverage, however, than the combination of the Parachute Regiment and Commando Brigade. It was decided at a meeting on 10th May that the landings would be at San Carlos, with a 3 pronged move east to Port Stanley supported by helicopter for troop movement where possible. At around 0400, 2 PARA and 40 Cdo scrambled ashore at San Carlos unopposed, with 45 Cdo reaching Ajax Bay at first light. For several hours before the landings, there had been diversionary raids at several other possible landing points; the only possible resistance to the San Carlos landings had been at Fanning Head. This had been signalled in by a special forces OP just the day before, so the prelude to the landings had been a helicopter-borne assault to neutralize the threat. 40 Cdo immediately secured the area to the east, into the Verde mountains – in combination with 45 Cdo’s position at Ajax Bay, the harbour was now well defended. 3 PARA cleared

Fanning Head definitively whilst 2 PARA dug in, having scaled the ridge of the Sussex Mountains. Now, 42 Cdo could be brought ashore from reserve. As the light gathered, the inevitable attention from the air began. Sorties of Argentine jets maintained constant pressure on the group – Argonaut, Antrim, Broadsword and Ardent all took repeated hits. Eventually Ardent, forming the southern screen as well as keeping the pressure on Goose Green, took its 17th and final hit. As its civilian NAAFI manager (a retired SASC instructor) brought its machine guns to bear on the raiders, Yarmouth took survivors on from alongside. Argonaut was luckier – although hit repeatedly, it was crippled but not sunk. By the end of the day, a huge defect had emerged in Argentine tactics. Their zeal to destroy the defensive capability of the group had blinded them to the fact that they had clear shots on Canberra throughout. By the time Ardent was being abandoned, Canberra had disgorged not only the fighting troops, but their logistic support as well. The brigade was ashore and ready to fight.

The Conveyor stops – 25 May By 25th May Antelope was lost in a very similar fashion, forming a perimeter well out into the Sound with no screening mountains. The aerial assault was relentless and eventually delivered a WWII design bomb which punched its way into the ship, but like the Exocet which finished Sheffield, did not detonate. Sgt Jim Prescott was tragically killed whilst trying to defuse the rapidly overheating bomb – he managed, however, to talk through the process to his team, ensuring that handling knowledge was passed on in case of further incidents.

Atlantic Conveyor being refuelled by RFA Tidepool

A loss more pivotal to the assault was that of the Atlantic Conveyor. She had been taken up from trade due to her massive carriage capacity, and was bringing the Chinooks so critical to the brigade’s overland assault in addition to tents, munitions and Harrier mats. Ironically the Exocet that sank her may well have been destined for Hermes; when the radar signature was detected, chaff rockets successfully diverted the missile. When it sought a second target, the giant, defenceless Conveyor was in the frame. As its oil-soaked plywood decking roared with flames, the task force’s air assets went up in smoke as well. The only way to Stanley was now by foot.

East to Stanley – 26 May

HMS Ardent on fire JR Army Med Corps 153(S1): 6-12

Julian Thompson’s original plan had been a direct advance on Stanley when the balance of the troops arrived. On 26 May news arrived from London – an immediate advance should be made, with a simultaneous attack on Goose Green. This dilution of an already understrength force pleased nobody but, 9

orders being orders, 2 PARA dutifully turned south and set out from the Sussex Mountains. Airlift was available for heavy weapons, but boot leather would have to suffice for everyone else. Meanwhile, 45 Cdo and 3 PARA set off on the long tab North and East, destination Stanley.

Sunray is down – 27 May Goose Green was to result in one of the conflict’s highest profile casualties – Lt Col Herbert “H” Jones VC. Naval gunfire began to soften the target in the early hours of the morning, with infantry fighting beginning at around 0600. The early phases of the attack involved repeated contacts with entrenched machine gun positions; well-dispersed, they bogged down the attack at several points. It was to break such a bottleneck that H Jones led his tactical HQ into the gully to the right of Darwin Hill, which A Coy had so far failed to overpower. He was cut down by an emplacement eventually neutralized by 66mm LAWs, and with the words “Sunray is down” command of 2 PARA was devolved to Maj Chris Keeble. It was time to test the alternate command structure set out for just such an eventuality – Jones had designated an entire alternate tactical HQ. Thankfully, the strategy held good and the battle continued apace. 3 were lost in one of the most distasteful episodes of the war, when Lt Jim Barry sighted a white flag flying in the trenches by the schoolhouse. He took 2 NCOs with him to take the surrender of the position; once in plain ground, all were cut down in a hail of machine gun fire. That night, Darwin was taken and with it came the information that the community hall at Goose Green held civilians in large numbers. Keeble’s plan of softening the settlement with an overnight bombardment was clearly now unworkable; permission was sought from Brigade HQ to negotiate. After a night of hasty field diplomacy Keeble went forward to the Argentine position with 2 reporters to witness talks, offering the options of surrender or release of hostages followed by continued military action. Air Vice Commodore Wilson Pedroza offered the surrender of the garrison and shortly afterwards the men of 2 PARA watched agape as the parade of 250 men were joined by another three times as many. The British battalion had defeated a defending force 3 times its size; the excrement smeared on walls and destroyed furniture was testament to the brave new Argentine world the islanders had been liberated from. 3 PARA now turned east to take Teal Inlet, a waypoint to Stanley, while 45 Cdo had drawn the short straw (but long walk) and were to head north to Douglas before following the paras’ trail through Teal Inlet.

increasingly beleaguered Argentine garrison.

Closing in – June After cross-decking from QE2 to Canberra and Norland, 5 Bde were put ashore on 1 June. Their immediate task on 2 June was to head east and form the southern prong of the attack, potentially entailing a long, cold walk. A local civilian suggested that telephone communications might still be working at Fitzroy, so a heliborne party deployed to the nearest working line at Swan Inlet. They managed to raise a farmer at Fitzroy who confirmed that Argentine forces had been and gone, leaving a golden opportunity. This was later confirmed by Patrols Coy 2 PARA, now under brigade command. Tony Wilson was keen to exploit this at the earliest opportunity, and so commandeered the sole Chinook to move the brigade to Fitzroy. A near blue-on-blue due to the unannounced nature of the flight brought criticism from San Carlos, but the brigade had, nonetheless leapt ahead. By 3 June 3 PARA under Hew Pike were established at Mount Estancia, staring up at Mount Longdon which stood between them and the final objective of Stanley. As the days passed, recce parties went forward to assess the strength and disposition of Argentine defence and artillery was brought forward to the battalion.

Farewell Sir Galahad – 8 June Another blow was struck from the air with the bombing of Sir Galahad as it lay in Port Pleasant near Fitzroy, with the Welsh Guards aboard. After the Scots Guards were deposited by Intrepid 3 days previously, it was decided that logistics ships should be used to land the Welsh. In Fitzroy, 16 Field Ambulance were due to disembark with a Rapier air defence unit, but the Welsh were supposed to be at Bluff Cove, not navigable by the ship. As the debate over safety at sea or a long walk to Bluff Cove continued, 4 jets screamed over and dropped a stick of bombs squarely on target. As petrol, ammunition and equipment blazed, the embarked troops triaged, treated and evacuated as best they could, many working with horrific injuries themselves.

Stanley in sight – 31 May 42 Cdo’s move was less footsore but potentially far more lethal. Key high ground to be secured in the battle for Stanley was Mount Kent and the ground around it, which overlooked the town. The only way to move the marines this far forward within the required timeframe was helicopter – an unarmoured flight in appalling weather, necessitating several hops for the required numbers. After being forced back by a whiteout on 30 May, 2 Sea Kings deposited K Coy of 42 Cdo and Lt Col Mike Rose of 22 SAS on Mount Kent, a Chinook following shortly behind with a 105mm gun and 300 rounds. After a day of isolation, the Sea King force brought the rest of the battalion in a series of daring low-level flights. Once established the unit quickly secured Mount Challenger, Estancia House and Bluff Cove Peak, tightening the grip on Stanley and providing an LUP for 3 PARA and 45 Cdo. With these units in place, a pincer was forming ready to close on the 10

RFA Sir Galahad

The final days – 10-14 Jun The formation took shape, Stanley was encircled by commandos, guardsmen and ships and the task force steeled itself for the advance into Stanley. The plan was divided into 3 stages. Firstly, Mounts Longdon, Two Sisters and Harriet were to be secured by 3 PARA, 45 Cdo and 42 Cdo (aided by the Welsh Guards) respectively. This first phase was to take place in the early hours of 12 Jun. Phase two involved the capture of Wireless Ridge by 2 PARA, who would be held in reserve during the first phase before JR Army Med Corps 153(S1): 6-12

moving through and beyond 3 PARA. The Scots Guards were to take Mount Tumbledown, the Gurkha rifle battalion Mount William and the Welsh Guards Sapper Hill. This was scheduled for the night of the 12th. The third and final phase would be a move through 5 Brigade’s consolidated positions and into Stanley, to defeat the occupiers in the street.

Longdon Longdon proved a fearsome environment for the Paras; the two months of occupation had allowed the Argentine forces to develop two well defended positions with numerous bunkers and machine gun emplacements. A combination of armament and topography made Longdon a challenge for the toughest of soldiers resulting in a hard fought engagement. The western position, “Fly half” was taken rapidly, although the platoon advancing from the west bypassed a position in the dark and subsequently took rounds to their rear. “Full back” lay to the east and was ferociously defended. The advancing Paras began taking rounds from at least 2 GPMG emplacements, joined by a .50 calibre heavy machine gun. At the start of the attack on the position, the detonation of an antipersonnel mine had triggered the beginning of a bombardment, the grids having already been set. As the shells rained in, the Paras tried sending a flank attack to the north of the position. They sustained withering fire, and the flank was recalled. The advance was finally made in true infantry style, on their bellies from the west along the ridgeline, expending virtually all grenades and finally resorting on 66mm weapons to clear positions. The summit was finally taken at the closest of quarters, with bayonet fighting in the trenches. The cost to the battalion was 23 dead and 47 injured, but a decisive victory was had.

Wireless Ridge The already battle hardened soldiers of 2 PARA readied themselves once more for battle, their objective to take Wireless Ridge in readiness to move into Stanley. In contrast to the austere logistics supporting Goose Green, they had armour, artillery and air support. At first light, the winning partnership of the 30mm cannon of the Blues and Royals and GPMGs of the battalion had cleared the bunkers and the assault on Tumbledown (in conjunction with Scout-borne SS12 missiles) had neutralized the Argentine guns which had hampered the final phase of the assault from across Moody Brook. A and B companies, with the Blues and Royals, finally got to look down to Stanley.

Tumbledown The original plans for the Scots to assault Tumbledown directly from the south up a fearsome slope were soon abandoned as a result of the ferocity of resistance met by an initial recce party. Given that 3 Cdo Bde were already dug in to the west, a flanking attack from there seemed to offer (relative) safety. The three companies assaulted from the west, moving through each other in the line of march. With each wave, more men were occupied by clearing and holding sangars as they went, leaving a dangerously understrength force holding the front line of attack. The series of dogged and relentless attacks eventually took the summit from, as it transpired, a very professional Argentine marine company. The fighting had been every bit as bloody as that on Tumbledown.

Harriet In contrast to the heavy fighting from the outset on Longdon, surprise minimized losses on Mount Harriet. After a delayed start, the Welsh Guards and 42 Cdo got to the foot of the slope undetected, and called in the spectacular firepower of the assembled batteries of 29 Cdo Regt RA, a firm deterrent to even the most committed occupier. As the rounds fell, the assault continued forwards and cleared to the summit using small arms, anti-tank weapons and grenades. Milan, the latest hi-tech anti-tank weapon was used in anger against the well established bunkers on the summit. When these were overrun, a treasure trove of rations, ammunition, maps and even a battlefield radar were taken.

Two Sisters 45 Cdo’s assault on Two Sisters was another triumph of committed, brutally tough soldiering. The men had to fight up the rocky outcrops under perpetual bombardment, eventually ransacking the captured positions for shelters, warm kit and food as they lay exhausted on the peaks of the mountain. Phase one was complete, with all objectives taken.

Mount Tumbledown

Two more hills to go… As the light gathered and battle raged on adjacent Tumbledown, the Gurkha rifle battalion waited to start their assault on Mount Williams. When Tony Wilson deemed the Scots close enough to the finish line, the Gurkhas were waved off, again with all the support that could be mustered. Artillery, Milan and .50 cal once again entered the fray but equally potent was the dedication of the Nepalese unit, which moved round Tumbledown under its Scottish stewardship to assault Williams from the north. The aggression worked up for the final attack proved unnecessary as the Argentines fled in the face of the Gurkhas, who they had been reliably informed were cannibals. The composite of the hugely depleted Welsh Guards and 40 Cdo waited impatiently to take the final ground before Stanley, Sapper Hill. White flags were already flying in the town, and nobody wanted to miss the action. For expediency, a company sized assault was launched by helicopter and followed up by the rest of the composite on foot. This made quick work of the few brave stay-behinds and by late afternoon the Welsh and commandos watched the Paras move into Stanley.

Going to town Two Ssters JR Army Med Corps 153(S1): 6-12

The move down from Wireless Ridge began at 1300, after Julian Thompson surveyed the situation from the air. The armour of the Blues and Royals, one vehicle proudly displaying 11

their regimental colour, ferried the Paras in as they swarmed towards Stanley. The order was received to halt at the racecourse – the occupiers wished to discuss terms.

Surrender – 14 Jun For several days before the encirclement of Stanley, Col Reid (listed as being 22 SAS) and Capt Rod Bell RM (who had been raised in Latin America) had been transmitting on the medical advice frequency of the King Edward Memorial Hospital, known to be occupied. Although no reply was received, it became clear early in negotiation that Gen Menendez’s staff had been listening. They now wanted to talk. In the afternoon of 14 Jun, Reid and Bell were carried forwards by Gazelle to a bizarrely formal meeting with Menendez. After quibbling over whether he could surrender the geographically but not geopolitically separate islands in the group, Menendez acquiesced to all terms except the use of “unconditional” in describing the surrender. After bad weather grounded him, Maj Gen Moore, task force commander, eventually arrived for a final round of talks at 2300. At 2359 on 14 Jun 1982, Britain took the surrender of

12

the Argentine occupiers of Stanley – the Falklands were retaken. As Britain celebrated its reassertion as a world power, the units of both the task force and the occupation buried their dead. To come was a massive effort in repatriating prisoners of war and a long journey home. For now, though, it was enough that the fighting was over.

Falkland Islands Memorial Chapel, Pangbourne, Berkshire

JR Army Med Corps 153(S1): 6-12

FALKLANDS WAR 25th ANNIVERSARY

Chronology of events The Falklands Conflict, 2 April to 14 June 1982, followed the invasion of the Falkland Islands by Argentina on 2 April 1982. It was a unique period in the history of Britain and Argentina and, although war was never formally declared, the brief conflict saw nearly 1,000 lives lost on both sides and many more wounded. 18 May

March 1982 Davidoff workers land on South Georgia illegally. HMS Endurance sent to South Georgia. Argentine naval vessels sent to 'protect' the workers.

April 1982 2 April 3 April 5 April

8 April 9 April 10 April 12 April 19 April 23 April 25 April 29 April 30 April

Argentine Forces occupy the Falkland islands. Debate in House of Commons. UN Resolution 502. Argentine forces take South Georgia Lord Carrington, Humphrey Atkins and Richard Luce resign. Ships of the Royal Navy, including the aircraft carriers HMS Hermes and HMS Invincible, leave Portsmouth and elsewhere. US Ambassador Haig arrives in London to begin his diplomatic 'shuttle' between the nations. Haig arrives in Buenos Aires. EEC declares sanctions against Argentina. Britain declares maritime exclusion zone 200 miles around Falklands. EEC foreign ministers declare support for Britain. Britain warns Argentina that any warship or military aircraft representing a threat to the task force would be dealt with accordingly. South Georgia recaptured, Argentine submarine Santa Fe damaged. Argentina rejects Haig's peace proposals. Britain declares total exclusion zone. US announces support for Britain.

May 1982 1 May 2 May 4 May 7 May

14/15 May 16 May 17 May

i

First British attacks. Argentine cruiser General Belgrano sunk. HMS Sheffield hit by Exocet missile. British Government warns Argentina that any warships or military aircraft more than 12 miles from Argentine coast could be regarded as hostile. UN Secretary-General begins talks with Britain and Argentina. SAS raid on Pebble Island supported by naval gunfire. Several Argentine Pucara aircraft damaged or destroyed. Final British proposals worked out. Proposals sent to Argentina.

20 May 21 May 23 May 25 May 27 May 28 May

Argentine government rejects British proposals. UN Secretary-General admits failure of UN talks. Beachhead establishes at San Carlos. HMS Ardent sunk, fifteen Argentine planes shot down. HMS Antelope damaged (explodes and sinks next day). Seven more Argentine aircraft shot down. HMS Coventry sunk by air attack and container ship Atlantic Conveyor destroyed by Exocet missile. British Forces move forwards to Teal Inlet and Mount Kent. British victory at Battle of Goose Green (2 Para).

June 1982 1 June 4 June 8 June 11/12 June 13/14 June 14 June 17 June 20 June 22 June 25 June July 1982 26 July

5 Infantry Brigade arrive at San Carlos. Britain and USA veto UN call for immediate cease-fire. Royal Fleet Auxiliaries Sir Galahad and Sir Tristram bombed at Fitzroy. Mount Harriet, Two Sisters and Mount Longdon taken by British forces. HMS Glamorgan hit by land-launched Exocet. Tumbledown Mountain, Wireless Ridge and Mount William taken by British forces. General Menéndez surrenders to MajorGeneral Jeremy Moore General Galtieri resigns. Southern Thule retaken. EEC lifts economic sanctions against Argentina. General Bignone replaces General Galtieri. Governor Rex Hunt returns to Port Stanley. Ceremony of thanksgiving at St. Pauls in London.

October 1982 12 October

Victory parade in London.

November 1982 4 November

A resolution calling for a peaceful solution to the sovereignty dispute voted by UN General Assembly.

JR Army Med Corps 153(S1): i

FALKLANDS WAR 25th ANNIVERSARY

ROLL OF HONOUR

Royal Navy HMS Coventry MEM(M)1 F O ARMES ACWEA J D L CADDY MEM(M)l P B CALLUS APOCA S R DAWSON AWEM(R)1 J K DOBSON PO(S) M G FOWLER WEM(O)1 I P HALL LT R R HEATH AWEM(N)1 D J A OZBIRN LT CDR G S ROBINSONMOLTKE

LRO(W) B J STILL MEA2 G L J STOCKWELL AWEAl D A STRICKLAND AAB(EW) A D SUNDERLAND MEM(M)2 S TONKIN ACK I E TURNBULL AWEA2 P P WHITE WEA/APP I R WILLIAMS

LT CDR D I BALFOUR POMEM(M) D R BRIGGS CA D COPE WEAl A C EGGINGTON

S/LT R C EMLY POCK R FAGAN CK N A GOODALL

HMS Fearless MEA(P) A S JAMES

ALMEM(M) D MILLER

HMS Argonaut AB(R) I M BOLDY

S(M) M J STUART

HMS Antelope

HMS Glamorgan POAEM(L) M J ADCOCK CK B EASTON AEM(M) M HENDERSON AEM(R)1 B P HINGE LACAEMN D LEE AEA(M)2 K I McCALLUM

HMS Sheffield

CK B J MALCOLM MEM(M)2 T W PERKINS L/CK M SAMBLES L/CK A E SILLENCE STD J D STROUD LT D H R TINKER POACMN C P VICKERS

STD M R STEPHENS

Atlantic Conveyor AEM(R)1 A U ANSLOW CPOWTR E FLANAGAN

LAEM(L) D L PRYCE

Royal Marines Royal Marines

HMS Ardent AB(S) D D ARMSTRONG LT CDR R W BANFIELD AB(S) A R BARR POAEM(M) P BROUARD CK R J S DUNKERLEY ALCK M P FOOTE MEM(M)2 S H FORD ASTD S HANSON AB(S) S K HAYWARD AB(EW) S HEYES WEM(R)1 S J LAWSON MEM(M)2 A R LEIGHTON

AEMN(I) A McAULEY ALS(R) M S MULLEN LT B MURPHY LPT G T NELSON APOWEM(R) A K PALMER CK J R ROBERTS LT CDR J M SEPHTON ALMEM(M) S J WHITE ALMEM(L) G WHITFORD MEM(M)1 G S WILLIAMS

HMS Hermes LT CDR G W J BATT POACMN K S CASEY

LT N TAYLOR

HMS Invincible LT W A CURTIS LT CDR J E EYTONJR Army Med Corps 153(S1): 13-15

JONES NA(AH)1 B MARSDEN

CPL J G BROWNING MNE P D CALLAN MNE C DAVISON SGT R ENEFER SGT A P EVANS CPL K EVANS CPL P R FITTON LT K D FRANCIS L/CPL B P GIFFIN MNE R D GRIFFIN A/SGT I N HUNT C/SGT B R JOHNSTON SGT R A LEEMING CPL M D LOVE

MNE S G McANDREWS MNE G C MacPHERSON L/CPL P B McKAY MNE M J NOWAK LT R J NUNN MNE K PHILLIPS SGT R J ROTHERHAM MNE A J RUNDLE CPL J SMITH CPL I F SPENCER CPL A B UREN CPL L G WATTS MNE D WILSON

Army Scots Guards GDSM D J DENHOLM GDSM D MALCOLMSON L/SGT C MITCHELL GDSM J B C REYNOLDS

SGT J SIMEON GDSM A G STIRLING GDSM R TANBINI WO11 D WIGHT

13

FALKLANDS WAR 25th ANNIVERSARY

ROLL OF HONOUR

Welsh Guards L/CPL A BURKE L/SGT J R CARLYLE GDSM I A DALE GDSM M J DUNPHY GDSM P EDWARDS SGT C ELLEY GDSM M GIBBY GDSM G C GRACE GDSM P GREEN GDSM G M GRIFFITHS GDSM D N HUGHES GDSM G HUGHES GDSM B JASPER GDSM A KEEBLE L/SGT K KEOGHANE GDSM M J MARKS GDSM C MORDECAI

L/CPL S J NEWBURY GDSM G D NICHOLSON GDSM C C PARSONS GDSM E J PHILLIPS GDSM G W POOLE GDSM N A ROWBERRY L/CPL P A SWEET GDSM C C THOMAS GDSM G K THOMAS L/CPL N D M THOMAS GDSM R G THOMAS GDSM A WALKER L/CPL C F WARD GDSM J F WEAVER SGT M WIGLEY GDSM D R WILLIAMS

Army Air Corps L/CPL S J COCKTON

S/SGT C A GRIFFIN

Royal Signals S/SGT J I BAKER MAJOR M L FORGE

L/CPL J B PASHLEY S/SGT J PRESCOTT SPR W D TARBARD CPL S WILSON

PTE M A JONES PTE P W MIDDLEWICK

Royal Army Medical Corps L/CPL I R FARRELL MAJOR R NUTBEEM

3 Para PTE R J ABSOLON PTE G BULL PTE J S BURT PTE J D CROW PTE M S DODSWORTH PTE A D GREENWOOD PTE N GROSE PTE P J HEDICKER L/CPL P D HIGGS CPL S HOPE PTE T R JENKINS

PTE C D JONES PTE S I LAING L/CPL C K LOVETT CPL S P F McLAUGHLIN CPL K J McCARTHY C/SGT I J McKAY L/CPL J H MURDOCH L/CPL D E SCOTT PTE I P SCRIVENS PTE P A WEST

Royal Air Force & Others Royal Air Force

Army Catering Corps L/CPL B C BULLERS PTE A M CONNETT

PTE S ILLINGSWORTH LT COL H JONES PTE T MECHAN PTE D A PARR CPL S R PRIOR PTE F SLOUGH L/CPL N R SMITH CPL P S SULLIVAN CAPTAIN D A WOOD

L/CPL A R STREATFIELD

Royal Engineers SPR P K GHANDI SPR C A JONES CPL A G McIIVENNY CPL M MELIA

LT J A BARRY L/CPL G D BINGLEY L/CPL A CORK CAPTAIN C DENT PTE S J DIXON C/SGT G P M FINDLAY PTE M W FLETCHER CPL D HARDMAN PTE M HOLMANSMITH

CPL D F McCORMACK

Royal Electrical and Mechanical Engineers CFN M W ROLLINS CFN A SHAW

2 Para

PTE K PRESTON

FLT LT G W HAWKINS

Falkland Civilians DOREEN BONNER MARY GOODWIN

SUE WHITLEY

Royal Fleet Auxiliary RFA Sir Galahad 3RD ENG C HAILWOOD 2ND ENG P HENRY

3RD ENG A MORRIS

Atlantic Conveyor 1ST RADIO OFF R R HOOLE

Gurkha Rifles L/CPL BUDHAPARSAD LIMBU 14

JR Army Med Corps 153(S1): 13-15

FALKLANDS WAR 25th ANNIVERSARY

ROLL OF HONOUR

Merchant Navy Atlantic Conveyor BOSUN J DOBSON MECHANIC F FOULKES STD D HAWKINS

MECHANIC J HUGHES CAPT I NORTH MECHANIC E VICKERS

Chinese RFA Sir Tristram

RFA Sir Galahad

YU SIK CHEE YEUNG SWI KAMI

LEUNG CHAU SUNG YUK FAI

Atlantic Conveyor

HMS Sheffield

NG POR CHAN CHI SING

Special Air Service Special Air Service A/CPL R E ARMSTRONG A/SGT J L ARTHY A/WO1 I M ATKINSON A/CPL W J BEGLEY A/SGT P A BUNKER A/CPL R A BURNS SGT P P CURRASS A/SGT S A I DAVIDSON WOll L GALLAGHER CAPTAIN G J

HAMILTON A/SGT W C HATTON A/SGT W J HUGHES A/SGT P JONES L/CPL P N LIGHTFOOT A/CPL M V McHUGH A/CPL J NEWTON A/WOll P O'CONNOR CPL S J G SYKES CPL E T WALPOLE

LAI CHI KEUNG

HMS Coventry KYE BEN KWO

JR Army Med Corps 153(S1): 13-15

15

FALKLANDS WAR 25th ANNIVERSARY

Introduction These papers were published in the Journal of the Royal Army Medical Corps in the months following the Falklands War. In many respects they reflect medical practice at the time. Unfortunately, they also draw attention to lessons we seem compelled to relearn on a regular basis.

16

There are, essentially, two groups of papers. The first, personal experiences provide a vivid description of life as a medical officer in conflict twenty five years ago. The second are papers which review particular areas of the practice of military medicine and surgery. Where appropriate, these are accompanied by a modern commentary.

JR Army Med Corps 153(S1): 16

THE FALKLANDS WAR

Original Contributors AFG GROOM. Commissioned July 1974. Retired in the rank of Lieutenant Colonel June 1993. Consultant Orthopaedic Surgeon.

MD JOWITT. Commissioned 1972. Retired Lieutenant Colonel 1989. Recalled April 1995. Retired as a Lieutenant Colonel November 1995. Consultant Anaesthetist.

CG BATTY. MB ChB 1973. FRCS Glas 1984. SSC 2nd Lt 9

P ABRAHAM. National Service Commission August 1958. Retired as a Brigadier February 1992. Director Army Psychiatry 1984-92. QHP.

Nov 1970 DS JACKSON Commissioned 1979. Retired as a Lieutenant Colonel 1988. Consultant Surgeon

P CHAPMAN. Commissioned October 1972. Retired Lieutenant Colonel July 1995. Consultant Surgeon 1988.

IP CRAWFORD. Commissioned October 1960. Commandant and Post Graduate Dean RAM College 1989-93. GM. QHP 1991.

RJ KNIGHT. Commissioned 1966. Retired as a Lieutenant Colonel May 1982. Consultant Anaesthetist.

JB STEWART. Commissioned October 1958. Retired June 1983 in the rank of Colonel. Consultant Pathologist. Professor of Army Pathology 1981-83.

R SCOTT. Commissioned October 1956. Retired August 1989 in the rank of Major General. Commandant and Post Graduate Dean RAM College 1982. QHS.

JE BURGESS. Commissioned September 1975. Director Primary Care – Health Alliance 1998.

RP CRAIG. Commissioned March 1963. Retired in the rank of Major General September 1994. Director Army Surgery 1992-93. Commander Med UKLF 1993-94. QHS 1992.

JM RYAN. MB ChB 1970. FRCS 1978. SSC 2nd Lt (Cadet) October 1967. DA Surg 1994-95. JT COULL. Commissioned March 1960. Retired in the rank of Major General December 1988. Consultant Orthopaedic Surgeon. Director of Army Surgery 1988-92. CB 1992.

WSP MCGREGOR. MB ChB 1958. FRCS Ed 1967. SSC Lt 29 Jan 1959. Cons Surgeon. Retired 1 Oct 1992. Died 4 March 2005.

M BROWN. National Service Commission January 1956. Retired August 1980 as a Major General. Director of Army Medicine , RAM College.

JR Army Med Corps 153(S1): 93

93

THE EVE OF THE SINKING OF THE ‘SIR GALAHAD’

Sir Galahad, Sir Galahad My heart for you doth weep You’re going to die tomorrow So that fifty souls can sleep

But when you die Sir Galahad The picture God will see Mankind washing its conscience In this cold and bitter sea

For on a cold June morning Rained madness from the sky Our soldiers, screamed and perished You heard and knew not why

So Sir Galahad we will sink you We will send you to the deep Lay quiet in your watery grave And guard our soldiers sleep

You burnt and writhed and twisted And you knew all their pain But you kept it all within you Your memories and our slain

For your name will stand in history As guardian of our slain You will die with honour While men will bare the shame

Your burning funeral pyre Was there for all to see A reminder of man’s inhumanity And of how stupid we can be JR Army Med Corps 153(S1): 17

(This poem was written by Jack Crummic, bosun on the Tugboat “Typhoon” and handed to WO2 Viner.)

17

FALKLANDS WAR 25th ANNIVERSARY

The Battle for Goose Green – The RMO’s view Capt SJ Hughes Abstract Summary: By virtue of the Battalion I serve with, I was the first Task Force Doctor on to the Falklands. On Friday the 21st May, 2 Para made an assault beach landing, thankfully unopposed, on San Carlos beach, the RAP was with them

Introduction: As 2 Para occupied the Sussex Mountains for six days and on Wednesday 2 May, moved off at last light to Camilla Creek House, 5 miles from Darwin. The Battalion laid up in the area of Camilla Creek during 27 May and early the next morning moved out to create history….

Goose Green – Friday 28th May, 1982 We set off from Camilla Creek House at about 2 a.m. tired before we started after the previous night’s TAB. On our backs the RAP (Regimental Aid Post) Medics were all carrying in excess of 80lbs of medical kit and the uneven ground ensured that we all fell regularly. We laid up near the mortar line just north of the Darwin Peninsula whilst A and B Companies put in their first attacks. There was a steady drizzle, and those of us who had worn our waterproofs were glad of them – some of us even dozed. About 2 hours after the initial H hour, Battalion Main HQ, (including the RAP) moved off and down the narrow track onto the Peninsula itself. To our left, a large area of gorse had been ignited by white phosphorous grenades and the flames lit up the night sky. The crackle of burning gorse could be heard above the reassuring crump of the naval gunfire support. We had just come level with the first cache of Argentinian prisoners, on the edge of the track, when the first salvo of the Argentinian guns bracketed the track. We heard the distant crump and the incoming whistle and barely hit the ground before the first rounds of “HE” hit the peat either side of the track. We wormed our bodies in, face down to the banks on either side of the track, so that our Bergens gave our backs some protection. The reality of the war began to sink in. Again we were bracketed, but miraculously nothing landed on the track, and the soft, wet peat, off the track, kept the shrapnel to a minimum. We had no casualties. A tracer round cracked 6 ins over my head from somewhere off to the right – a stray round buried my head further into the earth. The first two attacks had had no casualties, but now D Coy came up against stiffer opposition and Chris Keeble, the Bn 21C, asked me to move forward up the track to deal with the first casualties. His parting words, as I led the RAP off were, “Watch out for the sniper on the right flank.” I then realised where that not so stray round had come from, and was convinced that the collar of my waterproof jacket, white on the reverse, would make me a perfect target. It may well have but nothing happened. We ran low and fast for about 400 metres, until we came across the two D Coy wounded, both minor gunshot wounds. It was about 6 a.m. still with a further 4 hours of darkness – so after finishing our treatment regime, all we could do was reassure them and keep them warm and sheltered from the rain until dawn, when the first choppers would fly. The CO, ‘H’ appeared, with his TAC HQ and came to find 18

out how the casualties were – “Alright Sir, we’ll try and get them back to Camilla Creek in the captured Landrover.” He and the Adjutant, one of my close friends, David Wood, were joking about a shell that had landed between them, yet left them both unscathed. “These Argies have got some shit ammunition.” It was to be the last time I would see either of them alive again. TAC 1 disappeared and Battalion Main moved in around us. Time drifted by and the shelling periodically came our way. As the sky started to brighten we lost the benefit of the naval gun support and at dawn we found ourselves in a natural bowl of land to the north of Coronation Point. One or two more casualties were brought in, together with our first dead. Two of my Medics had lost friends and I had lost some of my own patients – we were all affected. We improvised shelter for the wounded using a captured Argie tent until at first light helicopters came in bringing ammunition resupply. We got the casualties into the Choppers and I went back to my routine of listening in to the Battalion Command net – Reading the Battle. There was a big battle raging ahead of us, and nothing seemed to be moving. We all began to dig into the peat because the shelling was now more constant, our own guns becoming less vociferous. Shortly after 1300, I heard the message over the net “Sunray has been hit.” The Battalion called for a helicopter to pick him up and it became obvious that there were other casualties in trouble. I rounded up my Medics and split them up into two teams – one under my command and the other under Capt Rory Wagon, the Doctor who had been attached to us from Ajax Bay Field Hospital (Table 1). Table I 2 Para Regimental Aid Post (2 & 9) Team A RMO (Doctor) Radio Op L/Cpl – RMA Pte – RMA (3)

Team B Attached Doctor Radio Op Cpl – RMA Pte – RMA (2)

Table 1. Padre and his bodyguard moved with Team A. RAP Deployment possibilities – 1. A & B Co-located. 2. A & B Deployed independently. 3. A & B “Leapfrog” One moves, other deals with casualties.

Both forward companies had casualties in locations 1½ km apart. Rory’s team went out to the right flank and I moved my lads out to the left, to the hills around Darwin. As we moved forward we had to dive for cover as two Pucara aircraft appeared ahead. They roared over us and I turned in time to see them JR Army Med Corps 153(S1): 18-19

spot two scout helicopters emerge from the direction of Camilla Creek House. The Pucara swooped, like hawks, and the choppers took desperate evasive action. One chopper disappeared up the valley whence it had come and managed to escape. The other chopper exploded in a ball of flame. The Pucara disappeared. We found ‘A’ Company on a hill 1 km to the west of Darwin, their casualties collected together at the base of the hill, amongst them the Company Medic. Again the shock of dealing with people you knew in a far from clinical environment – but we steeled ourselves and went to work. We dealt with the casualties and I’d once more called for helicopters. Ahead of us the battle carried on. There was no sign of ‘H’ so I asked the Sgt Major. “H is dead, Sir, and Captain Wood, and Captain Dent” – the CO and two good friends all at once; - but there was nothing else but to continue the job. The casualties had all had their wounds dressed and drips set up. We’d given them pain killers and filled them full of antibiotics. We tried to keep them dry and warm and kept up a steady banter to reassure them, especially a lad with a head injury, who I didn’t want to go into a coma. By now we were beginning to run low on medical supplies – there’s a limit to how much you can manpack. At least no more casualties had come in, although there were some wounded amongst the Argie prisoners for whom we did what we could. Then over the hill came what for me will always be the Seventh Cavalry – 4 scout helicopters, fitted with Casevac Pods and bringing our medical resupply. We got all the wounded away and even some of the more seriously wounded Argie prisoners. Then the shelling started again and we moved up the hill slightly, into a gully which gave natural cover against low trajectory artillery fire. It was here that we spent the rest of the day. The helicopters coming in under cover of the hill. We continued to treat casualties, our own, and in quiet phases Argentinians, with the smoke of the battle field and the burning gorse at times almost fogging us out. Fatigue was setting in and we all wondered how much longer this could go on. For most of the afternoon the battle had seemed to be going against us, but, as dark set in, it swung back in our favour and as darkness fell the artillery fell silent and gunfire became sporadic. We were still holding three battle sick – twists and sprains – and though we tried for a helicopter we knew they would keep, if it didn’t arrive. We were all expecting the battle to start afresh the next day, so we set up a stag system to look after the casualties and laid down in the gorse to sleep, after I’d first sat down with the RSM and the Padre to work out who our dead were. The day had been long and hard, tragic and frightening, the night was bitterly cold, and we none of us had sleeping bags.

JR Army Med Corps 153(S1): 18-19

Some people lay down actually in burning gorse to keep warm. I lay down in a clump of non-burning gorse and thanked my stars for the space blanket I’d bought in the UK and shoved in the back of my smock! I managed to wrap my body in this totally non-tactical piece of foil. The silvered surface caught the flicker of gorse flames and I crinkled like a Sunday roast, but it made the temperature bearable. Although I was exhausted I wondered whether I would sleep after the horrors of the day and as I lay in a twilight state every rustle of my foil blanket was a machine gun and every gorse was an artillery shell. I was aware of the tricks my mind was playing on me – and I wondered if I was cracking up. I slept. I awoke in the half light of mid-morning and couldn’t feel my feet. Then I could and they were painful. Around me the RAP was stirring. Chris Keeble happened by and told the Padre and I of his plan. He would give them the opportunity of an honourable surrender. There followed a void; a lack of hostilities. Whilst the Battalion took the time to fly in ammunition, we took the time to fly out our casualties and do what we could for the remaining injured amongst the prisoners. It was as we were treating the prisoners that we heard the news of the surrender. The battle was over. Although our work was not quite finished yet, at least it would not get any worse. All told we treated 33 of our own (Table 2) and over twice that number of Argentinians.

Wounded

Killed in Action

All Wounds Fatal and Non-Fatal

Gunshot Wounds

*16

12

28 (56%)

Shrapnel/Frag ments

*17

4

21 (42%)

Shot down – Helicopter Pilot (Massive injuries)

0

1

1

33 (66%)

17 (34%)

50

Totals

Table 2. There were no burns, psychiatric or mine injuries. One case of a fatality caused by close proximity explosion of a 30mm anti-aircraft shell has been included as a fragment wound. *All survived.

19

2 Para Memorial at Goose Green 20

JR Army Med Corps 153(S1): 20

FALKLANDS WAR 25th ANNIVERSARY

My experiences in the Falkland Islands War (Operation Corporate) Captain J Burgess RAMC It all began for us on the Second of April 1982, when we heard that the Argentinians had invaded the Falkland Islands. Most had never heard of these remote parts and had not been following the events of the previous week when the Argentinians had moved into the Island of South Georgia. At the time of the Invasion 3 Para were on Spearhead, as well as being part of the Parachute Contingency Force. All the medical boxes had already been packed and were fully scaled for a quick move. At 16.45 that Friday I asked the Intelligence Officer whether we would be required that weekend and he said there were no plans for the battalion to be deployed. I left for London. Minutes later a call came through from UKLF putting the unit on a greater stage of alert. A message was phoned to me in London and I hastily returned to Tidworth. Nothing happened until the following morning when the CO spoke to his officers, though he knew few facts. Every organisation in the battalion hastily obtained further war stocks, and on the medical front this meant taking a trip to Ludgershall to collect a large number of individual first aid packs and extra dressings and drips. These preparations went so smoothly that by the following day they were nearly completed. Meanwhile, a small group of the unit had flown to Gibraltar on the Friday night to requisition the SS Canberra and arrange the accommodation. There followed a few days of waiting; would we go or was it a preparation for nothing? Eventually the date for leaving Tidworth was agreed and on Wednesday, 7th we boarded the coaches for Southampton, This was a moving experience, large crowds turning up to wave goodbye as the police-led convoy drove to the docks. Once on board the Canberra it all shook into place, with the Regimental Aid Posts of 3 Para, 40 and 42 Commando occupying the crews’ hospital in the stern of the ship. This arrangement worked extremely well with sufficient space for each unit. The medics shared cabins while the doctors were in the old First Class areas of the ship. Drugs and other medical stores required for the journey were removed from the hold and brought to the crew hospital. On Good Friday we sailed away from Southampton to great cheers from a massive crowd that lined the shores on either side of the water. Car hooters blew, lights flashed and the cheers could be plainly heard coming over the calm water. If this was going to war it was a great way of setting about it. Life soon became more of a routine with morning sick parade, and then the rest of the day split into physical training and lectures on various topics from interrogation to first aid. Everyone received extra medical lectures and soldiers have never been so keen to learn all about these important matters. An extra team of stretcher bearers was found on the voyage and these consisted of the cooks, mess staff and soldiers from the Pay Corps. They were to do sterling work on the slopes of Mount Longdon. A few medical problems were encountered on the way: one soldier developed appendicitis and was operated on by a Royal Navy Surgeon in the passenger hospital on SS Canberra; he recovered in time to be fit enough to go ashore JR Army Med Corps 153(S1): 21-24

with the rest of the force. The ship put into Freetown for the day to refuel, and this necessitated the taking of anti-malarial prophylaxis until the Falklands were reached, though there were no cases of malaria encountered. The Canberra reached Ascension Island after about ten days at sea, and there we stayed for about two weeks until the other ships of the task force caught up with the forward elements. The island provided a much needed break ashore, but took its toll. Many went down with foot problems; the combination of wearing light training shoes on the ship, and the extreme dry heat of the tropical island ripped the feet to shreds, and some of these problems were only just cured by the time we reached our destination. It would be wrong to think that life at this time was serious quite the reverse. Most felt that while we were at Ascension Island, the talking was taking place and we were only out on a very pleasant cruise. There was much to do, whether it was lying in the sun, watching films or improving the profits in the bars. At one stage there was a threat of a submarine attack and the ship sailed the ocean around the island. No one objected as it improved the airflow in the ship. The ‘Canberra Medical Society’ was formed from the doctors of the services and the P and O staff, and this organisation arranged talks of various degrees of seriousness. Shortly, however, this fun was to stop. Notice was given that the Canberra was due to set sail, and in a southerly direction. This was the signal for life to become more serious. The lights were dimmed properly and all became aware that war was imminent. By day one could see 19 ships around the Canberra, but it was also appreciated that there were plenty more beneath the horizon and the surface. Most noticeable was the Elk, the ferry that contained all of our larger cargo items and which had been with us since the start of the voyage. The Norland was also there carrying our sister battalion 2 Para. HMS Fearless, HMS Intrepid and countless others protected us. A blood donor session was arranged, taking 360 units from the battalion, and about 1000 in all. The date of the session was so keyed as to allow full recovery of the soldiers, yet the blood be suitable for the expected date of the battle. On leaving Ascension Island plans for the military operation came into the open. The Commanding Officer, Lt. Col. Pike briefed us on the detailed plan to land at Port San Carlos. The medical staffing was altered as well as getting the team of stretcher bearers. We gained CSgt Faulkner who had been in the RAP in Northern Ireland, and who was currently out of a job, being on the air staff arranging parachute manifests. This enabled us to double up on the numbers in the rifle companies from one medical assistant to two per company. The RAP was then going to consist of Captain Burgess, Padre Heaver, CSgt Faulkner, Sgt Bradley and Pete Kennedy. At the earliest ‘O’ Groups we were told that we would be going ashore in Landing Craft (LCU) from the sides of the Canberra in the dark, and this procedure had been practised while at Ascension, but two days from the planned landing it was changed, the thought being that there were too many troops on the one ship. Consequently 3 Para were transferred to 21

HMS Intrepid by means of LCU. Here we got our first impressions of the conditions that the sailors had to endure with a ship sailing with a far greater complement than it had been built for. Even so the reception we received was superb in view of the difficulties of having to house an extra Battalion Group. It was while we were on this ship that a tragedy happened. One of the Sea King helicopters flying with members of the SAS on board came down at night after hitting an albatross. The loss of these 21 experienced soldiers was a hard blow especially as they were personally known to many on board. It was a greater shock than the loss of HMS Sheffield. Meanwhile the operation of the SAS to capture Fanning Head still went ahead as planned. The night of D-1 was a long night to remember. Since arriving on HMS Intrepid we had been ready to go into action, and now was the period of attempting to get some sleep while waiting for the time to go ashore and face the unknown. We were sitting in the Wardroom, reading, waiting, knowing that it was foggy outside, but that the fog could lift at any moment and give our position away; continually waiting for the bombs or torpedo to come at any second as we slipped into the sound. Eventually it was time to move and pick up one’s heavy Bergen and proceed down to the Tank Deck and be loaded aboard one of the LCUs. There was a slight hold up with 2 Para, and their unloading of the Norland with her narrow gangways and this resulted in 3 Para being further delayed. The company medics went with their respective companies, and the RAP followed up a few minutes later. By the time our boat floated out of the stern of HMS Intrepid it was broad daylight. Apart from the noise of the engine all was silent. It was a distinctly eerie feeling as we sailed past other ships in the sound and made our way up to the beach head about 3km from the settlement of Port San Carlos. Birds hovered overhead, but there were no aircraft. Our landing craft reached the shore with no difficulty and the RAP regrouped on the land just as the guns of a frigate opened up on the enemy position on Fanning Head where there was still resistance. A Pucara suddenly came from the East and attempted to gun our positions but without damage. The Royal Artillery and their Blowpipe returned the fire, but the effect at that stage was more devastating on 3 Para than on the enemy. Luckily no one was injured in the fighting. Our objective was to move into the settlement and this was quickly achieved, the 40 enemy present in the village rapidly fleeing. However, they brought down two Gazelle helicopters who were escorting a Sea King with an underslung load; there was no explanation as to why the helicopters were so far forward over enemy held territory. After one pilot was brought down the enemy opened fire on him in the water with a machine gun as he tried to swim ashore. He was dragged out by the locals and taken to the bunk house – the site designated to be the RAP but he died before medical help could arrive. Meanwhile the mortars kept firing on to the fleeing Argentinians. Later that day the battalion established itself on the higher ground around the settlement, and the RAP took up residence in the bunk houses with four members of the press. This building proved ideal in many respects, in that it provided shelter and good clean facilities, but its main disadvantage was that it was on the seafront and clearly visible to any attacking Mirage and Etendard bombers. Air raids continued that day, and for the next week, although no damage was done. On Sunday 23 May 3 Para sustained the first of its casualties when there was an incident involving ‘A’ and ‘C’ Companies and a map reading error. The end result was that 8 soldiers were wounded, two receiving 7.62 rounds to the head, one serious 22

abdominal wound and the other limb injuries, some serious. After it became clear that the enemy were not in the area, a Sea King helicopter arrived in Port Sam Carlos and flew the CO and half the RAP and stretcher team to the scene. The aircraft was full, and the pilot presumably tired. To avoid Argentinian detection he flew extremely low and as he approached the casualties behind a slight rise the tail of the plane hit the ground. This immediately caused the aircraft to lose control; it took off again and began to spin before crashing to earth once again. Luckily no one was injured in the crash and the helicopter did not catch fire. The wounded were then given further treatment and evacuated on other helicopters. They all survived although the two with head injuries are left with severe disability. The RMO and stretcher bearers were then flown back to the bunk house in Port San Carlos where we were then bombed, this time the bombs only just missing the house. It was a day to remember! The rest of the time in Port San Carlos went off really without incident, apart from the bombing raids. The next move for the battalion was to be a foot march across the island to the East. The Company medics went with their companies and the medical sergeant accompanied battalion headquarters; apart from many foot problems encountered with the cold and wet conditions there were few medical emergencies, the only incident of note was an accidental discharge when the culprit managed to shoot through his left shoulder with an SLR. As soon as the battalion went firm in the settlement of Teale Inlet the RMO flew in to treat some of the foot problems. He arrived as the last of the enemy were fleeing to the East. Here the RAP was set up in the bunk house and it was shared with a section of the Special Boat Service who were mounting operations throughout the time of our stay. The only problems were the intense cold as it had started to snow hard that night, a number of minor leg wounds caused by a sub machine gun and the local population who had not seen a doctor for some weeks. It initially seemed that we would be staying in the location for a number of days to sort out the foot damage, but that evening word came through from Brigade Headquarters that we were to proceed onwards with all speed to Estancia House. The soldiers marched onwards, often in agony. At Estancia House there was a far smaller settlement consisting of one house and a large barn. Part of the house became the RAP, and the barn an admin shelter. It was here that we received news of the losses at Bluff Cove which would mean inevitable delays. We were bombed at night, but it was ineffective except in scaring the civilian population, especially the children. Estancia House brought changes to the medical organisation of the battalion, and Captain Michael Von Bertele arrived with two extra medics from 16 Field Ambulance. These were to prove invaluable on Mount Longdon. Little happened in the wait before the battle. There were visits by General Moore, Brigadier Thompson, and the CO of the SAS; but this period was used as a time to prepare the battalion for the rigours ahead. There was a great delay, initially to await the arrival of two Royal Marine units; and then to let 5 Infantry Brigade catch up on their route from the South. The time was also used for aggressive patrolling behind the enemy lines on the hill, and attempting to find a way up the cliffs that buttressed the mountain. Eventually a medical plan was evolved which essentially made two RAPs. Captain Burgess with his own staff would march on the hill under the direction of Major Dennison the OC SP Coy. As much medical equipment was to be taken as possible, and personal items were excluded. The stretcher bearers would also come with the first wave on foot, carrying some medical stores and stretchers of the folding airborne type, and also a large JR Army Med Corps 153(S1): 21-24

quantity of belt ammunition for the machine guns. No Red Cross markers were used by anyone in 3 Para. The rearward RAP would follow up behind in Volvo BV tracked vehicles with further stores and would have the capability to move through the first RAP and set up independently if the advance proceeded down Wireless Ridge. After extensive medical briefings the various sections were moved up from Estancia House to an area occupied by ‘A’ Coy. This move was by BV, and during the deployment news came through of one minor injury as a result of a shrapnel wound. The form up area was about 8 km from the objective, and at this point most of the battalion gathered, and here were also included a large number of civilians who had agreed to help the operation by providing their own tractors to transport items such as mortar ammunition. It was a glorious evening as the sun slowly set, and all enjoyed a last hot meal in the comfort of a dug in position. Major Dennison gave a short talk to those under his command, and as he did so shells started falling close, but soon all fell silent once again. The still air was disturbed by the arrival of a helicopter with a secret signal stating that on the latest intelligence the objective had now been occupied by a battalion of the very best Argentinian Marines, instead of the company strength that we had all been expecting. The outcome of this was a resolute ‘No Change.’ At 2030 Zulu timing the RAP formed up and took its place in the march towards Mount Longdon. Shortly after leaving ‘A’ Coy position the RAP was in dead ground from Two Sisters which provided some protection from enemy OP and detection. The march moved on steadily until the Murrell River was reached which was crossed with little difficulty and then continued eastwards. The stretcher bearers with their difficult loads suffered more than most on the march, but at about 0100 on the 12 June the RAP reached the first of the objectives about 1½ km from the western edge of the mountain. It had been a dark night up until then, but the moon slowly rose above the eastern edge of the mountain silhouetting the objective. Suddenly the peace was shattered as ‘B’ Coy approached the mountain from the western edge, hit a minefield and gave away their presence. The attack then began to close in from the west, and as the support weapons were unable to give effective fire from 1500m out, SP Coy and the forward RAP then prepared to move up the slope to the rocks at the western edge of the mountain. The small arms fire by this time had begun to get intense, with tracer and parachute illuminant lighting up the sky from all directions. The RAP closed in to its position, a location where it would remain until the end of the battle. It took some time to regroup all the stretcher bearers, and they were required at once to collect the wounded from the minefield to the north. Very shortly after arriving the first two casualties were brought in. The first was one of ‘B’ Company medics Private Dodsworth. He had been going forward to help the wounded when he was hit in the pelvis and legs by small arms fire. He went into unconsciousness at the RAP and was soon placed on the first BV to be transported back to the helipad for further evacuation. He died shortly after leaving the RAP. The BV borne RAP came up the hill after this incident and provided extra necessary help with the second doctor. On their arrival the casualties began to be brought down in a steady stream. Many were seriously injured, having had limbs amputated in the minefields, and these were dressed further and then evacuated in the next vehicle for the six hour journey back to surgery. Some of the injured had been trapped in the minefields and due to the sniping at night they could not be evacuated as the attempts were beaten back repeatedly. News came through that another of the medics had been killed by a JR Army Med Corps 153(S1): 21-24

shell. LCpl Lovett from ‘A’ Coy, and that another was trapped in a minefield and was being mortared, and had possibly been killed. The stretcher team leader approached me and asked if he should make a further attempt to retrieve the injured from the minefield, but I replied that as the injured had already been treated by the medic it would be foolish to waste further lives in repeated attempts. Having had two killed and one missing I had to preserve my medical strength. The injured were soon removed when the snipers had been cleared from the hill, luckily none were too badly injured. The battle then took another phase as we won control of the hill except for a few small pockets of resistance dug into the rocks. A very heavy mortar and artillery barrage then commenced, the rounds landing amongst the vacated Argentinian positions. These claimed many lives, and seriously put at risk the viability of the RAP. One Argentinian, in attempting to escape ran through the RAP, indeed came between the area of the mortuary and where the RMO was attempting to treat the injured. He was shot by one of the sergeants who was standing by, and dropped dead in the middle of the RAP. The following day prisoners were to bury him in a makeshift grave, and while the Padre was saying a few words over the grave he was fired upon by a sentry escorting further prisoners down the hill. This led to a counter attack, as we looked in the direction of the shots, there were twenty of the enemy to be seen. Although a large quantity of ammunition was expended, no further casualties were reported. During the whole of the daylight casualties continued to arrive and these were evacuated as soon as possible by helicopter, although for some there was a very considerable delay. Every time a large helicopter arrived the position was immediately mortared again, so it meant that only the Scouts and Gazelles could be used. That night the shelling of the position continued with air-bursts lighting the sky and shower shrapnel around the rocks. One shell blew a medical assistant off a rock with slight injury, but an even closer burst knocked out the CSgt and he could not be found for six hours. A radio message asked that the medical team pick up a patient who had been injured and who was lying on the southern slopes of the hill about 500 metres from the RAP. It was decided that the medical sergeant should go out in one of the BVs to retrieve him. On the way out they struck an anti-personnel mine doing slight damage to the vehicle. On trying to reverse out another exploded. The vehicle returned without the casualty, but the medical sergeant was so badly shaken by these events and the shelling that he had to be evacuated as a battle casualty. The medical staff was now critical with two dead, one other case evacuated and two hurt by shell fire. That night an armourer passed through the RAP going to the top of the hill when he was hit by mortar fire, lacerating one femoral artery and fracturing the opposite femur. Two others went to his aid but these were also hit by mortar fire, resulting in both sustaining bilateral fractured femora. They were in close proximity to the RAP when they arrived, but the first died very shortly afterwards, and another in a helicopter as he was being evacuated. The third survived with one amputation, and the other leg severely damaged. The following morning saw advances by 2 Para who had passed through our position the previous day, and this took the pressure off 3 Para RAP. That morning an air raid passed over the position to strike at Brigade Headquarters, and then it all began to quieten, the shelling becoming less frequent and certainly less accurate as the enemy OPs were destroyed. The CO then began to brief his officers on the attack on Moody Brook, and the advance into Stanley itself, at least as far as the racecourse. During this ‘O’ Group on the side of the mountain the snow continued to fall, and everyone wondered how the 23

attack on Stanley would result as regards casualties. As the RAP was waiting, news came through from 2 Para that they were pushing forward into Moody Brook and large numbers of the enemy were to be seen fleeing in the direction of Stanley. Minutes later came the order to advance with full speed to Stanley. The medical orbit of the move altered in that the RMO rode in the BV with his usual team, while Captain Von Bertele moved off before on foot. During the move it was learned that there were white flags to be seen over Stanley, and all rushed forward down the slope into Moody Brook. The snow had melted by this time, the sun was shining, but clouds of smoke were clearly visible coming from the western edge of the city, and from Moody Brook itself. The RAP vehicle being the first of the BVs to get into Stanley was stopped by a helicopter carrying the 3 Para flat, and this was attached to a Bangalore torpedo and carried high, victorious into the city. The city was a mess, with no sewage, water or electricity; the battalion was forced to live in squalor with no food provided either. Looting Argentinian sources was the only way out until further supplies could catch up with the advance. Luckily there

24

was no shortage of Argentinian food in Stanley itself, the frozen steak being a favourite of 3 Para. Unfortunately with all the inadequate sanitation most of the battalion went down with diarrhoea and vomiting, and there was little that could be done to prevent this without a proper water supply provided by the Royal Engineers. On the first evening in Stanley the RMO and Captain Von Bertele along with two guards crossed the ‘White Line’ that separated the opposing forces in the city, by showing their Geneva ID cards, and then went up the road to King Edward VII Hospital. They were the first British soldiers into that area, and the welcome bestowed will always be remembered. It was one of the proudest moments of being a member of 3 Para. It is impossible to convey in words those embraces and messages of thanks from the medical staff and other civilians sheltering in the hospital. The Third Battalion the Parachute Regiment lost 23 killed and 48 wounded in the battle for Mount Longdon plus 12 wounded before the assault, and countless who suffered with their feet and will continue to suffer; but to liberate those islanders in the hospital did seem to make it all worthwhile.

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FALKLANDS WAR 25th ANNIVERSARY

My thoughts on the Falkland Campaign WSP McGregor, OBE FRCS (Ed), Lt Colonel RAMC Consultant Surgeon The regular soldier spends much of his time training for war. It is curious that the more training he undergoes, the less he savours the thought of going to war because the greater is his knowledge of the terrible destructive capability of modern war weapons. My call came as a member of the Parachute Clearing Troop – 16 Field Ambulance, not unexpectedly because I had followed the build up in the national press consequent on the invasion of the Falkland Islands by the Argentinian Forces. I had just finished a busy Outpatient Clinic and sat in my office completely drained of all compassion for the wives of majors, corporals and the rest of humanity when the ‘phone rang. “Come and join us” was the call, so off I went to war. We all knew that we were going to sail to war but we also knew that this was going to be a limited cruise. We should meet in Aldershot, parade, embark and sail and that somewhere around Ascension Island, the politicians would sort it all out and we would all turn around and sail back again. With a bit of luck I thought I might miss out on about two weeks of outpatients clinics. We duly paraded in Aldershot and for the first time in my long association with the Airborne forces, the unit P.C.T. was up to strength and had been completely equipped with all the paraphernalia of war that we had been trying to fight off for at least 10 years. After several false starts, we actually set off in a convoy of coaches and reached that most admirable port, Portsmouth. Much more, we were actually allowed to board the ship as part of the 2nd Para Brigade Troop. The ship itself had been recently acquired and converted from a North Sea Ferry – the Norland. Built for the holiday trade, with accommodation for 1,000 passengers, it suddenly had to accommodate 1,500 fairly carefree Paras, with all, if not more, of their equipment. Amid scenes reminiscent of the Hollywood films showing the departure of Kitchener’s force for the Sudan portrayed so well in the original film Four Feathers, the Norland sailed. I cannot say that I was unaffected. It was an emotional occasion. The crowds cheered, the band of 2 Para played such stirring music as “Don’t cry for me Argentina” and the RSM of 2 Para marched along the deck saying “If you lean on the rails, I’ll break your arms – stand up”. The Navy were particularly good. Ships in the dockyard sounded their sirens, Naval shore establishments lined the banks and cheered and the dockyard labourers showed a pride in the work they had put into these ships over the past two or three days. The journey south was accomplished with surprising ease. The holiday air persisted and as the climatic conditions improved, the holiday atmosphere became even more marked. The 2 Para group entertained the ship’s officers; the ship’s officers entertained 2 Para group and eventually we both entertained one another, but suddenly we found ourselves at Ascension Island. The war climate had not improved. The politicians had not resolved the problem. Suddenly there was a vast increase in traffic signals, cross decking of the supplies between ships became more urgent. Essential supplies such as ammunition were suddenly dug out from the bottom of the hold where they had been buried under piles of arctic equipment and rations. The holiday atmosphere evaporated quickly and very impressively. It changed to one of sheer JR Army Med Corps 153(S1): 25-26

professionalism. Training became more popular and more universal. Personnel began board drills with a more serious and interested attitude. The lifeboats of Norland were swung out and lowered, much to the amazement of the Captain who in his seven years in command, had never seen them move from the chocks. Much to the gratification of the Medical Services suddenly the big Army began to take us seriously. First Aid lectures became very much better attended and certainly the officers in the bar of an evening began to cultivate the company of the medical officers with rather searching questions. The Medical Services, to their great credit, carried on as usual. Trained as they were to a superb level, they tried to pass this knowledge on to the people whom before had been too busy to take any notice. When it became obvious that due to our combination of postings, circumstances and bad planning, medical potential of the 2nd Battalion Parachute Regiment was less than adequate - an intensive training programme was instituted. Much of the emphasis of this was on the setting up of intravenous infusions. We had provided, thanks to the preplanning of Major Malcolm Jowitt, RAMC, a plastic arm in which the insertion of intravenous infusions could be practised. It was after one such session when a member of 2 Para turned to his Regimental Medical Officer and said, “For all the good I’m doing Sir, I might well be sticking it up his ------”. This led to a short time vogue for rectal intravenous infusions. I would like here and now to condemn this practice, if only that in the Falklands, it would have led to a spate of frost bitten bums, comp saturated colons, unfixable drips, and dead soldiers. With this and many other merry japes, we eventually made or way south and suddenly the merriment went out of the situation. Following a training lecture by the Royal Naval personnel on the invincibility of the Royal Navy ships, came the news of the sinking of HMS Coventry. If this put a damper on the situation, it also concentrated the attitudes towards training even more. The actual run into the Falklands was, to say the least, sporting, with false sonar alarms about submarines which turned out to be whales, sleeping in lifejackets, sailing through minefields and making the arrival at the shore somewhat of a relief. There is no doubt that by the time disembarkation from Norland for the beachhead on rather flimsy landing craft, in pitch darkness and under fairly adverse weather conditions took place, the professionalism of 2 Para group had reached its peak. I have nothing but admiration for the soldiers of the Parachute Battalion, for the Royal Navy and for the Merchant Navy personnel who risked much to get us there. The arrival in San Carlos water of the M.V Norland highlighted the lack of communication between the different branches of the regular soldiers. While 2 Para disembarked and landed without incident, the first task of the P.C.T. was to establish aboard the Norland a mini-field hospital. This was done with the alacrity and expertise which one would expect of the unit. After a day spent in consistent air attack, it became obvious that the big ships would have to be withdrawn from San Carlos water during daylight and finally the message we had been trying to give to the Navy for some time got through – if there were troops ashore, the medical expertise should also be ashore. Besides, ships were dangerous. So, with a little difficulty, Parachute Clearing Troop arrived at Ajax Bay – the 25

first surgical teams ashore. Again it is a tribute to the Airborne soldiers that within an hour of landing, a surgical facility had been set up. This formed the basis of the field hospital which was eventually established at the old Refrigeration Plant at Ajax Bay of the Parachute Clearing Troop plus a marine medical support troop plus two surgical teams from the Royal Navy. This is the unit which bore the main bulk of the surgical load in the Falkland Campaign. The time spent at Ajax Bay had its moments. quite apart from the large casualty load, there came a time when the Argentinian Air Force decide to remove the field hospital from the order. Had their bombs had the right fusing, they would have done this most successfully. However, the unit survived. As the fighting advanced towards Port Stanley, it became obvious that surgical support was necessary nearer the front line. The only surgical teams whose equipment scales and general training fitted them for this task were 5 and 6 surgical teams of P.C.T. 5 F.S.T. were despatched to Teale Inlet, 6 F.S.T. were despatched to Fitzroy and in these locations, they carried on the treatment of battle casualties for the rest of the campaign. It fell upon 5 F.S.T to be the first to enter Stanley

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where they set up in the local hospital. They were followed quite shortly by 6 F.S.T. It is interesting that while at Ajax Bay and in support of 2 Para elements of the P.C.T. were deployed to reinforce 2 Para medical elements in the attack on Goose Green. The attack went in against superior numbers and that success has now entered the history of the British Army. Not only were 2 Para outnumbered but they had to endure severe mortar and artillery bombardment and the ever persistent attention of the Argentinian Air Force. Towards the end of the engagement, a party of airborne medics were carrying a wounded man from 2 Para on a stretcher when they were spotted by an Argentinian Pucara aircraft. As it prepared to attack, the men carefully laid down the stretcher, cocked their weapons and put up a very intense fire against the attacking aircraft. It is perhaps one of the inconsequentialities of war that the casualty on the stretcher is reported as saying “Don’t shoot at it fellows, you might make him angry.” I cannot help feeling that it was the anger of airborne forces which brought this conflict to a quick and successful conclusion. I cannot also help thinking that it was the expertise of the airborne medical service which resulted in the remarkably low casualty figures.

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War stores San Carlos settlement

Burn victims from Sir Galahad in Ajax Bay

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Bill McGregor operating at Ajax

Sea King over Ajax Bay refrigeration plant 28

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Medics treating wounded in the field Darwin Goose Green Battle

Bill McGregor & team operating at Fitzroy settlement JR Army Med Corps 153(S1): 27-36

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WO2 Les Viner treating a Galahad casualty on the ground at Fitzroy

Medics at the Battle for Darwin/Goose Green 30

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Main entrance Red & Green Life Maching at Ajax Bay - Note fridge door

Charles Batty & FST at Ajax JR Army Med Corps 153(S1): 27-36

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Sea King over San Carlos Settlement

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King Edward VII Memorial hospital Stanley - later burnt down

Bill McGregor operating in a KF shirt JR Army Med Corps 153(S1): 27-36

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Charles Batty operating

Post op Recovery area at Ajax 34

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Galahad survivors coming ashore at Fitzroy

Sir Galahad burning

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Sir Galahad abandoned

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OPERATION CORPORATE – THE SIR GALAHAD BOMBINGS Woolwich Burns Unit Experience P Chapman Summary During Military Operations in the South Atlantic to recover the Falkland Islands in 1982, the troopship Sir Galahad was bombed. Initial treatment of the injured in field medical units was followed by transfer to the hospital ship SS Uganda and evacuation to the United Kingdom where 48 patients were treated in the Burns and Plastics Unit, Queen Elizabeth Military Hospital, Woolwich. The treatment of these patients is described and the management of war burns discussed.

Introduction On 8 June the Royal Fleet Auxiliary SIR GALAHAD was at anchor in Fitzroy Bay. The 1st Battalion Welsh Guards, support troops, their equipment and munitions were on board. They were awaiting disembarkation from Bluff 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 ship. The 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 killed or injured by flash, blast and secondary missiles from multiple explosions. A total of 78 soldiers were burnt. Within minutes of the attack a massive evacuation of the ship was started, using helicopters, lifeboats, landing craft and inflatable rafts. Many wounded troops were successfully carried ashore, although all their equipment was lost. Medical facilities at Fitzroy were limited, as all the Field Ambulance equipment had been lost on board the SIR GALAHAD during the bombing. First aid was given and the wounded evacuated as soon as possible by helicopter to Ajax Bay where the main shore-based medical facilities were stationed in a disused refrigeration plant. Some of the injured were transferred directly to ships in San Carlos Water. All were ultimately evacuated to the hospital ship SS UGANDA which itself was under pressure to evacuate as many wounded as possible, to make room for the large numbers of casualties expected from the planned attack on Port Stanley1. Those fit enough were therefore transferred from UGANDA to the smaller hospital transport ships, HECLA, HERALD and HYDRA for passage to Montevideo and onward flight in RAF VC 10 aircraft to the UK via Ascension Island. On arrival in UK, wounded were held overnight at the Princess Alexandra’s Hospital, Wroughton, and then dispersed to other military hospitals in England.

Management Of the burnt soldiers who reached the UK, 27 were considered sufficiently healed to be sent home on sick leave, three were transferred to the RAF Hospital, Halton, and 48 were transferred to the Burns and Plastics Unit at the Queen Elizabeth Hospital, Woolwich. The field medical documentation and hospital case notes of those patients treated at Woolwich were retrospectively analysed. Each soldier was interviewed to make good any omissions in the JR Army Med Corps 153(S1): 37-39

The Sir Galahad on fire in Fitzroy

necessarily brief field records and to provide background information for construction of the historical picture.

In the South Atlantic Immediate first aid at Fitzroy included hosing down of burnt areas with cold water and application of basic field dressings2. As all medical stores had been lost in the ship, the two field surgical teams from 2 Field Hospital, supported by 16 Field Ambulance, had an extremely limited capacity3. However, shore-based infantry units, already established and equipped, were on hand to provide intravenous fluids, drip-giving sets and further field dressings. After receiving their basic first aid, casualties were 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 plant in Ajax Bay were also limited, so about half the patients were transferred to medical holding facilities prepared aboard FEARLESS, INTREPID and ATLANTIC CAUSEWAY. At Ajax Bay patients were routinely given intramuscular penicillin and booster doses of tetanus toxoid4. Morphine was available for pain relief. Hand burns were cleaned with cetrimide solution and put into plastic bags containing silver sulphadiazine 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 sulphadiaxine 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 37

patients with 6-10% burns, nine required intravenous drips, and two of these were also given a urinary catheter. A 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 used at Fitzroy and Ajax were sodium lactate and Polygeline. As most had been exposed to flash and smoke in the confines of the ship, steroids were administered, before transfer to the UGANDA, to 29 patients, roughly half of whom had one dose of hydrocortisone 100mg intramuscularly, the rest having 1 gram of Methylprednisolone intravenously six hourly. Most patients were transferred by helicopter to the hospital ship UGANDA within 24 hours. Here intravenous resuscitation was continued using Dextran 70 in those still with high haematocrit levels many hours after injury. The drip rate was controlled by reference to hourly haematocrit levels measured on a hand-held battery-powered centrifuge, using a regime now known as the “Uganda Rule” (Table 1)1. Hourly Haematocrit >60 50-60 15

11 1

9 1

8 2

10 1

2 1

9 3

17 0

11 2

7 4

5 1

2 0

7 2

Table 2. Intervals: Wounding to Surgery and Antibiotics

Method Two hundred and thirty three soldiers were injured in the Falklands Campaign. Data were obtained from the field medical cards, case notes and Hostile Action Casualty System coding sheets, and the records of all soldiers who received soft tissue limb wounds were analysed. Burn injuries were excluded. There were 174 injuries to the limbs and of these 49 involved the soft tissues only, ie 28% did not damage bone. Twenty eight lower limb and 21 upper limb injuries were studied.

Results The wounding agents covered the whole spectrum of weaponry (Table 1) and the range of tissue trauma varied from extensive, with tissue and skin loss and neurovascular injury, to minimal. 9 mm Mine Shrapnel 7.62 mm Grenade Mortar

4 5 4 (2) 8 (2) 4 12 (3)

Shell HV. Unspec Helo Crash Sidewinder Bomb Fragments TOTAL:

5 (2) 2 1 1 3 49

Table 1 Wounding Agents The figures in brackets indicate the number of cases in which sepsis developed.

The time intervals from wounding to first surgery and wounding to antibiotic administration are given in Table 2. Only 20 patients, 40%, underwent surgery before six hours had elapsed and nine patients, 18%, were delayed over 15 hours. A higher number of patients however, 28 (57%), received antibiotics before the six hour point. Table 3 gives the intervals at which delayed primary suture was carried out and most operations took place between five and seven days after initial surgery. Delay beyond this point was usually because of a dirty wound which required further dressings or further excision before safe closure. In this event skin grafts were used as a method of delayed closure. This technique was used for three legs and two arms. All the wounded in this series were given antibiotic cover (Table 4) and this was mostly one of the penicillins. In only one case was a combination used, Triplopen and Metronidazole, the JR Army Med Corps 153(S1): 55-56

Days Number

0-4 4 (3)

5-7 40 (6)

8-10 3 (0)

11-13 2 (0)

Table 3. Intervals: Surgery to DPS

Magnapen Crystapen Triplopen Penicillin (unspec) Tetracycline Metronidazole Erythromycin

2 8 26 10 2 1 1

Table 4. Antibiotics used in limb wounds

latter being employed to cover possible concomitant bowel injury. Of the 49 cases reviewed, three patients had septic wounds at delayed primary suture, ie frank pus in the wound, an incidence of only 6%: but subsequent infection after delayed primary suture developed in a further six cases making a total of nine or 18%. Erythematous or moist wounds and very minor degrees of infection, have been excluded, as have those wounds which had primary closure delayed because of separating sloughs and were not overtly clinically infected. Examination of the time intervals between injury and first surgery in those casualties who developed sepsis (Table 2) reveals that seven of the nine cases occurred when wound excision was delayed beyond six hours. Twenty-one of the 49 casualties were given antibiotics after six hours. Septic wounds also resulted in seven of the nine cases in whom the giving of antibiotics was delayed beyond six hours. Unfortunately there was insufficient time to prepare a fifth table showing the delay to surgery in those cases in which antibiotics were administered within three and six hours respectively. Table 1 also gives details of the wounding agents in the septic cases and does not suggest any link between the nature of the agent and the development of infection as the cases are evenly distributed. 55

Delayed primary suture was used as a method of closure in all casualties in this series and Table 3 illustrates the intervals between initial surgery and closure in the septic cases. It is striking that no infection occurred after DPS when that interval was greater than seven days.

Discussion The prevailing conditions in the Campaign led to erratic and often very delayed casualty evacuation, particularly as most of the battles commenced at night, and helicopter transport was in short supply 2. Current military surgical teaching dictates that all operations should be performed within six hours of injury to reduce infective complications 1. Twenty nine of the 49 casualties were treated after six hours had elapsed and this can readily be explained by the nature of the terrain and the consequent evacuation difficulties, coupled with the application of the triage system relegating these injuries to a lower priority when force of circumstances dictated it 1,3. The infection rate in this group approached 25% and this high infection rate can be related to delay in the primary wound excision. There were no septic complications when antibiotics were administered within three hours of wounding and this confirms recent experimental work showing that early antibiotic therapy (benzyl penicillin) totally inhibits the usual growth of bacteria in missile wounds when excision is delayed for twelve hours 4. It would appear that the antibiotic prevents the growth of the initial sparse mixed flora of contaminants derived from clothes and skin which, were they allowed to thrive, would have prevented the recovery of reversibly damaged tissue and led to super-infection with more pathogenic organisms. In addition, the recovery of tissue damaged on the periphery of the wound leads to a more limited primary excision. In another experimental study by the same authors with no antibiotic therapy, the conclusion is reached that infection can be overcome by wound excision within six hours but would be out of control by 12 hours 5. Owen-Smith and Matheson demonstrated that benzylpenicillin totally protected clostridial-contaminated sheep thigh wounds from gas gangrene provided that antibiotics

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were given within nine hours of wounding 6. No cases of gas gangrene were encountered in the limb injuries reviewed, but the infection rate in this series in that group of wounded who received antibiotics beyond six hours after injury was 33%. The extent of initial wound excision is an unknown quantity in this series, the patients having been operated upon by several different surgeons of varying experience in the management of these types of wounds 2. However, inadequate or insufficient wound excision will substantially contribute to the development of sepsis if at delayed primary suture devitalised tissue is not recognised and closure is undertaken. It should be appreciated that the second operation in the treatment of a battle wound provides an opportunity to inspect it and re-excise it where necessary and not just to close it. Indeed, altering the emphasis of the second operation from closure to inspection may permit a more conservative initial excision. In this series six cases of sepsis developed after delayed primary suture suggesting that the wounds were closed inappropriately. Five cases were closed well beyond the seven day point because of wounds which were of doubtful cleanliness. None became septic.

Acknowledgements I would like to thank Col R Scott L/RAMC, Professor of Military Surgery, for his help in the preparation of this paper and Mrs. Vera Crawford for the typing of the manuscript.

References 1 2 3 4

5 6

Field Surgical Pocket Book, Kirby N G, Blackburn G. London HMSO 1981. Jackson D S. et al. Falklands War: Army Field Surgical Experience. Ann R Coll Surg 1983; 65: 281-285. Owen-Smith, M S. High Velocity Missile Injuries in Hadfield J, J. Hobsley M. Ed Current Surgical Practice. Vol 2 London. Edward Arnold . 1978; 204-229. Dahlgren B, et al. local Effects of Antibacterial Therapy (Benzylpenicillin) on Missile Wound Infection Rate and Tissue Devitalisation when Debridement is Delayed for Twelve Hours. Acta chir Scand Suppl 1982;508: 271-279 Dahlgren B, et al. Findings in the First Twelve Hours Following Experimental Missile Trauma. Acta Chir Scand. 1981; 147: 513-518 Owen-Smith M S, Matheson J M. Successful Prophylaxis of Gas Gangrene of the high velocity missile Wound in Sheep. Br J Surg 1968; 55; I: 36-39.

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Commentary on Soldiers injured during the Falklands Campaign 1982sepsis in soft tissue limb wounds JR Army Med Corps 1984; 130: 97-9

Lt Col Paul Parker The major cause of preventable death in war-time has always been infection (1). One of the greatest medical lessons learnt in WW II was the prophylactic use of penicillin in the surgical units closest to the front (2). In the jungles of Burma, soldiers carried their own antibiotic tablets. Medical corpsmen gave antibiotics at point of wounding in Korea (3). In this small but significant series, there were no septic limb complications when antibiotics were administered within 3 hours of wounding. Septic wounds resulted in 7 of 9 cases where antibiotic administration was delayed beyond 6 hours(4). These simple yet important clinical observations were borne out by later experimental work at Porton Down: Intramuscular administration of Benzylpenicillin, begun within 1 hour of wounding, was effective in preventing streptococcal infections in a pig model of fragment wounds. When this administration was delayed until 6 hours after wounding, the medication was not effective (5). Two thirds of all war wounds are in the extremities and most are not immediately fatal(6). Yet we repeatedly forget the lessons of history and thus the eminently preventable morbidity and mortality associated with these complex open limb wounds still occurs. The US Military have recently (re)introduced a combat pill pack containing oral Moxifloxacin for pre-hospital

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self-administration in the field by the wounded soldier (7). Current UK military practice mandates iv Benzylpenicillin and Flucloxacillin on arrival at Role 2 for extremity wounds and iv Cefuroxime and Metronidazole for cavity wounds (8). These guidelines should still be followed pending a review of the available evidence.

References 1. 2. 3.

4. 5. 6. 7. 8.

Feltis JM. Surgical experience in a combat zone. Am J Surg 1970 119:2758 Poole LT. Army progress with penicillin. Br J Surg 1944 32:110-1. Scott R. Care of the battle casualty in advance of the aid station. Presentation at Walter Reed Army Medical Center Conference on 'Recent advances in Medicine and Surgery' based on professional medical experiences in Japan and Korea. April 19 1954. Jackson DS. Sepsis in soft tissue limb wounds in soldiers injured during the Falklands Campaign 1982. J R Army Med Corps 1984 130(2):97-9. Mellor SG, Cooper GJ, Bowyer GW. Effect of delayed administration of Benzylpenicillin in the control of infection in penetrating soft tissue injuries in war. J Trauma 1996 S128-34. Parker PJ. Bullet and Blast Injuries: Initial Medical and Surgical Management. 2006 Curr Orth 20:333-45. Tactical Combat Casualty Care: Tactics, Techniques and Procedure. Center for Army Lessons Learned. 2006 6-18. The British Military Surgery Pocket Book. 2004 UK: British Army Publication AC 12552.

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Rate of British Psychiatric Combat Casualties Compared to Recent American Wars HH Price Division Psychiatrist, Headquarters, 8th Infantry Division (Mechanised), US Army, Europe

Summary This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars. The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of various diagnoses are also presented. The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular constellation of factors may not recur.

Introduction The Falklands war is described by Surgeon Commander ScottBrown, as one of the Navy psychiatrists involved, as a 20th century reincarnation of the Afghan Wars or the 1896 Sudan Expedition1. Despite the technological advances of naval and air warfare in this conflict such as Exocet missiles and Harrier jets, the land war was fought without many of the weapons used in recent wars. There was little use of heavy armour or helicopter gun ships. General Thompson, the land force commander, said “The only difference between Hannibal and us is that he went by elephant and we are going to walk” 2. And walk they did, carrying most of their supplies, due to the poor road system on East Falkland. During the course of the war which lasted a total of 74 days with a 25 day land campaign from the landing at San Carlos Water to the capture of Stanley, the British lost 237 men killed, 777 wounded with 446 receiving significant hospital treatment. The rate of evacuated psychiatric casualties was 2% of all wounded with 16 declared cases evacuated from the hospital ship, Uganda. This rate compares favourably to the American experience in recent wars i.e., 23% of medical evacuees were psychiatric casualties in WWII, 6% in Korea and 5% in the early stages of the Vietnam War, reaching a high of 60% during the drug epidemic of 1972 3,4. The Falklands produced a low rate of psychiatric casualties. This paper will examine the factors which the American experience suggests affects psychiatric casualty rates, two of which were not present in the Falklands and six factors which were.

Factors not Present The low psychiatric casualty rate in the Falklands is significant in that two factors believed to have decreased psychiatric casualties in American experiences were not present in this campaign, i.e. the presence of psychiatric personnel in line units 58

and psychiatric screening of all evacuees. Due to the psychiatric disaster in the American Army during the Tunisian Campaign in 1943, psychiatrists were sent to corps level, then further forward to evacuation hospital level during the Sicily invasion. On 9 November 1943 the War Department re-established the position of division psychiatrist with the first division psychiatrist reaching a division at Anzio in March 1944. The increasing forward assignment of psychiatrists during World War II coincided with, and perhaps led to, a decrease in psychiatric casualties. However, even as late as August 1945, only seven out of 17 divisions in the Southwest Pacific had division psychiatrists5. During Korea, within 6-8 weeks of the onset of fighting, division psychiatry became operational6. By the time of Vietnam, there were more psychiatrists in the theatre per Army troop strength than in any previous war. 3 Though Abraham has written extensively on the treatment of battleshock (the British term for psychiatric combat casualties) and has proposed the development of Battleshock Rehabilitation Units at division level supported by Field Psychiatrist Teams, these have not yet been fully organised6. There are no behavioural science teams attached to British line units corresponding to the division psychiatrist, psychologist, social worker, and enlisted behavioural science technician (91G) in the U.S. Army. No Royal Army Medical Corps psychiatrists were invited to the Falklands. Psychiatric screening of medical evacuees has also been found to decrease rates of psychiatric casualties in the American Army. During the New Georgia Campaign in the Pacific during July and August 1943 no screening of evacuees occurred in the 43rd Infantry Division. This division had large numbers of psychiatric casualties as well as medical evacuees subsequently found to have psychiatric disorders at base hospitals7. This division lost 10% of its strength during one month to N-P casualties. It is reported that men actually “tagged” and JR Army Med Corps 153(S1): 58-61

medically evacuated themselves to rear bases. In another division, the 37th Infantry Division, also on New Georgia and taking the same amount of physical casualties, all psychiatric cases were screened by the division psychiatrist producing a negligible N-P evacuation rate7. During the Korean War and the Vietnam War all psychiatric evacuees were screened by psychiatrists except for drug abuse cases evacuated from Vietnam through Drug Rehabilitation Centers run for the most part by internists or general medical officers4. No psychiatric screening occurred in the Falklands because the two Royal Navy psychiatrists present were aboard ship for the duration of the conflict, one aboard the hospital ship Uganda and one aboard the Canberra, a troopship with a 50-bed hospital8,9. One was to have been placed in a mobile field hospital, but as all tents were lost in the sinking of the Atlantic Conveyor, the hospital was set up in a refrigeration plant at Ajax Bay primarily for surgical cases. All psychiatric casualties were evacuated to the Uganda. Though the British have a similar understanding of combat psychiatric casualties and their treatment10 as American psychiatrists, the location of the psychiatrists was not optimal for the rapid return to duty of cases. The Geneva Convention prohibits return of troops to combat from a neutral territory and permits wounded to be taken prisoner from a hospital ship. Therefore casualties were sent by ambulance ship to the neutral port of Montevideo and then to Britain by aircraft. Once aboard the Uganda at San Carlos Water the evacuee was as good as home in Britain despite the 8,000 mile distance. The Canberra, on the other hand, was legally a troopship and thus a legitimate military target, by Geneva Convention rules. Consequently after offloading troops and equipment during the landings on 21st May and taking on some casualties it was sent the next day to the east of the Total Exclusion Zone out of range of land based Argentine aircraft. If the British had been able to obtain complete air superiority, the Canberra could have been kept closer to the land battle medical evacuation chain and used for the treatment of psychiatric casualties and their return directly to combat. Of the 16 psychiatric cases evacuated to the Uganda, ScottBrown reported that four were battleshock cases, four had formal psychiatric illnesses, precipitated by combat all of whom were depressed, four were survivor reactions with bereavement and fear of minor trauma and four were cases of hyperventilation and depression without exposure to land combat1. The battleshock cases were treated with rest, warmth, food and small group therapy. The psychiatrist aboard took charge of a 250 bed low dependency ward and performed many consultation-liaison activities such as pain control consults and amputation counselling. Morgan O’Connell, the psychiatrist on the Canberra, consulted on eight cases. One was a case of bereavement, one had psychosomatic chest pain with family stresses, two were cases of alcohol abuse, one a case of acute paranoid schizophrenia with a previous history of hospitalisation, two homosexual civilian ship’s crew members with depression and a Senior NCO with disseminated sclerosis. He was also involved in preventative psychiatric group work with survivors of the Ardent after section, as well as the Special Air Service Squadron which lost 19 men in a helicopter crash. Only the bereavement case had been involved in the land combat; his helicopter crashed and the pilot died in his arms under heavy fire from Argentines8. Despite absence of psychiatrists ashore or in line units and the lack of psychiatric screening of evacuees all of which were removed from combat and sent to Britain, the Falklands Campaign still produced the remarkably low rate of 2% JR Army Med Corps 153(S1): 58-61

psychiatric cases of all medical cases. When viewed in the light of the American experience in the past three wars, this low rate represents a concentration of optimal factors leading to healthy functioning in combat. There are five optimal factors which appear important but first a look at an important factor which, while decreasing the rate of diagnosed psychiatric casualties, leads to their evacuation under other diagnoses.

Occult Psychiatric Casualties Marlow (1979) pointed out that during World War II “severe combat that produced few people who were labelled by the Medical Department as combat psychiatric casualties, also produced compensatorily large numbers of personnel withdrawn from battle for frostbite, illness or light injury, as well as AWOL and self-inflicted wounds”11. The low number of psychiatric casualties in the British campaign may have been offset by the fact that 20% of all land casualties were due to immersion foot12. A number of exposure cases however, occurred when the landing ship Sir Galahad was bombed at Bluff Cove with no voluntary component to their condition. Therefore the number of occult psychiatric casualties may have been negligible. In a climate very similar to the Falklands, when the 7th Infantry Division invaded Attu in the Aleutians in May 1943, large numbers of cold casualties occurred in a campaign lasting 21 days. This division, desert trained with neither proper training nor clothing for the cold wet weather, suffered 553 KIA, 1,154 wounded, 2,205 diseased, of which 1,518 were frostbite and trenchfoot. The North Pacific theatre had the lowest overall psychiatric casualty rate of the war13. In the European theatre during World War II and again in Korea, frostbite was also noted to be an evacuation syndrome. Evacuation of psychiatric casualties has occurred under organic diagnosis such as “blast concussion”, and diarrhoea. In Italy after the invasion at Salerno in September 1943, the incidence of diarrhoea increased by one third in the 5th Army. “Most patients recovered promptly after three to five days regardless of whether sulfonamides, or bismuth or Paregoric were used”14. During this same period many patients who had bypassed evacuation hospitals and were evacuated to North Africa with diagnoses of “concussion” or other somatic disease were subsequently discovered to be neuropsychiatric casualties14. The ratio of diagnosed psychiatric casualties to battle casualties was one to eight. Later in the Italian campaign with more thorough evaluation the ratio rose to one out of four to five battle casualties14. At times command pressure influenced diagnosing of psychiatric casualties. On Guadalcanal in 1942 General Patch, commanding the American Division, insisted on court-martialing officers with neuropsychiatric diagnosis. The division psychiatrist, serving also as the division surgeon, circumvented this by labelling these cases as “blast concussion”15. During the Iwo Jima campaign a high incidence of “blast concussion” evacuees occurred in Marine units. It was suspected that this was an attempt to decrease incidence of “combat fatigue”9. Malaria during World War II was another example of an evacuation syndrome, preventable by taking Atabrine. On Guadalcanal in November 1942 so many men were lost due to malaria that all men with temperatures up to 103º were ordered to remain in combat. This caused much resentment towards “healthy” N-P casualties5. Again in the battle for Buna, New Guinea in 1942 the 32nd and 41st Infantry Divisions, both without psychiatrists, overwhelmed forward treatment centers with malaria and diarrhoea cases5. By December 1942 the Southwest Pacific theatre psychiatry consultant reported that 59

42.7% of cases evacuated to the United States were psychiatric. In the past, when no possibility of evacuation existed, rates of psychiatric casualties and other evacuations syndromes were low. On Bataan in 1942 little psychiatric disease occurred despite heavy fighting, lack of food and inevitable defeat18. During the Vietnam War most psychiatric evacuees were screened by the “K-O” teams. “Drug abuse became a kind of evacuation syndrome with most of these patients becoming casualties only on the basis of the positive urine screening”4. This paper will now examine five optimal factors in the American experience which were present in the Falklands War.

Elite Units The British troops involved were from elite units such as the Marine Battalions, Special Air Service Regiment, Parachute Regiment, Special Boat Service, Guards and Gurkhas. These units have been serving together for years, the majority having seen service in North Ireland. The men knew their leaders and vice versa; strong group cohesion existed. The units were not dispersed and they fought together. Similarly, low rates of psychiatric casualties have occurred in American elite units. During the breakout from the Anzio beachhead in Italy in 1944 the 1st Special Service Force, a brigade of American and Canadian volunteers suffered a minimum of psychiatric casualties while taking heavy physical casualties17. Also in Italy, the 100th Infantry Battalion composed of Japanese-Americans from Hawaii suffered 109 battle casualties in a two week period with only one psychiatric casualty17. The 442nd Regimental Combat Team also made up of Japanese-Americans had a similar low rate17. The three Airborne Divisions fighting in Europe during World War II never had a neuropsychiatric casualty rate higher than 5.6% of battle casualties18. It should be noted, however, that in the Vietnam War the rate of psychiatric casualties did not increase when regular Army volunteer troops were replaced by draftees in 19674.

Duration of Combat The Falkland land campaign lasted only 25 days. Brief duration of combat exposure has, in American wars, been associated with low N-P casualty rates. During the invasion of Saipan, in a campaign of short duration from 19 June to 12 July 1944, the 27th Infantry Division had relatively few cases of psychiatric illness consisting of 5.6% of all admissions despite intense combat and heavy physical casualties19. The low incidence of “combat exhaustion” type cases of World War II during the Korean conflict has been attributed to the rotation policy for 12 months in the combat zone. This factor alone cannot always be relied upon to produce low rates. 24 hours after the newly arrived American Division went on the offensive at Guadalcanal, one third of the 350 casualties at the clearing station were psychiatric7. Later during the New Georgia campaign 70% of the total N-P casualties occurred during the first month, 26% in the second and 4% in the third and final month20. This decreasing incidence was due to improved screening of casualties but also to the changing character of the combat as the island was cleared. On Okinawa, in April 1945, after an initial period of light combat and relatively unopposed landings the psychiatric casualty rate rose on the third day of intense combat18. Of 100 psychiatric cases evacuated to Saipan a large sub-group consisted of men with over 140 days combat in the theatre18. Psychiatric casualties can occur early in a campaign in men with previous combat.

Indirect Fire In American wars the presence of indirect fire is associated with increased N-P rates. The British force experienced limited heavy bombardments, no intense counter-attacks, and 60

intermittent air attack. Few psychiatric casualties occurred while the Task Force was at sea despite the threat from Exocets and Argentine fighters. Similarly, during the voyage to Okinawa no psychiatric problems arose in troops due to the heavy Kamikaze attacks18. However, once landed at Okinawa 13.3% of all admissions were psychiatric cases. This was attributed to concentrated heavy artillery fire18. At Anzio the rate of N-P casualties rose in support troops for the first time due to heavy continuous bombardment of the surrounded beachhead.17. Later in Italy, the 88th Infantry Division in 22 days of combat in the Voltera area was under severe artillery fire and the N-P casualty rate was 24% with an incidence of diarrhoea as well17. Lack of exposure to artillery barrages has been suggested as one factor in the low psychiatric casualty rate in American troops in Vietnam3.

Unopposed Landing The most vulnerable moment for the British was the initial landing at San Carlos Water. The Argentines who had the opportunity to move in units to oppose the landing did not take the initiative. Heavy fighting at the beachhead as at Anzio and Salerno leads to heavy physical casualties and psychiatric casualties. When the 31st Infantry Division invaded Mindanao at the Parang beachhead in the Philippines, 25% of the initial 400 casualties were psychiatric.

Offensive vs Defensive Posture The British were constantly on the offensive in a mobile fluid advance primarily fighting with light infantry weapons. After the improvised battle at Goose Green in which the 600 men of 2 Para Battalion captured 1,400 Argentines while losing their Commanding Officer, it was decided by the British command to fully prepare for the final assault on the defensive perimeter around Stanley where the Argentines had withdrawn. Rapidly advancing troops experience low psychiatric casualty rates. During 3rd Army’s sweep across France in August 1944, the rate of psychiatric casualties was 7.4% of non-fatal casualties21. In Italy during the pursuit to the Gothic line, the advancing 34th Infantry Division troops had low rates of psychiatric breakdown despite severe physical fatigue in four days of marked fighting alternating with periods of no fighting during which it took heavy physical casualties. Under favourable tactical circumstances, even in the presence of severe fatigue and wounded rates, low N-P rates tend to occur. In Vietnam as the posture changed from offensive operations to more defensive withdrawal the rate of psychiatric casualties increased despite the overall decrease in combat participation.

Summary The low rate of British psychiatric casualties in the Falklands was due to a number of positive factors: the use of elite units, short duration of combat, little exposure to indirect fire, an unopposed landing and a consistently successful offensive posture, all of which influenced the rate of psychiatric casualties in past American wars. This low rate occurred despite the absence of any psychiatrists on land during the campaign and the absence of psychiatric screening of evacuees. The combination of favourable factors occurring in this conflict is not likely to occur in the most predictable future American conflict, a high intensity European war. The low rate of psychiatric casualties experienced by the British should not decrease planning and training for dealing with these casualties in any future conflict involving either the British or U.S. Army.

References 1

Scott-Brown A. Presentation, Symposium on Military Psychiatry. Royal Army Medical College, Millbank, Sept. 30, 1982

JR Army Med Corps 153(S1): 58-61

2 3 4 5 6 7 8 9 10 11 12 13 14

15 16 17

Sunday Times of London Insight Team. War in the Falklands: The Full Story. Harper and Row, New York, 1982 Tiffany, W J and Allerton, W S. Army Psychiatry in the mid-60’s. Amer J Psychiat 1967; 123: 812-813. Jones, F D and Johnson, A W. Medical and Psychiatric Treatment Policy and Practice in Vietnam. J Soc Issues 1975; 31 (4): 49-65. Challman, S A and Davidson, H A. Southwest Pacific Area, in Glass, A J AND Mullins, M S (eds). Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 513-577. Glass, A J. Psychotherapy in the Combat Zone. Amer J. Psychiat April 1954; 725-731. Billings, E G. South Pacific Base Command, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 473-512. O’Connell, M. Psychiatrists at War. Paper presented at Symposium on Military Psychiatry, Royal Army Medical College, Millbank Sept 30, 1982. Rottersman, W and Peltz, W. Western Pacific Base Command in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 59-621. Abraham, P. Training for Battleshock. J R Army Med Corps 1982; 128: 18-27. Marlow, D. Cohesion, Anticipated Breakdown, and Endurance in Battle. Considerations for Severe and High Intensity Combat. Unpublished, Dept. of Military Psychiatry, Walter Reed Army Institute of Research 1979; p14. Lessons of Falklands: Prepare for Surprises. U.S. Medicine Feb, 1, 1983; p3. Frank, R L. Alaska and the Aleutians (North Pacific Area), in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 681-737. Drayer, C S and Glass, A J. Italian Campaign (9 September 1943 – 1 March 1944), Psychiatry Established at Army Level, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 25-45. Kaufman, M R and Beaton, L E. South Pacific Area in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 429-471. Beaton, L E and Kaufman, M R. As We Remember It, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 739-797. Glass, A J and Drayer, C S. Italian Campaign (1 March 1944 – 2 March 1945), Psychiatry Established at Division Level, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 47-108.

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18 Markey, O B. Tenth U.S. Army, in GGlass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 639-679. 19 Kaufman, M R. Central Pacific Area, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 579-592. 20 Hallam, F T. War Neurosis-Report by XIV Corps Surgeon, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 10631069. 21 Thompson, L J, Talkington, P L and Ludwig, A O. Neuropsychiatry at Army and Division Levels, in Glass, A J and Mullins, M S (eds), Neuropsychiatry in World War II, Vol II, Overseas Theatres. Washington DC, U.S. Government Printing Office 1973; 275-373.

Footnote by: Col P Abraham L/RAMC FRCPsych Professor of Military Psychiatry Captain Price was obliged to refer to “the rate of evacuated psychiatric casualties” as “2% of all wounded” since these were the only data available to him. The true figure for incapacity for psychological reasons was approximately four times that number. The principal reason for this was that many were evacuated with a physical label, a case of hysterical deafness diagnosed subsequently in UK being fairly typical. Others avoided going through the evacuation chain by virtue of recovery before being caught up in it, or because the sudden armistice forestalled the need for transportation as a casualty. Concerning the possibility of occult psychiatric casualties occurring amongst those with cold injury, this was indeed not unknown, but the number may well have remained small because responses to cold stresses of one sort or another were managed within the unit wherever possible, which happens to be the correct procedure for overt psychiatric casualties as well.

61

THE FALKLANDS WAR

Commentary on Rate of British Psychiatric Combat Casualties compared to recent American Wars JR Army Med Corps 1984; 130: 109-13

Morgan O Connell After twenty five years, in general this paper reads correctly, however it needs to be emphasised that there were psychiatric assets ashore in the form of two dual qualified nurses embedded in the Surgical Support Team in Ajax Bay. They had been extracted from the psychiatric departments in the Royal Naval Hospital Haslar and the Royal Naval Hospital Plymouth, not because of their psychiatric qualifications but because of their SRN qualifications. Nevertheless they did function in this dual capacity within the Surgical Support Team and provided support for the surgeons and physicians on the ground in their triage. It is not entirely correct to say that no Royal Army Medical Corps Psychiatrists were invited to the Falklands. I initiated the signal in the aftermath of the Battle at Goose Green when it became apparent that we were already beginning to experience psychiatric casualties amongst 2 Para. This signal requested the deployment of an Army Mental Health Team. My understanding is that this was over-ridden by more senior Staff Medical Officers who quite clearly failed to understand the importance of having mental health assets on the ground, and in particular Mental Health assets identified with the Units in question, i.e. with the Army as opposed to the Navy/Royal Marines. I believe this had a long term effect on the subsequent failure/unwillingness/difficulty in recognising psychiatric casualties amongst the returned combatants. Whilst the Paper is entitled Rate of British Psychiatric Combat Casualties Compared to recent American Wars and by implication is addressing psychiatric casualties during combat, it needs to be emphasised that just because the shooting has finished, it does not mean that psychiatric casualties do not continue to present. This is amply born out by the number of Veterans on the Books of Combat Stress, the Ex-Services Mental Welfare Society (some 400) whose traumatic experience is identified as being the Falklands. It was certainly my experience before I left the Navy in 1996 that we continued to see casualties presenting from that conflict on a regular basis and indeed it was because of this that we set up the first PTSD

62

treatment programme in the country in the Royal Naval Hospital Haslar in 1987, to which Army casualties were referred who were suffering as a consequence of 1982. It has been suggested that amongst the occult psychiatric casualties were a number of non freezing cold injury/trench foot cases. I have discussed this with Rick Jolly who was the MOIC in Ajax Bay, in addition to which I saw some of these cases myself on board Canberra and there was no doubt in my mind that whilst they may well have had some form of psychological symptomathology, their primary disorder was that of trench foot and to have retained them on the ground with the inadequate facilities experienced by the fighting units, would have added to the burden of those units. Why were the figures so low? (and I believe the figures are valid). Well first and foremost of course, we won. Secondly the country was behind us as a whole as was witnessed by the send off which was exceeded only by the welcome on our return. Thirdly it was a relatively short conflict and there was virtually no record of atrocities. This was confirmed by the International Committee of the Red Cross who visited Canberra when it was hosting the 4,500 Argentinean prisoners of war who were returned to the Argentine. In addition there was virtually no night fighting other than in the final stages of the conflict and so the issue of combat exhaustion was a relatively minor problem. The breakdown of the psychiatric casualties currently on the Books of Combat Stress by unit, reflects what we have come to expect. i.e. where there are significant numbers of physical casualties including fatalities, then there are psychiatric casualties in proportion. Finally all are in agreement that the three week journey to the site of the conflict was a wonderful opportunity to complete preparation, if that can ever be completed, for going to war and by the same token the return journey, particularly for the sailors in their ships, even those which had sustained damage, gave all the opportunity for recovery.

JR Army Med Corps 153(S1): 62

FALKLANDS WAR 25th ANNIVERSARY

Military Cold Injury During the War in The Falkland Islands 1982: An Evaluation of Possible Risk Factors Lt Col RP Craig Queen Elizabeth Military Hospital, Woolwich

Abstract Throughout the history of war, there have been many instances when the cold has ravaged armies more effectively than their enemies. Delineated risk factors are restricted to negro origins, previous cold injury, moderate but not heavy smoking and the possession of blood group O. No attention has been directed to the possibility that abnormal blood constituents could feasibly predispose to the development of local cold injury. This study considers this possibility and investigates the potential contribution of certain components of the circulating blood which might do so. Three groups of soldiers from two of the battalions who served during the war in the Falklands Islands in 1982 were investigated. The risk factors which were sought included the presence or absence of asymptomatic cryoglobulinaemia, abnormal total protein, albumin, individual gamma globulin or complement C3 or C4 levels, plasma hyperviscosity or evidence of chronic alcoholism manifesting as high haemoglobin, PCV, RBC, MCV or gamma glutamyl transpeptidase (GGT). No cases of cryoglobulinaemia were isolated and there was no haematological evidence to suggest that any of those men who had developed cold injury, one year before this study was performed, had abnormal circulating proteins, plasma hyperviscosity or indicators of alcohol abuse. Individual blood groups were not incriminated as a predisposing factor although the small numbers of negroes in this series fared badly. Although this investigation has excluded a range of potential risk factors which could contribute to the development of cold injury, the problem persists. Two areas of further study are needed: the first involves research into the production of better protective clothing in the form of effective cold weather boots and gloves and the second requires the delineation of those dietary and ethnic factors which allow certain communities to adapt successfully to the cold. A review of the literature in this latter area is presented.

Introduction Local cold injury may greatly reduce effective combatant troops in war and can result in considerable morbidity during exercises in peacetime. Its significance and occurrence is underestimated and frequently under-diagnosed. Until the Falklands War of 1982 the last occasion in which British servicemen fought in a cold climate was in Korea and the remaining medically qualified veterans of that conflict have nearly all retired. There are historical instances in which the cold has inflicted more battle casualties than the enemy. Larrey 1 reported the loss of 11650 out of 12000 men of the 12th division of Napoleon’s Grand Army during the Russian Campaign and Hitler’s advance into, and subsequent retreat from, the USS during World War II resulted in both sides losing catastrophic numbers of men from the cold 2. The British Army documented 115,361 cases of frostbite and trench foot in the official records of World War I but the majority of these occurred early in the conflict. With the introduction of duckboards, the issue of dry socks and strictly imposed foot and hygiene discipline the incidence dropped during the later years of the campaign 3. The influence of these measures in combating cold injury was again manifest during World War II in North West Europe where British casualties were much lower than the 91000 suffered by the United States Army of whom some 87% were infanteers. There were times during the winter of 1944-1945 when the cold resulted in up to one-third of American battle casualties 4,5. No accurate figures for the number of British and JR Army Med Corps 153(S1): 63-68

Argentinian troops who fought in the Falklands and sustained cold injury are available although symptoms were recorded in 28.5% of 3 Para and 20-30% of 2 Scots Guards 6. Non-freezing and freezing cold injury not only reduces fighting capability but also occurs sporadically in the United Kingdom and in North West Europe amongst soldiers either on exercises or as a result of sleeping rough whilst intoxicated. Any blood constituent which would impair flow at reduced temperature is likely to predispose to damage in a cold environment. Cryproteins are known to do so 7. The digital necrosis seen in patients with cryoglobulinaemia is clinically indistinguishable from that produced by freezing and this appearance raised the possibility that there might be a group of otherwise asymptomatic individuals who had small quantities of cryoglobulins circulating in their blood which might predispose them to developing cold injury. The further possibility that there could be a number of Servicemen who were polycythaemic and hyperviscid due to the effects of chronic alcohol ingestion could explain why some but not all personnel who served in the Falklands campaign sustained cold injury whilst others subjected to similar conditions did not do so. This study examines these possibilities by comparing venous blood obtained from British Servicemen who had clinical cold injury during the campaign with a similar group who experienced the same environmental conditions but did not do so and a further group who did not participate. 63

Subjects and Methods Six groups of soldiers, three from 3rd Battalion, The Parachute Regiment and three from 2nd Battalion, Scots Guards were studied. The first two groups (A) consisted of men from these battalions who were diagnosed as having sustained cold injury in the Falklands. Confirmation of this diagnosis has been substantiated in most cases by objective measurement of impaired nerve conduction and by abnormal vasomotor response to a cold stimulus observed by strain-gauge plethysmography8,9. The second two groups (B) consisted of men of similar age who had gone to the Falklands but who did not sustain injury despite being subjected to an identical environment. Selection of these subjects was made by the subunit commanders who had led them during the war. The third group (C) consisted of a similar number of soldiers who did not go to the Falklands and who had not previously suffered the effects of cold elsewhere in the world. All personnel gave informed written consent for venipuncture, which was performed two to three hours after a midday meal. Consent forms were numbered serially and allocated randomly. Thus the sampling and analysis was performed blind and the groupings constructed after the results were obtained from the lists provided by the units. Samples of 20ml venous blood were withdrawn from the antecubital fossa using a venous tourniquet into syringes and needles warmed to 37ºC. 10ml of this blood was immediately transferred to EDTA lined bottles previously warmed to 37ºC and replaced in a warmer at the same temperature. The warmed specimens were centrifuged at 37ºC for 10 minutes at 1000 rpm followed by 15 minutes at 200 rpm. Thereafter, the supernatant plasma was collected into plain bottles at room temperature and transferred for cryoglobulin, total protein, albumin, IgC, IgA, IgM, complement C3 and C4 estimation. These plasma samples were divided into three aliquots, one placed at 4ºC, one at 37ºC and the third retained at room temperature. Regular inspection was carried out for 72 hours but no cryoproteins were observed. Immunoglobulin (IgG, IgA, IgM, C3 and C4) levels were estimated by immuno-nephalometry on a Disc 120 laser nephalometer (Hyland Laboratories, USA) using goat antisera to IgG, C3 & C4 (Atlantic Antibodies, USA), IgA, IgM, (ICL, Scientific, USA). Total protein and albumin levels were obtained by standard laboratory techniques. The other specimens were analysed by routine methods on a Coulter S Senior, (Coulter Electronics, Linton, Beds.) for haemoglobin, packed cell volume, red cell count and MCV. Plasma viscosity was determined on a Harkness Coulter Viscometer9 and gamma glutamyl transpeptidase levels were estimated by an automated method using the technique of Szasz10 on a Coulter Kem-o-mat autoanalyser. Reference ranges were: total protein, (55-79g/1), albumin, (30-42g/1), IgG, (5.4-16.1g/1), IgA, (0.9-3.4g/1), IgM (0.52g/1), C3, (0.7-1.7g/1), C4, (0.1-0.7g/1), plasma viscosity (1.51.72cp) and GGT (6-28iu/1). Quantitative data were compared between groups using an unpaired test and blood group data were analysed using a Chi Squared test with Yates correction where applicable.

Results Although the mean ages of the groups in 2 SG were higher than those in 3 PARA, no statistical differences were evident. They are shown on Table 1.

Table 1 Subjects Studied Number

Age (Yrs)

3 Para Group A

14

Group B

15

22.2

2.33*

Group C

16

20.3

2.55

Group A

16

24.4

3.10

Group B

16

23.8

4.02

Group C

16

25.8

4.74

2SG

* 1 SD

Information was obtained from the RMO’s of the two battalions6 on the distribution of blood groups as was data on those soldiers who were studied. Tables 2(a) and 2(b) show these distributions. The variation in the proportions of blood group genotypes between the two battalions reflects regional differences in the distributions of blood groups. In this small series no protection due to the carriage of blood group A was found nor were there any statistical indicators suggesting an increased tendency to suffer cold injury in holders of blood group O. Blood Groups

A

B

O

AB

Rh Pos.

178

41

183

25

Rh Neg.

30

0

51

0

208 (40.9%)

41 (8.1%)

234 (46.0%)

25 (4.9%)

Rh Pos.

165

52

263

18

Rh Neg.

17 182 (33.3%)

9 61 (11.2%)

19 282 (51.7%)

2 20 (3.64%)

3 Para

Totals 2 SG

Totals Table 2(a)

ABO and Rhesus Distribution between the Study Groups A

B

O

AB

Rh+

Rh-

Group A

8

1

4

1

10

4

Group B

6

1

8

0

13

2

Group C

7

0

8

1

12

4

Group A

5

0

9

2

15

1

Group B

4

2

10

0

16

0

Group C

5

2

9

0

14

2

3 Para

2 SG

Table 2(b) 64

JR Army Med Corps 153(S1): 63-68

Hb g/l

PCV

Red Cell Count (10–12/1)

MCV (f1)

3 Para Group A (n=14) Group B (n=15) Group C (n=16)

15.02±0.92 15.47±1.16 14.91±1.04

45.5±2.34 46.09±3.17 45.38±3.00

4.885±0.357 49.89±0.357 4.912±0.351

89.14±3.11 88.50±3.34 88.56±2.52

S Scots Guards Group A (n=16) Group B (n=16) Group C (n=16)

16.10±0.88 15.50±0.71 16.18±1.02

47.54±2.72 45.83±0.47 47.774±3.02

5.033±0.241 4.893±0.201 4.998±0.290

92.13±4.00 91.30±2.55 93.25±4.16

Table 3 Haematolog y Results ±ISD  P