• major trauma management
• military
• prehospital care
• prehospital care, clinical management
• research, clinical

The Authors' reply,

In southern Afghanistan the insurgent used powerful improvised explosive devices against dismounted (and mounted) troops. The awful signature injury of that conflict was the triple amputee, often with injuries to every internal organ from blast injury. In any previous conflict they would have died. Our trauma service evolved rapidly and recorded numerous unexpected survivors, in the statistical sense of the term. Every link in the chain had to work to enable a patient to survive from point of injury through to discharge. It behoves us to try …