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One hundred years on: Ypres and ATLS
  1. Rachael SV Parker1,
  2. Paul J Parker2
  1. 1 Emergency Department, Royal Preston Hospital, Preston, UK
  2. 2 Trauma & Orthopaedic Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Dr Paul J Parker, Department of Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2GW, UK; parker_paul{at}

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“Hemorrhage, hemorrhage, hemorrhage—blood everywhere—clothes soaked in the blood, pools of blood in the stretchers, streams of blood dropping from the stretchers to the floor” Robertson OH, unpublished WWI diaries.1

In the sombre predawn darkness at 03:50 hours on the morning of 31July 1917; British, French and Belgian Forces advanced along the ridges and fields of the Gheluvelt plateau. So began the Third Battle of Ypres. Their objective was a small village called Passchendaele only 13 km away. However, it would take 3 months and over half a million casualties to get there.

Two medical officers; both called Robertson, one Canadian and one American, were part of this offensive. The Canadian was Major Lawrence Bruce Robertson, a surgeon who used uncrossmatched whole blood transfused by syringe directly from donor to recipient to demonstrate the life-saving potential of blood transfusion and the need to resuscitate the badly injured with ‘something more than saline’. He felt that any danger of this novel blood transfusion method was vastly outweighed by its benefit. He published his experiences of 36 such transfusions, performed in the 2nd Canadian Casualty Clearing Station in the BMJ of 1916.2 Unfortunately, three of his patients suffered fatal haemolytic reactions and died. 

Sir George Makins, the Surgeon General of the British Expeditionary Force (BEF) at the time, expressed considerable concern about this use of uncrossmatched blood transfusion within the BEF. An American officer, Captain Oswald Hope Robertson (US Army Medical Officer Reserve Corps), born in Woolwich, London, and emigrated with his parents to America when he was 18 months old, was sent to assess and solve the problem. From his past experience in the transfusion laboratories of Harvard Medical School and the Rockefeller Institute, OH …

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  • Contributors RP attended the ATLS course, PP is a trauma surgeon with an interest in trauma physiology, resuscitation and prehospital care. PP and RP both cowrote the paper. PP acts as guarantor. PP affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. PJP conceived the paper, RSVP attended the ATLS course described in 2017. Both PP and RP contributed equally to the planning, writing and editing of the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. Two typos in the corresponding author’s address and in the content, and the layout, have been fixed.