Maj Gen Sanjeewa Munasinghe, RWP RSP USP … being a Presentation at the Defence Seminar entitled “Defeating Terrorism,” held at the Galadari Hotel in Colombo between 31st May 2011 to 2nd June 2011 …. with a NOTE by Michael Roberts clarifying the context at the end of the Speech
A medical Division in taking care of the injured and meeting their medical needs, boosts the morale and confidence of the troops. The Sri Lanka Army Medical Corps is a relatively small Division and by 2006 there were only 118 officers and 3200 men of which only a small proportion could be employed in the field. In order to address this problem, a group of infantrymen from each regiment were trained as nursing assistants in the combat life support training course. This extended to all special force personnel, commandos and young medical officers. In addition, all medical officers, nurses and paramedics of the corps were given ample training in handling and managing victims of chemical exposure. At the start of the operation, all male nurses, nursing assistants and medical officers in static Military Hospitals were mobilised to operational and non-operational areas in the field. The Ministry of Health provided civil medical officers, nurses and additional surgical teams to assist in the operation and strengthen army base hospitals.
Treating civilian casualties –– http://www.defence.lk/picturegallery/picc.asp?tfile=20090121&cat=DUTY
The areas of responsibility of the Medical Corps were divided among four medical battalions namely the Jaffna theatre, Vanni theatre, Eastern theatre, that is also the volunteer theatre, and the first battalion, which was responsible for the rest of the country and the Colombo theatre. The Medical Corp had four Army base hospitals and four field hospitals located strategically in each of the four battalions. Additionally, it had Army wards in six civilian hospitals and established nursing aid posts to coordinate the casualty management process.
In light of the nature of the operation, the Medical Corps had to provide an ADS, MDS based MEDEVAC system. Regimental nursing assistants were deployed at platoon and company level and were capable of applying proper dressing, giving intravenous fluid and analgesics, and carrying out splinting of fractured limbs. The casualties were then sent to Battalion Headquarters where a team of medics took over the task. Thereafter, they were transferred to Advanced Dressing Stations located at the Brigade Headquarters level. The responsibilities of the medical team at this point consisted of maintaining airway, breathing and circulation, continuation of antibiotics and IV fluids, giving tetanus toxoid, blood transfusion if required, stabilisation of fractured bones, performing life-saving minor surgical procedures and stabilisation of patients for transfer to MDS or Main Dressing Stations. The transfer of casualties was done by ambulances, trucks and sometimes APCs. MDS was located at divisional headquarters and the senior medical officer together with the medical staff were well-equipped to perform all life-saving surgical procedures and handle any type of medical or surgical emergencies as well as their complications.
There was a good communication system in each dressing station, which helped to not only convey relevant information to higher headquarters but also to obtain relevant expert opinions from Colombo in difficult situations. Evacuation of casualties from MDS to local hospitals or Army base hospitals was done by helicopters.
All major surgical procedures were performed at the ABA or local hospitals in the region. In a situation of mass casualties, a damage control procedure was adopted and patients were transferred to Military Hospitals and civilian hospitals outside the battle zone, mainly in Colombo. Patients who needed prolonged hospitalisation were finally transferred to the Military Hospital in Colombo.
The types of injuries encountered during the operation were as follows:
The largest number of casualties was received from the Vanni theatre with a fairly small percentage from the Eastern theatre. The majority of injuries sustained by the soldiers were due to blasts accounting for 59.6 percent and gunshot injuries accounting almost 40 percent and there was a small percentage of patients exposed to toxic gases. Majority of the blast injuries were due to mortar and artillery blasts. The balance includes anti-personnel mines, other IEDs and RPG blasts. In both the blasts and gunshot injury groups, majority were limb injuries, which were more among the blast injury victims.
Head, chest and abdominal and chest injuries were more among the gunshot injury victims. In addition, there were several spinal injuries as a result of blasts. Some of the blast victims had associated eye and/or ear injuries, and some had burns of varying degrees. Injuries varied from minor superficial soft tissue injuries to extensive, devastating injuries resulting in the loss of an organ or organs. Among the injured, 25 percent were severe injuries and 29 percent were moderately severe injuries.
Near drowning, an unexpected type of casualty, was encountered at one stage of the operation, when the LTTE blasted the Kalmadukulam Tank bund. However, medics were able to manage the casualties without any fatalities.
Two outbreaks of disabling infection, Chikungunya and Hepatitis A, threatened the troops during this operation.
It is important to note that there were no differences or discrimination in treating civilian and military casualties.
Immediate complications were mainly due to drug allergies but they were of mild to moderate degrees. A majority of intermediate complications were due to infections and were not serious. A small group of patients who had anti-personnel mine injuries developed acute Encephalopathy Syndrome, and another small group of patients who had extensive muscle injuries developed acute renal failure. However, after taking necessary precautions and changing management protocol, the medical team was able to successfully treat these complications. There was also a significant percentage of Post Traumatic Stress Disorders. The mental health department of the Military Hospital in Colombo undertook these cases.
Rehabilitation of those with varying degrees of physical disabilities was done at the Army Rehabilitation Centre known as the Ranaviru Sevana Rehabilitation Centre. The Army has commenced building a wellness resort to accommodate permanently disabled and totally dependent war heroes with the intention of looking after them throughout their lives.
In addition, there are currently three ongoing researches in Post-Traumatic Stress Disorders, Encephalopathy Syndrome and Post Traumatic Epilepsy. A project in collaboration with the bio-medical engineering group at University of Peradeniya in manufacturing custom made prosthesis is also currently underway.
As with any division, the Medical Corps too encountered a number of challenges in the execution of services. Inadequate manpower was the main challenge that faced the Medical Corps in this major multi fronted operation. However, proper planning, training and effective mobilisation of available people was the key to success. Controlling an outbreak of infectious diseases during this type of a military operation was a real challenge. The restriction of movement of the medical experts brought to control the epidemic, inability to follow necessary precautions to control the epidemic due to intense combat situations and floods owing to torrential rains were the primary setbacks to the casualty evacuation system.
Finally, it is essential to understand the vital lessons learned in the context of medical support in the Humanitarian Operation. The importance of having medically qualified men at the front line, who initiated treatment within few minutes of injury, was highlighted throughout the operation.The presence of capable medical officers and paramedics in the field helped to minimise mortalities and save many limbs in such a high intensity battle. This was enhanced by the presence of an effective, practical and sustainable MEDEVAC system.
Additionally, frequent visits of the Direct Army Medical Services and staff to the field, who joined the medics at ADS and MDS to treat casualties was an encouragement not only to the medics but also to the Field Commanders and the combatant. Proper planning, training, effective mobilisation of available resources, dedication and commitment of all those involved resulted in the rescue of many lives and limbs in this multi fronted operation.
Tamilnet Pics– see Roberts, TPS Pictorial for details
A NOTE by Michael Roberts
In addressing the topic of the death toll during the last stages of Eelam War IV an issue developed about the category “Wounded in Action” or WIA in my email conversations with Retd Brigadier Hiran Halangode: was their uniformity in the ways in which data was recorded on this point across different armies in the world. The suggestion was that slight injuries such as a bullet graze that did not incapacitate a soldier was not recorded in SL Army data on WIA.
Be that as it may, one beneficial result of this discussion was the copy of Major General Munasinghe’s tale of the SL Army Medical Corps delivered at the major conference entitled “Defeationg Terrorism” in 2011. While I do not have photographs that directly supplement this account, let me emphasize my admiration and admiration for the manner in which Tamil medical servants and those medics trained by the LTTE performed their humanitarian duties during the harrowing months in the last months of the war within the ever-receding Vanni Pocket and then in the “Last Redoubt” in March, April and May 2009.
Some sense of the organizational genius of the Tamil people –aided as they were by the government in Colombo – in preparing for the emergency from late 2008 and then in sustaining their medical work in daunting circumstances (designed, I stress, by the LTTE) can be derived from Dr. Veerakanthipillai Shanmugarajah’s detailed accounts available both on web and, as affidavits, in Engage Sri Lanka, Corrupted journalism. Channel 4 and Sri Lanka, (London 2013, ISBN 978-0-9926845-4-9). Some sense of this capacity can also be gleaned by some of the photographs presented by TamilNet during the height of the war –images I studied carefully and some of which I chose for inclusion in Tamil Person and State. Pictorial (Colombo, Vijitha Yapa Publications, 2014 … ISBN 978-955-665-231-4). These working personnel were not just doctors, but medical aides trained by the LTTE. See the two Pics above. )No greater accolade for LTTE efficiency can be provided than the manner in which these services had been set up over the years. A testimony in this regard was provided by Dr. Susiri Weerasekera who spent some time in the Tiger rehabilitation camps in 2010 in the course of artificial limb services. He was firmly of the view that the female medics he met were capable of being doctors. Bureaucratic rigidity, however, does not permit such transitions. Alas.
Alas Susiri has been laid low and I cannot call on him to elaborate. C’est la vie. But let this little note be my Valedictory for Drs. Weerasekera and Shanmugarajah.
More Images from MoD web site – segment entitled “In the Line of Duty”
SL naval personnel at Pulmoddai Beach with those Tamil civilians who either fled by sea or were evacuees brought by the ICRC-SLN combination
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