Trauma medicine
From conflict zones to civilian care
Dr. Rachel Hawes OBE recently spoke at The Royal Society of Medicine on trauma, teamwork and saving lives. She shared her experiences with the AfPP.
When Dr. Rachel Hawes OBE speaks about trauma care, her perspective is forged not only in operating theatres and emergency departments, but in some of the most demanding environments imaginable. A Consultant in Anaesthesia and Prehospital Emergency Medicine at the Royal Victoria Infirmary (RVI), and a senior doctor with the Great North Air Ambulance Service (GNAAS), Dr. Hawes has spent her career at the intersection of civilian trauma care, military medicine and prehospital innovation.
Finding her path into trauma medicine Dr. Hawes’ route into trauma and prehospital care began while she was still a medical student, when she was introduced to what was then known as the Territorial Army, now the Army Reserves. “I was told about the TA at medical school and it immediately appealed,” she said. “I liked outdoor activities, and you were paid - which meant I could ditch the bar job I was doing alongside university.” Joining the Army Reserves opened doors to opportunities she would not otherwise have had so early in her career: “It gave me access to a huge number of training courses and exercises that simply weren’t available elsewhere,” she explained. “That exposure allowed me to focus strongly on trauma, emergency medicine and prehospital care.” Crucially, it also gave her the framework to
begin translating military systems into civilian healthcare settings: “I could take what I was learning and use it to introduce new systems and processes into civilian care,” she said. “That included auditing the major haemorrhage protocol and looking at how we could standardise and improve resuscitation for all patients.” This early blending of military and NHS practice laid the foundations for the innovations that would later define her career.
Lessons learned under fire Dr. Hawes’ has balanced her role as an Army Reservist alongside her NHS career, since joining as a medical student. “The most defining moment in my career was
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Dr. Rachel Hawes OBE
when I was a registrar deployed to Afghanistan,” she commented. “There was a major incident following an IED explosion, with multiple critically injured casualties.” Stationed at Camp Bastion, she was faced with a quadruple amputee - the most severely injured patient of the day, and something she had never managed before: “It was a huge test,” she said. “But part way through, I realised that if I stuck to what I’d learned, I could deal with it. That moment – recognising your own capability under pressure - stays with you.” Although the injured service person was later flown home to family and sadly died, Dr. Hawes describes the learning from such incidents as profound. “You only gain that depth of understanding by working in these environments. What’s crucial is learning from every incident, simplifying systems and communication, and not reinventing the wheel when not necessary. Sharing good practice saves lives.”
Translating military medicine into civilian care Those lessons have had a direct and lasting impact on UK trauma care. During her deployment, Dr. Hawes observed military helicopters delivering blood transfusions directly
to patients at the scene of injury: “I recognised immediately that this could - and should - be done in civilian prehospital care.” That insight led her to head up the ‘Blood
on Board’ initiative in the North East and Cumbria, in partnership with GNAAS and the charities Northumbria and Cumbria Blood Bikes. Launched in January 2015, the service enables blood to be delivered to air ambulance crews 365 days a year, allowing transfusions to begin at the roadside, on a hilltop or in remote communities - rather than waiting until arrival at an emergency department. Since its launch, Blood on Board has treated
over 800 patients, and it is estimated that at least 200 lives have been saved that would otherwise not have been. “We’re incredibly proud of how the service
has evolved,” Dr. Hawes said. “Replacing major blood loss as quickly as possible is vital, and this initiative means life-saving treatment can begin immediately.” The programme has continued to develop,
with red blood cells and plasma now carried day and night, and systems in place to scale up rapidly during major incidents. Research into whole blood transfusion is ongoing, with Dr. Hawes leading feasibility and comparative
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