History of Contemporary Medicine in Iran
The Organization and Management of Medical Services to Injured Soldiers across the Country and in the Battlefields during the Iran-Iraq War
Ahmad Ali Noorbala MD •1
Author’s affiliation: 1Professor of Psychiatry, Tehran University of Medical Science, Roozbeh Hospital, Tehran, Iran.
•Corresponding author and reprints: Ahmad Ali Noorbala MD, Roozbeh Hospital, Tehran University of Medical Science, South Kargar Ave., Tehran, Iran. Fax: +98-216-693-0330, E-mail: Noorbala1@gmail.com
Accepted for Publication: 14 April 2010
The majority of Iranian combatants during the eight year Iran-Iraq war were untrained volunteers, known as Baseejis, from all walks of life with no military experience or training, and without adequate logistical support. Thus, there were an obviously large number of casualties among this group of combatants earlier in the war. Under these circumstances and in order to reduce the unnecessary physical and psychological trauma caused by the war, it was decided to organize a medical and surgical service for these war casualties which differed from classical warfare management in the following ways:
· It was decided that all volunteer combatants should attend a first aid course together with preliminary combat instruction prior to being dispatched to the front line so that they were able to knowledgeably provide proper basic wound care to their fellow combatants and to themselves.
· Within each of the smallest combat units or platoons, at least one or two trained medical helpers (relief workers) were assigned to transfer the wounded, at the first opportunity, from the front lines to safe first aid centers.
· It was the responsibility of the medical unit or First Aid Center of each battalion to establish well equipped primary care facilities in the front lines, such that the wounded could be stabilized by the administration of intravenous infusions, preliminary wound care and bandaging, stabilization of fractured limbs, as well as the dispensation of antibiotics and analgesics.
· It was the responsibility of the medical unit (Field Emergency Center) of each brigade or combat division to set up well equipped emergency field units (in close proximity to the front lines) such that they were able to give primary treatment, such as blood transfusions or the insertion of chest tubes to the transferred casualties and triage the wounded to an area behind the front lines for greater safety.
· Within each battlefront, a well equipped “field hospital” was established so those with serious wounds could be given primary and emergency surgical treatments instead of being transported to a city hospital. The equipments and emergency surgical staff of some of these field hospitals were comparable to the best hospitals within major cities. Many complicated and life saving surgical operations were undertaken within these field hospitals by some of the most experienced university professors of the country, which saved the lives of thousands of seriously injured combatants.
· Within the towns behind each battle front, in addition to the hospitals which were on alert to receive the casualties, a large convalescent building (Physical and Psychological Wounded Convalescent Center) was set up in order that the wounded who were no longer in need of emergency care were conveyed temporarily for rest and other necessary treatments, before transfer to hospitals within towns more distant from the front lines. Once they made a complete recovery, they were re-dispatched to the front lines, if deemed necessary.
· Airport Transfer Centers and Railroad Transfer Centers were organized at each airport and train station within the towns behind the front lines such that the relatively stable casualties could be transferred safely, accompanied by trained medical and nursing personnel, to other towns and cities (Diagram 1).
Diagram 1. Diagram of the organization of medical services for war wounded
· In order to organize the dispatch of specialized personnel to various fronts, special emergency medical teams were gathered in the capital and other large cities to coordinate with university medical schools, the Ministry of Health, the Red Crescent Society, and the armed forces, so as to the identify, gather and provide each battlefield with its required needs.
· The management for the formation and organization of emergency medical teams were under the auspices of a unit, known as the Headquarters for Relief and Treatment of War Casualties, which included the Central Headquarters of Relief and Treatment of War Casualties, the South Warfare Zone Headquarters, West Warfare Zone Headquarters, Kordestan Warfare Zone Headquarters and the Supportive Headquarters of the Warfare Zone. Each center had its own defined responsibilities (Diagram 2).
Diagram 2. Diagram of volunteer medical service providers to the war wounded
· An organization known as the Center for Coordination and Follow-up of War Casualties was established within the Ministry of Health in order to facilitate contact and visits by the relatives of war casualties. This organization played an advocacy role for the wounded and was responsible for expedition of the physical and psychological recovery of the war casualties.