Inside Europe's biggest military critical care ward
A look at work inside the new critical care ward at the £545m Queen Elizabeth Hospital in Birmingham, where injured troops evacuated from Afghanistan are being treated.
At the hospital, 23-year old Pte Andrew Garthwaite is greeted warmly by a man he doesn't remember.
It is the trauma surgeon who operated him in the crucial hours immediately after he was badly wounded in Helmand some six months ago, when a Taliban rocket-propelled grenade took off Andrew's right arm and killed one of his comrades.
Wing Cdr William van Niekerk was working at the field hospital at Camp Bastion when Andrew was brought in, and remembers him well.
Now, the surgeon is back in the UK working at the new Queen Elizabeth Hospital in Birmingham, which treats all the military casualties evacuated from Helmand. He is pleased with how well the young soldier's wounds are healing.
Andrew, who is serving with the Queen's Royal Lancers, is now undergoing rehabilitation at Headley Court in Surrey, but comes back to the hospital regularly for his injuries to be reviewed. He is hoping to be able to receive a "bionic arm", so he can continue his career in the Army.
"It's called Target Nerve Reinnervation, and what happens is they're going to pull the nerves from the stump around and into my chest area - and the nerves are going to talk to the muscles within the pec and when I think about doing stuff, my pec will move and operate the arm by using different muscles of my body, so with my thinking, the arm will move," he explains.
That stage is still some way off, but in the meantime, Andrew has nothing but praise for both the medics and his own regiment since he was wounded.
"I've been treated like you would at a five-star hotel," he says. "I just cannot believe how much the Army has done for me, and my family and girlfriend and friends. They have been so good with my treatment, and the prosthetics side of life.
"Hopefully, I'll return to work, but I might have to change the sort of job I do because obviously holding the weapon is going to be quite hard - but with this new arm I might be able to. You never know."
In a ward nearby, the civilian and military medics are preparing to receive a new military patient, who is being brought in on the latest medical evacuation flight from Helmand.
The team here have conference calls several times a day with their colleagues in Afghanistan, to ensure that both sides are prepared for the day ahead and know all they can about the patients about to be moved.
Those working on the military-managed ward and in critical care say that much has been learned over the past years in terms of ensuring seamless care from the point of injury to discharging military patients for rehabilitation at Headley Court.
Gp Capt Ian Sargeant is a consultant orthopaedic surgeon from the RAF who has worked at Selly Oak, and now the Queen Elizabeth Hospital, for several years.
He says that the high standard of care on the front-line is key to patient survival for the hundreds of military patients from Iraq and Afghanistan who often have complex injuries from bombs.
"There are many guys who would not be alive were it not for that care in Helmand," he says. "Here, we're looking at teamwork between many different surgical specialities. We have microbiologists who are meticulous about treating infections, and our nurse specialists manage these extraordinary wounds.
"We've also learned the importance of trying to integrate treatment of the injured limb with rehabilitation. So it wouldn't necessarily be that the limb is fixed or put in plaster to immobilise it. Instead, we do our best to get these limbs moving, while balancing the need to treat one wound against the other."
The NHS hospital treats 520,000 patients each year, military and civilian. According to figures from the MoD Defence Analytical Services and Advice (DASA) website, the medical staff here have treated 218 very seriously injured and 222 seriously injured service personnel from Afghanistan between 2006 and October 2010.
Of those military patients, 105 were given surgical amputations as a result of injuries sustained in Afghanistan. Figures from the British Limbless Ex-Servicemen's Association, suggest that of those patients, 12 are triple amputees, while 48 have lost both legs - often arriving at the hospital with a level of injuries which few would have been expected to survive only a few years ago.
The new military-managed ward at Queen Elizabeth Hospital where most are treated is a designated trauma and orthopaedics ward, where military patients are now cared for in single rooms or four-bed rooms, just as other NHS patients are in the new hospital.
However, it also has a common room and a quiet room where wounded military patients can be with their families or talk to welfare staff. A new physiotherapy area for military patients is also nearby.
For most, the initial period will be spent in the new critical care ward, Europe's biggest on a single site. Each bed bristles with hi-tech equipment, and the entire space is a lighter, more modern environment than the old Selly Oak equivalent.
The staff here care for military and civilian patients alike, with beds screened off by curtains, and ward sister Lisa Kennedy, one of the civilian staff, says there are no tensions between the needs of each, nor between the medical staff themselves, although there can be differences in recovery rates.
"The good thing that a military patient has going for them is their age," she says.
"They're usually young, fit healthy men who are used to running miles and miles, so they're used to repairing themselves better. Though it is a bit of a double-edged sword. They get better quicker, but they can also get sicker more quickly. But the recovery rates within the unit are very good."
Her military colleague, Leading Naval Nurse Su Jeffreys, agrees. "We all do the same job here, and we all do the same work side by side. The military and civilian patients don't get different care, but their injuries and their recovery time can be different."
She has also worked at the field hospital in Camp Bastion for several months. "When I came back from Afghanistan, I said that Birmingham was like Bastion but without the weather.
"The patients are in Bastion for a much shorter time. They come in, they're stabilised, and then they're sent back here, but it is a continuation of the same care."
Su admits that even for nursing staff used to dealing with trauma injuries, it can be difficult to witness the kind of wounds suffered by Britain's young service personnel.
"When you see someone badly injured who's just 18 years old, it can affect you. But I'd expect it to affect anyone, seeing someone who is injured, sometimes in pain, sometimes frightened and awake. We just have to give them the best care that we can."