Information from Annual reports

• The promise of the gift of the MSU from the Austin Motor Company was made in 1941

• The MSU was presented in 1947. The Birmingham Hospitals Contributory Association undertook to maintain and garage it.

• In 1947, after war time restrictions on staff numbers were lifted, it was possible to provide a team for the MSU consisting of senior surgeon, surgical assistant, anaesthetist and nurse.

• The 1947 report includes a commentary from William Gissane about early experience with the MSU that he said fulfilled all expectations. Some of his other comments are difficult to reconcile with the log book records! Perhaps he wanted to ‘talk up’ the MSU. 7 patients were attended in the last four months of 1947. Text attributed to Gissane is in quotes followed by log book data 

• ‘the accidents to which it has been called are all serious’ – only two were serious and immediately life threatening without the intervention of the MSU team. One of these patients with a severe flail segment died at the scene despite efforts to stabilise the flail with wires.
• ‘in almost every case resuscitation methods were essential’ – only two patients were transfused and one of those with multiple fractures was retrieved from the hospital to which he had been admitted.
• ‘the staff are now sufficient to permit absence of a team … for example on one occasion the unit was absent for six hours on a lifesaving emergency’ – this was a patient with 15% burns who was retrieved by the MSU. In most cases, the log book records time of accident and time MSU attended and this explains the six hour claim. Sometimes, attending staff did record the time the MSU was called and / or arrived but this did not happen until 1948.

Information from the log books

Some interpretation has been necessary because the log books have suffered water damage, the handwriting is often difficult or impossible to read, information is often incomplete and there are inconsistencies in recording e.g. two patients recorded separately were attended on the same call out but at other times a single log book page is used for more than one patient. The figures below are for the number of patients attended rather than call-outs.

Patients

The first patient was attended on 11 09 1947. 

The last patient was attended on 09 12 1954.

	1947	1948	1949	1950	1951	1952	1953	1954	Total
Total patients	7	31	27	23	15	16	9	8	136
Dead before MSU arrived	0	7	3	2	2	2	4	0	20
Patients treated	7	24	24	21	13	14	5	8	116
Died at scene	1	2	1	1		1		1	7
Died later		1	1	3			1		4

The tables below include all patients, even those who were dead when the MSU arrived, for whom any information was available. Very few records were complete which explains the varying totals.

Injury classification

	1947	1948	1949	1950	1951	1952	1953	1954	Total
Industrial	4	13	13	11	6	5	5	4	61
Rail	1	3	1	1					6
Road	1	7	4	4	3	5	3	4	31
Domestic	1	7	6	6	3	4	1		28
Other		1*			2**				3
Unknown			1	1		2			4
Transfer from another hospital		6T4 / B2	6T1 / B5	7T1/B5/?1	4T1***/B3	7T5/B2	2T2	2T2

Rabbit shooting*
Air crash**
Surgery performed at referring hospital by MSU team***

Treatments given

	1947	1948	1949	1950	1951	1952	1953	1954	Total
GA	2	2					1		5
Analgesia	6	9	4	10		7	4	5	45
Plasma and blood	2	1		1	5				9
Saline and blood				2					2
Saline							1		1
Plasma			2	5	2				9
Blood		7	4	5	5		4	4	29
Coramine**	1		1						2
Other*
Total	11	19	11	23	12	7	10	9	100

Many patients had splints applied or dressings. Although probably good for pain relief or infection control it is hard to see why a vehicle as sophisticated as the MSU was need for such simple treatment*

Indeed, in retrospect it is clear that most serious injuries involved extractions from machinery or vehicles and surgery was performed in the field. A flying squad might have been a better use of limited resources. This said, the MSU provided a safe environment for the transfer of severely injured and burned patients for other hospitals to the Acci.

Coramine is the trade name for nikethamide which is a respiratory stimulant**

Patients for whom I think the MSU made a difference

1. A man whose arm was crushed in industrial rollers required a GA and guillotine amputation to free him
2. A man whose chest was crushed in an industrial accident was moribund, but attempts were made to treat the flail segment, Coramine and analgesia were given
3. Although probably regarded as an inappropriate use of resources, the MSU attended a woman and gave her a lot of blood to treat haemorrhage following a ? spontaneous abortion. Without their intervention she might well have bled out before reaching hospital
4. Following an unspecified industrial accident, the MSU gave blood and analgesia to a man with open wounds to chest and abdomen that led to intestines falling out
5. The MSU attended a man with multiple fractures following an MVA whose BP was unrecordable. He was given blood and his fractures were splinted
6. At Tamworth Hospital, the MSU team operated on a man with a ruptured spleen and stomach. (It is notable that the MSU was called multiple times to Tamworth Hospital and once to Evesham Hospital to retrieve burns and trauma patients)
7. A man’s leg was caught in a domestic cultivator. He needed a GA and surgery to cut skin before he could be freed

With the exception of patient 2, all survived at least to be admitted to hospital.

Gender and age distributions

Age yrs	0 – 10	11 – 20	21 – 30	31 – 40	41 – 50	51 – 60	61 +	Unknown	Total
Female	6*	0	1	2	3	4	7**	1	25
Male	8***	11	21	19	18	9	5****		91
Unknown	1*****							6	7

• Almost all the girls suffered scalds of burns following clothes catching alight. There one exception – a 3 day old whose diagnosis was simply asphyxia. She died at the Children’s Hospital later in the day*
• Most elderly women suffered falls either at home or after being hit by a vehicle**
• Most young boys suffered burns but there were falls and in one case an accident on a railway line***
• Elderly males suffered a mixture of industrial and domestic injuries including a 72 year old who suffered an industrial accident****
• The saddest case was of a moribund 11 day old baby whose diagnosis was ‘burns to entire body. Perhaps the severity of the burn made it impossible to determine the baby’s gender******
• Almost all the injuries in males aged between 21 and 60 were industrial

Additional information:

• In 1953, the unit was abandoned, it was often found that severity of injury exaggerated, or patient removed and on way to hospital by faster less cumbersome vehicles
• Although a brilliant idea it was a premature idea as it required a back-up organisation with the local ambulance and police services, which were not at that time available

• Between Nov 1947 and Oct 1950, the MSU was called out 95 times. 63 of these were injured patients, and the rest for burns who were usually collected from cottage hospitals in the region.

• Of the 63 Trauma calls received, 34 were to factories (traumatic amputations were common)
• It was also not unusual for asphyxia to be recorded as the cause of death. Factory workers were trapped either in or under heavy machinery. Railway injuries accounted for 10% of the trauma cases. It is not entirely clear whether these unfortunate individuals intended to get run over by a train but if they were run over their chances of survival were poor. Only 14 cases RTAs.
• There was also an episode of shooting, the patient was a 17 year old and had been shot in the leg.

Example cases:

• The first genuine call was to a factory worker whose arm was trapped in a machine.

The patient was anaesthetised, and the arm amputated.  The patient was kept asleep and taken to the Acci and to the operating theatre.  Surgeon – Stuart Harrison

• A young man hit by a train with severe chest injuries (Stuart Harrison) 
• A double amputee a man stepped between the train and the platform (Ruscoe Clark case)
• A girl who suffered bilateral traumatic through thigh amputations, was given 8 pints blood transfused before adequate surgery, the patient recovered.

Description of the vehicle interior 

• The vehicle was divided into two main sections:
• A large section housing a central operating table, and, on either side, there were attachments to take two stretchers.  The unit could take up to 3 stretcher cases.  When not in use the side stretchers were maintained in lockers either side of the main compartment.
• The forward cabin hosing two cupboards and a writing desk.  Under the seat was a box containing plaster bandages plastic instruments, clips and slings for Thomas splints, wire cutters Elastoplast, strapping felt and cord.  
• Under the seat there as another box containing unsterile dressings i.e. wool, bandages, slings and a box containing tulle gras
• A third box kept under the same seat was designated to hold glucose, saline and plasma, four bottles in all leaving space for other impediments as required
• In the left-hand cupboard were 4 Thomas splints – two size 21 and two size 27
• In the right hand side cupboard were pegs for holding rubber aprons and on the floor an ice box.  The collection and return of blood from the Path Lab refrigeration was the duty of one person in the team.  A separate from was created to ensure patient safety and safe prescribing
• On the writing desk was kept the log book.  This was completed by the surgeon and the tear off portion accompanied the patient with is resuscitation card
• Under the writing desk was a small cupboard containing:
  • A Bownanometer 
  • Tourniquets
  • Higginson Syringe 
• In the main compartment in the central table the patients head should be at the drivers end.  There were arm rests, shoulder rests and overhead hooks to carry the infusion bottle and a sling for Thomas splints
• On the left hand side looking forwards thee were switches on the wall.  One for the fan which was built into the door between the two compartments, one for the water boiler which was adjacent and worked on the same principle as an immersion heater.  Another switch for the steriliser and finally a switch for the air conditioning.  One person had responsibility for the boiler and steriliser 
• The boiler emptied into a wash hand basis under which was a small cupboard containing the anaesthetic stand and a jug to fill the steriliser
• On the right hand side there were three cupboards.  The top one could be locked and was for the drug cupboard.  This locked cupboard contained a lockable internal cupboard for dangerous drugs.  The remaining compartment was in a rack to hold three small local anaesthetic solution bottles, three Winchesters and an infusion bottle with sterile water
• Before this cupboard in the steriliser there was a drum cupboard
• There were four drums which contained:
  • One drum for dressings
  • One drum for sheets, towels and gloves
  • One drum for cutting down and giving sets
  • One drum for instruments, tracheostomy set and Kirschner wire apparatus

• On top of the drum was a sterile tray holding two sterile kidney dishes, three syringes (2, 5 and 10ccs) with needles wrapped separately, and finally a sterile Cheatles forceps also wrapped
• A separate oxygen cylinder on a stand with a mask was available in the unit and a Novox Resuscitation apparatus in the step between the cupboards
• In the overhead lockers were found the remaining instruments i.e. amputation set, soft tissue set both in khaki cases.  This section also contained Kraner wire for splinting wrapped in felt, a urinal and bedpan
• An inventory of instruments was completed and when there were additions it was updated, framed and hung in the ambulance
• An inventory of the contents of the drums was similarly made, framed and attached to the drums

Provision of blood products on the Mobile Surgical Unit 

• Blood on the Mobile Surgical Unit was very forward thinking and the first of its kind
• Two containers were provided each to hold 4 bottles of blood.  The containers were kept in the Pathology Department
• One container was kept in the refrigerator with bottles in position and packed with ice.  The other was kept nearby
• When the unit was called the House Surgeon or responsible person was detailed to collect the container from the refrigerator and place it in the ice box which was kept in the right-hand side cupboard in the forward cabin
• At night the night superintendent detailed someone to collect ice from the refrigerator in the main kitchen and would personally supervise the placing of the ice in the space container together with four bottles of Group O blood and then place in the refrigerator in case of a call for further supplies of blood on the ambulance was called out on a second time the same night 
• When the ambulance was called out during the daytime these duties were carried out by the Sister in Charge of Casualty Theatre insofar as collection of ice was concerned.  The Pathology Department was responsible for seeing that the container was ready for immediate use.
• One of the unit orderlies was detailed on a daily basis to change the ice in the container by 09:00am each morning 
• Penicillin was kept in the refrigerator alongside the container and would accompany the latter in the ice box on each journey
• The blood and penicillin, if unused was returned to the refrigerator at the end of the journey