Some reflections on war for countries at peace: Would we know what to do?

In the west we have enjoyed peace for decades, but war is globally always present. Recent events have brought this into clear evidence. Once mass casualties occur, war enters civilian hospitals. As civilian Surgeons, used to our sophisticated elective work, would we know how to step up to the mark if required? Ballistic and blast wounds pose problems that need reflection before treatment starts. Delivery of early and complete debridement to high numbers of casualties, stabilising bone and closing the wounds becomes the role of the Ortho-plastic team. This article presents reflections from the senior author after ten years of working in zones of conflict. Import factors witnessed are how civilian surgeons are soon involved in unfamiliar work and must learn and adapt fast. Critical issues that arise are pressure of time, contamination, infection, and the need to never forget the importance of antibiotic stewardship even when under pressure. The advantage of supporting the Multidisciplinary team (MDT) approach, even as resources reduce, large numbers of casualties present, and staff are all under pressure, can bring order and efficiency to the chaos: It supplies best care to the victims within that current context and reduces unnecessary duplication of surgery and waste of manpower. The surgical management of ballistic and blast injuries could be added to the curriculum of young, civilian surgical trainees. This is preferable to having to acquire these skills during war with stress and minimal supervision. This would enhance the preparedness of counties at peace for disaster and conflict should the need arise. Well trained manpower could also support neighbouring countries who find themselves at war.