Episode 25 – Emily Mayhew

Michael: My name is Michael Coates. I am a former fire fighter, but I am also a former soldier. It is the
stories from the individuals within this military community that I am desperate to document. Our next
guest is a military medical historian. Her passion for history has led her to become a trusted advisor to
the CASAVAC Club. Her knowledge and understanding of blast injury, is now changing the way
children receive treatment around the world. Episode 25, Emily Mayhew, this is Declassified.

Michael: I have in front of me London, Fashion and the 80’s. Why does that have any link to why you
are in the studio today?

Emily: It is a very good question. I have a colleague who introduces me as, “This is Emily. My
colleague. She is a historian. It’s complicated.” And it really is complicated. This is my second career.
I came to London when I was just about 18 and I went into fashion and that was Last Century. I
worked there for 20 years and then left and went to University. So, I was a late bloomer, but I was
certainly a mature student . And I consider, the 2 parts of my life, to be very linked. Because if you
worked as I did in fashion and fashion retail what you learn to do is deliver on commitment: you have
got to open the shop and sell things to customers and your staff have got what they needed. And you
have got to deliver solutions quickly and easily and practically. And then I went to university and
studied History and became very involved in how you make history useful in everyday life. So now I sit
in the Science Department that’s even more complicated – Fashion, History, Science – and I work on
trying to find the best solutions particularly for our wounded Veteran Community, really quickly and
practically.

Michael: Why did you initially study history?

Emily: I always liked history. I was never maths. I knew it wasn’t going to be something where I had to
rely on having to do numbers otherwise, I might have done engineering. I was 40. It was late to get a
career started in anything else that was going to require a technical mathematical skill. My two
favourite subjects at school were History and English. But I always really, really, liked history. The book
I most remember having on my shelf at home was R. J. Unstead Great Men and Women of British
History. When I thought back to the kind of book that I would like to write that was really it. It was a
good course. I did the Open University and I could switch periods and centuries every year that went
on so you could get a lot down you in 3 and half years. I ended up doing History of Science and that is
where it really came from. I never really thought about History having specific subjects to focus on.
That was my BA.

Michael : Did you then go onto an MA ?

Emily: I went straight onto a MSc. My final year in BA was the History of Science, Technology and
Medicine and how the history of the decisions that we make about scientific discoveries and medical
practice and research . Often historically determined and also how most of the decisions are not
thinking about the history. I did not at the time see the gap for me but actually that was what I was
doing. I did a history of science MSc. From there, you have to do a thesis right at the end and I chose
the subject I knew about it was the History I knew about because it was part of my family. I realised a
lot of people knew a little about it, but they did not know enough, and it was very important and that
was the history of The Guinea Pig Club. And The Guinea Pig Club which was a club started by
patients in the Second World War who had really been badly burned as part of being in the RAF either
because their aircraft had crashed on take-off or landing or it had exploded in mid-air on The Battle of
Britain or the strategic bombing campaign and they had really bad burn injuries that no one had
expected them to survive.

Before 1939, they would have died in burns wards or infact not even in burn wards. My grandmother
was a nurse at the hospital, and it was a story I grew up knowing. I knew it was really important. I
wasn’t quite sure how but, I knew I had to go away and do as much research as possible, to see what
was in there. so, I did my master’s thesis to start with and that went straight into a PhD.

Michael: It’s fascinating with The Guinea Pig Club. Can you get into what it was about and go through
the history of?

Episode 25 Dr Emily MayhewDeclassified Podcast

Emily: It’s a really truly fascinating story and it tends to get lumped into the category of heart-warming
tale of human endurance you get the Battle of Britain, Stiff Upper Lip in the case of The Guinea Pig
Club no upper lip was mostly the case. But there is a really important medical point to make first of all
and that was there was a change in the way we treated severely, and we didn’t really know that we had
made a lot of progress. But the way we treated people when they had shock when they had their bad
trauma when they got the primary and secondary shock which is the body reacting to this tremors
insult… usually that would kill you on its own. Physical trauma. And then the body is often reacting or
over reacting to the damage that has been done. In the case of burns injury, the body rushes water to
the area. When you get a burn you get a blister that is what happens in essence the body rushes fluid
to the area because it knows it’s been burned and if you have a really bad body injury the body rushes
fluid to the area but if it is over a large amount of the body the body becomes dehydrated really quickly
and not just dehydrated but it is going to damage your heart, your body and your brain and if you
cannot get fluids to people quickly that is going to your wounds then the patient will die and that is
what really happened to people who had burns injury before 1936 and1937 . But during that time
hospitals became a bit more like hospitals we know today they did not have A & E departments but
they had departments that dealt with people who had sudden bad injuries but what they gave you at
that point, it was saline then it wasn’t the complex of things we have now they put back the liquids
that were getting lost at the wound site.

We did not really know what a huge turning point this was until we went to war and we started to get
young men being very badly burned not so much injured but very badly burned in their bodies faces
and hands and they were brought back and they were given a saline treatment and they were given
fluids as replacement therapy and then they didn’t die. And medical progress is made by unexpected
survivors. What happens to people who we would have expected to die but don’t die because we
haven’t expected that we are going to need to provide a long course of care for them. We have
planned for the people we know are going to survive but we have not planned for the people who are
supposed to die. The Battle of Britain there were 55 patients who were burned in Spitfires or
Hurricanes some of whom had landed in the sea and in being in salt water helped their wounds
tremendously. Kept them clean. So even if they were in the ocean, well they were generally in The
English Channel, for 3 or 4 days they would come out again not dead.

Michael: 3 or 4 days ?

Emily : Yes 3 or 4 days, absolutely. There is a legendary story of a command who was In a dinghy for
3 or 4 days and he was eventually forced to eat a seagull to stay alive and he drunk the blood as
everyone knows you cant drink salt water and when he was finally rescued for the remainder of his time
in hospital if you are ever in the military never be allowed to forget it for the rest of their lives but people
survived in the water. Anyone who has seen know keeping lists who was in who was back missing, so
no one meant missing with no one noticing. The coast guard went out to look for people so they would
hopefully be found if they were still floating on the ocean. They crash landed on the runways they
survived 2 or 3 weeks later You have a young 25-year-old man who has been expensively trained to fly
one of Britain’s new fighters no provision for fingers and hands are missing and clearly their burns injury
is getting worse and not better.

What had happened was the RAF had employed a plastic surgeon. They had no idea if it was, they
thought they might like to bolt it on with other surgeons to do other general surgical work during the
war, but they had a surgeon and a hospital at East Grinstead down in Sussex, near where I grew up .
His name was Archibald McIndoe. He was a New Zealander originally. He was given this hospital and
went down to inspect it and at the end of 1939 just after war had broken out he got his first patient a
young pilot who had been injured in training, his hands very damaged his face very badly damaged but
the worst part was his eyelids were very badly damaged . He was supposed to be wearing goggles it
was warm weather he was sweating your goggles making your eyes sweat a lot of pilots took off their
goggles and their gloves and that’s where they got burned. He lost his eyelids and wasn’t able to close
them and it was quite obvious the damage that was affecting his sight and if he could not mend his
eyelids them would this young boy be burnt; he would also be blind. So, he was wheeled into the
operating theatre.


Episode 25 Dr Emily MayhewDeclassified Podcast

McIndoe is asked about this later “How did you know how to replace a set of eyelids?” as no one had
ever survived these kinds of burns before. He said, “I looked down at the patient and God came down
my right arm.” I don’t think it was a religious moment. But what I think what he meant was he had
really good strong surgical instincts. And a strong sense that if he did not try and repair these eyelids
you are looking at someone blinded and not by the original injury.

So, there are 55 needing serious burn repairs in The Battle of Britain. And then the bombing campaign
starts. Strategic bombing campaign and they know this is where most of the patients come from and
indeed they do and for the remainder of The Second World War there would be 5,000 serious burns
cases coming out of the RAF whether it is fighter command, bomber command and 700 of them are
unexpected survivors. They would have been expected to die and they would have been put in part of
the hospital where they could not infect the other patients except, they had not died. A lot of things
were coming together. They started to realise we had enough Spitfires, Hurricane’s, Lancaster’s and
Wellington’s. But what we really needed was experienced pilots it wasn’t that we just had to treat
these people and if at all possible, they could go back to flying as that is really what is necessary. You
could have all the tech you want but what you really want is experienced people using it and training
others to know how to use it.

So by 1941 there are about 20 or 30 patients in the hospital during 1941 there are a mixture of fighter
command and bomber c command and I think coastal command and they have been in the hospital a
while getting regular skin grafts on their faces having their eyelids repaired their noses their top lips
repaired having ears built for them as the surgeon realised if you are going to need ears if you wear
glasses in later life you are going to need a little nub of ear. You might think you can still hear but if you
think about wearing sun glasses or in later life having to wear glasses you are going to need a little . to
put your glasses on. He is repairing their hands. The flaps you have on your bodies, but he is repairing
the really difficult bits. Not just the bits that are functional how you breath how you speak how you
pick things up but also how you communicate emotion how you communicate to other people and how
you are received in society.

By 1941, they realised that repairing someone’s burnt face was really complicated lots more going on
than just the technical repair and the patients it is quite remarkable that the patients have a sense that
there is something new. That they are a new group and I keep coming back to this phrase of
unexpected survivors. But it is so important. They realise this and they realise they are not just the
patients to the senior medics, but they are both on a journey of discovery together. So, it is a very
equal process the surgeons come and talk to them and they do not say you will be doing this, and I will
be doing this. They say I am hoping to do this. I want to talk to you about this no one has done this
before we need to find out what is going to work the best. So the patients go to each other operations
there is a balcony built over the operating theatre. When you look at pictures from the time you see
surgeons in white scrubs and you see patients in RAF uniform who are clearly mid surgical repair and
they are both watching what is being done as no one has seen it before an you need both peoples
points of view. The patient and the medic who will do future repair.

But the patients decide that beyond that what they need is a group just for them. They want to form a
group that only they can belong to so that they can support each other in support given and received,
socially. But while they are in hospital you become a member when you come to the hospital. It is one
of the criteria of membership. They get a bottle of sherry on the ration and they all pour out a little glass
of sherry and they raise a toast to starting a club for patients. There were two criteria you had to be in
the RAF. You had to be injured in service in the RAF during The Second World War and extended to
1947 to cover everyone who were bringing planes back. Really only that war and only that service and
you had to have a burns injury and then you could be in the club. It took them a couple of months and
they worked out because they were guinea pigs for these new surgical procedures, they called
themselves The Guinea Pig Club from the RAF and from unexpected survivors of burns injury from the
RAF and The Second World War and they really changed everything.

Michael: This was the hospital your grandmother was at?

Emily: That was the connection that I had. My grandmother worked at the hospital as a nurse. She
was a little bit older than the average nurse. She had been born in the 19th Century. She had been a

Episode 25 Dr Emily MayhewDeclassified Podcast

teenager in The First World War, so she knew what war looked like. It comes back to this idea that
when you are repairing someone’s face you are not just trying to replace it functionally that you are
trying to get the best possible outcome for them when they go out tino the wider public. Early on
during the War there had been issues at the hospital where people had joined the fighting command.
They were those dashing pilots of Spitfires and Hurricanes. They got married very quickly they bought
a red sports car because they didn’t know if they would come back. And of course, they did. They
unexpectedly survived. And there were cases reasonably frequently where their fiancé or new wife
would come down and say I do not recognise this person; this is not the man I married, and you can’t
prove it is because there are no finger prints. And they would walk away. And what McIndoe realised,
the surgeon realised that there was a better way to handle this. You did not just take people in and say
here is your husband known really for not very long and he is wrapped in bandages in now. So, he
asked my grandmother who he knew to come in and take charge of that process of how the wife’s
family and later on in children would be taken in to meet the patient who was the same man inside but
looked very differently on the outside. This is absolutely fundamental now. If you go into a burn’s ward
you manage that process whereby people find acceptance amongst their family and community.

Even very simple things. Like, if you have a really bad facial injury, they are very careful on when you
first see it. If you go in a burns ward there are no reflective surfaces and when you go to bathroom
whether there is a mirror in there. Back in the day in this hospital where my grandmother was they had
to be careful even with a tea urn because if you have been woken up and been told you have a facial
injury the first thing you want to do, is see it and you are not ready at that point to see it. That process
has to be carefully managed.

My grandmother was one of the people who was brought in to manage that process. She had been
through The First World War she had lost almost all her friends. She had seen the amount in particular
the south east of England tens and thousands of men and amputations and very serious injuries and
she could handle it. The surgeon wanted someone there and could handle it. The difficult
conversation with the fiancé the wife, the mum or the child. And the young man who had been
handsome but wasn’t anymore. So that was what she did there.

Michael: Almost like counselling?

Emily: It wasn’t called counselling. Absolutely, now you get trained for it you get a structure and it has
a medical basis if you do not do this properly then the repairs do not work as well.

Michael: Physically ?

Emily: Exactly, 100%

Michael: On a cellular?

Emily: We don’t know what the process is, but I think you cannot separate the phycological and the
physiological and the physical. And if you are experiencing a great deal of stress psychologically or
physically it is going to impact the rest of the way we are as human beings. So, if you can get
someone who is able to deal with the challenge of a really serious burns injury. If they understand
everything that happens to you and can communicate to the family the process can be as productive
as possible, they are going to envisage returning to work and leading a life beyond the injury and we
probably call this now post traumatic growth. But the surgeon sensed ( there wasn’t any data) if he did
not get that part of it right his job as a surgeon would be much more difficult so he secures that really
quickly. He does it by the end of 1941, so when they start the really big bombing campaigns and you
get hundreds of people coming in, during a year, which is more than a burn surgeon will see in a life
time, they really have the best system in place.

Michael: I actually for a minute there forgot we were recording just listening to you ( laughing).

The Guinea Pig club was set up so did they think it was only going to be for that moment in time during
the war or was there a long -term vision towards it? What was the feeling with the men?


Episode 25 Dr Emily MayhewDeclassified Podcast

Emily: It was just for that moment in the War. I think it was again they were sensing this process that
you come from a service with a very strong squadron ethos. You join the RAF you were in your
squadron you were in your fighting command you felt very strong you were a member of that it was
very supportive. What they wanted to do was add to that. They wanted people to not feel alone when
they went back. I don’t think they were thinking about what would happen at the end of the war. We
did not know when it was going to be the end of the war. We did not have a sense of that until after D
Day. We talk about the ending of the troops in South Africa but really when we went over in July 1944
that was when people had a sense that the war might be at an end. But before then we could easily
have been at war for ever.

Michael : So, it was all about looking after your mates?

Emily: Exactly it was about looking after your mates. Well actually let’s form a club and we will come to
that later. But I think they sensed that a patient that was talking to other patients, making jokes about
people eating seagulls, about saying I am in a bit of pain, my mums coming today I don’t really know
how I am going to talk to her , a patient that was talking in the ward was going to do better.

Michael: And speaking to people going through the same experience

Emily: When you knew you had that injury whatever came next there was always going to be a certain
amount of explaining knowing that you had this ward you had your comrades, your mates where you
never ever had to explain what had happened to you or something very similar. So, they completely
understood, and I think being in that space where you don’t have to say the reason my hands look like
this because everyone’s hands looked like that. That is something. I was going to say it is very
valuable but its more than that. It is absolutely invaluable. They sensed that so they created the club
so they could institutionalise that in something tangible.

Michael: How many members were there ?

Emily: About 30 but by the end of 1947 when all the aircrafts came back from all the fighting places
across the globe there were 649 members.

Michael: And what then was the vision of the club? Still to be social?

Emily: It was very interesting to be social, but they also had this really strong sense that they were
held social and half medical. They were on the cutting edge that they were the people that had but by
then they knew that plastic surgeons were the best in the world. Everyone came to them to learn and
they were of equally important part of that so they wanted to make sure that they kept up to speed of
the latest developments that could relate to them as well as getting together socially. And there was a
third element that I did not really understand until recently. And that was we always tend to read
history backwards. If you look at picture in 1947 those are skin grafts on the face, we know how to do
these now. But back in 1947 they did not know if grafts stayed on forever, they had no idea there might
be a point they could fall off. That was really the first time they had them that you. They had been
doing grafts particularly of the face and hands. If you think about how often you bump your hands it
is a graft that gets bumped all the time and a face that gets washed all the time and gets exposed to
the sun is that going to be a graft . There had been an outbreak of the infections on the ward in 1944
where some grafts had fallen off. That was the very worst-case scenario are these grafts going to
survive.

Another thing there was, and it is a significance difference between now and then. They thought you
could do a few surgical operations as possible they thought anaesthetic was bad for you the
chemicals were quite strong and they did not know if you had a lot of an they did not know if it was
bad in particular putting a tube down someone throat which did the breathing for them. So, they
tended to only do one surgical operation a month possible two. And they were concerned if this was
going to have a long-term impact on people’s respiratory tracks and breathing. So, patients wanted to
get together they wanted to make sure they were up to speed either latest medical happening, or

Episode 25 Dr Emily MayhewDeclassified Podcast

doctors wanted to keep an eye on the treatment they had given them. So, they decided once a year
that they would come back to the hospital and they would have a dinner in the evening which would
just be for members in the club, but they would spend the day before with their doctor understanding
what was happening to them. It was both the patient and the doctor understanding what was
happening to them, they were not being damaged by having a lot of anaesthetics’ but their grafts did
not fall off but if you had your hands prepared you might need a little extra graft but it was repair so it
was very much repair. But again, learning if you have never had someone had their eyelids replaced no
one knows what that looks like. It is the unexpected survivor. What we learned was that eyelids
shrunk, and they had to give slightly more tissue not too much not too little just enough. And then you
had to keep an eye on it for ten years to see if there was going to be extra work required. So,
everybody was learning. They learned on the Saturday and on the evening, they went into a dinner.
That was 100% social and they would go into the dinner and the doors would close and there would
not be a single person in that room apart from occasionally people brining in food who didn’t
understand exactly what was going on. It was one night a year where they did not have to explain
themselves. One night a year you do not need to explain yourself, it is enough.

Michael: How long did this go on for ?

Emily: That went on the last formal dinner was in the early 2000 by then. It went on until 2017 there
were still some members, but they don’t really get together now as travelling is difficult when you are
elderly, and they are elderly but again no one expected anyone with severe burn injury to survive into
their 90’s. I remember going to the very last Guinea Club dinner, but I was allowed to go because I had
written a book I didn’t stay for the whole thing. And there was a point at which I was sitting at the table
and I was a tiny bit bored because everyone was talking about golf club and problems with their car
and grandchildren …… these are just normal everyday conversations . I have come a long way to hear
these. And then I thought , NO that is the real victory. I do not want them to be sitting here about flying
a spitfire. I want to hear them talking about the problem they are having with their new ford fiesta and
that they have to get a golf partner as they don’t want to walk too much. Boring and normal is the
victory. You are not going for exemplary medal winning. When I see people, who have suffered a really
severe injury I always think that is what we are aiming for. That is what the Guinea Pig Club taught me.
Live to your 90 and be boring and normal. Because that is how you really win.

Michael: Over the course of that, 70 years, did we see any noticeable advances in plastic surgery ?

Emily: Absolutely. Firstly, we saw plastic surgery really being accepted as a discipline on its own
before The Second World War it existed, but it was not really used very much on burns wards as
people tended to die. As people with not very serious wounds. Did not need a graft It was used to
treat children with congenital deformities and we also started to see cosmetic surgery. The roots of
cosmetic surgery came from cinema when people see faces really big and want their faces lifted .
There is something like what we understand of plastic surgery today but no instituiolansation they are
not special courses academic journals there are not special schools where you go and learn it. Plastic
surgery is established as a discipline in its own right. And for the next 20 to 30 years every single
plastic surgeon and entire generation is created Commonwealth after the war comes and trains at East
Grinstead and plastic surgery is established as done by plastic surgeons an entire generation of them is
created and when you see a plastic surgeon today you are never more than two generation steps
because the chances are that the surgeon you see today was trained by someone who was trained by
McIndoe and the hospital is still there and it is still one of the most significant places where you can go
and train to do burns treatment , plastic surgery and maximal today which is repairing the bones of the
face and it is there and the centre of excellence as it was established during The Second World War.

Michael: This is definitely the least I have ever spoken. (laughing)

Emily: It is so important you go back there and everything we need to know now is sitting there. I am
the historian. I am not the plastic surgeon. I speak olden days if there are questions about this ask a
historian.

Michael: This is a perfect conversation to have and with regards to the gentleman, the pilots and
navigators that were affected did they feel that there was real purpose in what they were doing?

Episode 25 Dr Emily MayhewDeclassified Podcast

Emily: They absolutely did . They went in and talked to children that came into burns units. They had a
strong relationship with the hospital I think the last of them had their operation in 1947. If you were
burned in 1941 or 1942 that was a long time being repaired, they would get their grafts and go back
into the RAF. One of the most remarkable things for me is the RAF and the count recognises that they
should not be hidden away and not in the UK and it is something we should be really proud of. People
go back mid repair they fly Spitfires, Hurricane, Lancaster’s, Halifax…. They go back and they do the
job that they were trained to do because they can. And the public and the RAF learned to read the
injury. They learned to look at someone with an RAF uniform and a burn and know exactly what that
means. And that is part of the responsibility they feel they have to communicate that. Till 1944 the
vast majority are in Britain waiting to go to Europe sitting and waiting to go. The people who are
fighting the war every day are the RAF and some of them are showing the sacrifices they have made
and they take on responsibility for plastic surgery they become ambassadors for plastic surgery not
just the lives that they are now leading the repairs can be as fulfilling as the life they would have had
but also they would speak to people suffering from burns. They act as role models. So, in the Falkland
Islands we had the most significant burns ward since the World War II, they were down in the burn’s
units., Army and Navy. Simon Weston was asked to become an Honouree Guinea Pig Club was as
much as they valued their relationship with him.

Michael: There was a load of stuff I was going to speak to you about, and you are now the historical
advisor for the CASAVAC club?

Emily: So, I guess everyone realises by now that once I start, I don’t really stop. I was working at the
Imperial College and I had started to work with the Veterans Covert, and I know Dave Henson who you
have had on this show before. He is a colleague of mine he is building prosthetic’s that are
comfortable to wear every day because it is the normal boring stuff that is important stuff if you can
take care of that you can do anything. I was talking to him about long term outcomes and how we best
monitor those and how we can make sure 10, 20 years after people have been injured … what is the
best model for making sure people’s recovery is sustained. What is the best way to see? What about
life beyond survival? The long life. And we were just chatting away over a brew as you do. There is an
organisation started after The Second World War for unexpected survivors, but they meet once a year
and it had this incredible effect on their recovery and it is the Guinea Club and I know more about them
than anyone in the world. It is niche, and it’s my niche and I am very proud of it. And I start to tell him
the story and then he went quite for a bit and then he said let’s have a new guinea pig club and I said
yes I think that’s a very good idea so went away and he talked to David Wiseman who I know you have
also had on the podcast so they came up with the idea of creating a group that was half medical and
half social for the unexpected survivors of weapon trauma whether that was physical or psychological
from Iraq and Afghanistan. When we looked at the numbers there were 649 , guinea pigs. The people
that medical journal on before a certain point on Telic and in Herrick I would say they are not going to
make it and yet they did so we had about 700 unexpected survivors from weapon wounded. People
who were genuinely casavac back particularly on Herrick they were brought in on Chinooks and they
were treated on the Chinooks so by the time they bumped down their lives were saved.

So, I remember having this conversation becoming purposeful and them asking questions. I’m saying
I’m not giving you my best guess and I’m going to tell you what they did in 1946 and you can see if
relevant and I remember talking to David Wiseman who had a big bit of paper and a marker which is
how he does business and he put this up on the board. And he said I am not interested after 5 years I
am interested after ten years and then 25 years. I said, “I can tell you 70 years afterwards.” And he
said “Ok.” He then he sat down and said, “we need a new name as the new guinea pig club is not
really going to work for me.” So, they sat and thought about what everyone had in common in this
group of 700 unexpected survivors and what they had in common was that they had been casavac
out of the place where they had been wounded and then medevac’d. But that would make it a very
long name.

Michael: That’s the criteria?

Emily: Yes. You had to be casavac or very close to or casavac or medevac’d. So, what they decided
to call the club was , The CASAVAC Club. The membership is growing but There are potentially only

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700 members. If they are going to make an exception it has to go to a committee because that what
The Guinea Club did but very few and it had go through the committee and it had to be agreed that the
experience was the same so when they are in that room once a year they do not have to explain
themselves . That’s really the main rule – you don’t want to have to explain yourself. So, they set rules.
I think that was one of things I said to them as a historian. I know the reason The Guinea Pig Club
worked was because they stuck to the rules pretty closely, but they never lost focus. This always had
a military context not civilian. It had a very specific wounded context and it was from a very specific
military period. If you make membership open ended and people are coming in from different parts of
the world you end up with a lack of focus and if you don’t have focus, then you are not on the cutting
edge anymore . You cannot be as valuable to medicine as medicine can be for you.

Michael: We have said this before and my vague understanding of The CASAVAC Club and David
Wiseman that it is same injury same place same time same bomb …. Podcast have same mindset
same purpose.

Emily: But mostly you don’t have to explain that to anyone as you automatically know. You may have
to ask what Herrick or Telic you were on? As soon as you know that number. You don’t have to explain
anything else. The doors close and you don’t have to explain.

Michael: I said to one of the David’s “can we do a podcast on the CASAVAC Club” and David said, “No
speak to Emily.”

Emily: I am not in the CASAVAC club. I am the historical advisor and if you have any questions, I am
really very happy to answer. I go to the annual general meeting because I sit in there for an hour and
then I go. Cath The Cake Lady, me some of the people who have come to do the set it up we close
the doors and leave. Those guys that’s what they need. I remember sitting in a meeting with Dave
Henson and explaining this business about closing the door and not having to explain yourself and no
matter how friendly positive people are if they don’t understand and he turned to me and said “I want
that. And it will be enough. They are right it is enough.”

So, I went to the last Guinea Pig Club meeting and the first CASAVAC Club meeting and there was
such power in the room you felt that power and I kind of like don’t ever need to go again because I
know they are coming from the same place. They recognise the legacy they have learned the lessons
and they are taking it forwards. David Wiseman did a really clever thing. He got a beautiful silver baton
made at one end there is the logo of the Guinea Pig Club and the other end logo of the CASAVAC Club
and The Guinea Pig Club and 1921 to 2017 and the Casavac Club is 2017 and until the last member
dies then the CASAVAC Club will be no more and I think the arrangement they have come to is the last
surviving member gets to spend all the money. That’s written into the rules.

Michael: That’s why Wiseman is doing a lot of yoga

Emily: Yes, and really looking after himself. Suddenly someone has got a really good robot powered
jet pack I know who that is. I know where that money went . There are no questions so far relating to
the CASAVAC Club that were not answered by The Guinea Pig Club answered.

Michael: What are we seeing now? What are these guys being tested on? Socially, that’s one aspect
the advancement in medical science. Is it tangible ?

Emily: We are starting to see that. We are not very far. 2014 is when the last person comes out of
Afghanistan and its really not that long ago and we do not know what the unexpected survivors of
Afghanistan are going to have in 5, 10, 15 years down the line. The first thing we have got is a group
of people. I expect there might be a problem with your blood pressure. You might have problem with
your liver and kidneys. These are maybe issues that we need to be keeping an eye on. All those
long-term things. That if you are not paying attention to and that the. …. and have come back from
as close to death that we really know how to get people back from. They are the people They you can
go right up to death and snatch people out of his bony grip. But we don’t know if there are long term
consequences from that. The first thing we have is we have a focused place where we ask people can
you participate in this study. We know from the people that have experienced limb loss or really

Episode 25 Dr Emily MayhewDeclassified Podcast

serious injuries that arthritis is already starting to happen, and we need to focus on how their
prosthetics fit the way they control their weight the kind of exercise they do. We already know that not
just from one person but from everyone who has had a limb replaced as a result of Herrick and Telic. It
is a good number of them and again if you can go to the scientist and say you are going to do your
science and we are going to tell you the problems that need solving this is a partnership. It is an equal
relationship. This is a partnership. This is a joint enterprise in securing the long-term outcomes from
the unexpected survivors. So, the first thing it does is it gives focus to the people who want to do that
science. So, it thinks primarily in the wearing of prosthetic the way prosthetics should be the way
people should live their lives and move with them. We know from the CASAVAC Club that people wear
their prosthetics to 10 to 12 hours a day so there is no textbook that says that’s possible , they would
have said 4 to 6 and then you are in the wheelchair. Most people say to me I have put my wheelchair in
the attack now of you think that is ok, and I say well The CASAVAC Club experience tell me it is. So, if
you can get to see medics go to a lab check the way you are walking to see the effect it is having on
your bones to be careful and monitor for arthritis yes, I think it is fine.

Michael: Speaking and getting to know Dave Henson I have thought same age, and I thought “ Fuck
No. Now is the time these people are making the difference”. It’s not someone else making the
difference. I am sat with Dave Henson who’s doing a PhD and he is the one who is going to be making
the difference.

Emily: Exactly one thinks it is really interesting. The CASAVAC club went so much faster than I thought
it would. The Guinea Pig Club took a while to work out about ten years that it was going to go into
Burns Units and talk to burned children it was going to go to service personnel It took them a while to
understand they had value in that space. But right from the outset the CASAVAC club wanted to be
outward facing they didn’t just want to deal with medics they wanted to bring the experience they have
resilience they had the post traumatic growth the good days and the bad days and the lessons that
they have learned. They are learning everyday just being able to compare notes you are not doing this
on their own. They wanted to take it into other situations they wanted to work with charities they have
a strong sense they can bring in that space. So, the very first relationship they had was a new charity
called Scar Free who is looking at the long-term effects of scarring both physically and also the
psychological effects of scarring. Limb injury they understand what it is like to live with a complex
trauma. So, they connected with Scar Free, so they now work with them whenever they need to and
give them guidance on the physical and psychological repairs that this organisation is going to make.
We have just started that the CASAVAC club is going to partner up with Save The Children.

Michael: Before we go there, I want to link this. The Guinea Club lets’ look after us and then where
can we help others. The CASAVAC Club links with the Endeavour Fund who are now going into phase
3 and role models and impact on society. CASAVAC Club in itself, let’s look after ourselves let’s look
after our mates lets make sure everything is going well for us but where can we impact others. Your
direct work now with Save The Children but really focusing on trauma injury who have been in conflict
elsewhere in the world. Can you first of all explain how you create the link between yourself and Save
The Children and what is the impact is if any on The CASAVAC club and Save The Children.

Emily: I started working with Save The Children it was 2017 I did an event at the Science Museum I
was talking about coming out of Imperial College and the important context was both Dave and I work
in the department of Bioengineering solutions. Bioengineering is anything from hearing aid to a
prosthetic limb but very specifically in the Imperial Department of bioengineering we have the Centre
for Blast Injuries. We study the effect of blast injury. We started by doing it in the immediate term. We
started in 2010, so you can fill in the dots you can imagine why.

Now we are going with the field so we can study the long-term effects. I met Save The Children.
Children who had experienced Blast injury and what they asked me was what happens in children. I
know you know a lot about what happens to adult blast injuries but what happens to children. And
they said, “we don’t really know.” We have just assumed it is the same with adults but 50% less and I
then i talked to some paediatric doctors and they said, “no it is not.” We have a sense of what
happens. But it is much more complicated. The problem is no one is studying it. Most of the child
patients who have experienced blast injury who have some of the very similar injuries to the people
who came away from Herrick and Telic because its IEDs, its unexploded amunitiations, its all the same

Episode 25 Dr Emily MayhewDeclassified Podcast

stuff except they are little they tend to pick things up rather than tread on them and they are still
growing. So, we know what happens to a bone that has been blown up where the person is not
growing anymore . We have no idea what happens when they are still growing. We do not do it very
well in civilian life children who require prosthetics in particularly on their legs where prosthetic is
growing on our legs often not given to them until they stop growing because its expensive and
complicated. I don’t know if you have boys, but they tend to grow in spurts because they can grow in
3 months and the same as the pair of shoes they are outgrown.

Michael: I have a boy 2 girls. I can do my own little study. The boy literally right now he is constantly
hungry.

Emily: Constantly growing and you can almost hear them growing so imagine if you are in a low
resource environment and you are in a conflict zone and you have lost a leg . If you can’t walk you
can’t go to school. Blast injury it can cause illiteracy. It can cause early marriage. it can cause slavery
there are many more affects than disability just like they understood in The Guinea Pig Club. They are
never just repairing the body.

Michael: Please explain a little bit more . Let’s look at things like Afghanistan where there is systematic
child sex abuse with boys and children in conflict and some of the most vulnerable people on our
planet. And then we have this. You have picked up a cluster bomb where you have trod on, or you are
an orphan because this is real, this is reality.

Emily: Perhaps you have lost a limb, but you have survived because children can survive some of the
extraordinary, they are really the unexpected survivors really are children. The unexpected children
they can survive things adults can’t they survive for different reasons quite often they pick things up
which means they lose a hand, they may become disfigured, or lose an eye but they may also lose
their family at the same time so when they wake up on the post-operative ward it has to be explained
to them that they don’t have a hand anymore but they also don’t have a mum and dad. We assume
there is going to be family, support and prosthetics and people are going to be looked after. When you
are a ten-year-old boy who finds themselves with only one leg and in a place like Syria and you are
they going to be moved to a refugee camp the chances are your medical records are not going to be
transferred. The real challenges are there. The global cohort of people who are injured by blast injury
are children in low resource environments. We think 3 out of every 5 children in the world lives in a
conflict zone.

Michel: 3 out of every 5?

Emily: They live in a zone where they can be potentially be injured by a blast

Michael: So, whether it is the old Soviet Union

Emily: Libya, Syria, Afghanistan, either active conflict or post conflict. One of the things I did not know
it has been a really stiff learning curve is that it during conflict it is about even Children and adults get
injured in about the same rate. In a post conflict zone it’s about 50% more children because that’s
when children stop hiding in their houses and they go out and start going to go to school or work or
they are going to play and they go out into the rubble in the country the place where they live and they
pick things up they should not. It is one of the biggest problems when we are reconstructing places
that have been a war zone. When you see children and tell them when you see a shiny item do not
pick it up. It may be an IED or UXB, or unexploded munitions. But if you pick it up. They tend to play
in groups. The child who picks it up will be killed and the others will be injured and suddenly in that
hospital you are dealing with 5, 6 or 7 children who are needing amputations or really serious surgeries
and then they go to where ever their home will be and suddenly they can’t go to work and if they can’t
work what does that mean for their life’s. In the case of girls, it might mean an early marriage. If they
can’t go to school and they are relatively young and can’t finish their education they may have basic
literacy but the prospects for them are early marriage being abandoned by their family unable to make
their way in the place they are living in. people think blast injury causes physical damage it also causes
phycological damage but it also causes damage that is going to reverberate for the rest of their life.
Social damage. When I say blast, injury causes illiteracy they ask is it because people are blinded. No.

Episode 25 Dr Emily MayhewDeclassified Podcast

there are some steps in-between.

Michael: Mobility financially

Emily: Everything

Michael: That’s amazing. We don’t forget … We have looked at the World War II. looked at the
current conflict and the use of cluster bombs really springs to mind. Iraq and Afghanistan The First Gulf
War lots were used as well. But also, the cluster bombs and butterfly bombs were first tested or
dropped in Grimsby where kids were still prone to picking these things up.

Emily: Running over the rubble and picking things up. Nothing changes.

Michael: We are one generation away from this happening in this country!

Emily: Exactly. My dad grew up in Yorkshire and he grew up in Scarborough. And Scarborough was
bombed in the First World War and there were children killed in picking the wrong things up and people
talk about think about the kinds of bombs and monitor what is going on. The blast wave from an
explosion does not know whether it is from cluster munitions, or a home-made IED, or a missile , an air
strike missile. The blast wave does not have a nationality. It doesn’t have a flag. It doesn’t have a
tactical strategy.

Michael: It doesn’t care if it is a child, or a soldier, or whatever.

Emily: It’s the same thing. It doesn’t care if it was laid or dropped. What I really want to do, and It is
one of the reasons why I stay in the Science Department I want to stay focused on the wound. There
are other really good people who are trying to stop people bombing in the first place. Stop bombing by
the way, everyone put everything down and step back that would be a good thing but that is not my
job.

My job is to make sure that when these things do go off, we don’t spend a lot time talking about the
whys and where for we bring the best possible knowledge we can to the point of wounding to saving
their life and then life beyond survival, whoever you are, where ever you are. We have a sense we can
improve that now and we have to take that forward.

Michael: Emily I thank you very, very, very, much for coming in and we will leave it there.