LONDON/BIRMINGHAM The unit at Birmingham's Queen Elizabeth Hospital that will treat a Pakistani schoolgirl shot by the Taliban for promoting girls' education is known for dealing with complex trauma cases and has treated hundreds of soldiers wounded in Afghanistan.
Built at a cost of 545 million pounds, the hospital in central England has the world's largest single-floor critical care unit for patients with gunshot wounds, burns, spinal damage and major head injuries.
Malala Yousufzai, 14, shot in the head and neck by the Taliban last week, is due to arrive there on Monday, a hospital spokeswoman said, after an air ambulance flight from Islamabad.
While Pakistani surgeons removed a bullet from near her spinal cord during a three-hour operation the day after the attack, she now needs intensive specialist follow-up care.
That is likely to include repairing damaged bones in her skull and complex follow-up neurological treatment.
"Injuries to bones in the skull can be treated very successfully by the neurosurgeons and the plastic surgeons, but it is the damage to the blood supply to the brain that will determine long-term disability," said Duncan Bew, consultant trauma surgeon at Barts Health NHS Trust in London.
Judging the best way forward in such difficult cases requires a wide range of experienced medics working as a team.
"In trauma, it is really the coordinated impact of intensive care that is critical. It's not just about keeping the patient alive but also maximising their rehabilitation potential. With neurological injuries that is paramount," Bew said.
Just how much damage Malala has suffered is unclear, although doctors said youth was on her side since a young brain has more ability to recover from injury than a mature one.
"On the positive side, Malala has passed two major hurdles - the removal of the bullet and the very critical 48-hour window after surgery," said Anders Cohen, head of neurosurgery at the Brooklyn Hospital Centre in New York.
MALALA'S SECURITY A PRIORITY
Compared with some of the nation's ageing hospitals, the new National Health Service (NHS) hospital offers a spectrum of services ranging from plastic surgery to neuroscience.
They may all be needed in Malala's case.
The hospital and government officials declined to give any details about the security measures that would be put in place to protect Malala but a spokesman for the Home Office said her security was "a priority for both Pakistan and the UK".
Care of soldiers on the battlefield has improved dramatically in recent years, so that many now survive injuries that would have been a death sentence in the past.
As a result, Birmingham now handles extremely challenging injuries that were previously little known and has built up enormous experience in head and brain injuries, multiple fractures and amputations.
In the last five years, the Birmingham centre - the main receiving unit for British military casualties - has treated 481 service personnel seriously injured in Afghanistan, according to the Ministry of Defence. (Additional reporting by Michael Holden, editing by Peter Millership)
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