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Advances Have Cut Combat Deaths in Iraq and Afghanistan

Advances in several different areas—including armored vests and other protective gear, streamlined systems for evacuation and casualty management, and new medical approaches—have combined to produce significant improvement// in the chances of survival for U.S. casualties in Iraq and Afghanistan, according to a Special Editorial in the November/December issue of The Journal of Craniofacial Surgery.

For soldiers injured in combat today, the survival rate is 90 percent or higher—a significant improvement even since the Gulf War in the early 1990s, according to Col. W. Bryan Gamble, M.D., Commander of Landstuhl Regional Medical Center in Germany. Dr. Gamble credits advances in three key areas with improving the outcomes of combat injuries:

? Personal Protective Equipment: Incorporated into vests, new composite material plates are capable of stopping high-velocity rounds, making previously fatal chest wounds survivable. Standard equipment for each solider now includes an individual "one-handed" tourniquet, allowing prompt action to reduce blood loss. New bandages impregnated with clotting products are also being used to stop bleeding from severe injuries.
? Casualty Treatment and Evacuation: Forward Surgical Teams provide life-saving surgical treatment, often reaching injured personnel within minutes. In addition to saving soldiers who would otherwise bleed to death, the rapid response provided by these teams sets the stage for further damage control, surgery, and rehabilitation.
Once their condition has stabilized, casualties are efficiently and systematically transferred to the next level of care and more specialized treatment. Critical Care Air Transport Teams provide rapid evacuation of injured personnel—most reach Landstuhl within 24 hours, and are on their way to U.S. military treatment facilities within 48 to 72 hours.
? Medical Care Advances: Specific medical advances include "directed and purposeful" use of blood products, measures to protect against hypothermia, aggressive surgery to prevent damaging compartment syndromes, and improvements in ventilator design and technology. Weekly video teleconferences allow close and ongoing communication between doctors on the battlefield, at Landstuhl, and in U.S. treatment facilities. In addition, a trauma registry system has been set up to record and analyze the types of injuries that occur, thus allowing improvements in management.

War has been a constant in human history, and doctors and surgeons have stood by to provide care for injured soldiers. Over the years, the need to provide urgent care for devastating combat injuries has led to many new advances in medical care for the population at large. Today, accumulated advances in technology, military organization, and medical and surgical care have lead to unprecedented improvements in the chances of surviving combat injuries. "We stand on the next great leap forward of medicine for generations to come," Col. Gamble concludes.


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