Friday, December 10, 2004


In every major war that America has fought, the military has sought and found better ways to make sure that soldiers survive their wounds. It used to be that most casualties were deaths and that less than a majority were injuries. Today, in Operation: Iraqi Freedom, the vast majority of casualties are injuries while a small percent are deaths. The United States deserves a lot of credit for actively working to reduce the amount of battlefield deaths in each successive war.

Department of Defense
Iraq War
Deaths 1,004 (9% of casualties)
Wounds 10,369

Vietnam Conflict
Deaths 58,209 (28% of casualties)
Wounds 153,303

Korean War
Deaths 36,574 (26% of casualties)
Wounds 103,284

World War II
Deaths 405,399 (38% of casualties)
Wounds 671,846

World War I
Deaths 116,516 (36% of casualties)
Wounds 204,002

Civil War
Deaths 364,511 (56% of casualties)
Wounds 281,881

[CNN.com](AP) -- For every American soldier killed in Iraq, nine others have been wounded and survived -- the highest rate of any war in U.S. history.It isn't that their injuries were less serious, a new report says. In fact, some young soldiers and Marines have had faces, arms and legs blown off and are now returning home badly maimed. But they have survived thanks, in part, to armor-like vests and fast treatment from doctors on the move with surgical kits in backpacks.

"This is unprecedented. People who lose not just one but two or three extremities are people who just have not survived in the past," said Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston who researched military medicine and wrote about it in Thursday's New England Journal of Medicine.
In one traumatic case, Gawande tells of an airman who lost both legs, his right hand and part of his face. "How he and others like him will be able to live and function remains an open question," Gawande writes. Kevlar helmets and vests are one reason for the high survival rate.

"The critical core, your chest and your abdomen, are protected," said Dr. George Peoples, a Walter Reed Army Medical Center surgeon who served in Iraq and Afghanistan. "Parodixically, what we've seen is devastating extremity injuries because people are surviving wounds they otherwise wouldn't have." By mid-November, 10,369 American troops had been wounded in battle in Afghanistan or Iraq, and 1,004 had died -- a survival rate of roughly 90 percent. In the Vietnam War, one in four wounded died, virtually all of them before they could reach MASH units some distance from the fighting.
The strategy is damage control, not definitive repair. Field doctors limit surgery to two hours or less, often leaving temporary closures and even plastic bags over wounds, and send soldiers to one of several combat support hospitals in Iraq with services like labs and X-rays. "We basically work to save life over limb," said Navy Capt. Kenneth Kelleher, chief of the surgical company at the chief U.S. Marine base near Fallujah. "No frills, nothing complicated. If the injury is not going to be salvageable, we do a rapid amputation, and there have been a fair number of those."

If soldiers are shipped to a combat support hospital, the maximum stay is three days. If more advanced care is needed, they're sent to hospitals in Landstuhl, Germany, or Kuwait or Spain. If care will be needed for a month or more, they're whisked directly to Walter Reed or Brooke Army Medical Center in San Antonio. "The average time from battlefield to arrival in the United States is now less than four days. In Vietnam, it was 45 days," Gawande writes.

CNN.com - Report: 9 in 10 survive wounds in Iraq - Dec 9, 2004


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