As we honor the men and women who have served our nation in uniform, it is also worth recognizing the US military’s complete transformation of trauma care over the past 17 years of continuous military operations. This transformation, and the resulting decline in death and disability rates, deserves to be recognized as one of the most remarkable achievements in the history of US medicine.
In the civilian world, it takes 17 years on average for a new discovery to change medical practice. By contrast, the US military developed, fielded, or dramatically expanded more than 27 major innovations in little more than a decade over the course of the wars in Iraq and Afghanistan. As a result, the death rate from battlefield wounds decreased by half, to the lowest level in the history of warfare.
Reinventing Front-Line Care
Working with a research budget 1/30th the size of that of the National Institutes of Health, the Department of Defense (DoD) identified, prioritized, and funded high-impact combat casualty research to meet its most pressing needs and push new products to the field. To counter the rising toll of casualties from improvised explosive devices, the DoD supplied redesigned tourniquets to front-line soldiers and marines to help them stop life-threatening bleeding quickly and effectively. Surgical teams were positioned far forward to resuscitate critically injured warriors with a balanced mix of blood products and perform “damage control surgery” (which focuses on threats to life and defers definitive repairs until later).
To transport severely injured casualties, the military trained its MEDEVAC helicopter crews to provide advanced life support and often supplemented them with en route critical care nurses. Rather than keep wounded troops in-country until they were “stable enough to fly” as was done in Vietnam, the Air Force converted returning C-17s and other transport aircraft into “flying ICUs” staffed by specially trained critical care air transport teams. These efforts allowed for the rapid evacuation of critically ill and injured service members to Landstuhl Medical Center in Germany, then to the United States. These new transport procedures were so effective that it was not unusual for a warrior wounded in a remote province of Iraq or Afghanistan to reach Walter Reed or another US medical center within 48–72 hours of injury. The in-flight mortality rate on these transports was an astonishingly low 0.25 percent. Once back in the US, wounded troops received multiple surgeries and early and skilled rehabilitative care, assisted by new technologies designed to improve survival and enhance recovery from the invisible and visible wounds of war.