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ON POINT II: Transition to the New Campaign

The United States Army in Operation IRAQI FREEDOM May 2003-January 2005

Part IV

Sustaining the Campaign

Chapter 13
Taking Care of Soldiers


US Army Battlefield Medicine before Operation IRAQI FREEDOM

Since the Army’s birth in the Revolutionary War, medical treatment of battlefield casualties has significantly evolved and advanced. During the American colonies’ war for independence, litter bearers were often chosen from “underperforming soldiers” and were used to retrieve the wounded from the battlefield. Disease and malnutrition alone killed 10 soldiers for every 1 soldier killed in battle.2 During the earliest phases of the American Civil War, medical care—battlefield evacuation in particular—was extremely rudimentary. It took over a week, for example, for the Union Army to evacuate its wounded from the battlefield after the Battle of Bull Run in 1861. When Dr. Jonathan Letterman was appointed as the head of Medical Services for the Army of the Potomac, he was so appalled that he overhauled the medical practices in the Army, establishing policies for treatment, evacuation, and a series of general hospitals behind the lines. His efforts later became a model for the Army Medical Corps and the US Army as a whole. Medical care in the 19th century remained primitive, however, and more than half of all wounded Soldiers died from their wounds despite treatment, primarily due to blood loss and infection. Much of this was due to the poor understanding of the causes of disease and the importance of sanitation. During the war, the Union Army lost over 140,000 Soldiers in battle, but more than 224,000 died from disease and other causes.3 By the end of the Spanish American War in the 1890s, the “germ theory” of medicine had advanced to the point where medical personnel understood that whether or not a wounded Soldier lived was often determined by the first person to respond to the injury. Accordingly, litter-bearers were instructed on how to apply dressings in the field, both to treat the trauma of the injury or wound and to prevent infection of the wound.4 Because of this innovation, the number of injured who died from their wounds after reaching a field hospital decreased to 19 percent.5

The Army made significant medical strides during World War I. New medical advances used regularly during this time included the triage concept, blood transfusions, X-rays (first used in the Spanish American War in 1898), treatment for shock, and various reconstructive and orthopedic surgery techniques. The nature of bacteria-caused diseases was widely understood by World War I, and vaccines for smallpox and typhoid were available. Better frontline medical organizations and motorized transportation sped casualties to field hospitals. Though the Army vastly decreased the number of those who died from wounds and disease, deaths occurring from nonbattle causes still exceeded deaths caused by combat.6

The US Army revolutionized medical treatment in World War II. New techniques, including better field surgical care, sulfa drugs, penicillin, the use of more and better trained medics assigned to each combat unit, forward treatment centers, the use of plasma and whole blood products, greater emphasis on preventive medicine and field sanitation, as well as speedy evacuation off the battlefield dramatically lowered death rates from combat action. For the first time in US military history, the number of Soldiers lost to nonbattle injuries was lower than the number lost to combat causes.7 Progress in reducing casualty rates continued in the second half of the 20th century. During the Korean war, the Army used helicopters to airlift wounded Soldiers to mobile army surgical hospital (MASH) units located very close to the front lines. Only about 2 percent of Soldiers wounded in Korea who reached a MASH unit ultimately died of their wounds.8 During the Vietnam war, medical evacuation (MEDEVAC) helicopters, or “Dustoff” missions, were commonplace on the battlefield.* Dustoff helicopters, piloted with incredible bravery, flew with medics on board and provided uninterrupted treatment en route from the battlefield to rear area field hospitals. Though statistical death rates for Soldiers reaching hospital care remained about the same as the Korean war rates, many more Soldiers who would have died of their wounds on the battlefield in Korea were quickly evacuated to field hospitals in Vietnam. Rates of infection in that conflict were less than one-third the rate of World War II.9 In the last decade of the century, continued improvements in medical treatment, deployable hospitals, dedicated ground and air MEDEVAC units, and digital links to the United States during the first Gulf War in 1991 meant that only 2 of the 356 Soldiers wounded in combat died of their wounds once reaching a field hospital. This yielded a survival rate of 99.4 percent.10 Though almost perfect, the Army realized that the short duration and unique nature of the war should not lessen the continued efforts to improve medical treated for Soldiers.

*Helicopters were first used in World War II for casualty evacuation in the China–Burma–India Theater, and were widely used in the Korean War. Those early medical helicopters did not have medical attendants on board who could provide en route care, so they were strictly casualty evacuation (CASEVAC) birds. Vietnam was the first use of helicopters with the ability to provide en route care that is now considered to be the definition of MEDEVAC.

Chapter 13. Taking Care of Soldiers

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