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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


Personal Protection, Body Armor, and Casualty Rates

Various advances in medical care, from the point of injury to transportation and stateside medical treatment, greatly reduced casualty rates during OIF. New personal protective devices, often called body armor, played an equally important role in reducing casualties. Older style protective vests used before the mid-1990s were only useful in protecting against artillery shrapnel and low-velocity rounds. More sophisticated body armor, made from bullet-resistant Kevlar and ceramic plates, played a critical role in saving Soldiers’ lives. Like the Kevlar helmet developed more than a decade earlier, the layered Kevlar vest was built to stop several shots from low velocity handgun and some high velocity rifle rounds.36 The Interceptor vests that incorporated Kevlar covered a Soldier’s torso, but not the Soldier’s arms and legs. (See Chapter 12, “Logistics and Combat Service Support Operations,” for an in-depth examination of the personal body armor issue.) According to Army nurse Captain Ruth M. Roettger-Lerg, “I would see shrapnel wounds on arms and they would stop right at the FLAK (sic) vest.”37 The body armor dramatically reduced deadly torso injuries, but legs and arms remained exposed, and many Soldiers who survived the initial blast suffered from traumatic wounds.38

Though body armor saved many lives from blasts and direct-fire weapons, it also compounded the treatment challenges for doctors who faced many more “polytrauma” injuries to Soldiers that historically would have died from damage to their unprotected vital organs. Captain Ed Dunton, a trauma nurse at the CSH in Baghdad, stated, “Back home, you see a car accident and it will be blunt trauma or a head injury, or single gunshot wounds . . . but here you get all that encompassed in a single patient: a head injury along with blunt trauma along with penetrating trauma.”39 Of those Soldiers involved in an IED blast who sustained head injuries, more than half sustained some neurological problems caused by skull-penetrating fragments or blows to the head.40 Even when direct head trauma had not occurred, the concussive shock of the IED blast could cause Traumatic Brain Injury (TBI), a condition that could lead to a number of neurological problems. This particularly insidious wound was unfortunately far too common in Iraq. In 2003 the Defense and Veterans Brain Injury Center in Washington, DC, an organization affiliated with the DOD, screened 88 troops who had become blast victims in Iraq and identified 54 individuals (61 percent) with TBI.41 According to one estimate more than 1,700 of the Soldiers wounded in Iraq during this period were diagnosed with brain injuries; of those, half were severe enough to impair thinking, memory, mood, behavior, and overall ability to work. The complexity of injuries to Soldiers was challenging not only for the medical teams at all levels of care, including postdischarge care from the VA, but also to the families of the wounded Soldiers.42

Improved helmets and other gear also reduced serious injuries, though not as dramatically as the new body armor. For example, the Army issued a variety of new protective safety glasses to Soldiers to reduce eye injuries. Once the Army made them more comfortable to wear with the new helmet design and more suitable to the hot, dusty conditions in Iraq, Soldiers began wearing the goggles; this sparked a corresponding reduction in eye injuries.43 Of course, saving more lives in Iraq meant that a larger proportion of young men and women received treatment for serious injuries that affected them permanently, such as amputation and loss of vision.44

The wounds sustained during OIF reflect the character of the conflict. Roughly 62 percent of all US forces wounded by hostile action in OIF resulted from blast effects from artillery, mortars, and bombs of various types, including IEDs. Only slightly over 13 percent of US forces wounded in action were victims of small arms and other weapons.45 According to a recent Congressional research report, which looked beyond the period covered in this study, roughly 80 percent of all Soldiers wounded in OIF suffered a single wound, while roughly 20 percent suffered multiple wounds. The same study reported 575 amputations during OIF. IEDs caused roughly 42 percent of those amputations.46

Statistics are a sterile way of accounting for the sacrifice of Soldiers in combat, but some empirical information is necessary for a complete understanding of the American effort in Iraq in 2003 and 2004. A brief analysis of Army casualties reveals that during the invasion of Iraq, 19 March 2003 to 30 April 2003, the US Army lost 66 Soldiers, 47 of them to hostile causes. During the period covered by this study (May 2003 to January 2005), the Army lost 885 Soldiers, 656 of them to hostile causes, while 6,636 Soldiers were wounded in action.47 The casualty rate varied greatly from month to month based on the types of operations conducted by the Coalition, but peaked in the spring of 2004 and then again in the fall of 2004 during major operations against insurgent strongholds. Because the US Army had far more troops deployed than any other Service, it bore the brunt of the causalities, suffering roughly two-thirds of the total DOD losses during that period.48 No statistic can capture the tragedy of even a single death or serious wound, and no historical analogy is perfect. However, this is a remarkably low casualty rate when compared to the Army’s losses in conventional wars since World War II or when compared to its last major irregular conflict in Vietnam.

Because the methods of categorizing and recording casualties have changed over time, a thorough analysis of casualty statistics in various conflicts is beyond the scope of this work.49 Nevertheless, some historical comparisons can highlight the advances made in US Army battlefield care. In World War II, roughly 4 percent of Soldiers who reached a medical treatment facility died of their wounds.50 This ratio was lowered to around 3 percent during the Vietnam war.51 In OIF the rate hovered just under 2.5 percent. Taken together, these figures show that medical treatment has been consistently excellent, with relatively minor improvements over time. But they are somewhat misleading because far more Soldiers injured by enemy action are now reaching a medical treatment facility to be treated in the first place. In other words, far more Soldiers are surviving being “hit” and are reaching advanced medical care than ever before.

This improvement was linked to various factors discussed in this chapter to include the widespread use of sophisticated body armor, new emergency treatment techniques, equipment used at or very near the injury site, and improved MEDEVAC methods. In World War II the survival rate for Soldiers “hit” by enemy fire has been estimated at around 70 percent, to include Soldiers killed outright (KIA) and those who later died of their wounds (DOW).52 The survival rate for Soldiers hit by enemy fire in OIF has risen to just over 90 percent.53 This increase is partly explained by the differing nature of combat in these two conflicts, but clearly this rate marks a significant success for the Army and for the Army medical system and its personnel.

Chapter 13. Taking Care of Soldiers

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