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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

 

Notes

1. Only 2.47 percent of service members wounded in Iraq have died of their wounds after being evacuated to higher-level medical care outside of Iraq (545 of 22,057 total as of 2 December 2006). “Military Casualty Information,” DOD Personnel and Military Casualty Statistics, US Department of Defense, http://siadapp.dior.whs.mil/personnel/CASUALTY/castop.htm (accessed 5 January 2007).

2. John T. Greenwood and F. Clifton Berry Jr., Medics at War: Military Medicine from Colonial Times to the 21st Century (Annapolis, MD: Naval Institute Press, 2005), 5.

3. Greenwood and Berry, 30–33.

4. Greenwood and Berry, 50–52.

5. David Zucchino, “Bringing Back the Wounded With Heart, Soul, and Surgery,” Los Angeles Times, 2 April 2006, http://www.latimes.com/news/nationworld/nation/la-na-wounded2apr02,1,4738485.story?coll=la-health-medicine (accessed 15 August 2006).

6. Greenwood and Berry, 76. A good portion of the disease related deaths were caused by the 1918 flu pandemic.

7. Greenwood and Berry, 113–114.

8. Greenwood and Berry, 123–126; see also, Frank A. Reister, Battle Casualties and Medical Statistics: U.S. Army Experience in the Korean War (Washington, DC: Office of the Surgeon General, 1986).

9. Greenwood and Berry, 138, 140.

10. Greenwood and Berry, 158–159. The Army also benefited from having deployed a very substantial medical care system to Iraq and having to deal with very few combat casualties during the “100-Hour War.”

11. Greenwood and Berry, 172–173. The post-Gulf War drawdown that substantially reduced the number of hospitals in the Army inventory also drove the greater emphasis on evacuation out of theater.

12. Lawrence F. Kaplan, “America’s Near-Invisible Wounded,” The New Republic, 2 October 2003, http://www.trn.com/doc.mhtml?i=20031013&s=kaplan101303 (accessed 12 September 2006); Atul Gawande, M.D., M.P.H., “Casualties of War—Military Care for the Wounded from Iraq and Afghanistan,” The New England Journal of Medicine, 251:24, 9 December 2004, 2472, http://content.nejm.org/cgi/reprint/351/24/2471.pdf (accessed 22 August 2006).

13. Michael Peck, “‘Golden Hour’ Surgical Units Prove Worth,” Military Medical Technology Online, Volume 7, Issue 5 (9 August 2006), http://www.military-medical-technology.com/article.cfm?DocID=176 (accessed 11 August 2006).

14. Field Manual (FM) 4-02, Force Protection in a Global Environment (Washington, DC, February 2003), 1-2 to 1-3, 2-5 to 2-7, and appendix C.

15. US Army Medical Command, “High Tech Bandages,” AMEDD Innovations Since Desert Storm, http://www.armymedicine.army.mil/about/tl/factsbandages.htm (accessed 31 October 2006).

16. Andrea Stone, “High-Tech Bandages Designed to Save Lives,” USA Today, 25 February 2003, http://www.tricare.osd.mil/eenews/downloads/HighTechBandages.doc (accessed 31 October 2006).

17. Karen Fleming-Michael, “New tourniquet named one of Army’s 10 greatest inventions,” Army News Service, 22 June 2006, http://www.globalsecurity.org/military/library/news/2006/06/mil-060622-arnews03.htm (accessed 22 August 2006).

18. Fleming-Michael; David Zucchino, “War Brings Advances in Protection and Care,” Los Angeles Times, 3 April 2006, http://www.latimes.com/features/health/medicine/la-na-woundedside3apr03 (accessed 14 August 2006); “Army’s new life-saving training aims to cut combat deaths,” EMS House of DeFrance, 29 April 2005, http://www.defrance.org/artman/publish/article_1323.shtml (accessed 16 August 2006).

19. Lieutenant Commander Charles J. Gbur Jr., MC, USNR, 3/25 Battalion Surgeon, “Battalion Aid Station Support of Military Operations in Urban Terrain (BASS MOUT),” http://www.geocities.com/Pentagon/6453/bassmout.html (accessed 15 August 2006).

20. The evocative name that the public will recognize comes from the television program “M*A*S*H” and is “meatball surgery.” See “The Medical Frontline of War,” CBS News, 4 June 2006, http://www.cbsnews.com/stories/2006/06/04/Sunday/printable1680075.shtml (accessed 16 August 2006); see also, Gawande, 2473.

21. FM 4-02, 1-2.

22. US Army Medical Command, “UH-60L Medevac Helicopter,” AMEDD Innovations Since Desert Storm, http://www.armymedicine.army.mil/about/tl/97-factsuh60l.htm (accessed 31 October 2006).

23. Staff Sergeant Gregory Givings, interview by Colonel Richard Van Ness Ginn, 20 August 2003, Falls Church, VA, AMEDD Oral History Program, Operation Iraqi Freedom, Interview OIF-067, Draft Transcripts (14 January 2004), from the Office of Medical History, Directorate of Health Care Operations, Office of the Surgeon General, US Army Medical Department, 9; Leslie Sabbagh, “Birds of Mercy,” Popular Mechanics, October 2005, http://www.popularmechanics.com/science/defense/1894752.html (accessed 21 August 2006).

24. Sabbagh.

25. David Zucchino, “The Journey Through Trauma,” Los Angeles Times, 3 April 2006, http://www.latimes.com/news/nationaworld/nation/la-na-wounded2apr03,1,5197239.story?coll=la-health-medicine (accessed 14 August 2006).

26. FM 8-10-14, Employment of the Combat Support Hospital Tactics, Techniques, and Procedures (Washington, DC, 1994), 2-2, https://akocomm.us.army.mil/usapa/doctrine/DR_pubs/dr_aa/pdf/fm8_10_14.pdf (accessed 22 August 2006). This manual is currently under revision as FM 4.02-10.

27. Steven Donald Smith, “HBO Film ‘Baghdad ER’ Examines Combat Hospital,” American Forces Press Service, 17 May 2006, http://www.defenselink.mil/news/May2006/20060517_5149.html (accessed 22 August 2006); FM 8-10-14, 2-1.

28. Smith.

29. Specialist Rick Rzepka, “Men and Women of Combat Support Hospital dedicate themselves to saving lives here,” MNF-Iraq.com, 25 February 2006, http://www.mnf-iraq.com/index.php?option=com_content&task=view&id=194&Itemid=42 (accessed 22 August 2006).

30. “Life and Death in a War Zone,” PBS Airdate, 2 March 2004, NOVA transcript, http://www.pbs.org/wgbh/nova/transcripts/3106_combatdo.html (accessed 22 August 2006).

31. FM 8-10-14, 1-1 and 2-22; Gawande, 2472.

32. Lieutenant Colonel David Vetter, interview by Major Lewis Barger, 21 May 2003, Camp Wolf, Kuwait, AMEDD Oral History Program, Operation Iraqi Freedom, Interview OIF-522, Draft Transcript (23 September 2003), from the Office of Medical History, Directorate of Health Care Operations, Office of the Surgeon General, US Army Medical Department, 9.

33. Zucchino, “Bringing Back the Wounded With Heart, Soul, and Surgery.”

34. FM 4-02, 2-5 to 2-7.

35. Gawande, 2473.

36. Benny Evangelista, “Kevlar saving lives, minimizing wounds in Iraq,” San Francisco Chronicle, 7 April 2003, http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/04/07/BU275282.DTL&type=business (accessed 22 August 2006).

37. Captain Ruth M. Roettger-Lerg, interview by Mr. Ron Still, 24 July 2003, Wurzburg, Germany, AMEDD Oral History Program, Operation Iraqi Freedom, Interview OIF-046, Final Transcript (7 September 2004), from the Office of Medical History, Directorate of Health Care Operations, Office of the Surgeon General, US Army Medical Department, 16.

38. Gawande.

39. Zucchino, “War Brings Advances in Protection and Care.”

40. Denise Grady, “Struggling Back From War’s Once-Deadly Wounds, The New York Times, 22 January 2006, http://www/nytimes/com/2006/01/22/national/22wounded.html (accessed 22 August 2006).

41. Defense and Veterans Brain Injury Center, “Blast Injury” Information, http://www.dvbic.org/cms.php?p=Blast_injury (accessed 19 December 2007).

42. Michael E. O’Hanlon and Nina Kamp, “Iraq Index: Tracking Variables of Reconstruction & Security in Post-Saddam Iraq,” The Brookings Institution, 30 May 2006, 6, www.brookings.edu/iraqindex (accessed 22 August 2006).

43. Gawande, 2473.

44. Brad Knickerbocker, “In Iraq, fewer killed, more are wounded,” The Christian Science Monitor, 29 August 2006, http://www.csmonitor.com/2006/0829/p03s02-usmi.html (accessed 30 August 2006).

45. DOD, “Military Casualty Information.”

46. Hannah Fischer, United States Military Casualty Statistics: Operation Iraqi Freedom and Operation Enduring Freedom, Report RS22452, Congressional Research Service, 8 June 2006, http://www.fas.org/sgp/crs/natsec/RS22452.pdf (accessed 19 December 2006).

47. DOD, “Military Casualty Information.”

48. The Army generally provided more than two-thirds of the number of troops deployed to Iraq, so it may have suffered fewer casualties than its proportion of total deployed forces. This issue is outside the scope of ON POINT II, but it bears further study. DOD, “Military Casualty Information.”

49. Records keeping and changing terminology make direct comparisons nearly impossible. To cite one example, during World War II “battle wounds” were differentiated from “battle injuries”—wounds were caused by the enemy, e.g., getting shot, while injuries, such as breaking a wrist while diving into a fighting position during an artillery attack, were recorded separately. By Vietnam, the term “battle injury” included any physical injury incurred primarily or secondarily as a result of hostile action. For another discussion of the complexities of measuring and assessing battlefield casualties, evacuation, and treatment issues, see Colonel (Retired) Ronald Bellamy, “A Note on American Combat Mortality in Iraq,” Military Medicine, Volume 172, October 2007.

50. See Colonel John Lada, “Medical Statistics in World War II,” in The United States Army in World War II (Washington, DC: Office of the Surgeon General, 1975).

51. DOD, “Military Casualty Information.”

52. Lada; see also, Gilbert W. Beebe and Michael E. DeBakey, Battle Casualties: Incidence, Mortality, and Logistic Considerations (Springfield, IL: Charles C. Thomas, Pub., 1952).

53. DOD, “Military Casualty Information”; see also Gawande, 2473.

54. Staff Sergeant Daniel J. Seymour, “Mortuary Affairs Support In the Iraqi Theater of Operations,” Quartermaster Professional Bulletin, Spring 2005, http://www.quartermaster.army.mil/oqmg/professional_bulletin/2005/Spring05/Mortuary%20Affairs%20Support%20in%20the%20Irai%20Theater%20of%20Operations (accessed 10 October 2006).

55. Captain Shannon V. Stambersky, “A Lesson in Dignity in the Iraqi Desert,” Quartermaster Professional Bulletin, Spring 2005, http://www.quartermaster.army.mil/oqmg/professional_bulletin/2005/Spring05/Mortuary%20Affairs%20Support%20in%20the%20Irai%20Theater%20of%20Operations (accessed 10 October 2006).

56. Captain Arnd Frie et al, “Fallen Comrades: Mortuary Affairs in the US Army,” Army Mortuary Affairs History page, http://www.qmfound.com/fallen.htm (accessed 10 October 2006).

57. Frie et al.

58. Frederik Balfour, “A Wartime Oasis of Selfless Compassion,” BusinessWeek Online, 15 April 2003, http://www.businessweek.com/bwdaily/dnflash/apr2003/nf20030415_8932.htm (accessed 10 October 2006).

59. Balfour.

60. Anita Powell, “Mortuary affairs specialists perform a labor of love,” Stars & Stripes Mideast Edition, 13 November 2005, http://www.estripes.com/article.asp?section=104&article=32152&archive=true (accessed 10 October 2006).

61. Powell; Balfour.

62. Balfour.

63. Powell.

64. Office of the Chief of Public Affairs, “US Army Wounded Warrior Program Assists Soldiers,” 10 November 2005, http://www4.army.mil/ocpa/print.php?story_id_key=8185 (accessed 31 October 2006).

65. US Army Wounded Warrior Program Web site, http://www.armyfamiliesonline.org (accessed 31 October 2006).

66. Public Affairs, “US Army Wounded Warrior Program Assists Soldiers.”

67. US Army Medical Department, Mental Health Reports (OIF), http://www.armymedicine.army.mil/news/mhat/mhat.html (accessed 2 January 2007). Note: Since the first MHAT report, two more reports have been released—MHAT II in January 2005, and MHAT III in December 2006.

68. US Army Medical Department, Mental Health Reports (OIF), Operation Iraqi Freedom Mental Health Advisory Team (MHAT-II) Report, 30 January 2005, http://www.armymedicine.army.mil/news/mhat/mhat_ii/OIF-II_REPORT.pdf (accessed 2 January 2007).

69. Steve Bentley, “A Short History of PTSD: From Thermopylae to Hue Soldiers Have Always Had A Disturbing Reaction To War,” The VA Veteran, March/April 2005, originally published January 1991, http://www.vva.org/TheVeteran/2005_03/feature_HistoryPTSD.htm (accessed 23 August 2006).

70. Bentley, “A Short History of PTSD.”

71. Heidi S. Resnick, Ph.D., and Dean G. Kilpatrick, Ph.D., “Crime Related PTSD: Emphasis on Adult General Population Samples,” National Crime Victims Research and Treatment Center and Medical University of South Carolina, US Department of Veterans Affairs, http://www.ncptsd.va.gov/publications/rq/rqhtml/V5N3.html (accessed 31 October 2006).

72. Jennifer L. Price, Ph.D., “Findings from the National Vietnam Veterans’ Readjustment Study: A National Center for PTSD Fact Sheet,” US Department of Veterans Affairs, http://www.ncptsd.va.gov/facts/veterans/fs_NVVRS.html (accessed 31 October 2006).

73. Matthew J. Friedman, M.D., Ph.D., “Acknowledging the Psychiatric Cost of War,” The New England Journal of Medicine, 351:1, 1 July 2004, 75; and Jennifer L. Price, Ph.D., “Effects of the Persian Gulf War on US Veterans,” A National Center for PTSD Fact Sheet, United States Department of Veterans Affairs, http://www.ncptsd.va.gov/facts/veterans/fs_gulf_war_illness.html (accessed 24 August 2006).

74. Jonathan Finer, “Battle-Hard G.I.’s Learn to Release their Pain,” Washington Post Foreign Service, 14 June 2005, http://www.hws,edu/akumni/alumnews/showclip.asp?webslip=2191 (accessed 14 August 2006).

75. Operation Iraqi Freedom (OIF) Mental Health Advisory Team (MHAT) Report, 16 December 2003, Chartered by US Army Surgeon General, http://www.armymedicine.army.mil/news/mhat_ii/OIF-II_REPORT.pdf#search=%22Army%20Mental%20Health%20Advisory%20Team%20survey%202003%22 (accessed 24 August 2006).

76. T. Trent Gegax, “Wartime Stress: Poor morale and high suicide rates point to big problems for troops in Iraq,” Web Exclusive, Newsweek, MSNC.com, 2 April 2004, http://www.msnbc.msn.com/id/4632956/site/newsweek/ (accessed 24 August 2006).

77. Christiane Amanpour, “Brain Rangers’ Fight Iraq Stress,” 60 Minutes, CBS News, 27 February 2005, http://www.cbsnews.com/stories/2005/02/25/60minutes/main676553.shtml (accessed 24 August 2005).

78. “Combat Stress Team Helps Troops Cope,” Defend America, 5 November 2004, http://www.defendamerica.mil/articles/nov2004/a110504e.html (accessed 24 August 2006).

79. OIF MHAT Report, 30 January 2005, 3-4.

80. Lieutenant Colonel Steve Russell, Commander, TF 1-22 Infantry, Command Correspondence “Dear Family and Friends,” 20 June–24 August 2003.

81. Russell.

82. Nick Wakeman, “Satellite communications boost troops’ morale in Iraq,” Washington Technology, 24 November 2003, http://www.washingtontechnology.com/cgi-bin/udt/im.display.printable?client.id+wtonline (accessed 25 August 2006).

83. Wakeman.

84. William Jackson, “Internet cafes are morale booster for troops in Iraq,” Government Computer News, 24 November 2003, http://www.gcn.com/cgi-bin/udt/im.display.printable?client.id=gcn&story.id=24241 (accessed 25 August 2006).

85. Jackson.

86. Doug Swanson, “All the Comforts of War,” originally published in the Dallas Morning News, PE.com, 10 June 2006, http://www/pe/com/cgi-bin/bi/gold_print.cgi (accessed 25 August 2006).

87. “The Fight for Fallujah, TF 2-2 IN FSE AAR,” Field Artillery, March–April 2005, 10.

88. Kenneth W. Estes, “Command Narrative: 1st Armored Division in Operation IRAQI FREEDOM, May 2003–July 2004.” Unpublished study, 105.

89. Swanson.

90. Swanson.

91. James Dunnigan, “Why The Xbox is Important in the Iraq War,” www.strategypage.com, 12 February 2005, http://www.strategypage.com/dls/articles/200521223.asp?source=send (accessed 25 August 2006).

92. Staff Sergeant Richard Dashiell, “The Steel Snake Archery Club, Iraq,” www.texasarchery.org, http://www.texasarchery.org/L1/IAC.htm (accessed 25 August 2006); Sergeant Enrique S. Diaz, “Troops Add Jazz to Recreation Center,” www.mnf-iraq.com, 14 July 2006, http://www.mnf-iraq.com/index2php?option=com_content (accessed 25 August 2006); Private First Class Sean Finch, “V Corps ‘Garage Band’ Revs up to Rock Soldier Morale in Iraq,” Multi-National Corps–Iraq Public Affairs Office, 17 February 2006.

93. United Service Organizations, “History of the USO,” USO.org, http://www.uso.org/whoweare/ourproudhistory/historyoftheuso/ (accessed 30 August 2006).

94. “History of the USO”; Jared A. Taylor, “With No Camp in Iraq, USO Does What It Can,” Kansas City InfoZine, 17 August 2006, http://www.infozine.com/news/stories/op/stories (accessed 25 August 2006).

95. Taylor.

96. “US Central Command Unveils R&R Leave Program,” CENTCOM Press Release, 25 September 2003, http://www.centcom.mil/sites/uscentcom1/Lists/Press%20Releases/AllItems.aspx (accessed 30 August 2006).

97. Aliza Marcus, “US leave program gets a boost, along with troops,” originally published in The Boston Globe, boston.com, 2 December 2003, http://www.boston.com/news/nation/articles/2003/12/02/us_leave-orogram-gets-a-boost/ (accessed 25 August 2006).

98. Ms. Dianna Emmou, e-mail interview by Contemporary Operations Study Team, Fort Leavenworth, KS, 31 July 2006.

99. Emmou, e-mail interview, 31 July 2006.

100. Army Commander’s Guide to Family Readiness Group Operations, 1-2, http://www.hooah4health.com/deployment/familymatters/24Sept05_CDRsGuide.doc (accessed December 2007).

101. “Make the Most of Family Readiness Groups,” U.S. Army HOOAH 4 HEALTH.com. http://www.hooah4health.com/4life/hooah4family/frg.htm# (accessed December 2007).

102. Emmou, e-mail interview, 31 July 2006.

103. Ms. Ann Soby, interview by Contemporary Operations Study Team, Fort Leavenworth, KS, 31 July 2006.

104. Donna Miles, “Reducing the Military Divorce Rate,” American Forces Press Service, 13 June 2005.

105. Lieutenant Colonel Phil Andrews, e-mail interview by Contemporary Operations Study Team, Fort Leavenworth, KS, 1 September 2006.

106. Andrews, e-mail interview, 1 September 2006.

 


Chapter 13. Taking Care of Soldiers





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