Beyond The Battlefield: With Better Technology And Training, Medics Saving More Lives
"Beyond the Battlefield" is a 10-part series exploring the challenges that severely wounded veterans of Iraq and Afghanistan face after they return home, as well as what those struggles mean for those close to them. Other stories in the series can be found here.
Stepping carefully through the blinding sun and heat and dust of southern Afghanistan with Lance Cpl. Tyler Southern and several squads of sweating Marines was a brand-new Navy corpsman, James Stoddard. He had never treated a real-life battle casualty. He was 19 years old.
Yet when an IED blew off Southern's legs and right arm, leaving him bleeding to death in the smoking crater, Stoddard's reaction was quick and simple: "You see a missing limb, you throw on a tourniquet."
Stoddard had already strapped tourniquets on simulated bleeding limbs hundreds of times, maybe thousands. During four months of medical school, two months of field training and then relentless drilling with the Marines, he'd practiced slamming that tourniquet on and yanking it tight over and over. By feel, blindfolded, in the rain, in the heat and while a sergeant bawled him out, Stoddard’s fingertips learned to quickly trace out the slick of fake blood on a volunteer and, one-handed, slip that tourniquet up and strap it down hard.
That training helped Stoddard to power through the shock of seeing his buddy blasted into pieces. Southern's life now depended on him. What did that moment feel like? "I have no idea," Stoddard says. "I literally don't remember. Muscle memory took over."
That begins to explain why Tyler Southern didn't die that day, May 5, 2010. Thanks to Stoddard, Southern came home -- badly wounded, but alive.
Stoddard is part of a long and noble tradition. Battlefield medics have saved countless lives since the Civil War and techniques have improved steadily since then, in small and large ways (at the Battle of Manassas in 1862, for example, it took a week to get the wounded off the field; today that usually happens almost immediately, most often by medevac helicopter with a trauma specialist aboard).
Razor-sharp training, battle-tested new medical procedures and new technology -- and the heroic work of medics like Stoddard -- are rescuing and revivifying a new generation of severely wounded survivors.
Combat has always produced gruesome wounds, and until recently many were fatal. During the Vietnam war, out of every 10 who died on the battlefield, nine would have died even if a trauma surgeon was standing next to them -- there simply wasn’t the medical technology or know-how to keep them alive.
"We've changed that nine of 10 to five or six out of 10," says Dale Smith, a medical historian at the Uniformed Services University of the Health Sciences in Bethesda, Md., a Defense Department medical school. "That's a huge difference. We've had 43,000 wounded in 10 years of war, and only 6,000 died. That's 13 percent, as low a number as we've ever had."
I interviewed Smith last summer, and since then those numbers have risen to 46,300 wounded and 6,232 dead, roughly the same 13 percent.
Since March 2005, every troop headed into combat is certified with advanced trauma care training as a Combat Life Saver and carries at least two tourniquets and an airway tube. Those devices have dramatically cut the primary causes of previous combat deaths: choking and bleeding to death. A combat life saver medical kit also carries a needle and catheter for relieving pressure caused by a chest wound.
Other innovations include rapidly infusing patients in the operating room with a combination of whole blood, plasma and platelets to stem bleeding, rather the previous practice of using crystelloids or saline solution; rapid medical evacuation from the war zone aboard aircraft that are essentially flying intensive care units; and "smart" powered artificial limbs and experimental use of regenerated bone and spray-on skin.
"There's been more innovation in this war than in any other," said Dr. Robert Hale, a surgeon at the Armed Forces Institute of Surgical Research in San Antonio, where a number of clinical trials are about to get underway. "Much still has to be proven in the lab."
Tyler Southern, thanks to James Stoddard, is one of the saved.
In a previous war, he likely would have lived only minutes after an IED exploded beneath him, as all the blood in his body drained into the dust. Until recently, medics and corpsmen didn't use tourniquets. Official military medical practice was to pump IV saline solution into the patient and then try to stem the bleeding with bandages. The result: more than half of all those struck down in battle died of acute hemorrhage.
Tourniquets had long spooked military medical experts because in civilian practice, a tightly-bound limb could become damaged from lack of blood and require amputation. But by the early years of the Afghanistan and Iraq wars, the death rates in battle were so dismaying that combat trauma medics and doctors began reconsidering the tourniquet. In combat, they figured, better to risk the potential loss of a limb than to risk the loss of the patient. To embrace that strategy, the military turned on a dime: it supplied medics with redesigned tourniquets that could be applied and tightened with one hand.
The tourniquets proved so effective that in 2005 the military began issuing two to every combat troop, along with extensive instruction and training on how to use them on themselves and on buddies.
The tourniquet is only one innovation that is now saving lives. Another is the Combat Life Saver, a designation for a soldier or Marine who has been taught advanced trauma lifesaving skills.
The idea of extending battlefield medical expertise beyond medics came from the Israeli army's experience during the Lebanon war in 1982. Trained non-medical soldiers were saving lives by providing immediate treatment, usually tourniquets to stop the bleeding, before medics could arrive.
U.S. Army medical officers pushed the idea, which was met with resistance by the generals, according to Army medical historian Lewis Barger. Yet a few combat units at Fort Bragg tested the practice anyway, and such training proved invaluable during the invasion of Panama in 1989.
Today, nearly all soldiers and Marines have had CLS training. Even in basic training, soldiers are required to master skills that go well beyond Boy Scout first aid, including controlling bleeding, inserting a breathing tube through the nostrils, decompressing a chest wound with a needle, mouth-to-mouth resuscitation, cardiopulmonary resuscitation (CPR) and calling in a medevac helicopter.