Back in 1918, at the 11th hour of the 11th day of the 11th month, an armistice took effect, ending hostilities between the Allied Nations and Germany. This marked the end of World War I, the "war to end all wars."
Since then, we've gone through another World War and more than our share of conflict and battlefield injuries and deaths -- so much so that the original name of the holiday, Armistice Day to celebrate a hoped-for infinite peace, was changed to Veterans Day, to honor all the men and women who have served the country in all its wars. To them, we all owe our humble thanks.
Our technology moves as fast as the fighting to come up with new ways to save lives on the battlefield; amid the horror and heartbreak, there have been medical advances. To all of our benefit, breakthroughs born of war and its injuries make their way to our emergency rooms, hospitals, athletic fields and doctors' offices -- and this, of course, does not take into account the great medical talent, the many doctors, nurses and other care-givers trained in our armed forces.
Combat personnel today have a greater chance of survival than any war-wounded at any time in history. In the Revolutionary War, 42 percent of those hit in battle died of their injuries. Fast forward 150 years or so and still about 30 percent of those injured in World War II died of their wounds. In the Korean War, the Vietnam War and the first Gulf War about 24 percent of wounded soldiers died, despite medical advances.
But today's incursions in Iraq and Afghanistan have produced astonishing improvements that translate dramatically to lives saved. In the wars we're sending our forces to fight today, fewer than 10 percent of those wounded on the battlefield die of their wounds, representing a vast improvement in survival odds over any other war.
Communication and Speed Saves Lives
By far, what makes this possible are major changes in the speed at which care is begun. Instead of transporting the wounded to M.A.S.H.-style units, medical teams today move directly behind troops in Humvees carrying medical personnel and equipment -- equivalent to a fully equipped operating room -- prepared to set up right on the field. There, physicians stop bleeding and clean wounds. They provide essential damage control followed by quick transport to higher levels of care.
Within three days, seriously wounded fighters find themselves in technologically sophisticated hospitals in Landstuhl, Germany, or perhaps a military hospital in Washington, D.C., or Brooke Army Medical Center in San Antonio, Texas. (Read more here.)
During the Vietnam conflict, it was an average of six weeks before the wounded arrived at stateside military hospitals. For today's faster-paced medical transport system to work, the medical team needs meticulous systems of communication as a fighter's care is passed from one care-giving team in the field to the next in a combat support hospital to the next at a state-of-the-art military hospital. Medical personnel email pictures and medical records to those monitoring and preparing for the next phase of an injured patient's care, even as the military works toward developing more sophisticated telemedicine systems in the challenging environments of Afghanistan and Iraq. (Read more here.) Most importantly, doctors talk to each other constantly about patients' conditions as each transfer is made.
We saw the effects of such meticulous communication and speed of care in the civilian world in the aftermath of the tragic shootings of U.S. Rep. Gabrielle Giffords and nine others in Tucson, Ariz. Giffords landed in the sure hands of Dr. Peter Rhee, a Navy veteran who honed his surgical trauma skills on battlefields in Iraq and Afghanistan. If there is one thing to learn from military medicine today, it is the need for accurate and immediate communication among all health care providers.
Since 2003, about 12,000 wounded men and women have been evacuated from war zones to military hospitals, most by the U.S. Air Force's Critical Care Transport Team, the equivalent of a flying ICU. The improved treatment methods and technology aboard planes required for such timely transport has already made its way to civilian disaster relief.
During Hurricane Katrina, when so much went wrong, some things worked: hundreds of patients from flooded New Orleans institutions were moved safely to hospitals in other cities, transported by Air Force medical crews.
Stop the Bleeding
Before such transport is possible, the wounded must be stabilized, and these wars have resulted in an ongoing search for better ways to control bleeding immediately after injury. Today, the one-handed tourniquet is standard equipment, and our troops are trained to use it -- to help their buddies, or themselves.
Many war wounds don't lend themselves to tourniquet use, and the military has spent the past decade studying other options. Currently, guidelines call for using flexible gauze saturated with Kaloin, a substance that not only stops bleeding, but seals and protects the wound. Such technology can save lives on the home front as well, giving hemophiliacs and people taking blood-thinning medications less to fear from routine cuts and scrapes. Even as the new dressings are making their way into civilian ambulances, emergency rooms and onto high school gymnasiums, the Pentagon is investigating other materials and substances that may stop bleeding even faster.
Healing Limbs, Heads and Minds
Every war has its signature injuries, and the wars in Iraq and Afghanistan have, sadly, been the impetus for prosthetic research to replace lost limbs. Someone who has lost a leg today conceivably could own more artificial legs, designed at military prosthetics labs, than some people have shoes. Advances in materials, in socket design and in limbs that reproduce muscle-like activity can result in more natural movement patterns. Prosthetic legs are designed to help people walk. But they can now be customized with a springy response for runners, with knee movement to allow for pedaling a bike -- even with a mid-shin pivoting movement for the avid golfer. The field is wide open, with continuing research to encourage tissue to grow onto the prosthesis possibly laying the groundwork for direct nerve control of the limb.
Another signature injury from today's wars is traumatic brain injury, and our forces survive head injuries that would have killed them in earlier wars. Military surgeons were the first, for example, to remove portions of the skull to relieve pressure from a swelling brain. This technique was employed for Rep. Giffords to help save her life after she suffered a point-blank gunshot wound to the head.
And while post traumatic stress disorder, or PTSD, has likely been around since there were wars and other tragedies, research is attempting to better understand it over the long haul. One Department of Defense study will follow 3,000 Ohio National Guardsmen annually for a decade to examine PTSD while treating often-accompanying depression, anxiety and substance abuse. And despite the high cost ($12 billion in 2007) of treating veterans' mental illnesses and substance abuse problems, a recent study found such U.S. Department of Veterans Affairs treatment to be as good, or better, than mental health care in the civilian world.
It's ironic that for every advance in the human ability to kill and destroy comes a breakthrough in our ability to heal. During the Civil War, carts systematically removed casualties from the battlefield to hospitals, providing the model for postwar ambulance service. During the Spanish-American War, the military proved that mosquitoes carried yellow fever, paving the way for development of the Centers for Disease Control and Prevention. Mass-produced penicillin came out of World War II, and sophisticated helicopter evacuation of the wounded was first developed in the Korean and Vietnam wars, leading the way to civilian air medical transport systems.
Tragically High Cost
But the price for these advances is high. Because of the wars in Iraq and Afghanistan, more than 4,400 Americans have died. Some 66,000 military personnel have post traumatic stress disorder; about 175,000 have suffered traumatic brain injuries, with more than 5,000 of those brain injuries severe or penetrating; more than 1,000 people have had a limb amputated, and another 600 have lost a hand, a foot, a toe or a finger. (See the congressional statistical information.)
Thousands of warriors, many who would have died in earlier wars, are coming home. For them, the fight to figure out a new way to live with the consequences of their injuries and experiences is just beginning. (David Wood has written a compelling, heart-breaking series on this topic for The Huffington Post.) So, take a moment on this Veterans Day to honor the nation's fighting forces and those who care for them and pause to remember those who never came home. We also should wish that those who would rush to hurl our brave men and women into harm's way comprehend the solemn, lifetime consequences their actions may have on the bodies and psyche of our heroes in uniform.
Coleen Rowley: 11/11/11 Will Be Celebrated as Originally Intended: As Armistice Day!
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