Wounded Survival Rate Now Double What it was in Vietnam

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Recent advances in combat medicine are saving servicemembers’ lives at unprecedented rates, the assistant secretary of defense for health affairs told a group of government and medical officials at a “Government Executive” event Wednesday.

Dr. S. Ward Casscells said new medicines, equipment, protective gear and better facilities have decreased the military’s died-of-wounds rate from 23.9 percent in Vietnam to 10.1 and 12 percent in Iraq and Afghanistan, respectively.

“Overall, the battlefield care is much better than even in Desert Storm one. It’s really not what the doctors are doing. It’s Soldiers taking care of themselves; Soldiers taking care of each other. The best-trained medics we’ve ever had. The most courageous medics we’ve ever had,” Casscells said, noting that 170 medics have given their lives in Iraq and many more have been wounded.

“We train…them to do very quickly what EMTs and even paramedics do in the civilian sector. They learn fast. They’re 18-year-old kids and they know they’re going to be using those skills, and they’re paying attention because they know that they themselves could be one of the patients. Don’t underestimate what an 18-year-old kid who decided to defer college to serve his or her country can learn. They can learn a hell of a lot,” he continued.

One of them is Staff Sgt. Matt Sims, who was wounded three times during his second deployment to Iraq, but was never evacuated out of theater. He credits both new equipment and the medical training of other Soldiers – every new Soldier must be certified as a combat lifesaver and many others have some medical training – with saving his life.

Sims, a medic now at Rader Clinic, Fort Myer, Va., demonstrated the differences between new bandages and tourniquets and old versions that date to the Vietnam War. Old bandages were often hard to open, didn’t stretch and were easy to tear. It was difficult to get a bandage to stick to a punctured lung. Medics would have to use three different dressings for a regular bandage, pressure bandage and tourniquet. They would have to find a stick to use the tourniquet.

Now, in addition to the tourniquets each Soldier carries and some that are built into uniforms, the same bandage can be converted to a pressure bandage and also a tourniquet. Each bandage is easy to open and has all the parts it needs. The Asherman Chest Seal comes with gauze and a one-way valve that lets air out of a punctured lung. Some bandages have charcoal or a material made from sterilized shrimp shells to stop bleeding.

Sims also said that medical officials have learned that tourniquets should be applied immediately to prevent blood loss, and that limbs are safe for up to eight hours. Casscells added that it’s better not to over-hydrate patients with saline to raise their blood pressure because this can inhibit clotting. Doctors also have advanced clotting factors they can give patients who are losing too much blood.

“Getting definitive care on the battlefield at the point of injury, I think, attests to most of the lifesaving on the battlefield. If you stop a bleed soon, keep a wound clean at the point of injury, it’s saving hundreds of lives,” said Sims, who also praised the extensive training medics and Soldiers get on how to use lifesaving equipment.

If servicemembers need to be evacuated from theater after receiving initial treatment at a combat support hospital, they travel in C-17s that have been converted to flying intensive-care units complete with nurses and ventilators. Most servicemembers are at a military hospital in the States within 72 hours of their injuries.

“No one, I mean no one, dies in (them),” said Casscells, who visits Walter Reed Army Medical Center every day he is in Washington.

Both he and Sims noted that burns were one of the hardest injuries to treat, and that the only thing medics can really do in the field is keep them clean. But the military will soon have nonrejectable skin and servicemembers will be able to save skin stem cells to help regenerate skin, said Casscells. The military is also working on skin-growth factors and scar inhibitors.

According to Casscells, the military is also sending servicemembers who need extensive reconstructive surgery to experienced plastic surgeons at the University of California Los Angeles hospital. Some of those surgeons are also training military doctors.

But he said that some of the most important research is in how to prevent burns from occurring at all. Soldiers wear flame-retardant clothing in certain vehicles, and Casscells said engineers are looking at ways to redesign vehicles to make the fuel tanks less dangerous to servicemembers.

“A lot of solutions to medical problems aren’t medical…They’re engineering solutions, they’re IT solutions, they’re culturation—persuading people not to plant that bomb—stuff like that. The burn thing is one of them,” he said.

Sims said that whatever solutions and equipment the military comes up with, they have to be items servicemembers will actually use.

“The Army can make the best equipment in the world for burns. Best equipment to stop bullets. Best helmets and things like that. But if they don’t make it comfortable, Soldiers will not wear it, no matter how expensive, no matter how much money they spend. I know from experience: if it’s not comfortable to wear in Iraq, where it’s 100 degrees, if you don’t make something that can breathe, that’s comfortable to wear, Soldiers aren’t going to wear it…It’s not doing any good if it’s lying on the side of the road or in the vehicle and they’re not wearing it,” he said, adding that leaders also need to make sure Soldiers use all of their protective gear.

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