Attrition: The War On Massive Blood Loss

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July 3, 2012: The fighting in Iraq and Afghanistan during the last decade has resulted in major reductions in combat death rates. A major factor in this has been increases in the effectiveness and timeliness of medical care. Better body armor, tactics, weapons, training, and leadership also played a role, and the result was that troops in Iraq and Afghanistan were only a third as likely to die in combat as troops were in Vietnam, Korea, and World War II. But there's still room for improvement.

A recent analysis of the 4,600 combat deaths in Iraq and Afghanistan found that in a quarter of these cases it was possible to have prevented the death. What prevented soldiers from getting timely and appropriate medical care in these 1,100 cases was the fact that there was a battle going on. The most common cause of death here was loss of blood. Finding better ways to quickly stop massive bleeding is a major reason why combat deaths are down so much. For example, in the last decade ten percent of wounded troops died, compared to 16 percent in Vietnam, and 19 percent in World War II. That was all because of better treatment being applied more quickly.

The fighting in Iraq and Afghanistan has brought about a major change in how the United States deals with combat casualties. There are several reasons for this. The main one is that medics, and the troops themselves, are being trained to deliver more complex and effective first aid more quickly. Military doctors now talk of the "platinum 10 minutes," meaning that if you can keep the wounded soldier, especially the ones who are hurt real bad, alive for ten minutes their chances of survival go way up. To help make that happen medics have been equipped and trained to perform procedures previously done only by physicians, while troops are trained to do some procedures previously handled only by medics. All this increases the number of special procedures available on the battlefield, while the wounded are still under fire. This skill upgrade is made possible by a number of factors.

Over the last few decades there has been continuous development in methods and equipment for "emergency medicine" as practiced by ambulance crews and staff in emergency rooms. Military medics are trained to deliver emergency medical care under more dangerous conditions. The civilian stuff had slowly been coming over to the military but with the fighting in Iraq and Afghanistan, civilian innovations were quickly adopted by most military medical personnel.

Another change has been the high intelligence and skill levels of the volunteer military. High enlistment standards have largely gone unnoticed by most people, but within the military it's meant that combat troops, who are much brighter than at any time in the past, can handle more complex equipment and techniques. Getting the combat troops to learn these techniques for medical treatment is no problem because for them it could be a matter of life and death.

Another factor is the movement of medical teams, capable of performing complex surgery, closer to where the troops are wounded. These teams, like the medics and troops, have more powerful tools and techniques. This includes things like "telemedicine," where you do a videoconference with more expert doctors back in the U.S., to help save a patient. The speed is critical because if you can get a badly wounded soldier to the equivalent of a battlefield ER in less than ten minutes you can often save him. This has come to be known as the "platinum 10 minutes" and it has been accomplished by equipping medics and selected troops with medications and techniques that, in the past, only ER nurses or doctors would handle.

The "platinum 10 minutes" is part of a century old trend. During World War II the "golden hour" standard of getting wounded troops to an operating table was developed. Antibiotics were also developed at about the same time, along with the helicopter (whose first combat mission, in 1944 Burma, was to recover injured troops). So these new developments are not anything exotic but part of an ongoing effort.

In addition to several new battlefield techniques for stopping massive bleeding, the army is also putting more highly trained medical specialists closer to the battlefield. For example, the U.S. Army is training 1,200 critical care medics, at a cost of $45,000 each, in order to staff medical evacuation (medevac) helicopters with more highly skilled personnel. This will save a lot of lives. It was quite by chance that the army discovered how this can make a big difference. It all came about because the army collects and analyzes a lot of statistics. One that someone came across was the fact that medevac medics belonging to the National Guard (reserve) units had a 66 percent higher survival rate among the casualties they accompanied from the battlefield to the field hospitals. Taking a closer look it was found this was because the National Guard medics tended to be more highly trained, many of them being critical care emergency medical technicians in civilian life. This made the army realize that critical care trained medics on the medevac helicopters would make a difference. The first of these 1,200 new critical care medics will enter service this year. That’s because the training for critical care medics is an additional eight months, in addition to the basic four months for new combat medics. The critical care medics can perform a lot more procedures and recognize a much longer list of problems. Thus, existing, experienced medics are being given the additional training.

 


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