U.S. Combat Fatality Rate Lowest Ever
Technology and Surgical Care at the Front Lines Credited With Saving Lives
Back to the War Links PageBy Ceci Connolly
Washington Post Staff Writer
Thursday, December 9, 2004; Page A24Ten percent of soldiers injured in Iraq have died from their war wounds, the lowest casualty fatality rate ever, thanks in large part to technological advances and the deployment of surgical SWAT teams at the front lines, an analysis to be published today has found.
But the remarkable lifesaving rate has come at the enormous cost of creating a generation of severely wounded young veterans and a severe shortage of military surgeons, wrote Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston.
The war in Iraq has produced the "largest burden of casualties our military medical personnel have had to cope with since the Vietnam War," said Gawande's report in the New England Journal of Medicine. By contrast, 24 percent of soldiers wounded in the Vietnam War or the Persian Gulf War did not survive.
"It used to be our thinking that the number of deaths reflects the violence of the war," Gawande said in an interview. "Now, the number of deaths reflects how well surgical teams are doing in saving lives."
More than 10,300 U.S. service members have been injured in Iraq and more than 1,000 of them killed in action, according to Defense Department statistics cited in the report. "This can no longer be described as a small or contained conflict," Gawande wrote.
He praised the military's strategy of positioning close to the fighting smaller, "leaner and more mobile" surgical teams with the ability to erect a battlefield hospital in less than 60 minutes. Traveling in Humvees with hand-held ultrasound machines, portable ventilators, supplies of red blood cells and an array of surgical tools and pharmaceuticals, the teams focus on stabilizing patients and moving them for further treatment in less than two hours.
During the Vietnam War, it took injured soldiers an average of 45 days to reach a hospital in the United States. At the beginning of the Iraq war, the average was eight days, and now it is four. One airman hit by a mortar attack in September "was on the operating table at Walter Reed" Army Medical Center here "just 36 hours later," Gawande said.
The battlefield triage is called "damage control" because the emphasis is on stopping bleeding, keeping a patient warm and leaving almost everything else to doctors at a permanent hospital.
"The combination of Kevlar vests and a system that allows them to stop the bleeding makes it possible for them to survive injuries that were unsurvivable before," he said. "How you rehabilitate physically, let alone emotionally, someone who has that kind of loss is a serious question."
For every soldier killed, an average of 10 are injured, he said. Gawande found similarly low fatality rates among soldiers wounded in Afghanistan.
Early in the Iraqi conflict, when the fighting was more traditional battlefield combat, the most common injuries came from wounds to limbs that were not protected by body armor. More recently, as the engagement has shifted to guerrilla-style warfare with explosive devices, more injuries result from shrapnel that hits under vests and through neck- and armholes, Gawande said.
"And with suicide bombers, you see not just metal shrapnel, but also clothing, dirt and even bone from the attacker that is infectious," he said, "and can lead to more extensive surgeries and multiple surgeries."
With just 120 general surgeons on active duty in the Army and a similar number in the reserves, Gawande argued the teams are overextended and operating in far more dangerous circumstances.
"Many surgeons have been on a second deployment or an extended deployment, and even this has not been sufficient," he wrote. "Planners are having to contemplate pressing surgeons into yet a third deployment."
The American Medical Association and the state surgeon of the Wisconsin Army National Guard have expressed concerns that the Selective Service System may revive procedures for drafting medical personnel. Such a plan "was not undertaken at the request of anyone" at the Pentagon, a Defense Department statement said yesterday. "Furthermore, there is no need for such a plan."
Col. John B. Holcomb, commander of the U.S. Army Institute of Surgical Research, agreed that Iraq can no longer be viewed as a minor conflict. But he said the casualty rate and severity of injuries is not inconsistent with other wars.
A review of historical documents shows that "head and extremity injuries predominate, at least back to World War I, World War II, Korea and Vietnam," he said. Perhaps Gawande, who lacks military experience, was unaccustomed to the level of trauma seen in war, Holcomb said.
"The injuries in combat are devastating compared to what most civilian surgeons are used to seeing," he said, adding that the closest parallel he could think of were injuries sustained by someone run over by a train.
The number of general surgeons serving in Iraq is not as high as in the Persian Gulf War 13 years ago, Holcomb acknowledged. However, he said the key was placing the right doctors and nurses in the right place.
Iraq has brought other unanticipated medical challenges. Soldiers were suffering a "dismayingly high incidence of blinding injuries" because they refused to wear goggles that they described as " 'something a Florida senior citizen would wear.' So the military bowed to fashion," Gawande said, and purchased hipper protective eyewear that appears to be serving its purpose.
© 2004 The Washington Post Company
Reply 1 - Posted by: nihtwael, 12/9/2004 1:57:57 AM
Wait a sec, are we talkin' about the same quagmire here, the Mother of All Wars...?
Reply 2 - Posted by: StormCnter, 12/9/2004 5:47:14 AM
Fox's sometimes twinkie, Ceci, seems to think it is better to die than to survive severe injuries. The whole article is a scare piece that..gasp...we may draft doctors, and ...gasp...there will be a lot of badly handicapped survivors of this war, and .....gasp....all of this was unnecessary.
Reply 3 - Posted by: morgoth, 12/9/2004 7:11:14 AM
The flip side is that we will have many more severely wounded veterans to look out for. Be aware of this and choose your charities accordingly. Men and Women who give life and limb deserve our total support.
Reply 4 - Posted by: PocaDon, 12/9/2004 8:18:38 AM
This is a good article that raises serious questions such as the emotional comeback from such devastating injuries
Just 240 general surgeons are performing miracles. God bless them
Reply 5 - Posted by: hillarymustbestopped, 12/9/2004 9:03:14 AM
Is the NYT or the AP reporting this?
Reply 6 - Posted by: TunnelRat, 12/9/2004 9:22:38 AM
The highly effective body and vehicle armor our troops use has allowed many soldiers to survive explosions that would otherwise have been fatal. The downside is that we have an unusually high number of multiple amputees from this conflict.
My son goes back for his second tour in January...
Reply 7 - Posted by: Texas Pete, 12/9/2004 9:31:57 AM
Our young men and women are surviving wounds that would have been fatal in earlier wars. The better body armor, better medical techniques, vastly improved speed of medevac and the fact that most of the incidents where people are wounded tend to be of shorter duration all lead to this, as well as improved first aid training to the nonmedical troops.
It's going to be up to us, the voting citizens, to see that the VA is up to the task ahead.
Our Congressional Reps will be home for the Christmas break for the next few weeks, time to try for a face to face meeting to make sure they're interested in watchdogging the VA.
Reply 8 - Posted by: Hermoine, 12/9/2004 9:43:15 AM
1. We need to support all of vets, especially the ones with injuries, physical or psychologica.
2. The question seems to be would we rather them die in combat or live with injuries, even severe ones. I know Vietnam Vets who came back with severe injuries who went onto lead extraordinary lives. The remedies and assistive technology devices in today's new age of technology means that many of these vets, even amputess, will have a chance at living a more fruitful life.
Reply 9 - Posted by: weejun, 12/9/2004 10:31:02 AM
I suggest a portion of the Iraqi oil sales be set aside to provide long term care for our troops wounded and/or harmed in this conflict. Much of the world (and some of our own misguided citizens) accuse us of only going in there for oil anyway, so why not put some of that resource we're "stealing" towards a good cause?
Reply 10 - Posted by: wnaegele, 12/9/2004 10:56:01 AM
This article damns with faint praise -- if poor Ceci Connolly weren't a mere female, she would be a good catch for Al Jazeera ...
Reply 11 - Posted by: talkhard, 12/9/2004 1:09:45 PM
"But the remarkable lifesaving rate has come at the enormous cost of creating a generation of severely wounded young veterans"
A "generation"?! What the heck are they talking about? It's a few thousand injured soldiers, but it's certainly not a "generation." Talk about trying to put a negative spin on a remarkably positive story!
Reply 12 - Posted by: ussalaska, 12/9/2004 2:20:43 PM
see-sea comrade never met a story {under the Bush administration} that didn't have a negative side. This smarmy she beach has such a snide look on her twisted face, I'd just like to beach slap her. They did a brain scan on c-c rider, and it came back EMPTY. Just another liberal twit that has her thong in a knot.
Reply 13 - Posted by: NYbob, 12/9/2004 2:26:20 PM
Lots of people seem to think this war can be stopped, that it was a mistake, that somehow all this pain can be avoided. Maimed and dead G.I.s are an awful thing, but so was a plane of commuters fighting for their lives before being impacted into mincemeat in Somerset County. So was tens of thousands of urban workers doing whatever they could to avoid being blown up in the WTC. A LOT of death and injuries that day. The ONLY reason Ceci and others aren't dropping over from anthrax or backpack bombs is because we have ENOUGH Americans who are smoking out the nest of killers who started this. A lot of good people have died and many suffered because scum are trying to drag the world down. More will die, it's unavoidable. You don't have to get used to it, but you ought to understand it.
Reply 14 - Posted by: mb, 12/9/2004 2:42:59 PM
Very eloquent, #13. I agree whole heartedly.
Reply 15 - Posted by: nolie, 12/9/2004 3:00:31 PM
I don't remember the quote, but Dizzy Dean used to say "Statics" could prove anything.
Reply 16 - Posted by: naturfot, 12/9/2004 3:42:16 PM
The doctors have a job where they can actually work and not have to worry about law suits. PTL for them.
Reply 17 - Posted by: drumleggagh, 12/9/2004 3:43:37 PM
As my college statistics professor once said, "Statistics are like a bikini - what they reveal is interesting, what they conceal is vital!"
Reply 18 - Posted by: canyonero, 12/9/2004 5:00:53 PM
Iraq isn't payback for 9/11, so #13 should go blow.
Reply 19 - Posted by: wrogers, 12/9/2004 7:28:22 PM
Iraq is not "payback for 9/11" indeed...but it is a major beach head in the Muslim Middle East that happens to border every country that we might have to take out. It also was the impetus for Saudi Arabia to take a stand against militant Islam -a sea change from supporting it- the success of which was demonstrated by the first Al Quaeda attack on the House of Saud.
Finally, Iraq is to WWIV what Guadalcanal was to WWII: a necessary piece of real estate paid for at great price.
Reply 20 - Posted by: diesel, 12/9/2004 7:53:33 PM
I agree with #13, #18 thinks Iraq is the only country in the world that doesn't have terrorist. The front line against terror is now being fought in Iraq and not in New York or LA, although I wouldn't mind a little in Hollyweird. The war also exposed the UN and shows how they are totally useless. Same goes for the French, Germans, Russians ect. An ex military friend at work has it correct when he says we now have a threshold to keep a close eye on the despots over there.
Reply 21 - Posted by: NYbob, 12/9/2004 8:07:17 PM
#18, more of the left's eloquence. So positive it's view on world history, military planning and future foreign policy is correct. Pray tell us exactly what a 'progressive' would do. Allow Iraq to continue developing WMDs, pay suicide bombers, buy longer range missles from N. Korea, host BeenHiding's inner cirle, put assasination squads out to kill former Presidents, etc.? Or is all you got a grade school insult? BTW, it's OK to tout skerry's big plan to end the war. Let's hear it and please don't say it involves France saving us.
Reply 22 - Posted by: cannonfodder, 12/9/2004 8:24:09 PM
Ask any spouse if they want their loved one to come back home alive. They will all say yes. These military men and women are loved and wanted, despite any horrible injuries they may have.
Shame on any one for thinking otherwise.
Reply 23 - Posted by: rlwo, 12/10/2004 12:39:27 AM
#18 is nothing but a site pest.
