“The soldier, above all other people, prays for peace, for he must suffer and bear the deepest wounds and scars of war.” Douglas MacArthur

From 1967 to 1970, during the Vietnam War, my first assignment as a junior Air Force 2nd Lieutenant, was as Administrative Officer of the 4th Casualty Staging Flight attached to Wilford Hall USAF Medical Center, Lackland AFB in San Antonio, Texas. We received combat casualties still in battlefield bandages, often within 24 hours of injury, and either admitted them to Wilford Hall or further transported them to hospitals near home.

Recently it occurred to me to look back at how battlefield casualties were handled going back to the Revolutionary War and forward to Iraq/ Afghanistan. BATTLEFIELD MEDICINE is now a medical discipline! (But battlefield surgeon readiness may be at risk.)

BATTLEFIELD MEDICINE. “A war benefits medicine more than it benefits anybody else. It’s terrible, of course, but it does.” *

Introduction

SURGEONS IN EVERY branch of service in military hospitals worldwide perform complex, high-risk operations on active-duty personnel, their family members and some retirees in such small numbers that they may put patients at risk, a U.S. News & World Report investigation has found.

Three decades of research has shown doctors and hospitals with the highest volumes of certain complex surgical procedures achieve the best results. But military surgeons serve a population that’s relatively young and healthy. They lack the steady stream of older patients requiring surgery that would allow the doctors to sharpen their skills and sustain their readiness to help troops on the battlefield.

“You want to do more. In some cases, you’re begging to do more,” says Dr. Scott Steele, chair of colorectal surgery at the Cleveland Clinic, a West Point Graduate, former Army surgeon and Bronze Star recipient with more than two decades of service, including deployments in Iraq and Afghanistan…

The U.S. News analysis suggests that the surgical case shortage, coupled with the remoteness of some base hospitals from larger military or civilian medical centers, prompts some surgeons to tackle cases that may exceed their surgical skills…”  (A)

THE REVOLUTIONARY WAR

“When the Revolutionary War began its actual skirmishes in 1776, early attempts to prepare for the medical needs related to War were made in the City of New York. During the spring and summer of 1776, Samuel Loudon was publishing his newspaper the New York Packet, in which he included numerous articles and announcements regarding the Continental Army. On July 29, for example, came the following announcement written by Thomas Carnes, Stewart and Quartermaster to the General Hospital of King’s College, New York. Anticipating an increase demand for medically trained staff, he filed the following request for volunteers:

“GENERAL HOSPITAL New-York, July 29, 1776 Wanted immediately in the General Hospital, a number of women who can be recommended for their honesty, to act in the capacity of nurses: and a number of faithful men for the same purpose…King’s College, New York” (A)

“One of the most famous surgeons, and the first, was Cornelius Osborn. He was recruited in the Spring of 1776 and had little training even as a physician. The Continental Congress was even concerned about the well-being of the troops and the militia. They passed several ordinances and helped establish the order for the several field Hospitals during the War. The hospitals served about 20,000 men in the fight. Each hospital was required for each surgery to have at least one physician or surgeon, and one assistant, which was usually and apprentice of some sort. Each hospital’s staff numbers varied on how many wounded it served and the severity of the wounds….

Most of the deaths in the Revolutionary War were from infection and illness rather than actual combat. The common practice if a limb was badly infected of fractured was to amputate it, where most amputees died of gangrene a result of not properly cleaning instruments after surgeries. Only 35% of amputees actually survived surgery. There were no pain killers quite developed back then. So at most the patient were given alcohol and a stick to bite down on while the surgeon worked. Two assistants would hold him down, a good surgeon could perform the entire process in a mere 45 seconds, after which the patient usually went into shock and fainted. This allowed the surgeon to stich up the wound and prepare for the next amputation. Another way they decided to clean wounds, disease, or infection was by applying mercury directly to the cut of injured space, and letting it run through the blood stream which usually resulted in death.” (B)

“To seek treatment for any serious ailment, a soldier would have had to go to a hospital of sorts. Military regiments had a surgeon on staff to care for the men, so the soldier’s first stop would be with the surgeon. During battles, the surgeon could be found in a makeshift or “flying” hospital that consisted of a tent, an operating table, and some medical equipment. If the surgeon could not treat the soldier, he might be sent to a hospital. Many regimental hospitals were in nearby houses, while general hospitals for more in-depth treatment were sometimes set up in barns, churches, or other public buildings. The conditions were often cramped, which resulted in the rapid spread of contagious illnesses and infections….

Woe to the soldier who required surgery after being wounded on the battlefield! The conditions in “flying” hospitals were deplorable. Not only was the operating room simply a table in a tent, but there was little thought given to keeping the table and tools clean. In fact, wounds were sometimes cleaned using plain water from a bucket, and the used water would be saved to clean out the next soldier’s wounds as well.” (C)

“Hospitalization was a serious problem during the American Revolutionary War. Plans were made quite early to care for the wounded and sick, but at the best they were meager and inadequate. However on April 11, 1777 Dr. William Shippen Jr., of Philadelphia was chosen Director General of all the military hospitals for the army. Consequently the reorganization of hospital conditions took place…

After the battle of Brandywine, September 11, 1777, hospitals were established at Bethlehem, Allentown, Easton and Ephrata. After the battle of Germantown, October 4, 1777, emergency hospitals were organized at Evansburg, Trappe, Falkner Swamp and Skippack. Hospitals at Litiz and Reading were also continued. By December 1777, new hospitals were opened at Rheimstown, Warwick and Shaeferstown. Yellow Springs (now Chester Springs) an important hospital was organized under the direction of Dr. Samuel Kennedy. At Lionville, Uwchlan Quaker Meeting House was also made a hospital for a time. Apothecary General Craigie’s shop, Carlisle, was the source of hospital drugs….” (D)

WAR of 1812

“The big advances in military medicine were decades away.  William Morton would develop ether anesthesia for surgery, but not before 1846.  Florence Nightingale would create the professional nurse and reform the British hospital, but not until 1857.  Robert Koch would put forth his germ theory in 1890.  Although the War of 1812 took place well before these advances, there were many skilled military surgeons, most of them aware of the salutary effects of cleanliness.

At one Army hospital in Burlington, Vermont for example, the ward master had a long list of rules: chamber pots were to be cleaned at least three times a day and lined with water or charcoal.  Beds and bedclothes were to be aired daily and exposed to sunlight when possible. Once a month the straw in each bed sack was to be changed. If a patient died, the straw was to be burned…

Skilled as some practitioners were, the war took place in a period when some medical attention could kill you.  Army doctors used emetics to cause vomiting and cathartics to cause diarrhea, both as stomach cleansers.  Patients were sometime bled intentionally.  These cures often left the patients weak, dehydrated and unlikely to survive.

Battle injuries, of course, just compounded the misery.  A bullet in the head, chest or abdomen meant almost certain death.  A bullet in the limbs meant a twenty percent chance of death if the wound was cleaned and in most cases the limb amputated…

Stoicism seemed to be the watchword of the day.  There are accounts of soldiers singing, joking, and even smoking during an amputation.  People at this time were familiar with pain, and soldiers were expected to rise to the occasion. Recovery took place in the hospital, where, in some units, a soldier received half-rations and half-pay as an incentive to get well quickly.” (A)

“Military surgeons often resorted to so-called “heroic” treatments. Those treatments often seem crude and sometime barbaric to modern eyes. Bleeding, the deliberate opening of vein to remove blood from a patient, was thought to reduce blood volume and reduce fever and infection. Blistering, the practice of creating a skin infection on the patient, was thought to lead to pus that would carry away infection. Other physicians deliberately induced vomiting in an attempt to combat disease. Such practices were seldom helpful and often made the patient’s condition worse.

Among the items found in a surgeon’s medicine chest were opium and alcohol, useful for pain management, and quinine, found to be effective in treating malaria. But many drugs were either unhelpful or, in the case of the mercury used to treat syphilis, quite toxic.

Army medicine also suffered from some basic organizational shortcomings. The War Department was ill prepared when the conflict broke out in 1812. Officials had no standardized system of accounting for or replenishing its medical supplies, or for evaluating the competency and training of its medical staff.

But as the conflict wore on, army medicine improved noticeably. Congress created the post of surgeon general and outlined professional qualifications for selecting surgeons. In addition, the Congress attempted to improve cleanliness among soldiers through better camp sanitation, and tried to alleviate hospital overcrowding. Over time, the contents of the surgeon’s medicine chest became standardized, and a better system of hospitals emerged. Permanent hospitals were located well to the rear, away from the fighting, and linked to more mobile, “flying hospitals” closer to the front lines.

But in many ways, the most intractable problem remained the scientific unknowns. Solutions to the fundamental puzzles—the nature of disease, how it was transmitted, and how to prevent infection—remained several decades away. More often than not, army doctors found themselves groping in the dark for answers.” (B)

MEXICAN WAR

“Disease posed far greater threat than the battlefield. In addition to ubiquitous camp diseases like dysentery that had hounded Taylor’s army before it ever crossed the Rio Grande, the rainy season and its mosquito-borne malaria came directly on the heels of the city’s occupation and further compounded public health woes for all of Matamoros’ residents.[6] Smallpox, too, carried off its share of victims. Although all American soldiers were supposed to have been vaccinated against the disease upon entering the army, volunteers sometimes fell through the cracks in the rush to deploy troops, and one army surgeon complained his supply of the vaccine had been ruined by the Mexican heat.[7] Most to be feared was the deadly yellow fever, and with the help of correspondents on other battlefronts in Mexico and from coastal U.S. cities like New Orleans and Mobile, the bluntly titled English language newspaper The American Flag carefully tracked the fever’s progress throughout the Gulf of Mexico.[8]” (A)

To care for the many sick in General Taylor’s command, surgeons set up eight regimental hospitals, each sheltered in two or three large hospital tents, and a general hospital, housed in a large frame building in Corpus Christi. In the latter facility, those whose illness was likely to be prolonged joined the overflow of patients from the regimental hospitals. The medical staff manning these hospitals included the medical director for Taylor’s force, Presley H. Craig, Jarvis as director of the general hospital, a purveyor, and thirteen more department physicians. Three civilian doctors were hired until more Regular Army surgeons could be assigned to Taylor’s command..” (B)

“From the founding of the nation and throughout the first half of the 19th century, drugs were not regulated by the federal government. Problems with drug impurity were episodic, and when occurring, they were usually contained within a state or a region. The usual reaction to a case involving impure or bogus medicine was a call for reform at state houses with individual states instituting laws governing aspects of drug manufacture and trade, but these regulations were spotty at best. The situation changed during the MexicanAmerican War, which began in 1846 and ended in 1848…

Although the high death rate had many contributing factors from compromised food provision and poor living conditions to infectious diseases, public outrage focused on the medical care given to soldiers. It was concluded that adulterated drugs supplied to the Army had caused the large numbers of deaths among soldiers.

This enraged the public, and the outcry led Congress to pass the Drug Importation Act of 1848, the first federal drug law. It was very limited in scope and addressed only the purity of drugs imported into the United States. Congress charged Customs with enforcing the law. Special examiners were appointed at six major ports of entry—New York, Boston, Philadelphia, Baltimore, Charleston, and New Orleans. They checked the “quality, purity, and fitness for medical purposes” of imported drugs using the major  pharmacopoeias (publications describing drugs) and dispensatories for standards.” (C)

THE CIVIL WAR

 “Many of America’s modern medical accomplishments have their roots in the legacy of America’s defining war.”

“During the 1860s, doctors had yet to develop bacteriology and were generally ignorant of the causes of disease. Generally, Civil War doctors underwent two years of medical school, though some pursued more education. Medicine in the United States was woefully behind Europe. Harvard Medical School did not even own a single stethoscope or microscope until after the war. Most Civil War surgeons had never treated a gunshot wound and many had never performed surgery. Medical boards admitted many “quacks,” with little to no qualification. Yet, for the most part, the Civil War doctor (as understaffed, underqualified, and under-supplied as he was) did the best he could, muddling through the so-called “medical middle ages.” Some 10,000 surgeons served in the Union army and about 4,000 served in the Confederate. Medicine made significant gains during the course of the war. However, it was the tragedy of the era that medical knowledge of the 1860s had not yet encompassed the use of sterile dressings, antiseptic surgery, and the recognition of the importance of sanitation and hygiene. As a result, thousands died from diseases such as typhoid or dysentery…

Battlefield surgery…was also at best archaic. Doctors often took over houses, churches, schools, even barns for hospitals. The field hospital was located near the front lines — sometimes only a mile behind the lines — and was marked with (in the Federal Army from 1862 on) with a yellow flag with a green “H”. Anesthesia’s first recorded use was in 1846 and was commonly in use during the Civil War. In fact, there are 800,000 recorded cases of its use. Chloroform was the most common anesthetic, used in 75% of operations. ..A capable surgeon could amputate a limb in 10 minutes. Surgeons worked all night, with piles of limbs reaching four or five feet. Lack of water and time meant they did not wash off hands or instruments

Bloody fingers often were used as probes. Bloody knives were used as scalpels. Doctors operated in pus stained coats. Everything about Civil War surgery was septic. The antiseptic era and Lister’s pioneering works in medicine were in the future. Blood poisoning, sepsis or Pyemia (Pyemia meaning literally pus in the blood) was common and often very deadly…” (A)

“Early on, stretcher bearers were members of the regimental band, and many fled when the battle started. Soldiers acting as stretcher bearers rarely returned to the front lines. As the war evolved, stretcher bearers became part of the medical corps. At the battle of Antietam, there were 71 Union field hospitals. As the war went on, these were consolidated. There were ambulances here that were used to bring the wounded to temporary battlefield hospitals, which were larger, often under tents, and out of artillery range. Later in the war, patients were transported to large general hospitals by train or ship in urban centers. These did not exist when the war began. There was no military ambulance corps in the Union Army until August of 1862. Until that time, civilians drove the ambulances. Initially the ambulance corps was under the Quartermaster corps, which meant that ambulances were often commandeered to deliver supplies and ammunition to the front…

Large general hospitals were established by September of 1862 (11). These were in large cities, and soldiers were transported there by train or ship. At the end of the war, there were about 400 hospitals with about 400,000 beds. There were 2 million admissions to these hospitals with an overall mortality of 8%. In the South, the largest general hospital, Chimborazo, was in Richmond, Virginia. It was built out of tobacco crates on 40 acres. It contained five separate hospitals, each made up of 30 buildings. There were 150 wards with 40 to 60 patients per ward. The census was as high as 4000. They treated about 76,000 patients with a 9% mortality (12)…”  (B)

Most of the major medical advances of the Civil War were in organization and technique, rather than medical breakthroughs. In August of 1862, Jonathan Letterman, the Medical Director of the Army of the Potomac, created a highly-organized system of ambulances and trained stretcher bearers designed to evacuate the wounded as quickly as possible…

A system of triage was established that is still used today. The sheer number of wounded at some of the battles made triage necessary. In general, the wounded soldiers were divided into three groups: the slightly wounded, those “beyond hope”, and surgical cases. The surgical cases were dealt with first since they would be the most likely to benefit from immediate care. These included many of the men wounded in the extremities and some with head wounds that were considered treatable. The slightly wounded would be tended to next, their wounds were not considered life-threatening so they could wait until the first group was treated. Those beyond hope included most wounds to the trunk of the body and serious head wounds. The men would have been given morphine for pain and made as comfortable as possible…

Due to the sheer number of wounded patients the surgeons had to care for, surgical techniques and the management of traumatic wounds improved dramatically. Specialization became more commonplace during the war, and great strides were made in orthopedic medicine, plastic surgery, neurosurgery and prosthetics. Specialized hospitals were established, the most famous of which was set up in Atlanta, Georgia, by Dr. James Baxter Bean for treating maxillofacial injuries. General anesthesia was widely used in the war, helping it become acceptable to the public. Embalming the dead also became commonplace.

Medical technology and scientific knowledge have changed dramatically since the Civil War, but the basic principles of military health care remain the same. Location of medical personnel near the action, rapid evacuation of the wounded, and providing adequate supplies of medicines and equipment continue to be crucial in the goal of saving soldiers’ lives.” (C)

“Many misconceptions exist regarding medicine during the Civil War era, and this period is commonly referred to as the Middle Ages of American medicine. Medical care was heavily criticized in the press throughout the war. It was stated that surgery was often done without anesthesia, many unnecessary amputations were done, and that care was not state of the art for the times. None of these assertions is true. Actually, during the Civil War, there were many medical advances and discoveries..

Medical Use of quinine for the prevention of malaria

Use of quarantine, which virtually eliminated yellow fever

Successful treatment of hospital gangrene with bromine and isolation

Development of an ambulance system for evacuation of the wounded

Use of trains and boats to transport patients

Establishment of large general hospitals

Creation of specialty hospitals

Surgical Safe use of anesthetics

Performance of rudimentary neurosurgery

Development of techniques for arterial ligation

Performance of the first plastic surgery..”  (D)

SPANISH-AMERICAN WAR

“In the three decades between the Civil War and the Spanish-American War, virtually all practical experience of trauma medicine evaporated. Yet in those years, medicine advanced. The 1893 appointment of George Sternberg to Surgeon General allowed the rise of bacteriology and many other vogue advancements to be incorporated into trauma medicine. Additionally, the opening of 200 nursing schools across the United States kept attendant medical practitioners well-versed on germ theory and sterilization…

The Spanish-American War of 1898 was brief, with relatively few battle casualties, but epidemic disease, especially typhoid fever, devastated the volunteer troops. Post-war investigations and commissions generated better understanding of the problem of asymptomatic carriers and a series of recommendations that greatly improved military medicine. The new practices, including the development of a typhoid vaccine, saved thousands of lives during World War I. Studies that established the role of the mosquito in yellow fever spawned preventive measures that ended the huge epidemics of that disease in the Western Hemisphere; this in turn made possible successful construction of the Panama Canal…

New forms of surgical dressings especially designed for field use, composed of sterilized, sublimated, and iodoform gauze; sterilized gauze bandages, absorbent cotton, catgut, and silk, sterilized and packed in convenient envelopes; tow, compressed cotton sponges, and plaster of paris bandages were also prepared under the immediate supervision of this office…”  (A)

“Despite the lessons learned in the Civil War, the government had taken no concerted steps toward establishing a skilled nursing service to care for the sick and wounded during wartime…

The war with Spain was quickly demonstrating the important need for trained nurses as hastily constructed army camps for more than twenty-eight thousand members of the regular army were devastated by diarrhea, dysentery, typhoid fever, and malaria— all of which took a much greater toll than did enemy gunfire.

As a result of their work in the Civil War, religious sisters were recognized for providing skilled nursing services. In view of the urgent need for medical assistance in the summer of 1898, it was no surprise when the government called for every nursing sister who could be spared. Official government records indicated that the various orders furnished around 250 sister nurses, with the Daughters of Charity (originally referred to in the United States as Sisters of Charity), providing the majority of nurses.8 Although members of other orders were represented, their numbers were considerably less” (B)

World War I

Medicine, in World War I, made major advances in several directions. The war is better known as the first mass killing of the 20th century—with an estimated 10 million military deaths alone—but for the injured, doctors learned enough to vastly improve a soldier’s chances of survival. They went from amputation as the only solution, to being able to transport soldiers to hospital, to disinfect their wounds and to operate on them to repair the damage wrought by artillery. Ambulances, antiseptic, and anesthesia, three elements of medicine taken entirely for granted today, emerged from the depths of suffering in the First World War…

Antiseptics and anesthesia saved lives once they arrived at the hospital, but without motor ambulances and hospital trains to get them there, wounded soldiers stood little chance. From the impromptu rescue of soldiers from Meaux in September 1914, the American Ambulance Field Service grew to number more than 100 ambulances by the end of the first year of the war. Philanthropists such as Anne Harriman Vanderbilt bought cars, as did civic groups from cities around the United States. The Ford Motor Company donated 10 Model-T chassis to be converted into ambulances…

What inspired these major advances in medicine? There was a deep need, and people stepped up to find solutions. The new technology of war—heavy artillery, long-range cannons, barrage shelling, and machine guns—rained devastation at unprecedented levels. Medicine had to try to keep up. One good example of this evolution is in facial reconstruction surgery. Soldiers survived having jaws and noses shattered by artillery fragments, so surgeons at the American Hospital and Val-de-Grace Hospital pioneered maxillofacial techniques, and at the same time, brought dentistry into the medical sciences in France.”  (A)

“On the battlefields, physicians employed recently invented medical technology in addressing their patients’ injuries. The X-ray machine, which had been invented a couple decades before the war, was invaluable for doctors searching for bullets and shrapnel in their patients’ bodies. Marie Curie installed X-ray machines in cars and trucks, creating mobile imaging in the field. And a French radiologist named E.J. Hirtz, who worked with Curie, invented a compass that could be used in conjunction with X-ray photographs to pinpoint the location of foreign objects in the body. The advent of specialization within the medical profession in this era, and the advancement of technology helped to define those specialized roles.” (B)

WORLD WAR II

“Battlefield medicine evolved considerably between World War I and World War II. In the former, approximately 4 out of every 100 wounded men could expect to survive; in the latter, the rate improved to 50 out of 100…

A number of new drugs and medical techniques developed in the years between the world wars dramatically improved the survival rate among the sick and injured. For example, combat medics (and even men in the field) carried packets of sulfanilamide and sulfathiazole to coat wounds as a first line of defense against infection. Antibiotics such as streptomycin and penicillin also helped save the lives of countless soldiers…

American servicemen were also inoculated for a wide variety of diseases before being shipped overseas. The most common vaccinations were for smallpox, typhoid, and tetanus, though soldiers assigned totropical or extremely rural areas were also vaccinated for cholera, typhus, yellow fever, and, in somecases, bubonic plague.” (A)

“World War Two was a time where medicine began catching up with evolving technology.  In World War One infection took the lives of many soldiers along with disease.  The number of deaths from injury complications motivated scientists and doctors to determine cures for infection…  

One development was the creation of Penicillin.  It was created pre-war but was not used in large quantities till World War Two.  The first batches in 1939 were weak, but through determination a new version, 20 times more strong, came out in 1945 ().  On D-Day penicillin was used en masse, saving thousands of lives and strengthening America’s cause.  It saved many lives, but still left many to die because the time lapse between injury and treatment still remained very broad.  However, the number of people being infected was vastly decreased and survival chances were greatly increased…

The mediocre blood transfusion process was also greatly improved upon in World War Two.  Primitive techniques became more advanced, and the system of storing and distributing blood became more efficient.  With a better system of storing blood, blood was usually available when a soldier needed it.  The blood was also most likely fresher and less contaminated since the containers were better constructed.  However, blood was often in short supply.”  (B) 

“A major contribution of the 20th century was the widespread recognition and treatment of what we now call post-traumatic stress disorder, or PTSD. It has probably existed back into history. There are case reports from the Civil War, for example. During World War I, it was sometimes called “shell shock,” which probably included cases of actual brain damage. More often soldiers suffering from PTSD were diagnosed as “cowardice.” Soldiers were shot for it in the British, French, German, Austrian, and Russian armies. As the war dragged on, it became better recognized, but its treatment varied widely. The Russians tried to treat near the front lines, sending the soldiers back to their units as early as feasible. We adopted that practice, and in fact, armies today still treat psychiatric casualties this way. What may seem heartless, actually proved to be the most effective way to treat PTSD and to prevent long term sequelae. The recognition of PTSD as a psychiatric disease of war was not firmly established until World War II. They called it “combat fatigue.” But whatever they called it, they recognized it and treated it.” (C)

KOREAN WAR

“Though the Korean War came to be regarded as a failure by many because of its unsettled conclusion, in one area it was an unreserved success: the care and treatment of wounded soldiers. In World War II, the fatality rate for seriously wounded soldiers was 4.5 percent. In the Korean War, that number was cut almost in half, to 2.5 percent. That success is attributed to the combination of the Mobile Army Surgical Hospital, or MASH unit, and the aeromedical evacuation system – the casualty evacuation (casevac) and medical evacuation (medevac) helicopter. Both had been developed and used to a limited extent prior to 1950, but it was in the Korean War that both – particularly the helicopter – came into their own, and as Army Maj. William G. Howard wrote, “fundamentally changed the Army’s medical-evacuation doctrine.” Helicopter medevacs transported more than 20,000 casualties during the war. One pilot, 1st Lt. Joseph L. Bowler, set a record of 824 medical evacuations over a 10-month period. Another example tellingly highlights the impact of the helicopter. The Eighth Army surgeon estimated that of the 750 critically wounded soldiers evacuated on Feb. 20, 1951, half would have died if only ground transportation had been used…

The Korean War also provided an opportunity to study and test new equipment and procedures, many of which would go on to become standards of care in both the military and civilian medical communities. These included vascular reconstruction, the use of artificial kidneys, development of lightweight body armor, and research on the effects of extreme cold on the body, which led to development of better cold weather clothing and improved cold weather medical advice and treatment. The newest antibiotics were used widely, and other drugs that advanced medical care included the anticoagulant heparin, the sedative Nembutal, and the use of serum albumin and whole blood to treat shock cases. In addition, computerized data collection (in the form of computer punch cards) of the type of battle and non-battle casualties was used for the first time. The extensive detail and accessibility of this data allowed for the most thorough and comprehensive analysis of military medical information yet…” (A)

Medical professionals made significant changes to the way they treated injured troops during the Korean War, which led to fewer casualties as well as medical advancements for civilians. The war set the stage for how medical professionals treat trauma patients today.” (B)

VIETNAM

“Both the Korean and Vietnam wars proved to be severe challenges to the medical system, the former for cold weather operations, and the latter for tropical and jungle warfare. The medical services gradually adapted to these challenges. By the time of the Vietnam war, for example, operations could be done in contained, air-conditioned operating theaters that were containerized so as to be moved close to the battlefield. (See Figure 6.) Helicopter evacuation supplemented ground ambulances, and air transport replaced hospital trains. The system of progressive levels of casualty care has turned into doctrine, and remains the guiding principle for casualty care. Operation during the 40 years since Vietnam have produced far fewer casualties, yet have challenged the military medical services in different ways. Small unit operations at greater and greater distances have increased reliance on medical corpsmen, who are now trained to at least the level of civilian Emergency Medical Technicians, and often higher. Casualty care and evacuation in a hostile civilian environment, always a problem in warfare, has been made more complex by opponents who refuse to respect the non-combatant status of medical facilities and personnel.” (A)

IRAQ and AFGHANISTAN

“In the Vietnam War, with its close quarters and heavy use of helicopters, the time between hurt and help averaged two hours but could be as little as 30 minutes. With the improved speed came a reduction in deaths among the wounded, from 8.5 percent in World War I to 1.7 percent in Vietnam.

In the Persian Gulf, “many of the wounded may have to be carried first by litter from the field, then by truck back to a station where helicopters may evacuate them to a surgical hospital,” General Blanck said. “It could take hours in some situations.” The Platoon Lifesaver

Because of potential delays, the military now gives all soldiers training in a few emergency medical techniques like clearing respiratory blockage. “A wounded soldier’s survival may depend on his buddy’s ability to initiate lifesaving care on the battlefield,” wrote Lieut. Col. James A. Martin, commander of the Army Medical Research Unit. “Each soldier should possess the skill to clear an airway, control bleeding and start an intravenous fluid line to control shock.”

Foot soldiers do not have that full training, but in many platoons, General Blanck said, one soldier has been trained and designated the lifesaver.

“We did not have this in Vietnam,” he said, “and it may really be needed in the kind of warfare we may have in the gulf.”

Other changes since the Vietnam War include new vaccines and treatments, including one for Hepatitis A and one to prevent septic shock from a sudden invasion of certain types of bacteria in people who are most seriously wounded. There are vaccines against local diseases, and one against anthrax to protect troops who may be targets of biological warfare.

Once they reach a hospital, soldiers will benefit from improved techniques to repair torn blood vessels and treat burns. CAT scanners will be available in the larger hospitals of each corps, General Blanck said. Heat Is a Serious Factor”  (A)

“Injured veterans of the Iraq and Afghanistan Wars can give credit to the medical personnel of earlier wars, including the Vietnam War, for their care and recovery.

Surgeons, anesthesiologists, nurses, and other staff advanced medical practices for soldiers receiving care in the areas of trauma care and blood supply, repair of blood vessels to save limbs, and studying the effects of a range of weapons.

The contributions of medical personnel improved the outcomes of those wounded not only in Vietnam, but also subsequent wars.

A technique in trauma care in the use of topical antimicrobial chemotherapy for the care of burns and other wounds was available for the first time in the theater of operations.

Another practice that evolved during the Vietnam War was the use of universal donor, or Type O, blood banks in various stations throughout Vietnam.

Techniques that were developed during World War II and the Korean War greatly reduced the need for amputations in the field by tying the major artery to the affected limb.

The improvements in emergency responses and trauma care techniques that were developed during the Vietnam War are still relevant now.” (B)

“DRONES”

 “The Navy corpsman was overwhelmed. Dozens of Marines lay injured at the casualty collection point following a devastating artillery bombardment—and the corpsman didn’t have nearly enough to blood at hand to treat them all.

A soldier’s odds of survival increase nearly threefold if they receive a blood transfusion within an hour of being injured. Unfortunately, the Medical Battalion’s field hospital and its copious blood supplies was over a dozen miles away. With the combat zone interdicted by enemy fire, the odds that medical supplies or evacuation would arrive anytime soon looked grim.

Hastily, the corpsman transmits a map coordinate and a brief request.

Fifteen minutes later, a swarm of drones comes swooping down at over a miles per minute. Hatches in their bellies flip open, releasing not bombs but small boxes which come floating down near the collection point using paper parachutes.

Inside each box is some bubble wrap—and three units of blood ready for transfusion.

Overhead, the drones bank around and soar back to the medical battalion and glide towards a large trapeze-like contraption on the ground. Precise maneuvers allow a hook on the drone’s tail to snag onto the trapeze, bringing the unmmaned aircraft to a halt.

As the drones are recovered, staff swap out their spent lithium-ion batteries for recharging, replacing them with fresh batteries—and new cargo boxes in their bellies.

In a few minutes, the drones are ready to deliver even more life-preserving blood products.

The above battle may never have happened—but it was simulated in a series of exercise in Australia involving a U.S. Marine Corps Air-Ground Taskforce, the Australian Defense Force…and a gaggle of forward-deployed commercial drones.” (A)

(A).Will Blood-Bearing Delivery Drones Transform Disaster Relief and Battlefield Medicine?, by Sebastien Roblin,  https://www.forbes.com/sites/sebastienroblin/2019/10/22/will-blood-bearing-delivery-drones–transform-disaster-relief-and-battlefield-medicine/#4e4ddb506252

ROBOTIC SURGERY“U.S. Army physicians, located far from a field hospital, could soon be performing delicate, highly specialized surgery on wounded soldiers using robotics and other forms of telemedicine.

Army Surgeon General Lt. Gen. Nadja West said recently that the demands of future battlefields will force the military medical community to prepare for operational environments that are vastly different.

“We might not have the life-saving ‘golden hour’ evacuation system we have been accustomed to for the past 17 years,” West told an audience recently at an Association of the United States Army function.

“Our soldiers may be isolated for 72 hours or more, requiring prolonged field care if injured in an austere environment,” she said.

Enemy air superiority may not allow the U.S. military to fly critically wounded soldiers to well-equipped hospitals in far-off countries, so field hospitals may have to rely on new, robotic technology to save patients, West added.

Robotic surgery, which is currently used in non-invasive procedures, could be adapted to meet the Army’s battlefield needs, she said.

“There is robotic surgery that’s going on right now,” West said, adding that the challenge will be “how quickly we can scale it all throughout our enterprise.” (A)

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