Military Doctors Fault Pentagon on Battlefield Casualty Care
Doctors say medical advances won on battlefield might be lost unless Defense Department makes new techniques mandatory
By Michael M. Phillips
Jan. 7, 2016 2:29 p.m. ET
WASHINGTON—Top military doctors are warning that medical advances won on Afghan and Iraqi battlefields might be lost unless Secretary of Defense Ash Carter orders the Pentagon to make these techniques, drugs and devices mandatory for military physicians, nurses and medics.
Fourteen years of combat gradually produced a system that generated survival rates unprecedented in modern warfare, from front-line first aid to helicopter medevacs. The Pentagon, these doctors say, has failed to institutionalize many of those practices.
“Things are as good as they have ever been anywhere in combat-casualty care,” said Dr. Frank Butler, a former Navy SEAL and leading advocate of improved military trauma treatment. “And we need to understand what was done in the recent conflicts and do what we can to preserve it.”
The doctors intensified their campaign in a paper published in August in the Journal of Trauma and Acute Care Surgery, which argued that the U.S. might see a jump in battle deaths in the next conflict.
“It’s not that everybody is ignoring it; it’s that everybody is busy,” said one of the authors, former U.S. Surgeon General Richard Carmona, who was twice wounded while serving as a Green Beret medic in Vietnam.
Knowledge gained in wartime is often lost in peacetime. After World War II, the military failed to standardize lessons learned about tourniquets, morphine and battlefield blood products. After the Sept. 11 attacks, the military wasn’t fully prepared for the wounds it would encounter in Afghanistan and Iraq, particularly amputations and other injuries from roadside bombs.
“The U.S. military had not effectively sustained many of the lessons learned from past conflicts and went to war in Afghanistan without wide availability of tourniquets, without modern battlefield analgesics, without prehospital plasma, and without trauma care guidelines designed specifically for use on the battlefield,” said the paper.
The Pentagon said its performance on combat casualty care will improve.
A Defense Department insider, Dr. David Smith, deputy assistant secretary for health readiness policy and oversight, was one of the authors of the paper criticizing his own department. He is also the person the Defense Department turned to to defend its practices.
In a written statement issued in response to a query from The Wall Street Journal, Dr. Smith said the military is updating its training and rules to require the troops to use the latest techniques and tools.
“The work to institutionalize tactical combat-casualty care is underway, ensuring that when U.S. service members again go into harm’s way, the medics, corpsmen, pararescuemen and other professionals supporting them are fully prepared and trained with the most current battlefield trauma techniques,” he wrote.
Researchers who examined more than 4,000 autopsies of troops killed in action in Iraq and Afghanistan found that nearly a quarter died of wounds they could potentially have survived, had they received better treatment at the spot they were injured.
As the wars progressed, military doctors raced to address gaps in treating the injured. The results, for front-line medics, were guidelines that cover a range of tools from safer painkillers to battlefield transfusions to treatments for chest wounds.
The Army Rangers, who were far ahead of conventional military units in casualty care, cut preventable deaths to near zero when commanders forced every soldier to learn the latest techniques, according to medical researchers.
Those advances, however, have come through guidelines, not military-wide orders. In practice, doctors have found, the military has been inconsistent in applying the latest advances.
Trauma experts blame that in part on the structure of the military. There is no single general in charge of battlefield first aid; instead, commanders of combat units, not doctors, are in charge of Army medics, Navy corpsmen and Air Force pararescuemen.
“Lacking direction in the form of [Secretary of Defense] rule and Joint Staff doctrine, there is no assurance that advances in trauma care will be implemented consistently through the various components of the U.S. Military,” the authors wrote.
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