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Published: Sunday, 12/19/2004

The wounds of war

There is both good news and bad news from the war fronts in Iraq and Afghanistan. Thanks to an extremely efficient combat medicine system, only 10 percent of U.S. soldiers who are wounded in battle end up dead. The flip side: The survivors are living with injuries that are far more severe than in past wars.

The combat fatality rate of 10 percent so far in current military operations is the lowest of any war this country has fought, according to a report in the New England Journal of Medicine.

But the guerrilla nature of the conflict, with roadside bombs wreaking havoc, has produced thousands of GIs with crippling injuries that, in addition to personal anguish caused, will require expensive treatment and care far into the future.

As of last week, nearly 11,000 military personnel had been wounded since 2001, and more than 1,000 had been killed in combat, "the largest burden of casualties our military medical personnel have had to cope with since the Vietnam War," the report said.

In Vietnam and the Persian Gulf War, surgeon Atul Gawande pointed out, the fatality rate was 24 percent, compared with 21 percent in World War I, 30 percent in World War II, and 25 percent in the Korean War.

Dr. Gawande attributes the improvement in part to better protection by helmets and body armor being used by the troops but most especially to the success of "forward surgical teams" deployed by the military on desert battlefields.

These fast-moving teams of 20 medical personnel can set up a surgical hospital in just 60 minutes and come equipped with ventilators, ultrasound machines, and other technology that dramatically enhances the care of severely injured soldiers.

Evacuation from the war zone is far more efficient, too. In Vietnam, it took an average of 45 days before injured GIs reached military hospitals in the U.S. Now it's less than four days, in some cases as little as 36 hours.

Still, the number of soldiers with mangled arms and legs and terrible head and facial wounds has been extraordinary, raising questions of how these individuals will be cared for for the rest of their lives. In addition, the military has such a shortage of doctors, especially surgeons, that it has been extending the deployments of medical personnel indefinitely.

The success stories in saving the lives of our fighting men and women on the battlefield are filled with tales of heroism that are most gratifying.

Now the country must come to grips with the long-term cost.



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