U.S. Marines in Afghanistan transport fellow LCPL Jerome Hanley of Massachusetts, who was injured when insurgents attacked a waiting medevac helicopter in 2011.
Kevin Freer/AP
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Kevin Freer/AP
U.S. Marines in Afghanistan transport fellow LCPL Jerome Hanley of Massachusetts, who was injured when insurgents attacked a waiting medevac helicopter in 2011.
Kevin Freer/AP
In the early 2000s, when the United States invaded Afghanistan and Iraq, military surgeons were severely lacking in practical skills.
This is the first full deployment of the U.S. military in ten years. Much of the medical team’s experience comes from emergency rooms in large cities, which Army surgeon Tom Knuth told NPR in 2003, “is the closest you can get to combat without actually being in combat.”
Faced with hundreds of injured soldiers each month, surgeons are forced to perform surgeries they may have never seen before serving in a war zone, such as double amputations. Soldiers often reached surgeons too late for their contaminated wounds to be treated.
But as the fighting continued and casualties mounted, medical teams were forced to innovate.
Improvements such as makeshift surgical teams allow wounded soldiers to receive medical care during the “golden hour” after injury. Newly designed tourniquets became standard equipment, saving lives on the front lines.
“They achieved the highest battlefield wound survival rates in the history of warfare,” said Art Kellerman, former dean of the Uniformed Services University of the Military Medical College.
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Cost-cutting attempts
Now that the post-9/11 wars are over, some senior military doctors say the gains made are at risk.
The Pentagon attempts to reduce health care costs by outsourcing medical services at military treatment facilities to civilian agencies.
This created a spiraling effect on medical teams: Military hospitals lost the number of patients they needed to maintain doctors’ practices. Because of this and the pandemic, many clinicians are leaving the military. And the cuts continue.
“Some people have come up with the crazy idea of closing uniformed services universities,” said Surgeon General Todd Rasmussen.
Art Kellermann, former dean of the university, believes that the university preserves and supports all the advances in military medicine over the past 20 years and the many doctors who created them. Kellerman said these advances are just as important as equipment like helmets or body armor that give U.S. troops the confidence to rush into a firefight knowing they’re likely to survive if injured.
An internal Defense Department memo obtained by NPR found that outsourcing didn’t actually save the military money, but it did hurt readiness. The memo directs the Pentagon to change course and bring more medical services back to base hospitals and add additional medical personnel.
The future of battlefield medicine.
Even as the Pentagon works to sustain advances in military medicine, wartime medicine in the future may look very different.
In Iraq and Afghanistan, U.S. air superiority allowed troops to quickly treat the wounded. Since the enemy has no planes or helicopters, U.S. medical transport aircraft can fly to the rescue within 30 minutes of injury.
“Sooner or later, somewhere, we’re not going to have air superiority. I don’t care if we think we have air superiority. We should be prepared to lose air superiority,” said retired Air Force deputy surgeon general Sean Murphy.
He cited Ukraine as an example, where two conventional armies faced off and a large number of casualties were evacuated on the ground. Even more extreme, Taiwan could come into conflict with China:
“When we started looking at theaters like the Pacific, fighting over long distances and point-to-point, we realized we were not going to get to that golden moment,” Murphy said.
The solution, Murphy said, is for every soldier and sailor to become a medic. But to do that, he said, the Pentagon needs to urgently rebuild its existing medical force.
“The most important combat system or weapons system we have is a human system. It’s not an airplane or a ship or a tank.”
Listen to the full episode think about this Learn more about combat medicine and its changes.
The episode was produced by Walter Ray Watson and Connor Donevan, with sound engineering by Stu Rushfield. It is edited by Andrew Sussman and Courtney Dorning.
