BATTLEFIELD MEDICINE….The New England Journal of Medicine has an interesting article this week about battlefield medicine. It turns out that although the Iraq War so far has produced as many injuries as the Revolutionary War or the first five years of the Vietnam War, it’s produced far fewer deaths. Only 10% of injured soldiers have died, which is down not just from wars 200 years ago, but also from the 24% death rate in the Gulf War just a decade ago.
This is apparently due to a revolution in battlefield surgery. It’s a far cry from what Alan Alda used to do on MASH:
Today, military surgical strategy aims for damage control, not definitive repair, unless it can be done quickly. Teams pack off liver injuries, staple off perforated bowel, wash out dirty wounds ? whatever is necessary to stop bleeding and control contamination without allowing the patient to lose body temperature or become coagulopathic. Surgeons seek to limit surgery to two hours or less, and then ship the patient off to a Combat Support Hospital (CSH), the next level of care. Abdomens can be left open, laparotomy pads left in, bowel unanastomosed, the patient paralyzed, sedated, and ventilated.
….It is a system that took some getting used to. Surgeons at every level initially tended to hold on to their patients, either believing that they could provide definitive care themselves or not trusting that the next level could do so. According to statistics from Walter Reed, during the first few months of the war, it took an injured soldier an average of eight days to go from the battlefield to a U.S. facility. Gradually, however, surgeons have embraced the wisdom of the system. The average time from battlefield to arrival in the United States is now less than four days. (In Vietnam, it was 45 days.)
On a somewhat less serious note, there’s also this:
Surgeons also discovered a dismayingly high incidence of blinding injuries. Soldiers had been directed to wear eye protection, but they evidently found the issued goggles too ugly. As some soldiers put it, ?They look like something a Florida senior citizen would wear.? So the military bowed to fashion and switched to cooler-looking Wiley-brand ballistic eyewear. The rate of eye injuries has since decreased markedly.
Quick, somebody tell Virginia Postrel!