http://www.chron.com/cs/CDA/ssistory.mpl/special/iraq/2939032 Fewer Iraq casualties die, but wounds more severe By MARILYNN MARCHIONE Associated Press For every American soldier killed in Iraq, nine others have been wounded and survived -- the highest rate of any war in U.S. history. It isn't that their injuries were less serious, a new report says. Some young soldiers and Marines have had faces, arms and legs blown off and are returning home badly maimed. But they have survived, thanks in part to armorlike vests and fast treatment from doctors on the move with surgical kits in backpacks. "This is unprecedented. People who lose not just one but two or three extremities are people who just have not survived in the past," said Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston who researched military medicine and wrote about it in today's New England Journal of Medicine. The journal also published a five-page spread of 21 military photographs that graphically depict the horrific injuries and conditions under which these modern-day MASH surgeons operate. "We thought a lot about it," said the journal's editor, Dr. Jeffrey Drazen, and ultimately decided the pictures told an important story. "This war is producing unique injuries -- less lethal but more traumatic," he said. In one traumatic case, Gawande tells of an airman who lost both legs, his right hand and part of his face. "How he and others like him will be able to live and function remains an open question," Gawande writes. Kevlar helmets and vests are one reason for the high survival rate. "The critical core, your chest and your abdomen, are protected," said Dr. George Peoples, a Walter Reed Army Medical Center surgeon who served in Iraq and Afghanistan. "Parodixically, what we've seen is devastating extremity injuries because people are surviving wounds they otherwise wouldn't have." Most basic operations By mid-November, 10,369 American troops had been wounded in battle in Afghanistan or Iraq, and 1,004 had died -- a survival rate of roughly 90 percent. In the Vietnam War, one in four wounded died, virtually all of them before they could reach MASH units some distance from the fighting. Today in Iraq, real-life Hawkeyes and B.J. Hunnicuts have stripped trauma surgery to its most basic level, carrying "mini-hospitals" in six Humvees and field operating kits in five backpacks so they can move with troops and do surgery on the spot. "Within an hour, we drop the tents and set up the OR tables, and we can pretty much start operating immediately," said Peoples, whose photographs are in the medical journal. He's now at Walter Reed in Washington, which has treated 150 amputees from the Iraq war. American military hospitals collectively have had 200 amputees from Iraq and Afghanistan, three of them triple amputees. The record survival rates in Iraq have been achieved with an astonishingly small number of general surgeons. The entire Army has only about 120 on active duty and a similar number in the reserves. Of these, only 30 to 50 are in Iraq, plus 10 to 15 orthopedic surgeons, to care for 130,000 to 150,000 troops, Gawande reports. That's fewer than the 80 general and orthopedic surgeons on staff at two Boston hospitals -- Brigham and Massachusetts General. "It's a very tight supply," Gawande said of the surgeons in Iraq. "They're now also burdened with civilian Iraqis seeking their help because the U.S. has taken over many Iraqi hospitals." Virginia Stephanakis, a spokeswoman for the Army Surgeon General's Office, said Gawande had done excellent research and that his figures on casualties jibe with those on Department of Defense Web sites, though she wouldn't confirm the number of surgeons in Iraq. Gawande and others also credit nurses, anesthetists, helicopter pilots, other transport staff and an entire rethinking of the combat-medicine system for soldiers' survival. The strategy is damage control, not definitive repair. Field doctors limit surgery to two hours or less, often leaving temporary closures and even plastic bags over wounds, and send soldiers to one of several combat-support hospitals in Iraq with services such as labs and X-rays. "We basically work to save life over limb," said Navy Capt. Kenneth Kelleher, chief of the surgical company at the chief U.S. Marine base near Fallujah. "No frills, nothing complicated. If the injury is not going to be salvageable, we do a rapid amputation, and there have been a fair number of those." Faster transport If soldiers are shipped to a combat-support hospital, the maximum stay is three days. If more advanced care is needed, they're sent to hospitals in Landstuhl, Germany, or Kuwait or Spain. If care will be needed for a month or more, they're whisked directly to Walter Reed or Brooke Army Medical Center in San Antonio. "The average time from battlefield to arrival in the United States is now less than four days. In Vietnam, it was 45 days," Gawande writes. John Greenwood, a historian with the Army Surgeon General's Office, said the new strategy has made a big difference in survival. "Historically, the key change has been the ability to move the wounded man to definitive surgical care," he said. Close access Field surgeons moving with troops is the first step. Peoples traveled 1,100 miles throughout southern Iraq and into Baghdad, doing only what was absolutely necessary to save a life and shipping patients out. He said he tried to ignore personal danger, like the time his medical team was sent to an evacuated air base in southern Iraq. "At least, we thought it was evacuated," he said. But Iraqi soldiers were still being routed out. The medical team was told to pick any of the bombed-out buildings to use as a makeshift hospital. After finishing one surgery, he walked outside and noticed big red X's on all the other buildings warning against entry. By sheer luck, he said, "we had chosen the only one that hadn't been booby-trapped." As for the soldiers he took pictures of, he had this to say: "Every person depicted in those photos survived."
No, it isn't a bad thing, but having more maimed and disabled soldiers than in any war in history causes its own issues including increased veteran's healthcare costs as well as a much higher level of funds used to compensate disabled veterans. In other words, though the fatality rate might be the lowest in history, in the long run, this war will certainly cost this country far more than any other in history.
This war needs a shot in the arm. We ain't leaving till it's done, and the sooner, the better. My solution? Post everywhere in Iraq that the fighting needs to stop or the bombing will begin. Give 'em two weeks. When the jackasses start bombing us we back out, and bomb the s*** out of them. Go back in and continue to rebuild. Another explosion, another Air-raid. Do this until the fighter's stop bombing, or are dead. I've had it.
So it would be better if they were dead, rather than injured, so we could save some dough. That's.....brilliant!
come on dude, don't be a troll andy never said or even hinted that he would "rather" anyone to be dead as a money saving measure stating facts is not the same thing as advocating - learn the difference
Unless you're a 'troll,' any position taken involves advocacy. Otherwise, what is the point of saying 'this will cost us money?'
Uh, yes. And saying X is a 'problem,' ie undesirable, is advocacy. I don't think its undesirable that more soldiers are surviving as opposed to dying, certainly not because of monetary factors.
like I said, the money we are having to spend that is beyond our means is the problem - not that soliders are being wounded rather than dying your orginal response was dishonest in that you tried to twist what andy was advocating into him being against soliders surviving
The point is that this elective, unjustified war will end up costing this country FAR more than the human capital (lives lost) and "official" fiscal capital (appropriations earmarked for the war). I am not taking the position that it would be better if these lives were lost, I am just commenting that this war is going to take a much bigger fiscal and human toll on us than any other previous military action. Thousands of people are going to come home from this action totally dependant on the state to provide for them for the rest of their lives and that needs to be considered when adding up the costs of this war.
"more maimed and disabled soldiers than any war in history"?? That can't be right. Moon, you've really been tossing out some unsubstantiated comments lately. Credibility going south quickly.
Andymoon mis-read. The ratio of dead to wounded soldiers is the largest in U.S. history. Not the total number of wounded soldiers. I can see how that could be easily misinterpretted, though. The writer seems to have an agenda, hmm?
Interesting since originally you claimed he wasn't ADVOCATING anything. Nothing dishonest about it at all. If the point is that there is cost to the war, then its not RELEVANT in the least to the original article. The only thing that WOULD make it relevant is if he's saying exactly what I pointed out, that it's more costly to have them survive. That's exactly what he said. Otherwise he could have posted it in a Rockets thread 'cause it would be about as germane to the topic at hand. And spare me your silly accusations of 'trolling' and being 'dishonest,' as I'm not the one wholly misquoting the original article (ie 'most injuries from any war in history,' 'bigger human and fiscal toll than any war in history). Interesting since you're exaggerating like Dubya in this very thread.
Medical advances have a double edged sword. In the past, many of these survivors would have died of their wounds. The quality of life for many of these survivors will be nil. One could debate that the advances in battlefield medical technology allowing some of these severely wounded soldiers to survive may not necessarily be beneficial to those left with little quality of life. One could also argue that these same advances will benefit non-military personnel in civilian life. Many surgical advances derive from what we learn in battlefield surgery. To be honest, I do not know which is better. I personally would rather be allowed to die with dignity than be brought back from death only to survive as a quadruple amputee with half my face blown away.
Compared to the number of dead, we do have a higher ratio of wounded and maimed soldiers than any war in history. Sorry I wasn't as specific as you would apparently like, but your quibbling about semantics does not change the fact that we are going to face some very high back end costs for this war.
I haven't fabricated anything, therefore I have not "exaggerat[ed] like Dubya" at any point in this thread.
Well, you made these two statements: 'most injuries from any war in history,' 'bigger human and fiscal toll than any war in history,' neither of which appear in the article nor anywhere else. So it would appear that you have done exactly that unless someone stole your password and is posting for you?
