Why is this interesting? - The Combat Medicine Edition

Colin here. One of the lesser-told stories from 20 years of war in Iraq and Afghanistan is the step changes in combat medicine. Thanks to better training and more efficient medevac processes, an increasing number of armed forces members are surviving injuries on the battlefield. 

A recent article in Texas Monthly unpacks what’s happening:

Effective scoop-and-run care has achieved a medical marvel unprecedented in warfare: the overwhelming majority of Americans who have fallen in battle in Iraq or Afghanistan have been saved. Well-trained medics, standby medevac helicopters, and an abundance of forward surgical hospitals enabled the military to carry out a 2009 directive from the Pentagon requiring that every deployed American be within sixty  minutes of higher-level care, usually at a surgical hospital. That lifesaving window of time is known as the “golden hour.” Almost 60,000 Americans have fallen in combat since 2001; of those, some 53,000, or 91 percent, have come home alive. In Vietnam, it was 75 percent.

In the context of recent wars, most medics don’t have to spend tons of time sustaining life in the field. In many cases, medics are packaging up a casualty, and as the article describes, proceeding to “clear the breathing passage, stop the bleeding, package the patient on a litter, wrap them in a Mylar blanket, strap them in, and wave in the medevac helicopter to whisk the patient to a nearby combat surgical hospital.” Of course, none of this is easy. But the procedure has been refined and improved over the prolonged conflict. 

Why is this interesting?

But as different threats emerge and a new battlefield takes shape, combat medicine will have to continue to evolve. Young combat medics will need to learn different skills, including the types of extended care that are typically the purview of more highly-trained soldiers. What’s more, the “golden hour” will become more of a luxury. The article continues: 

Military planners and strategists increasingly see the golden hour of recent wars as an anomaly. Our enemies in Afghanistan and Iraq lacked air forces and had limited means to track and kill aircraft. American medevac helicopters could fly almost at will onto battlefields. Surgical hospitals could be placed where needed, and the big medevac jets, basically flying intensive-care units that ferried the severely wounded away to bases in Germany and on to the United States, could operate from airfields unimpeded.

Rising military forces in China, Russia, Iran, and North Korea, to name just a few potential adversaries, will not be so accommodating. They are perfecting long-range precision weapons designed to challenge American control of the air. Medevac helicopters will be at extreme risk, if they fly at all. High-tech weapons have proliferated far beyond the big powers: in Yemen, Houthi rebels are using armed drones and cruise missiles. Even without such threats, military tacticians say, keeping troops within sixty minutes of a surgical hospital is dangerous; it tells enemies where your forces will be concentrated.

At Fort Sam in Houston, where new medics are trained, they are moving beyond the idea of algorithmic medicine—if this then that—into more complex tactics of prolonged field care. According to the article, “it requires moving much of the work of hospital emergency rooms and intensive care units into the hands of combat medics working in the dirt … In the kind of slugfests the Army foresees, soldiers with multiple wounds are expected to be even more common. Lasers, directed-energy weapons, and thermobaric bombs all cause deep burns, wounds that are exceedingly difficult to treat.”

In other words, care will move out of the surgical center and onto the battlefield itself. Part of the issue will be not just overhauling the training of entry-level medics, something the article delves into in-depth, but also moving to equipment that is small, lightweight, and mobile enough to use in the field: Think exoskeletons that eliminate the need for litters and allow a wounded soldier to walk, or antibiotic powder to be applied directly to wounds. 

The future of warfare, against more sophisticated actors, will create new imperatives for field medicine to re-invent itself yet again. (CJN) 

Present of the Day:

You may have seen this floating around Twitter, but it’s too good not to post. Donnachaidha O’Chionnaigh explains, “None of the kids wanted toys for Christmas this year, they just wanted cash. Understandable, but cash as a gift, while practical, always feels impersonal, so I made special packaging. Went over well.” Brilliant. (via WITI contributor Steve Bryant) (NRB)

Quick Links:

• Per battlefield medicine, I highly recommend this email from a few months ago by our friends at the Quartermaster on SMARCH: “Security, Massive hemorrhage, Airway, Respiration, Circulation, and Hypothermia. The steps here are in order of priority for a tactical trauma situation- meaning that each step is more critical for being quickly addressed than the next.” (NRB)

• How luxury is evolving (CJN)

• Full-length Nick Cave live show from CPH. Thanks to BP for the link. (CJN) 

Thanks for reading,

Noah (NRB) & Colin (CJN)

PS - Noah here. I’ve started a new company and we are looking for a sr. backend engineer to join the team. If you are one of those or know anyone great, please share. Dinner’s on me at a restaurant of your choice if you help us find someone.

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