Medical innovations that once were novelties of the wars in Iraq and Afghanistan have become commonplace on the battlefield as the conflicts continue, and so has evidence that the recent advancements are saving lives.
Rare is the severely injured Soldier or Marine who arrives at a military hospital in Iraq today without having been treated with one of the Pentagon's newest blood-clotting dressings-either QuikClot, a granular substance favored by the Marine Corps, or HemCon, a bandage developed by the Army and made from a derivative of shrimp shells. The services have largely abandoned their disagreements over which product is best, and both dressings are now in wide circulation among combat troops and first responders. The dressings' manufacturers, meanwhile, have continued to improve their formulas and configurations to match requirements on the battlefield.
And whereas doctors reported casualtics two and three years ago who bled to death for lack of a tourniquet, today modern nylon tourniquets are ubiquitous in Iraq, and casualties routinely arrive at hospitals and aid stations wearing us many as four.
That commitment to advanced point-of-injury care, begun in theory before the war began but now embraced throughout the armed services, has helped to make the Iraqi battlefield the most survivable in American history. The percentage of casualties who die from their injuries had fallen to 9.4 percent by the end of last year, compared to about 15.8 percent in Vietnam, and military officials say medical care and body armor are largely responsible.
Yet the percentage of wounded troops who arrive at military hospitals alive and then die from their wounds has risen since Vietnam, from 3.2 percent to roughly 4.3 pereent at the end of last year. Military doctors are certain the "died of wounds" rate is up because more casualties with mortal wounds are surviving long enough to reach a hospital, but they are nonetheless focused intently on keeping more of those patients alive.
Doctors in Iraq are honing the concept of "damage control surgery." whereby initial treatment is reserved for life-threatening conditions and repairs and other procedures are left for later. They also have largely re-written the military's blood transfusion guidelines for battlefield patients, giving them less of the red blood cells common in civilian hospitals in favor of more plasma, platelets, and even fresh whole blood.
The services have also embraced the prompt and liberal use of a $6,000-a-dose clotting drug, called Recombinant Activated Factor VII, that is approved only for treating hemophilia, and which the FDA has linked to deadly blood clots leading to heart attack and stroke. Physicians in Iraq say they have seen dozens of patients treated with Factor VII who survived otherwise fatal hemorrhaging. They have not reported increased complications, though the Pentagon's medical record keeping doesn't track such things sufficiently.
The military's use of Factor VII is controversial among civilian doctors, who are generally less eager to experiment with it. But military physicians consider it a breakthrough, and say they will continue pushing the limits of modern medical care.
Said Colonel John B. Holcomb, the Army's top trauma advisor: "We're making decisions, in the middle of a war. with the best information we have available."
Mr. Little is the Baltimore Sun's National Correspondent.