United States Marines in Afghanistan carry their colleague LCPL Jerome Hanley from Massachusetts, who was wounded in an insurgent attack, to a waiting medevac helicopter in 2011.
Kevin Frayer/AP
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Kevin Frayer/AP
United States Marines in Afghanistan carry their colleague LCPL Jerome Hanley from Massachusetts, who was wounded in an insurgent attack, to a waiting medevac helicopter in 2011.
Kevin Frayer/AP
When the US launched its invasion of Afghanistan and Iraq in the early 2000s, military surgeons were no longer able to practice.
It was the first full-scale deployment of American forces in a decade. Much of the medical corps’ experience comes from big-city emergency rooms, which are “the closest to combat you can get without actually being in combat,” Army surgeon Tom Knuth told NPR in 2003.
Faced with hundreds of wounded soldiers every month, surgeons are driven to perform procedures they have never seen before serving in a war zone – like a double amputation. Soldiers often delayed getting to the surgeon so contaminated wounds could be treated.
But as the war continued and casualties mounted, the medical corps was forced to innovate.
Improvements like pop-up surgical teams get wounded soldiers medical attention during the “golden hour” after injury. Newly designed tourniquets became standard equipment, saving lives on the front lines.
“They achieved the highest survival rate for battlefield wounds in the history of warfare,” said Art Kellermann, who is dean of the Uniformed Services University, the military’s medical school.
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Efforts to reduce costs
Now that the post-9/11 war is over, some veteran military doctors say those benefits are at risk.
The Pentagon has tried to reduce healthcare costs by outsourcing care from military treatment facilities to civilian institutions.
This had a spiraling effect on the medical corps: military hospitals lost the number of patients they needed to maintain physician practices. Because of that and the pandemic, many doctors are leaving the military. And keep cutting.
“It’s a crazy idea … to launch to close the Uniformed Services University,” said surgeon Todd Rassmusen.
Art Kellermann, the former dean of the university, said that it has maintained and supported all the medical advances of the military for the past 20 years, and many doctors have made them. Kellerman said these advances are as important as helmets or flak jackets — giving U.S. troops the confidence to run quickly, knowing they’ll survive if wounded.
An internal Defense Department memo obtained by NPR found that outsourcing doesn’t save the military money, but it does hurt readiness. The memo directed the Pentagon to reverse course to bring medical care back to hospitals on base and increase medical staffing.
The future of war medicine.
Although the Pentagon is making efforts to preserve advances in military medicine, medicine in wartime can look very different.
In Iraq and Afghanistan, the military was able to treat injuries quickly because the US had air superiority. Because the enemy had no planes or helicopters, American Medivacs could fly to rescue within 30 minutes of an injury.
“Sooner or later somewhere, we’re not going to have air superiority. And I don’t care if we think so. We have to plan to not have it,” said Sean Murphy, retired deputy surgeon general of the Air Force.
He pointed to Ukraine, where two conventional armies square off with heavy casualties being evacuated on the ground. More extreme, the possibility of conflict with China over Taiwan:
“What we realized when we started looking at theaters like the Pacific and the distance and the peer-to-peer fighting, there’s no way we’re going to get there in the golden hour,” Murphy said.
Murphy says the solution is to make every soldier and sailor a medic. But to do that, he said the Pentagon must quickly rebuild its medical readiness force.
“The most important combat system or weapon system that we have is the human system. It’s not a plane or a ship or a tank.”
Listen to full episodes of Try This for a closer look at battlefield medicine and how it is changing.
This episode was produced by Walter Ray Watson and Connor Donevan, with audio engineering by Stu Rushfield. It was edited by Andrew Sussman and Courtney Dorning.
