Behind a 3-foot thick cement barrier and reinforced concrete walls, doctors, nurses, and technicians move amidst the screams of injured soldiers and the sounds of distant gunfire. On one side of the room, a soldier suffers massive leg trauma from a landmine. On the other side of the room lies a soldier with a lung injury from an improvised explosive. Another victim of flying shrapnel has severe facial lacerations.
In previous wars, there would have been little that medics could have done to treat such extensive injuries. However, here at the Balad Combat Support Hospital, one of the two biggest military medical facilities in Iraq, there is still hope.
The new weapons and tactics being employed in the war in Iraq have led to a new class of multi-system injuries never before seen in military hospitals. A new breed of medical innovations and people equipped to utilize them has similarly grown out of this conflict.
Many say that wars are the most efficient way to develop medical innovations because military doctors are often forced to find new solutions to recurring problems like mass trauma and limited drug supply. Despite the general support for these military medical discoveries, there still exists some concern about the validity and ethics of technologies developed by and exclusively for the military.
For the soldiers mentioned above, however, treatments pioneered by the military are lifesaving. For the first victim, army medics can use a new Hemcon bandage and a blood-clotting drug called Recombinant Factor VII to stop the bleeding and internal hemorrhaging. For the second, a new German-made portable heart-lung machine can be used to oxygenate his blood. For the third, the grim prospect of permanent facial damage is eliminated by plating techniques that will allow surgeons to reconstruct his face.
In addition to these treatments, advances in the delivery of care and the transport of patients have greatly reduced the rate of injury-induced deaths. Making diagnostic equipment like CT scanners available in hospitals on the front lines allows surgeons to better diagnose the severity of an injury and pursue the best course of action.
The continuity of care from injury to transport has been greatly improved; injured soldiers are airlifted from the battlefield, immediately assessed and treated at military hospitals like the one in Balad, and promptly transported via “flying hospitals” to the Army’s medical centers in Germany or the United States for further treatment. These advances have increased the survival rate for wounded soldiers from 70% during World War II to 90% during the war in Iraq.
The medical advances that this war has catalyzed are not unprecedented. In 1859, Florence Nightingale founded the School of Nursing and Midwifery after three years of work in a British hospital on the front lines during the Crimean War. While on the battlefront, she had recognized that most of the casualties were caused not by battle wounds but by poor sanitation, which led to diseases such as typhus, typhoid, cholera, and dysentery.
She changed the course of medical history by advocating sanitary living conditions for soldiers and improved design of hospital facilities. By the time she founded the School, she had also helped to establish the Royal Commission on the Health of the Army, had founded the Nightingale Fund for the training of nurses, and had written Notes on Nursing, which led to the development of the modern nursing profession.
Before World War II, the production of penicillin was limited to laboratory testing, but scientists quickly realized the need for penicillin when mass infections on the battlefield started claiming soldiers’ lives. Research funds were poured into speeding the production of penicillin, and after the war, penicillin was made mass-produced to benefit the civilian population.
An outbreak of yellow fever among American troops during the Spanish-American War led military doctors to discover that the disease was carried by mosquitoes.
The reasons behind the high rate of medical innovations pioneered by the military can be linked to the urgency to find new treatments during wartime. In his book Fatal Partners: War and Disease, Dr. Ralph Major asserts that, “An army [at war] is a vast laboratory of medical research where disease and injuries are seen on a far larger scale than in peacetime […] Many improvements in the treatment of infections, of wounds, and of fractures have come from experiences on the battlefield.”
Looking a little closer to home, Professor Eugenio Culurciello, an assistant professor in the Electrical Engineering Department at Yale, has recently received a grant from the Army to conduct groundbreaking research on neural prostheses, a type of technology that will allow victims of paralysis to move prosthetic devices by thinking of the action. The goal of the research is to produce a sensor that will be able to detect the brain waves which correspond to different types of movement, then to program prosthetic devices which will respond and produce the intended action.
Culurciello believes that the major reason he received funding from the Army was because the Army had significant interest in the final product; many soldiers suffer from loss of functionality or amputations due to wartime injuries. The success of this project would be a major step towards restoring normal function to these soldiers.
Although Culurciello stresses that he has complete autonomy over the project, he acknowledges that the funding from the Army does have limitations. Unlike funds from the National Institute of Health or similar academic bodies, funds from the government are never guaranteed. Most researchers have to apply for additional funds to supplement those granted by the Army.
Other criticisms of the military-funded research system have also been posed. A major concern is national security. While academic institutions are required to make their findings public, research funded or performed by the military is often kept secret. Even in the case that these technologies are disclosed to the public, civilian doctors are often unable to implement them because of the lack of training and licensing programs.
In actuality, a healthy dialogue exists between the military and civilian sectors of medicine. Of the technologies pioneered on the field, improvements in trauma care are the most important. According to a USA Today article, traumatic injuries are the leading cause of death in Americans under the age of 45.
The sheer volume of trauma cases seen in military operating rooms, coupled with the nature of multi-system injuries that requires military surgeons to perform many operations simultaneously, have resulted in military medics becoming adept in treating a wide range of trauma cases. These medics often gain a better grasp of what is and isn’t effective, and this knowledge is often passed on to colleagues within the civilian healthcare system. Advances in the speed and efficiency of civilian trauma care are precipitated by military medical advancements.
Another issue that has been difficult to resolve is the notion that many doctors simply use the battlefield as a testing ground for new procedures. While patients in the United States have to sign waiver forms and are fully informed before receiving untested treatments, soldiers wounded on the battlefield rarely have such a luxury.
Many question whether using technologies categorized as “investigational devices” on patients who do not know the full ramifications of their decisions is ethical. However, the practices have improved the quality of care and the lives of countless soldiers wounded in battle.
From the adaptation of the nursing profession to civilian healthcare systems to advanced surgical techniques, the theory that military medical advances save lives on the battlefront and at home is undeniable. However, with the current rate of advances in treatment being pioneered among our nation’s servicemen, the focus of many analysts has shifted to a new problem. What will happen when we try to implement increasingly sophisticated technologies in a system that is not up to the task?
The current infrastructure of the healthcare system can hardly keep up with the progress of civilian technologies, let alone those brought home by military medics. Is it possible that, in the hands of untrained practitioners, more harm than good could be done?
It is obvious that programs to train medical practitioners in these new technologies must be improved, but one important step towards that goal is to strengthen the communication link between the military and civilian physicians. In this way, we can ensure the highest standards of care for both our soldiers and our citizens.