Battle Field Angels (38 page)

Emergency helicopter transport, a service provided at most major metropolitan hospitals today, can be traced to the initial helicopter medical evacuations in the Korean War. Civilian medicine also has benefited enormously from the trauma care database created during the Vietnam War when six hundred military surgeons submitted reports on more than eight thousand vascular treatment cases. Meticulous medical corps recordkeeping has helped educate successive generations of doctors. The Vietnam records remain one of medicine’s most valuable databases of specialized trauma treatment today. Increasingly sophisticated and computerized military medical care in Iraq and Afghanistan is expanding that knowledge base.

Military medicine has contributed to a higher standard of civilian care. Many soldiers first experienced the benefits of regular medical attention after they entered the military. Others who had known only their family doctor benefited from access to medical specialists in the armed forces. In World War II, nearly a third of the nation’s doctors were pressed into the service to care for the 8 percent of the population that was in uniform. Those soldiers returned home with a greater understanding and expectation of medical care.

One of the greatest victories in the history of military medicine has been the defeat of disease on the battlefield. For thousands of years, disease was the deadliest enemy. Approximately 90 percent of deaths in the Revolutionary War were due to disease. It wasn’t until the twentieth century that rifles, grenades, mortars, artillery, and bombs killed more combatants than malaria, yellow fever, dysentery, and typhus. Disease-related deaths declined to 60 percent of fatalities in the Civil War, 50 percent in World War I, and 25 percent in World War II. Preventive medicine has been one of the primary beneficiaries of military medicine.

New technology continues to play a significant role on the battlefield. In 2003, the U.S. military debuted an innovative stretcher that brought sophisticated care to the wounded. The Life Support for Trauma and Transport is a mobile, five-inch-thick platform that has a variety of devices built into it: vital signs monitor, blood chemistry analyzer, suction equipment, defibrillator, ventilator, and infusion pump. Twenty prototypes were sent to Marine ground forces and Navy amphibious ships that year. The two-hundred-pound platform proved too heavy for field use but was effective in stabilization and evacuation. Researchers continue to enhance its capability to become a fully mobile intensive care unit for each wounded soldier and to reduce its weight to closer to forty pounds.

Similarly, in 2008, an armored ambulance, the Mine Resistant Ambush Protected Vehicle, made its first appearance on the battlefield. Designed to counter the prevalence of IEDs in modern warfare, the massive, heavily modified Humvee ambulance can hold up to six patients and is equipped with oxygen, suction, and vital-sign-monitoring capability. In some respects, the tide of military medical advances has shifted to taking acute-care capability onto the battlefield as a precursor to battlefield evacuation.

War has never been more survivable. About 30 percent of all wounds in World War II were fatal. From the Korean War to the first Gulf War in 1991, the wound mortality rate remained at approximately 25 percent. Less than 3 percent died after reaching a hospital, so the vast majority of those killed in battle died within minutes of being hit. By 2007, the mortality rate of the wounded in Iraq dropped to 10 percent.

Warfare continues to evolve and pose new challenges for military medicine. Inaccurate fusillades of fire in past wars have been replaced by remote-controlled precision weaponry. The muskets of old are now fully automatic weapons with night scopes. Horse-drawn artillery has given way to laser-guided missiles and multiple-launch rocket vehicles that can fire up to a dozen rockets that reach a speed of Mach 3.5 in eight seconds and have a range of three hundred miles. Future weapons will become even more lethal.

Researchers are working on technology that will make firearms more reliable in harsh conditions and enable the military to operate them electronically. The technology will produce exponential increases in firepower: 16,000 rounds of 9mm bullets per second and 250,000 40mm grenades per minute. In addition, the Army is developing a target-seeking cannon that is lightweight, mobile, and fully automated. It can fire six one-hundred-pound artillery rounds in sixty seconds, timed to detonate simultaneously on a single target.

Warfare in the twenty-first century has become expeditionary, mobile, and remote. American military interventions since 1989 have ranged from Kosovo to Somalia to Sierra Leone. The increasingly isolated nature of modern war results in seriously wounded soldiers far from established medical facilities. Military medical research and development is focusing on new technology that insulates the soldier against injury, enables greater self-care, and provides automated evacuation and treatment.

For one project, researchers engineered transportable blood platelets that can be stored at room temperature for up to two years and retain their clotting capability. For another, they are studying how estrogen can help wounded soldiers withstand significant blood loss. A more futuristic model shows soldiers being injected with magnetic nanoparticles before entering battle. If they are wounded, a magnetic tourniquet or similar handheld device could be used to concentrate the nanoparticles at the wound site to enhance clotting. Scientists at the Defense Advanced Research Projects Agency are working on a mobile device for use in the field that uses ultrasound to locate and stop internal bleeding. All four projects would give corpsmen and medics in remote regions valuable new tools to reduce gravely wounded soldiers’ vulnerability to shock from excessive blood loss.

Combat medical research also has focused on the speed of treatment. One goal is to increase by tenfold the ability of a soldier to treat his own wounds. Another is to enable pain control and treatment by a medic or by a wounded soldier himself within five minutes of being injured. In addition, DARPA researchers are seeking a fivefold increase in tissue repair efficiency, the ability to return a soldier to active duty within ninety-six hours of being wounded, and the reduction of medical logistical needs by at least half.

Military medical research may prove particularly useful in harsh desert and alpine combat environments. Some scientists are studying how mountain-climbing sherpas produce a natural hormone that enhances blood-oxygen exchange, enabling them to climb to the top of Mt. Everest without oxygen bottles. The hormone could help a wounded soldier survive when severe bleeding reduces his internal oxygen supply. Others are analyzing how a particular species of sea lion can keep blood flow away from vital organs in cold water. What they discover may help protect soldiers in subfreezing conditions. Still others are investigating a microorganism that produces an enzyme that deflects heat, which could prove useful in keeping soldiers in optimal condition during desert warfare.

Telemedicine technology based on wireless communication is being developed as well. The Telemedicine and Advanced Technology Research Center has worked on biosensors that could be woven into a soldier’s uniform. These would enable corpsmen and medics to remotely monitor each soldier’s condition, determine which casualty on the battlefield needs to be evacuated first, and prepare for incoming casualties.

Someday a remotely controlled Battlefield Extraction Assist Robot could be sent onto the battlefield to rescue the most seriously wounded. The humanoid BEAR is designed to enter the combat zone, pick up an injured soldier, and return to a sheltered position. The BEAR’s lifting capacity is five hundred pounds. It would reduce the frequency with which corpsmen and medics run into enemy fire to rescue wounded soldiers.

Once the soldier is delivered to a safer location, the corpsman or medic might use medical supplies airdropped only minutes before. In Afghanistan today, unmanned aerial vehicles are in greater use. Researchers are working on a version that could deliver a twenty-pound canister of medical supplies into battle. In the future, they hope to increase that capacity to two hundred pounds.

After a wounded soldier is treated, someday corpsmen and medics may be able to enter vital information onto a radio-frequency wristband via a handheld device. The wristband, which is under development, would contain the soldier’s personal information, medical history, and just-completed treatment and vital-sign data. This comprehensive medical file would accompany the injured soldier throughout the entire military medical care process.

Once the injured reach an aid station, surgery might be performed without a surgeon present. Robotic trauma pods are being developed, in which four operating tables extend out in four directions from a centralized console of remotely controlled surgical equipment. Surgeons would perform operations from another location. Trauma pods could reduce significantly the amount of time and distance between being wounded and receiving lifesaving surgical care.

Disease plays a significant role in any military force’s readiness, and it comes from many sources. In guerilla warfare conditions, IEDs can blast septic residue from Humvee tires and axles into soldiers’ bodies. In 2008, military vaccines were effective for only about eight of the forty-four pathogens known to exist in contemporary war zones. More than a dozen pathogens were identified during the past sixteen years. In order to keep pace with remote pathogen discovery, some researchers are working on methods to develop vaccines without access to the pathogens. The Defense Sciences Office at DARPA is working on techniques to produce as many as 3 million doses of vaccine in less than a month, using a transportable system.

Regenerative medicine is a priority of the military in an era when badly wounded soldiers are more likely to survive with permanently disfiguring injuries. In 2008, the Armed Forces Institute of Regenerative Medicine received $85 million for a variety of research projects. One project has focused on stem cells taken from the healthy skin of a burned soldier and spraying them onto the wound site to stimulate regrowth. Harvard and MIT scientists are developing biological scaffolds for destroyed noses and ears that can be implanted with a patient’s skin cells. The cells grow into a nose or ear that can be surgically attached to the wounded soldier.

The future of military medicine will continue to be a reflection of the environmental and physical hazards of the battlefield as well as the increasing lethality of weaponry.

During the past five hundred years, for every soldier killed outright by the enemy, four were wounded. About one third of those wounded warriors required significant medical treatment. That treatment often began on the field of combat at the hands of a corpsman or medic and continued along a chain of care that reflected the medical knowledge and social values of the day. In that, war has changed little.

There always will be a common denominator that links past battlefields with future war zones: the courageous and compassionate individuals who devote themselves to saving the lives of their brothers and sisters in uniform. Shorthanded, defenseless, and poorly equipped at the outset of nearly every major war, corpsmen and medics have proven to be innovative, independent, resourceful, creative, and motivated in the extreme. They often have emerged as the most decorated rank by each war’s end. Ray Duffee, Armando Leal, Nathaniel Leoncio, Monica Brown, and hundreds of thousands of other Americans have overcome their fear of death and their dread of disability to care for the broken and bleeding under unfathomable conditions.

Therein lies the true essence of military medicine: the extraordinary and unwavering devotion to duty by frontline corpsmen, medics, nurses, doctors, and specialists. They are the real heroes of military medicine. Millions of Americans owe their lives to these battlefield angels.

Paul Baviello, Corpsman
Vietnam
¹⁰³

N
o author flies solo. The route to a completed book often becomes convoluted, full of side trips, delightful discoveries, and dead ends. Regardless, not a single minute of the four years of research into
Battlefield Angels
was wasted because individuals and organizations all over the country kindly helped keep me on track and headed toward my destination.

Other than my family, literary agent Scott Mendel perhaps was the first to believe in the vision and potential of
Battlefield Angels
. Both his counsel and perseverance were invaluable, and he was responsible for finding a home for the manuscript. Two editors, Casey Ebro and Kelli Christiansen, were enormously helpful by keeping the manuscript on course and focused. Their editing rarely was disputable as they polished the ragged edges. Both Vicki Gibbs and Mary Sekulovich provided excellent editing guidance on early drafts as well.