War, the War of 1812, and the Spanish-American War combined, and more than in the first four years of military involvement in Vietnam, we have had substantially fewer deaths. Just 10 percent of wounded American soldiers have died.
How military medical teams have achieved this is important to think about. They have done it despite having no fundamentally new technologies or treatments since the Persian Gulf War. And they have done it despite difficulties with the supply of medical personnel. For its entire worldwide mission, the army had only about 120 general surgeons availableon active duty and two hundred in the reserves in 2005. To support the 130,000 to 150,000 troops fighting in Iraq, it has been able to put no more than thirty to fifty general surgeons and ten to fifteen orthopedic surgeons on the ground. And these surgeons and their teams have been up against devastating injuries.
I got a sense of the extent of the injuries during a visit to Walter Reed Army Medical Center in Washington, D.C., in the fall of 2004, when I was invited to sit in on what the doctors call their "War Rounds." Every Thursday, the Walter Reed surgeons hold a telephone conference with army surgeons in Baghdad to review the American casualties received in Washington. The case list for discussion the day I visited included one gunshot wound, one antitank-mine injury, one grenade injury, three rocket-propelled-grenade injuries, four mortar injuries, eight improvised explosive device (IED) injuries, and seven with no cause of injury noted. None of these soldiers was more than twenty-five years of age. The least seriously wounded was a nineteen-year-old who had sustained extensive blast and penetrating injuries to his face and neck from a mine. Other cases included a soldier with a partial hand amputation; one with a massive blast injury that amputated his right leg at the hip, a through-knee amputation of his left leg, and an open pelvic wound; one with bullet wounds to his left kidney and colon; one with bullet wounds under his arm requiring axillary artery and vein reconstruction; and one with a shattered spleen, a degloving scalp laceration, and a through-and-through tongue laceration. These are terrible and formidable injuries. Nonetheless, all were saved.
I F THE ANSWER to how was not to be found in new technologies, it did not seem to reside in any special skills of military doctors, either. George Peoples is a forty-two-year-old surgical oncologist who was my chief resident when I was a surgical intern. In October 2001, after the September 11 attacks on the World Trade Center and the Pentagon, he led the first surgical team into Afghanistan. He returned after service there only to be sent to Iraq, in March 2003, with ground forces invading from Kuwait through the desert to Baghdad. He had gone to the U.S. Military Academy at West Point for college, Johns Hopkins Medical School in Baltimore, Brigham and Women's Hospital in Boston for surgical residency, and then M. D. Anderson Cancer Center in Houston for a cancer surgery fellowship. He owed the army eighteen years of service when he finally finished his training, and neither I nor anyone I know ever heard him bemoan that commitment. In 1998, he was assigned to Walter Reed, where he soon became chief of surgical oncology. Peoples was known in training for three things: his unflappability, his intellect (he had published seventeen papers on work toward a breast cancer vaccine before he finished his training), and the five children he and his wife had during his residency. He was not known, however, for any particular expertise in trauma surgery. Before being deployed, he hadn't seen a gunshot wound since residency, and even then, he never saw anything like the injuries he saw in Iraq. His practice at Walter Reed centered on breast surgery. Yet in Iraq, he and his team managed to save historic numbers of wounded.
"How is this possible?" I asked him. I asked his colleagues, too. I asked
How military medical teams have achieved this is important to think about. They have done it despite having no fundamentally new technologies or treatments since the Persian Gulf War. And they have done it despite difficulties with the supply of medical personnel. For its entire worldwide mission, the army had only about 120 general surgeons availableon active duty and two hundred in the reserves in 2005. To support the 130,000 to 150,000 troops fighting in Iraq, it has been able to put no more than thirty to fifty general surgeons and ten to fifteen orthopedic surgeons on the ground. And these surgeons and their teams have been up against devastating injuries.
I got a sense of the extent of the injuries during a visit to Walter Reed Army Medical Center in Washington, D.C., in the fall of 2004, when I was invited to sit in on what the doctors call their "War Rounds." Every Thursday, the Walter Reed surgeons hold a telephone conference with army surgeons in Baghdad to review the American casualties received in Washington. The case list for discussion the day I visited included one gunshot wound, one antitank-mine injury, one grenade injury, three rocket-propelled-grenade injuries, four mortar injuries, eight improvised explosive device (IED) injuries, and seven with no cause of injury noted. None of these soldiers was more than twenty-five years of age. The least seriously wounded was a nineteen-year-old who had sustained extensive blast and penetrating injuries to his face and neck from a mine. Other cases included a soldier with a partial hand amputation; one with a massive blast injury that amputated his right leg at the hip, a through-knee amputation of his left leg, and an open pelvic wound; one with bullet wounds to his left kidney and colon; one with bullet wounds under his arm requiring axillary artery and vein reconstruction; and one with a shattered spleen, a degloving scalp laceration, and a through-and-through tongue laceration. These are terrible and formidable injuries. Nonetheless, all were saved.
I F THE ANSWER to how was not to be found in new technologies, it did not seem to reside in any special skills of military doctors, either. George Peoples is a forty-two-year-old surgical oncologist who was my chief resident when I was a surgical intern. In October 2001, after the September 11 attacks on the World Trade Center and the Pentagon, he led the first surgical team into Afghanistan. He returned after service there only to be sent to Iraq, in March 2003, with ground forces invading from Kuwait through the desert to Baghdad. He had gone to the U.S. Military Academy at West Point for college, Johns Hopkins Medical School in Baltimore, Brigham and Women's Hospital in Boston for surgical residency, and then M. D. Anderson Cancer Center in Houston for a cancer surgery fellowship. He owed the army eighteen years of service when he finally finished his training, and neither I nor anyone I know ever heard him bemoan that commitment. In 1998, he was assigned to Walter Reed, where he soon became chief of surgical oncology. Peoples was known in training for three things: his unflappability, his intellect (he had published seventeen papers on work toward a breast cancer vaccine before he finished his training), and the five children he and his wife had during his residency. He was not known, however, for any particular expertise in trauma surgery. Before being deployed, he hadn't seen a gunshot wound since residency, and even then, he never saw anything like the injuries he saw in Iraq. His practice at Walter Reed centered on breast surgery. Yet in Iraq, he and his team managed to save historic numbers of wounded.
"How is this possible?" I asked him. I asked his colleagues, too. I asked
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