Providing Quality Medical Care in the Crucible of Battle

By Peake, James B. | Army, October 2003 | Go to article overview

Providing Quality Medical Care in the Crucible of Battle


Peake, James B., Army


If the daily routine of Army Medicine is a "continuous live-fire exercise," the true "final exam" for any Army branch remains the crucible of battle.

The Army Medical Department (AMEDD) went through that crucible in Operation Iraqi Freedom (OIF). I can confidently say the AMEDD passed this test with honors.

Spc. Michael Colchiski told a USA Today reporter as he recovered at Walter Reed Army Medical Center from injuries suffered when his tank rolled over that "the quality of care I got from the soldier level up was outstanding. The medical treatment here is superb. It has been superb the whole way through."

Low U.S. casualties are a credit to tactical leaders and trainers who teach soldiers to protect themselves and to win quickly and decisively, to the soldiers at the front who execute what they have learned with skill and elan, and to the scientists, engineers and companies who give us the best technology.

Army Medicine's role crosses the spectrum of force health protection through effective preventive-medicine measures, rapid evacuation and state-of-the-art care, up front and early, when it is most effective.

I am particularly proud of our humanitarian role. AMEDD soldiers saved not only Americans but also prisoners and innocent civilians. Who can forget the photo of Army medic PFC Joseph P. Dwyer carrying an injured child? I am proud that one of the first and most deserving "instant celebrities" of this war was a soldier-medic doing what all our young medics do so competently and so passionately-helping the helpless, regardless of risk.

As war gave way to reconstruction, our humanitarian work was a key pillar of U.S. efforts to win Iraqis' hearts and minds and help them build a decent nation.

In OIF the AMEDD applied many lessons from earlier operations.

In the first Gulf War, combat support hospitals (CSHs) were large and immobile. Now they are modularized and can perform split-based operations.

OIF validated the importance of forward surgical teams (FSTs) attached to brigade combat teams to provide life-saving surgery quickly, close to the point of wounding. It also validated our medic Transformation program. The 91W (Health Care Specialist) military occupational specialty increases the training of combat medics to the basic emergency medical technician (EMT) level.

To capture now lessons, we are engaged in a comprehensive data collection in OIF. Analysis of this data will yield new ways to grow. Our surgery, trauma, anesthesia and orthopedics consultants-experienced experts who advise me, medical commanders and specialty practitioners-were sent to the theater for an in-country after-action review (the first time this was done since Vietnam). Here are some preliminary conclusions:

* Body armor. Preliminary analyses indicate that improved ballistic protection for head and thorax reduced abdominal, chest and head-penetrating injuries, the most life-threatening kind. Our U.S. soldiers mostly had extremity-type injuries. While the AMEDD did not develop the new, lighter armor, our statistics help to validate its value. Our scientists at the Armed Forces Institute of Pathology will scrutinize the data on the wounded and those who died to see how we might do even better in the future.

* Hemorrhage control. Medically, this may be the giant leap of this war. Bleeding is the leading controllable cause of battle deaths. We had available several new methods to control bleeding: QuikClot, chitosan dressings, fibrin hemostatic dressings, and one-handed tourniquets. QuikClot, a powder, is poured onto a wound to form a clot. Chitosan bandages, made from shrimp shells, stop arterial bleeding fast. Medics tell us that new user-friendly tourniquets are a big improvement.

* Forward surgery and rapid evacuation. Forward surgery during the "golden hour," right after wounding, when patients' chances of recovery are best, has proven itself again. …

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