Quick, improved trauma care saves lives

Tom Philpott: Military Update

GRASSAU, Germany — The survival rate for U.S. service members wounded in Iraq has reached 90 percent, higher than in any previous war, and 10 points higher than in the 1991 Persian Gulf War.

The major reason, says the general in charge of Army medical training, is improved trauma care being delivered moments after injury by medics and a growing number of soldiers trained as combat lifesavers.

Maj. Gen. George W. Weightman, commander of the Army Medical Department’s Center and School at Fort Sam Houston in San Antonio, traveled here in early November to discuss lessons learned from the Iraq war at a conference of medical service officers assigned to Europe.

Better body armor, forward-deployed surgical teams and swift medical evacuations are factors that have raised the survival rate. However, the most significant change, Weightman said, has been the performance of medics and combat lifesavers in applying trauma care techniques.

A few years ago the Army created the Joint Theater Trauma Registry, a tool to track what occurs for severely wounded patients, from injury through arrival at a stateside medical center. The data confirmed what some trauma experts had been preaching: The greatest potential for saving more lives was better, more immediate point-of-injury care.

That meant enhancing the skills and responsibilities of combat medics, and teaching many other soldiers lifesaving techniques offered through a new Tactical Combat Casualty Course. The improved training, now being used to great effect in Iraq and Afghanistan, was largely the vision of retired Lt. Gen. James Peake when he had Weightman’s job in the late 1990s, and during his tour as Army surgeon general from 2000 through 2004.

“He understood that we’d already polished the apple as much as we could on combat support hospitals and surgical capability. We’d already started working on the forward surgical team that (moved) surgery a lot closer to the point of injury,” Weightman said. “He realized that any other impact we were going to make on survivability … would have to be … at point of injury” and performed by medics and other troops, not doctors.

The Army no longer teaches that the critical period for a trauma patient is the first “golden hour’’ after injury, Weightman said in an interview here for this column. Far more important are the “platinum 10 minutes.”

“If we can keep them alive for that first 10 minutes then, by and large, we’ve got a little more time — an hour-and-a-half to two hours — before they have to have definitive surgery,” Weightman said.

It’s no small thing for doctors to give battlefield medics more trauma care responsibility.

“That was a giant leap of faith for us because, in the medical profession, we tend to guard our skills because we don’t want to do any harm,” Weightman said. In most situations, having less-skilled personnel do a procedure raises the risk to patients. However, the greater risk here is delay.

By medics and combat lifesavers “the additional skills, and focusing on several very specific circumstances, you can have an immense change to the morbidity result.”

“Medic” refers to a specific Army job specialty, requiring 16 weeks of training. Combat lifesavers are soldiers in other specialties who complete a combat casualty course. Its length is being extended from 24 to 40 hours of instruction. With Iraqi insurgents using bigger improvised explosive devices (IEDs), combat commanders are sending a lot of soldiers through the course.

“Some units in Iraq have put it for everybody,” Weightman said.

The three great threats to body-armored soldiers who receive traumatic wounds are blood loss from damaged limbs, sucking chest wounds and obstructed airways, Weightman said.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: