Back to Top Skip to main content Skip to sub-navigation

Medical Advances Since Gulf War Boil Down to Increased Lives Saved

Image of Medical personnel training on how to treat a neck wound. Click to open a larger version of the image. Wyoming Army National Guard Sgt. Shawn Todd, a combat medic assigned to Recruiting and Retention Battalion and Sgt. 1st Class Ethan Schanzenbach, 213th Regional Training Institute senior medical noncommissioned officer, treat a neck wound on a mock patient using modern medical gauze (Photo by: Kentucky National Guard Public Affairs).

Recommended Content:

Combat Support | Research and Innovation | Health Innovation Toolkit

Second in a series of articles on advances in military health care and technology since the Persian Gulf War, 30 years ago this year.

Read Part 1, here.

Tactical casualty care – an application of the lessons learned based on data collected during the Vietnam War and analyzed with computers in the 1990s – evolved since being initially published in 1996, noted Alan Hawk, manager of historical collections for the Defense Health Agency’s National Museum of Health and Medicine.

Hawk noted that this resulted in the development of improved hemorrhage control techniques and even early versions of telemedicine, allowing for medical consultations by physicians far from the point of care. He also included rapid vaccine development, from a concept developed by the Defense Advanced Research Projects Agency (DARPA), to develop defenses against novel biological warfare agents.

Tourniquets and gauze

But other tools have been less tech-oriented and just as effective in saving lives. Former Army Col. (Dr.) Leopoldo “Lee” Cancio and Dale Smith, a longtime author and a professor of military medicine and history at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, mentioned advanced forms of battlefield gauze, clotting agents, and combat application tourniquets (“CAT,” or “ratchet” tourniquets) as key ingredients in the rucksacks of not just medics, but all ground troops.

"In 2001, we were using a strap-and-buckle tourniquet," Smith said, which were about 80% efficient - meaning that, above the elbow or above the knee, blood vessels are "big enough that 20% leakage is going to kill you. So, in theater, some surgeons and some medics built a ratchet tourniquet." He described it as "a loop - you can put it on over your own arm and tighten it down. They are more than 98% efficient."

Exsanguination (bleeding to death) is the most common cause of potentially survivable death for wounded warfighters, according to the Army. To be blunt about it, Smith added, once you've already lost a limb, it's about saving your life.

"Today, the ratchet tourniquet is in everybody's kit bag, you can put it on yourself, you can put it on your buddy, and you can stop bleeding in less than 10 minutes," he said. "That's what I mean by survivability. You would've died in 2000 with this injury, but now you're alive and we've got a decent prosthetic device. It's not as nice as (the limb) you were born with, and there's a whole lot of psycho-social issues to being an amputee and a whole lot of learning to do."

The newer tourniquet is "a very nice piece of technology," Cancio agreed. "The concept is simple, but you've got to make it user-friendly."

He added that the mindset of the tourniquet as a last resort also had to be changed as it was introduced. With arrival times from point of injury to aid station of perhaps 30 to 60 minutes, he said, "even if you put it on unnecessarily, you're not going to do any permanent damage to that extremity."

The development of topical dressings to replace traditional gauze has been another big development that saves lives, Cancio said. Several iterations of the new dressings since 2003 have resulted in the "combat gauze" used today - so effective at stopping bleeding that it is not just carried in battle but used in the burn center where he works.

a picture of a tourniquet from 2016
An updated combat application tourniquet from 2016 (Photo by: U.S. Army).

Rule No. 1

These developments and advances in military medicine should not diminish the terrors of being on what Smith calls "the pointy end" of battle.

Suffering a traumatic brain injury or losing a limb are no small matters, no matter how sophisticated the subsequent treatment or prosthetic replacement limb may be. But in many cases, these developments mean not just survivability, but a "return to function," as Cancio put it, or even a "return to ambulation" despite losing one or even both legs. And that return to function could even mean staying on active duty. Gone are the days when losing a leg in battle meant an automatic medical discharge.

"At either end of this long sequence of events and different echelons of care is an individual who is wounded and a combat medic who is taking care of that individual," Cancio said. "That individual at the end of that process is returning to his family and community. So those people are really the most important factors in this whole process – the people, not the technology. And really, none of the technology that we talked about is meaningful or helpful unless we put it in the hands of medics who are properly trained."

Said Smith, "We have pioneered in the military pushing people to the limit of their training. In World War II, we didn't have enough doctors to put on airplanes to evacuate patients, and so we taught nurses to take blood pressures."

Now, he said, there are physician assistants, techs, advance practice nurses, people who do psychosocial work - the works. "You've got all levels of practice from psychiatrists on down to technicians who forward deploy to deal with acute combat reaction in theater. (The USU) even has a campus in San Antonio to get the medics and corpsmen trained up to give them college credit to jump-start their associate degrees, because we see them needing those degrees to move to the limits of practice and certification. So, the military is still in this business of extending the scope of practice of people in order to provide more robust, systematic care, wherever you are."

For example, “the Joint Trauma Registry has been a huge factor in educating people and keeping one group from not knowing what the previous group did – they are now getting better at that. All of this has contributed to improved survivability.” That includes intra-service communications, Smith said. “You’ve got more people at the table, they’re talking more frequently, both in the line and in medicine.”

At that, he paused, remembering a line from a fictional doctor -, the beloved Col. Henry Blake from the first few seasons of the TV show "MASH." Blake was consoling the usually irreverent main character, Army Capt. Benjamin "Hawkeye" Pierce, who was upset after one of his patients died.

Blake stated: "Look, all I know is ... there are certain rules about a war. And rule No. 1 is young men die. And rule No. 2 is ... doctors can't change rule No. 1."

"We can't change rule No. 1," said Smith. "But we can amend it, and we have been amending it, really, for the past 70 years, but phenomenally in the last generation."

Continuing this summer

(July): Advances in prosthetic limbs and quality of life after traumatic injury. (August): How 3-D printing is re-writing what's possible in post-traumatic care.

You also may be interested in...

Iraq Bomb Attack Led Soldier to Pursue Medical Career

Photo
5/12/2022
Iraq Bomb Attack Led Soldier to Pursue Medical Career

U.S. Army Sgt. 1st Class Mathew Maxwell (Left) and U.S. Capt. Brian Ahern, medical personnel assigned to a Defense POW/MIA Accounting Agency recovery team, check the pulse of a local villager during excavation operations in the Houaphan province, Laos, Feb. 5, 2019. (Photo by Staff Sgt. Michael O'Neal)

Recommended Content:

Combat Support | Health Readiness

“Buddy! Buddy! Are You Okay?” A Look Into The Marine Corps' Livesaver Course

Article Around MHS
4/19/2022
Combat Lifesaver Course practical

The Combat Lifesaver Course is a three-day course that teaches Marines lifesaving medical techniques to eliminate preventable loss of life on the battlefield.

Recommended Content:

Combat Support

Military Health System Research Program Seeks Funding Applications for FY2023

Article
4/7/2022
The Military Health System Research Program provides funding for projects that aim to improve care in military medical facilities like the Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas, pictured here. (Photo: Senior Airman Melody Bordeaux, U.S. Air Force)

The funding prioritizes research projects that focus on the delivery of military health care and system-level innovations that impact cost and outcomes.

Recommended Content:

Military Health System Research Branch | Research and Innovation

Military Health System Research Program Notice of Funding Opportunity

Fact Sheet
3/31/2022

This flyer describes the process for applying for and receiving funding by the Military Health System Research Program.

Recommended Content:

Military Health System Research Branch | Research and Innovation

How COVID-19 Made the Military Medical Community Stronger

Article
3/21/2022
Image of a service member being treated

Lessons learned from the COVID-19 pandemic has made the military medical community stronger and will help when confronting the next crisis, whether that’s another pandemic, a new conflict or natural disaster

Recommended Content:

Combat Support | Coronavirus and the COVID-19 Vaccine | Coronavirus

Top Military Health Leaders Discuss Future Readiness

Article
3/8/2022
An Air Force C-17 Globemaster III at Joint Base Pearl Harbor-Hickam, Hawaii, prepares to transport U.S. Army medical personnel to Guam in support of the global COVID-19 response on April 13, 2020.

Top military health leaders highlight the importance of preparing for the future to ensure both a medically ready force and a ready medical force.

Recommended Content:

Combat Support

Researchers Connect with Warfighters to Guide Tech Development

Article
1/25/2022
Military personnel trying an immersive training device

Researchers ‘get out of the clinic’ to learn warfighter challenges

Recommended Content:

Research and Innovation | Vision and Hearing Loss Prevention | Vision and Hearing Loss Prevention | Vision Center of Excellence

2022 MHS Research Symposium Opens for 'Abstracts'

Article
1/6/2022
Poster of the MHSRS 2022

Abstracts for this year's Military Health System Research Symposium, with the theme "Optimizing Readiness – The Power of Military Medical Research," are due by Feb. 16.

Recommended Content:

Research and Innovation | Medical Research and Development | MHS Research Symposium

How Maintaining Prosthetic Services Can Help Prepare for the Next Fight

Article
11/18/2021
Navy Seaman Chris Krobath, a prosthetics patient at Naval Medical Center San Diego, reached for new heights on the hospital’s climbing wall as part of rehabilitation therapy.

Despite the winding down of the conflicts in Afghanistan and Iraq, Military Health System services for our wounded warriors, particularly those who have lost limbs in these conflicts, remain steady and may well increase in scope during the coming years.

Recommended Content:

Technology | Research and Innovation

Practice makes perfect: Uniformed Services University students learn combat casualty care

Article Around MHS
10/22/2021
An instructor gives advice on how a team of medical school students at the Uniformed Services University should work on their simulated patient during the Advanced Combat Medical Experience. 

The Advanced Combat Medical Experience (ACME), a four-day medical field practicum at the Uniformed Services University of the Health Sciences (USU), is intense

Recommended Content:

Combat Support | Uniformed Services University of the Health Sciences

Expeditionary Medical Force Brings Optimal Readiness in Pacific Region

Article Around MHS
10/18/2021
A male soldier talks about a chart to to a female sailor.

The 121st Field Hospital of the 549th Hospital Center recently introduced an innovative way to increase medical Soldiers’ proficiency and competency by enhancing access to the field hospital equipment.

Recommended Content:

Health Readiness | Combat Support

Since 9/11, These 8 Military Medical Advancements are Saving Lives

Article
9/14/2021
Retired U.S. Army Sgt. Derek Weida jokes with a physician during his prosthetic leg fitting at a prosthetics clinic in Las Vegas in April 2018.

Years of military conflict in Iraq and Afghanistan brought innovations that completely transformed the Military Health System's approach to combat casualty care. Here's a list of just a few ways military medicine has evolved in the two decades since the 9/11 attacks.

Recommended Content:

Research and Innovation | Technology | MHS Remembers 9/11

DOD launches "First Aid For Severe Trauma" for HS students

Article
9/2/2021
High school students at a conference in Orlando, Florida

DOD's National Center for Disaster Medicine and Public Health launches "First Aid For Severe Trauma" designed for Grades 9-12, with Red Cross, Homeland Security.

Recommended Content:

Combat Support

New Flag and Patch Symbolize Growth at the Defense Health Agency

Article
8/19/2021
Service members from the Army, Air Force and Navy display the new Defense Health Agency patch following a reflagging and repatching ceremony at Defense Health Agency Headquarters in Falls Church.

The DHA will reveal a new flag and seal in a ceremony August 20 to signify the unity of all services under one joint combat support agency.

Recommended Content:

Defense Health Agency | Military Health System Transformation | Combat Support

Ready Reliable Care Framework is Improving MHS Patient Care

Article
8/18/2021
Ready Reliable Care is the Military Health System's framework for ensuring high-quality health care across the force.

The Military Health System's Ready Reliable Care framework helps ensure high-quality health care for all service members, veterans and their families.

Recommended Content:

Research and Innovation | Technology | Readiness Capabilities | Ready Reliable Care | Defense Health Information Technology Symposium | MHS GENESIS
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 14

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.