VFW Magazine May 2011 : Page 33

Left: GIs from Task Force Strike rush a wounded soldier to a medevac helicopter for airlifting to the hospital at Kandahar Airfield, Afghanistan, on Sept. 19, 2010. Below: Air Force Col. James King, part of a critical care air transport team, checks a patient’s vital signs aboard an air medical evacuation flight from Kuwait to Ramstein Air Base, Germany, in May 2003. AIR FORCE PHOTO The military didn’t arrive at this con-clusion by guesswork. When an American dies in battle today there’s a complete autopsy and “a total body CAT scan,” says Donald Parsons, deputy director of the Department of Combat Medic Training at Fort Sam Houston. Data derived from these sobering searches show 60% of mortal wounds are to the extremities, the arms and legs. Some 25% are to the head and neck, effort to save both life and limb, sur-geons at Role 2s have gotten very, very good at treating vascular wounds. When a person loses a lot of blood, he or she tends to go “hypothermic,” says Army Col. Daniel V. Chapa, Jr., director of Combat and Doctrine Development at the Army Medical Department Center and School in San Antonio. Hypothermia can lead to shock, and then to death. What surgeons do is take blood— whole blood—and warm it before infusing it back into the body. Warmth helps stave off hypothermia, and Chapa says the whole blood “aids in the coagulation process and [helps] stop the bleeding.” Advent of Shunts There’s more to blood flow manage-ment than that. When an artery or vein severs or is severely damaged, surgeons stationed at Role 2 facilities emplace temporary vascular shunts—plastic tubing—“to maintain blood flow to the rest of [an] extremity,” says Air Force Col. James King, chairman of the Department of Emergency Medicine at Wilford Hall Medical Center in San Antonio. While shunts are nothing new, the frequency with which they’re employed U.S. ARMY PHOTO “Tourniquets are probably the single most important change since the Vietnam War for folks in the field.” — Navy Surgeon General Vice Adm. Adam M. Robinson, Jr. ably the single most important change since the Vietnam War for folks in the field.” Once upon a time, medics and corps-men were taught employing these age-old devices could do more harm than good. Now, that philosophy has been turned on its head. Robinson applies the concept of “first principles” rules: “If I do harm to the extremity [by using a tourniquet], but I save the life, it’s better than not stopping the blood flow coming out of the extremity and losing the life.” From Baghdad to Bagram, what doctors are finding is “we are saving many, many more lives by our very liberal use of tourniquets.” and another 10% to the torso. Ironically, this wound distribu-tion is the product of protective gear. “Better body armor, better helmets,” says Parsons. “They’re protecting a lot of vitally important parts of the body,” he says, leaving the extremities to bear the brunt of the blast from IEDs or RPGs. The implication? If the military knows what’s killing its men and women it “can design [its] training program to try and mitigate those injuries as best we can,” says Parsons,“at the point of injury.” Controlling blood flow continues at the next step of treatment, at the Role 2 level. That’s where nimble, mobile for-ward surgical teams go to work. In an is. “The volume of extremity vascular injury that we’ve seen in the last 10 years has put their use on … steroids,” elaborates Rasmussen, ISR’s deputy commander. “One might use tempo-rary vascular shunts two or three times a year in civilian practice… During high casualty flow times [in a combat theater] you may use these shunts four or five times a week.” It’s here—at the juncture of torn veins and arteries reconnected via pieces of plastic—that saving a life and saving the quality of life overlap. “For years, it was May 2011 • WWW.VFW.ORG • 33

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