Skip to main content

Military Health System

Medical Advances Since Gulf War Boil Down to Increased Lives Saved

Image of Medical personnel training on how to treat a neck wound. 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:

Health Readiness & Combat Support | Research & Innovation

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...

FLOTEX-22

Photo
1/31/2023
FLOTEX-22

U.S. Navy Hospital Corpsman Dante Horner, a corpsman with 1st Battalion, 8th Marine Regiment, 2d Marine Division, performs tactical combat casualty care during Spanish FLOTEX-22 near Rota, Spain, June 9, 2022. This exercise features tactical level actions ashore, combined with joint training and planning, aimed at increasing overall bilateral interoperability between nations. (U.S. Marine Corps photo by Lance Cpl. Megan Ozaki)

Recommended Content:

Health Readiness & Combat Support

Eyes on Vision Readiness

Article Around MHS
1/27/2023
Military personnel gets eye exam

Good eyesight is often take for granted, but vision impairment can be the difference between mission success and mission failure. Find out what's happening on Joint Base Anacostia-Bolling so airmen in the National Capital Region remain sharply focused on their U.S. Air Force missions.

Recommended Content:

Vision and Hearing Loss Prevention | Vision Center of Excellence | Health Readiness & Combat Support

I Am Navy Medicine - and Certified Registered Nurse Anesthetist - Lt. Jason Balazs

Article Around MHS
1/27/2023
Military medical personnel administers ultrasound on patient.

National Certified Registered Nurse Anesthetist (CRNA) Week is January 22-28, 2023. Learn why CRNAs like Lt. Jason Balazs use extraordinary precision and focus to support critical mission readiness and their impact on this profession's long history and enduring record of patient safety.

Recommended Content:

Health Readiness & Combat Support

Frontline Expeditionary Dental Care is Near-Time Reality

Article Around MHS
1/26/2023
Field Portable Dental System

U.S. Army Medical Materiel Development Activity’s Warfighter Deployed Medical Systems is working to modernize several field deployable dental treatment systems to provide dental treatments to warfighters in a not-so typical way.

Recommended Content:

Dental Health | Research & Innovation

U.S. Army Medical Laboratory Forges Relationship with Australian Defence Force Institute

Article Around MHS
1/25/2023
Military personnel in medical laoratory

American soldiers from the 1st Area Medical Laboratory were hosted by their counterparts at the Australian Defence Force Malaria and Infectious Disease Institute in Brisbane, Australia. Find out what was discussed at this meeting to strengthen critical relationships, save lives, and enable both sides' mission readiness.

Recommended Content:

Building Partner Capacity and Interoperability | Health Readiness & Combat Support | Research & Innovation

Genome Sequencing Assists Research at Naval Health Research Center

Article
1/24/2023
Lab technicians doing genome research

Learn how unique samples from naval vessels, US-Mexico border populations, and DOD beneficiaries aided in the Naval Health Research Center’s sequencing efforts.

Recommended Content:

Research & Innovation | Coronavirus & the MHS Response | Coronavirus

U.S. Military HIV Research Lends Lessons Learned to COVID-19

Article
1/19/2023
Gloved hands working in laboratory

The U.S. military has engaged in HIV research for three decades, contributing critical lessons learned, knowledge, and expertise during the COVID-19 research and vaccine development effort.

Recommended Content:

Coronavirus & the MHS Response | DOD HIV/AIDS Prevention Program | Research & Innovation | Coronavirus

959th Medical Group Airmen at BAMC Receive Distinguished Awards

Article Around MHS
1/18/2023
U.S. Army Col. Renee Matos speaks at ceremony

The New Year’s revelry may be over; however, with a host of local and national awards, the 959th Medical Group still has cause to celebrate. Several 959th Airmen assigned to Brooke Army Medical Center were recognized recently for their selfless service, professionalism, and clinical expertise, both at home and overseas.

Recommended Content:

Health Readiness & Combat Support

Military Pharmacists Face Unique Challenges While Deployed

Article
1/12/2023
Military pharmacist counting pills

Deployed pharmacists are responsible for every medication used in their clinic. That includes preparing medication kits for medics on patrol, helping prepare aeromedical evacuation patients, normal outpatient prescriptions, and in some locations, even snakebite antidotes.

Recommended Content:

TRICARE Pharmacy Operations | Health Readiness & Combat Support

Naval Medical Research Center Uses Genome Sequencing for Variants

Article
1/12/2023
Military personnel pose for a group photo

NMRC’s efforts provided important support for sequencing and viral isolation to the Department of Defense and Military Health System.

Recommended Content:

Research & Innovation | Coronavirus & the MHS Response | Coronavirus

DOD Aims to Shield Warfighters From Novel Biological Agents

Article Around MHS
1/11/2023
Military personnel in chemical cloud

Newer and more complicated biological battlefield threats are prompting the need for stronger countermeasures. We explain the DOD's new advances in medical countermeasures - including cutting edge technology and artificial intelligence - to keep the warfighters operational and combat ready.

Recommended Content:

Research & Innovation | Chemical and Biological Exposures

“Call for Abstracts” Opens for 2023 MHS Research Symposium

Article
1/10/2023
Attendees enjoying the 2022 MHSRS scientific poster presentation

Preparations for the 2023 MHSRS are currently underway! Learn how you can qualify to present at the DOD's premier scientific meeting for the unique medical needs of the warfighter. (Deadline for abstracts: Feb. 19th)

Recommended Content:

Research & Innovation | MHS Research Symposium

Injured Fort Bliss K-9 Handler Makes Inspiring Return to Duty

Article Around MHS
1/10/2023
Military personnel with K9

A military working dog handler assigned to the 93rd Military Police battalion survives a horrific motorcycle crash with a speeding pickup driver, but his prognosis was grim. Find out how dedication, motivation, and his sweet connection with a K-9 got U.S. Army Spc. Cade Brown back on the road to recovery.

Recommended Content:

Warrior Care | Health Readiness & Combat Support

Theater Medical Command Experiment Focuses on Large-Scale Combat Operations, Future Operating Environment

Article Around MHS
1/6/2023
Military medical personnel at Fort Sam Houston

The Medical Capability Integration Directorate hosted its culminating limited objective experiment for calendar year 2022. See how the Theater Medical Command (TMC) Experiment will affect large-scale combat operations and prioritize limited Army Health System capabilities and how the TMC will support future operating environments.

Recommended Content:

Health Readiness & Combat Support

USAMRIID Focuses on Genome Sequencing to Detect Variants

Article
1/5/2023
Military medical personnel in laboratory

A connected family of laboratories across the MHS allows a more rapid response to the outbreak.

Recommended Content:

Research & Innovation | Coronavirus & the MHS Response | Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 47
Refine your search
Last Updated: July 20, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery