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

Medical Advances Since Gulf War Boil Down to Increased Lives Saved

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:

Combat Support | Research and Innovation | Health Innovation Month

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...

Revamped Virtual Med Center Makes Health Care Feel Like a Video Game

Article
7/26/2021
Picture of the Virtual Medical Center

The Virtual Medical Center, a joint Department of Defense/VA incentive, is relaunching by the end of summer, leveraging emerging technologies to increase and improve accessibility, convenience, and efficiency of medical care for all registered users.

Recommended Content:

Technology | Research and Innovation

Innovation working group strives to enhance METC training

Article
7/20/2021
Military personnel using virtual reality

Virtual/augmented reality, 3D printing, video/podcast production, and machine learning/artificial intelligence technologies and others like them will enhance the training students receive at METC and elsewhere by supplementing the lectures and providing realistic alternatives to actual experiences.

Recommended Content:

Health Innovation – Pathways to Ready Reliable Care | Health Innovations across the MHS Enterprise | Health Innovation Month

How COVID-19 fast-tracked innovation in the Military Health System

Article
7/20/2021
Military personnel receiving the COVID-19 test

As the COVID-19 pandemic disrupted every aspect of healthcare delivery, the Military Health System responded with new and innovative ways to fight the disease and deliver safe, quality care to patients.

Recommended Content:

Health Innovation Month | Innovation | COVID-19 Vaccine Toolkit | Coronavirus

Military Medical Research Leads to 18 New Cancer Drugs, other Devices

Article
7/14/2021
a patient prepares for a PET scan

A hub of cutting-edge healthcare innovation financing since the early 1990s, the CDMRP is well known among medical researchers around the world.

Recommended Content:

Research and Innovation | Medical Research and Development

Health Innovation

Video
7/14/2021
Health Innovation Month infographic

The Military Health System discusses how innovations in the healthcare community during COVID-19 have greatly affected us.

Recommended Content:

Health Innovation – Pathways to Ready Reliable Care | Health Innovations across the MHS Enterprise | July Toolkit | Health Innovation Month

CHAMP uses more predictive analytics to improve beneficiary healthcare

Article
7/8/2021
A game of tug-of-war

Military health innovation and Total Force Fitness go hand-in-hand.

Recommended Content:

Total Force Fitness | Health Innovation Month | Health Innovation – Pathways to Ready Reliable Care | Health Innovations across the MHS Enterprise | MHS Research Symposium

New Stop the Bleed course designed specifically for HS students

Article
7/7/2021
A medical care training exercise

New First Aid for Severe Trauma Training Can Help High School Students ‘Stop the Bleed’

Recommended Content:

Combat Support

Fast-Tracking Physical Therapy Can Save Time, Money – and Pain

Article
7/6/2021
Military health personnel checking out an injury

An Army physical therapist has won the DHA’s inaugural Leading Practices Program award with a method to see patients more efficiently.

Recommended Content:

Health Innovation – Pathways to Ready Reliable Care | Health Innovations across the MHS Enterprise | Health Innovation Month | Leading Practices Program

Military Health System Transformation Will Improve Care & Innovation

Article
7/6/2021
Infographic about Health Innovation Month

MHS Innovation Must Be Backed by Best Practices, Standardization

Recommended Content:

July Toolkit | Health Innovation – Pathways to Ready Reliable Care | Health Innovations across the MHS Enterprise | Health Innovation Month | Research and Innovation | Military Health System Transformation | MHS Research Symposium

DHA Spearheads Effort for Working Dog Research Collaboration

Article
6/25/2021
Picture of three different dogs

Working Dog Forum explored research to keep dogs in top form.

Recommended Content:

Combat Support | Veterinary Service | Public Health | Research and Innovation

30 Years after Desert Storm, Military Medicine Evolving ‘Phenomenally’

Article
6/9/2021
Military health personnel surrounding an operating table

Thirty years after the Persian Gulf War, technical advances in military medicine are saving lives and improving post-trauma quality of life.

Recommended Content:

Military Medical History | Health Innovation Month

Health Innovation: Joint Health Information Exchange

Infographic
6/2/2021
Social media graphic on Health Innovation Month showing a medical x-ray

Health Innovation Month Securely connecting DOD electronic health records with civilian networks through the Joint Health Information Exchange

Recommended Content:

July Toolkit | Health Innovations across the MHS Enterprise | Health Innovation Month

Health Innovation: Drive-Up Pharmacies

Infographic
6/2/2021
Social media graphic on Health Innovation Month showing a drive up COVID-19 test

Health Innovation Month Opening drive-up pharmacies kept access to prescriptions and lowered COVID-19 risk

Recommended Content:

July Toolkit | Health Innovations across the MHS Enterprise | Health Innovation Month

Health Innovation: Decide + Be Ready App

Infographic
6/2/2021
Social media graphic on Health Innovation Month showing a smart phone

Health Innovation Month. Developed app to help female service members make informed contraception decisions

Recommended Content:

July Toolkit | Health Innovations across the MHS Enterprise | Health Innovation Month

Health Innovation: COVID-19 Vaccine Clinics at the PX

Infographic
6/2/2021
Social media graphic on Health Innovation Month people getting a vaccine

Health Innovation Month. Placing COVID-19 vaccination clinics in the PX brings vaccines to the people

Recommended Content:

July Toolkit | Health Innovations across the MHS Enterprise | Health Innovation Month
<< < 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.