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\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eAn authoritative \u003c/span\u003e\u003ca href=\u0022https://jamanetwork.com/journals/jamasurgery/article-abstract/2729451\u0022\u003e\u003cspan\u003epaper\u003c/span\u003e\u003c/a\u003e\u003cspan style=\u0022color: black;\u0022\u003e in the American Medical Association Journal \u003cem\u003eSurgery \u003c/em\u003ehas added independent weight to the assertion long made by United States military officers, officials and politicians that US troops wounded in Afghanistan and Iraq had the best survival rates for any wars in US military history. Perhaps more significantly, it has also for the first time assessed combat casualty care statistics over the period of military operations in both campaigns, from 2001 to the end of 2017, to show how mortality rates were reduced in both Afghanistan and Iraq over time by some 44%.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe authors conducted an analysis of medical data for all 56,763 US casualties in Afghanistan and Iraq wounded between October 2001 and December 2017. This showed that in the early years of the Afghanistan conflict the fatality rate for casualties was 20%. By the beginning of 2018, this had fallen to 8.6%. Over the same period, the fatality rate for US casualties in Iraq decreased from 20.4% to 10.1%. These were the best-ever survival rates for US military casualties. Furthermore, over the 16 years of fighting, the authors say, there was a greater than three-fold increase in survival for the most critically injured casualties. In some ways, this data echoes the historical trend of medical advances being propelled during periods of major conflict, but the context of recent campaigns \u0026ndash; and particularly Western tolerances of casualties and expectations of duty of care \u0026ndash; add significantly to its resonance.\u003c/span\u003e\u003c/p\u003e\n\u003ch3 style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eTiming and tourniquets\u003c/span\u003e\u003c/h3\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe study points to three primary factors in these improved survival rates: better measures to control bleeding, more rapid blood-loss replacement and reducing the time from injury to reaching a field hospital (to 60 minutes or less, known as the \u0026lsquo;golden hour\u0026rsquo;).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eIn the case of the first, greater use of anticoagulant bandages, complemented by more rapid use of tourniquets, was of significant benefit. Traumatic amputation as the result of an improvised explosive device emphasised the importance of the fast application of tourniquets. Coping with and replacing blood loss was made easier by the extensive deployment of military paramedics, both with front-line troops down to platoon level and in land-based and helicopter ambulances.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eIn terms of the third factor, in Iraq, a combination of dedicated ambulance vehicles and helicopters meant that most US casualties reached hospital within an hour. In rural areas of Afghanistan, with troops spread over wide areas, casualty evacuation was frequently conducted by helicopter. In 2009, US Secretary of Defense \u003c/span\u003e\u003ca href=\u0022https://www.nytimes.com/2009/01/28/washington/28military.html?_r=0\u0026amp;module=inline\u0022\u003e\u003cspan\u003eRobert Gates\u003c/span\u003e\u003c/a\u003e\u003cspan style=\u0022color: black;\u0022\u003e became increasingly concerned about this. Many in the Pentagon argued that a target time of two hours between wounding and arrival at hospital was sufficient. Gates was unconvinced and overruled the advisers. He insisted that the US military do whatever it takes to reduce this time period to an hour, resulting in additional medical-evacuation helicopters being deployed by the US Army and US Air Force.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eAnalysis of US casualty statistics shows that Gates\u0026rsquo;s measure directly contributed to the increased survival of casualties. More broadly the three improved capabilities resulted in the survival of wounded troops who would in previous wars probably have died of their wounds.\u003c/span\u003e\u003c/p\u003e\n\u003ch3 style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eAdditional lives saved\u003c/span\u003e\u003c/h3\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe study estimated that some 2,166 casualty deaths in Iraq and 1,506 casualty deaths in Afghanistan were prevented through changes in practice, when compared with casualty survival statistics from previous wars. \u003c/span\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe new techniques applied by the US armed forces were paralleled by other similar developments in allied forces.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe survival of a greater proportion of seriously wounded troops was an important achievement. But many personnel were very badly injured, with wounds that would have been fatal in previous campaigns, resulting in an unexpected increase in the requirement to support their recovery and rehabilitation, and their long-term well-being.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eThe military authorities appear not to have anticipated fully that they would have to care for so many badly wounded personnel, and their families. This development overstretched almost to breaking point the US \u003c/span\u003e\u003cspan style=\u0022color: black;\u0022\u003eDepartment of Veterans Affairs, with reports in 2007 of inadequate arrangements at the Walter Reed Army Medical Center near Washington DC becoming a national \u003c/span\u003e\u003ca href=\u0022http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html??noredirect=on\u0022\u003e\u003cspan\u003escandal\u003c/span\u003e\u003c/a\u003e\u003cspan style=\u0022color: black;\u0022\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cspan style=\u0022color: black;\u0022\u003eWhile the US was able to quickly improve medical evacuation times, thereby reducing fatalities, there are \u003c/span\u003e\u003ca href=\u0022https://www.marinecorpstimes.com/news/your-marine-corps/2018/02/15/no-golden-hour-for-marines-headed-into-the-next-big-fight/\u0022\u003e\u003cspan\u003econcerns\u003c/span\u003e\u003c/a\u003e\u003cspan style=\u0022color: black;\u0022\u003e that the same support will not be available in future conflicts, and that fatality numbers could increase. As future battlefields are less likely to be US-dominated, and lacking a permissive air environment, potentially with peer-competitor opponents armed with sophisticated equipment (including missile systems), evacuation in an hour or less by helicopter may become increasingly difficult and in some scenarios may even be unachievable. Given the potential scale of future operations, there are also concerns regarding future US airlift capacity. As a result, the US armed forces are having to look into whether these could be compensated for by other advances in in-field medical capabilities and technologies, and further changes in practice, to adapt to the potential new operational environment.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\u0022text-align: left;\u0022\u003e\u003cstrong\u003eThis analysis originally featured on the IISS Military Balance+, the online database that provides indispensable information and analysis for users in government, the armed forces, the private sector, academia, the media and more. Customise, view, compare and download data instantly, anywhere, anytime.\u003c/strong\u003e\u003c/p\u003e","className":"richtext reading--content font-secondary"}), document.getElementById("react_FpPEfcdzuUylWMFUajhkDA"))});
\u003cp\u003e\u003cspan style=\"color: black;\"\u003eThe \u0026lsquo;golden hour\u0026rsquo; medevac policy that saved the lives of US troops in Afghanistan and Iraq contributed to the best survival rates for any war in US military history. But with the possibility that future battlefields are less US-dominated, keeping up casualty survival rates may prove more difficult, writes Ben Barry.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e
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