Now a WSJ article

[Handsome1]

Another military medicine article in the mainstream. NYT somewhat sensationally went after small miltary hospitals. The WSJ has now, on the front page of the weekend edition, gone after trauma. This is something the military takes great pride on...

http://online.wsj.com/articles/are-u-s-soldiers-dying-from-survivable-wounds-1411145160

Thoughts on this article in particular?
Thoughts on the recent publications and future impact?

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[colbgw02]

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[pgg]

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Google the title of the article, and click the search results link. It'll permit full access.


I don't disagree with the article, which is mostly critical of variable and inconsistent prehospital care, and some echelon 2 facilities, not care at the role 3s.

Corpsman / medic training, equipment, and doctrine does vary unit to unit. The claim is that up to 24% of battlefield deaths were "survivable" but even the article acknowledges that the people reviewing autopsies at Dover had no way of knowing if a "preventable" death from exsanguination was because someone didn't remember to out on a tourniquet, or because all those someones were too busy dodging bullets themselves.

There's legit criticism of the fact that medics / Corpsmen in line units don't have consistent medical leadership.

The article doesn't criticize higher echelon in-theater care, and indeed were I to have been shot or blown up there is no facility on the planet I'd have rather gone than the Kandahar Role 3 when I was there a couple years ago.

 

[HighPriest]

Then there's always the idea that even if people are dying from preventable causes, they're doing so far less often than they traditionally have in prior conflicts. War is war, and people die. So criticizing that idea is a moot point, but evaluating whether or not our fatality rates are improving - that is a valid point.
I also agree that we should always endure to improve our survival rates, and clearly that effort is being made or they wouldn't have these numbers to study in the first place. The article does a poor job of pointing that out.
And then there's the doc who said "even one death is too many." Yes, ethically that's a reasonable statement, but practically it sets a completely unreasonable precedence when you're talking about sending people out to kill. If one death is too many, then the only valid treatment strategy is not to send soldiers into conflict.
Articles like this hone in on those kinds of sentiments. It's more realistic to say that any preventable death is one too many, but I suppose it's somewhat of a semantic argument.

 

[met19]

The flight medics near my role 2 were only starting to carry blood by the end of 2012. My role 2 was aggressive about our care and had a very good rate of success- and we had both NATO and ANSF.

 

[pgg]

Part of the prehospital inconsistency comes from allowing line commanders to have an opinion in the matter.

One of the things brought up in the article was the low usage of ketamine for prehospital pain management. A couple times, after receiving a casualty who'd had a healthy dose of morphine or a couple fentanyl lollipops, I talked to the flight medics about drug choices, hoping to educate them a bit about the meritorious wonderfulness of ketamine and the sins of opiates, only to be told that they weren't allowed to carry ketamine. One even told me his CO didn't want his soldiers to go crazy when they got it, so that's why they didn't have it.

The in-theater hospitals had detailed, evidence based practice guidelines on everything. Those standards are solid and in widespread use.

The medics and Corpsmen have the TCCC guidelines and training - also solid and widespread. But there still was a lot of variability in how they were equipped and what they did.


Bottom line though, while we should always strive to be better, I think combat care from point of injury to CASEVAC out of country was pretty amazingly good on the whole, at least the last 5 or 6 years.