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In every war it has fought for the past 100 years, U.S. armies have lost fewer soldiers to combat than to disease. In World War II, 95.6% of U.S. soldiers who were admitted to military hospitals were treated for noncombat injuries, according to the Navy's Medicine & Surgery Dept. In the Korean War, that figure fell to 82.4%. And in Vietnam, 64.2% of soldiers who had to leave the field were hospitalized for disease, heat stroke, or accidental injury, compared with 27.6% who were injured in action.
The falling number of noncombat casualties is a testament to the military's emphasis on -- and advances in -- safety measures and preventive medicine. Besides being the right thing to do for American troops, heavy investment in preventive medicine is sound military strategy, Navy Admiral Dr. John Mateczun said at a press conference Mar. 13. Sick and wounded soldiers, he pointed out, can't fight.
ONE-HAND TOURNIQUETS. In the war with Iraq, preventive medicine will be more important than ever. Modern warfare is predicated on highly dispersed and fast-moving units. U.S. troops entering Iraq from the southern port of Basra, for example, must travel 400 miles to Baghdad. So even with high-tech forward medical teams, a wounded soldier often can be more than 100 miles from experienced surgeons.
It's true that a few new tricks could save some soldiers who are that far from help: High-tech bandages that contain Fibrin and Thrombin, drugs that promote blood clotting, are one example. One-handed tourniquets -- in place of the traditional two-handed cloth wrap that an injured soldier might not be able to manipulate -- buys more time.
Still, in many cases, it will be hours or days before wounded soldiers arrive at well-stocked medical facilities, a delay that could be fatal. "Disease and injury prevention are clearly where the emphasis should be," says Colonel Cliff Cloonan, chairman of the department of military and emergency medicine at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md.
HALTED BY DYSENTERY. In Iraq, keeping troops hydrated in scorching desert temperatures and disease-free will be essential, adds Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville. If those seem like mundane goals, you need only look back to the 1967 Arab-Israeli War, where 20,000 soldiers died in the heat after they were isolated from their sources of water. A decade earlier, when U.S. Marines were deployed in Lebanon, the entire force was incapacitated by dysentery within two weeks of entering the country.
The U.S. military has learned these lessons well. Thanks to time-tested hydration plans, ready-to-eat meals, and uniforms infused with permethrin, an insecticide that wards off ticks, mosquitoes, and other disease-carrying insects, the rate of hospital admissions due to nonbattle injuries in the 1991 Gulf War was lower than 50 per 1,000 patients. Compare that to 917 per 1,000 admissions in the Mideast theater during World War II.
Like modern warfare, preventive medicine is becoming increasingly high-tech. "The things that make the difference in terms of survival on the battlefield have nothing to do with what the average person thinks of as medicine," says USUHS' Cloonan. "We don't think of body armor as medicine but the truth is, it is -- in the same way a vaccine prevents you from getting a disease."
EYE PROTECTION. As recently as the last Gulf War, only special-operations troops were issued body armor, which includes a ceramic plate capable of deflecting high-velocity bullets. For the conflict in Iraq, body armor, such as SPEAR (Special Operations Forces Equipment Advanced Requirements), has been issued to all ground troops. The soft-armor vest provides protection against shell fragments, plus pistol and rifle rounds that hit the chest, neck, and groin areas. A medium-size vest weighs about six pounds.
The military also has updated troops' protective eyewear. An estimated 10% of battlefield casualties are from eye injuries, a figure that has steadily increased since the Civil War, says Harold Moody, project engineer at the U.S. Army Soldier & Biological Chemical Command in Natick, Mass. Soldiers' eyes are easily damaged by sun, sand, wind, and debris from nearby blasts. Modern munitions explode into fragments ranging from 50 milligrams to 300 mg in weight (an aspirin tablet is 325 mg).
New protective eyewear used by troops in Iraq is made of lightweight, yet tough, polycarbonate. It's designed to stop a 0.15-caliber fragment -- about an eighth of an inch in diameter -- that's traveling at a speed of 640-660 feet per second (about one-fifth the speed of a round fired from an M-16 rifle).
SAFETY WEAR. Concern that Saddam Hussein will launch a chemical or biological attack has also caused the military to focus on lightweight biochemical protective garb, says Navy Lieutenant Commander Donald Sewell, a Pentagon spokesman. Each of the 240,000 troops in the Persian Gulf has been issued two JSLIST (Joint Service Lightweight Integrated Suit Technology) uniforms, which were developed in 1997. Each suit weighs 5.6 lbs., is usable for 45 days, and can be laundered up to six times.
Troops have also been issued new masks that offer a wider range of vision, which allows soldiers to continue to perform their duties more efficiently. It's also easier and faster to change filtration canisters on the new masks than on past models, Sewell says.
Of course, only such much can be done to prevent harm, especially in the case of a biological or chemical attack. The sensors that pick up such agents are much more precise than they were during the first Gulf War, but troops still lack a single detector that can identify both threats. Moreover, it can take as long as 15 minutes for detectors to sound an alarm, by which time it could be too late for troops to don protective suits and masks. And once soldiers are suited up, desert heat could force them to shed the suits after 15 or 20 minutes, which might not be long enough for a threat to pass.
SPEED SAVES. In the end, however, an overwhelming advantage in firepower is the best medicine, say military tacticians. That's what held U.S. losses to just 295 soldiers in the 1991 Gulf War. In fact, a rapid victory helps save lives on both the winning and losing sides, since the highest casualties occur in protracted combat in which neither side has a decisive advantage. About 375,000 Iraqi soldiers were killed in its eight-year war with Iran, vs. estimates of about 20,000 during Operation Desert Storm.
Sudden victory isn't medicine exactly. But when it happens, it's just as good at saving lives.
Copyright 2003, by The McGraw-Hill Companies Inc. All rights reserved.
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