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Viewpoint: Don't lose lessons of combat medicine

Nov. 17, 2013 - 06:00AM   |  
By DR. JAY JOHANNIGMAN   |   Comments

The last decade of war has witnessed dramatic advances in techniques, technology and tactics across the entire U.S. military. Perhaps the most dramatic of these advances has been the care of combat causalities.

The current 8 percent died-of-wounds rate reported from operations Iraqi Freedom and Enduring Freedom is the lowest in the history of armed conflict. This is testimony to the effectiveness of military medicine in the face of the continued evolution of the destructive and wounding capabilities of the enemy.

It is an unfortunate truth that the treatment of trauma and the care of the wounded are invariably advanced during war. After 10 years and two wars of exhaustive combat causality care, the medical core retains a tremendous amount of knowledge that has resulted in countless lives saved. This knowledge has also resulted in the improvement of trauma care within the United States.

Lessons learned at war have resulted in paradigm shifts across many fields of medicine and trauma care. Advances have been seen in integrated trauma systems, pre-hospital interventions, coordinated patient movement, balanced resuscitation after a hemorrhage, damage control surgery and advanced rehabilitation.

As a Level 1 trauma center director, military surgeon and a veteran of multiple combat deployments, I have witnessed the exponential accumulation of experience and unwavering dedication that has accelerated the improvement of trauma care and medicine.

From the sands of Iraq to the mountains of Afghanistan, the sacrifice of the war fighter has provided the stage for the rapid advancement of research, development, testing and evaluation. As combat operations come to a close and the impact of sequestration is fully developed, the threat to the viability of the military medical corps and its lessons learned is palpable and imminent. Pentagon Comptroller Robert Hale recently stated that research and procurement accounts may be cut by 15 percent. This compares with an 8.2 percent cut in research and a 6.7 percent reduction in procurement in fiscal 2013.

The military medical corps is at a crossroads and in need of redirection. It can repeat the mistakes made after every previous conflict, return to the peacetime mission and relegate the care of the injured and traumatized patient to the bookshelf or civilian sector. Or we can remember that we cannot and must not lose the significant medical advances realized in the blood and sacrifice of our wounded soldiers. Ultimately, every member of the 133,000 strong military health system plays a role in combat casualty care, from the medic on the battlefield to the rehabilitation specialist working with an amputee.

More than any other time, the Defense Department must commit and codify the systems innovations that have resulted in the lowest fatality rate in the history of war. This will require a coordinated effort to support the military trauma system and invest in combat casualty care research in order to avoid resetting the system to pre-war capabilities, where deployable trauma systems were not available and outcomes potentially suffered. A collective responsibility is required to preserve and package the capabilities of our current medical care and trauma systems into a readily deployable operational system that can move forward to the battle just as rapidly as any advanced weapon system.

This will require a sustained commitment to the cycle of research, development, testing, evaluation and training that must be budgeted accordingly for the long term. War is not going away and the efforts of the medical corps have saved countless American lives those in uniform as well as citizens at home. To do less would be to dishonor the sacrifice of soldiers, sailors, airmen and Marines.

Dr. Jay Johannigman is a professor of surgery, trauma and surgical critical care at the University of Cincinnati Medical Center.

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