Afghan war brought advances in battlefield medicine

One-handed tourniquets, blood transfusions near the front lines, faster evacuations and more saved lives in 20 years of a U.S. military presence in Afghanistan.

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June 9, 2021 - 8:55 AM

In June 2012, medical personnel at Forward Operating Base Edinburgh, in Helmand Province, discuss a patient’s case. (Nelvin C. Cepeda/The San Diego Union-Tribune/TNS)

SAN DIEGO — When the last U.S. service member leaves Afghanistan, perhaps by early next month, America’s longest war on foreign soil will end — and so too a mission initially dubbed Operation Enduring Freedom.

Just what endures from the 20-year war is an open question, except in one area: battlefield medicine. There, gains have already taken root.

One-handed tourniquets. Blood transfusions near the front lines. Faster evacuations to trauma centers. All got implemented in Afghanistan, and all saved lives.

This has often been the case during the mayhem of military combat, which forces doctors to improvise, and quickly. The advances they make then spread to civilian health care.

Anesthesia has ties to the Civil War. World War I brought the first widespread use of X-rays. World War II was a proving ground for blood banks and antibiotics. Medical evacuation by helicopter started in the Korean War.

“These changes happen because there is a profound need, and because the injuries are of a scale, unfortunately, where you have enough cases to pioneer a technique and enough evidence to show that it works,” said Scott McGaugh, a San Diego military historian. “There’s hardly a corner of today’s health-care environment that doesn’t trace its roots back to the battlefield,”

McGaugh, author of “Battlefield Angels,” a 2011 book about combat medics, said Afghanistan, where catastrophic injuries were caused by roadside bombs and other improvised explosives, necessitated a significant change.

“In the last century, the whole notion was to get the wounded off the battlefield as quickly as possible,” he said. “This century, there’s a heavy emphasis on taking trauma care to the battlefield.”

The result is that war has never been more survivable. During the Revolutionary War, about 40% of the seriously wounded eventually died. In World War II, about 30% did.

In Afghanistan, what had been a 20% fatality rate in the early years of the war was reduced to 8.6% by the later stages.

“The only winner in war,” an old saying goes, “is medicine.”

Tourniquets to stem blood loss are ancient. They date at least to the reign of Alexander the Great and his invasion of Persia in around 334 B.C.

But they haven’t always been recommended. Dr. Matthew Tadlock, a Navy trauma specialist in San Diego, remembers being taught in medical school more than 20 years ago that “tourniquets are bad and shouldn’t be used.”

That’s because studies showed that the devices could cause nerve damage and might lead to amputations, according to Jeffrey Howard, who has studied their use and is an assistant professor of public health at the University of Texas at San Antonio.

At the Afghanistan war’s outset, tourniquets were not widely used. “But once we got in there,” Howard said, “we learned pretty quickly: We need these.”

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