Technology, medical advances raise soldiers' survival rates
November 28, 2005

First Sgt. Brent Jurgersen's experiences in Iraq - he was critically injured twice - illustrate several trends in this war.

1. Fewer wounded soldiers are dying on the battlefield.

A study published last year in the New England Journal of Medicine found that about nine of every 10 soldiers are surviving their war wounds, the highest survival percentage in U.S. history.

As of Sunday, 1,653 U.S. soldiers have been killed in action, while more than 15,800 have been wounded. (The total number of U.S. deaths, 2,106, also includes those who died in nonhostile activities.)

In World War II, the study showed, about 30 percent of Americans who were wounded on the battlefield died from their injuries. The figure was 24 percent during the Vietnam War.

The report's author, Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston, said Kevlar helmets and vests are partly responsible for the improved survival rate.

In addition, Gawande said today's troops are benefitting from quick-acting trauma teams on the battlefield. And the time it takes to get a wounded soldier to a hospital also has decreased sharply.

In Vietnam, it took an average of 45 days to get a wounded soldier to a hospital, he said; today, it takes about four days.

"Military doctors are still performing very much at unprecedented levels," Gawande said in an e-mail.

2. Those wounded soldiers who survive often suffer dramatic, disfiguring injuries.

That's the darker side to the increased survival rate.

Surgeons at Walter Reed Army Medical Center in Washington, D.C., have seen an increase in what one doctor called "devastating extremity injuries" due to mortar blasts and other explosions.

Military officials say they are seeing about twice the rate of injuries requiring amputation that they saw in World War I and World War II.

At Walter Reed, for example, 299 service members have been treated for injuries that required at least one limb to be amputated.

Many are surviving wounds that would have killed them in past wars.

USA Today reported earlier this year that some troops who survive bomb and rocket attacks also are suffering brain damage from the concussions of the blasts. A Walter Reed neurologist likened the injuries to "shaken-baby syndrome."

3. More injured soldiers are returning to active duty.

According to the U.S. Department of Defense, 53 percent of the 15,800 troops injured in the war were able to return to active duty within 72 hours.

But military officials say an increasing number of seriously injured soldiers, like Jurgersen, want to return to active duty when they might have automatically received a medical discharge in the past.

And they are being encouraged to do so, through a new program called the U.S. Army Wounded Warrior Project.

"That's very much different," said Lt. Col. Kevin Arata, public affairs officer for the Army's human resources command.

One example is Capt. David Rozelle, who returned to his command in Iraq despite injuries that required his foot to be amputated, Arata said.

Arata said the Army has changed its philosophy. If an injured soldier wants to remain on active duty and is physically able to do so, every attempt will be made to allow him or her to do so.

"That's a sea change in how we're looking at them," said Lt. Col. Bryan Hilferty, an Army spokesman. He said 10 to 15 soldiers with amputations have returned to or remained on active duty, including a special forces soldier in Afghanistan.

Hilferty said he doesn't know of a single Army soldier who has been medically discharged if he or she wanted to stay on duty. The wounded soldiers may not be able to return to combat positions, but the Army will try to find jobs they can do, he said.

4. Returning soldiers from Iraq and Afghanistan are stretching the resources of the U.S. Department of Veterans Affairs.

About 450,000 soldiers and Marines, including National Guardsmen and reservists, who served in Iraq or Afghanistan have been discharged.

Of those, about 120,000 have received medical treatment from the VA.

James Nicholson, secretary of Veterans Affairs, said in an interview that the VA has been able to meet the needs of the returning soldiers, as well as the 7.5 million veterans enrolled in health care programs.

But others aren't so sure.

Bill Bradshaw, director of veterans service for the Veterans of Foreign Wars, said he agrees with the need for the VA to give first priority to veterans returning from the current conflicts, but he says that has affected veterans from other wars.

"The lines are getting longer," he said. "You're sacrificing a little bit."

Others have suggested that the VA does not have enough money to meet the increased demand, particularly for mental health care. Several studies have shown an increasing number of returning soldiers suffering from post-traumatic stress disorder.