A Medical Revolution: Mortality Rates Among Today's War Wounded Half of During Vietnam Era

Landstuhl Regional Medical Center doctors perform surgery on a wounded servicemember. Today, the mortality rate among wounded troops is half of what it was during the Vietnam War. - Photo by Todd Goodman / Courtesy of U.S. Army

Refinements in medical care help more war wounded survive

Doctors cite new techniques in saving of about 2,200 troops

The number of troops dying as a result of battlefield injuries in the Iraq war is half of what it was during the Vietnam War, critical care and trauma surgery experts at Landstuhl Regional Medical Center say.

Medically speaking, today’s mortality rate among wounded troops is 50 percent less than it was roughly 35 years ago.

The lower mortality rate among today’s wounded troops has been achieved not so much by innovations but rather refinements to U.S. military medical care, doctors said.

“I think it’s the refinement of techniques that has really changed the outcomes of our multitrauma patients,” said Air Force Dr. (Lt. Col.) Guillermo J. Tellez, chief of Landstuhl Regional Medical Center’s surgery division. “It’s everybody putting their lessons learned toward refining techniques.”

Those refinements have saved thousands of lives since the beginning of the wars in Iraq and Afghanistan.

“There would have been an additional 2,200 people that would have died without the things that we’ve done,” said Air Force Dr. (Lt. Col.) Warren Dorlac, chief of critical care and trauma surgery at Landstuhl.

Those include: damage-control surgery, limb and abdomen incisions, external fixators, critical care air transport, formal trauma systems and concurrent process improvement.
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In damage-control surgery, surgeons treat only a patient’s most critical problems and get that patient out of surgery so he or she can receive additional treatment at a medical facility with more assets.
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The critical care air transport allows wounded patients to be evacuated from downrange to Landstuhl, where doctors can provide more comprehensive treatment. From July 2004 to July 2005, 690 critically injured patients were transported to Landstuhl via critical care air transport. The air transport capability allows U.S. military medical providers to have a smaller presence downrange.

Until very recently, the military lacked a formal trauma system that linked what doctors were doing to patients across its continuum of care — from downrange to Landstuhl and on to Walter Reed Army Medical Center in Washington, D.C.
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With concurrent process improvement, military medical providers have been able to examine data and make treatment changes just weeks later — something that has never been done in prior U.S. conflicts.

“It has been done on a large scale before, so at the end of one or two years in World War II someone says, ‘Hey, we’ve had a lot of complications with this,’” Dorlac said. “They pull all the records up, look at it and say, ‘We are having some problems. Yeah, let’s change that.’ We’re making decisions now after a month of data.”