Number of Combat Injuries in Afghanistan Doubled in 2010; Fatality Rate among Wounded Declined

A wounded Afghan soldier was carried to an American medevac helicopter in Kandahar Province, Afghanistan, on Dec. 7. Photo: Tyler Hicks/The New York Times.

Nearly 5,500 US troops suffered combat injuries in Afghanistan in 2010 - more than twice the number wounded in 2009. But fatalities among wounded declined, due to advances in battlefield medical evacuation and treatment that CJ Chivers describes as a "contest [which] pits a multilayered and expensive effort to keep troops alive against the sharply increased rate at which they suffer grievous injuries, some beyond what any medical system can heal."

KHAKREZ DISTRICT, Afghanistan — Intensified fighting and a larger troop presence in Afghanistan in 2010 led to the highest American combat casualties yet in the war, as the number of troops wounded by bullets, shrapnel and bombs approached that of the bloodiest periods of the war in Iraq.

But the available data points to advances in the treatment of the fallen, as the rate at which wounded soldiers who died reached a wartime low.

More than 430 American service members died from hostile action in Afghanistan last year through Dec. 21, according to official data released by the Pentagon last week at the request of The New York Times.

This was a small fraction of those struck. Nearly 5,500 American troops were wounded in action — more than double the total of 2,415 in 2009, and almost six times the number wounded in 2008.

In all, fewer than 7.9 percent of the Americans wounded in 2010 died, down from more than 11 percent the previous year and 14.3 percent in 2008.

The fatality rate declined even though many more troops patrolled on foot, exposing the force to greater dangers than in years past. Several doctors said the improvements came not from a single breakthrough but through a series of lessons learned over nearly a decade of fighting two wars, such as placing medevac helicopters closer to the fighting and the more extensive use of tourniquets.

Although fatality rates for wounded Afghan troops are not similarly available, doctors involved in their care said hospital records showed that they trail those of Western troops by a few percentage points, but have also fallen.

Several soldiers and those who care for them framed the improved survival rates as the grimmest sort of success. Many more troops — some missing multiple limbs or their genitals, or suffering brain damage — are being rescued from near death. But their wounds will be exceptionally difficult to overcome later as they try to resume work, and social and family lives.

Along with interviews with medics and military doctors, and a month spent by two journalists from The Times observing the collection and immediate treatment of troops suffering from a wide range of trauma, the data shows the results, in broad terms, of an evolving contest for wounded soldiers’ fates.

The contest pits a multilayered and expensive effort to keep troops alive against the sharply increased rate at which they suffer grievous injuries, some beyond what any medical system can heal.

A clear decline was evident: In 2005, 19.8 percent of wounded American soldiers died from their injuries. For the past five years in Afghanistan and Iraq, the fatality rates for wounded Americans have otherwise fluctuated between 9.4 and 14.3 percent.

(The data draws from a sample running into the tens of thousands; in 2006 in Iraq, for example, nearly 7,200 American troops were wounded by hostile action, more than 700 of them fatally.)

The statistics further served to reinforce consistent trends in the battlefield’s array of lethal hazards, and offered glimpses of wars within the war.

More soldiers in Afghanistan in 2010 were wounded by explosive devices (at least 3,615, compared to 828 troops reported to suffer gunshot wounds). But the higher fatality rates from gunshot wounds (12.9 percent versus 7.3 percent for wounds caused by bombs) made rifles and machine guns the most statistically deadly weapons.

Rocket-propelled grenades, for all their ferocious reputation, proved less of a threat. They wounded 373 American soldiers, of whom 13 — 3.5 percent — died.

It's worth your time to read the rest of CJ Chivers' well-researched and informative article at The New York Times.