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UTSA Researcher On Casualty Trends In War On Terror: 'The Only Winner In War Is Medicine'

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Bradley Fighting Vehicles of Task Force 2-7 during the Second Battle of Fallujah Nov. 2004. (Photo courtesy of Lt. Col. Coley Tyler.)

A University of Texas at San Antonio researcher uncovered new information about how battlefield trauma care evolved during the Iraq and Afghanistan wars. Troops' survival rates increased three-fold as the conflicts wore on, even as injuries became more severe.

Jeffrey Howard, an assistant professor in the UTSA’s Department of Kinesiology, Health and Nutrition, published these and other findings in JAMA Surgery on March 27.

Howard and his collaborators combed through Defense Department databases and reviewed the 56,763 injuries recorded in Afghanistan and Iraq from Oct. 1, 2001, through Dec. 31, 2017.

This is what they found:

·       Injuries caused by explosives increased 26 percent in Afghanistan and 14 percent in Iraq.

·       Head injuries increased 96 percent in Afghanistan and 150 percent in Iraq.

·       Survival for critically-injured casualties increased from 2.2 percent to 39.9 percent in Afghanistan and from 8.9 percent to 32.9 percent in Iraq.

·       The case-fatality rate was cut in half from 2001 to 2017 (Afghanistan from 20 percent to 8.6 percent and Iraq from 20.4 percent to 10.1 percent) even as injury patterns and severity increased.

Howard pointed to several policy changes and treatment advances to explain the uptick in survival. In 2009, Defense Secretary Secretary Robert Gates mandated that critically wounded combat casualties be transported by helicopter to a medical facility within 60 minutes of injury.

The trauma system adapted quickly, Howard said, expanding its infrastructure to allow for more rapid transport.

“They, in a very short period of time, went from about 25 percent of casualties being transported within an hour to around 75 percent,” he explained. “One of the overarching themes is reducing the time to a needed treatment.”

Credit Carson Frame / Texas Public Radio
Texas Public Radio
Jeffrey Howard, assistant professor in the Department of Kinesiology, Health and Nutrition in the UTSA College of Education and Human Development.

The military also became more adept at managing blood loss, honing the use of tourniquets and transfusion.

“A large portion of the preventable deaths are attributable to hemorrhage,” Howard said. “People get severely injured. They bleed a lot, and they wind up dying because either the blood loss is not stopped in time or they don’t get the blood replaced in time.”

Without these changes in intervention and policy, Howard estimates that about 3,600 more deaths would have occurred.

“Eventually there will be another war,” Howard said. “We don't necessarily know what that's going to look like. But what I hope is that we remember these lessons of the trauma system adapting rapidly to changing realities....that we apply these performance improvement measures... that we are constantly learning.”

“The only winner in war is medicine,” he said.


Carson Frame can be reached at Carson@TPR.org and on Twitter at @carson_frame.


Carson Frame was Texas Public Radio's military and veterans' issues reporter from July 2017 until March 2024.