San Diego Union Tribune

October 31, 2004

Mortality rates drop from past to present
Improved body armor, medical care cited

By Otto Kreisher

WASHINGTON – On average, two U.S. troops die every day in Iraq and almost 15 are wounded.

The war's 7-1 ratio of injuries to deaths is much higher than in past U.S. combat experience, where it ranged from 2-1 in the earliest conflicts to better than 3-1 in Korea and Vietnam.

Experts attribute the lower mortality rates to several factors, including the nature of the threat, the stronger body armor being worn by U.S. forces and improved battlefield medical care.

In 18 months of conflict, 1,106 U.S. personnel have died in Iraq from combat action or accidents and 8,150 Americans have been injured, according to Pentagon statistics as of Friday.

During the intense first six weeks of the allied ground assault on Iraq in March and April 2003, the ratio of wounded to killed was at the more traditional levels of 2-to-1 and 3-to-1.

After major combat operations were declared over on May 1, 2003, the ratio shifted to the current level of roughly 7-to-1. About 90 percent of all U.S. casualties have occurred since then and shrapnel from roadside bombs has been the primary cause.

The deadly effect of those crude but powerful weapons is reduced by "the better body armor," said Navy Capt. Steven Yowell, a physician at the Bureau of Navy Medicine.

Because of the protection afforded by the bulky "flak vests" the troops wear, "the serious chest-and abdominal-wounds percentages are lower," Yowell said. While there can be "significant bleeding" from wounds to the unprotected groin and arm pits, "it's not as immediately life threatening as wounds to the chest."

The next major factor in the survival rate is improvements in medical care, ranging from new first-aid devices, such as a "self-applying tourniquet" that a wounded fighter can use if no one else can help, and "QuickClot," which is effective at stopping life-threatening arterial bleeding, Yowell said.

"We have anecdotal evidence those are saving lives," he said.

Wounded Marines also get treatment first from the Navy hospital corpsmen who are attached to every small combat unit, then at "forward resuscitative surgery teams" that operate close to the battle. They can be treated at an "expeditionary medical facility," or at the two larger Army combat surgical hospitals in Iraq, Yowell said,

And the most seriously wounded are airlifted then to the permanent Army Medical Center at Landstuhl, Germany.

Wounded soldiers get a similar series of treatment, said Jaime Cavazos, a spokesman for the Army Medical Command.

A recent improvement in Army battlefield aid, Cavazos said, is the "combat life saver," ordinary soldiers who receive training so they can provide a higher level of first aid, including administering IV fluid to prevent shock from blood loss. The Army combat medics also "are much better trained than in Desert Storm," he said, giving them the skills of a civilian emergency medical technician.

The Army has a dedicated medevac helicopter unit in Iraq, using specially equipped H-60 Blackhawk helicopters to speed seriously wounded troops to the advanced medical facilities, Cavazos said. And they have deployed an ambulance version of the new Stryker armored troop carrier, he said.

Retired Army Maj. Gen. Robert H. Scales, a military scholar and historian, said using helicopters for medevac in Iraq can be difficult because many of the serious casualties have been in congested cities.

Michael Vickers, a former Army special forces officer, said he was surprised the death rate was not higher because of the insurgency nature of the conflict, which "levels the playing field" by giving the adversary more of the advantage on when and where to strike.

But, Vickers added, "We've gotten a lot better at medical treatment since Vietnam" and the body armor also is improved.

"There are two countervailing factors: The playing field benefits them more, they have more opportunity to inflict KIAs," he said, using the term for killed in action. But with the improved body armor and medical care, "we're converting KIAs into WIAs, (wounded in action)."

"The big difference is medical care," said Loren Thompson, a national security analyst at the Lexington Institute.

"The type of war that's being fought in Iraq normally produces fewer casualties than traditional combat. But that in itself does not explain the ratio," Thompson said.

"The big difference here is, when an American soldier is actually wounded, the emergency medical process in the field, the quick transport to hospital and new medical treatments goes to work," he said.

While the body armor and improved medical care are saving lives, the experts noted, the devastating effect of roadside bombs and car bombs mean many of the surviving troops have lost limbs or suffered serious face and head wounds.

And there are the less visible wounds. Officials at Landstuhl estimate that one in 10 of the service members evacuated from Iraq are treated for psychiatric or behavior problems, a product of the stress of a prolonged conflict where it is hard to spot the enemy.

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