Military medical system also over- stretched by the Iraq war
by Carl Osgood
WASHINGTON, Dec. 21 (EIRNS)The New England Journal of Medicine, in its Dec. 9 issue, presented still more evidence that the number of American troops killed in Iraq, 1,300 as of Dec. 21, is deceptively small. Dr. Atul Gawande, from the Department of Surgery at Brigham and Women's Hospital in Boston, Mass., reports that advances in trauma medicine, and the development of forward surgical teams that follow right behind the troops going into battle, have combined to save an unprecedented 90% of battle-wounded soldiers. By comparison, in World War II, some 30% of those wounded, died of their wounds, and in the Vietnam War, the figure dying was 24%.
However, this has been accomplished under constraints that call into question how long Army doctors can continue to save so many lives. According to Dr. Gawande, the Army is estimated to have only 120 general surgeons on duty, and another 120 in the reserves. It therefore is seeking to keep no more than 30 to 50 in Iraq, as well as 10 to 15 orthopedic surgeons. Second, while the Army's medical strategy was originally designed to complement a fast-moving war-fighting strategy, the war in Iraq has gone on far longer than planned.
Not only has the number of wounded continued to increase, but the nature of the injuries has changed, from mostly gunshot and shrapnel wounds to blast injuries from roadside bombs and suicide bombs, which have proven to be much more difficult to manage. Blast injuries from roadside bombs often extend upward underneath body armor, and are producing devastating injuries to legs and arms that often result in amputation. - Difficult Conditions -
As a consequence of the relatively small number of surgeons, and of increasing pressure on the military medical system, many doctors are in Iraq for the second time, and some are facing third deployments. These conditions are making it harder to recruit medical personnel into the military, especially the reserves. Since President Bush has declared that there will be no draft, the Defense Department is relying on financial incentives to attract more medical personnel. Whether that will work, remains to be seen.
The conditions described in the New England Journal of Medicine article were confirmed, in spades, by Dr. Darnell Blackmon, a Naval Reserve orthopedic surgeon deployed with the Army in Iraq. In a Dec. 14 email to this news service, Dr. Blackmon wrote that morale is the lowest that he's seen in 16 years in the service. "For the surgeon, in particular," he wrote, "the numbers of recruits are down, and the number wanting to resign their commissions has increased." He noted that many deployed surgeons are taken out of private practices that non-existent when they return home, and that the conditions they deploy into are horrible, with the power to make medical decisions taken away from them.
He further reported that most of the patients the surgeons treat in Afghanistan are local nationals whose care is paid for entirely by the United States. "Our own indigents at home do not receive such care," he said. He also noted the talk of a military draft for health-care personnel, as did the NEJM article.
If such a draft is carried out, what will happen to health care for Americans here at home?
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