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On Distant Battlefields, Survival Odds Rise Sharply
Alan Cullison
Wall Street Journal

KANDAHAR, Afghanistan — Under a dusty hospital tent where doctors yell over the roar of jet engines,
Dr. John York studied an electronic image of a blood vessel in the neck of a soldier wounded by an improvised bomb. It looked like a balloon ready to pop. Too delicate to operate on directly. Dr. York would have to try a procedure that had rarely been attempted so close to a battlefield.

Using a sophisticated X-ray machine, he snaked a tube from an artery in the soldier's leg until it reached his neck. Dr. York threaded in a feathery device that popped open and blocked blood from the ballooning
artery.

Today that soldier, Specialist Chancellor Alwin, is an outpatient at the army medical hospital in Washington. His only visible scars from the January procedure are a small one near his neck and another in his thigh. His wife, Samantha, says he suffers from moods swings and lingering nerve damage, "but we are thankful he is alive," she says.

Medical advancements have led to greater survivability of war wounds among U.S. troops in Afghanistan and Iraq, as well as greater complications in caring for survivors. WSJ's Alan Cullison reports from the 451st Air Expeditionary Wing medevac unit in Kandahar Province, Afghanistan.

Every war brings medical innovations, as horrific injuries force surgeons to come up with new ways to save lives. During the Civil War, doctors learned better ways to amputate limbs, and in World War I they developed the typhoid vaccine. World War II brought the mass use of penicillin, Korea and Vietnam the development of medical evacuation by helicopter.

The lessons of Iraq and Afghanistan, medical experts say, are still emerging. One legacy is new ways to control bleeding before soldiers lapse into comas or their vital organs shut down. Thanks to new clotting agents, blood products and advanced medical procedures performed closer to the battlefield, wounded American soldiers are now surviving at a greater rate than in any previous war fought by the U.S.

The rising survival rate, now touching 95% for those who live long enough to get medical treatment, is in turn introducing new problems caring for patients with serious and chronic injuries, including multiple amputations and brain damage. The cost of treating such lasting injuries will be borne by the U.S. medical system for decades to come.

On the medical front lines, however, military doctors often focus just on keeping wounded soldiers alive. In Afghanistan, troops are protected by new generations of armored vehicles, bulletproof vests and helmets that often keep them from getting killed outright in firefights. That leaves doctors and medics to face a dire range of war wounds—limbs mangled and severed by explosive devices, shrapnel and bullet wounds to the face and the neck, and unseen internal bleeding.

"If you can stop the bleeding, you gain time to save a life," says Sgt. Anthony Reich, the U.S. Air Force's equivalent of a paramedic, who flies into battle zones to retrieve the wounded and bring them to Kandahar air field for treatment. "Medical textbooks are being rewritten as we speak."…

Early in the Iraq war, medics supplemented old-fashioned gauze bandages with QuikClot, a clay kitty-litter-like substance manufactured by Z-Medica Corp. of Wallingford, Conn. When sprinkled into wounds, it absorbs water from blood and "stops bleeding like a clogged pipe," says Sgt. Reich, the Air Force medic.

X-ray of the pelvis of a soldier injured in Kandahar Province by an IED reveals shrapnel and a broken femur.
But surgeons at battlefield hospitals often had to pick the gooey granules out of wounds, and the byproduct of the clotter sometimes left burns on flesh. Z-Medica subsequently developed QuickClot Combat Gauze—surgical gauze treated with organic material that helps blood coagulate quickly, doesn't burn the flesh, and "is easy to push down into crevices and is easily removed," Dr. Dunne says…


The complete WSJ story can be viewed here.