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A new study finds that nearly a quarter of the 4,596 combat deaths in Iraq and Afghanistan between 2001 and 2011 were "potentially survivable," meaning that under ideal conditions — and with the right equipment or latest medical techniques — the troops may have had a fighting chance.
But the study also notes that 90 percent of the deaths occurred before the injured reached a medical facility: of the 4,090 troops who suffered mortal wounds on the battlefield, 1,391 died instantly and 2,699 succumbed before arriving at a treatment center.
Just 506 service members made it to a field hospital before dying of injuries — an indication that military researchers should work to improve field treatment capability, says trauma surgeon Col. Brian Eastridge with the U.S. Army Institute of Surgical Research.
"This study does not imply we are leaving our warriors on the battlefield languishing. 'Potentially survivable' implies there are potential improvements — areas we may look to where we could alter outcomes so they don't die in the immediate phase," Eastridge said.
Combat survivability is at an all-time high in Operations Enduring Freedom and Iraqi Freedom. Ten percent of all injuries resulted in death, as opposed to Vietnam, where the fatality rate was 16.1 percent, or World War II, with a 19.1 percent fatality rate.
But there is more the military medical community can do to improve outcomes, Eastridge argues.
"There's a tremendous amount of information we can gain and potentially improve clinical care if we know why casualties die on the battlefield," he said.
Among the potential fields for more research is hemorrhage control: The study showed that uncontrolled blood loss was the leading cause of death in 90 percent of the potentially survivable battlefield cases and in 80 percent of those who died in a military treatment facility.
"Bleed-outs" — especially those caused by groin or neck wounds — torment medics, corpsmen and physicians who can do little to stanch blood loss caused by major arterial injuries.
Two devices, the Combat Ready Clamp and Abdominal Aortic Tourniquet, have been built to treat these injuries, but the Combat Ready Clamp, now being fielded, is primarily for treating single groin or pelvic injuries and is ineffective against wounds involving the genital region or the loss of both legs.
The Abdominal Aortic Tourniquet, which acts like a big blood pressure cuff around the lower torso to stop extremity bleeding, is still undergoing approval.
Other advancements, such as freeze-dried blood products that promote clotting, and tranexamic acid, or TXA, a medicine that reduces clot breakdown, demand more attention, according to Eastridge and Dr. Frank Butler, a former Navy SEAL and chairman of the Tactical Combat Casualty Care Committee.
"Hemorrhage control, both control of torso hemorrhage and junctional hemorrhage are top research priorities," Butler told members of the Defense Health Board on June 25.
Previous research has resulted in policy changes that save lives, according to Eastridge. For example, early in the wars, medics and troops were discouraged from employing tourniquets in most cases to reduce risk of limb loss.
After analysis, the Trauma Combat Casualty Care committee recommended aggressive tourniquet use, reducing the number of deaths due to blood loss from limb injury from 26 a year to nine.
According to the study, nearly 65 percent of all troop deaths resulted from explosions while 22 percent died from gunshot wounds. The remainder fell under the category of "other."
The major cause of instantaneous death was dismemberment (498 cases), followed by brain injury (489). Heart and thoracic injury caused 349 mortalities.
The causes of death among those who died before arriving at a hospital was brain injury (940 cases), chest or heart wound (344), high spinal cord (216) and open pelvic wounds (101).
As of June 28, 5,106 U.S. troops have been killed in action in the conflicts in Iraq and Afghanistan according to the Defense Department.