The evolution of evacuating the war wounded

Medical evacuation of the wounded has been a challenge for the military since the Civil War. Horse-drawn ambulances carried the wounded from the battlefield to limited capability medical facilities. World War I saw the introduction of motorized ambulances and better hospitals.

World War II brought us close to what we regard as modern battlefield medical care and evacuation. Wounded were carried on litters to transport by boat or ambulance. The aid stations were close to the fighting, and the wounded were finally given access to critical medical care. If the wounded could be transported to an airfield, aircraft such as C-47s could fly the casualties to hospitals.

The Korean War brought the helicopter to military medicine, and casualties were transported faster and over greater distances. The survival rates of combat wounded in these two wars ranged from the 60 percentile to the 70s.

The military in Vietnam had access to better air evacuation capabilities. Casualties were often picked up by helicopters flown through enemy fire by aircrews who set a new standard of courage in flight. Each improvement in getting casualties to medical care has improved survival rates, and in Vietnam survival rates were 80 percent or more. In Iraq and in Afghanistan the survival rate for the wounded has exceeded 90 percent. Speed has long been seen as a critical factor in combat medical care for the wounded, but studies have raised an interesting fact.

According to the military newspaper "Stars and Stripes," the University of Maryland medical school has found that medical evacuation by airplane can cause more damage in those with traumatic brain injuries. Traumatic brain injuries are one of the leading causes of death and disability in these wars. Many are caused by the concussive effects of the large amount of explosives used in improvised explosive devices. It was found that military aircraft are pressurized to an altitude of 9,000 feet. For comparison, civilian airliners are pressurized to 6,000 feet. The studies showed that injured brains lost more brain cells at the higher pressurization altitude. Professor Alan I. Faden, who was part of the studies, said he hopes the Air Force will improve pressurization on aircraft. The results of this study were published Monday in the Journal of Neurotrauma.

Jack Dragoni attended Boston College and served in the U.S. Army in Berlin and Vietnam. He lives in Chaffee, Missouri.