Ninety percent of U.S. wounded survive

For an article in the Dec. 9, 2004 issue of the New England Journal of Medicine, Atul Gawande, an assistant professor at Harvard Medical School and a surgeon at Brigham and Women’s Hospital in Boston, gathered data on casualties and talked with surgical teams that served near the front lines in Iraq. He concludes that the “military medical system has made fundamental – and apparently effective – changes in the strategies and systems of battle care, even since the Persian Gulf War.” In that 1990-91 conflict, 24 percent of the wounded died, or more than twice the rate in Iraq and Afghanistan since 2001. The reduced death toll has occurred despite the limited number of medical personnel available. Gawande says that the shortage means that the Army keeps “no more than 30 to 50 general surgeons and 10 to 15 orthopedic surgeons in Iraq.” This relatively small cadre attends a fighting force growing to 150,000 troops. The surgeons are deployed in small teams of 20 people called Forward Surgical Teams (FST). “Each FST is equipped to move directly behind troops and establish a functioning hospital with four ventilator-equipped beds and two operating tables within a difficult-to-fathom 60 minutes,” Gawande explains.