Note: This is part two of a two-part series. Read part one hereIn part one of this series, SOFREP discussed the myriad challenges involved in improving the U.S. military’s practice of battlefield trauma care.  Unfortunately, bureaucratic delays and roadblocks to advancement are nothing new in the U.S. military, and no one should expect that making advances in combat trauma care should be any different.

At the start of the war in Afghanistan, for example, the U.S. military was using the same pain relief drug for wounded soldiers on the battlefield that was used by military doctors under Generals Sherman, Grant, and Lee in the Civil War. Let that soak in for a minute. Granted, morphine is a good drug, but when it is given intramuscularly, as it most often is, it works very slowly, and when it does start working, it can drop blood pressure and suppress breathing. Neither of those are good things for a combat casualty.

Today, there are far better medications with which to relieve pain, as well as other significant advances to improve the treatment of America’s combat wounded. The next step is making them permanent and prescribed throughout the entire U.S. military. An important lesson learned over the last 14 years of war is that in combat casualty care, the actions of combat commanders are critical to the rapid and uniform use of those advances.

The progress made

In combat operations, unit surgeons advise, but it is combat commanders who command. In fact, the most critical advances in casualty care during recent years of combat were made by senior combat leaders in special operations—imposing TCCC as the standard of care for SOF—and by Secretary of Defense Robert Gates, who mandated that casualties in Afghanistan be evacuated within 60 minutes of being wounded.

The question of just how to fully implement the advances made in combat medicine—particularly in the last 14 years in Afghanistan and Iraq—as well as how to ensure that those advances are preserved for future conflicts, was the subject of a paper published in the summer of 2015 in the “Journal of Trauma and Acute Care Surgery.”

The paper, entitled “Implementing and Preserving the Advances in Combat Casualty Care from Iraq and Afghanistan throughout the U.S. Military,” opens with a statement that almost perfectly captures just where U.S. military medicine was before 9/11/2001, and where it is today:

The U.S. military had not effectively sustained many of the lessons learned from past conflicts and went to war in Afghanistan without wide availability of tourniquets, without modern battlefield analgesics, without prehospital plasma, and without trauma care guidelines designed specifically for use on the battlefield. Hemostatic dressings had not yet been developed and fielded. There was no military deployed trauma system, no Department of Defense trauma registry (DoDTR), no weekly worldwide trauma teleconferences to review treatments and outcomes for all casualties occurring in the preceding week, and no Committee on Tactical Combat Casualty Care (CoTCCC).

The progress made has been nothing short of remarkable. Over the past 14 years, military medicine has made advances in essentially all aspects of trauma care, from controlling external bleeding, to relieving the pain of combat wounds, to using better methods for treating shock resulting from blood loss. Military medical personnel record all aspects of a casualty’s care. Evacuations from the battlefield, back to advanced medical facilities at Landstuhl, Germany, and the United States, are executed faster than ever before. In other words, U.S. military medicine has come a long way in caring for combat casualties.