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.