Medics and combat lifesavers are keeping more and more servicemembers alive with the help of some new trauma-care techniques.

The most important medical lesson learned in Iraq is that enhanced trauma care, delivered moments after injury, saves many lives, says Maj. Gen. George W. Weightman, officer in charge of Army medical training.

The survival rate of U.S. servicemembers wounded in Afghanistan and Iraq has reached 90 percent, 10 percentage points higher than during the 1991 Persian Gulf War, says Weightman, commander of the Army Medical Department’s Center and School at Fort Sam Houston, Texas. He credits better body armor, forward-deployed surgical teams, and faster medical evacuations. But the most significant factor behind the higher survival rate is the performance of medics and combat lifesavers applying new trauma-care techniques.

Servicemembers who take a 40-hour Tactical Combat Casualty Course use lifesaving techniques formerly reserved for physicians to treat the three most preventable causes of death on the battlefield. They learn to quickly apply tourniquets to stop hemorrhaging from wounded arms and legs. They insert needles in chests to prevent asphyxiation from sucking chest wounds. They learn to open obstructed airways by inserting a soft rubber tube through the nose and down the throat to save shock victims.

Other medical lessons learned in Iraq, he says, include:

• The number of operating rooms is a critical measure of medical readiness, because patients now receive only emergency surgery and prompt evacuation to medical centers out of theater. There they get both specialty care and the support systems only home units and families can provide.
   

• Medical resources still take a backseat to trigger pullers as commanders prepare for war. Therefore, to compete for precious space aboard transport ships or aircraft, the 286-bed combat support hospital, which fills up an entire transport ship, must be made smaller. The solution being developed is a 56-bed field hospital.
   

• From point-of-injury to final treatment stateside, the typical battlefield patient is transferred 14 times between helicopters, ground transportation, fixed-wing aircraft, military airports, and medical facilities. The Army is studying hand-held electronic technologies that would allow even faster transport of patient information between units.
   

• Medical personnel are at high risk for PTSD given the injuries they see and treat. “We refer to that as compassion fatigue,” says Weightman. “How many really banged-up, mangled bodies can you take care of before all of a sudden you just get numb or can’t handle it anymore? That’s present, and we’re acknowledging it.”
   

• Weightman says one civilian-trained trauma surgeon from New York City who was called up for duty in Iraq later reported he wasn’t prepared psychologically for the type of injuries he saw there.
  
  “Here’s a guy who trained for … 11 years of his life to see this, and he wasn’t ready. So what about the rest of the hospital staff? What risk are they at? ... I don’t know if we can do anything that fully prepares people for that kind of psychological trauma,” says Weightman. “But there’s a lot more we can do [to get] them halfway there, so it’s not quite the shock.”
   

• Medical personnel in Iraq have a split mission — treating Americans and Iraqis. Indeed, 74 percent of U.S. military hospital beds in Iraq are occupied by locals. Because Iraqi hospitals were looted and the medical system remains in disrepair, the U.S. military has to provide care to local citizenry, including Iraqi police, soldiers, and even captured insurgents.
   

• “You have to hand them off to something, and right now our biggest challenge in Iraq is to build up the Iraqi health care system so they can take care of their own people,” Weightman says.
   

• All U.S. medical personnel must be armed. Initially, Weight-man says, combat support hospitals had weapons for about half their staff, thinking that those treating patients wouldn’t need to be armed. “With the security environment in Iraq, though, there is no safe place,” Weightman says. “And, by the way, if you don’t have a weapon all the time, your tendency is not to know how to use it.”
   

• Medical personnel travel in convoys in Iraq, like most other U.S. forces, and must be trained to defend themselves and their convoy when under attack. Convoy training now is part of the Army’s medical curriculum.

Tom Philpott is a freelance writer and syndicated news columnist. His column, "Military Update," appears in 48 daily newspapers throughout the United States and overseas.