Army's claims for survival rate in Iraq don't hold up

In testimony last year in support of the Army's budget request, Lt. Gen. Eric B. Schoomaker, the Army surgeon general, told members of Congress of "unprecedented survival rates" in Iraq and said that "the percentage of soldiers that survive traumatic injuries in battle has continued to increase." Dr. S. Ward Casscells, the assistant secretary of defense for health affairs, told a panel in August that the survival rate in Iraq has doubled since Vietnam and that battlefield medical care is responsible.

Both are common refrains, but neither is entirely accurate.

By one measurement — the percentage of all injured troops who die — the battlefield casualty rate is at an historic low. In Vietnam the rate was 15.8 percent; in Iraq it is roughly 10 percent.

But according to the raw data, which must be gathered from two separate federal agencies to calculate a survival rate, the change comes from a sharp rise in the number of injuries so minor that casualties did not have to be removed from duty.

And according to Dr. Ronald F. Bellamy, a thoracic surgeon and retired Army colonel who is one of the Army's leading authorities on combat casualty statistics, the figure says almost nothing about the quality of medical care anyway.

The standard measurement of battlefield survival, Bellamy said, is a comparison of the number of deaths and the number of serious injuries — those severe enough to prevent a casualty from returning to duty within three days. And to determine the role of medical care, the military typically separates death reports into casualties who die before reaching a hospital and those who die afterward.

Using those measurements, the improvements are harder to find.

The rate at which troops with serious injuries die before reaching a hospital, which the military calls Killed in Action, is roughly 15.5 percent in Iraq, compared to 20 percent for the whole Vietnam War. But despite the Army's introduction in Iraq of advanced tourniquets, HemCon blood-clotting dressings and other changes geared at saving lives on the battlefield, the KIA rate has risen steadily since early 2005. If only the last three years are considered, the rate is roughly the same as it was in Vietnam 35 years ago.

Meanwhile patients who survive to reach a hospital — a separate category that the military terms Died of Wounds — are almost twice as likely to die today than the comparable group was in Vietnam. And despite changes in transfusion practices, the use of blood-clotting drugs and other innovations, that rate climbed steadily for the first three years of the war and has remained at roughly 5.2 percent since the start of 2007. The Died of Wounds rate in Vietnam was 3.2 percent.

Schoomaker said comparisons between wars need to consider the unprecedented lethality of modern weapons. Army data — which he wouldn't disclose for security reasons — shows that injuries have grown increasingly severe the past four years, more than accounting for the increased rate of death, he said. The majority of combat deaths in Iraq — roughly 83 percent, according to one Army study — involved injuries so severe that no medical treatment would have made a difference.

But according to Bellamy, the most favorable thing that can be said about the battlefield survival rates in Iraq is that slightly fewer casualties seem to be dying before they reach a hospital, which he attributes to body armor. The notion of a quantum improvement in medically related survival is a myth, he said — one repeated so often by Pentagon officials that it is rarely challenged.

Bellamy, who has written much of the Army's published literature about medical care in Vietnam, said numerous falsehoods endure about combat medical care in that war. For instance, people often claim that rapid helicopter evacuation improved survival, he said, whereas the Army's data suggests it didn't. He said he sees the same type of early, perhaps premature enthusiasm for battlefield medical advances today.

"Even once the war's over, the propaganda remains alive," he said. "No one ever stays around long enough to say, 'Look, they were lying to us all those years ago.'"

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