By Michael Arnold Glueck
When we as a nation send our young men and women to war, we make certain promises.
One of the most important is to provide them with the best medical care possible when their going in harm’s way brings them harm.
It wasn’t always so, or even possible.
Prior to the 20th century, far more soldiers died of disease than in battle. Even moderate wounds could turn fatal, due to infection and overall lack of care.
Historian Philip Gold notes that, “World War II witnessed enormous advances in treatment The ‘Million Dollar Wound,’ the one that got you out of the fight honorably and more or less intact, was far from uncommon. In Vietnam, the United States provided far and away the best medical care in history. If you could make it onto the MedEvac helicopter alive, your chances of survival were well over 90%. Tens of thousands of men, who would have died in previous wars, came home hurt and hurting, but still functional.”
Today, men and women wounded in Iraq and Afghanistan also are receiving superb military care.
But the wounded coming home today are different, as a new book by Dr. Ronald J. Glasser makes clear.
Americans who believe that the human cost of Iraq can be measured primarily by body bags, need to read “Wounded: Vietnam to Iraq.”
During Vietnam, Glasser served as an Army doctor, and afterward wrote “365 Days.”
The book is still in print 35 years later.
As the Iraq war lengthened, Glasser, now a pediatrician in private practice in Minneapolis, noticed something strange.
Although mercifully few Americans were being killed (the total at this writing is about 2,400), nearly all the wounded being returned (now over 24,000) were horribly damaged.
Deaths and “traditional” wounds were very low by historical standards.
But thousands of men and women were coming back missing limbs, with facial and closed-head injuries and suffering from severe blast trauma.
Glasser investigated, and the result was an article, “A War of Disabilities,” in the July 2005 Harper’s magazine, and a book that will be published in June.
This is the situation Glasser describes:
Because of advanced body armor and Kevlar helmets, there are very few serious gunshot wounds to the torso or protected part of the head.
Because the enemy lacks artillery and mortars, there are very few shrapnel wounds.
Instead, the weapon of choice is the improvised explosive device.
These are usually planted along roadsides or in vehicles driven by suicide bombers.
They are detonated (often by cell phone) when an American vehicle or convoy passes by, or are rammed into targets.
These improvised explosive devices are not “improvised” in any amateur way.
Some consist of several artillery shells (often stolen from unguarded Saddam-era ammo dumps), with gasoline and other nasty items added.
The blast can overturn a Bradley infantry fighting vehicle or a Marine assault amphibian.
The effects on humans are horrific. The Army, Glasser reports, is doing amputations at a rate unknown since the Civil War.
Closed head trauma are so complex and severe that the Army calls them “polytrauma.”
The Army has had to completely rethink battlefield care and procedures. Gone are the days of “patch ’em up fast and get ’em on the MedEvac.”
Instead, the big city emergency trauma center has moved to the battlefield.
The care can be magnificent. But the care is saving some terribly damaged people, and they will be patients for life.
As long as they remain in the military, they can receive what they need in a relatively timely manner.
But once they’re discharged, they go into a strained Department of Veterans Affairs medical system that is still handling World War II and Korean vets, and will be caring for Vietnam vets for the next three or four decades.
The influx of severely wounded Iraq and Afghanistan vets into the Department of Veterans Affairs is just starting.
The chronically underfunded Department of Veterans Affairs must get what it needs to care for them, and all veterans who require its services.
This is a debt that must be honored.
Glueck, of Newport Beach, is Senior Fellow in Medicine at the Aretea Institute, a think tank in Seattle.
