Battlefield medicine has come a long way. But that progress could be lost

When the U.S. launched its invasion of Afghanistan and Iraq in the early 2000s, the military's surgeons were severely out of practice.

It was the first full-scale deployment of American troops in a decade. A lot of the medical corps' experience came from big city emergency rooms, which "is the closest thing to being in combat that you can get without actually being in combat," army surgeon Tom Knuth told NPR in 2003.

Facing hundreds of injured soldiers per month, surgeons were thrust into performing procedures they might never have seen before serving in a war zone – like double amputations. Soldiers were often getting to surgeons far too late for their contaminated wounds to be treated.

But as the fighting continued and the casualties mounted, the medical corps was forced to innovate.

Improvements like pop up surgical teams got wounded soldiers medical attention within the "golden hour" after injury. Newly designed tourniquets became standard gear, saving lives on the front lines.

"They achieved the highest rate of survival for battlefield wounds in the history of warfare," says Art Kellermann, who served as the dean of the Uniformed Services University, the military's medical school.

You're reading the Consider This newsletter, which unpacks one major news story each day. Subscribe here to get it delivered to your inbox, and listen to more from the Consider This podcast.

An attempt to cut costs

Now that the post 9/11 wars have ended, some veteran military doctors say the gains are at risk.

The Pentagon has tried to cut healthcare costs by outsourcing care from military treatment facilities to civilian institutions.

This caused a spiraling effect on the medical corps: military hospitals lost the numbers of patients they needed to keep doctors in practice. Because of that and the pandemic, many clinicians left the military. And the cuts kept going.

"Crazy ideas...were floated to close the Uniformed Services University," surgeon Todd Rassmusen says.

Art Kellermann, former dean of the university, argues it preserves and supports all the military medical advances from the past 20 years, and many of the doctors who made them. Kellerman says those advances are as important as gear like the helmet or flak jacket – they give U.S. troops the confidence to rush into a firefight, knowing they'll likely survive if injured.

A Defense Department internal memo obtained by NPR found that outsourcing did not actually save the military money, but it did hurt readiness. The memo directs the Pentagon to reverse course to bring more medical care back to its hospitals on base and increase medical staff.

The future of battlefield medicine.

Even if the Pentagon makes efforts to preserve the advances in military medicine, future wartime medicine could look very different.

In Iraq and Afghanistan, the military was able to rapidly treat injuries because the U.S. had air superiority. Because the enemy had no planes or helicopters, an American medivac could fly to the rescue within 30 minutes of an injury.

"Sooner or later somewhere, we're not going to have air superiority. And I don't care if we think we are. We should plan for not having it," says Sean Murphy, a retired Air Force deputy surgeon general.

He points to Ukraine, where two conventional armies square off with massive casualties being evacuated by ground. Even more extreme, a possible conflict with China around Taiwan:

"What we've realized when we start looking at a theater like the Pacific and the distances and a peer-to-peer fight, there is no way we're going to get to the golden hour," Murphy says.

Murphy says the solution is to make every soldier and sailor a medic. But to do that, he says the Pentagon needs to urgently build back its ready medical force.

"The most important fighting system or weapon system we have is the human system. It's not a plane or a ship or a tank."

Listen to the full episode of Consider This for a closer look at battlefield medicine and how it's changed.