[Congressional Record Volume 150, Number 84 (Thursday, June 17, 2004)]
[Senate]
[Pages S6987-S6988]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          COMBAT CASUALTY CARE

  Mr. INOUYE. Mr. President, I rise today to recognize the courageous 
men and women of military medicine, whose efforts to preserve life on 
the battlefield must not go unnoticed. Since World War II, I have 
followed the advances in personal protection and combat casualty care 
which have changed the fate of thousands of our military men and women.
  The improvements in battlefield protection have given our military 
the lowest levels of combat deaths in history. While there is still 
regrettable loss of life in Iraq and Afghanistan, the fact that we are 
savings hundreds of lives which could not have been saved in past 
operations is proof that these advances are paying off.
  Historically, 20 percent of all war casualties resulted in death. 
Today, that rate has been cut in half. Additionally, the rate of total 
battlefield casualties has also declined by half.
  Many advances have led to these decreases. Improved body armor, the 
placement of forward surgical teams, improved medical training and 
evacuations, in theatre assessments of unforeseen medical 
complications, and superior medical technology are just a few of the 
changes I want to address.
  As we read about casualties in the press, one might not realize that 
much has changed. We read about injury or death by mortar or improvised 
explosive device. And, as in the past, when soldiers are injured, the 
first person they call out for is not their mother, not their 
sweetheart, or even God, but for a medic. But circumstances are 
different when that medic arrives today. Training of our medics has 
improved drastically. Today every medic is certified as an emergency 
medical technician. They are provided with improved medical kits with 
state-of-the-art medical equipment. The military unit on the ground has 
these additional capabilities and life saving techniques to improve 
combat care from the moment of injury.
  A second major development in treating battlefield injuries is the 
placement of forward surgical teams closer to the front lines. These 
teams target the 15-20 percent of wounded who, without care within the 
first hour after wounding, would die before seeing the inside of a 
combat support hospital. Uncontrollable hemorrhage has been a major 
cause of death in previous wars. Today, the forward surgical teams are 
well equipped to identify and stop bleeding using a hand held 
ultrasound machine to identify internal bleeding. Advances in 
hemorrhage control dressings have also had a substantial impact on 
saving lives.
  Circumstances were definitely a little different when I served during

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World War II. After I was injured, it took 9 hours to get to a field 
hospital where they performed military trauma surgery and over 3 months 
before I made it back to the United States. I spent 11 months in a 
hospital that was essentially a converted hotel in Atlantic City 
waiting for my final surgery and another 9 months in a rehabilitation 
facility in Battle Creek, MI. All told, it was almost 2 years from the 
time I was injured until I was able to return home to Hawaii.
  Today, military personnel injured on the battlefield can be 
transported from theatre to a military hospital in Europe in a matter 
of hours. Depending on the extent of the wounds, they can be flown back 
to the United States within days. The rapid, sophisticated treatment on 
the battlefield and expedited transfer to safety are two of the most 
striking differences between military medicine today and World War II.
  The story of Private Jessica Lynch is an excellent example. Following 
her rescue from the Iraqi hospital, Army medics, Air Force aeromedical 
evacuation troops and Special Operations forces transported her 
thousands of miles, used three different aircraft, and provided care 
during her entire journey, until she reached the safety of an Army 
hospital in Landstuhl, Germany. This was all accomplished in fewer than 
15 hours. This same approach has saved the lives of many other 
courageous, young heroes.
  What remains a mystery is how to treat the unexpected. Many deaths 
are the result of disease or non-battle injuries. In March 2004, there 
were 595 evacuations from Iraq for disease or other non-battlefield 
injuries. The Army Medical Department has deployed special teams with 
expertise in areas such as leishmaniasis, pneumonia, mental health and 
environmental surveillance to respond to these types of injuries. 
Having their critical assessments and recommendations while our troops 
are still in theatre will hopefully enable the command to decrease 
these illnesses.
  The good news is that we have already improved our rates on this 
front. In the Civil War, twice as many people died of disease than of 
battle wounds. In World War I, about 56,000 U.S. soldiers died of 
disease, 14,000 during World War II, but only 930 during the Vietnam 
War. And we continue to make progress.
  Press reports have highlighted the suicide rates of our troops 
serving overseas, but little acknowledgement has surfaced on how the 
military is addressing this concern. In July 2003, the Army sent a team 
of mental health experts to study the issues facing our troops in Iraq. 
This team was assembled to assess the increase in suicides in Operation 
Iraqi Freedom, evaluate the patient flow of mental health patients from 
theater, and analyze the stress-related issues Soldiers experience in 
combat.
  This was the first time a mental health assessment was ever conducted 
with soldiers in combat. I cannot stress the importance of the 
collection and analysis of this data and its potential to help the 
military address these issues at the earliest stages.
  We have also learned a great deal about providing better protection 
to our forces. We are now experiencing less than half of the theatre 
evacuations for chest and abdomen wounds than was seen during World War 
II, Korea, and Vietnam because of body armor.
  The 1991 Gulf War was the first major conflict in which all U.S. 
troops were provided body armor. At that time, the vests were made of 
Kevlar. They were capable of stopping shell and grenade fragments, but 
were a heavy 25 pounds to carry. The lighter interceptor body armor now 
used in Afghanistan and Iraq weighs only sixteen pounds and stops 
grenade fragments, 9mm slugs, and some rifle ammunition. The efforts 
placed in these advancements have paid off and should continue with 
renewed commitment.
  But while these advances have drastically improved our casualty 
rates, injuries to the limbs are increasing. Historically, 3 percent of 
those wounded in action required some amputation. Today that rate has 
jumped to 6 percent in Iraq. This requires our attention. We must focus 
on technology to reverse this trend.
  These are just a few of the advances in medical technology and 
treatment that are responsible for saving the lives of our military.
  As we think about today's improvements, we should remember the men 
and women that served before this conflict. Nearly half a million men 
were permanently disabled by wounds during the Civil War. Their 
sacrifices led others to develop improvements in orthopedic surgery and 
the design of prosthetic limbs. It is important that we recognize these 
sacrifices and contributions and continue our commitment to further 
advances.
  It is said that my generation was the greatest generation. But I have 
spent a great deal of time visiting our military personnel and must say 
that this generation is surpassing us by far. These men and women in 
uniform display the courage, strength, and devotion of our armed 
forces.
  I thank the Chair for allowing me to recognize the men and women of 
our military and to pay particular attention to lesser known positive 
data coming from the Global War on Terrorism.

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