Survival rates of US soldiers with the most critical injuries increased three-fold during the Iraq and Afghanistan wars thanks to tourniquets, blood transfusions and quick transport to the hospital, a new study finds.
While nearly 58,000 service members died during the Vietnam War, less than 10,000 have died in the recent conflicts.
Between 2001 and 2017, researchers say trauma teams improved their methods to control bleeding, replace blood and reduce transport times to hospitals.
Without these interventions, the team, from the University of Texas at San Antonio, found there would have been at least 3,600 more deaths.
A new study from the University of Texas at San Antonio found that survival rates of US military with critical injuries increased three-fold from 2001 to 2017 during the Iraq and Afghanistan wars (file image)
‘Prior work has documented pretty extensively of the historic low mortality rates of the current conflicts,’ lead author Dr Jeffery Howard, an assistant professor of kinesiology, health, and nutrition at UTSA, told DailyMail.com.
‘We wanted to provide a more comprehensive documentation from the beginning to the end and what we could identify that was associated with these reductions in mortality.’
For the new study, published in JAMA Surgery, the team looked at nearly 57,000 military casualties between October 2001 and December 2017.
They found that the rate of deaths was high early on in both wars, but gradually improved over time.
In Afghanistan, the peak was 20 percent when the war began in October 2001 before falling to 8.6 percent in December 2017.
Similarly, in Iraq, the peak was 20.4 percent at the war’s onset in March 2003 before it decreased to 10.1 percent in December 2017.
Researchers also looked at how likely military personnel were to survive based on a score given to their wounds, which is as follows:
- Mild: 1-9
- Moderate: 10-15
- Severe: 16-24
- Critical: 25-75
Critical injuries made up about 90 percent of combat deaths overall between the two wars.
‘What we call critical injuries, they’re really injured, that’s almost where all those fatalities occur,’ said Dr Howard.
‘Often times, they have a severe head injury and multiple injuries across the body because it’s caused by IEDs (improvised explosive devices). It can involve multiple body regions and a traumatic limb amputation – often times more than one.’
The team found that the chances of surviving with these critical injuries significantly increased over the study period from about nine percent to 33 percent in Iraq and from about two percent to 40 percent in Afghanistan.
Between the two conflicts, mortality rates were reduced by about 44 percent.
‘We hadn’t ever really looked at that before, and we thought we would see an increase,’ Dr Howard said. ‘But to see the increase, it was a little shocking because we didn’t have a feel for the magnitude.’
Researchers attributed the increase to three key interventions: tourniquets, blood transfusions and prehospital transport within 60 minutes.
Use tourniquets for US military with extremity injuries more than doubled in use from the early period to the late period in Afghanistan and increased eight-fold in Iraq.
Meanwhile, blood transfusions tripled in Afghanistan from the early period to the late period and doubled in Iraq.
‘As wounding patterns began to emerge – changes from gunshot wounds to blast injuries – the trauma system had to adapt and respond to the changes of injuries that were being seen,’ Dr Howard said.
When the team ran a simulator to see how mortality rates would have changed if none of the three interventions had occurred, they found there would have been nearly 3,700 more deaths.
‘That number, I didn’t know what to expect,’ said Dr Howard. ‘It made us sit back and think: “This could have been worse”.’
He says that the same interventions have been used in past conflicts, but they had to be relearned during the Iraq and Afghanistan wars.
‘While we made a lot of strides in the current conflict from what it was initially to what it ended up being, we want to make sure these lessons are not forgotten,’ Dr Howard said.
‘At some point, there will be another war, and we want to make sure we documented as accurately as possible what reduced mortality.’