Jewish World Review Jan. 19, 2004 /25 Teves, 5764

Drs. Michael A. Glueck & Robert J. Cihak

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New diagnoses and strategies create both short and long term problems for medicine and the military


http://www.NewsAndOpinion.com | War is hell and becoming even more hellish. The "advancement" of technology has provided new ways to live and terrible ways to die. Those that live because of body armor now face hellish injuries to what's left of limb and looks. These in turn provide new challenges to medicine and the military.

THE BODY ARMOR TRAP
While there has been a generational decline in infantry skills, the American infantry still widely outclasses anything the Iraqis can give back. The widespread use of body armor and infantry fighting vehicles has only increased the American advantage. The Iraqis respond by using mines (improvised explosive devices in Pentagonese) and rocket-propelled grenades. By historical standards, they don't kill a lot of people. They don't have to; they produce catastrophic wounds.


According to Erin Solaro, a Washington, D.C.-based writer whose thesis examined the relationship between casualties and combat effectiveness, and a member of the Coalition for a Realistic Foreign Policy, it used to be that if injured a lot of troops would pray for a million dollar wound. This is one that would get them off the line and into a clean, dry bed in a warm hospital with regular meals, at least for a while, hopefully doing (relatively) little permanent damage.


Solaro further notes they might convalesce at a training depot, where they were a lesson to the new recruits to take war seriously while they passed on the lessons that can only be learned by surviving combat. Others would serve in a rear echelon billet somewhere, again an object lesson to those troops about the brutal consequences of combat.

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The catastrophic wounds we are today seeing means that there is a smaller core of combat-wounded veterans for new soldiers to coalesce around. What this does to the morale of the soldiers is not difficult to guess. Wounds are always bad, but there's a difference between a through-and-through gunshot wound and losing a hand, or both. This kind of stress, especially in a situation where the enemy is often using civilians as cover, produces psychiatric casualties as well.

LONG TERM COSTS
The long-term costs of these wounds are immense: first, last and always to the service member. It is very hard to go from being fit, strong, and aggressive to being a young man who is blinded, or a young woman who has lost both her legs. Surgery has become extremely technical and effective — and very expensive. New limbs incorporating microprocessors can cost tens of thousands of dollars each. All this is followed by rehabilitation, technical training, and disability payments. And, finally, there are the inestimable and intangible social and family costs.

SOLUTIONS
There are no short-term solutions. Improving infantry training throughout the Army, and not merely for troops coded as infantry — -including women, who, traditionally barred by law and custom from serving as infantry now are — will probably help by making people better soldiers. And we will be in Iraq and Afghanistan for at least a decade, and perhaps a generation. We broke them, we own them, and we must patrol vigorously and actively from bases to screen and develop the new militaries.


And at the same time, we must ease the strain on both our active and reserve forces while developing real homeland defense capabilities: the New Year's flight cancellations in all likelihood thwarted an attempt to airburst a hijacked aircraft containing a radioactive device over Washington, DC. Sooner or later, our enemies will get lucky.

THE DRAFT?
In his article, "Saddam in the Slammer, so why are we on Orange?" David Hackworth revealed that between 14,000 and 22,000 troops have been medically evacuated from Iraq since the war began, approximately 3700 of whom had been killed and wounded in action. Daniel Zwerdling of National Public Radio has put the number of wounded alone at 9000, which would explain the range of Colonel Hackworth's numbers.


Given that we have approximately 135,000 troops in Iraq, these are terrifying numbers. We are running out of fresh troops, and combing fit soldiers out of rear areas for formal infantry conversion training will help only so much. Many Oped writers opine that the Army cannot survive this kind of strain without a draft, but the right sort of draft. One with a bare minimum of exemptions, that doesn't let the Left hide behind the unearned moral authority of protesting it while the Right simply refuses to be drafted; one that is designed to protect the homeland because it understands that draftees cannot be sent all places to do everything.


All of these distressing issues raise many formidable challenges — for medicine and the military — which will be explored in depth in future columns.

Editor's Note: Michael Arnold Glueck, MD wrote this week's column.




Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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