The medical legacy of a decade at war
September 11th, 2012
06:00 AM ET

The medical legacy of a decade at war

By Jennifer Rizzo

Following the terrorist attacks of September 11, 2001, the United States waged the "war on terror," a continued combat campaign that has lasted more than a decade. Thousands of Americans have been killed and almost 50,000 troops have been wounded in the wars waged in Iraq and Afghanistan.

Perhaps the most lethal uses of force by insurgents have been improvised explosive devices. Blast injuries from these bombs including the loss of limbs, traumatic brain injury, and severe burns are prolific among wounded troops.

But service members are surviving these extreme injuries that would have proved fatal decades earlier. A warrior wounded in battle now has a 50% better chance of surviving than in any previous war, according to the Defense Department, which credits some of this advancement with improved body armor, better doctor and medic training, and an efficient and timely evacuation system. According to the Air Force the military for example is able to get a wounded service member back to the United States in three days or less if needed, compared to the 10 days it took during the Gulf War and the 45 days it took during the Vietnam War.

Just like in preceding wars, medical research has churned out advancements to better heal the wounded and prevent more from dying on the battlefield.

Here's a look at some of the advances:

Traumatic Brain Injury

The Defense Department has documented almost 250,000 cases of Traumatic Brain Injury (TBI) since the year 2000, according to Defense Department spokeswoman Cynthia Smith. More than 60 TBI programs have been created at military medical treatment facilities at U.S. bases, and 11 new concussion restoration/care centers have been set up in deployed zones.

Before the wars in Iraq and Afghanistan, most attention was paid to severe traumatic brain injury, but with 95% of TBIs being mild in nature the research has changed its focus, according to Cmdr. John Hughes a Naval research neurologist.

"If you read a textbook 5 or 10 years ago on traumatic brain injury it was focused on more severe problems," said Hughes. "What we realized is that mild injuries are actually serious issues that we need to address."

To better understand the impact of these injuries more sophisticated techniques using MRIs have been developed that show the structural changes that take place in the brain.

Progress has also been made on early diagnosis of mild TBIs.

"The challenge really has been how do we diagnose these individuals," said Hughes. "How do we diagnose them as early as possible."

The military has taken steps to modify high-tech instruments used in hospitals and labs, making them portable units that can be used by medical personnel who are in the combat setting.

One example: a hand-held device called DANA (Defense Automated Neurobehavioral Assessment) that can be used to identify a concussion in the combat zone through a series of neurocognitive tests.


Some 1,400 service members have lost one or more of their limbs, according to the most recent numbers released by the Pentagon.

Limb-loss injuries that would have once been fatal are now not only survivable, but some wounded service members are even returning back to the combat zone. Their prosthetic limbs however weren't quite cutting it.

"Walking through trails in the mountain ranges of Afghanistan are much different than walking on a street downtown," said Col. Paul Pasquina, chief of the Department of Orthopaedics and Rehabilitation at Walter Reed National Military Medical Center. "We noticed that some of these prosthetic limbs were breaking."

Pasquina said that in the past decade not only have prosthetics been made more rugged, but now they're motorized. Powered knees and ankles make it easier to change walking and running speed, helping the wounded walk more naturally.

Sensors are also being developed including implantable brain devices to allow for better control of prosthetic arms. For example, if you think about opening your hand the implantable device would turn that intention into an electrical signal to the prosthetic arm, causing it to open your hand.

Regenerative Medicine

Regenerative medicine uses strategies to replace deficits in nerves, blood vessels, for complex wound coverage and for bone regeneration to salvage limbs. Something as common as skin grafts, to something as obscure as regenerating an ear, are examples of regenerative medicine.

The Defense Department established the Armed Forces Institute of Regenerative Medicine (AFIRM) in 2008 to fund projects to restore the function of damaged tissues and organs. By 2011 more than 80 projects have been funded by AFIRM

One of those projects: spray on skin. Researchers are exploring ways to replace the old-fashioned method of skin grafts by taking a tiny biopsy of skin, breaking down the cells, putting those cells in an aerosol container and then spraying it on a burn site, according to Capt. Eric Elster, an organ transplant surgeon with the Walter Reed National Military Medical Center.

Hand and face transplants are also less risky for surgeons to perform now that the anti-rejection medication is safer.

"In many respects we are dealing with casualties that would not have been survived in previous conflicts," said Elster, who has deployed as the chief of surgery at the Kandahar Airfield hospital. "Because of all those advances we are left with a big challenge, which is putting these patients back together again and that's where regenerative medicine comes into play."

A look back at leaps forward in previous wars:

Revolutionary War: Gen. George Washington orders the first small pox inoculation of soldiers. Harvard Medical School is founded by John Warren, a Continental Army surgeon.

Civil War: The military develops an ambulance system to transport the wounded.

World War I: Blood transfusions become more widely used. Neurosurgery makes big strides.

World War II: Penicillin is introduced. The chemical DDT is first used for the control of mosquitoes. There are advancements in antimalarial drugs.

Korean War: Advancements in vascular surgery. Understanding of viral vaccines moves forward. Measles, mumps and rubella vaccines are developed after the Korean war.

Vietnam War: Helicopter ambulances take flight. Intensive care for rabies begins. A Marine serving in Vietnam is the first person to survive a case of rabies.

*This list was compiled with information from Prof. Dale Smith, chairman of the Department of Medical History at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

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Filed under: 10 years of war • 9/11 • Afghanistan • Iraq • Military • Security Brief
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  8. John Wayne Gacy

    What a lethal looking cyborg. Ain't technology grand. Lose another f*****g arm for the MIC.

    September 11, 2012 at 11:13 pm | Reply
    • rp1588

      The primary medical legacies of these wars is that many people are dying for lack of medical care, because the US military destroyed the public health care systems of Iraq and Afghanistan.

      September 13, 2012 at 5:58 pm | Reply
  9. Cameron

    Sad. But doesn't this make one focus on India....our so called ally???!!! The American invasion of Afghanistan brought to the forefront the irrelevance of India as a nation. With a population of over 1.2 billion people there was no value that this nation could bring to the table. Their soldiers (ragtag) 1.2 million continue hiding in the trenches scared from Talibans. A few teenage Talibans invaded the country and held it hostage for days on end showing how useless India is. It was embarrasing for the world to observe this humiliation of a nation that was being touted as a regional power. But when I see all our soldiers come home crippled and thousands more dead....I say to my many Indian soldiers fight alongwith us in Afghanistan and put themselves at risk. ?????

    So who would want Indians as their neighbors??? The answer is a resounding....NO ONE !!!!

    September 11, 2012 at 3:23 pm | Reply
    • Patrick

      These indians screwed us when they sided with commie Soviets and now as well. When will we learn. I say bring all the jobs back home from India and no more aid to them Indies.

      September 11, 2012 at 3:26 pm | Reply
      • Sodomite

        India was allied with Russia long before they were the Soviet Union. A mutual hatred of Islam is the reason.

        September 11, 2012 at 9:19 pm |
  10. aMatterOfNumbers

    9/11 x 76 = 2004 Indian Ocean earthquake and tsunami death toll.

    We should wage war on earthquakes and tsunamis based on their ability to kill innocent people.

    September 11, 2012 at 1:13 pm | Reply
  11. Tigrr

    This is what the Bush WH gang did to NYC, America, and the world....
    Everyone should see youtbe - CIA Asset Susan Lindauer Can Now Speak 10 years after 9-11.
    Yeah, they did it. Congress knew. Does nothing.
    Grrrrrrrrrrrrrrrrrrrrrrrr! Pass it on.

    September 11, 2012 at 12:17 pm | Reply
    • Ted Bundy

      Susan Lindauer is a nutbar she never worked for the U.S. government in any fashon. The reason the government dropped the case against her is she was found to be mentally incompetent to stand trial. Her entire story is made up in her head lol.

      September 12, 2012 at 9:52 am | Reply

    Since none of the men involved in the 9-11 attach were actual Afghan's or Iraqi's – why attach those countries? Since
    Bin Laden's were Saudi Arabians and friends of the Bush family (they made sure the bin laden's who were in the US were put on a plane to their home – pronto). Why didn't "POPPY BUSH AND HIS COHORT BAKER AND OTHERS FROM THE CARLYLE GROUP head over to Saudi Arabia and have a friendly pow-wow to bring their wild one Osama Bin Laden in.
    They could have rounded up the whole Bin Laden clan – kept them all incarcerated in a place until someone told where he was or someone wanted to collect the big reward. People will do anything for money – note the republican politicians.

    September 11, 2012 at 11:50 am | Reply
    • alan s

      Evelyn: The U.S. attacked Afghanistan because the Taliban government of Afghanistan was harboring and supporting the Al Qaeda personnel who planned and executed the attacks of 9/11/2001, and because after 9/11 the Taliban government of Afghanistan rejected President Bush's demands that the Taliban government assist the U.S. in action against Al Qaeda in Afghanistan.

      September 11, 2012 at 12:49 pm | Reply
      • John Wayne Gacy

        Complete and utter bullsh!t.

        September 11, 2012 at 9:20 pm |
  13. Bob

    8/11 continues to be an embarrassment to the GOP. During the 2000 campaign, Bush mocked Clinton for launching a rocket attack against "a dirty guy who lives in a tent". Then Bush ignored the memos on his desk about the imminent attack, then he used the attack as an excuse to invade Iraq (and start us on the road to economic ruin) which was the only place in the Middle East without an Al Qaeda camp, and now we have Paul Ryan who multiple times voted against health care for First Responders.

    September 11, 2012 at 11:40 am | Reply
  14. ronjayaz

    Censored again by fascist CNN. See my FACEBOOK.

    September 11, 2012 at 11:38 am | Reply
  15. Jokesterer

    Carbon-based government waste.

    September 11, 2012 at 11:19 am | Reply
  16. Kate

    Americans will always go to the next war,if you wrap something in a flag and yell patriotism and for your freedom we will buy it. It's funny to me how they always talk about the future of war but never the future of peace.

    September 11, 2012 at 10:54 am | Reply
    • Blah blah the wheel's off your trailer

      Yes, Mitt Romney keeps beating the war drums for war in Iran without discussing ways in which this conflict could be resolved peacefully. Yet, during his convention speech Romney failed to recognize or even acknowledge our troops currently serving in Afghanistan or the veterans who have already served in Afghanistan and Iraq or the brave ones who died serving their country. And what is more ludicrous about Romney is that when pressed on why he didn't bother to acknowledge our Afghan and Iraqi war veterans, Romney replied "there was no need for me to go through a long laundry list." I guess our brave men and women in uniform are just an expendible laundry list!

      September 11, 2012 at 11:27 am | Reply
  17. George Patton

    The true tragedy here is that neither of these obnoxious wars should ever have taken place at all. Bush used 9/11 as an excuse to invade Afghanistan for the explicit purpose of exploiting Afghan underground mineral resources and later tried unsuccessfully to use the same pretext to invade Iraq for it's oil. Due to the ignorance of the general public, these wars have become quite politically popular, sadly enough!!!

    September 11, 2012 at 8:45 am | Reply
    • Guest part of what you wrote is true.

      Where are the mineral resources? Afghanistan has large deposits of rare-earth minerals. China is mining them.

      Iraq's oil is sold on the open market like every other country's.

      There were plenty of reasons why these wars shouldn't have happened, but if you stick to facts your position is stronger.

      September 11, 2012 at 9:58 am | Reply
      • Blah blah the wheel's off your trailer

        I'll give you facts as to why these wars should not have occured...

        "Government Insider Says George W. Bush Authorized the 9/11 Attacks"

        Stanley Hilton was a senior advisor to Republican Senator Bob Dole and he has represented hundreds of families of 9/11 victims in a class action law suit against GWB for treason and mass murder!

        Want facts? Google for full details.

        Now, as far as Iraq is concerned, prior to our invasion of Iraq, United Nations inspectors were on the ground in Iraq and the UN's mission to disarm Iraq was being accomplished peacefully without bloodshed and lost of life as both long and short range missiles were being dismantled and destroyed before the eyes of the world. Subsequently, the Iraqi military was being made ineffective and obselete and Iraq was no longer a threat to its neighbors and neither was it an imminent threat to the United States whatsoever. However, GWB interferred with and violated UN legislation and forced UN inspectors out of Iraq prematurely and violated international law when he told UN Ambassodor Kofi Annan that UN inspectors had 48 hours to leave Iraq before the bombs started dropping. Furthermore, what was outrageous about GWB's conspiracy to invade Iraq was while Colin Powell went before the UN General Assembly and told the world that satellite images showed that the Iraqi military was moving around WMDs from "point A to point B" and hiding them from UN inspectors, these so-called satellite images couldn't tell them where point B was. So if satellite images showed that the Iraqi military was moving WMDs from point A to point B, wouldn't the UN inspectors have gone to point B and find the WMDs? Totally outrageous. Furthermore, to invade a sovereign country in turmoil to stabilize it is one thing but to invade a sovereign country in peace time to destabilize it is totally unacceptable. That is why GWB and cabinet should be tried for war crimes against humanity. There's you facts!

        September 11, 2012 at 11:04 am |
      • Blah blah the wheel's off your trailer

        And by the way, conservatives would try to discredit the fact that GWB planned and authorized the 9/11 attacks but while I had by doubts from the start, I find it hard to question the motive or integrity of an insider who was a Republican and a stern supporter of GWB. Secondly, when I heard people saying after the 9/11 tragedy that they had hard facts that GWB was behind the 9/11 attacks, I questioned GWB's motives and then I said that the allegation sounded crazy. But when GWB lied about WMDs in Iraq, all the respect and trust I once had for him dissolved immediately. Ad now I do believe this dictator and war criminal was behind the 9/11 attacks.

        September 11, 2012 at 11:17 am |
      • alan s

        Guest: Outstanding comment. Rare that someone can think subtly, without shouting loudly in an effort to denounce one side or the other, regardless of facts. I enjoy reading comments from a writer who supports the President, yet openly admits he is imperfect, or that some of his actions failed; or from someone who supports Mr. Romney, yet does so recognizing Romney's flaws and the fact that Mr. Obama is not a traitor or monster.

        September 11, 2012 at 12:41 pm |
      • Guest

        Wait wait're a truther? Hah!

        September 11, 2012 at 1:05 pm |
    • Blah blah the wheel's off your trailer

      And that is why GWB and his cabinet shoud be hanged from the Freedom Tower!

      September 11, 2012 at 10:46 am | Reply
      • Steve

        Dont forget to hang Clinton for Kosovo and Obama for Libya...or are those conflicts ok because the president had a D next to their name?

        September 11, 2012 at 11:38 am |
      • Guest

        ..You're the same kind of monster and you don't even realize it. It's pathetic.

        September 11, 2012 at 12:58 pm |
      • John Wayne Gacy

        Dubya was overthrown in the coup d'etat that was the orchestration of 9/11 so Cheney could take over for the interests of the military industrial complex. If you wanna hang @ssholes with a "D" beside their name, start with Roosevelt and Truman.

        September 11, 2012 at 9:28 pm |

      I agree with your opinion, many of we people feel the same way. GWB once made the statement that"Saddam tried to kill his Daddy", but that's not the only reason he went into Iraq. All the warmongers and big oil people wanted Iraq's oil – however the could get it. They used the blood and lives of our young men to help all the corporations they were affiliated to become rich. The loss of our men and women and the loss of the Iraqi people will never be forgotten or forgiven, as all the previous wars will not be forgotten. I lost ancestors in every war this country has been involved in. It didn't make us better, it just make wars more frequent. We should be strong enough and with patience we could solve our differences with out war.

      September 11, 2012 at 11:21 am | Reply
      • alan s

        Evelyn: The U.S. invasion of Iraq may or may not have been wise, or just, but it wasn't done for Iraqi oil. Ever since the Iraqi invasion of Kuwait the U.S. had led and enforced a boycott of Iraqi oil. If anytime from 1991 until 2001 we had wanted Iraq to sell its' oil on the open market all we had to do was stop enforcing our boycott.

        September 11, 2012 at 12:45 pm |
  18. OffTheWorldPolitics

    War is a terrible thing, but serves an incredible purpose. It is true that many died and are injured in this war, but many more have died and been injured with no purpose at all. In the end it comes down to conviction. Men and women that make contributions for their countries and the free world live for a greater purpose than the vast majority. This is problem with free healthcare.... Many people live and die with a total sense of apathy and disregard for their own lives as well as the lives of others.

    Number of deaths for leading causes of death in the U.S.

    Heart disease: 599,413
    Cancer: 567,628
    Chronic lower respiratory diseases: 137,353
    Stroke (cerebrovascular diseases): 128,842
    Accidents (unintentional injuries): 118,021
    Alzheimer's disease: 79,003
    Diabetes: 68,705
    Influenza and Pneumonia: 53,692
    Nephritis, nephrotic syndrome, and nephrosis: 48,935
    Intentional self-harm (suicide): 36,909

    September 11, 2012 at 6:49 am | Reply
    • John Wayne Gacy

      ................"serves an incredible purpose"?????

      You are an absolute moron. End of story.

      September 11, 2012 at 9:30 pm | Reply

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