Rangers lead battle against avoidable combat deaths

By Frederik Joelving

NEW YORK (Reuters Health) - After years of fighting in Afghanistan and Iraq, the 75th Ranger Regiment can boast of having all but eliminated an enemy that all soldiers face: fatal blood loss, lung collapse and other injuries that needn't cause death, but often do.

Throughout nearly a decade of warfare, the regiment saw just one such "preventable" death, according to a new report in the Archives of Surgery.

"The military has advanced combat casualty care absolutely tremendously," said Dr. Donald Trunkey, a trauma surgeon at the Oregon Health & Science University in Portland.

"Quite frankly, the Rangers are the lead group, they are at the point of the spear," added Trunkey, who has worked extensively with the military but was not linked to the new report.

The Rangers tally more than 3,500 personnel and are the army's premier raid force. Since the late 1990s, the regiment has been trained in a casualty response system designed to minimize combat-related deaths.

Because most such deaths occur in the battlefield, before the soldiers reach a medical facility, simple medical skills have been drilled into all personnel -- not only the medics.

According to Lieutenant Colonel Dr. Russ Kotwal, the hope was that this approach, which is still not widespread in the army, would limit three common but preventable causes of combat deaths: blood loss from an extremity, lung collapse and airway obstruction.

As part of the system, which Kotwal and his colleagues at the U.S. Army Special Operations Command in Fort Bragg, North Carolina, have championed, all injuries are recorded and studied so that improvements can be made.

After 10 years of gathering data, he now feels confident that the efforts are responsible for the regiment's historically low casualty rates.

Since 2001, the Rangers have suffered 419 combat casualties, with eight percent of these soldiers dying as a result.

That's not statically different from the death rates of U.S. military ground troops in general. But when the researchers looked only at seriously wounded soldiers who weren't killed in action, they found that just two percent died of their wounds after reaching a medical treatment facility. For other troops, that number is nearly six percent.

The researchers say the difference could be due in part to better medical care right away, on the battlefield. Among the 32 Ranger deaths, only one was potentially survivable -- and that death occurred at the hospital, not on the battlefield.

To illustrate how the system works, Kotwal gave an example of Sergeant Leroy Petry of the Rangers, who was awarded the Congressional Medal of Honor by President Obama last month.

Fighting in Afghanistan, Petry and a couple of fellow soldiers found themselves in a chicken coop when a grenade landed just next to them.

Before it could explode, Petry grabbed it and threw it away. He saved himself and his colleagues, but he lost his hand when the grenade went off in midair. Blood was oozing from the stump, where bones stuck out.

"He put on his tourniquet, because he knew how to do that," Kotwal told Reuters Health.

"It's a very simple thing," he added. "It's just mastering the basics, that's it."

Kotwal said only one other military unit -- the 2nd Brigade Combat Team of the 101st Airborne/Air Assault Division at Fort Campbell, Kentucky -- has adopted the casualty response system so far.

It's hard to compare the Rangers' experience to that of other U.S. troops, in part because their fighting circumstances may be different and because only the Rangers collect data on preventable deaths.

Still, Trunkey said he is convinced the regiment's system has led to tangible results.

"No question about that," he said. "I would argue that the Rangers are more exposed because they are doing these special ops, and yet they still get the care they need."

SOURCE: http://bit.ly/qW9oQW Archives of Surgery, online August 15, 2011.

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