Figure 1-1

Distribution of fatal battlefield injuries in Vietnam.

Source: Adapted from Bellamy (1984, 1987a,b, 1995).

timely intervention. In addition, another 1 percent died of airway obstruction, which was potentially reversible, whereas 10 percent died of tension pneumothorax, which also was potentially reversible. Thirty-one percent died of severe brain injuries and 12 percent died later of their wounds.

In all, Bellamy estimates that just under 20 percent of those who die on the battlefield are potentially salvageable (Bellamy, 1984, 1987a,b, 1995). Bruttig (1998) estimates that approximately 10 to 15 percent of battlefield casualties have potentially surgically correctable injuries. However, because of the delays to definitive surgery, these patients do not survive. Unfortunately, no good comprehensive wound data for the latter group are available, so it is impossible to identify clearly what percentage of these patients are truly potentially salvageable (Bowen and Bellamy, 1998; Koehler et al., 1994). It is clear, however, that the single major cause of death in the potentially salvageable battlefield casualty is hemorrhage.

It may thus be reasonable to expect that with immediate and appropriate care a significant number of these patients could be salvaged. This impression is bolstered by the experience of the Israeli Defense Forces, which have an aggressive system of field treatment by physicians who stabilize the wounded in the battlefield and then rapidly evacuate them to field hospitals. In addition, every other soldier in the Israeli Defense Forces is trained as a medic. It should be pointed out, however, that, in conflicts in which Israel has been involved, evacuation to definitive care required very short flight times (Krausz, 1998).

Still, the battlefield of the 21st century will be very different from that of the past. The new battlefield will be "asymmetric and non-linear" (Bruttig, 1998); the large-scale wars of the past are less likely. Wars will most likely be



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement