The Wounded Come Home

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Despite improvements, new battlefield gear can't protect a soldier from top to bottom. Most troops in Iraq wear new $1,600 Kevlar vests with ceramic plates that slip into pockets in the front and rear to protect against small-arms fire. Their new $325 Kevlar helmets, although not bulletproof, afford greater protection than older models. While this gear shields the head and heart--along with the liver, lungs and guts--it leaves the extremities exposed. That's why 2 of every 3 wounds incurred by U.S. troops in Iraq involve legs or arms. It's also why some 100 U.S. troops have lost legs, arms, hands or feet in this war. Nearly half--45%--of the U.S. soldiers wounded in Iraq have been hit in the legs, with 19% injured in the arms, according to a recent Pentagon accounting shared with the American College of Emergency Physicians.

The homemade weapons put together by the Iraqi opposition and hidden along supply routes traveled by U.S. troops are devastating. "The energy of these rounds on impact is phenomenal," says Colonel Keith Albertson, chief of surgery at the 28th Combat Support Hospital. "These weapons were made to maim, and they do a good job at it. And a lot of the time the tissue damage done isn't apparent at the time of operation. A discouraging number of patients who left here with a damaged limb intact have ultimately needed to have it taken off later."

The reinforced vest and helmet, by protecting the soldier's vitals, have cut down on the instantaneous deaths once common in combat, and now bleeding has become the key threat to battlefield survival. Soldiers can bleed to death in almost no time at all. A wound to the aorta, the body's major blood vessel, can kill in about 5 min.; wounds to less vital vessels can kill in 10 to 15 min. On the modern battlefield more than 9 of 10 deaths occur before a soldier can be evacuated--and about half those deaths are the result of what military doctors call uncontrolled hemorrhage.

The military is using new products on the Iraqi battlefield to do one basic thing: keep a wounded soldier's blood inside him. One of the most promising is QuikClot, a 3.5-oz., $10 packet of mineral powder that sucks the water out of blood so clotting occurs more rapidly. The powder can even be poured into a gaping wound by the bleeding soldier himself. Military officials credit it with saving 23 lives in Iraq. In one case it saved the life of a Marine after a bullet pierced his neck, sliced his carotid artery and exited through his skull. The military is also using new $80 bandages made with chitosan, which is derived from shrimp shells. The chitosan chemically combines with blood cells to form a clot. And troops have begun getting new $8.50 one-handed tourniquets. The standard one requires a pair of hands to apply, which can be a problem for a soldier who has just lost an arm.