Through more than a decade of sustained combat, the men and women of the Air Force Medical Service have answered our nation’s call and maintained a standard of excellence second to none. Since the war began, the innovations and advancements across the Military Health System have enabled the highest combat casualty survival rate in history. As 2012 gets under way, I want you to know that our servicemen and women wounded in battle are receiving the best trauma care America has to offer. We call it “Trusted Care Anywhere.” 

Lt. Gen Charles B. Green, MD Air Force Surgeon General

Achieving such an unprecedented survival rate required a commitment to continuous learning. We leveraged and analyzed a lot of data to determine what really saves lives and makes a difference. I believe we never run out of lessons to learn, and there are even times we re-learn old lessons, such as how to use tourni­quets. Of course, wars always have yielded advances in medicine, and these have been no different. New lessons have been learned, including better ways to use blood and fluids to save lives, based on the amount of time it will take to transport some­one to a higher echelon of care.

Transporting Wounded Troops

The Air Force Medical Service’s signature contribution — aeromedical evacuation (AE) — in conjunction with our Expeditionary Medical Support (EMEDS) hospitals have made huge inroads as a direct result of these wars. On Sept. 12, 2001, we set up our EMEDS at McGuire Air Force Base, NJ. EMEDS are tent-based modular, scalable, rapid-response medical facilities used in humanitarian relief, wartime contingencies and disaster response. Our goal was to provide patient care for New York’s victims. Although we were not called upon to provide assistance, the tragedy enabled us to envision linking our EMEDS to our aeromedical evacuation system in order to move large numbers of patients to higher echelons of care.

Shortly after the invasion of Iraq, our EMEDS hospital at Balad became a key hub for transporting wounded servicemembers to definitive care in Germany and stateside. A similar hub at the Craig Joint Theater Hospital in Afghanistan soon followed. Now, 10 years later, the tireless efforts of hundreds of dedicated Air Force active duty, Reserve and Guard medics and aircrews resulted in the transportation and care of more than 90,000 wounded servicemembers with only four patients not surviving transport. Every war brought advances in medicine that benefit all patients, military and civilian.  This war is no different. 

The enhancement of our aeromedical evacuation system through the addition of critical care, air-transport teams has been and continues to be a huge factor in our unprecedented high  casualty survival rate. These teams have sped up the patient movement process by bringing increasingly advanced care closer to the point of injury than ever before, allowing patients to be moved to definitive care at a much faster rate. This has freed up hospital beds for new battlefield casualties and allowed us to use much smaller hospitals in the theater.

Saving Lives and Limbs

We believe the technologies we have brought into theater have saved limbs and lives. Newer vascu­lar shunts preserve critical blood flow. Automated ventilators get patients off assisted ventilation sooner and require fewer resources. New concussion-management regimens prevent repeated injury to the brain and allow time to heal before warriors return to duty. 

In the med­ical world, you never want to implement something that has risk — and yet, we have to keep moving forward. In our theater hospitals such as Balad, Air Force vascular surgeons have pioneered new methods of hemorrhage control and blood-vessel reconstruction based on combat-casualty experience. These innovations have saved limbs and lives and set new standards for military and civilian trauma surgeons.

These critical efforts are captured through another post 9/11 initiative, the Joint Theater Trauma Registry (JTTR).  This data repository collects all trauma-related data, providing timely information on care and outcomes of trauma patients at follow-on medical facilities. This registry greatly enhances clinical decision-making and measures subsequent outcomes for improving treatment and establishing valuable lessons learned for the future.