By Mike Santa Rita
Maryland Newsline
Tuesday, May 10, 2005

COLLEGE PARK, Md. - Most combat-related injuries in Iraq and Afghanistan have not  come from bullets but from blasts -- blasts from improvised explosive devices that tear at arms and legs, often leaving victims maimed for life.

The nature of these wounds makes it a very different kind of war than the one the United States waged in Vietnam, where gun shot wounds were much more frequent,  said Col. William Doukas, chairman of the Department of Orthopedics and Rehabilitation at Walter Reed Army Medical Center in Washington, D.C.

Better body armor, better armored Humvees and improved medical facilities near the action mean more wounded are surviving in these current conflicts, said Doukas and Brig. Gen. William Fox Jr., commander of Brooke Army Medical Center in Texas.

"We’re not seeing the thorax or abdominal wounds that we would have seen in Vietnam,"  Doukas said. Most who receive wounds are surviving them, he said, "and that’s because of the improved body armor."  

But some of the wounded are surviving with missing limbs or must undergo amputations and fittings with prosthetic devices -- and learn to adapt to the trauma and to a new way of life, Doukas and others said.

The loss of a limb is something that must be treated on both physical and psychological levels, said Joe March, spokesman for the American Legion, a veterans' advocacy group.

“Clearly it’s a traumatic [event] that involves lots of rehabilitation, both physically and emotionally,” he said. “Each individual copes as his own system allows him to, and clearly there are cases where people require counseling when they return.”

Doug Plank, executive vice president of the Coalition to Salute America’s Heroes, an advocacy group for wounded soldiers, said that spouses, who often become the soldier’s primary care taker, should not be forgotten.

“They’ve got spouses and kids who are traumatically affected,” he said of the wounded.

The Battlefield Count

The Army’s statistics bear out the role explosives are having in wounding U.S. soldiers on the battlefield.

In the Iraqi campaign, explosions, including from land mines and grenades, were responsible for 1,581 of those soldiers wounded in action from the start of the campaign in March 2003 through Feb. 28 of this year; gunshots, by comparison, accounted for 362 of the wounded, according to the U.S. Army Medical Department. Burns were a distant third, with 36 soldiers wounded. Another 299 wounds were from a variety of weapons, records show.

In Afghanistan, explosions  accounted for 62 of those soldiers wounded in action from the start of the campaign in October  2001 through Feb. 28 of this year; gunshots accounted for 27 wounds, said the U.S. Army Medical Department statistics. Another 21 battlefield wounds were from a variety of other weapons, statistics showed. 

Spokesmen for the U.S. Marines, Navy, Air Force and Coast Guard said those military branches do not break their statistics for the wounded down by kinds of  wounds.

While arms are being taken off by the blasts, the lower regions are the worst hit, Doukas said. “It is mostly legs,” he said. “The majority is still lower extremity.”

Victims’ destinations in the United States are either Brooke Army Medical Center in Texas or Walter Reed Army Medical Center in Washington, D.C. Staffs aim to treat the whole person, not just the wound, Doukas said. They help wounded soldiers transition back to military or civilian life.

But for many soldiers who have severe wounds, the military will never be their home again, Doukas said.

Over the last four years about 275 soldiers or Marines have undergone major limb amputations at Walter Reed, Doukas said. The majority of them have left the military for civilian life, he said.

Off the Battlefield

While many of the worst wounds are found on the battlefield, the majority of the Army’s wounded are sustaining injuries off the battlefield, records show. As of Feb. 28, 350 soldiers in Afghanistan had sustained non-battle related injuries since the beginning of the campaign there, while 110 soldiers had been wounded in action, according to the U.S. Army Medical Department.

Likewise in Iraq. Since the beginning of the campaign, 5,098 soldiers have sustained non-battle related injuries; 2,278 soldiers have sustained injuries in battle.

Doukas says mistakes made in training account for a large portion of the injuries off the battlefield. Vehicle injuries account for some circumstances (see related story), and mistakes made by paratroopers in training jumps also account for some, he said.

After treatment from medics on the scene and initial treatment from combat support hospitals, wounded soldiers are usually transferred to Landstuhl Regional Medical Center in Germany, where additional wound cleaning is performed before they are taken to either Walter Reed Army or Brooke Army medical centers in the United States.

Once in the U.S., a final decision is made on whether to amputate or try to save the limb.

“Injuries near the spinal cord tend not to recover, nerves that are peripherally cut are more savable,” Doukas said.

Many of those who have severe “open fractures” will opt for amputations rather than rehabilitation that would take months or even years, Doukas said. “In the very difficult cases … they often elect to have amputation,” he said.

Amputees are up right away with a temporary prosthesis, he said.

With new “C-legs” -- prosthetics equipped with chips and microprocessors -- recovering soldiers are getting a mobility out of their prosthetic legs that they never had in previous wars.

“Unfortunately, sometimes it takes a war to advance our technology,”  Doukas said.

Copyright © 2005 University of Maryland Philip Merrill College of Journalism