The U.S. Senate Armed Services Committee recently asked how our struggling Military Health System (MHS) would respond to a large-scale conflict with a peer enemy. As I testified, to meet this looming threat, the MHS needs urgent intervention to get back to its singular focus on lifesaving combat care. The good news: we already have many of the building blocks in place. Let me illustrate with the story of an unexpected trauma survivor.
In 2010, U.S. Army Seargent Erik Ramirez* returned home to San Antonio, Texas, after suffering a devastating injury to his chest while serving in Afghanistan. Few patients wounded in battle had ever survived such devastating injuries, and before 2010, none had survived his specific injury—a sniper’s bullet that entered just above his body armor, crossed through his chest, and destroyed the major vessels of his right lung. The story of why SGT Ramirez came home alive to his friends and family is a decades-long tale of a few dedicated military and civilian visionaries pushing the MHS to learn from experience and to embrace cutting-edge medical innovations. In the middle of a combat zone, he was placed on extracorporeal membrane oxygenation (ECMO), a form of heart and lung bypass to rescue his failing heart after life-saving “damage control” surgery. This miraculous intervention occurred within a highly organized system that achieved combat medical supremacy—one that stopped at nothing to minimize preventable death on the battlefield and to bring every servicemember with survivable injuries home alive.
Over the past decade, our casualty numbers have thankfully waned significantly. But now our MHS struggles to maintain its edge in preparing medical teams for combat. While military hospitals provide essential medical care every day, it more commonly takes the form of preventive care and treatment for healthy patients, not time-sensitive, emergency procedures in patients with severe traumatic injuries or organ failure. In fact, a recent study found that only 10 percent military general surgeons are getting experience they need to be combat-ready. As a result, we now stand perilously close to letting the strategic advantage of our military medical system slip into obsolescence.
History has shown that allowing our combat medical system to fully dismantle will cost our military dearly in the next conflict. Since the start of World War II, we estimate that the decline in combat medical readiness during peacetime has cost over 100,000 U.S. servicemember lives. This means that up to one in four combat deaths over the past century were potentially preventable. Doctors, nurses, medics—in short, our entire military medical system—entered World War II, Korea, Vietnam, and even Afghanistan and Iraq unprepared, and service members died needlessly as a result.
How do we reverse this alarming repeat of history? First, we must continue to invest in the innovations that enabled the lifesaving innovations teams performed on SGT Ramirez in 2010. Founded in 2004, the Joint Trauma System (JTS) embraced our combat wounded from the point of injury through rehabilitation served as the essential bedrock. Upon this foundation we added advanced technology like heart-lung bypass. Leveraging the expertise of the JTS in five to six accredited military trauma centers would afford a strategic geopolitical advantage and build surge capacity into our MHS.
*Name changed to protect patient privacy.