Todd’s first experience with trauma surgery as a surgeon: a case study in Northern Virginia, during the September 11, 2001, Pentagon explosion
After serving in the Air Force for awhile, and then going into private practice, Todd was going to be at the world-renown Mayo Clinic in Minnesota. He started his military career as a vascular surgeon in Northern Virginia, a few weeks before Sept. 11, 2001.
There was smoke from the Pentagon. I thought about my military career as a surgeon. He admits that it will be vastly different than he expected.
The casualty rate spiked to the highest rates since Vietnam and the doctor switched to trauma surgery. The way patients arrived from the war zone astounded him at first. When he realized that patients weren’t getting care soon enough, he stopped. By the time they arrived in the US, their wounds were contaminated and sometimes even too late to be treated without an amputation.
On the loss of American service members during the post-World War II war and what we can do to help the private health care sector: a case study of Fallujah
He says that it’s hard to admit that we let someone down and that somebody was a US service member. It’s difficult to admit that we could have done better. I think it’s worse if you don’t admit it.
The result was a sort of spiral. Military hospitals lost the minimum numbers of patients they needed to keep doctors in practice. Many clinicians left the military care because of the poor quality. Even more resigned during the pandemic, and Pentagon planners realized that the private health care sector they had hoped to lean on actually needed help itself, from the military. The cuts kept going.
“I remember one U.S. service member who came to us … by helicopter from the front lines in Fallujah. And he had been operated on by a small group of surgeons near the front line. I think the assumption was that we would need to amputate this limb because of the extent of the soft tissue injury in the thigh,” he says.
In past wars, a wound like that would have denied the lower leg blood flow for too long, leaving no option but amputation. The front-line doctors had used a temporary brain clot in a different way, when Rasmussen was closer to the scene. Essentially, they stuck a plastic straw into the thigh to keep blood flowing around the wound, saving the leg.
Pentagon Downsized Healthcare: The Legacy of the First Three Years in the Army: The Story of the “Firefight” Between the U.S. and Afghanistan
There was an attempt to outsourcing. He says that beneficiary care from the military treatment facilities to civilian institutions emptied out and wiped out storied military medical centers like Walter Reed.
Pentagon officials even floated an idea to close the Uniform Services University, the military’s medical school, which trains-up military doctors and preserves medical advances, like those made during the wars in Iraq and Afghanistan. “I mean, why do we need a military medical academy?” The man jokes.
“They achieved the highest rate of survival from battlefield wounds in the history of warfare. They were able to save people that would have died in any prior conflict,” says Dr. Art Kellerman, who served as dean of the Uniform Services University of the Health Sciences during the threats to shut it down.
Kellerman frames it as a national security priority. He says the success of U.S military medicine gave troops confidence in rushing into a firefight. U.S. allies joined the fight because a medevac from the U.S. would get to them within 30 minutes if they got blown up. The people in the fight believed they wouldn’t just survive, but they would live well as well.
They improved their ability to rehabilitate wounded warriors after being injured. And many of them were able to return to duty and others were able to return home to be with their families and to function for the rest of their careers. Some of them today are members of Congress,” he says.
“It’s not a plane, a ship or a tank.” — The golden hour of the American Army and the future of the fight
Military strategists caution that generals often try to refight their last war, but America’s next war may be different. In Iraq and Afghanistan, the golden hour was possible because the U.S. had air superiority; the enemy had no planes or helicopters.
“Sooner or later, somewhere, we are not going to have air superiority.” And I don’t care if we think we are, we should plan for not having it,” says Dr. Sean Murphy, who served 44 years and retired in 2021 as Air Force deputy surgeon general.
“What we’ve realized when we start looking at a theater like the Pacific, and the distances and a peer-to-peer fight, there is no way we’re going to get to the golden hour. So if we’re not going to be able to get a surgeon or somebody to the golden hour, then what we have to do is … to make everybody a medic,” he says.
“The most important fighting system we have is the human system. It’s not a plane or a ship or a tank,” says Rasmussen. He said he saw it again and again when he was a soldier.