June 12, 2007:
The historically low casualty rate in Iraq has enabled the U.S. Army to
introduce a lot of new battlefield medical technology. In effect, the army has
raised the standards for battlefield medicine so high, that leaked internal
reports, about how to make it even better,
make it sound like there's a medical disaster. The results say
otherwise, with the ratio of dead to wounded in Iraq and Afghanistan is
approaching one killed for every ten wounded. This is a dramatic increase from
Vietnam, where it was one in five. That was itself an improvement from World
War II, where it was one in four, and earlier wars where is was one in three.
This has been done with the application of a lot of new technology. But there
are problems. While the army has used an electronic medical records and patient
tracking system on the battlefield for the first time, the fact that the system
is being used in combat has slowed the introduction of some software upgrades.
This is less of a problem than it appears to be. The current system is using
the Windows 2000 operating system, and the computer people want to upgrade to
Windows XP (which was just replaced by Windows Vista). But Windows 2000 is
still being used by millions of commercial users because it was the first
widely available operating system from Microsoft that was stable, and based on
the entirely new Windows NT operating system Microsoft created in the 1990s.
The problem with the Medical Communications for Combat Casualty Care (MC4) and
the Joint Patient Tracking Application (which tracks the wounded from the
battlefield to hospitals outside the combat zone) was that these systems worked
so well that they were heavily used, often by people who had not received the
mandatory training given to all those who are supposed to be using the
software. Then there was the inevitable calls for new features, which also got
in the way of longer-range upgrades already in the works.
The vast number of new medical innovations
introduced in the last seven years has caused unanticipated problems. Medics
(who get nine weeks) and medical technicians (who get 52 weeks of training) now
had a lot more tools to use, and there were problems recruiting enough people
who could get through the medical technician school. Eager medics would
sometimes fill in for missing medical and pharmacy techs. This would work if
there was enough supervision, but often there was not. It appeared that the
relatively low casualty rate was very beneficial for military emergency medical
services. Not being faced with a flood of casualties, the Medical Corps has
been able to focus on bottlenecks and problems in the system, and work out the
details. But as the medical officials went looking for the bottlenecks and
problems, they exposed themselves to accusations of incompetence, or worse, for
compiling lists of things that need work. It's another example of no good deed
going unpunished.
