Attrition: Commando Brigade Mobile Hospital

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January 27, 2022: The Israeli Commando Brigade has created a special field hospital unit that can be quickly flown in and set up wherever the brigade is operating, be it peacetime or during a major war. A Field Hospital can handle critical injuries that can be fatal if major surgery is not available. The new Commando Brigade mobile hospital includes critical care facilities and two operating rooms so 24/7 treatment is available.

Need for such a portable Field Hospital came because over the last century medical advances and combat experience greatly increased the percentage of wounded troops who survive their wounds. A decade ago, this survival rate reached 90 percent and kept increasing. That's the highest rate in history. This became possible because of many new advances in emergency medicine and use of emergency medical equipment that combat medics and medical troops who serve on medical evacuation helicopters can use to keep critically wounded troops alive long enough to reach an operating room, which is what makes field hospitals so important.

During World War II, the first war where antibiotics were widely available, at least to Western forces, the concept of the Golden Hour became a standard. This meant that if a badly wounded soldier could reach an operating room in an hour he would probably survive. This also involved the introduction of helicopters, whose first combat mission, in 1944 Burma, were to recover injured troops. Over the last two decades the Golden Hour shrank to the Platinum Ten Minutes.

It wasn’t enough to have new treatments that could stop heavy bleeding and handle other usually fatal wounds. Medics had to be trained to provide more complex and effective first aid immediately. Medics have been equipped and trained to perform procedures previously done only by physicians, while troops are trained to do some procedures previously handled only by medics. The critical care medics increase the number of special procedures available on the battlefield. This skill upgrade is made possible by a number of factors.

Putting highly trained medics on medical evacuation helicopters was discovered because the U.S. Army collected a lot of statistics. One discovery in Iraq and Afghanistan was that it was noted that that medevac medics belonging to National Guard (reserve) units had a 66 percent higher survival rate among the casualties they accompanied from the battlefield to the field hospitals. Taking a closer look, it was found this was because the National Guard medics tended to be more highly trained, many of them being critical care emergency medical technicians in civilian life. This made the army realize that critical care trained medics on the medevac helicopters would make a difference. A year after this was noted in 2011 the army trained 1,200 new critical care medics, which took eight months, in addition to the basic four months for new combat medics. The critical care medics can perform a lot more procedures and recognize a much longer list of problems. Thus existing, experienced medics are being given additional training. Many other Western nations implemented similar policies.

Since the Vietnam War ended in the 1970s there has been continuous development in methods and equipment for civilian "emergency medicine" personnel on ambulance crews and in emergency rooms. This stuff had slowly been coming over to the military, but with the fighting in Iraq, it was soon adopted by most military medical personnel.

Another factor is the higher intelligence and skill levels of the volunteer military. High enlistment standards have largely gone unnoticed by most people, but within the military, it meant that combat troops, who are much brighter than at any time in the past, can handle more complex equipment and techniques. Getting the combat troops to learn these techniques was no problem, because for them, it could be a matter of life and death.

Another advance has been that medical teams capable of performing complex surgery were now closer to combat. These teams, like the medics and troops, have more powerful tools and techniques. This includes things like "telemedicine," where you do a video conference with more expert doctors back in the U.S., to help save a patient.

Israel was been a major innovator in emergency medical treatment and has been under constant attack by enemy armies and terrorists since the 1940s. Israeli medical treatment is considered world class, and one of the many reasons for the 2020 Abraham Accords between Arab states and Israel was that it made Israeli medical centers available to Arabs who were critically ill and otherwise had to travel to Europe or the United States for such care. It was noted during the current Syrian Civil War that Israel provided such care to thousands of wounded Syrian civilians when fighting reached the Israeli border for a few years. Many Arabs living in the Israeli Golan Heights Druze community had kin on the other side of the border, and the Syrian Druze knew of the seemingly miraculous medical care available in Israel. Druze are considered heretics by many mainstream Shia and Sunni Moslems and for that reason Druze are the only Arab group in Israel that regularly serve in the military, including commando units. Some of those Druze soldiers had survived seemingly lethal wounds because Israel had also developed the Platinum Ten Minutes capability. Until the Abraham Accords, it was not possible for seriously ill or injured Arabs to seek medical care in Israel. Now that is politically acceptable when it is medically necessary.

 


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