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Taking Care of Our Veterans: A Debt That Must Be Honored

Monday, 10 April 2006 12:00 AM

"Supporting the troops" is about more, far more, than yellow ribbons, bumper stickers and waving flags. It is about more than giving proper honor to courage, dedication, competence and sacrifice even when (or especially when) you don't support the war. It is about recognizing that when we send our young men and women to war, we as a nation make certain promises. One of the most important is to provide the best medical care possible when their going in harm's way brings them harm.

It was not always so, or even possible.

Prior to the 20th century, far more soldiers died of disease than in battle. Even moderate wounds could turn fatal, due to infection and overall lack of care. As for veterans who returned home, shattered in body or mind, they were more or less on their own.

Historian Philip Gold, Ph.D., notes that "World War II witnessed enormous advances in treatment of casualties. Despite the lethality of combat, the "Million Dollar Wound," the one that got you out of the fight honorably and more or less intact, was far from uncommon. In Vietnam, the United States provided far and away the best medical care in history. If you could make it onto the MedEvac helicopter alive, your chances of survival were well over ninety percent. Tens of thousands of men who would have died in previous wars, came home hurt and hurting, but still functional. Others have been lifetime patients, far too often not getting what they need."

Today, men and women wounded in Iraq and Afghanistan are also receiving superb medical care. But the wounded coming home today are different, as a new book by Dr. Ronald J. Glasser makes clear. All Americans who believe that the human cost of Iraq can be measured primarily by body bags need to read "Wounded: Vietnam to Iraq."

During Vietnam, Glasser served as an Army doctor. Although his specialty was pediatrics, he spent his tour treating Vietnam wounded at a hospital in Japan. After leaving the Army, he wrote "365 Days." No publisher would touch it until George Braziller, head of a fine arts press, took a chance.

The book is still in print 35 years later.

Glasser is now a pediatrician in private practice in Minneapolis. As the Iraq war lengthened, he noticed that there was something strange going on. Although mercifully few Americans were being killed (the current total is about 2,400), nearly all the wounded being returned (now over 24,000) were horribly damaged. Deaths were very low by historical standards. Moderate "traditional" wounds were also very low. But thousands of men and women were coming back missing limbs, suffering from severe blast trauma, facial and closed head injuries.

He investigated, then published an article, "A War of Disabilities," in the July 2005 Harper's Magazine. George Braziller, now 90 and still running his publishing house, read it, then called Glasser and asked him to write a short book that he would publish. Glasser turned it out in six months while maintaining his medical practice. The book will be officially published this June.

This is the situation he describes.

Because of advanced body armor and Kevlar helmets, there are very few serious gunshot wounds to the torso or protected part of the head. Because the bad guys lack artillery and mortars, there are very few shrapnel wounds. Instead, the weapon of choice is the Improvised Explosive Device, or IED. These are usually planted along roadsides or in vehicles driven by suicide bombers. They are detonated (often by cell phone) when an American vehicle or convoy passes by, or rammed into targets.

The term IED itself is a misnomer. These are not "improvised" in any basement- or garage-tinkering sense. Some consist of several artillery shells (often stolen from unguarded Saddam-era ammo dumps), with gasoline and other nasty items added. Anything that can overturn a Bradley infantry fighting vehicle or a Marine assault amphibian is not amateur work.

Because IEDs are triggered in close proximity to American vehicles and other targets, the blast effects are horrific. Arms and legs are mangled or torn off; the Army, Glasser reports, is doing amputations at a rate unknown since the Civil War. Closed head traumas are so complex and severe that the Army calls them "polytrauma."

To deal with IEDs, the Army has had to completely rethink battlefield care and procedures. Gone are the days of "patch 'em up fast and get 'em on the MedEvac." As Glasser describes it, the big-city emergency trauma center has moved to the battlefield.

The care can be magnificent. But the care is saving some terribly damaged people, and they will be patients for life. As long as they remain in the military, they can receive what they need in a relatively timely manner. But once they're discharged, they go into a strained DVA (Department of Veterans Affairs) medical system that is still handling World War II and Korean vets, and will be caring for Vietnam vets for the next three or four decades.

The influx of severely wounded Iraq and Afghanistan vets into the DVA is just starting. Now is the time to make sure that the battlefield medics and military doctors did not keep them alive so they could be abandoned to a half-century of neglect at home. The chronically underfunded DVA medical system must get what it needs to care for them and to continue caring for all veterans who require its services. This is a debt that must be honored.

Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., comments on medical-legal issues and is a Visiting Fellow in Economics and Citizenship at the International Trade Education Foundation of the Washington International Trade Council.

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"Supporting the troops" is about more, far more, than yellow ribbons, bumper stickers and waving flags. It is about more than giving proper honor to courage, dedication, competence and sacrifice even when (or especially when) you don't support the war. It is about...
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