WASHINGTON — A shortage of surgeons to treat the wounded in Iraq has left Army medical teams in the country scrambling to handle the largest number of military casualties since the Vietnam War, the New England Journal of Medicine reports today.
The Army has fewer than 50 general surgeons and 15 orthopedic surgeons in Iraq at any one time to serve more than 138,000 troops. Despite the numbers, advances in battlefield surgical techniques and care mean a greater percentage of soldiers wounded in Iraq are surviving than in any previous American conflict.
The article describes a military medical system that has undergone fundamental changes since the 1991 Persian Gulf War, but that nonetheless has been overwhelmed by the scope and severity of injuries occurring among troops in Iraq. It was written by Atul Gawande, an assistant professor at the Harvard School of Public Health and a former senior health advisor to the Clinton White House.
Since March 2003, 1,276 U.S. military personnel have died in the Iraq war, with an additional 9,765 wounded, according to Pentagon figures. The number of deaths directly related to combat passed 1,000 this week, the Pentagon said.
"Just as the rest of the military structure was unprepared for the length of the war and the evolution in the nature of the war, so has the military medical establishment been understandably unprepared for that," Gawande said in an interview.
"What is striking is that they have been able to adapt in ways that allow them to keep a high rate of survival for the soldiers," he said. "But there are costs, and what you see is a potential problem on the horizon."
Gawande did not specify the number of surgeons he thought the military should have in Iraq. He said there were several indications, though, that the current level was insufficient.
With just 120 general surgeons on active duty, the Army has been forced to use urologists, plastic surgeons and cardiothoracic surgeons to perform general surgery on soldiers in Iraq.
Many surgeons have been deployed for more than two years in the Iraq campaign, and military planners are contemplating pressing some to return, Gawande writes.
The physicians are working under difficult circumstances. In many cases, the military has taken over Iraqi hospitals, and the facilities are flooded with civilian patients whom the Americans are unable to treat. With no clear directive from the Pentagon on treating civilians, some physicians refuse to help even pediatric patients out of fear the children could be booby-trapped with bombs, Gawande writes.
