Curious twist in Afghanistan

KANDAHAR AIRFIELD, Afghanistan – The Afghan War’s medical legacy will not be in-theatre, but how the Taliban’s weapon of choice – the homemade bomb – has provided the catalyst for a generational leap in prosthetics that have afforded amputees a better quality of life, according to the Canadian doctor who has run NATO’s military medicine operations here for the past year.

"They are pushing boundaries on prosthetics and rehabilitation techniques like the space program did," said Brig.-Gen. Hilary Jaeger, who was the Canadian Forces surgeon general for five years before deploying to Afghanistan.

In an interview conducted before she left Afghanistan last week for her next job running Canada’s reserves, Jaeger discussed the insidious nature of improvised explosive devices, which have shattered many bodies and addled many minds, and how military medicine had tried to respond to the challenge.

According to figures compiled by the Pentagon for United States media, nearly 90 per cent of the soldiers wounded by improvised explosive devices this September survived, up from about 60 per cent last year.

Huge improvements in body armour and the armour that is slapped on the outer surface and interior of fighting vehicles were responsible for much of this.

Faster response times by U.S. medevac helicopter crews, who have transported the wounded to hospital 25 per cent faster on average this year over last year, according to the Marine Times, also have played a part in producing survivability figures that were far better than in Vietnam or in the Second World War.

For all that, thousands of soldiers in Afghanistan have been able to survive serious IED blasts because of a forgotten old standby, the tourniquet, which every NATO soldier carries in his modest medical kit.

"The most important time (to save a life) is in the first 10 minutes," Jaeger said. "What you need are tourniquets and clotting material and people who are competent using them.

"Of these two, the tourniquet is probably more important. It is ancient technology that went out of fashion a long time ago. But it has come back into usage in Iraq and in this conflict. It is dead simple and it saves lives."

One argument against the tourniquet was that when tightened around a limb to stop the flow of blood it also caused tissue to die, leading to unnecessary amputations. But in Afghanistan, IEDs have been so powerful that whether a soldier was on foot or in an armoured vehicle, the instant of the explosion, "amputation had usually already taken place," Jaeger said. "We should be more worried about bleeding to death from a lacerated artery than from dying tissue. It was something that was forgotten for a long time."

Most of those wounded in Afghanistan have been hit by IEDs, according to data published earlier this month by the Washington Post, which noted survivors had often received more severe wounds than those who survived such blasts even a few years ago.

"Your chances of surviving serious trauma are better here (on the battlefield) than in a hospital in a major city in North America," Jaeger said.

Referring to IEDs, the army’s only female flag officer said: "In the beginning, they were mostly leftover (artillery) shells, but over time, the charges have gotten larger and larger."

This was because the enemy is now making "homemade bombs with more and more jugs (of fertilizers such as ammonium nitrate)," she said. "There is still a wide variation. These things do not come off an assembly line. Each bomb is a hand-crafted original."

Another serious problem caused by IEDs are concussions. Curiously, military medicine was looking to research from the NFL and NHL to better understand the symptoms and how to respond to them, Jaeger said.

"We are getting smarter about people who have had their bells rung but say they are all right afterwards," she said. "Having a lot of those things, especially close together, is not a good thing."

While the military watched soldiers’ reactions to acute stress more closely than ever, "we do not see a lot of PTSD (post-traumatic stress disorder) because, almost by definition, these cases present themselves later."

While not speaking about a specific case, she said that any time a well-intentioned health-care worker had a patient who was a soldier who had deployed to Afghanistan there was "a tendency to make it (PTSD) the easy answer.

"Do situations arise where there is PTSD? Absolutely. Are there cases where there is an inappropriate overuse of this (conclusion)? Yes. One thing about PTSD is that you can make any story fit it."

Reviewing her year in Afghanistan, where she had a privileged seat among the NATO commanders in Kabul, Jaeger described it as "a graduate course" in how to bring together "strands of information from a hugely broad and disparate range of fields of endeavour."

Nevertheless, what impressed Jaeger the most in her year in Afghanistan had been the patients.

"I continue to be amazed at how resilient young people are," she said. "People have survived things here that you would not have thought possible."