Between Flesh and Steel

by Richard A. Gabriel

  The swirling nature of modern tactics requiring mobility and deep penetration coupled with the presence of precision-guided munitions and air capability on both sides means that medical assets will be extremely vulnerable to planned or accidental destruction. A division commander, for example, currently possesses the capacity to exert lethal force as far as sixty miles into the interior of the enemy front. Any medical assets close enough to deal with frontline casualties are within the zone of destruction and vulnerable to attack. Since a critical factor in keeping most wounded alive is that they be reached quickly, stabilized, and then evacuated for further treatment, how this lifesaving effort might be accomplished in a modern war is unclear. The old standbys of motor ambulance, wheeled or tracked vehicles, and the helicopter are all extremely vulnerable when they venture close to the forward edge of the battle area where casualties are expected to be concentrated. Motorized transport survived well enough in World War II and Korea because the weapons used in these conflicts were so inaccurate. In the U.S. military’s efforts in Vietnam, Iraq, and Afghanistan, the helicopter survived well enough as an evacuation vehicle because the U.S. military enjoyed complete air superiority to suppress enemy fire at the evacuation point. In future wars, these conditions are not likely to obtain.

  The professionally staffed and well-equipped medical services of modern armies are apt to face considerable difficulties in delivering medical care to the soldier on the battlefield. Again, too, the danger is that armies plan for the next war as though they are refighting the last one. In Iraq, for example, had the Iraqi Army not lost its will to fight and its air force not been destroyed before the ground battle began, the U.S. Army’s medical assets would have been vulnerable to attack, especially from chemical munitions delivered by air, artillery, and barrage rockets. As partial consolation, current statistics show that for every three soldiers wounded only one will require serious medical intervention to save his life. The key to survival may be in increasing the medical training in traumatic first aid for all soldiers so that they will be able to stop bleeding and prevent shock. It is also probable that high-intensity conflicts will be relatively short affairs, and perhaps planners should not give too much thought to returning the wounded to the battle as they might not have time to make much difference in its outcome. Increasing the soldiers’ medical training so that they can act as trained medical resources on the spot may make the most difference in saving lives. The idea is not a new one. In both ancient Greece and Rome, soldiers relied primarily on each other rather than on an organized military medical service to treat their wounds.

  Fortunately, since the 1970s no nation has yet fought a modern, high-intensity, conventional war in which both sides were well equipped and had the stomach for a fight. The closest example to this type of conflict was the Israeli-Arab War in 1973. In that war, the Israelis lost almost half of their ground forces to death, wounds, and injury and almost as much of their equipment in less than twenty days of sustained combat. The loss ratios for the forces of the engaged Arab states were even greater. While both sides tried desperately to provide what medical support they could, the nature of modern battle made it difficult, and thousands died of their wounds. In the case of the Iraqi-U.S. conflict of 1991, the Iraqis quit fighting within hours of the ground attack, and in the 2003 war they quit within two weeks. In the few places where Iraqi Army units chose to stand, the superior firepower, accuracy, and lethality of American weapons destroyed them within hours. While no official death rates have been released for the Iraqi Army, senior American combat commanders suggested publicly that as many as a hundred thousand Iraq combatants were killed or wounded in less than a hundred hours of combat. Under these lethal conditions, it is extremely unlikely that the Iraqi military medical service could have done much to stem the tide of death that swept over its army.

  The advances in the conduct of war have proceeded so rapidly that the military medical services can never really catch up and realistically provide the kind of survival assistance that the modern soldier has come to expect. Certainly this state of affairs has already been reached in other areas of the military arts. Training exercises conducted by the U.S. Army at the National Training Center at Fort Irwin, California, reveal time and again that against a relatively equally matched enemy, even the victor can expect little more than a Pyhrric victory in intense engagements. Military psychiatrists suggest that under those conditions, manpower loss from psychiatric collapse is likely to surpass the number of men killed by enemy fire. At the extreme, of course, no one really expects to survive a battle in which tactical nuclear weapons are used.

  Maybe the destructiveness of war has indeed exceeded our wildest expectations, and only foolish stubbornness motivates us to fend off the horror of war with the delusion that we can salvage the human wreckage so that life can go on after the battle. Yet, precisely this belief makes the conduct of war seem a plausible means for resolving national conflicts. No soldier who truly thought he was going to die would venture upon the battlefield unless he was insane. The paradox is that having striven for more than six millennia to find ways to relieve the suffering and pain of the wounded, we have finally achieved the goal, only to have it snatched from our grasp by the terrible power of modern weaponry. Even so, who among us is willing to suggest that the search for saving the wreckage of war ought to end?

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