Free Between Flesh and Steel by Richard A. Gabriel

8

SOME THOUGHTS ON WAR
    Not a single major military establishment in the world is without a military medical service. The connection between civilian and military medical establishments in highly industrialized societies is now symbiotic, with advances in one being quickly adopted by the other. The paralysis once engendered by the separation of the civilian and military establishments, closely paralleled in the tension between the physician and surgeon, is gone. Gone, too, is the dependence upon the brilliance of a few people, often military doctors, for medical advances. The search for new medical technologies is so highly organized and requires so many organizational resources that individual genius is unlikely to be productive unless linked with large research facilities. Even then, it is more likely that medical advances will be the product of research teams than of brilliant individuals.
    The impact of military medicine on casualty survival rates has been dramatic. It is noteworthy that almost 65 percent of the wounded receive only minor injuries and 20 percent of soldiers struck by enemy weapons are killed outright; thus, only 35 percent of the wounded require medical attention to survive. Undoubtedly battlefield medicine has had an enormous impact on survival rates and on the fighting ability of modern armies.
    It is wise to remember, however, that the military surgeon’s role has not changed much since he first appeared in ancient Sumer. His task is still to rescue as many salvageable bodies as possible from the carnage, treat them quickly, and return them to the battlefield so that the carnage may continue until, finally, one side’s will gives way. To accomplish this task, some practical realities remain historical constants. The first is that only 35 percent of the wounded in any given battle require seriousmedical attention to survive their wounds. As body armor recently has become a normal item of military equipment for the first time in almost five hundred years, the number of wounded requiring serious medical intervention to survive has declined by yet another 6 percent. The second constant is that regardless of the increasing destructiveness of modern weapons, the ratio of dead to wounded has remained almost unchanged for five hundred years. Third, although disease causes far fewer deaths than it used to, disease-related infirmities still account for the highest percentage of temporary manpower loss in campaigns. Together, the challenges confronting the military physician have remained remarkably similar throughout history.
    What has changed, of course, are the conditions under which the military physician must apply his or her skill. Three factors have altered these conditions: the dispersion of combat forces over far greater areas, the increased rates of destruction of locally engaged forces made possible by increases in the rates of fire and lethality of modern weaponry, and the greatly increased vulnerability of combat medical assets on the high-mobility battlefield. While the challenges to the military physician have remained essentially unchanged, the nature of modern war has greatly transformed the medical practitioner’s ability to meet them.
    The increased ability of weapons to acquire targets at longer ranges and to destroy them with greater certainty has necessarily dispersed combat forces. In World War II, the probability of a tank round hitting another tank on the first attempt was less than 10 percent, and then only if the tank was shooting from a stationary position. Today, the probability of a moving tank getting a first-round hit is almost 98 percent. Smart bombs and other precision-guided munitions, including guided artillery rounds, have made the modern battlefield a terribly lethal place. The tactician’s only solution when facing exponential increases in firepower, accuracy, and lethality is to disperse forces over wider areas and rely upon increased mobility to avoid being