Free Between Flesh and Steel by Richard A. Gabriel Page A

killed.
    One consequence of dispersion is that troops spread over very wide areas make it almost impossible to locate casualties. Unlike earlier wars of fixed lines and relatively shallow zones of operation, the modern conventional battlefield vastly complicates military medical teams’ efforts to determine the location, number, and severity of casualties and to react in time. The dispersion of casualties, first brought about by the introduction of gunpowder weapons and then by the adoption of linear tactics, has reached far greater proportions than anyone imagined even twenty years ago. In future wars, it may take much longer to locate and reach casualties for treatment.Despite the best efforts of medical teams, wounded men will remain untreated for many hours and even days. Many who would have been saved in earlier wars are likely to die. Those who survive until medical help reaches them are likely to present with infected wounds that will greatly complicate treatment and recovery.
    Increased firepower and lethality of modern weapons cause very high rates of destruction and wounding when employed in compact battle areas. Dispersion, after all, only works so long as one is avoiding contact or moving toward the battle engagement. At some point the forces must concentrate at the
schwerpunkt
(focal point) and the battle against contending forces joined. The loss of life and equipment in these engagements will probably be quite high for both attacker and defender, with kill and wound rates rising past 60 percent. It is unlikely that any medical service will be able to handle the sudden flood of the casualty stream under these conditions. In the case of a successful attack, the victor might be able to move rear area medical assets to the battlefield in time to treat some of the wounded. In the defender’s case, however, once his battle area is penetrated and the attack continued to his rear, his available medical assets are likely to be destroyed or crippled in a battle of annihilation. Iraqi forces faced this scenario in the Gulf War in 1991 and again in 2003. A defeated enemy, furthermore, can expect little in the way of medical help from a victor already overburdened by its own casualties.
    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