CHAPTER III
Care of the Wounded*
Excellence of Medical Care
Factors in Low Morbidity and Mortality
The excellence of care of the wounded
in Vietnam was the result of a combination of factors: rapid evacuation of the
casualty, ready availability of whole blood, well-established forward hospitals,
advanced surgical techniques, and improved medical management.
From the standpoint of methods used to
wound- mines, high-velocity missiles, and boobytraps- as well as the locale in
which many were, injured- in paddy fields or along waterways where human and
animal excreta were common-- Vietnam was quite a 'dirty' war. Yet helicopters
were able to evacuate most casualties to medical facilities before a serious
wound could become worse, There were, practically no conditions under which the
injured was denied timely evacuation; weather, terrain, time of day, enemy
contact, all were surmounted by the, capabilities of the air ambulances and the
skill of their crews.
The use of whole blood, occasionally
even before the arrival of an air ambulance, contributed to the low mortality
rate in Vietnam by better preparing the wounded for evacuation. Blood packaged
in styrofoam containers which permitted storage for 48 to 72 hours, in the field
could be placed in the forward area in anticipation of casualties. This was a
marked increase in the utilization of whole blood, since virtually none was used
at the division level in World War II. Stocks of blood, drawn from PACOM
(Pacific Command) in the early years and later
*This chapter, involved with
statistical analysis of World War II, Korea, and Vietnam as indices of the
quality of care of the wounded, is subject to all the handicaps of comparison.
Reporting procedures have changed over the last 25 years, and the most recent
reports included more individuals through the increased scope and efficiency of
the data collecting system; moreover, some information, gathered for Vietnam had
no true counterpart in the previous conflicts. Yet another problem is semantics:
'hospitals' is different from 'all medical treatment facilities,' which presents
the danger of 'comparing' what is actually two different populations. Concern
with these problems is highly justified, and any reader must view comparisons
merely as illustration of trends, not as absolute, fact. While the figures will
change as more complete information becomes available, the basic fact which they
illuminate will not- the care of the wounded in Vietnam has been superior to
that given in combat anywhere at anytime.
