Military Medicine

Traditionally, military medicine has progressed when war has forced doctors to devise better ways of caring for the wounded. Many advances in the treatment of shock, trauma, and infectious disease were developed under the pressureof war.

The Cold War (that period of indirect conflict and proxy wars between the United States and the Soviet Union that lasted from the end of World War II in 1946 until the disintegration of the Soviet Union in the early 1990s) forced military medicine into a period of self-examination and planning for new and varied demands.

Post-Cold War questions focus on how to balance a medical staff's combat readiness with other missions. In an environment where the military is highly mobile and fast-moving, and when it is deployed against considerably weaker forces, nonbattle injuries must be expected. For example, in 1991, in Operation Desert Storm (in which the US attacked Iraq after the latter invaded its oil-rich neighbor Kuwait), soldiers were far more likely to be evacuated for noncombat injuries than for combat injuries. Motor vehicle accidents were the mostcommon cause of noncombat injuries.

Military medical staff must be prepared for disease and nonbattle injuries such as environmental and safety hazards. In military operations in Haiti and Somalia, about 10 percent of United States forces were seen for disease and nonbattle injuries, usually accidental injuries. Sports injuries are also persistent problems.

Military medical staff must make many special preparations based on the living conditions of the countries to which they will be traveling. More than one-fifth of the world lives in extreme poverty with little sanitation, where infectious diseases are the leading cause of death (17 million deaths peryear). As a result of war, more than 50 million refugees and other displacedpersons face additional risk for disease fostered by poor sanitation in camps. Under such conditions, United States military members have limited protection, because so many pathogens are resistant to antibiotics and insecticides.Diseases such as cholera and malaria were once thought to be under control but are now found in many countries. Malaria affected entire battalions duringthe wars in Korea and Vietnam. During the occupation of Somalia, 350 U.S. troops contracted malaria.

Poor sanitation also leads to diarrheal diseases, such as dysentery. During the Civil War, diarrheal diseases caused more deaths than battle wounds. Though diarrheal diseases rarely kill modern United States troops, they reduce combat capability. For example, when U.S. troops arrived in Saudi Arabia for Operation Desert Storm, more than half contracted diarrhea during the first month and of these, about 20 percent missed at least one day of work. Again, military medical personnel can offer very little, since the organisms that causediarrhea quickly develop resistance to new drugs.

Troops exposed to rough living conditions are also at risk for incurable insect-borne diseases such as dengue fever, yellow fever, and Japanese encephalitis. Military medicine must be prepared to cope with influenza, tuberculosis,hepatitis, meningitis, biological weapons, sexually transmitted diseases, andheat casualties.

In addition to care of the troops, military medical personnel are responsiblefor the families of troops and for some military retirees. Retirees make upmore than 50 percent of patients, up from 8 percent of patients in the early1950s. Between 1986 and 1996, 35 percent of military hospitals closed. Duringthe same decade, the number of people seeking help from the Military HealthServices System has dropped only 9 percent. The trend is to accept fewer inpatients at military base hospitals.

Military medical personnel must be prepared to support large deployments, such as those in the Balkans, but must also prepare for expanding roles in treating victims of natural disasters and terrorism.

Military medical personnel have assisted in emergencies such as the bombing of the federal building in Oklahoma City and in major jet crashes. These outreach missions help military medical personnel hone their skills in addition toproviding humanitarian aid. In the post-Cold War climate, military medical personnel are called upon to provide medical support for peacekeeping missions. Sometimes medical personnel are seen as less threatening than others in United States military uniforms, and their humanitarian efforts are more likelyto be accepted.

The medical education of military physicians is changing to prepare for the military's new role. The military medical school curriculum includes trainingin casualty care research, public health, preventive medicine, humanitarian assistance, disaster medicine, medical simulation training, tropical medicine,specialized family care, and teleradiology (diagnostic images transmitted over telephone lines).

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