Army officials declined to discuss Bernstein's death or release an autopsy report or other record, saying privacy laws prohibited it. But the official records available do little to clarify what happened. The officer's death certificate, for instance, lists the cause of death as "shrapnel injury of the leg," according to Bernstein's father, though Sams and other survivors don't recall his vehicle being hit by anything but bullets.
Everyone associated with the incident who could be contacted - Sams, three other soldiers who survived the ambush and Bernstein's father - recalls hearing the story that Bernstein's artery retracted into his abdomen and continued to bleed after he was injured, making a tourniquet useless. But four doctors who specialize in trauma injuries, commenting on descriptions of Bernstein's wound provided by Sams and two other soldiers who were at the scene, doubt that explanation.
"An injury like that is fairly common. I'll probably see one or two tonight," said Dr. Norman McSwain, a trauma specialist and professor of surgery at Tulane University who served on the military's combat medicine committee. "And it sounds like a tourniquet would have been effective."
"I've treated God knows how many of these things, and the vessel might retract an inch or two at the most," said Champion, a retired chief of trauma at Washington Hospital Center in Washington, D.C., and former director of research at the Maryland Shock Trauma Center. "If a tourniquet is available and applied properly, with an injury like that you have several hours. The bottom line is, it's not acceptable to die from that kind of an injury."
Brian Hart, whose son, Pfc. John Hart, died in the same ambush from a bullet wound in his neck, lobbied heavily for better armor on military vehicles after the incident. The bullet that killed Bernstein pierced the metal skin of his unarmored Humvee before hitting his leg, and the incident became a prominent example of the deficient armor on many American military vehicles. Hart said his son often complained that the 173rd Airborne Brigade's budget was too tight, and two soldiers who survived the ambush said that at least one of the squad's M249 machine guns failed after firing a few rounds.
"I always just assumed that they had the best equipment available," Hart said. "It turns out they don't even have some basic supplies. It's unbelievable."
Most of the military medical officials interviewed cautioned against re-evaluating combat injuries, saying that even a seemingly routine injury can take a deadly and unexpected turn in wartime. But they were unanimous in saying that tourniquets have proven themselves indispensable in combat and that the troops in Iraq and Afghanistan need more of them and have to be trained how and when to use them.
"Every soldier in Iraq should have a small, lightweight and functional tourniquet carried with them at all times," said Col. John B. Holcomb, a trauma surgeon and commander of the Army's Institute of Surgical Research, who said he keeps one in his pocket during tours in Iraq. "The training is doable, the equipment is cheap and it's directed at the largest source of preventable deaths in combat."