Readers Speak Out On Troops' Untested Medical Care

April 04, 2009

I was the chief of staff of the Army hospital in Baghdad from January 2004 to January 2005. And while much of the article "Untested in Battle" (March 29) was factual, the tenor of the reporting gave the impression that experimental and untested methods were used in Iraq without strict regard to patient safety. That's not true.

As the article suggested, when I first arrived in Iraq we did not have a reliable source of platelets in theater.

Unlike civilian hospitals, where blunt trauma is common, almost all of our casualties suffered from severe penetrating trauma injuries that often required replacement of blood products.

In those situations, using fresh whole blood was the only alternative.

It took almost a year from my arrival in Iraq for plateletpheresis machines to arrive in theater, and that reduced the need for whole blood drives. But even then, mass casualty or single massive transfusion situations occur in medically austere environments, and using whole blood is often the only real option.

Regarding the use of Activated Factor VII, we knew that there were only preliminary data to support its use. But when you have someone actively bleeding from penetrating trauma, you use everything that you can to save a life.

Subsequent research brought its use into question, but at the time we used the drug, it was perceived as a lifesaver.

It is true that body armor has significantly reduced the number of injuries to the chest and abdomen in Iraq and Afghanistan. But I defy anyone to come to Walter Reed Army Medical Center and tell the single, double and triple amputees that decisive surgical care on the battlefield did not save their lives.

Dr. John H. Chiles, Bethesda

The writer is a retired colonel in the U.S. Army.

Robert Little's reporting on the Department of Defense's attempts to implement aggressive tactics to address death from hemorrhage glosses over the fundamental problems of treating and doing research in populations of patients who are bleeding to death.

Advances in medicine come not only from thoughtful laboratory or clinical data but, as acknowledged in the article, also from the judgment of front-line experts in efforts to save lives. Then come the studies.

In his work at the Army Institute for Surgical Research, Col. John Holcomb exhibited a thoughtful and considered response to an avalanche of young Americans dying from exsanguinating hemorrhage on the battlefield.

Aggressive and innovative resuscitative techniques were born in high-pressure, resource-constrained environments bombarded by large influxes of massively and multiple-injured patients on the brink of death from catastrophic hemorrhages.

Many of us, including many of those saved, are glad Colonel Holcomb's leadership was there and the decisions were not left to armchair ex-post-facto pundits who have never been there, never done that, never had a 23-year-old bleed to death under their hands.

Dr. H.R. Champion, Annapolis

The writer is a trauma surgeon who was one of the founders of the R. Adams Cowley shock trauma system and trained military surgeons for combat casualties for more than 30 years.

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