Nearly 3,500 Americans have been killed in Afghanistan in more than a decade of fighting. In that time, more than five times as many have been wounded. It is a toll that carries a heavy burden, long-term implications, and one that benefits from historical perspective.

This year is the 150th anniversary of the end of the Civil War, which included the battle at Antietam, the bloodiest day in American history. Three thousand Americans were killed and 17,000 wounded, in one day’s fighting. Our nation was appalled at the single day’s carnage, which became a harbinger of many more horrific days to come. Like the wars of today, the true human cost mounted when the guns fell silent.

Pioneering Civil War surgeon Jonathan Letterman became responsible for more than 9,000 wounded men in a single day. His fledgling ambulance system had just replaced battlefield chaos in which Army band members and slackers had been the stretcher bearers, and the wounded often lay untreated on the battlefield for days. Barnyard horse stalls became patient wards at a time when surgeons called symptoms of infection “laudable pus.”

More than half of those wounded died from infection and beyond that, nonexistent hygiene standards and ignorance spawned disease epidemics that killed more men than enemy fire. It wasn’t until World War II that the enemy killed more Americans in combat than disease.

In World War II and as recently as in Vietnam, approximately 30 percent of those wounded died. Similarly, 25 percent of those in the first Gulf War died from their injuries. Today, as the Middle East battlefield death toll mounts, only 10 percent of our men and women in combat die from their wounds, sending the rolls of the wounded skyward. A recent Army study predicts that the fatality rate of the wounded could be decreased to as low as 7 percent. Today, survivability has never been more likely on the battlefield. Disability, not death, has become the signature image of combat.

As we mourn those who have been killed in the Middle East dating back to 2003’s Operation Iraqi Freedom, America now faces more than 50,000 wounded soldiers who have come home from the Middle East. They have returned in large part because of the tremendous advances in military medicine, advances that ultimately will improve civilian health care as well.

In fact, military medicine’s legacy is pervasive. Life flights, X-rays, reconstructive surgery, PTSD diagnosis, blood transfusions, triage, trauma specialties and micro surgery all were pioneered, proven or advanced in combat care.

In Vietnam, medics rushed to treat the wounded within the “Golden Hour” after they were wounded. Recently, a Navy critical care nurse told me, “We consider it the ‘Platinum 10 Minutes’ in which we’re expected to begin stabilizing a patient. I’m expected to be able to get a needle into a wounded soldier’s vein in the back of a helicopter, in the dark.” Critically wounded soldiers in Vietnam typically reached U.S. military hospitals in about six weeks. Today, it can take only four or five days.

When corpsmen reach the battle zone, they often learn that stateside training they received a few months earlier has already been updated with new information and techniques.

The pace of medical advance is certain to accelerate. Researchers, including some in San Diego, have worked on a microchip inserted into a soldier’s dog tags or even under his skin that can monitor his condition and send information wirelessly to a nearby medic. Another research initiative focuses on new bandages that monitor a patient’s condition and automatically dispense one of several medicines based on his need.
Still another research project centers on developing the capability to quickly manufacture artificial blood to meet emergent battlefield needs. Nearly $15 million has been invested in research to restore memory by bridging gaps in injured brains.

To be sure, all Americans should mourn the battlefield fatalities we have suffered in recent years. Yet for many, it’s difficult to develop a proper perspective. Today, 35-year-olds were born after Vietnam and many grandparents were born after World War II. We should not become distracted by reports that Detroit suffered more deaths in 2007 than soldiers in Afghanistan or that body counts have dropped from previous years. The loss in any extended war is inexorable. It mounts one flag-draped body at a time. Today’s generation only knows of marathon battles that chip away at our nation’s soul, one death at a time.

Equally important, we must be prepared to support the 50,000 who have come home with injuries, some of which we are only now beginning to recognize. With greater medical knowledge comes a greater burden of treatment. The malady called “soldier’s heart” in the Civil War is recognized as PTSD today. And the RAND Corp. predicted 300,000 cases of PTSD among the first 1.6 million Americans deployed to the Middle East in this century. That’s the equivalent to the entire population of Pittsburgh. RAND pegs the total lifetime cost for those soldiers at between $70 billion and $150 billion.
Those who serve our nation in uniform today extend the legacy of the 40 million Americans who have served since our nation’s birth. Those lying in beds at San Diego Naval Medical Center and elsewhere are kindred spirits to the 1.4 million Americans who have been wounded in the course of more than two centuries of service. Meanwhile, the Department of Veterans Affairs recently faced a backlog of more than 900,000 disability claims. At one point the average wait for VA benefit applicants in San Diego was more than nine months.

As we reflect on the sesquicentennial of our Civil War and confront the long-lasting ramifications of America’s international military commitments in the 21st century, history tells us the cost of those commitments is likely to stretch decades into the future.
Scott McGaugh, is marketing director of the USS Midway Museum. He is the author of New York Times bestseller “Surgeon in Blue” and “Battlefield Angels, Saving Lives Under Enemy Fire.”

By Scott McGaugh