Are U.S. Soldiers Dying in Combat From Survivable Wounds?

In an unassuming building in suburban Washington, a team of military medical specialists spent six months poring over autopsies of 4,016 men and women who had died on the battlefields of Iraq and Afghanistan.

They read reports from the morgue at Dover Air Force Base, where bodies arrived in flag-draped coffins. They examined toxicology reports. They winced at gruesome photos of bullet wounds and shredded limbs. In each case, the doctors pieced together the evidence to determine the exact cause of death.

Their conclusion would roil U.S. military medicine: Nearly a quarter of Americans killed in action over 10 years—almost 1,000 men and women—died of wounds they could potentially have survived. In nine out of 10 cases, troops bled to death from wounds that might have been stanched. In 8%, soldiers succumbed to airway damage that better care might have controlled. "Obviously one death or one bad outcome is too many, but there are a lot of them," said one of the researchers, John Holcomb, a former commander of the U.S. Army Institute of Surgical Research.

A U.S. Army soldier receives medical assistance 

after being injured by an explosive in Afghanistan

 in 2012. Agence France-Presse/Getty Images

The findings appeared in the Journal of Trauma and Acute Care Surgery in 2012 to almost no public attention. But in military medical circles, they have fueled a behind-the-scenes controversy that rages to this day over whether American men and women are dying needlessly—and whether the Pentagon is doing enough to keep them alive.

Lt. Col. David Marcozzi, a trauma doctor, left, shows 

a flight medic where to insert a chest-decompression 

needle during a training session at Bagram Airfield in 

Afghanistan. 

Michael M. Phillips/The Wall Street Journal

Indeed, a new internal report concluded that the military still hasn't fully adopted battlefield aid techniques that could have kept many wounded men alive in Afghanistan. Some of those techniques have been used to great effect—often with little extra cost—by elite commando units, such as the Army Rangers, for more than a decade, say active-duty and retired military trauma specialists.

In response, the Defense Department points to steps it has taken—including putting nurses and blood-transfusion equipment on medical-evacuation helicopters. "I would argue that particularly the primary lifesaving components" of the latest casualty-care guidelines "are readily implemented across the theater," said David Smith, deputy assistant secretary of defense for force health protection and readiness.

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But Dr. Smith did say that the wider military hasn't uniformly implemented the lessons learned from elite units and that the Pentagon was working "to remove that variation." He said the agency was still examining the internal casualty-care report from Afghanistan. The report, completed in May but not widely circulated outside the military, was written by a medical-research team that visited 26 front-line clinics—and found that only one had fully implemented the latest guidelines.

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