With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow and his orphan—to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations.
Lincoln’s Second Inaugural Address, March 4, 1865
This memorable quote hangs over the door of many US operating rooms in the combat theater. It provides an appropriate focus regarding the privilege and responsibility of those engaged in military medicine. Caring for those who have been injured on the battlefield has been an integral part of the fabric of medicine since the days of the ancient Greeks. Working in an austere, and often hostile, environment with limited resources is a humbling and intensely emotional experience. It is an unfortunate but equally accurate truism that war advances our understanding of care of the injured patient unlike any other worldly event.1 The scope of this chapter will attempt to characterize the most recent recognitions and advances that have emerged as lessons learned over the past years of armed conflict.
Many of the lessons of modern military medicine are, in fact, not new but simply principles recognized by many previous generations of combat medics. Hypotensive resuscitation (Walter Cannon, MD, World War I), the value of whole blood transfusion (Edward Churchill, MD, World War II), and the utility of vascular shunts (the Korean War) are just a few examples of the pivotal lessons “rediscovered” during the current conflicts. Military medicine by its very nature is challenged by the task of preserving its own history and the lessons learned. The majority of providers of combat medicine return home and to civilian and academic practices without fully cataloging and preserving lessons learned. The military medical corps’ challenge is to maintain and promote ongoing combat medical support and research in periods between conflicts. Generations of medical officers may come and go without seeing an armed conflict, and lessons learned are all too often lessons forgotten.
Modern warfare has changed in scope and condition. The classic large battlefield campaigns witnessed in World War I, World War II, and Korea (and feared during the Cold War with Russia) are less relevant in today’s global security scenario. Over recent decades, armed conflict in the Global War on Terror has emphasized the necessity of fluidity, precision, and speed of engagement. The current battlefield is shaped by the reality of the asymmetrical or nonlinear battlefield. Lines of engagement may be spread out over a wide geographical continuum and the forward edge of the combat zone may shift hundreds of miles in a single day as rapidly mobile armored and cavalry units mobilize with dramatic speed and capability.