THE ECONOMIST: Parallels Between Wounded and Fatalities in Ukraine and U.S. During the Vietnam Conflict

Western military forces have remained largely untouched by significant losses since the 1950s, and the Ukrainian ordeal offers valuable insights for them to glean. Western intelligence agencies, including those of the United States and Britain, closely monitored Russia’s amassing of troops along the Ukrainian border in the initial weeks of 2022. Their awareness of Vladimir Putin’s invasion plans stemmed from their successful acquisition of classified documents. Yet, a pivotal query loomed—would Putin indeed take the audacious step?

A key harbinger of his intent to initiate the invasion, as highlighted by Major General Tim Hodgetts, the Chief Surgeon of the British Armed Forces, was the relocation of field hospitals toward the Russian-Ukrainian border.

“While indicative, it wasn’t catastrophic. Russia had previously established hospitals for training purposes. What stirred greater concern was the nationwide blood donation drive among university students. Red blood cells have a shelf life of just six weeks unless frozen, and donors are only eligible every three months,” elaborates The Economist.

However, even more disconcerting were the events unfolding within the field hospitals themselves. Russian medical practitioners were observed performing surgeries on large animals under anesthesia.

“Medical markers and indicators can foresee the advent of warfare,” General Hodgetts concludes.

The publication emphasizes that this ongoing conflict in Ukraine underscores a pivotal lesson for future confrontations. The Russian incursion has emerged as Europe’s most substantial conflict since 1945, replete with engagements of a magnitude and intensity unprecedented for Western armies since the Korean War. The toll in military casualties now exceeds the losses incurred in recent American and European campaigns.

Between 2001 and 2019, the United States experienced the loss of more than 7,000 military personnel in Afghanistan and Iraq. In stark contrast, Ukraine faced a devastating toll that was more than double that number within a single year, as revealed by leaked American documents, while Russia’s casualties escalated to a staggering 6 to 7 times higher. The impact of this ordeal is set to revolutionize the landscape of military medicine, asserts the article.

In the theaters of Afghanistan and Iraq, a remarkable advancement in wartime medical care was accomplished by the U.S. military and its coalition partners. Recognizing that a majority of fatalities occur prior to a soldier’s arrival at a medical facility, significant strides were made through the strategic employment of helicopter evacuations for the wounded and prompt treatment during the critical “golden hour” — a time window when survival prospects are substantially elevated. This paradigm shift resulted in the survival of soldiers who, in previous eras, would have succumbed to their injuries. The ratio of wounded to killed, previously at 3 to 4 in the context of Vietnam, surged to a remarkable ten to one.

“Insights from classified data suggest that Ukraine’s situation mirrored that of Vietnam,” notes individuals with knowledge of the classified information. Post-2001 conflicts witnessed no more than a 2% fatality or injury rate among American soldiers, in stark contrast to Ukraine’s estimated 5-10% casualty rate. An exhaustive 2022 study by the Royal United Services Institute (RUSI) underscored the grim reality that 40% of wounded Ukrainian military personnel suffered from incurable injuries, the article highlights.

These figures, to some extent, underscore the limitations that shape medical aid on both opposing fronts. The Russian military, notably, views infantry as dispensable, often returning injured soldiers to the frontlines with severe shrapnel wounds and cardiac issues. The jarring disparity was further highlighted when Tanisha Fazal, a war medical expert affiliated with the University of Minnesota, expressed incredulity upon witnessing footage of a Russian officer employing an outdated rubber tourniquet. Strikingly, this identical tourniquet had been in use by American forces during the early 2000s Afghan campaign.

Ukraine, on its part, is actively disentangling itself from the vestiges of the Soviet-era medical support system. Prior to 2017, the country lacked proficient combat medics, a situation highlighted by ZSU instructor Maria Nazarova. By 2022, Nazarova had successfully trained a cohort of 650, a modest fraction considering the magnitude of a million-strong military force. At present, the training facility, grappling with an insufficient number of instructors and facilities, is only able to prepare fewer than 300 individuals per month for combat roles, with each trainee undergoing a mere 4-week program.

The ongoing counteroffensive, compelling Ukrainian troops to navigate minefields amidst the onslaught of drone surveillance and artillery bombardments, further amplifies the strain on medical assistance.

“Never since last June have I encountered such an escalated demand for tourniquets,” reveals Yevhen Vorobyov, a Kiev-based lawyer who actively volunteers across six distinct brigades.

He underscores that the shortage extends to chest seals and ultrasounds. The shortfall is aggravated by systemic issues. Vorobyov underscores that the delivery of military supplies to the frontlines continues to be characterized by inefficiencies and a lack of coherence. Senior medical personnel find themselves entangled in a bureaucracy of paperwork for irregular and limited supply requests. Tensions often simmer between the forward-deployed units and the central medical command within the General Staff, with the latter primarily perceiving its role as hospital management rather than furnishing frontline aid. Nazarova highlights that this lack of support extends to pivotal equipment like injections, emphasizing that over 90% of medical provisions for military medics are sourced through volunteer channels. This bureaucratic quagmire, however, bears far-reaching ramifications.

“During the 2000s, the U.S. military underwent a pivotal realization: administering whole blood transfusions to injured soldiers, as opposed to isolated components like plasma, directly translates to saved lives. Last summer, the Ukrainian Ministry of Health officially embraced this practice, although it encountered bureaucratic hindrances. Notably, the medical command imposed certain restrictions. Nevertheless, numerous forward-thinking Ukrainian brigades persist in adhering to this approach,” the report elaborates, referencing insights from Nazarova.

Consequently, the quality of medical care within the military exhibits a pronounced disparity. In a large-scale conflict, Western armed forces would possess several advantages, encompassing a more skilled medical workforce and superior equipment. Yet, medical experts from American and European ranks concede that an extensive conflict would jolt the existing medical support framework, which has been fine-tuned over decades of countering insurgent entities without the presence of artillery, rockets, and drones.

Merely 70 American helicopters met their fate in Afghanistan and Iraq within the period spanning 2001 to 2009. By contrast, Russia experienced the loss of 90 helicopters within a span of just 17 months.

“The recognition that an imminent war is poised to redefine notions of aerial supremacy has fundamentally transformed strategic perspectives within both the U.S. and NATO military establishments,” remarks John Holcomb, a distinguished professor hailing from the University of Alabama who notably led the U.S. Army Institute of Surgical Research.”

He cautions that comprehensive preparation is imperative for extensive “on-field” medical care. The type of injuries sustained will also diverge. Approximately 79% of American casualties in post-September 11, 2001 conflicts stemmed from improvised explosive devices. In contrast, recent research published in the “Journal of the American College of Surgeons” highlights that over 70% of Ukrainian casualties result from artillery and missile bombardments. These occurrences often inflict damage on multiple body regions and organs, giving rise to “polytrauma.”

The substantial management of such injuries is poised to impose a formidable burden upon European armed forces. Consider, for instance, the critical matter of blood supplies. Ronald Tee, a military medical logistics expert affiliated with the Royal College of London, characterizes this as a “strategic asset” for the Alliance. Failing to secure it within the military healthcare system poses the risk of a “systemic collapse of morale,” he contends. Dr. Tee underscores the case of Estonia: the country’s primary blood reserves during peacetime could be rapidly depleted in a single day of wartime.

However, blood supplies are not synonymous with conventional ammunition. The viability of fresh blood extends only for weeks (and a few months when frozen), rather than years. Thawing frozen blood necessitates a considerable timeframe. Furthermore, blood donation rates in the UK consistently dip below a week’s worth of supply, as General Hodgetts notes. Interestingly, the exigencies of warfare can help navigate legal challenges. Britain is presently channeling investments into self-sufficient production of freeze-dried plasma, formerly reliant on limited French and German manufacturing capacities that could become strained in wartime scenarios.

Another pressing challenge arises in the realm of transporting the substantial count of wounded soldiers. On the 11th of July, the leaders of NATO sanctioned the Alliance’s inaugural comprehensive defense strategies since the era of the Cold War. These strategies encompass precise logistical arrangements for the transit of a significant volume of casualties throughout Europe. Notably, the allocation of wounded individuals among different member nations of the Alliance is under scrutiny. Regular consultations take place among NATO’s medical leadership, occasionally joined by Ukraine’s chief surgeon, to evaluate the operational efficacy of these protocols during times of conflict. A considerable portion, up to 60%, of Ukraine’s military wounded are conveyed via railway networks.

“Once upon a time, medical personnel aimed to establish conspicuous hospitals in conflict zones. The Ukrainian experience, where Russia targeted facilities adorned with prominent red crosses on their roofs, raises the notion that perhaps adopting a more covert integration with the terrain could yield better outcomes,” observes The Economist.

Data from the World Health Organization indicates nearly 900 instances of attacks on medical establishments during the conflict. Medical practitioners are now contemplating strategies to fortify, conceal, or disperse their facilities. However, the adaptability and mobility of lightweight field hospitals will naturally entail a more circumscribed scope of assistance. Another burgeoning concern revolves around devising measures to avert electronic emissions from medical equipment inadvertently serving as signals for enemy bombing targets.

Preparedness for Action
The ongoing conflict has also reignited discussions about the role of nuclear weaponry. In the autumn months, Western leaders expressed apprehension over Russia’s potential deployment of tactical nuclear arms. The United States, along with its allies in Great Britain and France, issued stern warnings to the Kremlin, indicating that such a move would result in substantial military reprisals. This stance eventually curtailed the perceived threat. In the era of the Cold War, NATO devised strategies for nuclear engagements on the battlefield, although these plans gradually faded away during the 1990s. Presently, concerns are surfacing that both America and its allies might not possess the requisite medical readiness for a nuclear conflict. A prime example of the potential shortcoming is the significant demand for anti-radiation kits.

Ukraine, in its pursuit of innovative solutions, has ventured into employing large cargo drones with the capacity to transport payloads of up to 180 kilograms over distances of 70 kilometers, specifically for the purpose of evacuating the wounded. This pioneering effort has positioned Ukraine as the inaugural nation to successfully execute such a robotic medical evacuation. The objective at hand is to glean insights from these pioneering experiments, utilizing the broader spectrum of Ukraine’s experiences. Achieving this goal necessitates the transformation of anecdotal knowledge into a foundation of dependable data.

Responding to these emerging challenges, the United States has put forth an offer to assist Ukraine in establishing a comprehensive “trauma registry,” akin to the one previously employed during their deployments in Afghanistan and Iraq. This registry functions as a meticulous database, meticulously documenting the nature of injuries sustained, the subsequent treatment protocols, and the ensuing recovery process. The implications of such analysis transcend beyond military realms and extend to the broader populace. Dr. Holcomb reported a notable 30% reduction in trauma-related fatalities within his University of Alabama medical institution by applying the skills and insights garnered from military contexts. Thus, Ukraine’s adversity stands poised to stimulate significant advancements in the field of medical science.