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President's Commentary: Caring for Democracy’s Defenders

By Lt. Gen. Susan S. Lawrence, USA (Ret.)

Historically, disease often determined wartime’s winners and losers. In the modern era, injuries, or trauma, take the greater toll on U.S. armed forces. And as I wrote in December’s column, suicide takes far too many of our warfighters.

Disease literally plagued Athens during the Peloponnesian War, which began in 431 B.C., and led to the deaths of 100,000 citizens by some estimates. Illness helped the Russians defend their home country from Napoleon’s army and caused more than 60% of both Northern and Southern casualties during the American Civil War.

An article found on the National Institutes of Health website makes the case that during the United States’ first 145 years of war, far more of the country’s military personnel perished from infectious diseases than from enemy action.

In the article, Two faces of death: fatalities from combat in America’s principal wars, 1775 to present, historian Vincent J. Cirillo reported that, for the United States, this trend was reversed in World War II when vaccines and antibiotics became broadly available. He divided U.S. principal wars into two eras: the Disease Era, 1775-1918, and the Trauma Era, from 1941 to the present.

It is an ugly irony of combat that warriors are more vulnerable while caring for their wounded teammates. In future conflicts with peer or near-peer adversaries, the United States and its partners and allies may lack the air superiority or the spectrum dominance needed to arrange for medical evacuations. Meaning, the so-called golden hour—that critical time between the injury and treatment from a surgical team—may be greatly extended, leaving the wounded near the front lines for days, especially in the vast expanse of the Indo-Pacific or Africa.

Fortunately, the Defense Department is planning and preparing for the worst-case scenario. We cannot fully predict the extent to which technology will support the care of our military personnel in future conflicts. But we may well see robotic vehicles ferry patients from the front lines. The Navy is exploring humanoid robots to fight fires onboard ships and remove hazards. And the Army Applications Laboratory has sought sources to provide anatomically correct mannequins to improve medical training for the treatment of women trauma patients.

Also, zero-trust cybersecurity will go a long way in ensuring the security and integrity of health data. A lack of security could compromise privacy and allow a future adversary to alter health data, falsely indicating that a significant number of military members are unable to join the fight.

Additionally, the Defense Health Agency (DHA) is applying artificial intelligence, machine learning and predictive algorithms to allow systems to make connections that would be difficult or impossible for humans. These technologies promise to reduce costs, increase readiness and optimize military health care.

The mission of the DHA’s Joint Trauma System is to improve care for combat casualties from the strategic level down to the tactical edge through evidence-driven performance improvement. The trauma center has also expanded the data capture and collection capabilities of its Defense Department Trauma Registry with the addition of special injury registries.

And the Military Health System’s GENESIS program modernizes military electronic health care record keeping. It replaces multiple systems with just one, allows all medications to be electronically sent by off-base providers to military pharmacies and uses barcodes to verify medication information and prevent errors. The system went live in 2020 and has since been deployed across the country and overseas.

Additionally, the Defense Centers for Public Health-Aberdeen monitors soldier medical data to identify the most common injuries, trends and risk factors. The data reveals that overuse injuries from running, marching or other repetitive movements are the leading category of injuries for soldiers.

Perhaps one day, a comprehensive mechanism for synchronizing all service member health care efforts across government, industry, and academia will exist. Whether disease, combat-related wounds or mental health issues, expeditious and efficient care of warfighters must always be our first priority.