Battlefield knowlesge saves 200,000 lives a year?

I have wondered for several years about a particular scenario.

From World War II onwards, our military has performed an astonishing miracle of both retrieving wounded from the battlefield to a place where they can receive primary or secondary medical care in increasingly brief windows of time.  The armed forces came to recognize that there is a golden window between wound and treatment which varies by the nature of the wound.  

But whatever the wound, if the wounded soldier can be retrieved and treated within that window, recovery rates can be astonishing.  I recently finished an autobiographical account by an Army doctor in Iraq during the surge.  They were the second level of treatment.  

Wounded in the field, a soldier would receive the most basic treatment (apply pressure, stop the bleeding, etc.)  in the field from a medic or a fellow soldier.  Evacuated, they would be taken by truck or helicopter to a field hospital.  If necessary, once stabilized they would be evacuated to the third level in Germany or the US.

This doctor's hospital had a survival rate of something like 95%, a tribute to the basic field treatment, the rapidity of evacuation, and to the field hospital staff themselves.  Truly amazing.  

Before the 20th century, armies and wars were accustomed to most deaths being from disease rather than battle and most wounds in battle to result in death.  

With modern techniques, training, and logistics, there are far fewer deaths outside of battle (primarily accidents and suicides) and far higher survival rates from even the most grievous injuries.

I know that much of that battlefield knowledge has seeped back into emergency room treatments and procedures in the US.  But how much and to what effect.  

My impression has been that we are now similarly far more attuned to getting prompt treatment and that once delivered to an emergency room, survival rates are probably far higher than they used to be.  But how much higher.  

My suspicion has been that there might have been a hidden, albeit tragic, boon to our dearly purchased battlefield knowledge.  In approximate numbers, we suffered 2,500 deaths in Afghanistan across 20 years and roughly 4,500 deaths in Iraq over ten years.  

In the US there are very roughly some 250,000 preventable accidental deaths each year (suicides, car accidents, murders, etc.)  

From Korea onwards, we purchased a great deal of valuable knowledge about how to save lives under tragic and kinetic conditions.  How many lives are saved every year owing to that battlefield knowledge?

This paper sort of gets at that question.  From Medical advances mask epidemic of violence by cutting murder rate by Roger Dobson.  There is plenty of reason to have concerns about some of the study's methodological approaches but it seems reasonable at a first order assessment.

Murder rates would be up to five times higher than they are but for medical developments over the past 40 years.

According to new research, doctors are saving the lives of thousands of victims of attack who four decades ago would have died and become murder statistics.

Although the study is based on US data, the researchers say the principle applies to other countries too: “There is reason to expect a similar trend overall in Britain,” said Dr Anthony Harris, the lead author of the study.

In the research he and a team from Massachusetts University and Harvard Medical School found that technological developments had helped to significantly depress today's murder rates, converting homicides into aggravated assaults.

“Without this technology, we estimate there would be no less than 50 000 and as many as 115000 homicides annually instead of an actual 15 000 to 20000,” they say in a report of the study in the journal Homicide Studies (2002;6:128-66).

The team looked at data going back to 1960 on murder, manslaughter, assault, and other crimes. It merged these data with health statistics and information on county level medical resources and facilities, including trauma centres, population, and geographic size. The researchers then worked out a lethality score based on the ratio of murders to murders and aggravated assaults.

They found that while the murder rate had changed little from a 1931 baseline figure, assaults had increased. The aggravated assault rate was, by 1997, almost 750% higher than the baseline figure.

The team also described the dramatic overall decrease in trauma mortality in the second half of the 20th century.

The period of greatest change came between 1972 and 1977, on the heels of the US involvement in the Vietnam war, which triggered big advances in trauma care.

The team found that at county level significant drops in lethality of assault were linked to availability of high levels of care. The impact of a county simply having a hospital also had a significant impact, reducing lethality ratios by as much as 24% a year.

Not quite addressing my question but close.  Dangerously muddied by clear gun control advocacy concerns as well.  Their statement is that technology improvements have improved survival rates and no doubt that is to some degree true.  In the military context, however, it has been less about technology and more about logistics and procedures.  I suspect the same is true for Trauma Centers.

I am deeply leery about the absence of the methodology and detailed data but taking the researchers at face value, the answer is that owing to improved battlefield trauma practices including better technology, better logistics, and better care processes, we are saving something on the order of 80% of lives that would otherwise be lost.  The researchers focus on gun wounds and estimate conservatively, and approximately, 50,000 saved lives a year.

If we were to expand that to include non-gun avoidable deaths (failed suicides, automobile trauma, etc., an additional 200,000 deaths each year) then we likely are looking at something like 800,000 non-gun trauma deaths each year.

Between the two categories of gun deaths and non-gun trauma deaths, in total it would appear that there is a basis to believe that there might be as many as 850,000 avoided trauma deaths a year owing to improved trauma care response, largely improved through battlefield experience.

That figure sounds way too high to me, but it is at least an opening estimation.  If we were to deflate it by about 75%, we'd still be saving 200,000 lives a year beyond what we would have done fifty years ago.   Which is astonishing, miraculous and wonderful.  

I have with some frequency argued that American medical system costs are higher than in Europe because Americans tend to live riskier more kinetic lives than Europeans.  I suspect this data ties in to that argument.

Additionally, it is highly suggestive with regard to the gun control argument.  The researchers ironically almost appear to bemoan that improved trauma care is masking the degree of potential violence on American streets by reducing the death count while increasing the casualty rate (fewer dead, more wounded who survive.)

That is a highly suspect position.  It is good to save lives.  Period.

Number of guns has increased hugely over the past four decades as has the ease of acquisition of guns.  At the same time, number of gun deaths have come down substantially, at least in part by improved ER trauma processes and capabilities.  

Something similar has happened with automobiles.  Car accident deaths are down substantially while number of vehicles is up.  The reduction in car accident deaths is in part, probably mostly, due to better safety designed into the vehicles themselves (such as airbags).  But still, if there is an accident, survival is better simply because ER trauma is so much better as well.

I wonder if the bigger opportunity might lie with improved training of Americans around risk estimation and risk taking.  Maybe.