Compass Points – A Gaping Wound
The golden hour for restoration
Compass Points – A Gaping Wound
The golden hour for restoration
June 3, 2024
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Marines are in a life and death profession. Leaders of Marines are charged with providing sound leadership for Marines in garrison and in combat. In the ebb and flow of combat an ambush or other unexpected event might leave some Marines momentarily cutoff, isolated, and alone. But there should never be a plan to intentionally strand Marines without adequate provision for resupply, reinforcement, evacuation, or rescue. That would create mortal wounds too grievous to be repaired.
What should be done about a gaping wound? The foundation of medical treatment is the Latin phrase, "Primum non nocere." The phrase is attributed to the original Hippocratic Oath, "First, do no harm."
After returning from several weeks in eastern Ukraine conducting surgery and training doctors, Dr. Jeff Colyer, writing in the Wall St Journal warns, "Why You Should Be Alarmed by the Wounds I Treated in Ukraine -- Americans aren’t prepared for the calamitous injuries produced by modern conventional weapons."
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. . . The wounds in Afghanistan and Iraq were largely caused by standard rifle rounds or improvised explosive devices—sometimes a Claymore mine strapped to a paint can full of bolts. The wounds in Ukraine are worse for several reasons.
First, military-grade rifles use bullets that yaw when they hit a body, often in clusters of two or three rounds. The yaw blows out bone and soft tissue in clumps the size of your fist.
Second, Russian artillery has fired more than six million shells, each with a fatal radius of 40 yards. Ukraine has fired only two million back. The U.S. hasn’t been involved in artillery duels like this since the Korean War, when modern medical techniques were nascent. Injuries suffered during an artillery barrage require multiple operations, complex wound care and significant rehabilitation for years.
Third, drones are revolutionizing the battlefield in Ukraine, much as the machine gun did during World War I. Small drones, such as a modified quadcopter with explosives attached, create wounds that cascade from head to toe. The U.S. military has never had to deal with this before.
Finally, glide bombs and hypersonics have replaced the dumb bomb. These munitions plow through trenches and sophisticated concrete structures, leaving a trail of devastation in the blink of an eye. The Russian Kinzhal missile, a hypersonic launched from the air, can wipe out an entire city block.
During the U.S. Civil War, the world was aghast at the death toll from the new Gatling gun. Today we are witnessing a new revolution in the destructiveness of conventional warfare. It’s happening in real time, and the U.S. isn’t prepared.
-- Jeff Colyer
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At least the soldiers in Ukraine could get to Dr Colyer and his fellow surgeons quickly. Will wounded Marines in the future be able to be evacuated quickly? The “golden hour” is critical.
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During the wars in Iraq and Afghanistan, military medical teams were well positioned on the battlefield to support the "golden hour" response – the ability to get wounded warfighters off the battlefield and delivered to the care of a full-scale military hospital within about an hour.
. . . Imagine a wounded Marine stranded on a remote Pacific island. The highest level of care available might be an independent duty corpsman. Evacuation to a higher level of care might take several days. For military medics, this scenario requires a new kind of training, new equipment, and a new approach to casualty care.
"We're worried about future casualties because those distances [to hospitals] are so great," said Air Force Col. Stacy Shackelford, chief of the Joint Trauma System (JTS), Joint Base San Antonio, Texas. In the future, a lack of U.S. air superiority and vast distances could prohibit quick evacuations. Those conditions likely mean that the "golden hour" handoff to a surgical team will not be possible, Shackelford warned.
The golden hour is the critical time window for trauma patients to receive a series of life-saving interventions – starting at the point of injury and transitioning to handoff to a surgical team. Moving patients quickly through that process is essential to saving lives and improving outcomes.
-- Health.mil
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Why would doctors at the US military's Joint Trauma System be worried about, "a wounded Marine stranded on a remote Pacific island"? Why would anyone be planning for Marines to be stranded? In recent decades, Marines fight as part of a MAGTF, Marine Air Ground Logistics Task Force. They should never be stranded.
To be left stranded is a terrible thing. What happens when forces are cutoff, marooned, left behind, and stranded? Just one example. In the book, The Road Past Mandalay, John Masters, a 30-year-old Chindit Brigade Commander behind enemy lines in northern Burma, ordered the execution of 19 of his own men as he was making a withdrawal under pressure from the Blackpool block.
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The doctor said, ”I’ve got another thirty on ahead, who can be saved if we carry them … These men have no chance. They’re full of morphia. Most of them have bullet and splinter wounds beside what you can see. Not one chance at all, sir, I give you my word of honor. Look this man’s died already, and that one. None can last another two hours, at the outside.”
Very well, I thought to myself. I have two thousand lives in my hand, besides these. One small mistake, one little moment of hesitation and I will kill five times these nineteen.
I said aloud, “Very well. I don’t want them to see any Japanese.” … He nodded and I went back up the ridge, for the last time. One by one, carbine shots exploded curtly behind me. I put my hands over my ears, but nothing could shut out that sound.
-- The Road Past Mandalay by John Masters (excerpt from Chapter 20)
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Some Marine senior leaders today are putting their hands over their own ears. But they will not be able to blot out what they are doing. Even the Joint Trauma System in San Antonio is worried about, "a wounded Marine stranded on a remote Pacific island." Is the Marine Corps just as concerned?
Marines are in a life and death profession. Leaders of Marines are charged with providing sound leadership for Marines in garrison and in combat. Any plan that intentionally strands Marines on isolated islands without any adequate method for resupply, support, reinforcement, or evacuation is a self-inflicted wound. There is a gaping wound in the Marine Corps today. How can it be repaired? First, do no more harm. Next, understand that as an organization, the Marine Corps is in the golden hour right now. The golden hour must be used to take immediate action to reverse the damage. The clock is ticking. The gaping wound must be sewn up now. It is time to take action now to restore Marine Corps units, equipment, and capabilities. Action taken today will save Marines in combat tomorrow.
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Wall St. Journal - 05/31/2024
Why You Should Be Alarmed by the Wounds I Treated in Ukraine
Americans aren’t prepared for the calamitous injuries produced by modern conventional weapons.
By Jeff Colyer
Dr. Colyer is a plastics/craniofacial surgeon. A Republican, he served as governor of Kansas, 2018-19.
https://www.wsj.com/articles/why-you-should-be-alarmed-by-the-wounds-i-treated-in-ukraine-e93b538f
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Health.mil - 06/08/2022
How Military Medicine Is Preparing for the Next Conflict
By Janet A. Aker
https://health.mil/News/Articles/2022/06/08/How-Military-Medicine-Is-Preparing-for-the-Next-Conflict
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The Road Past Mandalay: A Personal Narrative
By John Masters
https://www.goodreads.com/book/show/198452.The_Road_Past_Mandalay
The horror that Stand-in Forces (SIF), isolated and unsupported on remote islands, will have inadequate on-scene medical and casualty evacuation support should not come as a surprise to anyone. Like the rest of Force Design 2030, the SIF concept was never vetted through the Combat Development Process. Had the SIF concept been properly vetted, it would have been exposed for what it is - - a fool’s errand. The entire area of logistics (medical, food and water, maintenance, transportation, etc.), survivability, positioning and repositioning, and even the effectiveness of the anti-ship missiles have never been sufficiently addressed, much less resolved. In the mad rush to appear revolutionary, the Marine Corps put empty words ahead of the mission and the welfare of the Marines needed to accomplish it. The entire SIF concept needs to be scrapped before Marines, isolated and unsupported on remote islands, are needlessly killed and maimed.
I recently had an email exchange with an individual I do not know who has his own Substack Account. ( Amphibiosity) It appears that he is a Marine Colonel in the USMCR and currently a civilian employee in Quantico. He has actively defended FD-20XX. In one exchange he claimed that the Chinese cannot deploy forces to threaten the missile batteries and that the “near by” MAGTF can support them. Imagine my surprise….. he also opined that the terms winning or losing have no meaning as the objective is to create a political situation in our favor. I will not engage any further because I simply lack the intellectual depth to understand what he is talking about. I relate this exchange for a simple reason. Try as I might, I simply cannot understand the viability of the concept. It is a concept that has no flesh and blood component.