Military Medical Care in T2K

[Raellus]

In recent years, survivability rates for wounded soldiers (in first-world armies) have gone way up. I can't remember the figures, but a soldier wounded in 2011 has a much better chance of surviving his wounds than a soldier wounded in Vietnam during the late '60s who, in turn, had a better chance of making it than a soldier wounded during WWII and so on...

I wonder how much this rate would dip in the later years of the Twilight War. By the Battle of Kalisz, I assume that a lot of the more advanced pharmaceuticals (anesthesia, antibiotics) and skilled trauma doctors would have been used up, with no hope of adequate replacement.

How much of the basics of military medical care would still be available in 2000? How much morphine? How many antibiotics? How much blood plasma? Could post-exchange industries continue to produce these modern essentials? If so, at what rate? If not, what are the practical substitutes?

What kind of treatment could a wounded soldier in 2000 hope to receive? There are no more air-evacs, many fewer trained combat surgeons, etc. Do the chances of surviving a bullet wound diminish to WWII levels (at the best)? Is it worse than that? Would a simple bullet wound to a limb in 2000 result in an amputation and a 50% chance of gangrene and death? Am I being too pessimistic?

I'd like to discuss these and related questions here.

[pmulcahy11b]

By 2001, virtually ANY wound has the potential to be fatal, even something like a simple scratch that IRL, you'd probably just clean out with hydrogen peroxide, and put some Neosporin and a large bandaid on and never bother going to the doctor for. By 2001, something like that , which IRL we'd consider minor or even trivial, could easily result in an amputation or even death from sepsis. Many bullet wounds that would receive prompt attention IRL could easily result in maiming or death. Minor illnesses could weaken someone's immune system just enough for something more severe to get in, something that IRL would probably be stopped with some over-the-counter medications and extra fluids and a few days of laying around watching TV quietly and sleeping.

Like before about 1943 or so, the biggest killers on the battlefield are again going to be infection, illnesses, and sometimes, the result of botched medical care by the relatively unskilled or doctors in over their heads without modern medications, equipment, or even proper medical procedures that went wrong due to doctors trying to do relatively primitive analogs of procedures that were state-of-the-art four years before.

[pmulcahy11b]

Originally Posted by Raellus

What kind of treatment could a wounded soldier in 2000 hope to receive? There are no more air-evacs, many fewer trained combat surgeons, etc. Do the chances of surviving a bullet wound diminish to WWII levels (at the best)? Is it worse than that? Would a simple bullet wound to a limb in 2000 result in an amputation and a 50% chance of gangrene and death? Am I being too pessimistic?

If anything, I think that T2K is too optimistic. A lot of care is going to be little better than a Civil War field doctor could administer, and it was well known that treatment at a Civil War field aid station was most likely going to kill you.

[Targan]

Originally Posted by pmulcahy11b

If anything, I think that T2K is too optimistic. A lot of care is going to be little better than a Civil War field doctor could administer, and it was well known that treatment at a Civil War field aid station was most likely going to kill you.

I think that's a little bit pessimistic. Yes, it's true that modern medicines and in many cases medical equipment will be in short supply on the T2K battlefield, but medics and doctors in the T2K world have one important commodity that their Civil War counterparts lacked - knowledge. Even someone like me, a civilian first aider with an interest in the biological sciences, has far, far more accurate knowledge about the workings of the human body than a Civil War era surgeon. Today we understand the importance of strict hygiene, where possible, during medical procedures. We understand the mechanisms of infection, of shock, of blood types and blood pressure, of how the nervous system works. We know that neat alcohol is far better than nothing when it comes to antiseptics.

I think all of that counts for a lot. Survival rates would definitely be significantly higher than on a Civil War battlefield.

[Legbreaker]

I agree, and as I posted elsewhere recently, it wouldn't be hard to believe the best medical treatment available, even in a fully equipped (but short on supplies) prewar hospital, would be no better than that available during WWI. In many areas, where modern medical infrastructure is lacking, a casualty may be lucky to received 1850's treatment.

This isn't to say that where the drugs, medicine, bandages, trained surgeons, etc are all available and in the one place and the one time a casualty wouldn't recieve A grade treatment though - just that take one of more of those elements away and you've got problems.

[Raellus]

Good discussion, so far.

What sort of medicines could be produced post-exchange? Could penicilin molds be grown fairly easily? With all the drug-resistant bugs out there, though, it might not be able to do a whole lot any more.

Pre-exchange medical drugs would be some of the most valuable commodities on the market c. 2000 and beyond (although expiration dates are an issue- although I'm not sure how much that would effect the potency of most medicinal drugs).

Post-exchange drugs would also be quite valuable. I'm wondering what kinds of medicinal drugs could be produced, though.

[ArmySGT.]

Wouldn't medicine be carried on by Colleges and Universities far from major urban centers?

Adams State near Alamosa, Colorado for example.

While Colorado has several significant targets that will draw down weapons, that part of Colorado is farm land without a target upwind until Las Vegas, NM.

[Legbreaker]

As a rule, medicines must still be good a full year after their expiry date (there are mandatory lab tests with the time effectively sped up to do so). It's quite possible that these chemicals, etc could still be quite safe for even longer, however it really depends on what it is and how it's stored.
A vial of morphine kept for six months on the dash of a humvee for example could well kill you, but if that same vial was kept refridgerated and motionless...

[Lundgren]

From a documentary about the battle of Somme, there was a claim that the survival rate was better for those wounded that where stuck in no mans land, than those brought to the hospital. But as already mentioned, there has been quite some advancement in both techniques, and in the knowledge of hygiene.

In a world where there is a lack of of chemical anesthesia, I assume that someone skilled in hypnosis would be worth his weight in gold, no matter how fat he his. The hypnotic coma, or Esdaile state as it is also called at times, would definitely increase the survival odds when going under the knife. But it still would not be much help at a trauma center when someone comes in being critical.

[Adm.Lee]

A big problem is going to be in the "Golden hour." As I understand it, current trauma specialists can heal an awful lot of damage if they can get to a victim within an hour of the injury. Without air or ground ambulances, that looks pretty grim. I think a lot more people will die of bleeding out or shock than we see currently, but the general medical knowledge might bring things back to the WW2 level of wound survival.

Diseases, however, that chills me-- the lack of medicines and vaccines we now use to keep a lot of us alive through childhood and beyond is going to hurt.

[Graebarde]

I recently read an article about DOD's SLEP (shelf life extension program) for medicines. They were discarding millions of dollars in meds when the 'recommended' shelf life was reached from their war stocks. They did studies, and these have been going on for over ten years, which has found MOST medicine is still uesable years after the 'recommended' shelf life date. It is a classified document, since the FDA which authorized the study etc, did not want to upset the phamacutical companies by letting civilians know their antibiotic was actally good three years later. The news was leaked but not the list of hundreds of medicines they have on the list. The article did say however they do not keep nitro capsuls and some other meds that are 'life or death' at the moment beyond the 'recommended' date. With that said, if it doesn't require refrigeration, it may well be potent enough to work. Doses might have to increase, but that's better than throwing it out as useless.

FB

https://slep.dmsbfda.army.mil/ - good luck getting into this site.

http://www.upmc-biosecurity.org/webs..._med_cntr.html

http://www.medicaltuesday.net/VoicesofMedicine.aspx

[WallShadow]

What makes the survival rate go up as science progresses is not necessarily the utility belt of wonders the medic has, but the pool of knowledge of what works and what doesn't work, or how to use an old tool in a new way ("maggots and leeches can be your friend!")

On the other hand, the survival rate in combat went up due to improved transport and a solid technological and logistical base for high-powered treatment of those who would have been worm-fodder in wars past. THIS or the lack of it will be the reason for the survival/recovery rate to slip. Knowing that you could save your buddy if you had a medevac chopper and a fully-equipped and staffed trauma center within 10 minutes round trip time will do you no good if you haven't seen an aircraft in the sky in weeks and you are surrounded by hostiles who lust after your ammo, your fuei, your food, and your shoes.

[atiff]

Originally Posted by Graebarde

I recently read an article about DOD's SLEP (shelf life extension program) for medicines. They were discarding millions of dollars in meds when the 'recommended' shelf life was reached from their war stocks. They did studies, and these have been going on for over ten years, which has found MOST medicine is still uesable years after the 'recommended' shelf life date.

The father of one of my best friends is a pharmacist (in New Zealand), and told me this many years ago. Mostly it is government rules that puts the 'best before' date on it, but he said most things are usable to use for quite some time thereafter. He said topical medicines and the like are still useable for several years after BBD, but he said best not to test the theory on internal medicines. T2K would alter that risk profile on choices, I think, but gives a few more options

[Legbreaker]

Note again it's a requirement for medicines to still be good at least 12 months after their use by date. I know this from my time in the quality assurance department of a pharmaceutical company.

[Graebarde]

As alluded to in one of the articles, and one I really agree with, it has more to do with making money than anything. But that's another topic. FB

[Legbreaker]

Really it's just a safety issue. What would happen if somebody died from a drug which was supposed to be still good? Pulling back the expiry date is supposed to offset poor storage practises.
Sure the pharmaceutical companies get to make and sell more drugs for long term storage, but that's really just a side benefit to them, not an end unto itself.

[Fusilier]

Lots of those expired meds end up being shipped to third world countries to be put back on the shelves.

[Sanjuro]

I read once that during the Napoleonic Wars, if a soldier was wounded badly enough to need hospitalization, he was 98% likely too die of that wound. This improved in irregular steps (the first significant improvement being led by Florence Nightingale in the Crimean War) until the Korean War, when 98% of casualties who reached a MASH survived.
Cleanliness, supportive care and decent shelter will significantly improve the odds a casualty can survive- but take the modern gear and drugs if you can!

[Raellus]

Originally Posted by Adm.Lee

A big problem is going to be in the "Golden hour." As I understand it, current trauma specialists can heal an awful lot of damage if they can get to a victim within an hour of the injury. Without air or ground ambulances, that looks pretty grim. I think a lot more people will die of bleeding out or shock than we see currently, but the general medical knowledge might bring things back to the WW2 level of wound survival.

I agree. I also wonder how many skilled trauma specialists would be around c. 2000. The area behind the FBS is supposed to be safer (relatively speaking) but with all the tactical nukes and chem rounds that were being lobbed about between '97 and 2000, I'm sure that more than a few field hospitals were obliterated. Also, I wonder what a skilled trauma specialist could do without a lot of the modern tools that they currently rely upon.

I think that VC/NVA field hospitals would provide a good model for the best medical care a wounded soldier could receive in the T2KU, c. 2000. I haven't come across particularly detailed descriptions of such facilities and personnel but many books I've read allude to the wonders that Vietnamese doctors performed by lamplight in subterranean jungle hospitals. I'd love to learn more about this.

[pmulcahy11b]

Originally Posted by Raellus

I agree. I also wonder how many skilled trauma specialists would be around c. 2000. The area behind the FBS is supposed to be safer (relatively speaking) but with all the tactical nukes and chem rounds that were being lobbed about between '97 and 2000, I'm sure that more than a few field hospitals were obliterated. Also, I wonder what a skilled trauma specialist could do without a lot of the modern tools that they currently rely upon.

By Soviet doctrine, that's the area where Warsaw Pact Airborne, Air Assault, and special ops go to hunt...er, I mean conduct raids.