The counterinsurgency tactic that is sending U.S. soldiers out on foot patrols among the Afghan people, rather than riding in armored vehicles, has contributed to a dramatic increase in arm and leg amputations, genital injuries and the loss of multiple limbs following blast injuries.
These devastating injuries affected unit morale. And they gave rise to talk on the battlefield that some troops had made secret pacts not to help each other survive if they were so severely injured, a new report said Tuesday.
The number of U.S. troops who had amputations rose sharply from 86 in 2009, to 187 in 2010 and 147 so far this year, military officials said Tuesday, releasing the report on catastrophic wounds.
Of those, the number of troops who lost two or three limbs rose from 23 in 2009 to 72 last year to 77 so far this year. Only a dozen or so of all amputations came from Iraq and the rest were from Afghanistan, where militants are pressing the insurgency with roadside bombs, handmade land mines and other explosives.
Officials said genital injuries also have risen significantly, but they did not give specific figures.
The sharp rise in severe injuries came as a buildup of foreign forces expanded the counterinsurgency strategy that seeks to protect civilians, win their support away from insurgents and help build an Afghan government the population will embrace instead. The soldier on foot is at greater risk for severe injuries, Tuesday's report noted, "and the injury severity (in Afghanistan) confirms this."
Military doctors told a Pentagon news conference that their study found that while the severity of injuries was going up, the rates of those killed in action was going down. They attributed the improved survival rate to improved care both immediately on the battlefield _ such as applying tourniquets _ and in their later care.
The report, completed in June, was ordered early this year by the Army surgeon general, Lt. Gen. Eric B. Schoomaker, to look into the causes of the steep increase in severe injuries, prevention, protection, treatment and long-term care for the troops. The task force report made 92 recommendations, including some on training, injury analysis, improved blood products and improved care for the injured during transport _ some of which have already been implemented.
But officials said they weren't just looking at saving lives, but also saving lifestyles.
"These are life-defining injuries for these warriors and their families, but it is not desperate," said Brig. Gen. Joseph Caravalho Jr., an army doctor and head of the study. "It's not just about saving lives, it's about doing everything military medicine can do to help them lead full and productive lives."
Their care addresses what he called the "emotional and spiritual" aspects of the injuries, which Caravalho noted some of the troops could be living with for the next 60 years or more.
The task force was looking into what the doctors called "dismounted complex blast injuries" _ dismounted meaning those suffered by troops on foot and complex in that they produce a pattern of wounds. It involves amputation of at least one leg, severe injury or loss of a second extremity and wounding of the pelvis, abdomen or urinary tract and genitals. The report said that these devastating types of injuries "took their toll on unit morale.
"To some, the resultant burden on their family and loved ones seemed too much to accept, and, anecdotally, some actually developed `do not resuscitate' pacts with their battle buddies in the event of this type of injury," it said.
Two military doctors this year have said publicly that they had heard talk among young Marines that some didn't want to go on living _ and had made such agreements _ for cases in which they might sustain loss of their genitals. The agreement reportedly was that if they were so injured on the battlefield, their buddy would not apply a tourniquet. One doctor later said he knew of no instance where this actually took place and the other never offered any specifics on the talk that went around in the field.
Asked why he included this in his report, Caravalho said, because the rumor "is plausible and if it's plausible, then that's enough to be concerning to me. ... I want to make sure that we do everything we can to help our young people realize that this is not a desperate, hopeless situation."
He said the military went through similar issues earlier in the war, for instance when troops were getting devastating burns, "and we've given those folks full and productive lives."