Contents

APPENDIX I

Medical Program for the Study of Wounds and Wounding

Major James C. Beyer, MC

A comprehensive medical program in the continuing study of wounds and wounding would include the following:

Functions:

1. To insure a coordinated and standardized reporting of battle casualty statistics.

2. To consolidate and unify operations in order to furnish a complete and continual coverage of any hostility.

3. To simplify the establishment of a research unit in an overseas theater.

4. To serve as a source of material for all interested developmental and planning agencies in the Medical Corps, the Quartermaster Corps, the Army Field Forces, and the Ordnance Corps.

5. To provide a consultation group for all medical problems pertaining to the use and development of body armor and weapons.

Types of work:

1. The scope of the work should include all types of battle casualties and certain related nonbattle casualties.

2. Statistical survey as to:

a. Number of wounds per casualty.
b. Regional incidence of all wounds.
c. Regional incidence of lethal wounds.
d. Type of wound.
e. Causative agents-type, weight, velocity.

3. Wound ballistics studies:

a. Size and shape of wounds.
b. Severity of wounds.
e. Photographs of wounds.
d. X-rays.
e. Missile passageway.
f. Recovery of missiles.

4. Pathology:

a. Studies directly related to wound ballistics.
b. General studies related to effects of stress and combat.
c. Companion studies not related to wound ballistics.

5. Studies of survival time and cause of death in DOW's and KIA's.

6. Body armor studies:

a. Effectiveness of body armor.
b. Use and development of protective equipment.
c. Comparison studies of allied troops not wearing body armor.
d. Possible use of body armor in atomic-type warfare.

7. Wounding as related to training, tactics, terrain, type of combat, and so forth.

8. Long-term followup of WIA personnel as to hospital stay, type of recovery, sequelae, and so forth.

9. Studies of hostile WIA and KIA.

10. During peacetime, the members could be engaged in:

a. Completion of studies and reports.
b. Laboratory experimentation and field tests.

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c. Investigation of accidents involving U.S. weapons.
d. Training and consultation.

A program of this caliber and magnitude would require that at least some of the participating medical officers should be qualified in pathology and have some training at the Ordnance School and the Ballistics Research Laboratory, the Medical Laboratories of the Army Chemical Center, and Army Field Forces schools. A basic knowledge of the essential statistical methods would also be of great value.

With the development and greater usage of the nuclear-type weapons on the battlefield, battle casualty survey units would possess the appropriate organization to continue the studies on the effects of the conventional weapons and expand to cover the combined effects of both agents. In order to facilitate the prompt utilization of such a unit in the event of new hostilities, it would appear that some consideration should be given at the present time (1961) to the planning and conception of the program. Hurriedly placed missions in the field will fail to realize a comprehensive harvest of all the available material.

The flow of casualties from the main line of resistance into medical installations provides several ideal locations for the conduct of various phases of a comprehensive battle casualty survey. In order to gain information regarding the casualty-producing effectiveness of U.S. weapons and to furnish essential data to the experimental wound ballistician who is collaborating with the ordnance design engineer, a temporary survey of the enemy KIA casualties should be made. All wound tracks should be charted, measured, and dissected with an attempt made to recover all retained missiles. Enemy WIA casualties can also be studied at prisoner-of-war sites.

Permanent teams should be available at mobile army surgical hospitals for the twofold study of WIA and DOW casualties. In addition, any KIA casualties who reach such an installation can also be included. A medical officer is required to direct the program, and he can be supplemented by Medical Service Corps officers and enlisted men with adequate equipment and personnel within the survey team proper for complete photographic and X-ray coverage of all casualties. Concurrent with the studies at the mobile army surgical hospitals, personnel must be available to conduct interviews and to collect data regarding the immediate circumstances surrounding the time and the place of wounding of each casualty.

The study of the WIA casualties should be a continuing process extending to evacuation hospitals and on to the Zone of Interior or to the point of final discharge of the casualty. Therefore, the disposition of each surviving wounded casualty is determined and copies of the autopsy examinations and abstracts of the clinical records for each DOW casualty are forwarded to a central agency.

Study of the KIA casualties is contingent upon the type and place of burial utilized by the Quartermaster Graves Registration Service. This again is dependent upon the scope and location of the hostilities. When local cemeteries are established in the theater, a survey team should be attached to each one. Here again, the survey team should be able to function as an integral but independent unit with minimal dependency upon the local command for personnel, equipment, and supplies. The survey team members who are conducting interviews and collecting information concerning the circumstances of wounding of the WIA casualties can gather similar data for the KIA casualties. This information is of prime concern in determining the effectiveness of any items of personnel armor, such as the helmet and forms of body armor.

All of these activities, with definite basic plans drawn up concerning the conduct and scope of each phase, should be considered before the onset of any hostilities. The methodology governing the gathering of data should be investigated, and an acceptable format should be established. In that way, many of the shortcomings of the statistical data presented in this volume will be avoided and all interested agencies will be willing to accept any of the findings. Many of the variations in the tables of the preceding chapters have a valid and logical explanation, but there are numerous other disparities which could have been eliminated if uniform data collecting procedures had been established.

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Therefore, to achieve any degree of success in such a program, one agency should be responsible for developmental planning, for training key personnel, and for providing a single repository for storage and dissemination of the material. In addition, personnel and loan material would be available for indoctrinating newly appointed medical personnel and for the continuing education of all interested individuals. A component of the Office of the Surgeon General would be most qualified to direct the program.

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