APPENDIX I
Medical Program for the Study of Wounds andWounding
Major James C. Beyer, MC
A comprehensive medical program in the continuing study ofwounds and wounding would include the following:
Functions:
1. To insure a coordinated and standardized reporting ofbattle casualty statistics.
2. To consolidate and unify operations in order to furnish acomplete and continual coverage of any hostility.
3. To simplify the establishment of a research unit in anoverseas theater.
4. To serve as a source of material for all interesteddevelopmental and planning agencies in the Medical Corps, the QuartermasterCorps, the Army Field Forces, and the Ordnance Corps.
5. To provide a consultation group for all medical problemspertaining to the use and development of body armor and weapons.
Types of work:
1. The scope of the work should include all types of battlecasualties 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 andKIA'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 ofcombat, 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 wouldrequire that at least some of the participating medical officers should bequalified in pathology and have some training at the Ordnance School and theBallistics Research Laboratory, the Medical Laboratories of the Army ChemicalCenter, and Army Field Forces schools. A basic knowledge of the essentialstatistical methods would also be of great value.
With the development and greater usage of thenuclear-type weapons on the battlefield, battle casualty survey units wouldpossess the appropriate organization to continue the studies on the effects ofthe conventional weapons and expand to cover the combined effects of bothagents. In order to facilitate the prompt utilization of such a unit in theevent of new hostilities, it would appear that some consideration should begiven at the present time (1961) to the planning and conception of the program.Hurriedly placed missions in the field will fail to realize a comprehensiveharvest of all the available material.
The flow of casualties from the main line ofresistance into medical installations provides several ideal locations for theconduct of various phases of a comprehensive battle casualty survey. In order togain information regarding the casualty-producing effectiveness of U.S. weaponsand to furnish essential data to the experimental wound ballistician who iscollaborating with the ordnance design engineer, a temporary survey of the enemyKIA casualties should be made. All wound tracks should be charted, measured, anddissected with an attempt made to recover all retained missiles. Enemy WIAcasualties can also be studied at prisoner-of-war sites.
Permanent teams should be available at mobilearmy surgical hospitals for the twofold study of WIA and DOW casualties. Inaddition, any KIA casualties who reach such an installation can also beincluded. A medical officer is required to direct the program, and he can besupplemented by Medical Service Corps officers and enlisted men with adequateequipment and personnel within the survey team proper for complete photographicand X-ray coverage of all casualties. Concurrent with the studies at the mobilearmy surgical hospitals, personnel must be available to conduct interviews andto collect data regarding the immediate circumstances surrounding the time andthe place of wounding of each casualty.
The study of the WIA casualties should be acontinuing process extending to evacuation hospitals and on to the Zone ofInterior or to the point of final discharge of the casualty. Therefore, thedisposition of each surviving wounded casualty is determined and copies of theautopsy examinations and abstracts of the clinical records for each DOW casualtyare forwarded to a central agency.
Study of the KIA casualties is contingent uponthe type and place of burial utilized by the Quartermaster Graves RegistrationService. This again is dependent upon the scope and location of the hostilities.When local cemeteries are established in the theater, a survey team should beattached to each one. Here again, the survey team should be able to function asan integral but independent unit with minimal dependency upon the local commandfor personnel, equipment, and supplies. The survey team members who areconducting interviews and collecting information concerning the circumstances ofwounding of the WIA casualties can gather similar data for the KIA casualties.This information is of prime concern in determining the effectiveness of anyitems of personnel armor, such as the helmet and forms of body armor.
All of these activities, with definite basicplans drawn up concerning the conduct and scope of each phase, should beconsidered before the onset of any hostilities. The methodology governing thegathering of data should be investigated, and an acceptable format should beestablished. In that way, many of the shortcomings of the statistical datapresented in this volume will be avoided and all interested agencies will bewilling to accept any of the findings. Many of the variations in the tables ofthe preceding chapters have a valid and logical explanation, but there arenumerous other disparities which could have been eliminated if uniform datacollecting procedures had been established.
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Therefore, to achieve any degree of success insuch a program, one agency should be responsible for developmental planning, fortraining key personnel, and for providing a single repository for storage anddissemination of the material. In addition, personnel and loan material would beavailable for indoctrinating newly appointed medical personnel and for thecontinuing education of all interested individuals. A component of the Office ofthe Surgeon General would be most qualified to direct the program.
