Bless the “Battlefield Angels”

Soldiers call them “Doc,” but Scott McGaugh calls the military’s medics “Battlefield Angels” in his new book by the same name. Not actually doctors — but not really nurses, either –they’re out on the battlefields of Afghanistan and Iraq, armed with guns as well as gauze, and are usually the first ones tending to the physical and mental wounds of U.S. troops. He spoke of these medical miracle workers in an email exchange with Battleland:

What is a Battlefield Angel (BA)?

A battlefield angel is the corpsman or medic willing to risk his or her life to save another, sometimes under enemy fire. When battlefield conditions dictate that troops take cover, that’s usually when a corpsman or medic is called on to become exposed to mortars, shrapnel, and IEDs in order to save lives. More than one soldier has looked up at a corpsman or medic and called him “my angel.”

Does it take a certain kind of person to be a BA?

Absolutely! Someone who is focused and compassionate. Most medics and corpsmen work well independently, and are driven by a sense of responsibility for others. They typically are secure in themselves and confident in their abilities. Many have the ability to make decisions under stressful conditions and many have a great deal of ingenuity. They do their duty for the sake of helping others, never in quest of the spotlight.

Why did you write this book?

In writing Midway Magic, the story of the USS Midway aircraft carrier’s unprecedented 47-year odyssey of service, I was inspired by the impossibly young men who saved lives in the aftermath of horrific flight deck incidents. In talking with medical officers in the Navy, I was amazed to learn that wasn’t atypical. The legacy of corpsmen and medics in uniform is largely an untold story, a story of young men (and today, women), running toward enemy fire when soldiers, marines, and sailors fall wounded. Their story had to be told, their legacy preserved.

Part of that legacy is how military medicine is changing the face of war. It wasn’t until World War II that the enemy killed more Americans in war than disease. Today disability, not death, is becoming the enduring price of war. In World War II, 30% of those wounded in action ultimately died. Today, in the Middle East, it’s closer to 10%. In some American cities today, the violent death rate per 100,000 is higher than that suffered by the American military in Afghanistan. War has never been more survivable, and never has it produced as many catastrophically disabled veterans as our nation faces today. We need to understand and appreciate both the benefits and challenges posed by advances in military medicine.

What do BAs tend to do after they leave the military?

In today’s all-volunteer military, many medics and corpsmen remain in the healthcare field, sometimes as doctors, and often as medical technicians and specialists. Education and training are major motivations for young people to enlist in the military today.

Before 1975 when the military draft was in place, almost anyone could be tapped for corpsman school. Those young men more often resumed non-medical lives when they left the military. Two examples: Ray Boone was ordered to corpsman school because he had worked in a veterinarian’s office. After WWII where he was a decorated corpsman on Tarawa, he became an insurance broker in Iowa. Corpsman Wheeler Lipes was the first non-physician to surgically remove a stricken submarine sailor’s appendix while on patrol. Blackballed by some Navy doctors as a result, Lipes ultimately left the Navy to become a hospital administrator.

How has the BA’s role changed over time?

The role has changed as medical science has progressed. In the Civil War, aid station personnel frequently were derelict soldiers handed off to the medical department. By the end of World War II, corpsmen and medics were reconstituting dried plasma in foxholes and giving battlefield transfusions. They had two powerful new tools in the war against combat’s longtime nemesis, infection: sulfa and, later in the war, penicillin.

Today, corpsmen and medics are highly trained paramedics, able to carry an amazing array of miniaturized medical equipment into battle. They are the first link in a highly evolved chain of care that can deliver a critically wounded soldier from the Middle East to Bethesda in a few days, compared to six weeks during the Vietnam War.

In addition, military medicine, in the hands of corpsmen and medics, has created a profound impact on civilian healthcare. The potential of anesthesia was validated in the Civil War. Triage was highly refined in World War I. Emerging advances such as blood banks, dried plasma, and antibiotics were validated on the battlefield by treating thousands of wounded soldiers in World War II. Medical evacuations by air were pioneered in the Korean War. In the future, soldiers will wear dog tags that monitor their vital signs, enabling corpsmen and medics to determine from afar who needs treatment first. Robotic surgery on the battlefield is part of the future of combat medicine as well.

How has the BA’s role changed since 9/11?

Each war produces unique challenges for battlefield angels, and combat in Iraq and Afghanistan has been no different. America’s first extended wars since the elimination of the draft are taking a serious toll. Soldiers, as well as corpsmen and medics, are seeing their tours of combat duty extended, as well as multiple tours of duty in high-risk zones. This is producing a generation of warriors facing unprecedented levels of PTSD. Corpsmen and medics have become better trained and more vigilant than ever in identifying PTSD, both in soldiers and themselves.

The future of war more likely will be framed by battles and campaigns in increasingly isolated and inaccessible regions of the world. Identifiable battlefields and battle lines have become a distant memory as future wars in the digital age will dictate even broader education and training for corpsmen and medics. The counterinsurgency nature of post-9/11 wars will require a new dimension of corpsmen and medic training, well beyond hands-on trauma care and into a world of telemedicine on the battlefield.

Can a woman be a BA?

Many women are corpsmen and medics, but by Department of Defense policy are excluded from most combat assignments. However, Monica Brown (in the book) is a good example of how the lines of battle have become blurred today. In wars against insurgents that have no front lines, a female corpsman on a non-combat patrol can suddenly be faced with casualties during an enemy’s ambush or following an IED detonation. Brown’s heroism surfaced during an enemy ambush. In light of the changing nature of war, the Department of Defense is beginning to consider broadening the woman’s role (including corpsmen) in combat. In recent years the Navy has considered authorizing female deployments on submarines, for example. While the debate in some quarters continues on whether a woman is physically strong enough to handle the demands of battle, it’s clear that with today’s nature of war, women in uniform are experiencing enemy fire on an unprecedented scale.

Who is the most famous BA?

I asked the same question at major Navy medical centers, of Navy surgeon generals, and at the Navy’s Bureau of Medicine & Surgery. The answer was always the same: There is no singularly famous “battlefield angel.” In every conflict there have been otherwise anonymous young corpsmen and medics who rose to extraordinary levels of bravery and compassion, on the spur of the moment, in the heat of battle. The corpsman/medic specialist really began to be developed in World War II. In virtually every war since, there have been singular and remarkably frequent acts of corpsman bravery by young people who go on to lead anonymous lives as small business owners, teachers, doctors, mechanics, and parents.

Having said that, if there is one corpsman who captured America’s attention, it was Wheeler Lipes in World War II after he removed a stricken submarine sailor’s appendix while on patrol in enemy water. Only corpsmen sailed with submarine crew during the war and he was the first to perform an appendectomy at sea (using galley utensils!). Although some USN doctors were harshly critical of him, his amazing accomplishment generated nationwide headlines, made it into a Ripley’s Believe It or Not edition, and became the basis of a mid-1950s television episode of The Silent Service.

Who should be the most famous BA?

How can a young man on Tarawa, an atoll smaller than Central Park, who saved dozens of lives, be more famous than a Korean War corpsman who, after being blinded by enemy fire, continued to treat the wounded on the battlefield? How does the Vietnam corpsman, while surrounded by the enemy, who treated exposed men under enemy fire before being killed compare to others? Over the course of the 36-day battle to take Iwo Jima, a corpsman fell wounded every 90 minutes. How to they compare to the corpsmen who allowed themselves to become Japanese prisoners of war so they could treat sick and wounded American POWs?

Corpsmen and medics will tell you they neither deserve nor warrant recognition or fame. They always say, “I was just doing my job.” I believe comparison across wars, the march of medical science, weaponry’s increasing lethality, and individual acts of heroic compassion is folly.

Do BA’s win more than their fair share of combat decorations (it sure seems that way)?

I would strongly disagree that it’s more than their “fair share.” Corpsmen and medics deservedly are often one of the most decorated groups in war. That’s because they frequently are stationed in the most perilous situations. They find themselves in the unique position of instantaneously deciding to risk their lives to save perhaps a dozen others. That’s not often the case for a single infantryman, artillery unit, tank commander or naval aviator. When others appropriately take cover under enemy fire, a corpsman or medic’s job sometimes requires him to treat the exposed wounded without hesitation.

Quantitatively, 16 million Americans served in World War II. Navy corpsmen earned 1,520 Medals of Honor, Navy Crosses, Silver and Bronze Stars. While that may seem like a lot, of the nearly 470 Medals of Honor awarded in World War II, Navy corpsmen received only seven (four on Iwo Jima, three on Okinawa), less than two percent.

How come the Marines don’t have their own BAs and have to rely on the Navy?

The Marines are part of the Navy Department. (Many people think the Marines are an independent branch of the military.) So it made sense that the Navy’s medical department develop a field medical training component for some corpsmen so they could serve in the Marines Corps. Those corpsmen, as well as many Army medics, live a dual life of carrying a weapon and engaging the enemy while also serving as medically trained lifesavers.

How has the growing scourge of PTSD changed the BA’s mission, if at all?

It’s part of a broader continuum of medical science racing to keep pace with weaponry and evolving battlefield conditions over the past 235 years. At one time PTSD-like symptoms were called “soldier’s heart.” Severe psychiatric cases sometimes were abandoned while on the march. As medical science understands PTSD and traumatic brain injury more completely, corpsman and medic training has evolved so that today’s battlefield medical personnel are trained to watch for relevant symptoms on and off the battlefield.

The tools BA’s now have allow them to keep many troops alive who would have died in earlier wars. Tell us about this.

A simple comparison of a contemporary corpsman’s “assault pack” with a World War II corpsman’s “hospital corps pouch” makes in the point. The basic supplies of a corpsman on Iwo Jima included 6 bandages, diagnosis tags, tincture of iodine, ammonia, two rubber tourniquets, scissors and forceps, gauze, jack knife, adhesive plaster and wire for splints. Corpsmen in World War II appropriately were referred to as “first aidmen.”

Now consider today’s corpsman “assault pack:” nasopharengeal airway (keeps the tongue from blocking the airway), crycothrotomy set (for easier tracheotomies), IV injection set, bandages, gauze, sodium chloride injection set, splint, scissors, tape, tourniquet, burn dressing, surgical instrument set, lantern, otoscope, thermometer, catheter and needle unit, gloves, surgical sponge, stethoscope, and more. Today, corpsmen are highly trained paramedics, able to perform a number of procedures under enemy fire.

Early in the Civil War, a wounded Union soldier might lay on the battlefield for days before receiving any kind of medical treatment from an unlicensed volunteer surgeon. In the same period of time today, a soldier wounded in the Middle East can be halfway back to the United States for highly sophisticated treatment. Millions of Americans owe their lives to the battlefield angels who make survival of war possible. It’s a privilege to help preserve their legacy.

What’s the most surprising thing you learned writing this book?

I’m amazed at how a young man or woman can be trained and become able to deal with battlefield carnage and bleeding bellies, save lives, and then go on to resume “normal lives” as civilians. I wonder, when I pass an older man in the grocery store, whether he was a corpsman in Vietnam or medic Korea and shudder at what he might have endured. Corpsmen and medics are universally modest and almost never seek recognition.

I marvel at how they were able to do their job, often as young people only a few years past high school. That realization inspires me when I think of the future generations of young Americans who I believe will be every bit as capable of such devotion to duty.