Autopsies, CT Scans of war dead yield life saving data

NY Times:

Within an hour after the bodies arrive in their flag-draped coffins at Dover Air Force Base, they go through a process that has never been used on the dead from any other war.

Since 2004, every service man and woman killed in Iraq or Afghanistan has been given a CT scan, and since 2001, when the fighting began in Afghanistan, all have had autopsies, performed by pathologists in the Armed Forces Medical Examiner System. In previous wars, autopsies on people killed in combat were uncommon, and scans were never done.

The combined procedures have yielded a wealth of details about injuries from bullets, blasts, shrapnel and burns — information that has revealed deficiencies in body armor and vehicle shielding and led to improvements in helmets and medical equipment used on the battlefield.

The military world initially doubted the usefulness of scanning corpses but now eagerly seeks data from the scans, medical examiners say, noting that on a single day in April, they received six requests for information from the Defense Department and its contractors.

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The medical examiners have scanned about 3,000 corpses, more than any other institution in the world, creating a minutely detailed and permanent three-dimensional record of combat injuries. Although the scans are sometimes called “virtual autopsies,” they do not replace old-fashioned autopsies. Rather, they add information and can help guide autopsies and speed them by showing pathologists where to look for bullets or shrapnel, and by revealing fractures and tissue damage so clearly that the need for lengthy dissection is sometimes eliminated. The examiners try to remove as many metal fragments as possible, because the pieces can yield information about enemy weapons.

One discovery led to an important change in the medical gear used to stabilize injured troops on the battlefield.

Col. Howard T. Harcke, a 71-year-old Marine Corps radiologist who delayed retirement to read CT scans at Dover, noticed something peculiar in late 2005. The emergency treatment for a collapsed lung involves inserting a needle and tube into the chest cavity to relieve pressure and allow the lung to reinflate. But in one case, Colonel Harcke could see from a scan that the tube was too short to reach the chest cavity. Then he saw another case, and another, and half a dozen more.

In an interview, Colonel Harcke said it was impossible to tell whether anyone had died because the tubes were too short; all had other severe injuries. But a collapsed lung can be life-threatening, so proper treatment is essential.

Colonel Harcke pulled 100 scans from the archives and used them to calculate the average thickness of the chest wall in American troops; he found that the standard tubing, five centimeters long, was too short for 50 percent of the troops. If the tubing was lengthened to eight centimeters, it would be long enough for 99 percent.

“Soldiers are bigger and stronger now,” Colonel Harcke said.

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They changed the tubing to eight centimeters. The autopsies also led to changes in areas covered by body armor.

What is surprising to me is that it has never been done before. The military has always done lessons learned studies on every aspect of combat and operations during a war. This is just an important extension of that which will make our troops better able to survive enemy attacks and stay in the fight.

Those who have made the ultimate sacrifice are now giving us more data to help their brothers in arms win.