For Military, Different Wars Mean Different Injuries For troops in Iraq and Afghanistan, a former military physician says, bullets aren't the main threat. Bombs are. And that means military medicine faces a host of new challenges.
NPR logo

For Military, Different Wars Mean Different Injuries

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
For Military, Different Wars Mean Different Injuries

For Military, Different Wars Mean Different Injuries

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

RACHEL MARTIN, host: There's a special kind of tourniquet in use by the U.S. military in Afghanistan. It's called a combat action tourniquet, and it's standard issue to every Marine and U.S. service member. It's got a black, plastic cinch that you pull to tighten, and it allows troops in Afghanistan to go out on foot patrol with the tourniquet already loosely strapped around their thighs so it can be tightened quickly if an arm or foot is blown off.

That tourniquet wasn't around in Vietnam, and now it's saving lives - lots of them. It's changes like these that Dr. Ronald Glasser details in his new book. It's called "Broken Bodies, Shattered Minds: A Medical Odyssey from Vietnam to Afghanistan."

Dr. Glasser joins us now from the studios of Minnesota Public Radio in St. Paul. And a warning to listeners: The topics in this book are graphic. Welcome, Dr. Glasser.

Dr. RONALD GLASSER: Well, it's nice to be here.

MARTIN: Thanks for being with us. So a lot of this book, Dr. Glasser, is looking at how battlefield medicine has changed over time. You were an Army doctor during the Vietnam War. What was it like then? Describe what that work was like.

GLASSER: There have been enormous changes, of course. I mean, in Vietnam, the comment was if you keep going back, sooner or later, they'll kill you. And in Afghanistan and Iraq, the comment is if you keep going back, sooner or later, you'll be brain- damaged. The difference is that in Vietnam, you were shot, and in Afghanistan, you were being blown up. But you know, you mentioned about the combat action tourniquets. The Marines don't like it. I mean, the officers view it as a kind of defeatism on the part of the troops.

MARTIN: How so?

GLASSER: Oh, yeah.

MARTIN: That they have to be prepared for these things?

GLASSER: Yeah. I mean, you put it on, and it's because you're going to get blown up. But the Marines don't care. I mean, they understand. They just said that - basically, the hell with it. We're going to wear it anyway. If our legs get blown off, at least we'll survive. And that's one of the big, of course, differences - is, every war has its own weapons; every war has its own strategies; and every war has its own injuries. And in Afghanistan, it's being blown up.

MARTIN: You also write about the complexities of those injuries. You can lose legs when you walk over a land mine or an IED goes off in your path. But some of these injuries are very personal injuries that the military isn't likely to really be public about. Can you talk a little bit about that?

GLASSER: Yeah. But nobody expected these injuries. I mean, the reason - the armor really protects you from bullets or shrapnel or whatever - you know - from the back, side and front. So when you get your leg blown off, the chances are that you're going to have a genital injury. The understanding of this throughout the military is quite substantial. There are informal recommendations now, to the troops being sent to Afghanistan and Iraq, the male troops, that they should store their sperm. Now, the Army doesn't recommend it, nor does the Army like having anybody even hear about it. But you know, our Army is not made up of fools, and it is a reasonable precaution to take.

MARTIN: You write extensively in the book about how these wars are characterized by these invisible injuries: post-traumatic stress disorder or traumatic brain injuries. And it's interesting how you chronicle how that language has changed over time. I mean, in previous wars, this kind of acknowledgement of these injuries, they were called things like shell shock, combat exhaustion, combat stress.

GLASSER: Yeah. It's been there forever. In our Civil War, it was called melancholy at the beginning - you know, this desire for home. Then it became the irritable heart because the soldiers were shaking. And we had it in our Second World War, when at that time it was beginning to be called combat neurosis. But this is PTSD. The one great success of medicine in Afghanistan is the realization, and the connection, between traumatic brain injuries, concussive injuries and PTSD - showing that there is damage to the brain if you've had a concussive injury.

MARTIN: How has an acknowledgement that PTSD exists, that there are long-term psychological wounds associated with combat, how has that changed battlefield medicine? How has it changed the work of the medic on the ground?

GLASSER: Well, I mean, the importance of Afghanistan and Iraq is the new technology. And that's, in essence, the tensor MRIs. I mean, you get a mild concussive head injury, whether you're playing football and hitting your helmets together - and there's data from North Carolina State that if you play college football, you're going to hit your head 900 times in your four years of playing football. And the NFL, of course, is - it's a major concern that they have. Well, they're worrying about people hitting their helmets together. I mean, there are Marines - I mean, there are deployments, three or four deployments, where everybody has been exposed to an IED.

And it's a misnomer. I mean, if you wire together 355 millimeter shells, put them in the ground, put some Semtex on top of it and a butane canister, it'll turn over a 60-ton M1A1 tank. It's hardly improvised. The heat within five, 10 meters of the blast is like 7,000 degrees Fahrenheit. The blast wave is four to 800 atmospheric pressures. It travels at 14,000 feet per second. And if you're standing 20 meters away from it, you're going to get your head rattled.

MARTIN: Wondering if you think medics today are more likely to recognize their own psychological scarring as a result of their deployment?

GLASSER: Yeah. I think so, you know? But it's tough. I've always admired the military. I mean, where else in our country are you going to learn as an adolescent, or even as a young adult, that when somebody tells you to do something, they expect you to do it; that the person next to you is as important as you are. There's a nobility there that is astonishing.

And I think they all know this, but it's still tough to admit that you can't sleep at night. It's tough to admit that when a car backfires, you really get scared. But the advances being made in the connection between psychological injuries - in essence, diseases of the mind and damage to the brain - has been narrowed because of Afghanistan.

MARTIN: Ronald Glasser. He's a doctor and former military physician. His new book is called "Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan." He joined us from the studios of Minnesota Public Radio in St. Paul. Dr. Glasser, thanks so much for being with us.

GLASSER: Rachel, thanks.

Copyright © 2011 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.