Newswise — Bethesda, MD – Advances in medicine that dramatically improved warfighter survival and recovery in America’s most recent wars are the focus of a new book, “Out of the Crucible: How the U.S. Military Transformed Combat Casualty Care in Iraq and Afghanistan,” just published by the Borden Institute.  These advances in technology, products, and patient care during Operation Enduring Freedom and Operation Iraqi Freedom were driven by military health professionals determined to exceed what modern medicine thought was possible.

During the Wars in Iraq and Afghanistan (circa 2001-2014), the U.S. military completely transformed its approach to combat casualty care.  By doing so, it achieved the lowest death rate from battlefield wounds in the history of warfare. Although this is one of most remarkable achievements in the history of American medicine, few outside the armed forces (and a small number of civilian trauma and emergency care specialists) understand the magnitude of what was done. Fewer still know how it was done.

Out of the Crucible, co-edited by Dr. Arthur L. Kellermann, dean of the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences (USU), and Navy Capt. (Dr.) Eric Elster, chair of the USU-Walter Reed National Military Medical Center Department of Surgery, tells that story.  It includes 44 chapters by 110 world-renowned experts that are interspersed throughout the book with dramatic photographs and powerful first-person stories told by individuals who served during the conflicts or who benefited from these advances.   

The book is divided into three sections: 

  • “Foundations” provides a brief history of America’s military health system, and explains how the education and research infrastructure put in place before September 11, 2001 set the stage for the advances
  • “Innovations” describes 27 distinct technologies, products and changes in healthcare delivery that dramatically improved warfighter survival and recovery
  • “Challenges” considers the operational obstacles and threats future war might bring, and examines nine promising areas of research aimed at optimizing warfighter health and resilience and further advancing combat casualty care

“Few Americans outside the surgical and emergency medicine communities know this story. I hope we can do justice to all who worked so hard and gave so much to achieve the highest rate of survival from combat injuries in the history of warfare,” said retired Army Lt. Gen. (Dr.) Eric Schoomaker, former U.S. Army Surgeon General and one of the book’s authors.

A free, downloadable PDF of the book is now available on the Borden Institute’s website at: and will be available soon in hardback or paperback through the Government Printing Office’s U.S. Government Bookstore at

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The Uniformed Services University of the Health Sciences (USU), founded by an act of Congress in 1972, is the academic heart of the Military Health System. USU students are primarily active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service who receive specialized education in tropical and infectious diseases, TBI and PTSD, disaster response and humanitarian assistance, global health, and acute trauma care. A large percentage of the university’s more than 5,800 physician and 900 advanced practice nursing alumni are supporting operations around the work, offering their leadership and experience. USU’s graduate programs in biomedical sciences and public health are committed to excellence in research and oral biology. The university’s research program covers a wide range of clinical and basic science important to both the military and public health.