Lessons of war: Combat-related injury infections during the Vietnam War and Operation Iraqi and Enduring Freedom

In more than a decade of war, numerous advancements have been made to improve overall combat-related mortality. Battlefield case-fatality rates (CFRs) have declined steadily throughout the 20th century, from 19.1% among all wounded in World War II to 15.8% in Vietnam and 9.4% in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF).¹ However, infectious complications remain the leading cause of both morbidity and mortality in combat-injured personnel. While there has also been continual evolution of battlefield tactics leading to new mechanisms of injuries and infectious complications, the trends echo patterns seen previously. We continue to face wound infections, growing antimicrobial resistance, and seek "novel" solutions that on reflection have often been previously investigated. Learning to apply the lessons of previous conflicts is of paramount importance to progress. Here, we will attempt to compare the challenges and lessons of combat-related injuries and infections from the Vietnam War with those of OIF/OEF.