TOM BEARDEN: One of the biggest changes is in the speed of transporting the wounded to the level of care they need.
It begins on the battlefield. Helicopters take the wounded directly to nearby combat support hospitals, like the 28th. But if a soldier needs more sophisticated care, they don't stay near the front lines very long.
Once stabilized, the wounded are loaded onto medical transport aircraft to take them to Landstuhl Regional Medical Center in Germany. These flying intensive care units carry up to 200 seriously injured soldiers.
DOCTOR: Welcome to Germany. We're going to take good care of you here.
TOM BEARDEN: If the person needs more care than even Landstuhl can deliver, patients are then flown directly to major military hospitals in the United States.
COL. JOHN HOLCOMB: The rapid evacuation we speak of now is from the hospital back to the United States. It's not unusual for soldiers who are severely injured to be back in the United States in two-and-a-half to three-and-a-half days.
DOCTOR: Lay back. Lay there. I'll be back.
TOM BEARDEN: Holcomb says survival rates have also improved because of a technological revolution that reaches down even to the front lines.
COL. JOHN HOLCOMB: There's ultrasounds on the battlefield for diagnostics, small, portable ultrasounds. There's oxygen generators on the battlefield. There are I.V. pumps in the battlefield, small, portable anesthesia machines, small, portable monitors on the battlefield.
We have CAT scans on the battlefield now at every combat support hospital. So you can approach in many respects the type of care we get back here to a level-one trauma center.
TOM BEARDEN: But some of the improvements have been far less high-tech. In the 1990s, studies showed that most battlefield fatalities were the result of uncontrolled bleeding, so doctors took a fresh look at tourniquets.
COL. JOHN HOLCOMB: The end result is there's been six million tourniquets sent to the battlefield. Every soldier, sailor and airman carries a tourniquet on their body, and medics carry multiple tourniquets on their body, and that really springs from better training.
TOM BEARDEN: Doctors also started treating bleeding from inside of the body, injecting a clotting agent called recombinant factor VIIa. It was first approved by the FDA to treat hemophilia.
Early on, some researchers and politicians questioned using it on injured soldiers, concerned about negative side effects. But after clinical trials began, the controversy subsided.
COL. JOHN HOLCOMB: It's an FDA-approved drug used in off-label fashion. If you step back from the controversy that's been generated largely in the media and look at an FDA-approved drug used in off-label fashion, 60 percent to 80 percent of the drugs we use everyday are used in exactly that fashion.
TOM BEARDEN: Factor VII is now routinely used in U.S. emergency rooms for people who have suffered massive blood loss.
Researchers at the Surgical Research Institute are trying to develop ways to increase survival rates even further. Jose Salinas says managing fluid intake for burn patients in transport aircraft is particularly challenging and particularly critical.
JOSE SALINAS, U.S. Army Institute of Surgical Research: It is a life-or-death issue. If you give the patient too much fluid, you're going to end up with complications that are life-threatening and possibly can lead to patient death. If you give the patient too little fluid, you'll end up with complications again that could lead to life-threatening situations.
TOM BEARDEN: So Salinas and his colleagues are conducting tests aiming to build a computer-controlled fluid monitoring system that will automatically adjust I.V. pumps as the patients' needs change.
JOSE SALINAS: The software basically looks at the EKG.
TOM BEARDEN: And Salinas is taking a fresh look at one of medicine's most traditional diagnostic tools: vital signs.
JOSE SALINAS: The classic example is blood pressure. Whenever you're in an accident on the highway or you get shot in Baghdad, the first thing they come to you and they do is they take your blood pressure. Unfortunately, blood pressure is not a very good indicator of what your actual status is after you get injured.
What we're trying to do is we're trying to develop technology that will look at those standard vital signs together with new and improved vital signs that will let us make much better predictions that are much more accurate and much more effective when it comes to treating trauma patients.
TOM BEARDEN: The military is also working on body-monitoring systems that soldiers can actually wear. Lieutenant Colonel Jeffrey Cain is a research physician at the Institute of Surgical Research.
LT. COL. JEFFREY CAIN, U.S. Army Institute of Surgical Research: Number one, it could identify the casualty on the battlefield who needs some type of medical intervention immediately. And that way we can come -- you know, the unit can then initiate some type of a rescue plan to get to that casualty.
On the other side of that, it can prevent unnecessary dedication of assets during a firefight. If somebody is hit and they are injured catastrophically or killed outright, you know, it doesn't make any sense to divert assets at that particular time in the operation to go to somebody who we cannot save or who is already dead. And that's a very critical piece of information to those tactical commanders.