Twice over the course of this summer I have been glued to the TV by breaking news coverage of the global and political consequences of bullets. The experiences have me thinking about the intertwining of medicine and history.
My first TV-binging experience was on June 6, when I watched the profoundly moving commemoration of the 80th anniversary of the Normandy invasion. To this day, the statistics remain sobering: more than 4,000 died in the first hours of the invasion on the beaches of Normandy.
Even more sobering is the fact that nearly four times as many allied soldiers (an estimated 173,000) were severely wounded or missing that day. Of course, much credit for the wounded’s 80% survival rate goes to physicians, surgeons, battalion medical officers, and nurses positioned close to the front lines, treating the wounded on the beaches and battlefields.
Yet, much is also owed to medics who provided first aid and primary medical care even closer to the front lines. These so-called “band-aid bandits” were essential in keeping soldiers alive until they could reach a doctor.
Flash forward to July 13, 2024, the day a would-be assassin targeted former President Donald Trump. The attempt on Trump’s life drew me and millions of Americans to the television. We all shared a sigh of relief as Trump struggled to his feet from under a pile of Secret Service agents, merely nicked on the tip of his ear by the bullet.
A cloud of déjà vu crept into my consciousness of a nearly identical scene from March 30, 1981. President Ronald Reagan was leaving a speaking engagement at a Washington, D.C., hotel when 25-year-old John Hinckley Jr. crouched a few feet away and fired six shots in 1.7 seconds at Reagan from a .22-caliber revolver.
Like Trump, Reagan initially appeared to be relatively unharmed, as one shot missed his head and instead hit his press secretary. Meanwhile, one Secret Service agent was shot in the head, and a policeman was shot in the neck. Once Reagan was in the limousine, a Secret Service agent discovered blood on Reagan’s lips. Nonetheless, Reagan was able to walk himself into the hospital. Inside the hospital, Reagan complained of breathing problems and then collapsed to one knee. A trauma team found his systolic blood pressure was 60 mm Hg, compared to his usual 140 mm Hg. During exploratory surgery, doctors found a bullet lodged in the president’s lung, less than an inch from his heart.
Ultimately, surgeons successfully removed the bullet, although Reagan lost more than half his total blood volume. Because of the outstanding medical attention, the president was back at work in the Oval Office soon after.
Watching news coverage of the July 13 Trump assassination attempt again drove home for me the power of bullets to alter history. Just weeks earlier, I was filled with awe for the brave young men who stormed the Normandy beaches and climbed cliffs to take out German bunkers on the Atlantic Wall. But I also paid silent homage to lesser recognized heroes of that invasion — the doctors, medics, and nurses who risked their lives to care for the wounded and injured.
Strangely, one paradoxical benefit of combat is rapid advances in medical technology. Medical professionals are better at saving lives faster from an accelerated pace of real-world experiences treating trauma victims. In 1944 they capitalized on tools such as penicillin, blood transfusions, and airplane ambulances — technological advances not available during World War I.
As a consequence, developments in military trauma care have greatly influenced civilian emergency care for trauma patients and patients who were at risk for wound infections. For example, based on experiences from World War I, surgeons in World War II learned that delaying closure of a wound to allow more thorough clinical inspection significantly improved outcomes. In the civilian population, a 1985 study of 1,436 patients undergoing trauma surgery found that taking such steps reduced the wound infection rate as much as eightfold.
Such notions can be counterintuitive to physicians. We must immediately act in emergencies. Yet, in other circumstances, experience from the battlefield has taught physicians and nurses additional lessons that have improved the care we provide our patients. Another significant lesson from World War II that improved patient care is the development of modern triage systems, as military medical teams faced large numbers of casualties and had to develop methods for prioritizing treatment based on the severity of injuries.
While use of medical triage in warfare dates back to at least the 18th century, the U.S. Army advanced the techniques through performing triage closer to front lines in World War II. Development of more portable field hospitals were credited for higher survival rates of soldiers with abdominal wounds. This has translated into greater focus on triage training for first responders such as paramedics and emergency medical technicians, who are typically first on the scene of school shootings and other mass casualty incidents.
The success of D-Day required the coordination of many disciplines, leaders, politicians, commanders, supplies, strategy, tactics, and the valuable assistance of the healthcare profession. I shudder to think that things might have turned out differently on D-Day and on July 13, 2024. Thank God they didn’t. But if the injuries had been worse for Trump, I choose to believe that the experiences of healthcare professionals spanning the decades from D-Day might have once again guided history in the right lifesaving direction.
Neil Baum, MD, is a urologist in New Orleans, the corporate medical officer of Vanguard Communications, adjunct professor of the Tulane University School of Medicine in New Orleans, and the author of The Complete Guide to a Successful Medical Practice.
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