By Manav Tanneeru
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(CNN) -- More than 20,000 U.S. troops have been wounded so far as a result of combat in Iraq and Afghanistan. But according to experts, more of them are surviving their injuries in comparison to past conflicts because of advances in military medicine, faster evacuations and better body armor.
Many of the serious injuries in Iraq have been the result of roadside bombs, rocket-propelled grenades and suicide bombers. These weapons can cause anything from shrapnel and bullet wounds to traumatic head and neck injuries to massive burns and injuries to limbs that require amputations. (Watch a slideshow about how a roadside bomb changed two soldiers forever)
Although these injuries are often horrific, a recent University of Pennsylvania study says the percentage of soldiers who survive their injuries has improved markedly since the last U.S. war that involved a large and protracted troop mobilization engaged in guerrilla warfare -- the Vietnam War.
The ratio of the number of deaths to the number wounded declined from 24 percent in Vietnam to 13 percent in Iraq through March 31, 2006, the study said. In other words, a greater percentage of soldiers who are wounded in battle now live through their injuries. (Watch a slideshow about how one soldier is overcoming the loss of his leg)
"We've still got some people we can't save, but we're getting more of the critically injured actually into the hands of medical care than we did in Vietnam and that makes a big difference," said Dr. Dale C. Smith, the chair of the department of military medical history at the Uniformed Services University of the Health Sciences (USUHS).
Improved strategy and technology
Improvements in medical care starting from the point of injury on the battlefield to the final stop at a military hospital in the United States are contributing to the decline, experts say.
The first few minutes after a soldier is wounded are crucial, Smith said. "Roughly 90 percent of the people who are going to die on a battlefield die in the first five to 10 minutes," he said.
Combat medics are learning new techniques and receiving new tools -- like wound dressings that can clot blood and tourniquets that can be applied by one hand -- to raise the chances of saving lives. (Watch how medics are extending the 'golden hour' )
Evacuation times from the battlefront to nearby combat support hospitals have also improved. "The objective on the battlefield is to get the soldier from point of injury to definitive surgical care in one hour," Capt. Brian Krustchinsky, an instructor in combat medic training, told CNN.
Combat support hospitals, which are now more mobile and more sophisticated than in past wars, have moved closer to the front, reducing the time of medical transport, according to Col. Charles Beadling, a professor of military and emergency medicine at USUHS.
"One of things that we became acutely aware of in the first Gulf War was that we had these very large medical facilities that were not practically mobile," he said. "They were built with the paradigm of the Cold War and large force-on-force conflicts in mind."
Changes in war tactics, especially the increased importance of speed and mobility, led to the change to mobile units that could go anywhere very quickly while retaining a high level of care, Beadling said.
Finally, transport to Landstuhl Regional Medical Center in Germany now takes less than 24 hours and a soldier can get back to the United States in less than a week. During Vietnam, that journey sometimes took 48 days. (Read about how some Marines are healing together)
Additionally, improvements in body armor over the last 35 years -- like more effective vests, better helmets, ballistic glasses and ear protectors -- also help, experts said.
Psychological toll unknown
Random violence, suicide bombing, door-to-door combat and long tours of duty are certain to take a psychological toll on the troops. But exactly what that toll is, is hard to predict say experts.
A study of four combat units published in the New Journal of Medicine in July 2004 concluded that at least 15 percent -- nearly one in six -- of those surveyed meet the criteria for major depression, anxiety or post-traumatic stress disorder (PTSD). (Read more about PTSD and women at war)
Yet, less than 40 percent of those who had PTSD sought help, the study said.
Nina Berman, who published a book of photographs featuring veterans of the Iraq War who won Purple Hearts, said advances in medical care, like prosthetics or surgery, cannot address the underlying emotional trauma of some of the injuries.
"Even if someone had their 35 surgeries and are back home, they're dealing with their post-traumatic stress," she said.
"One soldier thought Iraq was the best experience of his life and then a year later, he tried to kill himself," said Berman, whose work has appeared in news outlets like National Geographic and The New York Times Magazine.
"Another soldier that was really trying to be politically active and was trying to do lots of things has recently shut out the outside world because he is freaking out too much."
But, others are persevering, she said. One wounded soldier she met got married and is doing fine. Another wounded soldier who lost a leg returned to school.
"Medicine can now save [the grievously wounded] and we are coming to terms with what our social responsibility to them is," Dr. Smith of USUHS said. "I think [society has] changed in sufficient ways that America will respond to them as we've always responded to those who've borne the battle."
CNN's Bill Tucker and Dr. Sanjay Gupta contributed to this report.
Combat medics are learning new techniques and receiving new tools to raise the chance of saving lives.
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