World-War-2-Cartoons-Punch-1943-05-05-385When I was in the Navy, we used to have an expression when the paperwork burden would get too great, something to the effect of “What we need is a good war.” The belief was that war had a cleansing effect on the bureaucracy, streamlining processes and making things measurably better. I suspect, after 10 years of readiness, my former colleagues are no longer so convinced of that.

I was reminiscing about my military service in part because I was loaned a copy of Unbroken – A World War II Story of Survival, Resilience, and Redemption.  Well worth a read, it tells the well researched and improbable story of survival of the impossible by Louie Zamperini. My first thought, upon finishing it, was that World War II was fought by folks my son’s age. I cannot see him piloting a bomber, and I suspect when World War II started many parents felt the same as well.

Medicine is using the aviation industry as a standard to move towards regarding process improvement and safety. My other thought was about how the aviation industry became so focused on safety. This book makes me think that our World War II experiences probably played a large role in this evolution. When the war started, training accidents were common. In fact, for every one combat aircraft casualty, there were 6 training casualties. Zamperini and other survived their training in part because they were excellent problem solvers in potentially lethal situations. The non-combat risks included the hardware itself, the weather, support structures including landing facilities, the risk of human error, and the risks of navigation.

To reduce this loss of aircraft and people (as many as 1 in 4 aircrew died in World War II), the entire way of thinking about flight had to be changed. It took the national needs, tremendous human loss, and an understanding that system change was vital to our survival to bring about that change in the military. Louie was an early casualty (his poorly equipped and maintained plane crashed in the Pacific on a search and rescue mission) and spent much of the later war in the POW camps in Japan so he didn’t experience this system change. Many would say it was then the military pilots and crew transferring what they learned into civilian aviation that improved civilian air travel as well.

The book reaffirms the horror of war, in particular the pacific theater. I know that as a trade-off, safe air travel is not nearly enough to compensate for the losses of my parents generation. We consider losses from death but almost worse were the emotional trauma that survivors have faced. Zamparini was quoted as saying that if he know he would have to relive his experiences he would kill himself. Now in his mid 90s, he is an amazing individual. His story is one of personal triumph when he was failed by the system. What we have begun to learn in medicine is the need to minimize personal heroism and maximize the triumph of the system.