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It was first used by the armies of the Roman Empire.Since the U.S. invasion of 2001, the pattern of injuries sustained in Afghanistan has changed when compared to previous conflicts, such as Vietnam.Suter says the tourniquet – long a controversial tool because, if badly applied, it can damage nerves or tissues on a wounded limb – in particular has had an enormous impact in Afghanistan.RS trains thousands of Afghan security personnel in emergency first aid during winter's relative lull in fighting, and the country's young air force carried out its first evacuations in 2016, flying 9,000 wounded soldiers to safety.Like Suter, she says the tourniquet plays a key role.When NATO combat forces withdrew at the end of 2014, more than 3,500 foreign soldiers had been killed and about 33,000 wounded (including 20,000 Americans), according to the Pentagon.More than 20,000 Afghan noncombatants are estimated to have died in the conflict since 2005, and the situation has grown more grim with each passing year: Civilian casualties approached 11,500 in 2016, the highest recorded by the U.N. since 2009 .
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