View Full Version : The stunning success of battlefield medicine

12-11-05, 11:18 AM
Posted on Sun, Dec. 11, 2005
The stunning success of battlefield medicine
High-tech hospitals give the wounded a greater chance at survival.
By Tom Infield
Inquirer Staff Writer

BALAD AIR BASE, Iraq - There's no mistaking the approach of a helicopter. It beats and pounds and flails at the air. The walls shake as it nears.

The gale brings doctors and nurses in quick-step. The plywood door of the E.R. tent thumps open, and in rolls a bundle of blankets on a litter with five swollen toes sticking out.

Sgt. Derek Drew, 26, of Goldsboro, N.C., lies awake, but appears confused and scared. He was riding in a humvee when a hidden bomb detonated under the wheel well. His right knee is mangled, and he has hand and foot fractures.

"I figured it was just a matter of when," he says of getting wounded. "I just hoped I could talk about it afterward."

Under 52 brown tents near the runways of Balad Air Base, 50 miles north of Baghdad, sits the most advanced combat hospital that an invader has ever set up on another nation's turf.

This is the Air Force Theater Hospital-Iraq, part of a vast U.S. military complex that covers 12.5 square miles and has 30,000 personnel.

U.S. officials say the hospital is equivalent to top trauma centers in major American cities.

Along with better body armor, advances in medical technology, and faster speed in airlifting wounded soldiers back home, an improved military hospital network has contributed to a greater saving of American lives than in any previous war.

"If you reach our hospital alive, you have a 96 percent chance of leaving alive," said Col. Eli Powell, of San Antonio, Texas, commander of a 350-member hospital staff that includes 40 doctors and physicians assistants.

The hospital is the linchpin in a combat medical system - improved since the Gulf War, not quite 15 years ago - that seeks to stabilize the wounded and get them on a plane out of Iraq as soon as possible, often within hours.

In a recent three-day period, several dozen soldiers and Marines passed through the plywood door, decorated in cheery Christmas wrap. In short order, almost all were gone again, aboard an aircraft to Germany and then on to the United States.

American civilian workers and Iraqis were also treated at the hospital.

Drew, who was flown here for evacuation from the Army's 10th Combat Surgical Hospital in Baghdad, was gone within 15 hours. He was carried onto a C-17 Globemaster cargo plane along with other wounded bound for the American military hospital in Landstuhl, Germany.

While in Iraq, Drew - the father of a daughter, 5, and a son, 4 - called his wife to tell her of his injury. And, as he had hoped, he was able to talk about it afterward.

Drew will be all right, Powell said, "but he has a lot of healing to do."

The prognosis: He'll live

Monday afternoon. Faces are grim in the E.R.

A soldier has been shot in the head. It's an oddly bloodless scene as he lies in a coma. The only mark on his shaved scalp is a purple-red blotch the size of a quarter, two inches above his right ear.

Neurosurgeon Gerry Grant, 38, of Rockaway, N.J., wonders aloud whether he was wearing his helmet. No one here knows.

A CT scan shows that a small-caliber bullet knifed through the soldier's brain but ran out of momentum when it hit bone on the opposite side of the skull.

The surgery to remove the bullet goes well. Grant makes no prognosis, except that the soldier will live.

Later, taking a break, he reflects on what he has seen in Iraq.

He says that although "it is a privilege to be here," he finds it "personally difficult" and often needs to distance himself from his emotions.

"These are devastating, horrific injuries," he says. "They're all kids, 21 years old."

A career Air Force doctor with the rank of major, Grant is called Eagle. It's easy to see why. His prominent brow hoods sharp, deep-set eyes.

Most troubling to him, he says, are the severely burned patients who come into the emergency room with their faces charred and shivering from the loss of skin.

Unlike head-trauma patients, they typically are able to talk. Grant often knows before he puts a breathing tube down their throats that these may be their last words. Pneumonia or infection will kill them when they get to Germany.

A Methodist, he prays for them.

More like 'M*A*S*H*'

"This place is much more like M*A*S*H* than I ever expected," said Powell, the hospital chief.

The helicopters, the tents, the combat-zone camaraderie - all of these ring familiar to doctors who grew up watching the TV series about combat surgery in the Korean War.

The doctors, who include a contingent from Australia, sometimes wear 9mm pistols on their hips.

There's no "Hawkeye Pierce" on staff, but there's a cuddly "Radar" - and a stuffy "Dr. Frank Burns."

Maj. Mark Reynolds, 35, an ophthalmologist who grew up in Northeast Philadelphia and went to La Salle University, said the microscope he uses to operate on wounded eyes has once or twice shaken when a mortar landed somewhere not far off. "You can wait for a minute or two," he said, "and it becomes OK."

Medical technology has advanced, of course. The hospital has respiratory equipment and an intra-cranial monitor that was unavailable even in the Gulf War in 1991. Digital X-rays, replacing film, now enable doctors to e-mail results to Germany ahead of patients. A simple device using a sponge and pump alleviates the need for nurses to change wound dressings three times a day.

Yet, there are no inside toilets. The potties are out back.

Scary goggles

The little girl is all dolled up in pigtails and plastic earrings for her big trip from Baghdad to the hospital in Balad.

Accompanied by her grandfather, she is on her way to get wrist surgery after having been hit by an American vehicle on a road near Najaf.

Led to a Blackhawk helicopter, she doesn't appear rattled by the darkness or even the noise of the rotors. But when she gets a look at the crew chief, wearing a goggled helmet in the dim green light of the interior, it's as if she has seen an alien. She wails.

Next day, at the hospital, the tears are dry. The 4-year-old lies on her tummy in red pajamas, playing with crayons.

The grandfather, dressed in a red keffiyah scarf and dark dishdasha robe, is sleeping in a chair beside her bed.

Next to them, an Iraqi boy with a brain injury stares at the ceiling. His father lifts his hand and tenderly kisses his fingers.

This is a ward reserved for Iraqis. The Iraqis typically outnumber American patients and those from other Operation Iraqi Freedom coalition countries at the hospital. They include wounded police officers and members of the Iraqi army.

Unlike U.S. troops, the Iraqi patients can't be sent out of country. So they stay until they are well.

Abbass Matalb, 60, grandfather of the little girl, says that she was tending sheep with her grandmother. When the grandmother's attention was diverted, she wandered into the road and was hit.

"Her name is Amal," a translators says. "That means hope."

At each war, better odds

With each war in American history, the wounded have had a greater chance of surviving.

In the Civil War, the ratio of wounds to battle deaths among Union forces was 2-1. By World War II, the ratio had climbed to 2.3-1. And by Vietnam, it was more than 3-1.

In Iraq, the favorable trend has accelerated.

As of Thursday, according to the Defense Department, 15,955 U.S. personnel had been wounded but survived; 1,676 had been killed in action (out of 2,138 who had died from all causes). That's a wounded-to-KIA ratio of 9.5-1, the best ever.

Col. Tyler Putnam, 46, of Beltsville, Md., a critical-care surgeon, said there have been advances in medical technology besides those at hospitals.

Simple, innovative things have made a difference. For instance, soldiers and Marines typically carry a packet of quick-clotting powder that stops bleeding, still the number-one cause of battle deaths.

But one of the biggest advances, Putnam said, is in the ways that trauma care is delivered.

One of these is mobile intensive-care units - flying ICUs.

"Even the sickest patient can now be evacuated," he said.

On toward Washington

The planes take off from Balad before first light most mornings.

First the walking wounded come on board and take seats along the walls of the big C-17 jets.

Then the patients on stretchers are placed on racks that look like triple bunk beds.

Last come the ICU patients. It takes a team of six soldiers to lift each bed, laden with IV bags and tubes and monitors. A team of three critical-care specialists comes along.

The flight from Balad to Ramstein, Germany, where Landstuhl is located, takes five hours. From there, it is nine hours to Andrews Air Force Base, near Washington.

On the Ramstein-to-Andrews leg of a recent trip flown by the 172d Airlift Wing of the Mississippi Air National Guard, the soldier who was shot in the head is brought aboard.

He is bound for Walter Reed Army Medical Center in Washington. With him are members of his family. Doctors have said there are signs of hope for how well he might recover.

Also aboard is Sgt. Dale Jorgensen, 23, of Belle Center, Ohio, a Marine who was shot in the lower back.

Surgical staples run in a straight line down his chest. He has lost much of his colon and small intestines.

His heavily muscled shoulders and chest heave with each labored breath. Yet he wants to talk.

Taking off an oxygen mask, he tells of the Navy corpsman who may have saved his life in a firefight. The corpsman had pulled off Jorgensen's armor vest to check on his wound. Then he lay atop Jorgensen to protect him from a possible second bullet.

His wife, Joette, awaits.

"She's just happy I'm alive," he says.

Contact staff writer Tom Infield at 610-313-8205 or tinfield@phillynews.com.