Cheating grim death
Lightning-fast treatment is the key to success
During the Vietnam War, it could take a wounded soldier a month to make it home for treatment. Iraq is different, partly because it's an urban battlefield and partly because the military has radically retooled its system of treatment and evacuation. "We have to provide fast, flexible medical care," says Lt. Col. Slobodan Jazarevic, a vascular surgeon at Landstuhl who is returning to Iraq to head the 44th Medical Command. "There are no lines of battle. The battle is fought everywhere."
Badly wounded patients like Coleman are quickly flown to Landstuhl and spend three to five days there before being shipped to the States. The very ill move even faster. "The biggest change in military medicine in the past 10 years has been the CCAT s [critical care air transports]--flying ICU s," says Air Force Col. Kory Cornum, an orthopedic surgeon who commands the 86th Medical Squadron at Landstuhl. Cornum recently operated on a patient who was in the intensive care unit at Walter Reed Army Medical Center in Washington, D.C., just 36 hours after being badly wounded in Iraq. "Our country's the only country that can do that," Cornum says. "Not the only country that can but the only country that will."
At Landstuhl, a hospital that had become a snoozy Cold War relic is back in full war mode; more than 20,000 patients have arrived from Iraq and Afghanistan since the wars began. After the battle in Fallujah began, on November 8, the hospital took in 455 patients in a week. When the call goes out on the hospital PA system that a plane from downrange is "wheels down" at nearby Ramstein Air Base, staff members start lining up gurneys outside the emergency room door. The critically ill arrive first, by ambulance; their CCAT teams wheel them directly to intensive care or an operating room.
24-7. More-stable patients like Coleman are carried off buses on litters. Those with bad backs and other less pressing health problems--the "disease nonbattle injury" cases, which make up the bulk of troop loss in any war, far more than from enemy fire--walk off the bus themselves and are handed a list of their doctor appointments and a phone card so they can call home. The traffic is choreographed in the Deployed Warrior Medical Management Center, a fancy name for a handful of modular offices in the parking lot outside the ER. There, doctors, nurses, and dispatchers work 24-7, monitoring an online database where their counterparts in the Middle East list the incoming wounded--multiple trauma from a vehicle rollover, abdominal pain, amputations. Says Capt. Monabell Vamvas, a triage nurse and reservist from Glendale, Calif.: "I know every person on that flight."
If the rapid evacuations are one of the big medical success stories of this war, another is improved body armor, which physicians credit with much of the reduced death rate. Flak jackets have been used for decades, but even in the 1991 Gulf War, they weren't capable of stopping high-velocity rifle rounds. Now they do. "It is also different because soldiers wear it," says Army Col. David Burris, a trauma surgeon and interim chairman of surgery at the Uniformed Services University of the Health Sciences. "It's thrilling. I'd much rather prevent an injury than fix it."
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