Cheating grim death
Lightning-fast treatment is the key to success
But the vests don't prevent all injuries. Because arms and legs aren't protected, extremity injuries like Coleman's now account for some 70 percent of battlefield wounds. Surgeons say the damage is comparable to a catastrophic machinery accident back home. At least 152 soldiers have had limbs amputated; the number of traumatic brain injuries is also up. But it's as yet impossible to tell if those injury rates have increased, partly because the number of survivors has risen, skewing the statistics, and because the Army is compiling its trauma registry from paper records. One wounded soldier could have records at three or four places in Iraq and could arrive at Landstuhl with medical records and X-rays on his Army blanket or with no records at all.
Simple solutions. Surgeons say the use of new fast-clot bandages and better tourniquets and access to fresh whole blood are helping to keep severely wounded patients from bleeding to death. The fact that trauma teams trained together at civilian trauma centers back home helps, too, according to Col. John Holcomb, commander of the Army Institute of Surgical Research. But sometimes even a simple solution can help. Soldiers were suffering devastating eye injuries from shrapnel, but doctors realized such injuries could be prevented if the soldiers wore sunglasses with shatterproof polycarbonate lenses, such as WileyXs. "Most of the injuries were from people who got sweaty and took their glasses off for one second," says James Burden, one of four ophthalmologists at Landstuhl. Once the Army distributed posters with gruesome injury photos, the sunglasses stayed on. Says Burden: "We've seen injuries drop dramatically."
The patients are also changing battlefield medicine. Forty percent of the troops in Iraq are National Guard and Reserve, who are older than active-duty soldiers and more likely to have heart problems or back trouble. "A fair number of reservists and National Guard were activated with cataracts," says Burden. "Once they go into theater with the bright sunshine, they started complaining of problems. We fix them up and send them back."
For seriously wounded soldiers like Coleman, the next step on the journey home is a military hospital stateside. Because he's a marine, Coleman wound up in the National Naval Medical Center in Bethesda, Md. His parents took unpaid leave from their jobs to be at his bedside. Coleman spent the fall undergoing surgery and fighting off a staph infection, making the slow progression from hospital bed to wheelchair to, finally, a walker. "I can wiggle my toes!" he exclaimed last week, two months after shrapnel from the IED tore into his legs. His right leg is no longer in peril. His new calf, which surgeons built out of muscle grafts from his abdomen and skin grafts from his flank, flexes as if it had always been there. But he still has a long way to go; at least one more surgery for bone and nerve grafts, then lengthy physical therapy. On his bedside table, on top of his laptop, lies an application for veterans' disability benefits. "I'm torn right now," he says of the decision ahead--to try to stay in the Marine Corps or seek a medical discharge and use his benefits to go to film school. "If I can do the job I came into the Marine Corps to do, then I want to go back. I'll have to see what they say."
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