ccml Trauma management in Iraq

[Eric Hodgson]

The Journey Through Trauma

U.S. troops who survive the critical 'golden hour' after being
seriously wounded in Iraq owe their lives to a fast-acting team of
battlefield medics, pilots, nurses and surgeons.

By David Zucchino, LA Times Staff Writer
April 3, 2006

http://www.latimes.com/news/nationworld/nation/la-na-
wounded3apr03,0,3069118.story

As Lance Cpl. Ryan Buchter lay bleeding in the Iraqi desert, his fate
hinged on the efficiency of a medical lifeline that stretches halfway
around the world. From that moment forward, hundreds of strangers
would work to save him.

Buchter's platoon was in a village called Husaybah on Nov. 8,
searching for the enemy. He was standing in the doorway of a
farmhouse when an insurgent inside rolled a grenade at his feet.

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 The explosion shredded Buchter's left leg as superheated shrapnel
tore through muscles and tendons. More shrapnel crushed his right
hand and sliced into his nasal cavity.

Buchter groped for his nose but couldn't feel it. He thought it had
been blown off. He leg was so shattered that he was certain he would
lose it, and he imagined being left crippled at age 20.

"And not once did I cry," he recalled later, "until I thought, like,
I was going to lose my leg and stuff."

A Marine applied a pressure bandage to Buchter's leg, trying to stop
the bleeding. Another wrapped his hand and pressed gauze against his
pulverized nose. The Marines quickly loaded Buchter into an armored
vehicle, which delivered him to a medical aid station nearby.

Buchter survived the "golden hour"  the 60 minutes following a
serious battlefield wound, when the speed and competence of emergency
treatment can mean the difference between life and death. Ordinary
fighting men teamed with doctors, surgeons and nurses to keep him
alive.

His fellow Marines  what the military calls his "battle buddies" 
were able to stanch his bleeding by putting their combat lifesaving
training to quick use. Exsanguination, or bleeding to death, is the
leading cause of death for American troops in Iraq.

As a military doctor examined his leg inside the aid station, Buchter
was alarmed by the concerned look on the man's face.

"If I lose my leg, I'm coming back to get you," he told him.

The doctor assured Buchter that his leg would be saved. "You've got
my word," he said.

Then a surgeon arrived and warned Buchter that he might indeed lose
his leg. The best option to save it, he told him, was a very painful
and sometimes disfiguring surgery called a fasciotomy, the extensive
cutting and cleaning of the wound.

"And I was like, 'Cut me up if you have to. I just don't want to lose
my leg,' " Buchter recalled.

The medical odyssey of this Marine was just beginning. Buchter was
now a patient in a virtual assembly line of care. It begins with
soldiers and medics on the battlefield and shifts quickly to
helicopter crews who pluck the wounded from kill zones. It continues
to surgeons and nurses and X-ray technicians at desert facilities,
and to virtual flying hospitals that airlift the wounded from Balad
to a U.S. military hospital in Germany.

It leaps the Atlantic to major military medical centers in Texas and
Washington, D.C. It passes through military hospitals from New York
to California. It culminates with months of painstaking physical and
occupational therapy in hospital wards and private homes. About
17,400 wounded have been treated since the war began three years ago.

The fulcrum for treatment in Iraq is the U.S. Air Force Theater
Hospital in Balad. In addition to the troops brought directly to the
hospital, any seriously wounded American must make a stop in Balad to
be flown for treatment in Germany. The facility is housed inside
three dozen tents and three trailers on the packed sands of a former
Iraqi air force base 50 miles north of Baghdad. Sandbags, concrete
blast walls and concertina wire provide protection from insurgents,
car bombs and mortars.

The military says no injured American is more than 30 minutes from
Balad or one of three combat support hospitals operated by the Army.

The rapid evacuation of wounded troops begins with Black Hawk medevac
crews of four  nicknamed "dust-off" teams  trained to respond
rapidly to distress calls from the battlefield.

>From their dusty tent base about a mile from the hospital, the Army
air ambulance companies keep three helicopters and crews ready at all
times. The copters occupy a corner of the air base, the thumping of
their rotors competing with the roar of F-16s taking off and the low
hum of armed reconnaissance drones.

The crews are called to action by "nine-lines," the emergency radio
calls from the battlefield that provide nine essential bits of
information: location, number of wounded, whether the landing zone is
"hot," or under fire, and so on. In most cases, the crews say, their
helicopters lift off within eight to 10 minutes

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