The fight for life in war

BALAD AIR BASE, IRAQ — Maj. Diana Hunt and her colleagues see war’s toll every day.

Soldiers disfigured by powerful bomb blasts; flesh and nerves shredded by jagged shrapnel. Young patriots who survived ambushes only to hold their buddy’s hand while he exhales his last breath.

The beds fill each night with warriors too sick or wounded to carry on the fight. On this night, the room is dim and soothingly quiet. Nurses and technicians whisper. The only sounds are the hum of a generator and blankets rustling as a soldier shifts in his bed.

The ambiance is deliberate. Hunt wants these patients to relax because they’ll soon be hoisted into a loud, chilly airplane for a five-hour flight to Landstuhl Medical Center in Germany. She doesn’t want the experience to compound the trauma they’ve already faced.

“The most important thing for us is to make sure that they don’t remember the experience because it is severely stressful and very traumatic,” said Hunt, an Air Force nurse and reservist from McChord Air Force Base.

She works in what the military calls a CASF, or a Contingency Aeromedical Staging Facility. It’s where patients temporarily stay between their care at the theater hospital and their flight to medical centers in Germany and the United States.

This CASF sits adjacent to the Air Force Theater Hospital in Balad, one of two major combat trauma centers in Iraq and a clearinghouse for most casualties flown out of the country. With its teams of specialists and array of diagnostic machines, it is the most advanced theater hospital in warfare history. Earlier this year, 40 McChord reservists from the 446th Airlift Wing volunteered for a four-month deployment in Balad’s CASF. They’ve consoled, administered medications and loaded hundreds of patients into aircraft. The reservists return home this month.

Twenty other reservists from McChord have served in crews on the next stage of the medical airlift system, taking care of patients as they fly aboard C-17s converted to giant, winged ambulances.

“None of us would have stayed in if we didn’t believe in the mission,” said Maj. Ken “Rhino” Winslow, an Issaquah nurse practitioner who was based in Germany on a critical care air transport airlift team — essentially a paramedic in the sky.

More than 90 percent of those injured in combat in Iraq survive their injuries. In Vietnam, the rate was 76 percent. Modern body armor, better-trained medics and forward surgical teams get soldiers’ wounds treated faster. If they reach the hospital, they have a 96 percent chance of survival.

Not only are patients treated faster and with better care than in prior wars, they also are handled more sensitively.

Once patients move from the hospital to the CASF, they stay anywhere from a few hours to a few days. Those who take care of them try to make them as comfortable as possible.

To accomplish that, the CASF has accepted donated sheets, pillows and blankets. They have donated clothes for soldiers because most were hospitalized with just their uniforms. The CASF also has fully functioning toilets, a hot shower and a recreation room with a donated television and Sony PlayStation 2.

Outside is the latest addition that Lt. Col. Dean Wagner, CASF commander, is proud to show off. Some of his reservists got together, gathered supplies and built a deck with a basketball court and barbecue pit.

“We don’t want you to feel like you’re in Iraq,” he said.

At the CASF, which is calm and has a slower pace, patients open up about their fears.

They disclose things they wouldn’t share with their units, their wives or their mothers, said Maj. Hunt, who lives in Seattle and works for Airlift Northwest as a civilian.

“We’re not going to be shocked or appalled. We’re not going to be alarmed,” she said.

Patients refer to that acceptance in surveys about the quality of their care, she said.

“They say they felt like someone was talking to me, treating me like a human being,” she said. “It’s so different from Vietnam.”

Lt. Col. Karen Winter, chief nurse, recalled a talk with a Marine who was with a friend when they were hit with mortar fire. Both had been hurt. He described holding his friend’s hand and knowing the minute he’d died.

“I wanted to cry and I didn’t,” she said.

There was another soldier who’d lost a hand in a vehicle accident. She asked if he wanted her to call home to let his family know what happened.

“He asked me to wait. He said, ‘I’ll lose whatever shred of control I have,’” she said.

Senior Airmen Regina Cook, 38, an Olympia resident, said she never asks a patient what happened. They’ll tell you once they learn to trust you, she said.

A medical technician for the Air Force, she works for Group Health Cooperative in civilian life. This is her second deployment.

While the job is rewarding, it’s also draining. It’s tough to forget once she’s home.

“Many of them are kids who are my kids’ ages, 21 and 18. They’re just starting life. You get tired of seeing it, tired of seeing them being hurt,” she said.

She sometimes steps out on the deck to relieve stress.

“You try to forget, but you can’t. Sometimes they can’t sleep and if they don’t sleep, they stay up all day and they say that they’re scared to sleep.”

Army Spc. Brandon Lander, 21, of Ocean Springs, Miss., was a recent CASF patient. He broke his clavicle when he fell from a wall during guard duty at a base near Al Muqdadiyah, 60 miles northeast of Baghdad. The CASF experience helped ease the pain, the stress of being hurt and the anxiety over separation from his unit, he said, his left arm still in a sling. He was interviewed in Germany, where he was waiting for a medical flight home.

“If anything, it’s changed my view of the armed forces,” he said. “We joke around in the Army that the only thing you can count on the medics to do is to tell you to take some Motrin and take some water.

I’m glad to say that’s a bit of an over-the-top joke.”

Most seriously injured U.S. soldiers spend less than a day in the hospital before they go to the CASF. They are stabilized so they can be flown out on a C-17.

While the CASF is tranquil, the hospital is busy, with moments that seem chaotic.

Almost every hour, helicopters delivering patients thunder over and touch down on the concrete landing pad outside. The rotors kick up dust as nurses rush out with gurneys.

The hospital has about 20 tents, which are protected by concrete barriers and sandbags. They include a long emergency room tent that serves as an assembly line of sorts, with lab tests, CAT scans, and other diagnostics that spit out instant reports. It marks the first time many of these machines have been available in theater, said Lt. Col. Don Taylor, the hospital’s commander.

Hundreds of patients come through, and doctors perform 300 to 400 surgeries every month, Taylor said.

Care for Iraqis

One recent morning, patients quietly rested in their wards.

Some had combat injuries, but many were in for medical ailments such as kidney stones or diabetes. U.S. civilian contractors, many of them older and prone to more medical problems, also are treated here.

Suddenly, an Iraqi police officer was wheeled into the emergency room. He was hurt in an insurgent rocket attack. He screamed in pain but had no visible injuries. Doctors carefully rolled him over, asking through an interpreter where he hurt.

More Iraqis pour into the emergency room now than Americans, a recent trend that might be a consequence of Iraqi forces taking a larger role in the conflict, Taylor said. The hospital also sees Iraqi civilians since much of the country’s health care system is defunct.

An hour earlier, in an operating room down the hall, surgeons performed brain surgery on a suspected insurgent who had been hurt in a bomb blast. Even insurgents are treated here, a concept that is difficult for some to swallow.

“You could have a U.S. soldier injured and the insurgent who caused it side by side. It’s hard to see when you’ve seen the damage caused by the weapons and the people who used them,” Taylor said.

He paused. “My hope is to turn their hearts and that maybe they’ll tell us something that will save lots of lives downstream.”

A curtain is drawn around insurgents so they can’t be seen. They are closely guarded.

“It’s difficult taking care of people who are trying to kill me. But I have to divorce myself from the political aspects,” said Maj. Brett Schlifka, a neurosurgeon from Madigan Army Medical Center.

IEDs and amputations

While combat death rates are much lower than in Vietnam, the number of amputations is much higher, said Lt. Col. Rick Davis, an Air Force orthopedic surgeon from Nellis Air Force Base in Nevada.

Improvised explosive devices, or IEDS, maim with blasts of shrapnel, which tears through muscles and nerves, leaving dead flesh. Davis, one of the hospital’s three orthopedic surgeons, said he has about 60 amputation cases a month.

He still thinks about a case in which he tried to save a soldier’s leg.

When the soldier’s vital signs dropped, the focus became saving the patient’s life, which meant amputating the limb during an hours-long surgery.

The next day, the patient died from an infection.

“The effort to save his leg turned into an effort to save his life. He was 37. I’m 37. That one kind of hit home,” he said.

The closest thing back home to the wounds he sees here were from farm accidents, in which patients get a limb caught in machinery, Davis said.

“A lot of the older docs, they go to a trauma refresher to make sure they’re prepared for what they see here,” he said.

On a recent night, airmen prep about 9 p.m. for the approaching early morning mission. Wagner, the CASF commander, looks at his numbers. He has 11 patients flying out. None needs critical care. It’s a smaller mission than the night before, when he had about 40 patients.

“I love it when nobody’s here because that means nobody got hurt,” he said.

Around 2 a.m., Maj. Melanie Carey, a CASF nurse hurries over to the hospital for three patients just added to the evening’s mission.

She reviews their medical charts. She checks on their medications and asks questions of the ward nurse. One patient was wounded with shrapnel. Another is a soldier with gallstones. The third is a British soldier who’d fallen ill with a bug bite on his ankle.

Preparing patients for the flight home is tricky.

Patients with brain or eye injuries are susceptible to air pressure changes that could cause gases in their wounds to expand. So they require restrictions on altitude. Air crews also have to guard against dehydration and cold temperatures.

All patients are logged into a central computer system, along with information about their condition, medications and special requirements.

Carey’s night gets busier with a call over the radio. The mission is leaving an hour early.

“I almost never see it go out at the time it’s supposed to,” she said.

The patients are picked up and taken to the flight line. Each is carefully hoisted into a bus and then driven to the plane. Airmen grab each litter and walk them up the ramp and secure them into a station inside the large C-17. Patients who can walk find a seat along the wall and they fall asleep almost as soon as the pilot makes his steep, rapid combat take-off.

The C-17s are equipped for a quick setup of stanchions and life support systems. Patients are strapped in rows of beds, stacked two high. If an emergency arises in which a patient needs immediate transport to a medical center outside Iraq, a jet and crew can be ready to fly within an hour.

The airlift system is another benefit to wounded patients, who can be flown to Germany in one to two days and to a military hospital in the United States in a few more days. In Vietnam, many patients couldn’t be stabilized as soon and had to wait two to six weeks before returning to the United States.

“No one in the world really has an airlift system like we do,” said Maj. Winslow, the Issaquah reservist.

Winslow worked with the most critical patients, those with multiples injuries, gunshot wounds or amputations, who are cared for by Critical Care Air Transport Teams. CCATTs are dispatched like paramedics.

When they get the call, they assemble their monitors and supplies, such as heart or blood pressure monitors, and fly down-range, usually from Ramstein Air Base in Germany.

Aeromedical crews spend eight hours on the plane before they even see their patients. It’s then another eight hours back. Their flights average 12 to 15 patients carried on litters, with 15 to 25 who can walk. The crews are worn out by the end.

Staff Sgt. Selina Barone, a McChord flight medic, said critically injured patients are sedated and closely monitored.

Patients who are sleeping create an illusion that they’re less seriously wounded than they really are, she said.

Barone, of Port Orchard, was on the flight that carried ABC anchor Bob Woodruff and cameraman Doug Vogt to Germany after they were hurt by a bomb blast while reporting in Iraq.

But she most vividly remembers a 23-year-old soldier who was paralyzed from the waist down and thinking about how much physical therapy was in his future.

She remembers a wounded soldier who turned out to be from her son’s unit out of Fort Riley, Kan. Her son is a combat medic.

“The ones that really stand out are the ones you connect with the most,” she said. “But you have to control that on this job because once you are overwhelmed, then you can no longer be effective ... you can no longer do your job.”

McChord mission

Reporter Scott Gutierrez accompanied airmen from McChord Air Force Base on their mission to deliver equipment and troops to and from Iraq.