War Medicine

We got a talk from a neuroradiologist who went to Landstuhl, Germany and Iraq to participate in the care of our troops. Her particular interest was traumatic brain injury, but she found when she got there that she simply wanted to participate in everything. She told us it was like being a medical student again, and she loved it. She scrubbed into the surgeries, she attended on the neuro/spinal ICU, she transported patients. I had read descriptions of how medicine is practiced in the Iraq and Afghanistan wars, but this talk brought everything to life. She began with a broad overview - a geography lesson, statistics on the injured and killed, and basic nomenclature. Then she showed us pictures of the weapons used - the improvised explosive devices, the rocket propelled grenades, the mortar, the small arms and sniper weapons. She described the medical consequences of these injuries including aspects we don't think about such as infection, hearing loss, and post-traumatic stress disorder. She then showed the protective gear used by the troops - body armor, HMMWV/humvees, tanks and described how those have changed the types of injuries seen (as a result of body armor, there are few torso injuries, but many face and extremity ones). She described the triage system whereby injured soldiers get taken to forward surgical teams that are at the front lines. These teams perform any life-saving maneuvers before sending the soldiers to the combat support hospital. There, further surgeries are performed until the soldier can be flown to the hospital at Landstuhl and finally back home. Within a period of 24-48 hours, a critically injured soldier may be on an ICU-capable plane back home. This has led to a much higher survival rate, and as a result, the system has to deal with the rehabilitation of severe injuries like amputations and psychological "shell shock."

I was really moved by this talk. Medicine exists at so many frontiers and in so many variations. The types of injuries seen here are unlike any others I've seen. The disciplined high-quality care in the setting of few resources and overwhelming demand is impressive. The dedication and courage of our troops in every setting is really inspiring.

Image of a medical evacuation flight from Balad Air Base, Iraq to Ramstein Air Base, Germany in 2007 is in the public domain, from Wikipedia.