As published in The Boston Globe, March 25, 2003, Page: A19 Section: National/Foreign

Recent Gains In Treating Battle Wounds Seen Paying Off

by Raja Mishra

BOSTON, Mass. - March 25, 2003 - As the first major wave of casualties from the fighting in Iraq arrived at a military hospital in Germany yesterday, authorities and specialists in battlefield medicine said recent advances in rapid treatment were paying dividends only a week into the war.

New clot-inducing bandages allowed medics to staunch heavy bleeding in the middle of the desert battlefield. Armor-plated ambulances and medically-outfitted Black Hawk helicopters quickly transported the wounded to mobile intensive care units, where trauma surgeons, toting a surgical suite's worth of equipment, stabilized them just a few miles from where they were hurt. Finally, C-141 transports flew eight wounded soldiers from a field hospital in the Kuwaiti desert to Landstuhl Regional Medical Center in southwestern Germany, into the hands of doctors with three decades of battlefield injury treatment.

"The quality of care . . . is absolutely of the highest order," said Landstuhl's commander, Colonel David Rubenstein.

The six US Marines and two Army soldiers joined four other wounded soldiers from the Iraq campaign already under care. All remain in stable condition, most suffering from blast injuries, said military doctors. None of their identities were released.

"We're fully expecting them to recover," said Major Yong Chun, Landstuhl's medical director yesterday. "They may have a long rehabilitation process."

More casualties are expected to arrive at Landstuhl today at around noon.

Battlefield medicine has the same basic objectives as civilian care: Stabilize the injured, then quickly transport them to hospitals. In the field, matters are complicated by bullets and artillery shells.

Soldiers must first treat each other. Most are trained in first-aid, but front-line medics usually are nearby. Bleeding often tops their agenda: Blood loss has been blamed for half of all battlefield deaths in wars past. Until this war, medics relied on gauze and tape, the same basic tools used by troops since the Civil War.

In Operation Iraqi Freedom, however, many carry bandages coated with blood-clot forming compounds that supercharge the body's natural wound-plugging abilities. The new bandages - some containing human clotting agents, others with agents derived from shrimp shells - can stop life-threatening arterial bleeding fast.

In the midst of combat, heavily armored M113A transports - tanks without gun turrets - carry casualties away, with on-board oxygen supplies, pain medicines, spinal boards, and decontamination suits.

Aid outposts, with two doctors and 30 medics apiece, receive patients several miles behind front lines. They are equipped to perform minor stabilizing surgeries during combat. These front-line doctors must be ready to keep casualties alive for up to 120 hours. This means more fluids on hand and more antibiotics, specialists said.

They must also be willing concentrate time and resources on patients likely to survive, said Massachusetts General Hospital's Dr. Michael V. Callahan, an infectious disease expert who helps the US military test new medical devices. "Previous doctors had an inability to draw the line between salvageable and unsalvageable patients," he said. "Training is as important as new technologies in this respect."

But technology will aid them: New hand-held ultrasound devices will allow for detailed battlefield diagnosis of internal injuries.

Casualties will then be moved farther away from combat, to MASH units, field hospitals that today are a far cry from the green canvas tents made famous in the sitcom, with solid walls and medical technology equal to many US trauma centers.