Emergency Room

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Their tales are as old as war itself. But Landstuhl is unique because getting here fast from two time zones away can mean the difference between life and death. "If they can make it back to Landstuhl, their chance of survival is really good," says Lieut. Colonel Warren Dorlac, an Air Force trauma surgeon who has spent the past seven months operating on wounded soldiers at Landstuhl. "These guys are surviving incredible amounts of trauma, and they're doing well."

Armored vehicles and protective gear mean that killer head and chest wounds are far less likely than in the past. Portable blood supplies and blood-clotting powders to pour into wounds have reduced the death toll even further. But many of the men and women who pass through Landstuhl owe their lives to the Critical Care Air Transport Teams (ccatts), the flying intensive-care units that treat the troops as they are lifted from the battlefield by helicopter to a combat hospital within minutes of being hit. From there they are flown six-and-a-half hours to Landstuhl. "None of us have ever taken care of this large an amount of Americans injured in conflict," says Air Force Colonel Tyler Putnam, one of Landstuhl's trauma surgeons. "This is unlike anything we've ever experienced, or maybe will ever experience again."

Few doubt that the evacuation system has saved soldiers' lives. But it was born out of a bitter failure — the Oct. 3, 1993 debacle in Somalia. There, 18 American soldiers died and some 80 were injured while pinned down in a hostile corner of the capital, Mogadishu, with no way out. Just two days earlier, a U.S. medical team had flown out of Somalia to Landstuhl with a planeload of injured servicemen, leaving behind a skeleton staff in the 40-bed battlefield hospital. "There was no system to fly critically ill people in the air; we had to create it on the ground," says Colonel John Holcomb, one of only two Army surgeons left in Somalia that day, which was memorialized in the film Black Hawk Down. They performed 34 surgeries in a nonstop 36-hour stint.

Haunted by the event, Holcomb and others began pushing for change. Army and Air Force commanders together argued that the military needed a joint medical strategy

Landstuhl, the largest American military hospital outside the United States, has been transformed from what was once a sleepy military facility into a top-line trauma center

in wartime that included a permanent fleet of airborne intensive-care units (ICUs). Although the plan was expensive, the commanders believed it was the surest way to save lives. "Before that, the traditional way was to keep casualties on the ground until they were stable," says Holcomb. By then, many were dead.

Today, the Air Force has about 110 active-duty ccatt teams, many of which have logged tens of thousands of kilometers shuttling between Baghdad and Landstuhl. The aircraft are fitted with the same kind of sophisticated medical equipment that would be found in any high-tech ICU, and a doctor, nurse and technician are aboard each flight. Holcomb says the greatest medical achievement in the Iraq war has been how fast injured soldiers are moved to safety. "The rapid evacuation of casualties is stunning," he says.

At first glance, Landstuhl doesn't seem like it could play a key role in any war. The complex of low-slung buildings and neatly manicured pathways, set on a forested hillside above a small town, looks more like a country retreat than a set from M.A.S.H. Taken over by the Americans in 1951, the hospital was regarded for years by military doctors as a quaint backwater, out of touch with both Pentagon politics and the cutting-edge research of combat medicine. Dorlac says it was "a 9-to-3 life," a place where staff took weekend ski trips in the Alps and enjoyed a few sleepy European years. Putnam, the Air Force trauma surgeon, says he dreaded his deployment here in 2002, thinking he had been handed a term in exile. "It felt like a small community hospital when I got here," he says. "They were focused on outpatients. There was very little war-related treatment going on."

In the summer of 2003, with staff reeling from the flood of patients following the U.S.-led invasion, the hospital received another jolt to its system: Colonel Rhonda Cornum. Her appointment as head of the hospital was a sharp break after 50 years of all-male leadership. Her combat credentials were impeccable, however. As a flight surgeon on attack missions during the 1991 Gulf War, Cornum's Black Hawk 214 was shot down over southern Iraq. Five of the eight people aboard died, and she ended up in enemy captivity, with both arms broken and a bullet in her shoulder. During her eight days as a pow — one of only two female U.S. prisoners in that war — she was kissed and groped by an Iraqi soldier in the back of a truck. Cornum opted to keep quiet, but when she yelped in pain from her injuries, the soldier stopped.

The incident made her an instant celebrity in the U.S. — living proof that even under the worst circumstances, American women were fit for combat. But Cornum, 50, says she put that "in pile B" of what she endured, compared to the hellish pain of her wounds and being almost bombed by U.S. jets strafing nearby targets. Being 36 at the time, with a toughened hide, helped. "I'd dealt with a number of people who'd died in helicopter wrecks before," she says, sitting on a couch in her office, which is decorated with certificates from marathons she has run and photographs of her previous military units. Still, her capture left her with a sharpened sense of what might torment the young soldiers — many barely out of high school — lying in Landstuhl's wards.