The Wounded Come Home

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Yet the American soldiers in the current Iraq war have a better chance of surviving those wounds and getting back home than any other soldiers in history. Better protection, faster evacuation and improved medical techniques at the edge of combat have dramatically reduced battlefield mortality. At the same time, although body armor and wound-sealing potions have made it less likely that soldiers will be killed in battle, they have also increased the likelihood of certain kinds of injuries, especially amputation, because a soldier's extremities remain vulnerable to the kind of homemade munitions the Iraqis are routinely deploying. The Iraqis lack the air power and artillery that can easily kill, but the weapons they are using — RPGs, car bombs and improvised explosive devices — have increased the ranks of the wounded. And these wounded seem to be threatening the morale of the soldiers left behind. While the Air Force has flown 1,513 battle casualties from the Iraqi theater, 9,341 have been flown out for other health reasons, including mental stress.

When the wounded come home, they are rarely greeted with waving flags and parades. Maimed soldiers are routinely flown from Iraq to Landstuhl Regional Medical Center in Germany, where they are stabilized before heading to the U.S. The most seriously injured are flown to Andrews Air Force Base, outside Washington, usually on nighttime flights, and then transported to Walter Reed Army Medical Center in Washington or Bethesda Naval Hospital in Maryland. "The wounded are brought back after midnight, making sure the press does not see the planes coming in with the wounded," said Democratic Senator Patrick Leahy of Vermont on Oct. 16 on the Senate floor.

In World War II, about 1 in 3 U.S. casualties died. During the next three wars — Korea, Vietnam and the Gulf — about 1 in 4 died. In the current war, about 1 of every 8 wounded soldiers have died.

Half of battlefield deaths occur within 30 minutes of wounding, largely on account of blood loss. But survival rates skyrocket if a casualty can get to a medical facility within the so-called golden hour after an injury. There are four major U.S. military medical outposts in Iraq, and the medical corps' critical mission is to keep wounded soldiers alive until they can be taken to one of them.

So far, a key rescue unit has a sterling record. The 159th Medical Company (Air Ambulance) has whisked more than 3,600 injured and ill troops to medical help with only a handful dying along the way. "We've given people a lot of tomorrows," says Major Arthur Jackson, chief of the unit's Baghdad squad. But many will face grim times. "People say, 'Well, he didn't die,'" says Captain Todd Farrell, a 159th helicopter pilot. "But a lot of these guys have an arm blown off or their leg blown off below the femur. Their lives are still going to suck."

At the front these days, small mobile surgical teams travel with combat forces. Navy Captain H.R. Bohman, a surgeon, was one of an eight-member medical team that did surgery 8 miles from Baghdad — the closest American operating room to the city — as the Iraqi capital fell to U.S. forces in early April. "We can document at least four Marines who are alive today who would have died if they'd had to be sent back as far as we were sending people back in the first Gulf War," says Bohman, a 30-year Navy veteran.

Such units generally consist of a trauma surgeon, an orthopedic surgeon, an emergency physician, an anesthetist, nurses and technicians. They carry with them a rudimentary field hospital in 70-lb. rucksacks. Their supplies include 5-lb. portable ultrasound units that allow quick and accurate diagnosis of internal bleeding and collapsed lungs. The ultrasound devices also can be used to locate shrapnel deeply buried in a thigh or torso. The teams also carry football-size electronic equipment for monitoring a patient's vital signs, small anesthetic-delivery devices and portable ventilators that help a wounded soldier breathe.

Despite improvements, new battlefield gear can't protect a soldier from top to bottom. Most troops in Iraq wear new $1,600 Kevlar vests with ceramic plates that slip into pockets in the front and rear to protect against small-arms fire. Their new $325 Kevlar helmets, although not bulletproof, afford greater protection than older models. While this gear shields the head and heart — along with the liver, lungs and guts — it leaves the extremities exposed. That's why 2 of every 3 wounds incurred by U.S. troops in Iraq involve legs or arms. It's also why some 100 U.S. troops have lost legs, arms, hands or feet in this war. Nearly half--45%--of the U.S. soldiers wounded in Iraq have been hit in the legs, with 19% injured in the arms, according to a recent Pentagon accounting shared with the American College of Emergency Physicians.