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The Wounded

By JOHNNY DWYER

Published: March 27, 2005

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Treating combat trauma on the ground in Iraq. Photographs by Lynsey Addario.


As of March 18, 11,344 American soldiers had been injured in the war in Iraq. Starting with the first tourniquet or I.V. applied at the scene of the trauma, today's war wounded experience a rapid sequence of carefully choreographed medical treatments. From the battlefield, an injured soldier is carried to a nearby combat medical facility, where doctors try to stop the bleeding, sanitize the wounds and begin treatment. If the injuries require further care, the patient is evacuated by cargo plane to a military hospital at Landstuhl, Germany, and finally transferred to a long-term-care facility in the United States. During the Vietnam War, a comparable journey took 45 days; today, it takes less than 4. The speed of the process, combined with improvements in body armor and surgical care, has made a lifesaving difference: the current survival rate among wounded soldiers is 87 percent -- up from about 75 percent in Vietnam.

If the rates of survival are encouraging, for many injured soldiers the conditions of survival are not. ''You live,'' says Lt. Col. Craig Silverton, an orthopedic surgeon who has treated soldiers in Iraq, ''but you have these devastating injuries.'' Modern body armor helps spare the head, heart, lungs and other internal organs, but the areas that remain unprotected -- limbs, neck and face -- are exposed to explosive forces that were often fatal in previous wars. Amputation rates among soldiers, according to recent Congressional estimates, have doubled to 6 percent from the historic norm. Brain injuries are also common.

The Air Force Theater Hospital, located 50 miles north of Baghdad at Balad Air Base, plays a central role in the treatment of combat trauma in Iraq. The hospital, part of the 332nd Expeditionary Medical Group, is a provisional structure of ventilated tents set on a cement foundation, powered by rumbling generators and fortified by sandbags and towering concrete blast walls. Many of the hospital's staff members had not treated combat trauma before arriving in Iraq; they typically spent their careers as medical professionals performing procedures like hip replacement and kidney-stone removal. Now they handle deep flesh wounds, burst eardrums, shattered teeth, perforated organs, flash burns to the eyes, severed limbs. In addition to tending to American soldiers, the hospital treats many Iraqi National Guard members, Iraqi civilians and insurgents.

Over four days last November, when these photographs were taken, doctors and staff members at the 332nd saw a flood of injuries and casualties from counterinsurgency operations in Falluja and insurgent strikes elsewhere in the country. That month, the hospital cared for 620 patients and performed 510 operations, a 65 percent increase from the previous two months. ''These young kids are heroes,'' says Col. Joseph Brennan, a head and neck surgeon. ''Somebody's got to pay the price. And these kids are paying the price.''




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