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Treating the U.S. war wounded: Keep them moving

The U.S. strategy for treating troops critically wounded in Afghanistan and Iraq runs counter to what's intuitive in civilian life: Get them to a hospital, get them stable, but then get them in the air.

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Senior Airman Steven North and Air Force Capt. Orlando Duran prepare an injured U.S. soldier for transport to Germany from the hospital at Bagram air base in Afghanistan. North and Duran are critical-care intensivists. They escort the troops and make sure each has a mounted tray full of equipment customized to his needs aboard the flight.

Linda Davidson / The Washington Post

Wounded Army Spec. Bryce MacBride lays on a litter in the hallway at Bagram's Craig Hospital.

Wounded Army Spec. Bryce MacBride lays on a litter in the hallway at Bagram's Craig Hospital.

Linda Davidson / The Washington Post

A wounded Marine, Lance Cpl. Nathan Lamie, 24, is among the injured troops who are queued in the hallways, carried out to a bus, then driven to the runway where their flight to Landstuhl Regional Medical Center in Germany awaits.

A wounded Marine, Lance Cpl. Nathan Lamie, 24, is among the injured troops who are queued in the hallways, carried out to a bus, then driven to the runway where their flight to Landstuhl Regional Medical Center in Germany awaits.

Linda Davidson / The Washington Post

A critically wounded patient is given a cart that holds the portable equipment that will keep him alive and monitor his status aboard the flight to Germany.

A critically wounded patient is given a cart that holds the portable equipment that will keep him alive and monitor his status aboard the flight to Germany.

Linda Davidson / The Washington Post

Typically, seriously wounded troops are moved from the 'point of injury' to a combat support hospital, then to one of the sophisticated 'Role 3' hospitals. Bagram's is one of four such hospitals in Afghanistan.

Typically, seriously wounded troops are moved from the "point of injury" to a combat support hospital, then to one of the sophisticated "Role 3" hospitals. Bagram's is one of four such hospitals in Afghanistan.

Linda Davidson / The Washington Post

Wounded NATO soldiers are taken by bus, then loaded onto a C-17 Aero medical flight to Germany after a short stay at the hospital at Bagram air base in Afghanistan. Five nights a week, evacuation flights leave the airfield for Ramstein Air Base in southwestern Germany.

Wounded NATO soldiers are taken by bus, then loaded onto a C-17 Aero medical flight to Germany after a short stay at the hospital at Bagram air base in Afghanistan. Five nights a week, evacuation flights leave the airfield for Ramstein Air Base in southwestern Germany.

Linda Davidson / The Washington Post

Medical crews attend to wounded soldiers aboard a C-17 Aero medical flight from Bagram to Germany. More than 4,000 critical patients have been evacuated to Europe from Iraq and Afghanistan since 2001. Fewer than 10 have died en route.

Medical crews attend to wounded soldiers aboard a C-17 Aero medical flight from Bagram to Germany. More than 4,000 critical patients have been evacuated to Europe from Iraq and Afghanistan since 2001. Fewer than 10 have died en route.

Linda Davidson / The Washington Post

Air Force Maj. Marilyn E. Thomas monitors Army Sgt. Hiram Provorse aboard the flight. Provorse, 34, had been wounded in a mortar attack in Logar province a few days before he was scheduled to leave.

Air Force Maj. Marilyn E. Thomas monitors Army Sgt. Hiram Provorse aboard the flight. Provorse, 34, had been wounded in a mortar attack in Logar province a few days before he was scheduled to leave.

Linda Davidson / The Washington Post

After the flight lands at Ramstein Air Base, the patients will be taken to a giant hospital in nearby Landstuhl for a few more days of treatment before flying home across the Atlantic. Many soldiers are back in the United States within five or six days of being wounded.

After the flight lands at Ramstein Air Base, the patients will be taken to a giant hospital in nearby Landstuhl for a few more days of treatment before flying home across the Atlantic. Many soldiers are back in the United States within five or six days of being wounded.

Linda Davidson / The Washington Post

Army Spec. Bryce MacBride, 20, is helped to the restroom by Aero medical crewmen Jaime Tate, left, and Nik Falcon.

Army Spec. Bryce MacBride, 20, is helped to the restroom by Aero medical crewmen Jaime Tate, left, and Nik Falcon.

Linda Davidson / The Washington Post

Critical Care Aeromedical Transport team members Robert Stratton and Kristina Forbes record patient statuses aboard the flight.

Critical Care Aeromedical Transport team members Robert Stratton and Kristina Forbes record patient statuses aboard the flight.

Linda Davidson / The Washington Post

Army Sgt. Tomas Rodriguez, in the background, stayed overnight at the Bagram hospital to keep watch on a severely wounded soldier from his infantry who was to be evacuated to Germany.

Army Sgt. Tomas Rodriguez, in the background, stayed overnight at the Bagram hospital to keep watch on a severely wounded soldier from his infantry who was to be evacuated to Germany.

Linda Davidson / The Washington Post

Injured troops from Afghanistan are taken to the Landstuhl Regional Medical Center in Germany. After being evaluated and possibly operated on here in Germany, most U.S. troops are then flown to Walter Reed Army Medical Center in Washington, the National Naval Medical Center in Bethesda, or Brooke Army Medical Center in San Antonio.

Injured troops from Afghanistan are taken to the Landstuhl Regional Medical Center in Germany. After being evaluated and possibly operated on here in Germany, most U.S. troops are then flown to Walter Reed Army Medical Center in Washington, the National Naval Medical Center in Bethesda, or Brooke Army Medical Center in San Antonio.

Linda Davidson / The Washington Post

Jennifer Provorse helps her husband, Army Sgt. Hiram Provorse, stretch his calf muscles before he is taken to surgery at Landstuhl. Provorse suffered injuries to both legs, an arm and his neck in a mortar attack in Afghanistan.

Jennifer Provorse helps her husband, Army Sgt. Hiram Provorse, stretch his calf muscles before he is taken to surgery at Landstuhl. Provorse suffered injuries to both legs, an arm and his neck in a mortar attack in Afghanistan.

Linda Davidson / The Washington Post

Three bones in Provorse's left leg were broken, torn arteries in both legs were repaired with bypasses, and a shrapnel fragment nestled against his third vertebra.

Three bones in Provorse's left leg were broken, torn arteries in both legs were repaired with bypasses, and a shrapnel fragment nestled against his third vertebra.

Linda Davidson / The Washington Post

Jennifer Provorse talks to her husband before he is taken off to surgery.

Jennifer Provorse talks to her husband before he is taken off to surgery.

Linda Davidson / The Washington Post

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