Teleconferencing from the war zone improves treatment for wounded soldiers

By David Brown
Saturday, October 30, 2010; 2:45 AM

BAGRAM AIR FIELD, AFGHANISTAN -- It's a heart-stopping and heartbreaking catalogue of the mayhem, heroics and human toll of modern war.

Every Thursday afternoon doctors, nurses and medics gather in a conference room at the military hospital here, linked by telephone or videocam to colleagues at all the combat hospitals in Afghanistan, and at military hospitals in Europe and the United States. Over two hours, this virtual assembly of about 80 people reviews the care of every U.S. service member critically injured in Afghanistan in the previous week.

Among the 13 discussed at one recent meeting, nine will have permanent disabilities: Two lost one leg; two lost a leg and a foot; two lost both legs; two lost both legs and a hand; and one was paralyzed from the waist down. Three of the nine also lost their genitals.

The conference helps ensure no injuries are overlooked in patients who often have a dozen wounds or more. It's a way of double-checking innumerable pieces of information that have been entered into a database and will be studied to help improve practice. It's also a way of gently monitoring everyone's performance.

Lots of people take care of these patients, but few see them for more than the 36 hours before they are flown out of Afghanistan. The weekly conference assembles, for everyone's benefit, the chapters of a narrative whose only common character is the broken body of the soldier himself.

Treatment and transport

These transcontinental medical rounds reflect a revolution in the care of battlefield casualties.

No longer are grievously injured soldiers kept in one place until they're stable and have had their wounds fully addressed. Instead they're moved in a seamless process that combines treatment and transport from the battlefield to a combat hospital, to Bagram, to a military hospital in Landstuhl, Germany, and then to one of the giant medical centers in Washington, Bethesda or San Antonio.

The system is based on an approach called "damage control surgery," imported from civilian medicine but perfected in the past nine years in the Iraq and Afghanistan wars. Wounds are addressed in stages. Surgery is kept as short as possible. Most soldiers with critical injuries get two operations in two hospitals in the first 24 hours.

Experience has shown that fewer trauma victims die if you treat them in step-wise fashion. But most Afghanistan trauma is caused by make-shift bombs or IEDs that inflict such extensive damage that fixing the body in two or three operations is impossible anyway.

"Twenty years ago, if you left the operating room without fixing everything, you weren't a good surgeon," said Rodd Benfield, a 39-year-old Navy surgeon from San Diego deployed to Kandahar Air Field in southern Afghanistan. "We don't believe that anymore."

IEDs not only blow limbs off the body, they drive dirt deep into flesh and often peel skin back a foot or more above the bone's jagged end. The shock wave kills tissue that initially looks normal and takes days to "declare" its true condition. With damage-control surgery, these wounds are washed out, and dead tissue removed, under general anesthesia every day for a week or more.

Similarly, abdominal cavities are explored and re-explored, as surgeons look for wounds overlooked in the first operation, or that have developed since. Pelvic injuries, often massive because of between-the-legs IED blasts triggered by soldiers on foot patrol, are left open, protected with bandages and repaired step by step.

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