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U.S. strategy for treating troops wounded in Afghanistan, Iraq: 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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Washington Post Staff Writer
Saturday, November 27, 2010; 4:57 PM

AT BAGRAM AIR BASE, AFGHANISTAN Only the head and feet of Sgt. Diego Solorzano are visible outside his camouflage blanket and below the skyline of medical devices keeping him alive.

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Clamped to his litter is an over-the-legs shelf. On it are three vacuum canisters putting gentle suction on wounds in Solorzano's thighs and abdomen, two IV pumps delivering drugs to his veins, a ventilator breathing for him, and a monitor recording his pulse, EKG rhythm and blood pressure.

In the intensive care unit of the military hospital here, Solorzano - "Sgt. Solo" to the members of Able Company, 1st Battalion, 506th Infantry - has a nurse at his bedside and a doctor never far away. He's been to the operating room three times in the previous 24 hours. He's hemorrhaged his entire blood volume five times and had it replaced. He's unconscious and may not survive.

In any U.S. hospital, Solorzano would be considered too sick to put on an elevator and take to the CT-scan suite. Now he's about to fly across half of Asia and most of Europe.

An Air Force chaplain puts a folded blue-and-white-plaid blanket over Solorzano's feet. A few minutes later, Maj. Michael Gonzalez, the physician who's just taken over his care, says, "Okay, I think we're ready to go."

Six people wheel him out of the ICU, down a hall and out a door to a loading zone. They put him and three other critical patients on a specially fitted bus that will drive several hundred yards onto a runway. There, a hulking C-17 jet waits, its tail ramp down and spilling light in the pre-dawn darkness.

If the soldier's condition worsens during the flight, Gonzalez and the nurse and respiratory therapist helping him will have to count on having the knowledge, tests, drugs and equipment to "advance his care" just as they would in the ICU he's leaving.

The U.S. military's ability - not to mention its willingness - to take a critically ill soldier on the equivalent of a seven-hour elevator ride epitomizes an essential feature of the doctrine for treating war wounds in the 21st century:

Keep the patient moving.

In the civilian world, victims of car accidents and gunshots hope to get to a hospital that can save their life - and then stay there. The military strategy is pretty much the opposite - and is, paradoxically, part of the reason the care of soldiers wounded in the Iraq and Afghanistan wars has been so successful.

In both those theaters, the military has placed a few extremely sophisticated hospitals very close to the battlefield. Within a few hours of being wounded, casualties can reach neurosurgeons, maxillofacial surgeons, interventional radiologists, ophthalmologists and intensivists - specialists that previously were farther "up-range" and days away.

Advanced care so close to the fight is feasible only if casualties don't fill up the hospitals and prevent new ones from coming in. To keep that from happening, patients are moved within hours of being treated.


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