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    Saturday, October 27, 2007

    USA TROOPS protected, medical Assurance = LIFE

    Body armor could be a technological hero of war in Iraq

    Bullet-stopping ceramic plates help ground troops stay safe. New battle gear also includes skateboard-style knee pads.

    Staff writer of The Christian Science Monitor
    Forget JDAMs and MOABs, satellites and stealth bombers. For the American GI on the ground in Iraq, the true technological marvel may be four-pound ceramic plates slipped into flak jackets.

    Capable of stopping most bullets, the body armor worn by virtually all of the Army and Marine combat troops in Iraq is being credited with saving many lives. Soldiers shot at close range are walking away with no more than sore backs and broken ribs.

    While the newest smart bombs and electronic wizardry usually get more attention, unheralded improvements in soldiers' gear are improving performance and safety on the battlefield. The new body armor, in particular, may help dramatically reduce casualties in the frequent firefights troops are facing on the road to Baghdad.

    In addition to the lighter and more protective body armor, US soldiers and marines now wear more comfortable, stronger helmets and boots, as well as kneepads.

    "Everything they have is much better," says Robert Kinney, director for individual protection at the Army's Soldiers Center lab in Natick, Mass. "It means a tremendous increase in their quality of life."

    Some of the new equipment results from years of research and development at the Natick lab. Others are drawn from more unusual sources: The kneepads are offshoots of those worn by roller bladers.

    The new body armor, named "the interceptor," is composed of a layered Kevlar vest, similar to but stronger than ones worn by police, as well as attachments to protect the neck and groin. Two other plates slip into the vest and cover vital organs.

    As a result, far fewer casualties arrive at military hospitals with abdomen or chest wounds, says Air Force Maj. Mark Ervin, a surgeon at the Landstuhl Regional Medical Center in Germany. "That's kind of remarkable," Maj. Ervin says. Patients with shrapnel wounds from mines or other explosives often come with wounds along their extremities that stop "like a sunburn line" right where the body armor starts, Ervin adds.

    Altogether it weighs 16 pounds, a third lighter than the previous 20-year-old bulky design that protected only against shrapnel but couldn't stop bullets. Even the earlier vests, though, were far superior to the metal plates sewn into cloth worn by World War II aircraft gunners.

    The lighter weight is welcome relief for soldiers already carrying 100 to 120 pounds of gear. The military began developing the new body armor in the wake of the debacle in Somalia, when US soldiers were wounded after ditching their heavy armor.

    The new gear got its first major battlefield try out during Operation Anaconda in Afghanistan in 2001. Manufacturers credit it with saving the lives of 29 Americans. Similar lightweight ceramic equipment lines the cockpits of military helicopters.

    Manufacturer Simula Inc. has supplied the Army and Marines with 100,000 ceramic plates at a cost of about $800 per soldier, says the company's CEO, Brad Forst. Since January, Simula has ramped up production to 4,000 per week at its Arizona factory and started shipping the plates directly to Kuwait, Mr. Forst says.

    Soldiers' helmets have also evolved since the first Gulf War. Instead of the sling that secured the helmet, the new design uses form-fitting foam pads similar to those found in bicycle helmets.



    Army Medevac Unit Races Against 'Golden Hour'


    Morning Edition, October 25, 2007 · At around midnight, the radio traffic gets heavy inside Eagle Dustoff's operations center.

    Dustoff is an Army medevac unit made up of 90 soldiers and 12 Blackhawk helicopters.

    The unit works out of a remote corner at Balad Air Base, about 60 miles north of Baghdad. Their mission is simple: Evacuate anyone injured on the battlefield as quickly as possible.

    About every half hour, especially at night, an alert comes in.

    An instant messaging system that's attached to an electronic voice blares out the latest injuries in a staccato "Speak & Spell" voice: "LN2 has shrapnel all over the body. A hole in his back may be an exit wound from a chest injury."

    It's at this moment that the clock starts ticking and the "Golden Hour," an emergency medicine concept, begins.

    A dispatcher inside the operations center grabs a walkie-talkie to alert the crew on call to get moving.

    He shouts "MEDEVAC! MEDEVAC! MEDEVAC!" into the two-way radio.

    Mary Rone, from Berkeley, Calif., the only female pilot in the unit, is rustled from a deep sleep and rushes to the operations center.

    "If a soldier survives the attack, after the first couple of minutes, as long as they're transported to a facility within that hour, their chances of survival are over 95 percent," Rone said.

    Within three minutes, Rone will rush to runway to power up the Blackhawk along with the lead pilot, Chief Warrant Officer Alex Bonilla.

    Within eight minutes, the chopper will be on its way to evacuate the injured.

    First Lt. Samuel Diehl, a recent graduate of James Madison University in Virginia and also a pilot in the unit, says the there are two types of injuries he typically encounters.

    "The majority of injuries are pretty much traumatic amputations from explosions and a lot of extremity gunshot wounds, because [the soldiers are] covered by the body armor," Diehl said.

    As the on-call unit rushes into the operations center, their commander, Maj. Michael Pouncey, studies an electronic map of Iraq that shows shifting sectors colored in red. The red areas are danger zones — areas where the helicopters are likely to come under fire. So Pouncey quickly works out the safest route to get to the patient.

    It's been about 2 minutes since the medevac alert came over their walkie-talkies. The crew gets their orders and races out to the runway in near pitch darkness.

    The helicopter swoops up over Balad Air Base and heads east toward the grid coordinates.

    Inside the darkened cabin of the Blackhawk, the smell of diesel is thick. Outside, the pitch darkness is illuminated by colored streaks of red tracer fire and the occasional flash from a gun muzzle.

    Flying to the Wounded

    The helicopter hovers over a blackened field and attempts to land.

    But even with night vision goggles, the pilots can't locate a safe place to touch down.

    They are tense. They know someone is waiting for them, injured, maybe dying, almost certainly in agony.

    For several minutes, the chopper circles just a few hundred feet overhead. The medic and the crew chief double as the Blackhawk's security. They lean out the windows and scan the ground, hoping no one is aiming anything at the helicopter. Experience has shown that the painted red cross on the side of the chopper gives these soldiers little protection from those wanting to shoot it down.

    Finally, the pilots find a safe place to land. The medic, Sgt. Christopher Blesset, slips out of the open window to link up with the ground contact.

    He sees three soldiers dragging a nylon litter — a type of stretcher — through the dusty field. It's too loud to exchange any words, but Blesset knows it has been about 15 minutes since the person lying in the litter was shot. Blesset and the three soldiers load the litter into the Blackhawk.

    In what seems like seconds, the helicopter rises into the sky. The two pilots, Bonilla and Rone, cut through the darkness at top speed. At this point, Bonilla is focused on one thing only.

    "My goal is for the patient not to die in my aircraft," Bonilla said. "We do whatever we can to keep that patient alive until he gets to a higher level of care, so he can get better treatment than [what] we provide in the aircraft with the little bit of equipment that we have."

    In just seven minutes, the helicopter will touch down at one of the most advanced combat field hospitals in history.

    Medics from the trauma ward rush out to the pad to pick up the patients.

    Less than 25 minutes since the attack, the patient is inside the trauma ward at the Air Force hospital inside Balad Air Base....



    'Miracle Workers' Save Lives at Balad Field Hospital


    All Things Considered, October 25, 2007 · Air Force Maj. James Eadie is the coordinating surgeon on-call one recent evening at Balad field hospital in Iraq. He has just been informed that four U.S. soldiers are coming into the trauma ward.

    "OK, listen up," he shouts out to a crowd of about 30 medical technicians and doctors. "We got four patients coming in."

    Three have taken shrapnel from an IED blast. One of them has been hit in the thigh by a high-velocity round.

    At this moment, the clock starts ticking. Balad field hospital is located within Balad Air Base, about 60 miles north of Baghdad. It is the most advanced forward-operating combat hospital in the history of warfare.

    Within minutes, four medics wheel gurneys into the E.R. One soldier's left thigh is wrapped in a blood-soaked bandage. Dr. Eadie races to his side.

    "What's your name?" Eadie asks. "Mellinger," says the soldier. "Brad Mellinger."

    "Ok, Brad, can you touch your toes for me?" asks Eadie.

    Mellinger can't. His left femur is shattered in a hundred different pieces.

    Twenty minutes before, Mellinger, who goes by Brad but is named Kevin, was running a reconnaissance mission on the banks of the Tigris River when he went down.

    He's talking, which is a good sign. But he's in agony. A medic approaches the gurney and administers 10 milligrams of morphine.

    Lt. Col. Jeffrey Bailey, the chief surgeon, takes notes. "He seems like a guy with a potentially life-threatening injury," Bailey says quietly.

    The femur is the strongest and longest bone in the body. It's in a part of the body that holds the most blood; a wound to the femur can mean death by bleeding unless the circulation is temporarily cut off.

    Dr. Jeff McNeil, a major in the Air Force, works to get the bleeding under control. It takes just minutes before McNeil can be confident that Lt. Kevin Mellinger will survive.

    About 45 minutes later, McNeil will move to the operating room to clean out Mellinger's wound, washing out bits of bullet and bone fragments from his thigh.

    "And then we'll get him on the next flight to the [U.S.] Army hospital in Landstuhl [Germany]," McNeil says.

    Unprecedented Survival Rates

    The case of Kevin Mellinger is instructive. It says a lot about how combat medicine has changed.

    In Vietnam, a soldier with Mellinger's wound had a 33 percent higher chance of dying. In Iraq, he can count himself among the 95 percent of the wounded who live.

    "It's a sad fact that surgery has advanced and benefited from all the tragedies and trials of war," said Lt. Col. Christopher Coppola.

    Coppola, like all the other doctors at the Air Force medical center at Balad, is a specialist back home. He does pediatric surgery, but in Iraq he's a trauma surgeon.

    Coppola says the kind of trauma he has seen here is incomparable to what he would see in the U.S. A single patient here may have a destroyed eye, shrapnel embedded in the body, massive chest wound and missing limbs.

    "And so you come over here and work for four months, as we Air Force surgeons do, and it's as if you work in a busy trauma center for two years," Coppola said.

    After Vietnam, the use of tourniquets went out of fashion. It often took six to eight hours to transport a Vietnam-era soldier from the battlefield to a trauma center. In that time, a tourniquet could lead to gangrene, infection and either an amputation or slow death.

    But in Iraq, the combination of tourniquets, chemical blood-clotting pads and lightning-fast transport to this field hospital have resulted in unprecedented survival rates. Most often, the field medics — sometimes a young private-first class — are the first ones to treat the wounded.

    "And they [the field medics] know not to waste time doing too many procedures," says Coppola.



    Combat Medicine: Fast-Tracking Troops to Germany


    Morning Edition, October 26, 2007 · The tiny hillside hamlet of Landstuhl, Germany, is barely a six-hour flight from Balad Air Base in Iraq. But it might as well be on another planet. Landstuhl is green and peaceful and far away from the dust-choked deserts of Iraq.

    Army Lt. Kevin Mellinger arrived at the U.S. Army Regional Medical Center in Landstuhl about 20 hours after being shot in the thigh by a sniper in Iraq. The high-velocity round shattered his femur into a hundred different pieces.

    The flight from Balad actually lands at nearby Ramstein Air Base, where a bus equipped to carry stretchers and medical equipment meets the patients.

    Landstuhl hospital is about 10 minutes away from Ramstein. When the bus arrives, dozens of hospital medics and volunteers are on hand to help off-load the patients.

    By the time Mellinger arrived at the medical center, he had already undergone one operation at Balad hospital in Iraq. At Landstuhl, doctors will perform a second, to wash out the bone and bullet fragments.

    After a few hours of rest and recovery, Mellinger wakes up to call his wife back home in Fort Bragg, N.C.

    "I told her that I was coming home for Christmas," he said. But his wife didn't quite understand. "What?" she asked incredulously. "I thought you were extended for 15 months. That's what they told me yesterday."

    But then Mellinger broke the news. "Babe, I got shot."

    Lessons in Trauma Care

    On the other side of the hospital, the doctor who operated on Mellinger at Landstuhl, Navy Capt. Charles Pasque, looks at the soldier's x-rays. Pasque sardonically calls it a "good war wound."

    The doctor explains that with physical therapy, Mellinger will recover within a year.

    He notes that Mellinger got lucky. The bullet struck a blood vessel in his thigh. But it also ricocheted off his femur, which slowed the bullet down and prevented a potentially worse exit wound.

    By the time Mellinger arrived at Landstuhl, the doctors already had a thick file with his medical records, including x-rays and a CT scan.

    It's another innovation of combat medicine. Doctors now transfer electronic files and scans back and forth between Landstuhl and the combat hospitals in the war zones.

    There is also a live video link between Landstuhl and the combat field hospitals in Balad and Bagram, Afghanistan.

    "We're able to prepare well in advance for the patient's arrival," explains Col. Stephen Flaherty, the chief of surgery at Landstuhl. "We know exactly what has happened to [the patient] and what interventions have already taken place."

    Flaherty says that since the start of the Iraq war, doctors have learned key lessons in trauma care. That's due in part to the distances and the speed at which critically wounded soldiers now travel.

    "You know, 10 years ago, 15 years ago, we were not flying people who were critically ill at 10,000 feet. We can do that now," Flaherty says.

    That's because of the risk of what's known as "compartment syndrome." High altitude sometimes causes muscles and tissue to swell and decay.

    But over the past three years, doctors at Landstuhl have learned that they often need to perform an immediate fasciotomy, a procedure where an incision is made deep into the skin, to relieve that pressure.

    'My Time is Not Yet'

    Back in the recovery room, Mellinger is emerging from a fog. Lying in his hospital bed, he starts to recall the incident that could have killed him.

    "It was scary, it was very scary. I thought I was gonna get shot again because they were close," Mellinger said.

    He pauses for a moment and remembers what went through his mind.

    "I thought to myself, 'Well, God, if this is my time to go, well, I know I'm going to heaven.' So I felt confident," he said. "But then I thought, 'Lord ... I know my time is not yet.'"

    Mellinger is just 24 years old, his whole life ahead of him. Indeed, he was lucky. He cheated death.

    But he also knows that since the war began, more than half of those who didn't make it out of Iraq were even younger than him.



    Now if you with al Qaeda or Taliban medical treatment is different.

    If you die you are a Martyr.

    If you are wounded you are given some heroin, hash or mary-jane, patched up and delivered to your family.

    If you are hurt bad, then you want to get caught, go to USA Army medical step #1 above.


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    Anonymous Anonymous said...

    I really appreciate it.

    7:27 PM  

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