LANDSTUHL, Germany — As the number of casualties from the Persian Gulf grows, U.S. military officials say they are ready to handle the wounded despite significant cutbacks in medical facilities for American armed forces in Europe.
The U.S. military has only one major hospital left in Europe, down from three during the 1991 Persian Gulf War. Two of the facilities were shut down as the U.S. scaled back its troops on the continent, leaving Landstuhl Regional Medical Center in southwestern Germany as the military's largest hospital overseas.
To cope with a potential flood of war wounded, the Navy has activated a field hospital at its station in Rota, Spain. Together, the Landstuhl and Rota facilities act as the clearinghouse for virtually all American wounded, who are flown first to Europe for treatment before going to the U.S.
The two hospitals have a total of about 450 beds, far fewer than what was available during the 1991 war, when Landstuhl and big hospitals in nearby Frankfurt and Wiesbaden offered nearly 1,000 beds.
Even then, there were questions about whether the military was adequately prepared to handle large numbers of casualties.
Col. David Rubenstein, chief of the Landstuhl hospital, acknowledged that his greatest concern is "too many patients"-- not the kind or extent of their injuries, he said, but simply a volume that could overwhelm the hospital's resources.
Landstuhl has taken in 203 patients from the current conflict, 87 of them combat casualties, many with blast wounds. Typically, a patient stays just a few days before being transferred to the U.S., freeing up beds for the next arrivals.
U.S. military planners prefer not to talk about casualty projections, fearing a negative effect on troop morale and support for the war at home.
But in 1991, Rubenstein said, "the initial projection was that there would be thousands upon thousands of casualties. That didn't materialize. Our planning has become more precise."
If necessary, he can call on German military and civilian hospitals for support through agreements worked out with local governments. Rubenstein has access to 3,000 extra hospital beds within a half-hour's drive of the Landstuhl medical center.
In peacetime, the Landstuhl facility, which sits atop a wooded hill that's a five-minute helicopter ride from Ramstein Air Base, has a capacity of about 150 beds. Over the last year, Rubenstein said, the hospital has been gearing up for a war in the Persian Gulf, putting up temporary buildings and doubling the number of beds, to 322. It can expand to 450 if necessary.
The hospital has boosted its staff of 1,300 with 600 employees, the majority of them Army reservists called up from the U.S. This has increased the number of physicians from 120 to about 140, surgeons from 35 to 45 and specialists from 33 to 37, with expertise in everything from rare skin diseases to radiology. "We do everything here but open-heart surgery," Rubenstein said.
To preserve a sense of normality in these tense times, he has insisted that the hospital continue to treat its civilian patients and military spouses and children. For now -- things could change if war wounded start flooding in -- Landstuhl's doctors and nurses are delivering babies and providing neonatal and pediatric care.
New staff members must take a weeklong course in treating severe trauma injuries and work under the supervision of more experienced military doctors.
The hospital also has beefed up its number of mental health staffers, from 16 to 20, whose job is to counsel not just the wounded but also those who tend to them.
"We've learned how to process both the soldiers and staff in these kinds of events," said David McLean, chief chaplain at Landstuhl.