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The Journey Through Trauma

U.S. troops who survive the critical `golden hour' after being seriously wounded in Iraq owe their lives to a fast-acting team of battlefield medics, pilots, nurses and surgeons.

April 03, 2006|David Zucchino | Times Staff Writer

Balad Air Base, Iraq — As Lance Cpl. Ryan Buchter lay bleeding in the Iraqi desert, his fate hinged on the efficiency of a medical lifeline that stretches halfway around the world. From that moment forward, hundreds of strangers would work to save him.

Buchter's platoon was in a village called Husaybah on Nov. 8, searching for the enemy. He was standing in the doorway of a farmhouse when an insurgent inside rolled a grenade at his feet.

The explosion shredded Buchter's left leg as superheated shrapnel tore through muscles and tendons. More shrapnel crushed his right hand and sliced into his nasal cavity.

Buchter groped for his nose but couldn't feel it. He thought it had been blown off. He leg was so shattered that he was certain he would lose it, and he imagined being left crippled at age 20.

"And not once did I cry," he recalled later, "until I thought, like, I was going to lose my leg and stuff."

A Marine applied a pressure bandage to Buchter's leg, trying to stop the bleeding. Another wrapped his hand and pressed gauze against his pulverized nose. The Marines quickly loaded Buchter into an armored vehicle, which delivered him to a medical aid station nearby.

Buchter survived the "golden hour" -- the 60 minutes following a serious battlefield wound, when the speed and competence of emergency treatment can mean the difference between life and death. Ordinary fighting men teamed with doctors, surgeons and nurses to keep him alive.

His fellow Marines -- what the military calls his "battle buddies" -- were able to stanch his bleeding by putting their combat lifesaving training to quick use. Exsanguination, or bleeding to death, is the leading cause of death for American troops in Iraq.

As a military doctor examined his leg inside the aid station, Buchter was alarmed by the concerned look on the man's face.

"If I lose my leg, I'm coming back to get you," he told him.

The doctor assured Buchter that his leg would be saved. "You've got my word," he said.

Then a surgeon arrived and warned Buchter that he might indeed lose his leg. The best option to save it, he told him, was a very painful and sometimes disfiguring surgery called a fasciotomy, the extensive cutting and cleaning of the wound.

"And I was like, 'Cut me up if you have to. I just don't want to lose my leg,' " Buchter recalled.

The medical odyssey of this Marine was just beginning. Buchter was now a patient in a virtual assembly line of care. It begins with soldiers and medics on the battlefield and shifts quickly to helicopter crews who pluck the wounded from kill zones. It continues to surgeons and nurses and X-ray technicians at desert facilities, and to virtual flying hospitals that airlift the wounded from Balad to a U.S. military hospital in Germany.

It leaps the Atlantic to major military medical centers in Texas and Washington, D.C. It passes through military hospitals from New York to California. It culminates with months of painstaking physical and occupational therapy in hospital wards and private homes. About 17,400 wounded have been treated since the war began three years ago.

The fulcrum for treatment in Iraq is the U.S. Air Force Theater Hospital in Balad. In addition to the troops brought directly to the hospital, any seriously wounded American must make a stop in Balad to be flown for treatment in Germany. The facility is housed inside three dozen tents and three trailers on the packed sands of a former Iraqi air force base 50 miles north of Baghdad. Sandbags, concrete blast walls and concertina wire provide protection from insurgents, car bombs and mortars.

The military says no injured American is more than 30 minutes from Balad or one of three combat support hospitals operated by the Army.

The rapid evacuation of wounded troops begins with Black Hawk medevac crews of four -- nicknamed "dust-off" teams -- trained to respond rapidly to distress calls from the battlefield.

From their dusty tent base about a mile from the hospital, the Army air ambulance companies keep three helicopters and crews ready at all times. The copters occupy a corner of the air base, the thumping of their rotors competing with the roar of F-16s taking off and the low hum of armed reconnaissance drones.

The crews are called to action by "nine-lines," the emergency radio calls from the battlefield that provide nine essential bits of information: location, number of wounded, whether the landing zone is "hot," or under fire, and so on. In most cases, the crews say, their helicopters lift off within eight to 10 minutes.

At the sites of injuries -- most often caused by improvised explosive devices or car bombs -- the pilot and copilot remain in the helicopter. The crew chief provides security as soldiers on the ground help the medic load and strap down the wounded.

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