Army Cpl. Robert Bosley, a reservist with the 2290th U.S. Army
Hospital in Washington, D.C., learns how to operate a field respirator at Fort
Sam Houston, Texas, from his instructor, Army Staff Sgt. Rachel Marchbanks.
Photo by Donna Miles
(Click photo for screen-resolution image); high-resolution image available.
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At the same time, the military is boosting know-how about treating combat
casualties so everyone on the battlefield, regardless of job specialty, knows
the most basic steps to take to help save a life.
Operations in Iraq and Afghanistan represent the first time these concepts,
which the Army started introducing about eight years ago, are being applied in
combat.
Army Maj. Gen. George W. Weightman, commander of the U.S. Army Medical
Department Center and School here, said the trend reflects research about
injuries, particularly trauma injuries. "What we have found is that the sooner
you get to people after they have been wounded, the better your chances of
saving them," he said.
Weightman said that's particularly true of injuries involving extensive blood
loss, "because that's what kills people on the battlefield if they don't die
instantly," he said. "So the sooner we can get the medical people to them, the
better the outcome."
Recognizing the importance of quick care for wounded troops, the Army started
beefing up its training programs — introducing a three-day combat lifesaver
course taught to all soldiers in their units and creating a whole new job
description for combat medics, who receive their training here, Weightman
explained.
In addition, the Defense Medical Readiness Training Institute here prepares
doctors, nurses, physician assistants and other medical service corps
professionals from all military services for the rigors of combat and the
challenges of providing patient care on the front lines.
But just as important as increasing expertise about combat lifesaving,
Weightman said, is getting it as close as possible to the patient.
In response, each Army company typically includes four to five combat medics,
who operate "right there where the action is happening," he said.
In addition, forward surgical teams, 20-person units that include three
surgeons and an orthopedic surgeon are being assigned at the battalion or
brigade level. Weightman said these teams moved alongside the combat forces
during the early, "manuever" phase of operations in Iraq, cutting medical
evacuations, when necessary, to less than 20 minutes.
Weightman said these teams offer not just trauma care, but also a full spectrum
of services ranging from physical therapy to preventive medicine. "We've pushed
a lot of resources down to the brigade level and the division level," he said.
"So not only can we treat them far forward, we can prevent them from getting
sick and needing to get evacuated."
When necessary, air evacuations to higher-echeleon care facilities are far
shorter than in the past, Weightman said, thanks to the positioning of medical
helicopters closer to the units. "We're able to get down and get to the
soldiers after they'll been wounded and get them back to definitive care in
under an hour — in many cases, in 20 or 30 minutes," he said.
Four Army combat support hospitals throughout Iraq offer the most advanced
patient treatment available in the country, "the best care short of a medical
center," Weightman said.
For medical service troops, the trend toward offering care closer to the front
offers unique challenges and opportunities.
Army Sgt. 1st Class Quentin "Shane" Thompson experienced the trend firsthand
during the opening days of Operation Iraqi Freedom. While coalition troops were
moving north toward Baghdad, Thompson traveled directly alongside them with the
blood supply used to treat casualties.
"We were constantly moving," said Thompson, who quickly set up operations each
time the unit stopped, drawing packed red blood cells from the back of a
refrigerated 5-ton truck.
"Blood management has usually been done in the rear echelon," said Thompson,
now a microbiology instructor at the U.S. Army Medical Department Center and
School's laboratory technician course. "But now the idea is to get the blood
to the person as close as possible to the front lines. We're trying to provide
the best care possible as far forward as possible."
Maj. Tracy Smith, director of the school's physical therapy specialty program,
said she's witnessed the same phenomenon in her field. Although physical
therapists and their assistants once rarely deployed to the battlefield, today
they're in Southwest Asia, providing sports medicine and other related care so
troops can more quickly recover from their injuries and return to the battle.
"In the past, people with minor injuries would normally be sent way back to the
rear," she said. "But with technicians and therapists now forward-deployed,
we've become force multipliers. We truly enhance the numbers of warfighters
(available for duty)."
Maj. Mary Adams-Challenger was among just two physical therapists in Iraq
during the first rotation of Operation Iraqi Freedom, although that number has
since increased exponentially.
By providing physical therapy care at the 21st Combat Support Hospital in Balad
rather than farther to the rear, she said she was able to help return troops to
duty faster, and with better long-term results. "Early intervention is the key
with these acute injuries," she said. "It's all about timing. If you're able to
provide sufficient treatment early on, it's far better for the patient."
 | Army Sgt. Samuel Adegbilero from the 130th Engineering Brigade,
left, receives physical therapy care at the 21st Combat Support Hospital in
Badal, Iraq, from Army Sgt. Erick Cedeno, an occupational therapist assigned to
the 10th Combat Support Hospital, and Army Staff Sgt. Wendy Hansen, a physical
therapy technician from the 21st Combat Support Hospital. Photo by Maj. Mary
Adams-Challenger, USA
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 | High resolution photo
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 | Army Sgt. 1st Class Quentin "Shane" Thompson takes a break at
Logistics Base Dogwood in Iraq, sitting amidst blood supplies he transported
while assigned to Unit Medical Logistics Battalion (Forward). Photo by Sgt.
Erine Oats, USA
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 | High resolution photo
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