Doctors and nurses work around the clock at this hospital to meet the needs of U.S. soldiers who have been severely injured in Iraq, Afghanistan or other combat locations.
The influx of patients with blast and gunshot wounds, burns, or other traumatic injuries from Improvised Explosive Devices (IEDs) and other attacks, has remained steady since the beginning of the U.S.-led invasion of Iraq over two years ago.
A total of more than 28,000 soldiers, airmen, sailors and Marines from Operations Enduring Freedom and Iraqi Freedom have already been treated at Landstuhl hospital, the largest American medical facility outside the continental United States.
While most Americans are resting over the holiday season, the medical personnel at Landstuhl will be working away to help injured troops get well and get home to their loved ones stateside as soon as possible.
"Sure, we would like to be able to go home for the holidays, but so would the soldiers in Iraq," said Major Insel Angus, a reservist nurse from Reno, Nevada, who arrived in Germany last February.
Tough, but rewarding
With an average of 10 critical patients a week, the ICU is the busiest area in the entire facility.
"For the year that I have been here, we have maybe had one or two days when our census was one or none," said Angus. "It does not stay slow for very long and it is always too busy for our taste."
Angus belongs to a reserve group of 300 medical specialists who were brought in to help stabilize the critically wounded and get them back to the United States for further treatment.
Most of her colleagues have left family, regular jobs and even private practices behind.
Yet, recently, Angus and two thirds of her reserve group voluntarily extended their rotation in Germany for another year.
The 49-year old Angus, who became a patient herself when she had to battle cancer two years ago, admits that the job in Landstuhl is emotionally the hardest she has ever worked.
"Once in a while you look at the face of a patient and you see that it is a kid that looks back at you," said Angus.
"But," she added, "it is also the most rewarding job I've ever done."
Medical evacuation
On average, patients stay no longer than three to four days in Landstuhl before they are flown back home from nearby Ramstein Air Base.
Prior to getting on medical evacuation flights, most of the wounded are brought to Ramstein's 435th Contingency Air Staging Facility (CASF), which provides temporary medical care and support for injured soldiers on their way in or out.
The ward is operated by 90 permanently assigned airmen, including 40 reservists.
In the large patient hall, long rows of field beds are lined up. The facility has a maximum capacity of 100 beds. During major attacks in Iraq, up to 60 patients have been treated at a time.
All of the Air Force reservists, like Tech. Sgt. Kathryn Bicker from Phoenix, Arizona, are deployed to Germany for a 120-day rotation.
"I have first-time moms on my team, who have never been away from their children," said Bicker, a medical technician.
"And we have airmen from Keesler Air Force Base in Louisiana, who have watched their homes be destroyed by Hurricane Katrina while they were here," she explained.
For troops injured "down range," Bicker's unit is a first step out of combat and one step closer to home.
Grateful to be heading home
"Laying here in a hospital bed, I realized that the people that watch over us every night also make strong sacrifices," said Lance Cpl. Christian Boyd, 19, from 2/2 Marines, who was injured while on patrol by an IED.
Boyd was anxious to get home. “I am so happy to get to see my mom, my sister, my family because those are the people that kept me going everyday.”
For the final leg of their long journey home, the 86th Aeromedical Evacuation Squadron (AES), at Ramstein Air Base operates at least three regular flights a week, carrying 40 to 50 patients on each scheduled mission.
Additional medical evacuation flights get added if there are critical patients with urgent medical needs. "We have had missions, where we dedicated an entire C-17 aircraft to one single patient," said Lt. Col. Steve Hill, the 86th AES Director of Operations.
On the nine-and-a-half-hour flight to Andrew's Air Force Base the nurses and medical technicians on board experience the gratefulness of their passengers first hand.
Capt. Kristin Keller, an in-flight nurse, says she feels honored to help the soldiers. "To see their faces when we land back in the States, they just light up, some of them are crying, they are just so excited to be home," Keller explained.
Yet, there is also a downside for the troops.
"As happy as they are to be going home, they are also just heart broken to be having to leave their buddies back down range," she added.