Video: Inside a flying intensive care unit

By Robert Bazell Chief science and health correspondent
NBC News
updated 3/6/2007 9:30:03 AM ET 2007-03-06T14:30:03

Call it the UPS for wounded bodies.

It might seem a slight to compare the treatment of U.S. casualties in Iraq to a package delivery service. But rapid, logistically complex movement is precisely what makes the medical care for the wounded soldiers and Marines in this war so good.

Throughout the history of warfare the first goal of military medicine always has been to rush the injured away from the danger of battlefield to an area where they can be treated safely. Until now, that usually meant close to the action.

As recently as the 1991 Gulf War the U.S. wounded remained for weeks or months in hospitals in Kuwait or nearby countries. Now, C-17 Air Force cargo planes, converted into flying intensive care units, transport the injured to hospitals in the United States — usually with a stop in Germany — within a few days. This means admission to facilities with the highest standards of care and, just as important, far easier access to family and friends.

The transport system begins usually begins with a Medivac helicopter, or sometimes a vehicle, rushing the wounded to the nearest hospital. The medics, both in the field with units and the ones in the helicopter, have gotten better at stopping bleeding with improved dressings. In addition, every soldier carries a tourniquet designed with Velcro and a simple twist mechanism that can be applied quickly and easily — even to oneself. 

When military medical officials studied the deaths in Vietnam they learned that 6,500 deaths occurred from bleeding from extremities. These simple steps to stem bleeding have played a big role in lowering the death rate in this war.

Dealing with the basics
It is when the wounded arrive at a Combat Support Hospital (CSH or “Cash,” in military speak) that the care becomes very different from a hospital in the United States.

For the seriously wounded the goal is not necessarily to fix the problem, but to keep the patient alive and stabilize him or her long enough to get to the next stop on the journey home.

For example, doctors, nurses and medics in Iraq worry far less about infection than they would at a hospital in the U.S., although the staff works to keep everything as clean as possible. The wounds themselves are often the filthy aftermath of bomb explosions. In addition, Iraq’s ever-present dust is always blowing, sometimes even into the operating room. When infections occur it is usually three or four days after an injury. By that time, the patient is thousands of miles away.

It is the same with treatments involving surgical repair of bones and internal organs.

“Often you can’t fix everything at once,” says Dr. Darryl Pugh, an Army surgeon in Baghdad from Ft. Belvoir, Va. “Sometimes we do a little bit here, then the guys down the road in Landsthul and Walter Reed do the rest. It’s a very different kid of medicine.”

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“You learn to just deal with the basic stuff,” says Dr. Robert Thaxton, an Air Force doctor from San Antonio at the hospital at Balad, north of Baghdad. “I gotta stop the bleeding. I gotta put an airway in. You don’t need a lot of the fancy stuff. Stabilize. Keep them alive. That is your job.”

After they are stabilized at the outlying CSH’s, the patients travel by helicopter to the hospital at Balad where they are re-checked and treated further, if needed. From Balad they take the C-17 flight to Germany and then onto the U.S.

Highest survival rates
Even with the high-tech equipment and highly-trained medical staff on board, there are still risks. Bubbles in the body can expand or even explode in the under-pressurized cabin. The noise and vibrations can make some injuries worse. Flight surgeons must certify the patients can make the journey.

This medical transport system is under constant pressure to keep its precious cargo moving quickly. 

Medivac helicopters make dozens of runs a day from the field and between hospitals. C-17s take off almost every night. Everyone knows that, at any moment, bad weather, mechanical problems with the aircraft or a surge in casualties can cause a backup, leaving some very sick troops unable to be moved. When that happens, one doctor told me, “We have to make some very tough decisions.” 

Usually the operation runs smoothly, resulting in a survival rate of 96 percent among those who make it to the first hospital — the best in U.S. military history.

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