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Quick, quality care key to treating head trauma

The emphasis in battlefield medicine has been moving the injured rapidly to facilities where they can receive immediate trauma care, reports NBC's Robert Bazell.

Within 40 minutes of the attack, Bob Woodruff and Doug Vogt were taken to the Air Force Field Hospital at Balad, Iraq. There they were stabilized in what was probably the most crucial part of their care.

NBC's Pentagon Correspondent Jim Miklaszewski was at that hospital only days ago.

“By all measures,” Miklaszewski says, “It's the best field hospital of its kind, performing brain surgery on an almost daily basis, with an overall survival rate of 96 percent.”

Starting in Vietnam — and much more in Iraq — the emphasis in battlefield medicine has been moving the injured rapidly to such facilities. Experts agree that the most critical determinant of survival with a good outcome is getting the injured person to a high-level treatment center as quickly as possible.

Trauma experts, like Dr. Maurizio Miglietta of New York University's School of Medicine, talk of “a golden hour.”

“The clock starts ticking as soon as the injury occurs and bleeding worsens,” Miglietta says. “Secondary injuries, such as low oxygen levels and low blood pressure, will happen after an injury and those all double and triple your chance of dying.”

In World War II, half of the wounded died. Because of rapid transport, the death rate dropped to 25 percent in Vietnam, and in Iraq it is now about 12 percent.

But many who survive the fast, high-quality care have severe long term effects. With brain injury, neurologists often talk of “the rule of thirds” — one-third survive with no or few lasting effects.

“You have 33 percent of people who will have mild to moderate impairment,” says Dr. Greg Esper of Emory University School of Medicine. “Another third may have moderate to severe impairment.”

And with brain injury, the experts say, it often takes days or weeks to know the full extent of the damage.