[Marxism] Lasting head injuries on the rise in Iraq

Lueko Willms l.willms at jpberlin.de
Thu Jul 8 10:27:37 MDT 2004

## Nachricht vom 08.07.04 weitergeleitet durch Lüko Willms
## Original-Nachrichen-ID: ccilqs$l6t$1 at pencil.math.missouri.edu
## Ersteller: rich at math.missouri.edu

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   Interesting details on the injuries suffered by US soldiers in  

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Lasting head injuries on the rise in Iraq
BAGHDAD, Iraq . The soldiers were lifted into the helicopters under
a moonless sky, their bandaged heads grossly swollen by trauma,
their forms silhouetted by the glow from the row of medical monitors
laid out across their bodies, from ankle to neck.

An orange screen atop the feet registered blood pressure and heart
rate. The blue screen at the knees announced the level of postoperative
pressure on the brain. On the stomach, a small gray readout recorded
the level of medicine pumping into the body. And the slender plastic
box atop the chest signaled that a respirator still breathed for
the lungs under it.

At the door to the busiest hospital in Iraq, a wiry doctor bent
over the worst-looking case, an Army gunner with coarse stitches
holding his scalp together and a bolt protruding from the top of
his head.

Caption: U.S. Marines carry a wounded comrade to a waiting helicopter
during the battle for the city of Husaybah, Iraq, on April 17. So
far in April, more than 900  soldiers and Marines have been wounded
in Iraq,    more than twice the number wounded in October, the
previous high. ANDREW CUTRARO / AP

Lt. Col. Jeff Poffenbarger checked a number on the blue screen,
announced it dangerously high and quickly pushed a clear

liquid through a syringe into the gunner's bloodstream. The number
fell like a rock.

"We're just preparing for something a brain-injured person should
not do two days out, which is travel to Germany," the neurologist
said. He smiled grimly and started toward the UH-60 Black Hawk
thwump-thwumping out on the helipad, waiting to spirit out of Iraq
one more of the hundreds of Americans wounded here this month.

While attention remains riveted on the rising count of Americans
killed in action . more than 100 so far in April . doctors at the
main combat support hospital in Iraq are reeling from a stream of
young soldiers with wounds so devastating that they probably would
have been fatal in any previous war.

More and more in Iraq, combat surgeons say, the wounds involve
severe damage to the head and eyes . injuries that leave soldiers
brain-damaged or blind, or both, and the doctors who see them first
struggling against despair.

For months the gravest wounds have been caused by roadside bombs .
improvised explosives that negate the protection of Kevlar helmets
by blowing shrapnel and dirt upward into the face. In addition,
firefights with guerrillas have surged recently, causing a sharp
rise in head wounds.

The neurosurgeons at the 31st Combat Support Hospital measure the
damage in the number of skulls they open to get to the injured brain
inside, a procedure known as a craniotomy. "We've done more in eight
weeks than the previous neurosurgery team did in eight months,"
Poffenbarger said.

Numbers tell part of the story. So far in April, more than 900
soldiers and Marines have been wounded in Iraq, more than twice the
number wounded in October, the previous high. With the tally still
climbing, this month's injuries account for about a quarter of the
3,864 U.S. servicemen and women listed as wounded in action since
the March 2003 invasion.

About half the wounded troops have suffered injuries light enough
that they were able to return to duty after treatment, according
to the Pentagon.

The others arrive on stretchers at the hospitals operated by the
31st CSH. "These injuries," said Lt. Col. Stephen Smith, executive
officer of the Baghdad facility, "are horrific."

By design, the Baghdad hospital sees the worst. Unlike its sister
hospital on a sprawling air base located in Balad, north of the
capital, the staff of 300 in Baghdad includes the only ophthalmology
and neurology surgical teams in Iraq, so if a victim has damage to
the head, the medevac sets out for the facility here, located in
the heavily fortified coalition headquarters known as the Green

Once there, doctors scramble. A patient might remain in the combat
hospital for only six hours. The goal is lightning-swift, expert
treatment, followed as quickly as possible by transfer to the
military hospital in Landstuhl, Germany.

While waiting for the helicopters, the Baghdad medical staff studies
photos of wounds they used to see once or twice in a military
campaign but now treat every day. And they struggle with the
implications of a system that can move a wounded soldier from a
booby-trapped roadside to an operating room in less than an hour.

"We're saving more people than should be saved, probably," Lt. Col.
Robert Carroll said. "We're saving severely injured people. Legs.
Eyes. Part of the brain."

Carroll, an eye surgeon from Waynesville, Mo., sat at his desk
during a rare slow night last Wednesday and called up a digital
photo on his laptop computer. The image was of a brain opened for
surgery earlier that day, the skull neatly lifted away, most of the
organ healthy and pink. But a thumb-sized section behind the ear
was gray.

"See all that dark stuff? That's dead brain," he said. "That ain't
gonna regenerate. And that's not uncommon. ... We do craniotomies
on average, lately, of one a day."

"We can save you," the surgeon said. "You might not be what you

Accurate statistics are not yet available on recovery from this new
round of battlefield brain injuries, an obstacle that frustrates
combat surgeons. But judging by medical literature and surgeons'
experience with their own patients, "three or four months from now,
50 to 60 percent will be functional and doing things," said Maj.
Richard Gullick.

"Functional," he said, means "up and around, but with pretty
significant disabilities," including paralysis.

The remaining 40 percent to 50 percent of patients include those
whom the surgeons send to Europe, and on to the United States, with
no prospect of regaining consciousness. The practice, subject to
review after gathering feedback from families, assumes that loved
ones will find value in holding the soldier's hand before confronting
the decision to remove life support.

"I'm actually glad I'm here and not at home, tending to all the
social issues with all these broken soldiers," Carroll said.

But the toll on the combat medical staff is itself acute, and

In a comprehensive Army survey of troop morale across Iraq, taken
in September, the unit with the lowest spirits was the one that ran
the combat hospitals until the 31st arrived in late January. The
three months since then have been substantially more intense.

"We've all reached our saturation for drama trauma," said Maj. Greg
Kidwell, head nurse in the emergency room.

On April 4, the hospital received 36 wounded in four hours. A U.S.
patrol in Baghdad's Sadr City slum was ambushed at dusk, and the
battle for the Shiite Muslim neighborhood lasted most of the night.
The event qualified as a "mass casualty," defined as more casualties
than can be accommodated by the 10 trauma beds in the emergency

"I'd never really seen a 'mass cal' before April 4," said Lt. Col.
John Xenos, an orthopedic surgeon from Fairfax, Va. "And it just
kept coming and coming. I think that week we had three or four mass

The ambush heralded a wave of attacks by a Shiite militia across
southern Iraq. The next morning, another front erupted when Marines
cordoned off Fallujah. The engagements there led to record casualties.

"Intellectually, you tell yourself you're prepared," said Gullick,
from San Antonio. "You do the reading. You study the slides. But
being here ... it's just the sheer volume."

In part, the surge in casualties reflects more frequent firefights
after a year in which roadside bombings made up the bulk of attacks.
At the same time, insurgents began planting improvised explosive
devices (IEDs) in what one officer called "ridiculous numbers."

The improvised bombs are extraordinarily destructive. They're
detonated by remote control and may be packed with such debris as
broken glass, nails, sometimes even gravel.

To protect against the blasts, the U.S. military has wrapped many
of its vehicles in armor. Troops wear armor as well, providing
protection that Gullick called "orders of magnitude from what we've
had before. But it just shifts the injury pattern from a lot of
abdominal injuries to extremity and head and face wounds."

The skull of the Army gunner whom Poffenbarger was preparing for
the flight to Germany had been pierced by shrapnel from four 155mm
shells, rigged to detonate one after another in what soldiers call
a "daisy chain." The shrapnel took a fortunate route through his
brain, however, and "when all is said and done, he should be
independent. ... He'll have speech, cognition, vision."

On a nearby stretcher, Staff Sgt. Rene Fernandez struggled to see
from eyes bruised nearly shut.

"We were clearing the area and an IED went off," he said, describing
an incident outside Ramadi where his unit was patrolling on foot.

The Houston native counted himself lucky, escaping with a concussion
and facial wounds. Waiting for his own hop to the hospital plane
headed north, he said what most soldiers tell surgeons: What he
most wanted was to return to his unit.

By Karl Vick for The Washington Post coming home: the series tao
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