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Dead Men Walking
Discover February 22, 2007 | MedicineIn a flash, the blast incinerates air, sprays metal, burns flesh. Milliseconds after an improvised explosive device (IED) detonates, a blink after a mortar shell blows, an overpressurization wave engulfs the human body, and just as quickly, an underpressure wave follows and vanishes. Eardrums burst, bubbles appear in the bloodstream, the heart slows. A soldier-or a civilian-can survive the blast without a single penetrating wound and still receive the worst diagnosis: traumatic brain injury, or TBI, the signature injury of the Iraq War.
But in the same instant that the blast unleashes chaos, it also activates the most organized and sophisticated trauma care in history.
***Heroic measures may be yielding unprecedented survival rates, but they also carry a grim consequence: No other war has created so many seriously disabled veterans. Soldiers are surviving some brain injuries with only their brain stems unimpaired.
The moment an injured soldier hits the helipad at Balad, he's swept into a whirlwind of critical care. It's the one ER in the world where up to 10 surgical specialists are hell-bent on saving a life. Patients get lined up with IVs and catheters, undergo CT scans and X-rays, and then hit the operating table-the hospital's best time is 18 minutes. The head-and-neck team tackles their trauma while a cardiothoracic surgeon and a vascular surgeon go to work on the chest. They're shoulder to shoulder with the urologist, who's brushing against the chief trauma surgeon, who's coordinating everything over the buzz of orthopedic surgeons drilling external fixators into bone. It's crowded. It's hot.Amid the cramped bustle, doctors are pushing the boundaries of medicine. They're going through crates of the hemophilia drug Factor VII, yet to be approved for trauma but a wonder drug in stopping bleed-outs. ***
In a matter of minutes, a surgeon will saw the skull in half and discard the damaged portion. There will be a plastic replacement waiting farther down the line. Shrapnel is excised, cerebral tissue swells, and the scalp is pulled taut and sewn back over a ballooning brain. Thanks to the wealth of surgical resources, a procedure that takes several hours in any general hospital in the United States might take Balad surgeons 30 minutes. "The secret to our hospital's ability is throughput," Powell says. "We have to keep churning. Things that would overwhelm a major hospital would not overwhelm us. During the worst incident, we had 35 people come to us in 90 minutes, all by helicopter, landing with just horrible injuries."
"There are soft tissue traumas where we have no scalp, no eye, and no skull base left," Grant says. "And we have to somehow treat that acutely in one surgery setting."
Oh, a plug for Discover, which our house subscribes too. It's a great magazine for helping one understand science.