Military surgeons in Iraq treat crushed bones, embedded shrapnel and nearly severed limbs, sometimes all at once.
The evolution of surgery and emergency treatment on the battlefield influences civilian care. The invention of the ambulance and helicopter evacuation came from wartime necessity.
On Friday, Lt. Col. W. Darrin Clouse, chief of endovascular services at Wilford Hall Air Force Medical Center in Texas, shared what surgeons face daily in Iraq with physicians and staff at Roper Hospital.
"If you want to be a surgeon, go to war," Clouse said, paraphrasing the Greek maxim. "You have to do everything. You touch every part of the body."
Vascular surgery, which focuses on the body's circulatory system of veins and arteries, is important in war, where a major cause of death is bleeding.
After the Cold War, surgical teams were made leaner and more mobile and traveled closer to the action, Clouse said.
In Iraq, a team of five can travel where needed, within 100 yards of battle, and deliver immediate care. A general surgeon, an orthopedic surgeon, an anesthesiologist and two operating room technicians comprise a team, Clouse said. On their backs, they carry all they need to set up a mobile operating theater.
Patients are then sent to the "CASH," or Combat Support Hospital, then on to Germany and the U.S. The philosophy of military surgeons is to keep the patient alive at any cost and use unconventional approaches, as needed. "Then, move them," Clouse said.
Getting the injured to surgeons faster is one reason amputations have dropped from about 50 percent in World Wars I and II to less than 10 percent today. During the World Wars, injured troops were evacuated before receiving definitive care.
The rate of amputations was nearly halved during the Korean War, when large numbers of military surgeons began using patients' own tissue to rewire vascular injuries, Clouse said. Also, helicopter evacuations got the injured to care faster.
In Iraq, the convergence of various military units has demanded improvements in communication and the use of electronic records.