equipment. (Orthopedic surgeons, for example, have to detect fractures by feel.) But they can go from rolling to having a fully functioning hospital with two operating tables and four ventilator-equipped recovery beds in under sixty minutes.
Peoples led the 274th FST, which traveled 1,100 miles with troops during the invasion of Iraq. The team set up in Nasiriyah, Najaf, Karbala, and points along the way in the southern desert, then in Mosul in the north, and finally in Baghdad. According to its logs, the unit cared for 132 U.S. and 74 Iraqi casualties (22 of the Iraqis were combatants, 52 civilians) over those initial weeks. Some days were quiet, others overwhelming. On one day in Nasiriyah, the team received ten critically wounded soldiers, among them one with right-lower-extremity shrapnel injuries; one with gunshot wounds to the stomach, small bowel, and liver; another with gunshot wounds to the gallbladder, liver, and transverse colon; one with shrapnel in the neck, chest, and back; one with a gunshot wound through the rectum; and two with extremity gunshot wounds. The next day, fifteen more casualties arrived.
Peoples described to me how radically the new system changed the way he and his team took care of the wounded. On the arrival of the wounded, they carried out the standard Advanced Trauma Life Support protocols that all civilian trauma teams follow. However, because of the highproportion of penetrating wounds--80 percent of casualties seen by the 274th FST had gunshot wounds, shrapnel injuries, or blast injuries--lifesaving operative management is required far more frequently than in civilian trauma centers. The FST's limited supplies provided only for a short period of operative care for a soldier and no more than six hours of postoperative intensive care. So the unit's members focused on damage control, not definitive repair. They packed off liver injuries with gauze pads to stop the bleeding, put temporary plastic tubes in bleeding arteries to shunt the blood past the laceration, stapled off perforated bowel, washed out dirty wounds--whatever was necessary to control contamination and stop hemorrhage. They sought to keep their operations under two hours in length. Then, having stabilized the injuries, they shipped the soldier off--often still anesthetized, on a ventilator, the abdominal wound packed with gauze and left open, bowel loops not yet connected, blood vessels still needing repair--to another team at the next level of care.
They had available to them two Combat Support Hospitals (or CSHs--"CaSHes"--as they call them) in four locations for that next level of care. These are 248-bed hospitals typically with six operating tables, some specialty surgery services, and radiology and laboratory facilities. Mobile hospitals as well, they arrive in modular units by air, tractor trailer, or ship and can be fully functional in twenty-four to forty-eight hours. Even at the CSH level, the goal is not necessarily definitive repair. The maximal length of stay is intended to be three days. Wounded American soldiers requiring longer care are transferred to what's called a level IV hospital--one was established in Kuwait and one in Rota, Spain, but the main one is inLandstuhl, Germany. Those expected to require more than thirty days of treatment are transferred home, mainly to Walter Reed or to Brooke Army Medical Center in San Antonio, Texas. Iraqi prisoners and civilians, however, remain in the CSHs through recovery.
The system took some getting used to. Surgeons at every level initially tended to hold on to their patients, either believing that they could provide definitive care themselves or not trusting that the next level could do so. ("Trust no one" is the mantra we all learn to live by in surgical training.) According to statistics from Walter Reed, during the first few months of the war it took the most severely injured soldiers--those who clearly needed prolonged and extensive care--an average of eight days
Peoples led the 274th FST, which traveled 1,100 miles with troops during the invasion of Iraq. The team set up in Nasiriyah, Najaf, Karbala, and points along the way in the southern desert, then in Mosul in the north, and finally in Baghdad. According to its logs, the unit cared for 132 U.S. and 74 Iraqi casualties (22 of the Iraqis were combatants, 52 civilians) over those initial weeks. Some days were quiet, others overwhelming. On one day in Nasiriyah, the team received ten critically wounded soldiers, among them one with right-lower-extremity shrapnel injuries; one with gunshot wounds to the stomach, small bowel, and liver; another with gunshot wounds to the gallbladder, liver, and transverse colon; one with shrapnel in the neck, chest, and back; one with a gunshot wound through the rectum; and two with extremity gunshot wounds. The next day, fifteen more casualties arrived.
Peoples described to me how radically the new system changed the way he and his team took care of the wounded. On the arrival of the wounded, they carried out the standard Advanced Trauma Life Support protocols that all civilian trauma teams follow. However, because of the highproportion of penetrating wounds--80 percent of casualties seen by the 274th FST had gunshot wounds, shrapnel injuries, or blast injuries--lifesaving operative management is required far more frequently than in civilian trauma centers. The FST's limited supplies provided only for a short period of operative care for a soldier and no more than six hours of postoperative intensive care. So the unit's members focused on damage control, not definitive repair. They packed off liver injuries with gauze pads to stop the bleeding, put temporary plastic tubes in bleeding arteries to shunt the blood past the laceration, stapled off perforated bowel, washed out dirty wounds--whatever was necessary to control contamination and stop hemorrhage. They sought to keep their operations under two hours in length. Then, having stabilized the injuries, they shipped the soldier off--often still anesthetized, on a ventilator, the abdominal wound packed with gauze and left open, bowel loops not yet connected, blood vessels still needing repair--to another team at the next level of care.
They had available to them two Combat Support Hospitals (or CSHs--"CaSHes"--as they call them) in four locations for that next level of care. These are 248-bed hospitals typically with six operating tables, some specialty surgery services, and radiology and laboratory facilities. Mobile hospitals as well, they arrive in modular units by air, tractor trailer, or ship and can be fully functional in twenty-four to forty-eight hours. Even at the CSH level, the goal is not necessarily definitive repair. The maximal length of stay is intended to be three days. Wounded American soldiers requiring longer care are transferred to what's called a level IV hospital--one was established in Kuwait and one in Rota, Spain, but the main one is inLandstuhl, Germany. Those expected to require more than thirty days of treatment are transferred home, mainly to Walter Reed or to Brooke Army Medical Center in San Antonio, Texas. Iraqi prisoners and civilians, however, remain in the CSHs through recovery.
The system took some getting used to. Surgeons at every level initially tended to hold on to their patients, either believing that they could provide definitive care themselves or not trusting that the next level could do so. ("Trust no one" is the mantra we all learn to live by in surgical training.) According to statistics from Walter Reed, during the first few months of the war it took the most severely injured soldiers--those who clearly needed prolonged and extensive care--an average of eight days
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