A8 TRAUMA TRANSIT


EZ RE


KLMNO


SUNDAY, NOVEMBER 28, 2010


PHOTOS BY LINDA DAVIDSON/THE WASHINGTON POST Wounded troops at the hospital at Bagramair base in Afghanistan are taken by a specially equipped bus to the runway and then loaded onto a C-17 medical flight toGermany.Many will then fly to theUnited States.


‘Care is not interrupted by pesky little things like moving the patients 10,000 miles’


flight from A1 In both those theaters, the


military has placed a few ex- tremely sophisticated hospitals very close to the battlefield. With- in a few hours of being wounded, casualties can reach neurosur- geons, maxillofacial surgeons, in- terventional radiologists, oph- thalmologists and intensivists — specialists that previously were farther “up-range” and days away. Advanced care so close to the


fight is feasible only if casualties don’t fill up the hospitals and prevent new ones from coming in. To keep that from happening, patients are moved within hours of being treated. Typically, seriously wounded


soldiers move from the “point of injury” to a combat support hos- pital and then to one of the sophisticated “Role 3” hospitals (of which Bagramis one of four in Afghanistan). If they’re hurt bad- ly enough that they won’t be able to recover quickly in-country, they’re brought to Bagram, if they’re not already here. This all takes place within two


or three days of the wounding, with the patient getting surgery and resuscitation at each stop. Five nights a week, evacuation


flights leave the airfield here for Ramstein Air Base in southwest- ern Germany, where there’s been a U.S. military air base since WorldWar II.They are then taken to a giant hospital in nearby Landstuhl for a few more days of treatment before flying home across the Atlantic.Many soldiers are back in the United States within five or six days of being wounded. This strategy was devised after


the 1983 Beirut Marine barracks bombing, in which some of the wounded had to wait more than 12 hours to get surgery and air- crews did not have the expertise to care for them in transit. It works only if transport doesn’t alter or diminish the care soldiers are getting. “The flight is squeezed in be-


tween surgeries, not the other way around,” said Col. Christian R. Benjamin, an Air Force physi- cian and commander of the hos- pital in Bagram. “Continuity of care is not interrupted by pesky little things like moving the pa- tients 10,000 miles.” For evacuations from Bagram,


last summer was the busiest in eight years. The number of criti- cal patients evacuated reached a new peak in July, when 100 were transported. But October proved even more dangerous. By the end of the month, 144 critical patients had been flown out of Afghani- stan, up from 60 the previous October and 25 in October 2008. More than 4,000 critical pa-


tients have been evacuated to Europe from Iraq and Afghani- stan since 2001. Fewer than 10 have died en route.


In Afghanistan In the early afternoon of Oct.


27, Solorzano was shot several times in his thighs while on patrol near Yahya Kel, in central Afghanistan about 15o miles


Air ForceMaj.Marilyn E. Thomas monitors Army Sgt.HiramProvorse aboard the medical flight toGermany. Provorse, 34, was injured in a mortar attack in Afghanistan’s Logar province.He was wounded only a fewdays before he was scheduled to leave.


southwest of Kabul. The bullets broke his right femur and severed his femoral arteries, which sup- ply blood to the legs. “We were told it was impossi-


ble to get him out of the firefight quickly,” Col. Jay A. Johannig- man, one of the surgeons who had worked on Solorzano, said as he watched Gonzalez and his team package the patient for the flight to Germany. Nothing more was known


about the circumstances of Solor- zano’s wounding. Damaged bod- ies travel up-range faster than details about how they got that way. But a buddy who came with him, Sgt. Shawn Allen, did men- tion this: It was Solorzano’s 24th birthday. At the hospital at Forward


Operating Base Sharana, sur- geons tried to get the bleeding under control, without complete success. Solorzano required 30 units of blood, or about 21/2


times


the body’s normal capacity. He received CPR for 65 minutes and suffered unknown damage to the brain. He slowly slipped into the “coagulopathy of trauma,” in which the finely tuned clotting system goes haywire from the consequences of low blood pres- sure, falling temperature and ris- ing acidity in the blood. He was then flown to Bagram.


Ten minutes after his arrival, Johannigman and Maj. Mark Kromer, a 34-year-old Air Force surgeon who grew up in Chevy Chase, took him to the operating room to try to control his bleed- ing once more. They were there four hours. For two of those hours, Johannigman squeezed the aorta shut inside Solorzano’s abdomen, effectively cutting the


AwoundedMarine, Lance Cpl.Nathan Lamie, 24, is among the injured troops who are queued in the hallways of Bagram’s CraigHospital awaiting a flight to Landstuhl RegionalMedical Center inGermany. The next destination often isWalter Reed ArmyMedical Center or theNationalNavalMedical Center.


size of his circulatory system in half so the blood that remained would go to Solorzano’s heart and brain. Three hours after leaving sur-


gery, Solorzano became increas- ingly unstable and was probably still bleeding. He was taken back to the operating room for 90 more minutes. About 3 a.m., the hospital was running low on blood of his type and activated the “walking blood bank.” Someone began calling volun-


teers from a list of pre-screened A-positive donors. Allen, Solorza- no’s buddy, went out into the


chilly night, doing his own search. “I knocked on doors,” he said.


“I was pulling people off buses. I saw soldiers and said, ‘Anybody A-positive? Please rally to the hospital.’ ” More than 50 people showed


up. Thirty-five units of whole blood were collected. Solorzano got 21 units still warm from the donors, the state in which it’s almost a miracle drug. Finally, long after the sun was up, his body pulled out of the dive and leveled off. In all, he’d gotten about 65


units of blood; required a drug, vasopressin, to support his blood pressure; and was in a coma. But he was alive, a fact Johannigman attributed as much to the patient as to the doctors. “We’re privileged by the sol-


diers we’re taking care of,” he said. “They’re specimens of health.We can leverage thephysi- ology of these young soldiers.” Whether he would survive, or


for how long, was uncertain. The staff nevertheless decided to send him to Landstuhl. “We used to say we wouldn’t send someone unless they were


stable.Nowwesay theyhave to be ‘stabilizing,’ ” said Maj. David Zonies, Bagram’s “trauma czar.” “We have pushed our comfort zone considerably.” Johannigman said, “Just like


the soldiers never leave anyone behind, the doctors want to get everyone home.” Solorzano’s parents were con-


tacted inHuntington Park, Calif., and advised to fly to Germany as soon as possible.


In flight Solorzano’s litter was the last


one carried into the brightly lit belly of the airplane, so it would be the first one taken off in Germany—evidence of the grave condition of its occupant. But Solorzano wasn’t the only object of the Critical Care Aeromedical Transport (CCAT) team’s atten- tions. There were three other critical


patients, 18 more patients who were carried on but not critically ill, and 15 who walked on. The patients, the aircrewand a


few passengers occupied the for- ward two-thirds of the jet’s cav- ernous interior. At the forward end were containerized toilets. Toward the aft end was a 10-foot- high cargo box. Beyond it, in an area dark and 15 degrees colder, the retracted ramp sloped up- ward, piled with pallets of cargo. A single row of seats lined the


walls of the plane. Toward the center of the fuselage, the litters were clamped to hangers sus- pended from the ceiling.Onthese triple-decker bunks were patients whose wounds did not require constant vigilance. They lay un- der brightly colored quilts, hand- made by nameless American vol- unteers and given to them, along with candies and crayoned thank-you cards from schoolchil- dren, as part of the “repatriation package.” A profusion of tattooed elbow


webs, biceps amulets, skulls and slogans adorned the arms resting on the sleeping men’s chests and stomachs. At the aft end of the aircraft


were the four critical patients. The sickest other than Solorzano was a soldier who had lost both legs and had his pelvis blown open by a homemade bomb.Near him was a man who had been shot in the left side of the head. The bullet damaged the Broca’s area of the brain, where language expression resides. The soldier can follow directions but can’t speak. “He may never regain that,”


Gonzalez said grimly as he re- viewed a clipboard of data. Only one of the critical patients


could engage the CCAT team in conversation: Hiram Provorse, a red-haired, 34-year-old sergeant and mechanic who had been wounded in a mortar attack in Logar province a few days before he was scheduled to leave. At the foot of his bed, a one-


page summary catalogued his wounds: all three bones in his left leg broken, torn arteries in both legs repaired with bypasses,anda


flight continued onA9


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