Continuing Afghanistan Conflict More Severe Injuries Keep Landstuhl Busy

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By Sandra Basu

WASHINGTON — On Dec. 27, when the U.S. military was only two days away from completing its pullout of troops of Iraq, came casualty reports from Afghanistan, a stark reminder of the war still being fought: Three soldiers died, in Paktia, Afghanistan, of wounds suffered when their unit was attacked with an improvised explosive device.

While military action in Iraq may have ended in 2011, military medical centers such as Landstuhl Regional Medical Center in Germany continue to be busy caring for seriously wounded from Afghanistan.

“Despite the fact that [the conflict in Iraq] is over, our numbers have actually not decreased considerably. … Even in June of last year, it was the 10th-busiest month in terms of casualties since the beginning of the conflict, so our numbers really haven’t significantly decreased,” Air Force Maj. David Zonies, MD, interim trauma director at Landstuhl Regional Medical Center (LRMC), told U.S. Medicine.

Casualties

LRMC has been treating patients evacuated from Iraq and Afghanistan, including Coalition military members and civilian government employees and civilian contractors. 

Zonies said the medical center is fully staffed to continue to care for the injured troops that come in from theater. In 2011, LRMC received 7,615 wounded troops from theater, with 202 of them from non-U.S. Coalition Forces. Overall, the complexity and severity of injuries seems to have increased.  


Landstuhl Regional Medical Center in Germany remains busy caring for war casualties in Afganistan. _ LRMC photo

“The injury patterns we saw from Iraq were more gunshot wounds and smaller explosives,” said Zonies. “In Afghanistan, the explosives that are used are, I presume, of a higher capacity because the amputations that are generated from the dismounted improvised explosive devices are causing severe lower extremity amputation, multiple extremity amputations, and, because of the high impact of the explosives to the lower legs, it creates injuries to the pelvis and perineum.”

Afghganistan Casualties Transported Directly to Brooke Army Medical Center
Brooke Army Medical Center in San Antonio also continues to be very busy with patient care, even as military operations have ceased in Iraq.
“The numbers here at Brooke Army Medical Center (BAMC) have gone up, but that is because patients are taking direct flights from Afghanistan straight here to San Antonio, so we are becoming more of a hub for casualties,” Col. Joseph Chozinski, deputy commander for clinical services for Brooke Army Medical Center, told U.S. Medicine. “That is not to say that the total number of casualties has gone up, because we don’t get all of the casualties here.”
It also is business as usual at Brooke’s Army Burn Center, which has been responsible for caring for burn-injury casualties from the wars and is the only burn center in DoD. The Army Burn Center treats burn patients from the local area as well as military casualties, according to Chozinski.
One effect of the Iraq drawdown, Chozinski said, is the expected return of deployed military medical personnel. This will help BAMC provide more services and allow it to send fewer patients to civilian providers in the TRICARE network.
“The more people we have to deploy, the less care we can offer stateside, and so getting some of these people back will make our clinics robust and will allow us to not send as many patients ‘downtown’ as we had been,” he said.

In November, the Army released a report on dismounted complex-blast injuries detailing the severity of those injuries, which are defined as explosion-induced battle injuries sustained by a servicemember on foot patrol that involves traumatic amputation of one leg, at least a severe injury to the other leg and a possible pelvic, abdominal and/or genital or urinary injury. The report stated that the incidence of these injuries had increased during the last 15 months of combat in the Afghanistan and that the number of extremity injuries, to include major amputations, had exceeded that seen within Iraq at any point.

The report also pointed to the increase in the number and severity of genitourinary injuries, particularly injury to the external genitalia. Zonies confirmed that the number of genitourinary injuries appears to have spiked over the last year or so.

Landstuhl Prepares For The Future

While patient care is at the forefront now, Landstuhl is preparing for when fewer war casualties will come through the doors. 

“As the conflict starts to wind down, one of the questions we have here is, ‘How are we going to flex-up flex-down?’, because certainly if we see less patients, which is a good thing, we won’t need the same amount of resources here,” Zonies said.

Landstuhl officials are working to create a document that will codify what has been learned during the past decade about establishing effective care for injured troops.

“Should there be a conflict here again that we need to support in another five or 10 years or somewhere else in the world, and a medical-center need to stand up a trauma center, we are currently working on a document that will codify what we have learned … so we don’t have to relearn the same painful lessons of how to set up the various systems and contingencies that we have here. So someone can just pull it off the shelf and know exactly how many personnel you need in each area,” he said.

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