Surgeons help boost survival rate

Jace Radke

Friday, Feb. 25, 2005 | 9:10 a.m.

Lt. Col. Mark Erickson has been to the Middle East twice in the past three years and is likely to be sent back again soon because people with his skills are in such demand there.

The Las Vegas Valley resident is a surgeon.

"Someone needs to do the job, and I know there is a good chance of me being rotated back there in the future," said Erickson, chief orthopedic flight surgeon at Nellis Air Force Base.

While many specialty skills are in short supply in Iraq, surgeons are among the heaviest tasked military groups as they rotate through makeshift hospitals in Iraq.

According to published reports, including a New England Journal of Medicine article published in December, surgeons are being stretched to care for wounded soldiers in Iraq. Pentagon officials say that there isn't a shortage, but they acknowledge surgeons are among the busiest of the military's personnel.

"Clearly there is a high operation tempo," said Dr. Michael Kilpatrick, deputy director of deployment health support with the Pentagon's Office of Health Affairs. "There are times when it gets very busy for our deployed surgeons."

Kilpatrick estimates that between 50 and 80 surgeons are currently in Iraq, and said the majority of military surgeons have already served in Southwest Asia at least once since fighting began in Afghanistan in late 2001.

He added that the military has adapted to having a finite number of surgeons in the region.

"This is a different war situation than we've ever had," Kilpatrick said. "Right now if an injured soldier can't return to duty within 72 hours the soldier is transported out of theater.

"We are working with a small, highly mobile medical footprint where the goal is stabilization in theater before quickly moving the patient out to hospitals in Germany and the U.S."

The approach seems to be working, according to Dr. Atul Gawande, an assistant professor at the Harvard School of Public Health who penned the New England Journal of Medicine's December article on care of wounded soldiers in Iraq.

Gawande notes that 90 percent of those wounded in action in Iraq and Afghanistan have survived their injuries, up from 76 percent during the Vietnam War. There have been a total of 1,462 U.S. casualties in Iraq and Afghanistan, 1,116 killed in action and 346 as a result of noncombat-related injuries, according to the Defense Department.

"If you look at the outcomes of the injuries and illnesses, the folks we have over there are doing a phenomenal job," Kilpatrick said. "The survival rates are the best we've ever had."

Erickson was stationed in Oman from May through August 2002 in Support of Operation Enduring Freedom, and last year spent March through June in Iraq as part of Operation Iraqi Freedom.

In Iraq Erickson spent most of his time at Tallil Airbase in Southern Iraq near An Nasiriyah, but he was also called upon to work in a mobile medical center at the Baghdad International Airport.

Erickson, 47, was the only orthopedic surgeon stationed at the airport for about three weeks last spring.

"It was generally pretty busy up there (Baghdad), and I was on call 24 hours a day," Erickson said. "There was really only room for two procedures at a time, and, just like (in) a civilian trauma center, when your beds get full you can get overwhelmed."

At the airport Erickson worked in what is known as an EMEDS, Expeditionary Medical Support, unit, which is basically a series of bunker-like tents where medical equipment is set up.

"You're living and working in tents so the challenge is keeping the dust and dirt out," Erickson said. "The weather can also be difficult, because it gets hot and you want to be able to get the patients out of the sun and under cover as quickly as possible."

In Baghdad and around the heavily guarded central part of the city known as the Green Zone, doctors see more gunshot wounds and blast injuries from homemade bombs, mines and suicide bombers, military officials said.

At Tallil Airbase, which serves as a major medical facility for Southern Iraq, the injuries are more varied.

"In Tallil, I'd say about 50 percent of the injuries were vehicle-related," Erickson said. "The main north-south highway runs right by the base, and we'd get a lot of injuries relating to motor vehicles.

"We also saw a lot of gunshot wounds."

Kilpatrick praised the ability of military doctors to adapt to changing circumstances in Iraq and Afghanistan.

"We've obviously gone from major combat to minor insurgency to major insurgency and things continue to change," Kilpatrick said. "The ability of these doctors to remain flexible is a tribute to the training that gave them an idea of what kinds of scenarios they would be facing."

Erickson said that while the surgeons in Iraq are working hard they do it with a good attitude.

"The biggest thing I saw was how everyone was motivated to do as good a job as they could," Erickson said. "The health care there (in Iraq) is actually very good for an austere environment.

"It's not the same as a trauma center in Las Vegas, but it's probably better than what you'd find in some rural communities."