Operation Battlefield Survivability

The Syrian paramilitary fighter, paid by Saddam Hussein to kill Americans, was having surgery to repair the gunshot wounds to his buttocks and legs. U.S. Navy corpsmen already had removed the maggots that infested his wounds during his three days in hiding.

Also Wednesday evening, an Iraqi civilian, his eyes fixed in a thousand-yard stare and his breathing labored, was being examined for a severe head injury suffered hours earlier when he fell from a speeding truck. An Iraqi hospital had merely stitched up the gash at the back of his skull and released him.

And an Iraqi prisoner of war arrived in handcuffs, needing care for a broken nose and eye and jaw injuries suffered when he resisted arrest and took a swing at a Marine. When captured, he was carrying an AK-47 and a rocket-propelled grenade launcher.

Welcome to a moderately active night at the Shock-Trauma Platoon, backed by the Forward Resuscitation Surgical System, two interlocking 360-square-foot tents set up in a muddy, windblown field on the outskirts of this city 100 miles north of Baghdad.

The system is meant to bring emergency-room-style medical care closer to the battlefield and is being touted as the largest advance in combat care since the development of the MASH system of mobile hospitals more than 50 years ago.

“It used to be a race to see if we could get the patient to surgery before he expired,” Navy critical care nurse Lane Folsom said. “Now we’re taking the operating room to the patient, rather than the patient to the operating room.”

The goal is to save the lives of U.S. personnel and others who might otherwise die en route to a rear-area hospital. The medical personnel are in the Navy; Marines fill support jobs in this unit. The Army has established a similar system of mobile emergency rooms.

“We want to capture that golden hour, the first 60 minutes after an injury, when chances for survival are the greatest,” said Dr. William Freudenthal, one of two doctors assigned to this Shock-Trauma Platoon. Two more are part of the surgical team, which trained at Los Angeles County-USC Medical Center.

Being close to the front has meant moving 10 times since the start of the war for this Shock-Trauma Platoon. Before Marines assaulted Tikrit, the ancestral home of Hussein, the platoon and the surgical system already were encamped close enough to hear gunfire from automatic weapons and see the artillery shells explode in brilliant flashes. Earlier in the war, the team dealt with two dozen critically wounded patients -- some U.S. but mostly enemy -- during a 24-hour period in southern Iraq.

Rounds went whistling over the tents while doctors and corpsmen worked on the wounded. “That was the night of hell,” corpsman Lionel Ortega said. “The sky was orange. There was a lot of fear around but a lot of work to do with patients too.”

Freudenthal is convinced that four of the patients treated during that period would have died without the care. Foul weather had grounded evacuation helicopters. The first care given to a wounded soldier or Marine still will be provided, in most cases, by battlefield medical corpsmen, whose bravery is legendary. A Navy corpsman, Vann Johnson, was killed by shrapnel while treating a wounded Marine.

But bringing doctors closer to the front is seen as a boon to what the military calls “battlefield survivability” for troops. After the war, officials will assess whether care has been enhanced enough to justify the cost and danger faced by medical personnel.

There also is the issue of whether the Marine Corps, chronically short of trucks, can justify the use of such vehicles to haul medical gear and personnel. Spread throughout southern and central Iraq, the Marine Corps had 10 of the trauma platoons and six of the surgical system teams. In Tikrit, there was one of each, united by the interlocking tents. As in the 1991 Persian Gulf War, medical teams treated more enemy than U.S. personnel.

The Geneva Convention requires that military medical personnel treat all comers. That often isn’t easy, technically or emotionally.

A story circulated among U.S. forces that an Iraqi soldier being treated by U.S. doctors laughed and said, “I killed two of yours.”

The story, true or apocryphal, had an effect. “Some of my guys have some difficulty treating guys who 20 minutes earlier were trying to kill Marines,” Navy corpsman Monica Florence said. “But I figure once they’re here, and without weapons, you just take care of them. They’re human.”

When prisoners are being treated, a Marine guard is nearby. Prisoners and U.S. personnel are kept separate in recovery tents. On this night, the Marine guard also provided some comfort to the Syrian, who had been wounded after he attempted to ambush a convoy bringing supplies to the medical unit.

“We’re going to make you better. You’re not going to hurt anymore,” Lance Cpl. Brandon Peterson told the groaning patient.

Later he explained his attempt to provide solace to his enemy: “Maybe he’ll go home someday and tell people that Americans aren’t so bad after all,” he said.