The images are horrifyingly graphic: gaping, blood-gushing war wounds.
The faces and voices of the military doctors display the strain of daily efforts at "damage-control" surgery as the doctors speak directly to the camera.
FOR THE RECORD:
Training for doctors: An article in Monday's LATExtra section about training videos for military doctors bound for Iraq and Afghanistan incorrectly characterized part of UCLA and Pelagique LLC's contract with the military. The contract included development of an ultrasound simulator for training, not an ultrasound simulator training video. —
"There are a lot of limbs lost," Air Force Maj. Mark Gunst says quietly. "The wounds are always dirty. They're always more extensive than you think they're going to be.... What it looks like on the outside may be only be the tip of the iceberg."
The images and interviews are contained in educational videos produced under a first-of-its-kind effort involving a dozen doctors from UCLA's medical school in cooperation with the Department of Defense.
The goal is to prepare military doctors for the wounds they will see when they deploy to Afghanistan and Iraq — particularly blast-injury wounds from roadside bombs, the enemy's weapon of choice.
Blast injuries, the videos show, are significantly more complex and destructive than the gunshot and knife wounds that the doctors have encountered during their pre-deployment training at urban trauma centers such as Los Angeles County-USC Medical Center.
"What blast injuries do is combine four or five ways of killing and focus them all on one person," said Dr. Eric Savitsky, the lead UCLA doctor on the two-year, $850,000 project funded by the Army.
A blast injury can include massive blood loss, organ and tissue destruction, severe burns and scalding damage to the throat and lungs through inhalation of superheated air — followed quickly by aggressive infection caused by the shards of metal, dirt and other debris embedded at high velocity into the body.
More than 80% of battlefield wounds inflicted on U.S. personnel are blast injuries.
Although the military has compiled other "lessons-learned" material — including a computerized trauma registry tracking more than 40,000 battlefield injury cases — the videos and accompanying text from the UCLA project are seen as a notable advancement in getting doctors ready for both the number of casualties and the gravity of their wounds.
"Even for the most experienced physicians, there is a steep learning curve once they get here," said Army Col. Brian Eastridge, the joint theater trauma system director in Afghanistan. "They have so much to learn about how to resuscitate casualties, how to operate on casualties, how to prioritize casualties, how to treat casualties."
The videos "are going to make that learning curve much easier to pick up on," Eastridge, a surgeon on his fifth deployment, said in a telephone interview from the military hospital in Bagram, Afghanistan.
The film footage comes from the work of a Los Angeles-based veteran cinematographer who was given total access to the emergency room at the Air Force hospital in Balad, Iraq, for six weeks.
Stephen Sheridan filmed night and day while wounded military personnel were rushed into surgery, as well as Iraqi civilians, security personnel and children, and even some insurgents who, just minutes earlier, had attempted to kill Americans.
Sheridan documented a 14-hour operation in which a golf-ball-sized piece of shrapnel was removed from a soldier's skull. He recorded the improvement over several weeks of a 6-year-old child wounded by an insurgent's bomb. And Sheridan was there when a dozen victims from a helicopter crash were brought in.
"It's amazing: You see guys come in so injured and bloody you figure they can never survive," he said. "But these doctors are rock stars — their endurance is incredible."
The amount of blood shown and the close-up views of severed limbs and traumatic wounds — in one scene, a doctor pushes a soldier's intestines back into his body — are far more graphic and extensive than news agencies will show.
The videos include detailed, written explanations by military doctors and other experts, including the UCLA doctors, about emergency surgeries done to stabilize wounded soldiers, airmen, sailors and Marines so they can be airlifted in a specially equipped Air Force cargo plane to the military's Landstuhl Regional Medical Center in Germany.
The videos will be used at medical training sites in the United States and at military hospitals in Afghanistan and Iraq.
Separated into 13 chapters dealing with a medical specialty — such as amputations, brain injuries, burns, eye damage, burns and spinal injuries — and a dozen chapters showing specific operations, the videos are contained on a single DVD. There is a chapter on pediatric trauma, based on the many children wounded by explosions and stray gunfire.
Borden Institute, a military publishing company, plans to distribute 5,000 copies of the book portion of the overall project, which is titled "Combat Casualty Care: Lessons Learned from Operation Enduring Freedom and Operation Iraqi Freedom."
The DVD was introduced in August for viewing by several hundred military medical professionals at the Advanced Technology Applications for Combat Casualty Care Conference held in Florida.
The idea for a multimedia educational presentation was championed by Robert Foster, who, until his recent retirement, was a high-ranking official responsible for research projects for the office of the secretary of Defense.
When doctors began to report back to him about the medical challenges faced by the wounds inflicted by so-called improvised explosive devices, Foster gathered the bureaucratic support needed to develop a competitive grant to be offered through a program to encourage research by small businesses.
After the bidding process, UCLA and Pelagique LLC, a spinoff of the UCLA Center for Advanced Surgical and International Technology, were chosen first for a $100,000 contract to develop the project, and then a $750,000 contract to develop the videos, book and an ultrasound simulator training video.
Savitsky has shown parts of the videos to his students at UCLA to help them gain admiration for their medical colleagues in the military.
"When I show it to my residents, their jaws drop open," he said.