It wouldn’t be until the first trauma case that we’d all truly find out.

Finished reading Paradise General by Dr. Dave Hnida.  He is a medical doctor who mid-life (with wife and family at home) joins the Army Reserves.  He serves two tours, one in 2004 and one in 2007 in Iraq.  The torus are short (four months) but overwhelming.  A tidal wave challenge to skills and endurance and humanity and physical and mental exhaustion.  

He is a good story-teller and it is an eye-opener in the detail to some larger picture trends of which I was aware.

One aspect is the well-established fact that the chances of survival from a wound are highly correlated to the amount of time between wounding and treatment.  Hence a tiered service provision.  There are medics in the field who provide the first and most basic treatment - tourniquets, morphine, basic splints.  

Then there are the medics who accompany the infantry from the field of engagement, usually via helicopter, to front line hospitals of which there were about a dozen in Iraq.  If the wounds are more severe, the patient is transported to one of the other eleven hospitals where there are specialists (such as neurosurgeons, burn specialists, etc.).  If so severely wounded, they are transported directly to the American base in Germany or back to the USA.

Every transport is a risk to the patient so you do it as little as possible.  But you balance that with getting them the appropriate level of treatment as soon as it is known what that level is.  

Within the forward hospital, there is an amazing coordination of skills and shifts as well, to say nothing of personalities and contingencies.  

All war is tragic and not all wounded on the field even make it to the first stage of hospital treatment, but if they do, the prospects of survival reach 90%, 95%, even 98%.  Phenomenal but at an immense cost to all the support personnel involved.  Long hours, constant hours, perpetual existential and ethical decisions to be made, doubts and disappointments, physically exhausting conditions betweens the work, the bad food, and the heat, etc.  

Recommended reading for an important aspect of the near battlefield experience.

Given that the doctors served a four month rotation, the hand off between the old team and new team was critical and hung by the thread of a couple of days shadowing and by the safety nets of the medics and the nurses (on a fifteen month rotation).  Hnida on his first day of full responsibility.  From Paradise General by Dr. Dave Hnida, Chapter 5.  

The place looked like a foreign land, and as I scanned the room, I was surprised at how young the medics were. Some of them looked like they had just been introduced to a razor. With an average age of maybe twenty-three, they had already seen enough carnage to last several lifetimes. Many had no background in medicine before being deployed; some were carpenters, some were schoolteachers, and others full-time college students. All were reservists and all had volunteered to spend fifteen months of their lives saving lives. And they were very good at it. The hospital boasted a survival rate of more than 95 percent, which meant we new docs were under some serious pressure to perform. They silently stared and tightly nodded greetings as Courage handed me my full cup of high-octane. As I nodded back, I could read their thoughts: Is this guy stupid or smart, arrogant or cool? And what about the rest of the doctors? Just who and what were they? It wouldn’t be until the first trauma case that we’d all truly find out.