GIs in Iraq surviving horrific wounds

For every American soldier killed in Iraq, nine others have been wounded and survived — the highest rate of any war in U.S. history.

It isn't that their injuries were less serious, a new report says. In fact, some young soldiers and Marines have had faces, arms and legs blown off and are now returning home badly maimed. But they have survived thanks, in part, to armorlike vests and fast treatment from doctors on the move with surgical kits in backpacks.

"This is unprecedented. People who lose not just one but two or three extremities are people who just have not survived in the past," said Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston who researched military medicine and wrote about it in Thursday's New England Journal of Medicine.

The journal also published a five-page spread of 21 military photographs that graphically depict the horrific injuries and conditions under which these modern-day MASH surgeons operate.

"We thought a lot about it," said the journal's editor, Dr. Jeffrey Drazen, and ultimately decided the pictures told an important story.

"This war is producing unique injuries — less lethal but more traumatic," he said.

In one traumatic case, Gawande tells of an airman who lost both legs, his right hand and part of his face. "How he and others like him will be able to live and function remains an open question," Gawande writes.

Kevlar helmets and vests are one reason for the high survival rate.

"The critical core, your chest and your abdomen, are protected," said Dr. George Peoples, a Walter Reed Army Medical Center surgeon who served in Iraq and Afghanistan. "Paradoxically, what we've seen is devastating extremity injuries because people are surviving wounds they otherwise wouldn't have."

By mid-November, 10,369 American troops had been wounded in battle in Afghanistan or Iraq, and 1,004 had died — a survival rate of roughly 90 percent. In the Vietnam War, one in four wounded died, virtually all of them before they could reach MASH units some distance from the fighting.

Today in Iraq, real-life Hawkeyes and B.J. Hunnicuts have stripped trauma surgery to its most basic level, carrying "mini-hospitals" in six Humvees and field operating kits in five backpacks so they can move with troops and do surgery on the spot.

"Within an hour, we drop the tents and set up the OR tables, and we can pretty much start operating immediately," said Peoples, whose photographs are in the medical journal.