[Congressional Record Volume 150, Number 56 (Wednesday, April 28, 2004)]
[Senate]
[Pages S4466-S4468]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 PRAISE FOR MILITARY MEDICAL COMMUNITY

  Mr. STEVENS. Madam President, the Senator is very kind, and I thank 
the Senator from Tennessee.
  Madam President, I come to the floor today to inform the Senate of 
the outstanding commitment, courage, and professionalism of our 
military medical community. This morning, the Senator from Hawaii and I 
cochaired a hearing with the Surgeons General and the chiefs of the 
Nursing Corps from each branch of the Armed Forces. We were joined by 
Army Surgeon General James Peake, Navy Surgeon General Michael Cowan, 
and Air Force Surgeon General George Taylor. From the Service Nursing 
Corps, we heard from Army COL Deborah Gustke, Navy ADM Nancy Lescavage, 
and Air Force GEN Barbara Brannon.
  I want the Senate to note and personally thank each of our witnesses 
today for the outstanding leadership they provided to our military 
medical community. Their individual accomplishments are numerous.
  I offer a special recognition to Surgeons General Peake and Cowan, 
who will be retiring from Active Duty this year. We greatly appreciate 
their service in military medicine, to our Nation, and especially their 
assistance to the Appropriations Subcommittee on Defense. The insight 
they provided to the subcommittee is invaluable. I congratulate each 
one of them on a successful and distinguished career.
  During today's hearing, the members of the committee and I were told 
of outstanding accomplishments by our military medical leaders. I have 
come to the Senate to share some of what we learned today with my 
colleagues.
  Over the last year, our thoughts have never been far from the 
battlefields, or from the soldiers and families who have sacrificed so 
much for our Nation. I salute our brave soldiers, sailors, airmen, and 
marines for their efforts in the war on terrorism. I join the families 
of our lost sons and daughters in mourning and remembering those who 
made the ultimate sacrifice in the defense of freedom.
  I have seen many headlines about the casualties of the war, but the 
accomplishments of our military doctors, nurses, and corpsmen are 
seldom mentioned. These health care professionals were among the first 
to rush to the battlefield, and they are still on the front lines 
providing care in some of the most dangerous and difficult conditions.
  Today our combat medics regularly perform miracles. They use 
transformational technology to successfully expand the ``golden hour'' 
of trauma care, the critical hour of opportunity from when a trauma is 
sustained and the lives can be most often saved.

[[Page S4467]]

  One telling statistic is the lowest ``died of wounds rate'' in 
recorded history of warfare.
  A number of factors have contributed to this accomplishment, but the 
mobile surgical teams have been crucial. They bring resuscitative 
surgical care onto the battlefield. Without the care they get within 
the ``golden hour'' after being wounded, the 15 to 20 percent of 
wounded soldiers they target would probably die while being evacuated 
to the combat support hospital.
  These surgical teams are specially equipped to deal with excessive 
hemorrhaging, which has been the major cause of death in previous 
conflicts. One of the transformational technologies employed by these 
surgical units is a hand-held ultrasound machine used to identify 
internal bleeding, a truly lifesaving piece of equipment.
  Other technologies the medics have employed include haemostatic 
dressings and the chitosen bandage. These are two new lifesaving wound 
dressings that are being used in Iraq and Afghanistan.
  Approximately 1,200 haemostatic dressings have been deployed under an 
investigational new drug battlefield protocol. In one account we 
learned of today, the dressing was successfully applied to a thigh 
wound to completely control arterial bleeding when a pressure dressing 
and tourniquet proved unsuccessful. There are two similar reports of 
special forces medics using chitosen bandages to treat severe bleeding 
caused by gunshot wounds to the extremities. Approximately 5,800 of 
these chitosen bandages have been deployed to the theater of 
operations.
  These are just a few of the examples of military medics using 
revolutionary medical technologies to lead the way in trauma treatment, 
lead the way in saving lives. Military researchers continue to 
investigate numerous other cutting-edge technologies, and those efforts 
are the foundation for the future of medical health care while in the 
service. Many of these same technologies will likely be used someday in 
civilian trauma centers across our country.
  Aeromedical and ground evacuation crews, operating from Blackhawk 
helicopters, a variety of fixed-wing aircraft, and ground evacuation 
vehicles, such as the Stryker, have also performed exceptionally during 
operations in Iraq and Afghanistan. The crews have demonstrated an 
ability to swoop into a hostile environment and pull wounded service 
members from the battlefield. They provide critical in-flight trauma 
care until more substantial care can be provided at fleet and field 
hospitals.
  Military health professionals also ensure the health and safety of 
our soldiers in a number of other ways. When forces deploy around the 
globe, environmental health professionals are on the ground surveying 
the environment for biological and environmental threats. Among these 
military health professionals are nationally recognized experts in 
chemical, biological, radiological, and nuclear threats. Their 
expertise ranges from medical surveillance and epidemiology to casualty 
management. Chemical, biological, radiological, and nuclear training 
has been incorporated into the soldiers' common skills training, 
advanced individual training, and leadership courses.
  Our health professionals also consider the mental health of our 
troops to be a top priority. In July 2003, a team of mental health 
experts from treatment facilities around the Nation left for Iraq. 
Their mission was to assess mental health issues and address concerns 
about a spike in the number of suicides occurring in the theater of 
operation. These professionals evaluated the mental health patient flow 
from theaters and assessed the stress-related issues soldiers 
experienced in combat operations.

  The survey team remained in the theater for 6 weeks and traveled to 
several base camps. I am told this is the first time a mental health 
assessment team has ever conducted a mental health survey with soldiers 
in an active combat environment.
  While many of the medical providers are deployed in the support of 
contingency operations, the military health system continues to provide 
outstanding care to service members, their families, and our retirees 
here at home.
  These professionals never waiver in their commitment to the highest 
quality of health care for our beneficiaries.
  The caregivers here at home also provide rehabilitative care to our 
troops after returning from combat. Perhaps the best example is the 
amputee center at Walter Reed Army Medical Hospital, which provides 
state-of-the-art care to service members who have lost limbs in battle. 
The center aims to return each amputee to the highest level of 
performance and quality of life. I have personally visited with wounded 
soldiers at the center, and I can tell you they are achieving their 
goal.
  I have come to the Chamber to commend our military health care 
professionals who have served with distinction throughout the global 
war on terrorism. Their dedication and commitment to their fellow 
service members is unmistakable, and their service is responsible for 
saving countless lives, both of our American service members and 
injured Iraqis. We are truly grateful for their service.
  I ask the whole Senate to join me in commending the military service 
of these medical professionals who have done so much for us.
  I ask unanimous consent that the article from the Washington Post of 
April 27, entitled ``The Lasting Wounds of War,'' by Karl Vick, be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       The Lasting Wounds of War

                             (By Karl Vick)

       Baghdad.--The soldiers were lifted into the helicopters 
     under a moonless sky, their bandaged heads grossly swollen by 
     trauma, their forms silhouetted by the glow from the row of 
     medical monitors laid out across their bodies, from ankle to 
     neck.
       An orange screen atop the feet registered blood pressure 
     and heart rate. The blue screen at the knees announced the 
     level of postoperative pressure on the brain. On the stomach, 
     a small gray readout recorded the level of medicine pumping 
     into the body. And the slender plastic box atop the chest 
     signaled that a respirator still breathed for the lungs under 
     it.
       At the door to the busiest hospital in Iraq, a wiry doctor 
     bent over the worst-looking case, an Army gunner with coarse 
     stitches holding his scalp together and a bolt protruding 
     from the top of his head. Lt. Col. Jeff Poffenbarger checked 
     a number on the blue screen, announced it dangerously high 
     and quickly pushed a clear liquid through a syringe into the 
     gunner's bloodstream. The number fell like a rock.
       ``We're just preparing for something a brain-injured person 
     should not do two days out, which is travel to Germany,'' the 
     neurologist said. He smiled grimly and started toward the UH-
     60 Black Hawk thwump-thwumping out on the helipad, waiting to 
     spirit out of Iraq one more of the hundreds of Americans 
     wounded here this month.
       While attention remains riveted on the rising count of 
     Americans killed in action--more than 100 so far in April--
     doctors at the main combat support hospital in Iraq are 
     reeling from a stream of young soldiers with wounds so 
     devastating that they probably would have been fatal in any 
     previous war.
       More and more in Iraq, combat surgeons say, the wounds 
     involve severe damage to the head and eyes--injuries that 
     leave soldiers brain damaged or blind, or both, and the 
     doctors who see them first struggling against despair.
       For months the gravest wounds have been caused by roadside 
     bombs--improvised explosives that negate the protection of 
     Kevlar helmets by blowing shrapnel and dirt upward into the 
     face. In addition, firefights with guerrillas have surged 
     recently, causing a sharp rise in gunshot wounds to the only 
     vital area not protected by body armor.
       The neurosurgeons at the 31st Combat Support Hospital 
     measure the damage in the number of skulls they remove to get 
     to the injured brain inside, a procedure known as a 
     craniotomy. ``We've done more in 8 weeks than the previous 
     neurosurgery team did in 8 months,'' Poffenbarger said. ``So 
     there's been a change in the intensity level of the war.''
       Numbers tell part of the story. So far in April, more than 
     900 soldiers and Marines have been wounded in Iraq, more than 
     twice the number wounded in October, the previous high. With 
     the tally still climbing, this month's injuries account for 
     about a quarter of the 3,864 U.S. servicemen and women listed 
     as wounded in action since the March 2003 invasion.
       About half the wounded troops have suffered injuries light 
     enough that they were able to return to duty after treatment, 
     according to the Pentagon.
       The others arrive on stretchers at the hospitals operated 
     by the 31st CSH. ``These injuries,'' said Lt. Col. Stephen M. 
     Smith, executive officer of the Baghdad facility, ``are 
     horrific.''
       By design, the Baghdad hospital sees the worst. Unlike its 
     sister hospital on a sprawling air base located in Balad, 
     north of the capital, the staff of 300 in Baghdad includes

[[Page S4468]]

     the only ophthalmology and neurology surgical teams in Iraq, 
     so if a victim has damage to the head, the medevac sets out 
     for the facility here, located in the heavily fortified 
     coalition headquarters known as the Green Zone.
       Once there, doctors scramble. A patient might remain in the 
     combat hospital for only six hours. The goal is lightning-
     swift, expert treatment, followed as quickly as possible by 
     transfer to the military hospital in Landstuhl, Germany.
       While waiting for what one senior officer wearily calls 
     ``the flippin' helicopters,'' the Baghdad medical staff 
     studies photos of wounds they used to see once or twice in a 
     military campaign but now treat every day. And they struggle 
     with the implications of a system that can move a wounded 
     soldier from a booby-trapped roadside to an operating room in 
     less than an hour.
       ``We're saving more people than should be saved, 
     probably,'' Lt. Col. Robert Carroll said. ``We're saving 
     severely injured people. Legs. Eyes. Part of the brain.''
       Carroll, an eye surgeon from Waynesville, Mo., sat at his 
     desk during a rare slow night last Wednesday and called up a 
     digital photo on his laptop computer. The image was of a 
     brain opened for surgery earlier that day, the skull neatly 
     lifted away, most of the organ healthy and pink. But a thumb-
     sized section behind the ear was gray.
       ``See all that dark stuff? That's dead brain,'' he said. 
     ``That ain't gonna regenerate. And that's not uncommon. 
     That's really not uncommon. We do craniotomies on average, 
     lately, of one a day.''
       ``We can save you,'' the surgeon said. ``You might not be 
     what you were.''
       Accurate statistics are not yet available on recovery from 
     this new round of battlefield brain injuries, an obstacle 
     that frustrates combat surgeons. But judging by medical 
     literature and surgeons' experience with their own patients, 
     ``three of four months from now 50 to 60 percent will be 
     functional and doing things,'' said Maj. Richard Gullick.
       ``Functional,'' he said, means ``up and around, but with 
     pretty significant disabilities,'' including paralysis.
       The remaining 40 percent to 50 percent of patients include 
     those whom the surgeons send to Europe, and on to the United 
     States, with no prospect of regaining consciousness. The 
     practice, subject to review after gathering feedback from 
     families, assumes that loves ones will find value in holding 
     the soldier's hand before confronting the decision to remove 
     life support.
       ``I'm actually glad I'm here and not at home, tending to 
     all the social issues with all these broken soldiers,'' 
     Carroll said.
       But the toll on the combat medical staff is itself acute, 
     and unrelenting.
       In a comprehensive Army survey of troop morale across Iraq, 
     taken in September, the unit with the lowest spirits was the 
     one that ran the combat hospitals until the 31st arrived in 
     late January. The 3 months since then have been substantially 
     more intense.
       ``We've all reached our saturation for drama trauma,'' said 
     Maj. Greg Kidwell, head nurse in the emergency room.
       On April 4, the hospital received 36 wounded in 4 hours. A 
     U.S. patrol in Baghdad's Sadr City slum was ambushed at dusk, 
     and the battle for the Shiite Muslim neighborhood lasted most 
     of the night. The event qualified as a ``mass casualty,'' 
     defined as more casualties than can be accommodated by the 10 
     trauma beds in the emergency room.
       ``I'd never really seen a `mass cal' before April 4,'' said 
     Lt. Col. John Xenos, an orthopedic surgeon from Fairfax. 
     ``And it just kept coming and coming. I think that week we 
     had three or four mass cals.''
       The ambush heralded a wave of attacks by a Shiite militia 
     across southern Iraq. The next morning, another front erupted 
     when Marines cordoned off Fallujah, a restive, largely Sunni 
     city west of Baghdad. The engagements there led to record 
     casualties.
       ``Intellectually, you tell yourself you're prepared,'' said 
     Gullick, from San Antonio. ``You do the reading. You study 
     the slides. But being here. . . .'' His voice trailed off.
       ``It's just the sheer volume.''
       In part, the surge in casualties reflects more frequent 
     firefights after a year in which roadside bombings made up 
     the bulk of attacks on U.S. forces. At the same time, 
     insurgents began planting improvised explosive devices (IEDs) 
     in what one officer called ``ridiculous numbers.''
       The improvised bombs are extraordinarily destructive. 
     Typically fashioned from artillery shells they may be packed 
     with such debris as broken glass, nails, sometimes even 
     gravel. They're detonated by remote control as a Humvee or 
     truck passes by, and they explode upward.
       To protect against the blasts, the U.S. military has 
     wrapped many of its vehicles in armor. When Xenos, the 
     orthopedist, treats limbs shredded by an IED blast, it is 
     usually ``an elbow stuck out of a window, or an arm.''
       Troops wear armor as well, providing protection that 
     Gullick called ``orders of magnitude from what we've had 
     before. But it just shifts the injury pattern from a lot of 
     abdominal injuries to extremity and head and face wounds.''
       The Army gunner whom Poffenbarger was preparing for the 
     flight to Germany had his skull pierced by four 155mm shells, 
     rigged to detonate one after another in what soldiers call a 
     ``daisy chain.'' The shrapnel took a fortunate route through 
     his brain, however, and ``when all is said and done, he 
     should be independent. . . . He'll have speech, cognition, 
     vision.''
       On a nearby stretcher, Staff Sgt. Rene Fernandez struggled 
     to see from eyes bruised nearly shut.
       ``We were clearing the area and an IED went off,'' he said, 
     describing an incident outside the western city of Ramadi 
     where his unit was patrolling on foot.
       The Houston native counted himself lucky, escaping with a 
     concussion and the temporary damage to his open, friendly 
     face. Waiting for his own hop to the hospital plane headed 
     north, he said what most soldiers tell surgeons: What he most 
     wanted was to return to his unit.

  Mr. STEVENS. I thank the Senator from Tennessee.
  The PRESIDING OFFICER (Mr. Sununu). The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent to speak in 
morning business for as much time as I may require.
  The PRESIDING OFFICER. The Senator has that right.

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