[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.
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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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