SOUTH-CENTRAL IRAQ March 31 —
The howitzers flash, recoil and roar, lobbing shells over the
heads of sweating Navy surgeons.
Inside sweltering khaki tents, the eight-man operating team tends
to the wounded: Moaning Iraqi fighters, claiming to have been shot
by their own when they tried to surrender. Two Marines. Two British
allies, one dying.
If the chop-chop-chop of helicopters signaled the closeness of
MASH units to the front in Korea and Vietnam, the howitzers do the
same in Iraq firing American outgoing artillery over the heads of
surgical teams operating between American and Iraqi lines.
Front-line units like these make it possible to get critically
wounded onto the operating table within an hour of the time they
fell in battle.
"The 'golden hour' of trauma. You have one hour to get them to
surgery before bad things start to happen," says Cmdr. Robert
Izenberg, a surgeon in T-shirt, operating scrubs and pushed-down
white mask.
"We ARE the front line," adds Capt. Tony Serfustini, a surgeon,
standing outside one of the tents, a discarded and bloody wooden
splint by his feet. "Can't get any farther forward than that."
The teams, called forward resuscitative surgical systems, are
operating for the first time ever in combat. The six eight-member
teams, scattered over Iraq, mark the closest Navy teams have ever
operated to the battlefield.
The front-line lifesaving units grew out of the 1991 Gulf War,
Somalia and other Marine engagements of the past decade or so.
Past wars, including Vietnam and Korea, had static fronts for
months and years at a time in Vietnam, 14 hospitals that never moved
tended to patients scooped out by helicopter or plane.
In the Gulf War and onward, Marine units rushed too far forward,
on too many fronts, for the old-style "scoop-and-run" medical teams
to get critically wounded to care in time.
"It's a different conflict," said Serfustini, a Vietnam veteran
and now a surgeon and Navy reservist in Las Vegas, Nev. "This is a
conflict in motion. Vietnam was a conflict in stagnation."
The forward surgical units took seven years to design. Navy
physicians and others worked to come up with mobile units that were
truly mobile replacing ones that at times needed a C-130, and a
landing field, to move.
The result: a surgery team that can move in four trucks, set up
in an hour, and tear down in an hour. There are two surgeons, an
anesthesiologist, a nurse, operating technicians, and corpsmen,
together capable of tending to a maximum of 18 patients in 24
hours.
Their intended patients: the 15 percent to 20 percent of
battlefield wounded who die if they do not receive critical care in
an hour.
The front-line surgeons are meant to stop bleeding, stop
contamination and get the wounded on down the line.
Nothing time-consuming: shunts instead of intricate grafts on
torn blood vessels, clean up instead of repair of perforated
intestines.
"It's lifesaving surgery and limb-saving surgery," said
Serfustini, wearing sunglasses, a flak vest over bare skin and a
bandanna wrapped around his head.
"Damage-control surgery. I still provide the same high level of
care. It just doesn't have all the bells and whistles," said
anesthesiologist Cmdr. Bruce Baker, who works with a portable oxygen
generator, blood-gas monitor and devices to warm fluids going into
patients.
The Iraqi sun keeps the medical tents a stifling 80-plus degrees
during the day, instead of the 68 degrees surgeons prefer to keep
sweat off the tools and out of the patients.
Despite tightly sealed seams, dust from southern Iraq's sand
storms snaked on black hoses leading to monitors.
In south-central Iraq, the team one day treated only one Iraqi
civilian, brought in praying, his guts showing with what appeared to
be shrapnel wounds, cause unknown.
The Geneva Convention and the doctors' Hippocratic oath requires
them to treat all critically wounded, Iraqi soldiers and American
Marines alike.
At Zubayh, the heaviest test yet, the team dealt with two
Marines, two Britons and eight Iraqis.
Some of the Iraqis "said they'd tried to leave and surrender, and
been shot" by their leaders, Serfustini said.
For the Iraqis in particular who lack the Kevlar helmets and flak
jackets of American forces immediate surgery meant stemming blood
loss, and survival.
"We're making a difference," Serfustini said. "The real proof
will be the assault against Baghdad. Check back with us in a couple
weeks."
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