- The Washington Times - Sunday, November 4, 2001

U.S. soldiers severely wounded in ground combat in Afghanistan should have improved chances for survival, thanks to doctors who can attend to their injuries minutes after they occur.
The Army's forward surgical teams, which follow every brigade, offer the closest thing yet to battlefield surgery.
"These teams must stay 'one major terrain feature,' such as a hill, behind the forward line of troops," said Lt. Col. Thomas E. Knuth, a surgeon who heads the Army Trauma Training Center in Miami.
Soldiers at risk of death from serious head injuries or from extensive blood loss from other wounds, who normally "would have to be evacuated 150 to 200 miles to a hospital, can be on an operating table in a matter of minutes," Dr. Knuth said in a telephone interview.
Significant medical treatment literally is "right over the hill," he said, adding that patients can be taken to it by jeep or helicopter, depending on their condition and the landscape.
Doctors, nurses and other medical personnel who make up the sophisticated 20-member forward surgical teams are being trained at the Army Trauma Training Center. Dr. Knuth says he fully expects some trainees are headed for Afghanistan.
The concept of these skilled medical teams was developed after the Persian Gulf war, and the first one was established in 1995. "I was a member of that team," which did not operate in a combat situation, said Dr. Knuth.
A key objective of this new approach was to save more lives on the battlefield itself. According to doctors at the Army Medical Command in San Antonio, about 20 percent of those wounded in combat during Vietnam and the Gulf wars died before reaching a physician.
That death rate, they said, is comparable with the rate experienced during the Civil War.
Dr. Knuth said it is essential to provide medical intervention to a trauma patient within the first hour of injury before he goes into shock.
Dr. Robert Mosebar, a retired Army colonel who helped plan combat medical operations at the Army Medical Command, told the Boston Globe a major cause of death on the battlefield is blood loss resulting from severed arteries or internal hemorrhaging that failed to clot within 30 minutes.
Since the Vietnam War, the military has put much emphasis on developing faster medically-equipped helicopters, such as the Black Hawk, to evacuate the wounded, says Virginia Stephanakis, spokeswoman for the Army Medical Department.
But helicopters cannot always reach those who urgently need care, and the typical military medic is not qualified to perform surgery. So emphasis is being placed on bringing better treatment to the battlefield.
With surgical forward teams, wounded soldiers can receive life-saving care and be "stabilized" before they start on what can be a long flight to the nearest military hospital, Dr. Knuth said.
The ground troops now in Afghanistan, as well as those to be added in the near future, are special operation commandos.
"The special forces have forward surgical teams," said Dr. Knuth, who noted that such units also benefit from having highly trained medics.
Maj. Gary Kolb, spokesman for Army special operations at Fort Bragg, N.C., said medics in special forces units "go through extensive medical training," lasting about a year.
Since 1996, they have trained with paramedics at hospitals in New York and Tampa, officials said.
"They are certified as real paramedics, and they can almost do minor surgery," Maj. Kolb said in a telephone interview.
Dr. Knuth went further. "They almost have to operate at the level of being a surgeon," he said. "They may have to complete an amputation. They may have to put a chest tube into a chest wound."
Because curbing blood loss is crucial to saving lives on the battlefield, there is much interest in new blood-clotting technologies.
Examples include a special bandage that features a protein that acts as a coagulant and a hand-held ultrasound device that allows medics to locate internal injuries and bleeding.

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