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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. Robert Siegel.

AUDIE CORNISH, host:

And Im Audie Cornish.

2010 marked the ninth year for the war in Afghanistan and it was the worst one by far for American troops. More than 500 Americans have been killed in Afghanistan this year and thousands more were wounded.

SIEGEL: We have two reports on Afghanistan in this part of the program, about the challenges of treating all those wounded service members and about the Army's conclusions on one of the most scrutinized battles of the war.

We'll begin with a visit to Bagram Air Field.

CORNISH: Many of the wounded passed through the trauma ward there at the Joint Theater Hospital.

And as NPR's Quil Lawrence found out, treating such a volume of injuries brings its own grim benefits. Surgeons at Bagram are using their experience to save lives in ways they could not have just a few years ago.

QUIL LAWRENCE: Winter is the quiet season in Afghanistan but it's almost never quiet at the Joint Theater Hospital on Bagram Air Field.

(Soundbite of helicopters)

LAWRENCE: Choppers pull right up to the door outside the emergency room, the goal is to get any wounded soldier to a field hospital within one hour of injury. Doctors and nurses rush the latest arrivals back to the warmth of the E.R.

(Soundbite of a trauma room)

LAWRENCE: In fact, the temperature of this emergency room is cranked up to about 100 degrees, one of the many things that are a little different here. The high temperature keeps bleeding patients from losing their body heat.

The war is teaching everyone, says Colonel Chris Benjamin, the hospital commander.

Colonel CHRIS BENJAMIN (Physician/Commander, Joint Theater Hospital): One of my surgeons is a trauma director at Cincinnati. He's famous for saying that at the beginning of this conflict, we were taking the best trauma medicine from the civilian sector and we brought it to Iraq and Afghanistan. Well, here we are seven, eight years later, and when he goes back to his civilian trauma center in Cincinnati, he's taking what we've learned in these conflicts to teach them the advances that we've made.

LAWRENCE: For all the resources spent on war technology, the medical breakthroughs over the past nine years in Iraq and Afghanistan are disarmingly simple, says Benjamin.

Col. BENJAMIN: The soldier out in the field that encounters an explosion or a gunshot wound, the most important part of his entire chain of survival - from the explosion until we can get him to Walter Reed, and all the many steps along the way - probably the most important is what his battle buddy does, the guy in the next vehicle or the guy who was 50 meters away.

LAWRENCE: In fact, the biggest new lifesaving device is hundreds of years old -the tourniquet. Only a decade ago, it was considered a last resort that could hurt more than it helped. But early during the Iraq War, soldiers began carrying their own makeshift tourniquets - a cord and a stick to twist it tight. Now all U.S. soldiers carry special tourniquets designed for use with one hand.

The change reflects the chilling number of wounds that involve lost limbs, says Dr. Rachel Height, a lieutenant colonel and Bagram's head surgeon. She says no one sees double amputations before they come to a war zone.

Lieutenant Colonel RACHEL HEIGHT (Physician/Chief Surgeon, Joint Theater Hospital): I could probably count on one hand how many double amputations I'd had to take care of or do.

LAWRENCE: And now, how many?

Lt. Col. HEIGHT: I dont even know. It's a lot. It's pretty regular.

LAWRENCE: Height says another lesson is whole blood. Over many decades, science found ways to break blood into its components - white and red cells, platelets - and store them each with a different shelf life. But the carnage of U.S. battles in Iraq forced doctors to hold blood drives right on base.

And they discovered that fresh, whole blood works wonders at resuscitation, says Height.

Lt. Col. HEIGHT: To me, it's pretty exciting and fascinating to take care of people, you know, that literally died on the table at a down-range theater yesterday, come to us and within a few hours, we can take their breathing tube out and they're calling home and talking to their family.

LAWRENCE: In Vietnam, saline substitutes were used but that seeped into the respiratory system, causing whats called Danang Lung. Whole blood leaves the lungs healthier and avoids the risks and complications of ventilator machines.

Another advance also keeps the patients conscious, even through severe pain.

Major Christa Riley is an anesthetist. She says ultrasound technology is now used to zero-in on the nerves.

Major CHRISTA RILEY (Anesthetist, Joint Theater Hospital): We use little, tiny plastic tubes, catheters we put in next to nerves. And these guys with amputations dont have pain in those stumps. We can anesthetize a large nerve that, you know, serves the legs and basically make them comfortable for flight.

LAWRENCE: And flight is another important tactic at Bagram. Most of the wounded are on their way to a much larger hospital in Germany or the U.S. within a day or two of arriving here. That way, the doctors at Bagram can concentrate on the next batch of patients.

But that innovation means sometimes the doctors here never even get to talk with the patient whose life they're saving, says Riley.

Maj. RILEY: Just be able to tell them, you know, I'd like to be able to say hey, you did well, you're strong and thank you.

LAWRENCE: But it also spares the doctors at Bagram some of the more painful moments, she says.

Maj. RILEY: One of our nurse anesthetists here actually was with one of these patients, getting ready to take him to the OR. He was surprisingly - he was awake and he didnt have a breathing tube in. And he was there when the young man called his mother to tell her. And I think he broke down. He had to leave, because I think he could hear this young man's mother crying and sort of falling apart on the other end of the phone.

Unidentified Man: Hello. Do you speak English?

Unidentified Woman: Very good. That was good.

LAWRENCE: There are times when the doctor can't talk with the patients anyhow. A recent Medevac brought in four Polish soldiers caught in a massive roadside bomb explosion. A translator helped talk with the men, who were all conscious and suffering concussions.

(Soundbite of a trauma room)

LAWRENCE: The hospital treats from all the NATO countries in theater, as well as Afghan soldiers, and quite often, captured insurgents. The doctors say the detainees get the same care, though they're usually under armed guard. Afghan civilians also come here if a local hospital refers them.

Mr. BAQIR ZHAN: (Foreign language spoken)

LAWRENCE: Baqir Zhan(ph) is here with his brother's wife, Saber. Her clothing caught fire from a cooking stove about three weeks ago. Saber has burns on almost half her body. The girl is only about 13 years old and has been married a few months.

The doctors have tried skin grafts without success and theyve contacted the Shriners Hospital in Cincinnati, which is willing to take Saber. But her brother-in-law isnt sure.

Mr. ZHAN: (Foreign language spoken)

LAWRENCE: We'd have to talk with our family, he says, adding, it's much better if she can be treated here.

LAWRENCE: It's not clear he understands that Saber will probably die if she doesnt get better care. It's just part of a cultural divide that can be frustrating, says Dr. Riley.

Lt. Col. RILEY: She is fighting and I think that's whats giving the doctors here some hope. Dr. Height said to me, I can't give up on her because she's not giving up. And I think that's fair.

LAWRENCE: Red tape may be the greatest obstacle to saving the young girl's life. Saber needs a passport and a visa, or a special dispensation from the American or Afghan government, a condition the doctors here at Bagram haven't figured out how to cure yet.

Quil Lawrence, NPR News.

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