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ROBERT SIEGEL, host:

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

The Air Force Theater Hospital at Balad Air Base, just north of Baghdad, is the most technologically advanced field hospital in the history of warfare. Many of the 30,000 servicemen and women injured in Iraq have been through the hospital, about half of them left with permanent disabilities. In previous wars, many of them would have died. The high survival rate owes much to the system of evacuating and treating the wounded quickly.

In part two of NPR's series on medical care in the combat zone, NPR's Guy Raz reports from Balad Medical Center.

Major JAMES EADIE (Surgeon): Okay, listen up. We got three patients coming in, or four patients coming in. Yeah, I believe we're going to take a quick look at…

GUY RAZ: Major James Eadie, the coordinating surgeon-on-call, gathers the overnight staff into the trauma ward.

Maj. EADIE: In fact, we're going to take bed one and two…

Four wounded soldiers are about to arrive by helicopter to the emergency room. Three have been hit by an IED, one struck through the thigh by a high-velocity round. The clock starts ticking.

Four medics wheel a gurney into the E.R. The soldier's left thigh is wrapped in a blood-soaked bandage. Dr. Eadie races to his side.

Maj. EADIE: What's your name? What's your first name?

First Lieutenant KEVIN MELLINGER (U.S. Army): Kevin Mellinger.

Maj. EADIE: Mellinger?

First Lt. MELLINGER: Yes.

Maj. EADIE: What do you go by?

Unidentified Man #1: What's your first name?

First Lt. MELLINGER: Brad.

Maj. EADIE: Brad, move your toes for me.

RAZ: The young officer is First Lieutenant Kevin Mellinger. He goes by the name Brad. He was commissioned into the Army barely a year ago after graduating from Oregon State. Twenty minutes ago, his scout unit was running a reconnaissance mission on the banks of the Tigris. Mellinger is fighting the pain of a gunshot wound that shattered his femur into a hundred different pieces.

Lieutenant Colonel Jeffrey Bailey, the senior most doctor at the hospital, grips his clipboard and takes down notes as the other docs get to work on Mellinger.

Lieutenant Colonel JEFFREY BAILEY (Chief Surgeon): He seems like a, you know, a guy with a potentially life-threatening injury.

RAZ: The femur is the strongest and longest bone in the body. It's in a part of the body that holds the most blood, and a wound to the femur can mean death by bleeding unless the circulation is temporarily cut off. But though Mellinger's in a haze, he's talking - a good sign. And he's able to describe what just happened.

First Lt. MELLINGER: Once I got shot, you know, I felt that my leg - they kind of got heavy and numb. And I was actually able to stand up for a couple of seconds and then I went down.

RAZ: Dr. Jeff McNeil, a major in the Air Force, works to get the bleeding under control. It takes just minutes before McNeil can walk away, confident that Lieutenant Kevin Mellinger will survive.

Dr. JEFF McNEIL (Cardiothoracic Surgeon, Air Force Theater Hospital): And then we'll go to the recovery area. And with an injury like this, with an open femur fracture, he'll be evacuated out to Landstuhl on the next flight.

RAZ: About 45 minutes later, McNeil will move to the operating room to clean out Mellinger's wound, washing out bits of bullet and bone fragments from his thigh. The case of Kevin Mellinger is instructive. It says a lot about how combat medicine has changed. In Vietnam, a soldier with Mellinger's wound had a 33 percent higher chance of dying. In Iraq, he can count himself among the 95 percent of wounded who live.

Lieutenant Colonel CHRISTOPHER COPPOLA (Trauma Surgeon, Air Force Theater Hospital): It's a sad fact that a surgery has advanced and benefited from all of the tragedies and trials of war.

RAZ: This is Lieutenant Colonel Christopher Coppola. Like all the other docs here, he is a specialist back home. He does pediatric surgery. But at the Air Force medical center here in Balad, he's a trauma surgeon. Coppola says the kind of trauma he's seen here is incomparable to what he would see in the U.S. A single patient here may have a destroyed eye, shrapnel embedded in the body, bleeding from the chest and missing limbs.

Lt. Col. COPPOLA: So you come over here and you work for four months, like we Air Force surgeons do. And it's as if you work in a busy trauma center for two years.

RAZ: After Vietnam, the use of tourniquets went out of fashion. It often took six to eight hours to transport a Vietnam-era soldier from the battlefield to a trauma center. In that time, a tourniquet could lead to gangrene, infection and either an amputation or slow death. But in Iraq, the combination of tourniquets, chemical blood clotting pads and lightning-fast transport to this field hospital have resulted in unprecedented survival rates. Most often, the field medics — sometimes a young private first class — were the first ones to treat the wounded.

Lt. Col. COPPOLA: They know not to waste time doing too many procedures, waste time getting control of specific blood vessels, but just to put the tourniquets on, get an airway in a tracheal tube, and move quickly to us.

RAZ: Dr. Coppola is tall and lanky with a gentle disposition. Aside from his work as a pediatric surgeon, he's also a student of medical history.

Lt. Col. COPPOLA: We're no smarter than Vietnam-era surgeons. We just are, I think, reaping the advantage of technology and vehicles.

Unidentified Man#2: Lab.

RAZ: Everyday, it seems, a visiting group of dignitaries or a high-ranking officer tours the hospital. It's become a showcase for the Air Force in Iraq, which runs the facility. Invariably, someone will describe the docs here as miracle workers. Lieutenant Colonel Stephen Bowers(ph), one of the doctors here, recoils when he hears that.

Lieutenant Colonel STEPHEN BOWERS (Doctor, Air Force Theater Hospital): To say that the life saving went on here is kind of an exaggeration because it's really the whole system that's at work.

RAZ: A system that will take a young soldier, like Lieutenant Kevin Mellinger, from the battlefield to the trauma ward at Balad to Landstuhl Medical Center in Germany thousands of miles away all in less than 24 hours.

Unidentified Man#3: MC4 to room 60, MC4 to room 60.

RAZ: With the first round of surgery done, Mellinger rests inside the intensive care unit. He'll soon board the flight to the army medical center in Landstuhl, Germany. He says he's excited to see his family when he gets back home, but he's also conflicted about leaving. Mellinger's platoon will now be left without a commanding officer. And the platoon sergeant, his deputy, just arrived to the unit.

First Lt. MELLINGER: He's brand new, though, just switched out, and so I was kind of training him up on how we do things. And so he'll - they'll do fine. I just wish I was there with them.

RAZ: A giant C-17 cargo plane hums on the flight line at Balad Air Base. Mellinger's on a stretcher. He'll be loaded into this flying hospital stacked underneath two other patients on stretchers. For five hours, he'll try to sleep or gaze up at the stretcher above him. It's a little uncomfortable, but after 11 months in Iraq, he's not bothered. He's on his way home.

Guy Raz, NPR News.

SIEGEL: You can hear about Lt. Mellinger's evacuation to the army medical center in Landstuhl, Germany tomorrow on NPR's MORNING EDITION. And you can follow his journey in a slide show at npr.org.

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