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LYNN NEARY, host:

The U.S. Army Medical Center in Landstuhl, Germany, is where wounded troops from Iraq and Afghanistan end up before they head back to the United States to begin the long road to recovery. Advances in medical technology combined with the rapid evacuation of injured troops from the battlefield have meant that more than 95 percent of wounded troops will survive. It's the highest survival rate in the history of warfare.

NPR defense correspondent Guy Raz concludes our series on medical evacuations from Iraq with this report from Landstuhl.

(Soundbite of church bell ringing)

GUY RAZ: The tiny hillside hamlet of Landstuhl, Germany, is barely a six-hour flight from Balad Air Base in Iraq. But it might as well be on another planet - green and peaceful and far away from the dust-choked deserts of Iraq.

About 20 hours ago in Iraq, Army Lieutenant Kevin Mellinger was shot in the thigh by a sniper during a reconnaissance mission on the banks of the Tigris. The high-velocity round shattered his femur into a hundred different pieces. Kevin Mellinger's now arrived at Landstuhl Hospital.

A bus pulls up to the entrance of the hospital. Inside are several wounded and ill American troops, all coming in from Iraq. About three dozen medical technicians and volunteers are there to help off-load the patients.

Unidentified Man #1: Got it.

Unidentified Man #2: Okay. Lower. Lower.

Unidentified Woman: (unintelligible) Charlie.

RAZ: Lieutenant Mellinger's already had one operation at Balad Hospital in Iraq. He'll now undergo a second one here at Landstuhl to wash out the bone and bullet fragments.

(Soundbite of hospital machine beeping)

RAZ: Mellinger wakes up in the ICU, several hours after the operation. He'll now rest for another day before getting on another flight, this time back home to Fort Bragg, North Carolina.

Now that he's safe and stable, he can call his wife.

Lieutenant KEVIN MELLINGER (U.S. Army): Well, I told her that I was coming home for Christmas, and she didn't understand that, and she's, like , well, I thought you were extended for 15 months? That's what they told me yesterday. I said, well, babe, I got shot.

(Soundbite of laughter)

RAZ: On the other side of the hospital, the doctor who operated on Mellinger, Navy Captain Charles Pasque, inspects x-rays of the soldier's femur bone.

Dr. CHARLES PASQUE (U.S. Navy): In his particular injury, this is what we call a good war wound, if you have to have one. So he should be fine as long as he doesn't get infected. So he'll - he's looking at a minimum of two to three months recovery, and as long as up to 12 months basically to get your strength back and your gait, you know, how you walk and run back.

RAZ: He explains that Mellinger got lucky. The bullet struck a blood vessel in his thigh, but it also ricocheted off his femur, which slowed the bullet down and prevented a potentially worse exit wound.

By the time Kevin Mellinger arrived here in Landstuhl, the doctors already had a thick file with his medical records, including x-rays and a CT scan. It's another innovation of combat medicine. Electronic files and scans have been e-mailed from Balad Theater Hospital in Iraq.

There is also a live video link between Landstuhl Hospital and the combat field hospitals in Balad and Bagram, Afghanistan.

Dr. STEPHEN FLAHERTY (Chief of Surgery, Landstuhl Regional Medical Center, Germany): So we're able to prepare well in advance for that patient's arrival to know exactly what has happened to them and what interventions have already been taken place.

RAZ: This is Colonel Stephen Flaherty, the chief of surgery at Landstuhl Hospital. He says that since the start of the Iraq War, key lessons in medical science have been learned in part because of the distances and the speed at which critically wounded soldiers now travel.

Dr. FLAHERTY: Those technologic advances have allowed us to care for these patients in a different way. You know, 10 years ago or 15 years ago, we were not flying people 4,000 miles at 30,000 feet who were critically ill. And we can do that now.

RAZ: They couldn't do it 10 years ago because of the risk of what's known as compartment syndrome. High altitude sometimes causes muscles and tissue to swell and decay. But over the past three years, doctors here at Landstuhl have learned that they often need to perform an immediate fasciotomy. It's a procedure where an incision is made deep into the skin to relieve that pressure.

(Soundbite of hospital machine beeping)

RAZ: Back in the recovery, Lieutenant Kevin Mellinger's emerging from a fog. Lying in his hospital bed, he starts to recall the incident that could have killed him.

Lt. MELLINGER: It was scary. It was very scary. I thought I was going to get shot again because they were close and they shot me really close, so I thought that, you know, another shot was going to hit me somewhere else.

RAZ: He pauses for a moment and remembers what went through his mind.

Lt. MELLINGER: I thought to myself, you know, well, God, if this is your time for me to go, you know, I know I'm going to heaven. So I felt confident. As a matter of fact, I was, like, Lord, I was, like, I know my time is not yet.

(Soundbite of laughter)

RAZ: Lieutenant Kevin Mellinger is just 24 years old, his whole life ahead of him. Indeed, he was lucky. He cheated death. But he knows that since the war began, more than half of those who didn't make it out of Iraq were even younger than he is.

Guy Raz, NPR News.

NEARY: Other parts of this report and an audio slideshow showing the journey from Balad Air Base to the U.S. Army hospital in Landstuhl are at npr.org.

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