Landstuhl Provides Advanced Care for Wounded Warriors

LANDSTUHL, Ger­many, April 27, 2011 — The pace nev­er slows at Land­stuhl Region­al Med­ical Cen­ter here, the largest U.S. mil­i­tary med­ical facil­i­ty out­side the Unit­ed States and the first stop for wound­ed troops evac­u­at­ed from the war zones.

Landstuhl Regional Medical Center, Germany
More than 61,000 U.S. and coali­tion ser­vice mem­bers, civil­ian employ­ees and con­trac­tors have been flown to Land­stuhl Region­al Med­ical Cen­ter, Ger­many, since Jan­u­ary 2004.
DOD pho­to by Don­na Miles
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More than 61,000 U.S. and coali­tion ser­vice mem­bers, civil­ian employ­ees and con­trac­tors have been flown here since Jan­u­ary 2004, pub­lic affairs offi­cer Chuck Roberts report­ed. And with oper­a­tions begin­ning to esca­late in Afghanistan as spring sets in, the pace sees no sign of let­ting up.

About 12,700 of Landstuhl’s patients since 2004 have been bat­tle-injured, about that same num­ber have been able to return to duty “down­range” after treat­ment here, Roberts said. But for the vast major­i­ty of patients who arrive here, Land­stuhl serves as a way point on the trip from the war zone to high­er-lev­el med­ical care in the Unit­ed States.

This en route hub, where patients receive the most advanced “Lev­el 4” med­ical care, is crit­i­cal in the process of con­tin­u­al­ly mov­ing com­bat wound­ed to ever-increas­ing lev­els of care, Air Force Lt. Col. (Dr.) Ray­mond Fang, direc­tor of trau­ma care here, told reporters.

“Down­range, they have lim­it­ed hold­ing space, so they have to move peo­ple,” he said. “If they don’t move peo­ple quick­ly, they will quick­ly be over­whelmed.” Most com­bat casu­al­ties arrive here with­in three days of being wound­ed, Fang said, not­ing that Land­stuhl has “the lux­u­ry of keep­ing peo­ple a lit­tle longer and being able to surge for a lit­tle bit longer.” The goal, he explained, is to sta­bi­lize patients until it is safe to move them to the Unit­ed States or, in the case of coali­tion forces, their home coun­try, for con­tin­ued care.

“We try to ensure peo­ple don’t move from our facil­i­ty until they are tru­ly ready to be safe­ly moved,” typ­i­cal­ly with­in about three days, Fang said. “We look at them, we make sure no injuries are missed, … [and] we keep them until we feel from our expe­ri­ence that it is safe for them to move onward.”

Expe­ri­ence is one of the most impor­tant qual­i­ties Landstuhl’s 3,000-member staff brings to the mis­sion. Unlike in the com­bat the­ater, which expe­ri­ences con­stant per­son­nel turnover as med­ical staffs reg­u­lar­ly deploy and rede­ploy, Landstuhl’s staff mem­bers typ­i­cal­ly serve at least three years.

“We take our role very seri­ous­ly, act­ing as the cor­po­rate mem­o­ry [and] cor­po­rate knowl­edge,” Fang said.

After sev­en years as trau­ma direc­tor here, Fang brings a near­ly unprece­dent­ed lev­el of exper­tise to the table as he over­sees the care of the most seri­ous­ly wound­ed incom­ing patients.

That’s crit­i­cal at a time when Land­stuhl is see­ing some of the most severe­ly wound­ed patients of the war, based on the Injury Sever­i­ty Scale index used in civil­ian trau­ma cen­ters. “In the past year or so, our aver­age ISS score for our [inten­sive care unit] patients — who we real­ly focus on, because they are the most sig­nif­i­cant­ly injured –- have been the high­est in the war,” Fang said.

“These patients are young, they are fit and they have the best pro­tec­tion avail­able right now, but their injuries are very severe,” he said.

Civil­ian trau­ma patients typ­i­cal­ly suf­fer from blunt trau­ma from a car or motor­cy­cle acci­dent or a pen­e­trat­ing trau­ma from a gun­shot or stab­bing, Fang explained. Com­bat wound­ed troops fre­quent­ly suf­fer both, he added, as well as blast injuries.

“With these blast injuries, you get the blunt part of the con­cus­sive wave, you get the pen­e­trat­ing part of the frag­ment, you get the heat part with the burns,” he said. “You also get the blast com­po­nent: the shock wave, the pres­sure wave of the blast itself. So we have four mech­a­nisms in one. It’s our most com­mon mech­a­nism of injury here.”

Despite the sever­i­ty of their wounds, Fang report­ed an amaz­ing sur­viv­abil­i­ty rate among wound­ed war­riors who arrive at Land­stuhl. “You have a greater than 99 per­cent chance of sur­vival if you can make it to us,” he said, cit­ing 2010 sta­tis­tics. “That is real­ly unprece­dent­ed.” Most of the few­er than 1 per­cent who have died after arriv­ing at Land­stuhl suf­fered non­sur­viv­able injuries, but were brought to Ger­many to reunite with their fam­i­lies, he added.

Fang attrib­uted the strik­ing sur­vival rate to a well-devel­oped med­ical sys­tem that gets bat­tle­field casu­al­ties med­ical treat­ment faster and clos­er to the point of injury than ever before and moves them to pro­gres­sive­ly more-advanced care facil­i­ties. That, he said, is an impor­tant fac­tor.

“These patients, by our grad­ing scales, are much more injured, and yet they are doing well,” Fang said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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