Inside Kandahar Combat Hospital: Saving Lives and Limbs

June 24, 2010— -- The combat hospital at Kandahar Air Field may lie deep in Taliban country, but as far as military hospitals go, it is cutting edge.

Doctors there use advanced technology and medical techniques once unheard of this close to the battlefield to ease wounded soldiers' pain, to salvage limbs and to save lives.

In fact, about 98 percent of coalition soldiers who get to the hospital alive survive after treatment.

In the minutes before the injured arrived recently, the trauma team nurses prepared the treatment bays, hanging IV fluids and checking equipment. The doctors reviewed what little information they'd been given about the patient on his way.

"He has a traumatic amputation of the right leg below the knee," said Dr. Richard Hilsden, the trauma team leader. "Other than that, we have no other information."

Hilsden is a captain with the Canadian forces, part of the multi-national team of doctors, nurses and medics staffing the U.S.-run hospital. Hilsden had been in Kandahar for only a month. He practices family medicine back in Canada.

When an ambulance pulled up, Hilsden quickly assessed the soldier, an American. His right foot was gone, lost in an attack on his guard tower by a rocket-propelled grenade.

Pfc. Kelly Beechinor, 23, was just one week shy of heading home.

Once in a trauma bay, Hilsden called in orthopedic specialists to assess and stabilize the soldier's leg injury. Surgery would be essential, but the doctor's immediate concern was the soldier's pain.

To help with pain management, Dr. Kevin Brady, an Army lieutenant colonel with the Pentagon's Joint IED Defeat Organization, was visiting Kandahar to teach the staff about the latest developments to treat pain.

He brought with him the technology to do nerve blocks -- knocking out pain close to the source.

"Up to this point, the technology hasn't been widely dispersed throughout the combat zone," said Brady.

"[Our] organization has a mission to train the force and to get equipment and technology down range into the hands of the soldiers, sailors, airmen and Marines so that they can do their jobs rapidly and effectively."

Brady teamed up with Hilsden to help the U.S. soldier following his surgery. Using a stimulator, a small device that delivers a weak electronic pulse, Brady was able to locate the nerves in the soldier's leg.

When he saw the knee twitch, he knew he had found the right spot.

"We are seeing patellar snap, so that's the key that we are actually getting the femoral nerve," Brady said.

He then inserted a catheter to deliver pain medication directly to the nerve.

"These patients, because of the nature of the combat injuries, can get multiple surgeries," he said. "This catheter, then, will give pain relief for the ride home. And then it can be used for subsequent procedures."

Rediscovering Old Remedies

While doctors are heralding such high-tech tools for battle zone medical care, a more rudimentary technique increasingly is saving lives.

Like many of the injured, when Beechinor arrived at the hospital, he was wearing not one but three tourniquets to help stop the bleeding from his injuries.

In the civilian world, tourniquets have a bad reputation, blamed for causing additional damage. Nowadays they are rarely used.

But on the battlefield, where everyone is trained to use them correctly, tourniquets -- modern ones are pneumatic; think of a blood pressure cuff -- have been saving countless lives and limbs by quickly stopping blood loss after injury.

When a Canadian soldier arrived at the hospital with both legs broken by an IED blast, he also had damage to a major blood vessel in one of his legs.

"He had some injuries that would put his [life] at risk for immediate amputation or amputation down the road," said Hilsden.

"We had to work quickly to make sure we did what we could to save his leg," said Hilsden. "He had a very well-applied tourniquet at the highest part of his thigh, and that probably saved his life."

In fact, as IED blasts remain one of the biggest threats in war zones, battlefield doctors are noticing a remarkable change in recent years: Tourniquets are becoming a de-facto part of a soldier's battle uniform.

"A lot of the soldiers are putting [tourniquets] on before they go out on a mission," said Dr. Shannon Hart, another trauma team leader. "They have them on their arms and legs so that should they need it, they tighten them up. So they are wearing them as part of their own body equipment."

Saving Lives with Blankets

In recent years, the military has developed the Joint Theater Trauma System, which studies ways to develop and implement the best practices for saving lives. The military currently tracks 135 different data points on every patient to learn about what treatments work and don't work.

Like tourniquets, another simple remedy that greatly improves survival rates is the use of blankets to keep patients warm.

"We have learned a lot about temperature control and hypothermia," Hart said. "Hypothermia causes ... significant bleeding that can't clot well. So we've significantly saved a lot of lives by having the temperature control."

Kandahar's combat hospital also has one of just three CAT scan machines in all of Afghanistan, along with neurosurgeons and radiologists, among the many specialists on call.

"Billions of dollars are spent on fighter jets and Apache helicopters," Hilsden said. "We can invest in front line, close-to-the-point-of-injury medical care and we know it saves lives.

The CAT scan machine is used to check anyone injured in an explosion for signs of brain injury. But radiologists also can use the scan in other ways.

When a member of the Afghan security forces arrived at Kandahar with a gunshot wound through the chest, he suddenly developed difficulty breathing. Hilsden suspected a major blood vessel in his chest had been hit by the bullet.

Dr. Mike Lee, a radiologist, used the CAT scan to perform an angiogram, tracking the blood vessels in the soldier's chest.

"What I want to see is any injury to the arteries," Lee said. "If there is any bleeding from that area or any specific damages to the vessels so that it can help the surgeons with their surgery."

With the scan images arrayed on a series of computer screens, Lee tracked the large blood vessels and saw that they were not damaged by the bullet. But he also discovered that a lung had collapsed because of blood pooling in the soldier's chest.

Surgeons were able to correct the damage.

"We have pretty advanced equipment here," Lee said. "We are able to do many, if not all, of the things that most trauma places can do back in the States."

Recently, that difficult task became easier. Since 2005, the hospital had been housed in a jumble of makeshift wooden buildings and tents tucked behind concrete blast walls. But it was still vulnerable to rocket and mortar attacks.

Last month, the hospital moved into a new, hardened facility housing 12 trauma bays, a 16-bed intensive care unit, and a 35-patient ward.

"The advantage of this place is that its bomb-proof," says Dr. Eric Kuncir the head trauma doctor, as he walked through the new operating rooms. "If there is a rocket attack here on base, we don't have to take cover. We just keep working."

There's a double edged sword, however, to now having a facility reminiscent of Walter Reed or Boston General.

"It seems like we are here to stay, wouldn't you say?" Kuncir said. "We are not going away until the mission ends and we will take care of the war casualties and the civilian casualties as best we can.

"From the perspective of, say, a mom or dad who's sending their kid over here with the prospect of so many of them getting hurt ... [w]e've done everything we can to bring the capabilities that exist back in the States to the battlefield."

In war, saving lives sometimes is the only good news.