Battle Field Angels (31 page)

More than half of the burn injuries sustained during the Vietnam War were accidental. Combat burns from an artillery round exploding inside a bunker, armored personnel carrier, or ship’s compartment were particularly horrific and could lead to dehydration and shock. Often they were compounded by penetration wounds from shrapnel and other serious complications such as smoke and flame inhalation. A trachea badly burned by heat could become swollen and cut off oxygen to the lungs. The complexity of serious burn injuries from enemy fire carried a 70 percent fatality rate.

If a soldier or sailor survived the first few hours, the new antibacterial cream Sulfamylon reduced burn infections by half. Developed by the Army’s biological warfare medical researchers in the 1950s, Sulfamylon replaced the standard treatment of a copper sulfate solution that was found to be toxic.

Preventive medicine was far more effective during the Vietnam War than it had been in previous wars and military conflicts. A new policy of six weeks of acclimation upon arrival in Vietnam before transfer to a combat unit contributed to a decline in disease incidence. In addition, Dapsone, a drug known to be effective against leprosy, was used to reduce the incidence of malaria among troops. It was particularly effective in reducing the malaria recurrence rate from a high of 40 percent to 3 percent. Although disease still accounted for 70 percent of Army hospital admissions, the rate per 1,000 soldiers was 66 percent less than that of soldiers in Southeast Asia during World War II and 40 percent less than the disease rate during the Korean War.

Casualty care underwent several changes in the Vietnam War. Most doctors were trained to rely heavily on X-rays, laboratory results, and consultation with other doctors. That was possible only at a permanent hospital. In Vietnam, the priority became expedited battlefield evacuation to hospitals both in the rear and offshore. Highly efficient helicopter medical evacuation to permanent Army hospitals led the Army to assign fewer medical officers to combat battalions. Instead, the wounded were brought to the doctors at hospitals by helicopters with crews that received increased training in resuscitative care.

The Navy’s deployment of the World War II-era USS
Repose
and USS
Sanctuary
as hospital ships improved the chances of survival for many patients. Both vessels were modified with helicopter pads to accommodate the steady stream of medevac arrivals. The hospital ship fleet employed state-of-the-art trauma medicine equal to that in the most sophisticated trauma centers in the United States.

In many respects, the defining medical advances of the Vietnam War were in logistics, communications, coordination, and transportation of wounded soldiers and sailors, supplies, and equipment more advanced than that which had been available in the Korean War.

In the three decades following Vietnam, increasingly sophisticated technology was developed and incorporated into military medicine. Corpsmen and medic training was expanded. Battlefield medics who were called “aidmen” during World War II for their first aid training would become highly trained emergency medical technicians under fire.

Iraq

H
e looked impossibly young and serene lying on the desert sand. His weapon lay a few feet away, and one of his boots had disappeared. Dust hanging in the darkened air blurred the view of the nearby Iraqi city. Blood pumped out of his thigh. The odor of a slashed belly mixed with those of explosives and burned flesh and hair. The medic knelt as he studied the casualty. He pulled what looked like cat litter from his kit. He sprinkled it into the gaping chest wound, and the blood clotted in seconds. He turned his attention to the bleeding abdomen. A choking sound gurgled up from the chest. Two quick blinks. A gasp. Another. Stillness. Death had beaten the medic.

Unseen lights overhead were turned on as the medic pushed himself up on his feet. He first should have checked under the body armor. The shrapnel that had buried itself in the chest cavity would have been impossible to miss. He’d remember that tomorrow when his turn came again in the simulation chamber at a military medical training center at Fort Drum, New York.

Combat medicine in World War I had been little more than first aid: slow the bleeding and get the soldier onto a stretcher bound for a hospital in the rear. World War II medicine in the bottom of bomb craters had been similar, though modestly trained corpsmen and medics were armed with antibiotics and a better understanding of how to ward off infection and shock. By the time America waged war in the Middle East in 1991 and again in 2001, sophisticated training and technology turned corpsmen and medics into well-equipped battlefield emergency medical technicians and paramedics.

Realistic simulations converted the classroom into a war-like environment where corpsmen and medics practiced tracheotomies and inserted chest tubes under challenging conditions. Some training regimens were increased from ten to sixteen weeks and included far more technical instruction than corpsmen and medics had received for previous wars.

Soldiers also were taught “buddy aid.” When they patrolled in Iraqi neighborhoods in 2003, many carried one-handed tourniquets and an antibiotic coagulant that looked like cat litter. They had been shown how to provide immediate care for themselves and other soldiers within minutes of being wounded. That training was developed after a 1993 military mission in Somalia had gone awry and eighteen Marines had died. One stranded Marine had bled to death only a mile away from a military hospital. Guerilla warfare had demonstrated to the military that greater medical training for all soldiers in combat was crucial to survival.

The Iraqi desert heat made sleep impossible for the Marines scheduled for a predawn patrol “outside the wire” into neighborhoods controlled by the enemy. Land mines were buried in dirt roads, snipers were posted atop cinder-block buildings, and caches of ammunition and artillery shells were hidden in backyards and vacant lots.

As sunrise brightened Ar Ramadi on October 4, 2005, the Marines prepared to leave their base of operations, Camp Snake Pit. Located in the northwest corner of the city at the junction of a major canal and the Euphrates River, the Pit was the Marines’ 3rd Battalion headquarters. It was also home to Lima Company, which had arrived from Twentynine Palms, California, in September.

Chaos reigned in Ar Ramadi, a city of nearly 400,000 inhabitants. The police force had vanished when the United States invaded two years earlier. Warring Sunnis and Shiites held sway over individual neighborhoods. The northern half of the city, with its commercial districts and paved streets, retained some semblance of order. The south, the Marines’ patrol area at dawn, teemed with insurgents, spies, improvised explosive devices, and promised deadly crossfire ambushes.

Ar Ramadi was the southwest corner of the Sunni Triangle, formed by Tikrit to the north and Baghdad to the east. The region was the epicenter of Muslim insurgents dedicated to driving the United States out of Iraq. Nearly 90 percent of Sunnis supported armed resistance against the Americans. The insurgents’ war of attrition in and around Ar Ramadi grew increasingly deadly in late 2005. Twice as many Marines were killed in Ar Ramadi as in Baghdad, a city whose population was fifteen times greater.

Young soldiers, some still teenagers, prepared for their patrol mission. Lieutenants Brad Watson and Matt Hendricks, Corporals Andrew Bedard and Shawn Seeley, and corpsman Nathaniel Leoncio would patrol in one of the twenty-one Humvees assigned to the mission.

Captain Rory Quinn knew that nearly all of his Lima Company Marines faced battle for the first time. Most had less than a month’s combat experience as part of a battalion that had a long and storied history dating back to World War II amphibious assaults on Peleliu and Okinawa and the brutal Battle of Chosin Reservoir in Korea. Marines in the battalion had earned fifteen Medals of Honor.

Quinn had studied World War II, Korea, and Vietnam combat tactics that dictated avoiding movement on obvious trails where the enemy lay in wait. But Iraq had become America’s first “road war.” Patrols were limited to asphalt and dirt streets. Few advances moved across open fields or through stands of timber. The Americans rarely caught the enemy by surprise in stark desert neighborhoods devoid of vegetation. The insurgents planted IEDs along expected Marine patrol routes. The IEDs often were preludes to deadly ambushes.

At twenty-four years of age, corpsman Nathaniel Randell Leoncio was older than most of the Marines who had joined Lima Company about a month before it deployed to Iraq. Short and slightly built, “Doc Leo” nonetheless radiated a commanding presence. His wide Filipino eyes narrowed almost to slits when he smiled, pushing dimples into his cheeks. The corpsman enjoyed jokes, pranks, and “talking smack.” Leoncio also represented the increasing speed of combat care.

For more than sixty years, the distance between battle and definitive trauma care had been shortening. During World War II, mobile Army hospitals trailed soldiers across Europe. In Korea, helicopters ferried the wounded out of foxholes to MASH units a few hours away. In Vietnam, acute-care hospitals were established in the combat zone. By the time Operation Iraqi Freedom was launched in 2003, both the Army and Marines had established small, extremely mobile hospitals that practically accompanied the infantry on patrols. An Army Forward Surgical Team was comprised of twenty personnel, including four surgeons. The team used one tent and surgical supplies contained in a handful of specialized backpacks (intensive care unit, surgery, anesthesia, and orthopedics, among others). It traveled in six Humvees and in one hour could set up a few hundred yards from a planned mission. Miniaturization made the FST’s mobility possible. Sonogram machines were the size of cassette recorders, and laboratory blood analysis units were as small as PDAs.

Typically, a combat support hospital was located less than an hour away from the battle zone, with about two hundred beds that could be assembled in forty-eight hours. From there, the gravely wounded could be evacuated to Germany or the United States within days for even more comprehensive care.

Although the Marines had trained in California’s high desert near Palm Springs for months, the heat felt different when they arrived in central Iraq. It drained the men who faced as many as three patrols a day. Even on days with no scheduled patrols, the Marines maintained “twominute warning” status, ready to roll out on minimal notice.

Each type of patrol held a unique danger. Door-to-door searches were tediously slow. Other patrols required Marines to sprint from one sheltered location to the next. The precise positioning of a Marine’s gear on his body was crucial. No one could afford to be distracted by raw blisters from a flak jacket, gloves, knee pads, signaling devices, helmet, or spare ammo when running to avoid snipers.

Corpsmen accompanied Marines on every mission. Chronically undermanned, Marines relied on corpsmen to jump the same walls, hit the ground, and scan the darkness with night-vision goggles, just as they did on patrol. Corpsmen often were tasked with calming a family or guarding detainees while soldiers completed a search. On occasion they used mirrors to search Iraqi women out of respect for the local culture. Most corpsmen in the battalion carried an M16 rifle or shotgun to blend in with the other Marines. Earlier in Iraq, some corpsmen carried only M9 pistols, which marked them as desirable targets for enemy snipers. To the enemy, an American soldier in the field carrying only a pistol was likely a corpsman or medic. Many corpsmen, though, carried other weapons in addition to their medical gear.

Corpsmen knew that despite their training, the element of the unknown made every mission and every casualty impossible to anticipate. Many adopted a combat mindset when they arrived in Iraq. Each expected to face enemy fire and multiple casualties, and each also understood it was entirely possible that he was replacing a corpsman who may have been wounded or killed. Some adopted a fatalistic approach to cope with the unknown, believing “those who were going to die, would die.” Each knew the primary mission: combat triage. The goal was to keep the wounded alive until they could be evacuated.

If I do this first, how much time is it going to buy?
Corpsmen made instant decisions with this question in mind. Buying time was critical because corpsmen could not always be sure when evacuation might be possible. It could range from a few hours to days due to enemy fire, dust storms, or sand storms. Speed and effectiveness were paramount. A wound that might require stitches in a hospital could be closed quickly with a safety pin on the battlefield. In a hospital, an injured soldier unable to breathe might have a tube inserted to assist him. On the battlefield, a corpsman more likely would cut a hole in the soldier’s trachea to help him breathe, while taking care not to sever nearby arteries. Lifesaving decisions were made without the benefit of sophisticated equipment.

Corpsmen monitored their medical supplies in the field as closely as soldiers kept track of their ammunition. A corpsman frequently used the tourniquet or pressure dressings contained in the individual first aid kit carried by each soldier. Under dire battlefield circumstances, corpsmen sometimes reused bandages taken from soldiers who had died minutes before.