08 May 2011

LAT: After severe war injuries, a new battlefield

                Intelligence - OPEN SOURCE
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Troops with severe war injuries such as multiple amputations face a long and difficult rehabilitation. Naval Medical Center San Diego is where some learn a new way of life.

May 7, 2011

Reporting from San Diego—
Marine Lance Cpl. Juan Dominguez has come a long way since October, when a roadside bomb in Afghanistan ripped off his legs above the knees and shredded his right arm above the elbow.

A Navy corpsman, part of the same patrol, kept Dominguez from bleeding to death and wisely refused his pleas for morphine, lest he go into shock. Then there was the Navy doctor at nearby Forward Operating Camp Dwyer who "wouldn't let me die" and the intensive care he received at Landstuhl Regional Medical Center in Germany.

After that, Dominguez spent five months at the National Naval Medical Center in Bethesda, Md., and at Walter Reed Army Medical Center in Washington, D.C., where he underwent 23 surgeries. Today, the 26-year-old from Deming, N.M., is an outpatient at Naval Medical Center San Diego.

"This is home now," he said of the hospital on a hill beside Balboa Park.

Dominguez is among a growing number of Marines and soldiers who have suffered catastrophic wounds that will require years of care in military hospitals. The Pentagon and the Department of Veterans Affairs are scrambling to put together a continuum of long-term care for Dominguez and other severely wounded personnel.

Based on what trauma doctors call the Injury Severity Scale index, the average score for battlefield casualties brought to the Landstuhl intensive care unit is at its highest level in the nearly 10 years that the U.S. has been at war, Landstuhl's top trauma surgeon, Air Force Lt. Col. Raymond Fang, said last week.

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

The number and rate of double- and triple-amputees have risen dramatically in the last 18 months. So has the number of military personnel suffering wounds to the genitals and urinary tract.

The most grievous wounds are traceable to the Taliban's continued use of improvised explosive devices. U.S. counter-insurgency strategy calls for soldiers and Marines, whenever possible, to go on walking patrols rather than ride in armored vehicles — increasing their vulnerability to buried roadside bombs.

The Army surgeon general, Lt. Gen. Eric Schoomaker, has formed a Dismounted Complex Blast Injury Task Force headed by Brig. Gen. Joseph Caravalho Jr., a cardiologist and commanding general of Brooke Army Medical Center in San Antonio. Its report is due in weeks.

The task force, including 27 medical experts, is charged with going beyond trauma medicine and examining "all the optimal acute management and rehabilitation of these more severely wounded warriors, including pain control, psychological and spiritual support, and family support."

At Naval Medical Center San Diego, patients are seen by doctors and therapists from a wide range of specialties. Outpatients like Dominguez live in two-person rooms on the hospital grounds.

Dominguez arrived a month ago. Days later, the corpsman who had saved his life, Stuart Fuke, 22, of Honolulu, arrived directly from Landstuhl; he had been shot in the thigh while on foot patrol.

Programs never dreamed of when the U.S. invaded Afghanistan in 2001 and Iraq in 2003 are now part of the San Diego regimen for wounded personnel, including a full range of sports activities, counseling for family members and group discussions with Vietnam veterans.

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Tweaked helmet would better protect our troops

A slightly larger helmet with more foam padding would better protect soldiers and Marines from traumatic brain injury, researchers find. The Department of Defense says that more than 130,000 military personnel have suffered such injuries in Iraq and Afghanistan.

By Tony Perry, Los Angeles Times
April 24, 2011

It is the "signature wound" of the Iraq and Afghanistan wars: traumatic brain injury from the blast of the enemy's improvised explosive devices. Now two researchers say that minor changes in the military's combat helmet could reduce the incidence and severity of these injuries.

Using complex computer modeling to determine the impact of such blasts on helmets, physicist Willy Moss and mechanical engineer Michael King of the Lawrence Livermore National Laboratory in Northern California concluded that soldiers and Marines would be better protected by wearing a slightly larger helmet with 1/8 inch more foam padding.

"I'm almost embarrassed," King said, that the finding was so simple.

The two researchers had been selected by the Army and its Joint IED Defeat Organization, which is looking for better ways to protect military personnel against improvised explosive devices, to perform the yearlong, $540,000 study based on previous work on blast-induced traumatic brain injury.

The assignment was to test which kind of helmet liner provided the most protection: two pads used by the Army, two used by the National Football League, and one used in other sports equipment. The pads had different configurations and hardness of foam, and different spacing and design of air pockets.

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