RAMSTEIN AIR BASE, Germany--It's warming up in the Middle East, and as the mercury rises, so does the intensity of fighting in Iraq and Afghanistan. And that means the number of seriously injured American soldiers passing through here is also rising every day.
Ramstein is known as the U.S. military's gateway to Europe, since it's where most personnel touch down when deployed here, the Middle East, or Africa. It's also part of the Kaiserslauten Military Community, whose 54,000 U.S. citizens make up the world's largest concentration outside the United States. But it's also a gateway of a much more solemn kind. This is where soldiers badly wounded in combat are taken and from where they are then flown back home.
And for the medical personnel here, whose job it is to process each and every one of those soldiers, whether they walk off the plane under their own power or if they're unconscious and clinging to life, each day means finding a way to remain positive while confronting the very real human effects of America's wars.
These also may be the first people outside the war zones who see the effects of new military approaches by the opposition. That's because they can see changes in the patterns of the injuries the arriving soldiers have, said Julio Lairet, who leads Critical Care Air Transport Teams (CCATT), which handle the most serious patients. "Changes [in] devices [may cause different wounds]. A grenade or land mine might be different than an "improvised explosive device" (IED).
Also, Lairet said, American soldiers are spending more time in mine-resistant ambush protective vehicles, and though they can save the lives of the soldiers in them when they hit an IED, their increased use has also boosted thoracic or lumbar fractures in those attacks.
Ultimately, though, advances in the technologies and techniques available to medical personnel from the battlefield all the way to Ramstein and beyond means that soldiers are surviving combat today at much higher rates than during Vietnam, said Col. Scott Rice, who commands the medical mission at Ramstein.
I've come here as part of Road Trip 2011, and within minutes of my arrival, a C-17 touches down after the long flight in from Bagram Air Base in Afghanistan, and the scenarios that Rice and Lairet have been describing are played out in front of me. We drive out to meet the giant plane, and after a short period of crews unloading luggage and other equipment and gear, it's time to start taking off the "wounded warriors." It's not long before tears are rolling down my cheeks.
Three types of patients
According to Air Force Maj. Linda Warhover, who works with the 86th Contingency Aeromedical Staging Facility (CSAF) here, Ramstein handles three categories of injured soldiers. The least serious are known as thru-regulated, or ambulatory, patients. These are the men and women who are able to walk, need only minor care, and who will be sent directly back to the U.S. Then there are the medical transient detachment patients, those whose wounds are serious but not grievous. And finally there are the most serious, the inpatients, intensive-care unit-level patients who must be stabilized at the nearby Landstuhl Regional Medical Center (LRMC) before they can be flown home. Many of these are deeply unconscious and have very uncertain futures.
There are various organizations involved in the transfer of these soldiers from "downrange," as the war zone is called, to hospitals or their homes in the U.S. The first I encounter is the 10th Expeditionary Aeromedical Evacuation Flight (EAEF), whose responsibility is to staff the flights to and from Ramstein with nurses and med-techs capable of tending to the less serious patients.
Another is the 86th CASF, Maj. Warhover's unit, which offers 24/7 operations support for all Ramstein aeromedical missions, including providing the crews that receive patients from flights arriving from Iraq and Afghanistan, or delivering patients onto flights heading for the United States; and taking injured soldiers to LRMC or to the CASF's own facilities.
And finally there's the 86th Aeromedical Evacuation Squadron, which provides all the logistical behind-the-scenes support involved in making sure airplanes are always available to fly wounded soldiers out of the war zones--or from anywhere in Europe or Africa--and that all the resources required for handling these patients are ready when needed.
The combat wounded who are sent to Ramstein have already passed through several other medical stations. The first and most immediate is battalion care, essentially a field medic who administers the initial aid. Next, a battle surgeon will help them, most likely stabilizing them and potentially trying to save their life. Then they'll be taken to a real medical facility, perhaps in Kandahar in Afghanistan or Bagram in Iraq, that will have a real operating room, and the ability to do a CT scan, or administer some some sort of subspecialty like cardiothroasic, vascular, or neurologic surgery. Next, they go to Ramstein and to the LRMC.
And then, finally, they're flown back to the United States where they will be taken to the hospital closest to their home base--either Walter Reed, Bethesda, or Brooke Army Medical Center. If they're suffering from major burns, they have to go to Brooke, as that is the only Department of Defense burn center. Patients with penetrating head wounds go to the Navy National Medical Center at Bethesda.
Each week, the 10th EAEF flies several missions to Afghanistan and Iraq to pick up wounded, and there are also three scheduled flights to Andrews Air Force Base near Washington, D.C. Those flights will be filled with all three categories of wounded soldiers, as well as the medical teams to treat them, other passengers, and some cargo.
But if more flights are needed, they'll be sourced up, explained Linda Cleary, the chief nurse for the 10th EAEF. "We're always poised for a mission," said Maj. Julia Wiley, also of the 10th EAEF.
On the C-17 that has just arrived, there are all three types of wounded soldiers. The most serious, I'm told, include a soldier who lost both legs when he was hit by an IED, and another who attempted to hang himself. He was without oxygen for 10 minutes and is now suffering from brain damage.
Watching the CASF crew carefully carry these soldiers and the less seriously wounded off the plane, I quickly realize I wasn't emotionally prepared for what this visit would be like. Over the years, I've gone to many different military installations, including submarine bases, chemical warfare defense centers, and even Cheyenne Mountain, the former home of NORAD. But none of these was involved in the daily reality of combat, and for the first time in my life, I'm face to face with what happens to soldiers when they get hit. As the piece of paper taped to the inside of one of the CASF ambulances puts it best, the arrival and intake of these men and women--there is at least one female soldier among the wounded coming off the C-17--is a "real world" mission.
'I think it went through a sand bag'
I was told by my hosts that as long as I got a release, I could talk to any of the able wounded soldiers I wanted. At first, I didn't think I could do it. It felt disrespectful and I wasn't sure what I would say. But then I was told that there was one guy who would make it easy for me.
This was Army Specialist Jameson Read, a 22-year-old from Trenton, Mo., who was serving in Kumar Province in Afghanistan with Alpha Company of the 2-27 Infantry, 3rd Brigade, when we was shot in the arm by a Pakistani militant who was part of a coordinated attack on his unit.
Read explained that his team knew they attack was coming, but that when the militants opened fire, mostly with DSKAs, a Soviet .50 caliber machine gun, there was little they could do about it. "They were pouring it on, and we were pouring it on," Read said. The militants fired a rocket-propelled grenade that went into an American barracks and would have killed five or six soldiers, he explained, except it was a dud.
Read himself was "gunning on a 60 mm mortar" when the bullet hit him. It might have been worse, but, he said, "I think it went through a sand bag." His arm was ripped open, and he quickly tried to throw on his tourniquet, but he wasn't able to. Racing with adrenaline, he ran to the nearest aid station where he began the multi-step process that's taken him here. Today, he'll be put on one of the regularly scheduled C-17 flights to Andrews.
Lying on his cot, Read is playing around on a HTC Wildfire and listening to music on his Zune. He's very upbeat and chatty. He said he would fully recover, and when I asked him if he'd be going back into combat, he said that he expected two or three weeks of physical therapy back home and then he was eager to rejoin his team. "They're down a guy with me" injured, he said. He also said he "had a bone to pick" with the Pakistanis who shot him and he was looking forward to dealing with that.
At the CASF center, Warhover explained the setup. They have 97 employees, including two flight surgeons, 19 nurses, and pharmacy and logistics technicians. The crew is also responsible for going to the incoming and outgoing flights and bringing the soldiers off or putting them on the planes.
The night before a flight is scheduled to fly back to the U.S., like today, the CASF crews go to the LRMC to pick up the least serious patients. Those soldiers will be taken to the CASF center, where they will see a flight surgeon, get their medications, spend the night, and then the next morning, be processed to fly home.
For the more serious patients, that means a 9 a.m. pickup from LRMC on flight day and being staged at the CASF center until it's time to go to the flight line. On some days, there may be CCATT patients. These days, I'm told, there isn't an outbound flight without one, and ominously, the flight leaving this afternoon has eight CCATT patients, the most anyone can remember being on a single flight.
I ask about the injuries those patients sustained, and Warhover wants to make sure I really want to know. She says she often doesn't--as it can be too emotional to deal with. But I do, and I'm told that the eight include three soldiers who have lost both legs in various explosions, one who has lost a single leg, one with a traumatic brain injury, and two with serious burns. I can understand why Warhover doesn't want to see the so-called PMRs, the patient move requests.
Of course, not all the patients that come through here were wounded in combat. In fact, of the 122,000 patients that have come through the CASF, just 21 percent were suffering from battle injuries, Warhover said. The other 79 percent had non-battle injuries, illnesses, or other maladies. Of those 122,000, about 43,000 were eventually sent back into combat.
It's time to go back to the flight line, where another C-17 is about to be loaded up with passengers--including the eight CCATT patients and three CCATT teams who will care for them during the flight. Though the plane is staffed by the 10th EAEF, it is flown by members of the Mississippi Air National Guard.
The first of two ambulances arrives, and the CASF crews begin gently carrying the wounded soldiers who can't, or at least aren't supposed to, walk onto the plane. Among them is Read, who sees me and flashes a big grin and a thumbs-up as he's carried up the ramp into the giant C-17.
Among the passengers on this flight are at least two wives of CCATT patients. The military flies some of the wives to Ramstein to meet their husbands so they can accompany them home. And off to one side of the plane, I see Maj. Gen. John Ellington, the chief of chaplains for the National Guard Bureau, leaning in closely and talking with one of the wives. When he gets up, I gingerly walk over and introduce myself and ask her if she wouldn't mind answering a few questions.
Her name is Larissa Daniel, and she's 22, and from Georgia. She said her husband Chris, who's 25, was injured two weeks ago in Iraq. She said that the military people she's dealt with have "been very helpful here," but that her experience so far has been "overwhelming" and "anxious is all I've felt."
Daniel said she feels that her husband has been getting good care but said that because he has suffered a brain injury, it's not known how long he'll be at Bethesda.
I had noticed that Ellington had given her a coin, and she showed it to me. "He told me just to look at it when I feel alone," she said, "and know I'm not alone...that they're praying for [us]. Chris has so many people out there praying for him."
Despite the grave situation facing at least eight of the passengers on board the plane, the mood as everyone is being loaded up is surprisingly upbeat. People are smiling, others are cracking jokes. It seems they have to keep the mood positive. And Read, eager to show anyone who will look a photo of his injury on his Wildfire, drops it and it breaks open. "Epic fail," someone yells," and Read retorts, "I've dropped that thing like 20 times."
Someone picks up the parts, and he snaps it back together and it turns right back on. This kid and his devices are not to be stopped.
At the same time, women from the USO are handing out packages of homemade cookies to all the wounded soldiers. They figure the treats will help with the long flight back to the States.
One former Marine who works at Ramstein as a liaison to the members of his service--as opposed to Air Force or Army personnel--who come through is helping out with the cookie mission, and when I say that I didn't know Marines did such things, he looks at me and eyes flashing, says, "If you print that, I'm going to track you down and do what the military trained me to do."