NUMBER OF WOUNDED IN ACTION ON RISE
Iraq Toll Reflects Medical Advances, Resistance Troops Face

By Vernon Loeb
Washington Post Staff Writer
Tuesday, September 2, 2003; Page A01


U.S. battlefield casualties in Iraq are increasing dramatically in the face of continued attacks by remnants of Saddam Hussein's military and other forces, with almost 10 American troops a day now being officially declared "wounded in action."

The number of those wounded in action, which totals 1,124 since the war began in March, has grown so large, and attacks have become so commonplace, that U.S. Central Command usually issues news releases listing injuries only when the attacks kill one or more troops. The result is that many injuries go unreported.

The rising number and quickening pace of soldiers being wounded on the battlefield have been overshadowed by the number of troops killed since President Bush declared an end to major combat operations May 1. But alongside those Americans killed in action, an even greater toll of battlefield wounded continues unabated, with an increasing number being injured through small-arms fire, rocket-propelled grenades, remote-controlled mines and what the Pentagon refers to as "improvised explosive devices."

Indeed, the number of troops wounded in action in Iraq is now more than twice that of the Persian Gulf War in 1991. The total increased more than 35 percent in August -- with an average of almost 10 troops a day injured last month.

Fifty-five Americans were wounded in action last week alone, pushing the number of troops wounded in action since May 1 beyond the number wounded during peak fighting. From March 19 to April 30, 550 U.S. troops were wounded in action in Iraq. Since May 1, the number totals 574. The number of troops killed in Iraq since the beginning of May already has surpassed the total killed during the height of the war.

Pentagon officials point to advances in military medicine as one of the reasons behind the large number of wounded soldiers; many lives are being saved on the battlefield that in past conflicts would have been lost. But the rising number of casualties also reflects the resistance that U.S. forces continue to meet nearly five months after Hussein was ousted from power.

Although Central Command keeps a running total of the wounded, it releases the number only when asked -- making the combat injuries of U.S. troops in Iraq one of the untold stories of the war.

With no fanfare and almost no public notice, giant C-17 transport jets arrive virtually every night at Andrews Air Force Base outside Washington, on medical evacuation missions. Since the war began, more than 6,000 service members have been flown back to the United States. The number includes the 1,124 wounded in action, 301 who received non-hostile injuries in vehicle accidents and other mishaps, and thousands who became physically or mentally ill.

"Our nation doesn't know that," said Susan Brewer, president and founder of America's Heroes of Freedom, a nonprofit organization that collects clothing and other personal items for the returning troops. "Sort of out of sight and out of mind."

On Thursday night, a C-17 arrived at Andrews with 44 patients from Iraq. Ambulances arrived to take the most seriously wounded to the nation's two premier military hospitals, Water Reed Army Medical Center in Washington and the National Naval Medical Center in Bethesda. Dozens of others stayed overnight at what the Air Force calls a contingency aeromedical staging facility, which has taken over an indoor tennis club and an adjacent community center.

On Friday morning, smaller C-130 transports began arriving to take the walking wounded and less seriously injured to their home bases, from Fort Bragg in North Carolina to Fort Lewis in Washington state. Another C-17 was due in Friday night from Germany, with 12 patients on stretchers, 24 listed on the flight manifest as ambulatory and nine other passengers, either family members or escorts.

"That's going to fill us right back up by the end of today," said Lt. Col. Allen Delaney, who commands the staging center. Eighty-six members of his reserve unit, the 459th Aeromedical Staging Squadron, based at Andrews, were called up for a year in April to run what is essentially a medical air terminal, the nation's hub, for war wounded from Iraq.

At Walter Reed, a half-hour drive from Andrews, Maj. Gen. Kevin C. Kiley, the hospital's commanding general, said there were only two days in July and four in August that the hospital did not admit soldiers injured in Iraq.

"The orthopedic surgeons are very busy, and the nursing services are very busy, both in the intensive care units and on the wards," he said, explaining that there have been five or six instances in recent months when all of the hospital's 40 intensive care beds have been filled -- mostly with battlefield wounded.

Kiley said rocket-propelled grenades and mines can wound multiple troops at a time and cause "the kind of amputating damage that you don't necessarily see with a bullet wound to the arm or leg."

The result has been large numbers of troops coming back to Walter Reed and National Naval Medical with serious blast wounds and arms and legs that have been amputated, either in Iraq or at Landstuhl Regional Medical Center in Germany, where virtually all battlefield casualties are treated and stabilized.

"A few of us started volunteering [at Walter Reed] as amputees in 1991, and this is the most we've seen ever," said Jim Mayer, a double amputee from the Vietnam War who works at the Veterans Administration. "I've never seen anything like this. But I haven't seen anybody not get good care."

Kiley said that Walter Reed has 600 physicians and 350 physicians in training, plus reservists and the ability to bring in more nurses if necessary. The hospital "could go on from an operational perspective indefinitely -- we have a lot of capacity," he said. The hospital has treated 1,100 patients from the war, including 228 battlefield casualties.

National Naval Medical Center was most severely stressed during the major combat phase of the war, said Capt. Michael J. Krentz, its deputy commander. During that period, 800 of the hospital's medical professionals -- a third of its regular staff and half its military staff -- deployed overseas to the USNS Comfort, a Navy hospital ship. The hospital called up 600 reservists to replace them.

Before the fall of Baghdad in April, the hospital had 40 patients a night -- mostly Marines -- from Iraq. Now the number is down to three, since the Marines have begun departing and will soon hand peacekeeping duties in their area south of Baghdad to multinational forces.

"Taking care of returning casualties is our number one job -- that's why we're here," Krentz said. "That's our sworn duty, and it's our honor to do so."

Kiley and Krentz said high-tech body armor and state-of-the-art battlefield medical procedures are keeping more seriously wounded soldiers alive than ever before.

Krentz said advanced radiological equipment aboard the Comfort enabled doctors to spot internal injuries and operate much sooner than they might have otherwise been able to, preventing fatalities. In fact, he said, patients had been stabilized so well overseas that there were no deaths of returning service members at Bethesda.

Kiley said he had seen several cases in which soldiers had been operated on in the field so quickly that doctors managed to save limbs that might otherwise have been lost. "But it's a long haul even when they do preserve limbs," he said.