Navy Surgeons Fight For 'Golden Hour'

Caption U.S. Navy surgeons and a nurse operate on a wounded Iraqi civilian while medical staff from the Forward Resuscitative Surgeon System, Team 6, look on at an emergency hospital on the road to Bagdad near Ad Diwaniyah in central Iraq, Saturday, March 29, 2003
The howitzers flash, recoil and roar, lobbing shells over the heads of sweating U.S. Navy surgeons.

Inside sweltering khaki tents, the eight-man operating team tends to the wounded: Moaning Iraqi fighters, claiming to have been shot by their own when they tried to surrender. Two Marines. Two British allies, one dying.

If the chop-chop-chop of helicopters signaled the closeness of hospital units to the front in Korea and Vietnam, the howitzers do the same in Iraq — firing American outgoing artillery over the heads of surgical teams operating between American and Iraqi lines. Front-line units like these make it possible to get critically wounded people onto the operating table within an hour of the time they fall in battle.

"The 'golden hour' of trauma. You have one hour to get them to surgery before bad things start to happen," says Cmdr. Robert Izenberg, a surgeon in T-shirt, operating scrubs and pushed-down white mask.

"We ARE the front line," adds Capt. Tony Serfustini, a surgeon, standing outside one of the tents, a discarded and bloody wooden splint by his feet. "Can't get any farther forward than that."

The teams, called forward resuscitative surgical systems, are operating for the first time ever in combat. The six eight-member teams, scattered over Iraq, mark the closest Navy teams have ever operated to the battlefield.

The front-line lifesaving units grew out of the 1991 Gulf War, Somalia and other Marine engagements of the past decade or so.

Past wars, including Vietnam and Korea, were more static. In Vietnam, 14 hospitals that never moved tended to patients scooped out by helicopter or plane.

In the Gulf War and onward, Marine units rushed too far forward, on too many fronts, for the old-style "scoop-and-run" medical teams to get critically wounded to care in time.

"It's a different conflict," said Serfustini, a Vietnam veteran and now a surgeon and Navy reservist. "This is a conflict in motion. Vietnam was a conflict in stagnation."

The forward surgical units took seven years to design. Navy physicians and others worked to come up with mobile units that were truly mobile — replacing ones that at times needed a C-130 transport plane, and a landing field, to move.

The result: a surgery team that can move in four trucks, set up in an hour, and tear down in an hour. There are two surgeons, an anesthesiologist, a nurse, operating technicians, and corpsmen, together capable of tending to a maximum of 18 patients in 24 hours.

Their intended patients: the 15 percent to 20 percent of battlefield wounded who die if they do not receive critical care in an hour.

The front-line surgeons are meant to stop bleeding, stop contamination and get the wounded on down the line.

Nothing time-consuming: shunts instead of intricate grafts on torn blood vessels, clean up instead of repair of perforated intestines.

"It's lifesaving surgery and limb-saving surgery," said Serfustini, wearing sunglasses, a flak vest over bare skin and a bandanna wrapped around his head.

"Damage-control surgery. I still provide the same high level of care. It just doesn't have all the bells and whistles," said anesthesiologist Cmdr. Bruce Baker, who works with a portable oxygen generator, blood-gas monitor and devices to warm fluids going into patients.

The Iraqi sun keeps the medical tents a stifling 80-plus degrees F (32-plus degress C) during the day, instead of the 68 degrees F (20 degrees C) surgeons prefer to keep sweat off the tools and out of the patients.

Despite tightly sealed seams, dust from southern Iraq's sand storms snaked up black hoses leading to monitors.

In south-central Iraq, the team one day treated only one Iraqi civilian, brought in — praying, his guts showing — with what appeared to be shrapnel wounds, cause unknown.

The Geneva Conventions and the doctors' Hippocratic oath requires them to treat all critically wounded persons, Iraqi soldiers and U.S. Marines alike.

At Zubayh, the heaviest test yet, the team dealt with two U.S. Marines, two Britons and eight Iraqis.

Some of the Iraqis "said they'd tried to leave and surrender, and been shot" by their leaders, Serfustini said.

For the Iraqis in particular — who lack the Kevlar helmets and flak jackets of American forces — immediate surgery meant stemming blood loss, and survival.

"We're making a difference," Serfustini said. "The real proof will be the assault against Baghdad. Check back with us in a couple weeks."