“Give a thumbs up.”
That’s the first order wounded soldiers receive at the Landstuhl Regional Medical Center in Germany. As the largest U.S. military hospital outside the country, Landstuhl is the chief caretaker of injured troops evacuated from Iraq and Afghanistan. Often, because soldiers’ injuries from roadside explosives and bombs are so severe, a thumbs up is the only way doctor and patient can communicate, says Eric Frykberg, M.D., a UF professor of surgery at the College of Medicine-Jacksonville.
“It was incredibly touching to see these patients – intubated so they couldn’t talk, with devastating injuries and covered with burn dressings – somehow muster the strength to give us that universal ‘I’m OK’ sign,” said Frykberg, who spent two weeks at the hospital in August as part of an American College of Surgeons visiting surgeon program.
Even with years of experience as a former U.S. Navy surgeon deployed to Saudi Arabia during the first Gulf War and as a busy trauma surgeon in Jacksonville, Frykberg said he was surprised by the level of devastating injuries among soldiers taken directly from combat-zone field hospitals to Landstuhl.
“I was in the military, but what I saw at Landstuhl was something you rarely see – it was mass casualty and managing mass casualty is very different from anything we’ve learned and requires a whole new approach to medical care,” he said. “I’ve been here in the trauma center for 22 years and published a lot of about trauma, so this is the kind of person they’re looking for – someone experienced in trauma to go over there and have a give-and-take approach to educating the military surgeons about trauma care while also learning from them many new techniques being applied to wounded soldiers.”
Frykberg conducted two grand rounds lectures and was involved in the care of about 36 patients at Landstuhl.
“The most common reason by far for injuries are bomb blasts – the IEDs (improvised explosive devices), suicide bombers and roadside bombs,” he said.” I saw only two typical war injuries from gunshot wounds.”
Bombs cause devastating blast injuries rarely seen in a typical trauma center stateside, Frykberg said.
“You hear about the deaths on the news, but there’s very little you hear about a whole generation having really devastating injuries like mangled bodies and lost limbs,” he said. “We have a huge level of amputees among these young soldiers now looking toward a life of significant disability.”
Like the injuries, the type of care provided at Landstuhl differs from hospitals here. The focus at Landstuhl is stabilizing patients so they can be sent back to the U.S. The hospital is just a way station between the battlefield and hospitals where they will recover, such as Walter Reed Hospital in Bethesda, Md., or the San Antonio Burn Center in Texas.
“We helped stabilize the patients, assisted surgeons in the OR and got the medical records up to date so we could provide the continuity of care needed to get the patients back to the states for their definitive care,” he said. “Then we turned around and prepared for more incoming patients.”
But each patient leaves with one thing from Landstuhl, a quilt with the words “For an American warrior” embroidered on it, and each patch quilt is signed with personal messages by the volunteers who make them.
“Even now, when I look at my photos from my Landstuhl experience and see the quilts being loaded with each patient for the flight home, I recognize the dedicated and caring medical personnel who helped that patient make it that far, as well as all the supporters back home,” Frykberg said. “The handwritten signatures, comments and drawings say it all.”