DIWANIYAH, Iraq—The explosion thundered across the 82nd Airborne Division's headquarters camp. Men screamed in pain, then yelled: "Medic! Medic!"
1st Lt. Ken Smith, a physician's assistant from Phoenix, Ariz., was 40 yards away and dashed to three soldiers who were collapsed next to a cargo truck where they had been unloading boxes of water bottles and food rations Wednesday night. Another man was on the ground on the other side of the truck.
The 82nd had taken over an abandoned Iraqi military base here Wednesday, 40 miles east of Najaf. The base had been the target of U.S. bombing, but a dud was buried in the sand.
One of the men had stepped on the unexploded cluster bomb, which hurled hot shrapnel in all directions.
A quarter-mile away, surgeons and nurses were nearly finished setting up an operating room in the same camp. Lt. Col. Kelly Bal was listening as an aide told him that the 782nd Forward Surgical Team's new home was operational when he heard the "Boom!" and then the screams.
During the Persian Gulf War, the Army's Combat Area Surgical Hospitals, or CASH, couldn't relocate as quickly as the troops moving forward, leaving longer gaps of distance and time between wounded soldiers and emergency aid.
"When they looked back," Bal said, "most of what people died from—they bled to death early on from abdominal wounds or extremity injuries."
Following a British concept, the Army created the forward surgical teams. Six such teams are now deployed in Iraq. Bal's unit has traveled with the 82nd's brigade headquarters, often setting up only a few miles from the fighting.
This bomb scene was much closer.
Smith and the medics bandaged the men's wounds. The soldier who stepped on the bomb lost half his foot, though the blast had cauterized the wound and limited the bleeding. The bomb fractured the tibia, the large bone between the knee and ankle, of another soldier and shot shrapnel into the legs and feet of all four.
A sergeant pulled up in a pick-up truck, helped load the wounded in back and drove them across camp to the surgeons, whose unit was attached to a medical team from the 407th Forward Support Battalion.
Medics placed the soldiers in the treatment area on stretchers supported by what look like steel sawhorses. The lights weren't working yet. Doctors, nurses and medical technicians hovered around each patient, a swarm of shadows dotted by pocket flashlight beams pointed at bloody wounds.
"I need to cut off your shirt, sir," a nurse told a patient.
A doctor called out: "Gloves. I need some gloves."
"You're going to be OK," a voice said. "I'm a doctor."
Dr. Matt Vreeland ordered that morphine be ready "at the bedside of each patient."
"Sergeant, are you allergic to anything?" someone asked.
Emergency medicine professionals talk about the "golden hour," the first hour after a traumatic injury, when medical attention dramatically increases the patient's chances of survival and recovery. Logic dictates that if the surgeons are closer, they can treat patients faster.
"The surgeries here are aimed at saving a life, saving a limb and preventing infection," said Vreeland, an emergency medicine surgeon with the forward support battalion. "If you can clean out an abdominal wound and prevent infection, you can save a life."
A helicopter is usually standing by to evacuate seriously wounded patients to a CASH. This time, all four bomb victims were stabilized by the forward team and then flown out to a hospital in the rear.
The 782nd Forward Surgical Team includes an orthopedic surgeon, Bal, and three general surgeons, plus nurse anesthetists, technicians and operating room and intensive care nurses. They travel light, though. Unlike the mobile hospitals of "M(ASTERISK)A(ASTERISK)S(ASTERISK)H" TV show fame, with hundreds of staff, the forward surgeons are a team of 22.
"Wherever we go, we have to be able to put our equipment on the back of a Humvee," Bal said.
The team doesn't limit their work to U.S. or coalition soldiers. When they stay in one spot for a few days, they attract civilian patients.
In Samawah, 82nd troops brought in a 10-year-old girl who was hit by an Iraqi car. She had a head injury, trouble breathing and a fractured femur, the thigh bone. The surgeons put in an airway, stabilized her and sent her to a mobile surgical hospital by helicopter.
Last week, U.S. soldiers brought in two pro-Saddam Hussein militiamen who tried to fire a rocket-propelled grenade before being shot by U.S. troops. The surgeons saved one of them and worked six hours, using nine units of blood, on the other before he died.
"Only the United States," Bal said, "would have put that much effort and resources and time on someone who was trying to kill them a half-hour earlier."
(c) 2003, Knight Ridder/Tribune Information Services.