It’s a different war, yet it is all too familiar for USF professor Larry Carey. The war in Iraq reminds him of 1964. During that time, Carey could step outside the hospital where he was stationed in the Vietnam War and know he was in a war zone. And though he can only see the scenes of horror of the current war on television, they remind him of his service as a trauma surgeon.
“You can remember the experience of being there and the sounds and noises of all the sick people,” Carey said. “We could sometimes see the fighting going on. We’d see tracer bullets, and we would know in a few minutes we could expect to get some casualties.”
Stray bullets occasionally hit the naval hospital in Da Nang where Carey, now a professor of surgery at USF’s College of Medicine, was stationed.
But a bullet flying into the trauma surgery station was the least of Carey’s concerns.
Carey was more concerned with beating the “golden hour.” Carey’s target was this time frame, a crucial point between life and death.
“There is a sort of standard call of the golden hour,” Carey said. “If you can keep the time from injury to treatment within an hour, that’s ideal.”
Carey waited for the battle casualties to come in for treatment. Traditionally, seriously injured soldiers are evacuated from the war sites to locations where they can be treated.
But as the time increases between the initial injury and time it is treated, the soldier’s chances of living decrease.
The battle the United States is fighting now, Carey said, makes the casualties and speed of treatment hard to predict.
“It’s a different type of war,” Carey said. “(But) I don’t think there’s been a big deal of change in the way soldiers are taken to the hospital.”
In this war, the position of battle lines could change at any time, and as the coalition forces aim to take out the Iraqi regime, the war could last months.
“The advantage in Vietnam was that it wasn’t this great, big war,” Carey said. “We had hospitals distributed at the countryside. One of the reasons why the survivor rate in Vietnam casualties was lower than any previous wars was because it was shorter.”
Carey said the medics and surgeons in Vietnam stayed at the hospital, and it was usually military personnel’s duty to carry in the injured troops.
Once the casualties came in, it was up to Carey, who worked in triage, to decide who would have priority for treatment.
“When a large number of injured people were brought to the hospital, we had a process for sorting them out,” Carey said. “What you do is try to look at all the people who had been brought in as quick as you can, to see what treatment is needed.”
One of the most difficult situations for most trauma surgeons in war is to decide who will receive immediate care.
“If their injury was very severe and they looked like they might not survive, they were observed, while people who look like they may survive are treated,” Carey said.
Determining the severity of a soldier’s condition was difficult, Carey said, but there was no time to second-guess his actions.
“It’s something that you learn to do over time because you have to,” Carey said. “And it maximizes the chances that those who need care are going to get what they need.”
Like Carey, Lewis Flint, a surgery professor at USF, had to adjust to the unusual work environment that comes with war. Flint, however, was stationed to care for wounded troops with an infantry in the battlefield in Vietnam.
“We did our first aid in a large version of a fox hole generally at a campsite that was usually 8 to 10 feet deep with armored carriers lined up in circles, like in the movies,” Flint said. “It’s a different kind of intensity than in the hospital. In the field, you’re taking care of patients, and at the same time you’re getting shot by people you don’t even know.”
Flint said medics in his unit were responsible for stabilizing wounds, applying bandages, starting intravenous fluids, putting splints on broken bones and sending casualties to the hospital.
“I felt pretty secure most of the time,” Flint said. “We were usually working in a tent that was over a hole in the ground, and the guys in the infantry battalion were very good about protecting us. But there’s no way you get used to the shells going off around you.”
One thing Flint did become familiar with was the shipment of newsletters every two to three weeks that updated medics on results from research units. It was through this, Flint said, that medics learned about the “golden hour.”
He said in order to reduce the number of casualties in war, that type of conducted research needs to continue. Flint said research has improved since Gulf War I when Gen. Norman Schwarzkopf decided he didn’t want any medical research conducted.
Research on casualty treatment is beginning to pick up its pace with Operation Iraqi Freedom, however, most research teams are based in Kuwait. Flint said that most of what the medics know about treating injured patients should be known by the time the patient arrives, and the only way to do that is to continue communication as it was done in Vietnam.
“It was a very good, very rapid exchange and dissemination of information,” Flint said. “It’s always negative when valuable information that could be gleaned and analyzed is not. It means that we can’t learn from our mistakes.”