Burn Team Mans Front Lines Against Combat’s Tragic Toll

By Sharon Cohen Associated Press

SAN ANTONIO – The five badly burned soldiers arrived sedated and swathed in bandages, with the screech of the plane’s wheels on the tarmac and waiting ambulances marking the end of a 7,500-mile journey.

Dr. Kevin Chung waited inside Brooke Army Medical Center as the ambulance convoy drew near. He knew the soldiers were coming in from Germany, after being evacuated from Iraq.

Now Chung and some 30 doctors, nurses and others took over.

They cut open the men’s bandages and, using diagrams of the human body, mapped the soldiers’ burns – shading in red for third-degree, blue for second-degree – to plan for surgery.

They called the soldiers’ families. They needed permission to operate.

Quickly.

The men were injured when a roadside bomb turned their vehicle into an inferno. One man who had escaped ran back to help a trapped comrade.

“This one’s the hero,” Chung said, as the first stretcher rolled in.

“They’re all heroes,” a nurse replied.

Chung did a bronchoscopy to check the “hero’s” lungs. Tar-like soot deposits appeared on a video monitor.

If this soldier – the one who had escaped – had so much lung damage, what about the men who had been trapped?

He examined them. Their lungs were worse.

Brooke’s burn center – the only one of its kind for the nation’s military – has its own rhythms and rituals.

The center’s 40 beds are tucked in a fourth-floor wing of the sand-colored hospital at Fort Sam Houston. In the halls and on the walls, there are reminders of the war – the scarred young men, the clocks set to Iraq and Afghanistan time.

This is a place where patients celebrate every small step toward recovery and where a clenched-teeth grimace speaks more eloquently than words.

Doctors operate in 90-degree heat, sometimes six at once working on a soldier; nurses, in boots, masks and long gowns, sweat as they scrub down patients in steaming showers; families congregate, longing for the day loved ones will emerge from the cocoon of bandages.

In another era, another war, many patients probably would never have made it this far.

But troops today have better body armor, fast evacuation from the battlefield to war zone hospitals, then state-of-the-art treatment in Germany and the United States.

Brooke has special teams that fly to Landstuhl Regional Medical Center in Germany to bring home the most severe cases, sometimes handling emergencies in midair.

Once patients arrive at Brooke, skin grafts are usually done within 24 hours to stave off infection, the major cause of death.

“The faster you get the burn off the patient, the better off you’re going to do,” says Dr. David Barillo, chief of the flight evacuation team.

These days there is a steady flow of wounded from Iraq and Afghanistan – more than 570 thus far, of which only about 6 percent have died. Many survivors, however, are permanently scarred. Some also suffer from blast-related wounds, such as head injuries or fractures. Others can’t walk, cut their food or tie their shoes.

“We now have an entirely new population of burn survivors … with oftentimes lifelong and life-changing injuries,” says Dr. Evan Renz, a Brooke surgeon.

Some will recover. Others will learn new ways to become independent.

“You have to believe that you’re doing the best thing for the patient by helping them survive,” Renz says. “You have to believe that in the end, when all is said and done, they will be glad they made it through.”

The morning after the five badly burned soldiers arrived, one soldier went into shock and died.

With burns, Chung says, patients can rally, then suddenly take a turn for the worse – all the while dealing with excruciating pain.

“I can’t think of a more devastating injury,” he says. “In the most tragic instances a lot of us say to ourselves … sometimes life is worse than death.”

Of the five burn patients, one was transferred out of intensive care.

The “hero” was rebounding, too. Then an infection set in – and he died.

Within three weeks, four of the five were gone.

Chung had lost patients before, but each one, he says, leaves him shaken.

“You walk a tightrope,” he says. “I tell the family members that they need to be realistic. At the same time, I don’t want to be the person to take away hope. How can you justify giving up on anybody?”

Chung always reminds himself of Merlin German, the most critically burned patient he treated who survived. German was burned over 97 percent of his body and underwent 40 surgeries during nearly 17 months in the hospital.

Practically everyone who has met the Marine describes him with one word: Miracle.

Sitting in the therapy gym, sucking on a “fentanyl pop” – a plastic stick tipped with a morphine-like painkiller – he pulls a T- shirt of his own design from his gym bag.

On the front, it says: “Got 3 percent chance of surviving; What ya gonna do?” The back lists four options: “a. Fight Through. b. Stay Strong. c. Overcome Because I Am A Warrior. d. All Of The Above!” The last one is circled.

But living choice “d” isn’t easy.

It means one surgery after another, learning to walk again with grafts and adjusting to a ripple-scarred face.

But more than two years after German, 21, nearly died from a roadside bomb, he has a steel resolve and a supportive family led by his mother, Yvonne.

Last December, after months of practice, he donned his Marine dress blues and hit the dance floor at Brooke’s Holiday Ball.

He surprised his mother, taking her into his wounded arms, gliding across the room to a Rod Stewart song, “Have I Told You Lately That I Loved You?”

The crowd stood and applauded.

German’s path to the dance floor began in the intensive care unit.

It’s where Capt. Kristine Broger, an ICU nurse, thrives in heat and silence.

She’s accustomed to rooms set at 80 degrees or warmer if heat lamps are on to help those who can’t control their body temperature after their burned skin has been removed.

And she’s familiar with patients who can’t speak – at least, at first – because they’re sedated or on ventilators.

Broger meets those patients by talking with loved ones and looking at photos they tack up on the walls – snapshots that remind everyone of the person beneath the bandages.

Seeing these “kids” month after month, “they become part of you and you get to know the family like your own,” says Broger, just 27 and a veteran of Iraq.

Broger has a strategy for coping with the ICU’s stresses.

“After the locker room, I try not to bring anything home with me. But some days,” she says, “it’s more difficult than others.”

Chris Edwards is in Year 3 as a burn center regular.

The Army staff sergeant was wounded when a 500-pound bomb exploded under his Bradley as he was crossing a bridge in Iraq. He was burned over 79 percent of his body.

Since then, he has endured 34 surgeries, including grafts over his entire body, eye operations and holes drilled through his lower right leg bones and heel and metal rods inserted to stabilize them.

“You start thinking, what did I do to deserve this?” says Edwards, 36, who also served in the Marines. “It really tests your faith. Not only that, you’re really thinking: What did my family do to deserve this?”

Some days, he says, “I just … beg somehow for God to kill me and take away the pain and just let me die.”

And yet, as hard as it has been, Edwards still looks for humor – as he has all his life.

“If you’re a patient and you laugh for a second, that’s one second more that you don’t have to worry about how bad things hurt. … For that second, you’re a regular person. I try to keep people laughing as much as I can.”

Sgt. Shane Elder patched up the wounded in Iraq and sent them home to be healed.

Now he’s treating burn survivors at Brooke, gently massaging and stretching their scars so they don’t shrink and turn fingers into claws.

Elder, a former medic, is an occupational therapist’s assistant. Off-duty, he’s just one of the guys, hosting an occasional poker game for patients at his home or joining them for dinner or a movie.

“You don’t work with these guys … and just talk about your burn scar,” he says. “They become your friends.”

Elder helps burn patients face their fears. His advice is simple:

“You’re not the same person you were before,” he tells them. “If anything, you’re a stronger person. … Get back out there.”

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EDITOR’S NOTE

More than 3,500 Americans have died in Iraq, but tens of thousands more are coming home, some tragically wounded. This is one in an occasional series by The Associated Press that looks at those who survived, the scars they bear and what their long-term care will mean.

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San Antonio crew

Five specialists are ready to fly

SAN ANTONIO – The waterproof cases, filled with about 1,200 pounds of medical equipment, are always packed, ready to be loaded on a plane when the call comes. The team’s five members are ready, too. They can depart for Germany in hours.

Details

They’re known as SMART, the Special Medical Augmentation Response Burn Team, and they travel from Brooke Army Medical Center to bring home severely burned troops evacuated from Iraq and Afghanistan to a military hospital in Germany.

Brooke’s burn surgeon on duty in Iraq – doctors do six-month stints – contacts the team leader, who can launch his group from San Antonio even before the wounded soldier is stabilized in Iraq.

The flights are for those with major burns.

The journey begins when the team (including a surgeon, nurse and respiratory therapist) flies to Germany, usually on a commercial plane, hauling hundreds of pounds of medical equipment.

They meet the patients at Landstuhl Regional Medical Center and return with them, usually on a C-17 transport, prepared for almost any medical midair crisis.

– Associated Press

“You have to believe that you’re doing the best thing for the patient by helping them survive.”

Dr. Evan Renz

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