Otolaryngologists on the Front Lines

The steep hills of Lebanon impeded medevac helicopters from lifting Israeli wounded, so “tankbulances” were deployed. Merkava Mark IV tanks, which can withstand heavy direct fire and climb 70-degree inclines, are outfitted with full operating theaters. They can transport up to 12 wounded, plus crew. The downside is that tankbulances are not covered by Geneva protections. However, when conventional ambulances are targets of fire, there is little to lose.

The US military employs a four-tier triage system. At the first level, the casualty is treated by a buddy or medic. At Level II the patient is examined by the medical company of the brigade or division. Level III is treatment in a theater-deployed hospital. In Iraq that means Balad, a large complex 30 miles north of Baghdad. It is a state-of-the-art trauma facility, equal to any in the United States, according to physicians who have worked there. The most serious cases are flown to a Level IV facility. Stateside that is usually either the Walter Reed Army or Bethesda Naval medical centers. However, when the patient cannot tolerate a long flight, he or she is transported to Landstuhl, Germany, the only Level IV facility outside the United States.

Standard of Care

Air Force Lieutenant Colonel Michael S. Xydakis, MD, an otolaryngologist who served in Landstuhl for four years, is impressed by the level of care. “Information from Balad was relayed to us by secure electronics and contact was maintained with air transport,” so that everything was ready before the patient landed. Once in Germany “all the king’s horses and all the king’s men” were pulled out for the troops. Dr. Xydakis says it is fortunate that Landstuhl is situated in Germany, which, he believes, has the best medical care in Europe. With unusually specialized cases, German colleagues could always be called upon to lend enthusiastic assistance. He once turned to surgeons from Hamburg University with a complicated laryngeal fracture, and they did a noteworthy job, he said.

Recent reports have brought attention to facility and bureaucratic inadequacies at the Walter Reed medical complex and at the loci for the wounded in Israel’s summer war. But every otolaryngologist interviewed for this report professed extraordinary devotion to the care of his patients. They rate all their health care colleagues as nothing less than heroic on the battlefield, and insist that once their charges have stabilized, they will continue to receive cutting-edge care. Dr. Hoffer believes those injured in battle may be good candidates for cochlear implants. Dr. Holt has seen those with disfiguring wounds that will require facial reconstructive surgery, and those with injuries to the mouth and throat will likely require extensive swallowing and speech therapy. Over and over, otolaryngologists said that “nothing is too good for our young men and women.”