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Afghan war spurring advances in medical science

By Dave O'Brien, Winnipeg Free Press - November 28, 2009

KANDAHAR AIRFIELD, Afghanistan -- War may be hell, but it's been good for science and medicine.
Doctors working in Afghanistan say the catastrophic injuries they're seeing from clashes between coalition and insurgent forces have been advancing the study of trauma treatment and the little-understood effects of blast injuries. They're also improving emergency first aid delivered in the field, according to the medical personnel.

A lot of the new knowledge is being learned at the multinational health facility, which was started by Canadians but is now run by Americans.

From the outside, the military hospital, located on the edge of the Kandahar Airfield airstrip is nothing more than a large industrial warehouse, but inside it looks much like any hospital, except for the fact it's more crowded and there are no private rooms.

It has a CT scanner, three operating suites, an acute-care ward, medical beds and specialists, including a neurosurgeon.

The doctors and nurses look the same as medical staff anywhere, as well, except for the sidearms they carry if they are military personnel.

The precise number of beds is classified, according to Lt.-Col. Chris Linford, a Canadian, and second-in-command at the hospital.

The military, as repeatedly discovered during this media tour, doesn't like to give out any information it believes could help the enemy, no matter how seemingly trivial the issue. Full disclosure is, of course, another casualty of war.

When a soldier is injured in the field, he or she is often in the operating room within 30 minutes, and may already have received medical treatment before arriving. The patients are stabilized and, depending on their condition and long-term needs, they can be flown to Germany for further care.

But when multiple casualties arrive, even a soldier with severe wounds might be told to take a seat, said Capt. Mike Penkman, who trained as a family doctor in Brandon, Man., after getting his medical degree courtesy of the military.

"It's difficult having to tell someone who might be holding his guts in his hands to take a seat, but that's the way it is sometimes."

Penkman said he is frequently horrified by the devastating injuries he sees, particularly those caused by roadside bombs. "It's numbing how serious the injuries are," he said.

"The closest comparison you might see in civilian life might be a car accident, but even that doesn't come close to what we get here."

But doctors are now learning that other serious injuries are not detectable by the usual medical techniques. Blast injuries, for example, can cause physical injury, but frequently there is no immediate evidence of harm, Penkman said.

That's why the military has launched a study on the effects of blasts on the body, particularly the brain.
Dr. Catherine Tenn, an expert in the field from Medicine Hat, Alta., arrived here recently to begin a study of the phenomenon.

Penkman said the medical profession is also gaining more knowledge about the treatment of trauma, the use of blood products and resuscitation techniques.

The techniques of field medicine have also grown exponentially as a result of the conflict in Afghanistan, according to Canadian army medic Cpl. Jean Sebastien Morin.

"There's new courses, new protocols and new material now. Everything is totally different."

New products, such as quick-clotting bandages that cauterize wounds through a chemical process, are helping to save lives, Morin said. There are also new tourniquets and other equipment that make immediate treatment safer and more efficient, he said.

The hospital also cares for Afghans injured in the fighting. Two children recently had their skulls surgically lifted to ease the swelling caused when shrapnel ripped into their bodies when they accidentally tripped a roadside bomb intended for Canadians.

The fathers of both children are living on the base until their children can go home.

With no end in sight to the fighting, the coalition is building a new hospital on the base to manage the horrific injuries that are being sustained by allied soldiers and Afghans alike.

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