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To date, over 30,000 US troops have been wounded while fighting in Iraq. Many of them involved traumatic injuries that demanded intense, highly specialized medical care. While US forces benefit from the skills of world-class trauma surgeons, the high-tech hospital equipment these medical professionals depend on in the US doesn't accompany them to the Iraqi battlefield.

There, the operating rooms, which have come a long way, resemble the long metal bins used to collect trash at construction sites but with the added benefits of a roof and lighting:

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In the US, surgeons are aided with computer-assisted robotics. In Iraq, they rely instead on a delicate mix of experience and MacGyverism. Despite these grueling, bare bone conditions, surgeons enjoyed excellent clinical success. One surgeon describes how his colleagues deftly navigated their rudimentary surroundings...

Systems-based competency plays a major role in our ability to integrate technology into practice, and it is nowhere more evident than on the battlefield. The description of the environment in which we worked sets the stage for looking at the technologies that helped us maintain a 97% survival rate in our hospital and provide life-saving stabilization surgery and comprehensive craniofacial reconstruction within a matrix of tents, 2-by-4s and duct tape.

The technology that was not available to use is a fairly short list. We did not have robotics, real-time telemedicine, ready access to stereolithography models, magnetic resonance imaging, or an image-guided surgery system. Our greatest resource was the training, education, and experience of the practitioners and their ability to overcome adversity."

...while tending to injuries like these:

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In one case, the surgeons treated an Iraqi man whose face was severely disfigured by a gunshot blast. Usually, the Iraqi injured cannot make the long trip required to receive follow-up care. As a result, surgeons will attempt to perform all of the reconstructive surgery practicable in a single operation, sometime squeezing in reconstructions that would span multiple surgeries. In this particular case, properly reconstructing the man’s face would require numerous follow up visits for additional procedures. The injured Iraqi man was seen by seven different surgeons over the course of more than a year.  

Whether their patient was an Iraqi civilian, Iraqi soldier or fellow US serviceperson, the surgeons are eager to provide this highly-specialized and cost-prohibitive medical care, sometimes exceeding even their own everyday life-saving heroics. In December, a prominent local surgeon gave his life during the course of such heroics:

A New Jersey doctor --who was a well-known trauma surgeon at the Hospital of the University of Pennsylvania -- has been killed in Iraq, according to the Department of Defense.

In a statement issued Friday night, the DoD said 42-year-old Maj. John P. Pryor of Moorestown died Christmas Day when a mortar round hit near his living quarters. He was serving with a forward surgical team with the Army's 1st Medical Detachment, based in Fort Totten, N.Y.

(snip)

Schwab said Pryor joined the hospital in 1999 after graduating medical school at the State University of New York in Buffalo. He described Pryor as a "star" who quickly rose through the hospital ranks to become director of its trauma program.

"John was one of those truly good people," said Schwab. "Everyone that ever touched him walked away a better person because of him."

Pryor deployed Dec. 6 for his second tour of duty in Iraq as a combat medic with the Army Reserves, and was due to come home in April, Schwab said. He said Pryor had studied Arabic, knowing he could be dealing with wounded Iraqi civilians -- especially children -- and wanted to make them feel at ease.

Pryor wrote of his experiences as a surgeon confronting violence in Iraq and inner-city Philadelphia in articles published in The Philadelphia Inquirer and The Washington Post.

Originally posted to Bob Sackamento on Wed Mar 25, 2009 at 03:01 AM PDT.

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