Just after 9 a.m., the helicopter descends past jagged, snowcapped mountains, and the crew rushes a soldier with a gunshot wound to his leg into the trauma center. Nurses, doctors and medical technicians, clad in camouflage scrubs, flood into the room, unwrapping his bloody bandage, checking vital signs and inserting lines for intravenous fluids. • The injury is minor compared with what these military medical workers see on a regular basis. In addition to a growing number of gunshot victims, the trauma center sees many NATO troops whose legs and arms have been blown off by land mines hidden in the Afghan countryside, victims of what the military has termed dismounted complex blast injury. On busy days, staffers treat dozens of patients, as they did on a recent Saturday when insurgent forces staged a series of attacks around Kabul. • By nighttime, the soldier will have been carefully bundled onto a stretcher, or "packaged," and along with a dozen other wounded service members, put on a C-17 cargo plane and flown to the Army's military hospital in Landstuhl, Germany.
The Craig Joint Theater Hospital at Bagram Air Base is a vital cog in an increasingly efficient military medical system that has produced record survival rates for American troops. Today, more than 90 percent of wounded service members survive, a rate that outpaces previous wars such as Vietnam and that has grown steadily throughout the conflicts in Iraq and Afghanistan. The survival rate has climbed even as Afghanistan produces growing numbers of traumatic brain injuries, genital injuries and other catastrophic wounds from improvised explosive devices. More survivors mean more patients.
The modern, 50-bed hospital in eastern Afghanistan, which serves as the staging point for the war's most badly wounded troops before they are transported to Germany and points beyond, has a strong Central Texas connection. Much of the medical staff is made up of Air Force personnel stationed in San Antonio, and a recently arrived Fort Hood unit helps command the hospital.
The Bagram hospital sits behind a series of grim-looking concrete blast walls at the edge of a busy airfield where helicopters, fighter jets and cargo planes shriek around the clock. One of the largest and most technologically advanced hospitals in Afghanistan, it boasts one of the country's two Level III trauma centers, an advanced facility just below the top standing of Level I.
The facility is situated an hour north of Kabul, near the Hindu Kush mountain range and the volatile border with Pakistan, an area that is home to several insurgent groups and some of the war's fiercest fighting. Since opening in 2007, Craig Joint Theater Hospital has treated about 4,000 patients a month — 130 every day including noncombat patients.
And hospital officials anticipate it is about to get much busier at the hospital, where the staff is gearing up for the spring fighting season, when Taliban and other insurgent groups traditionally emerge from their winter slowdown and increase attacks. The hospital is preparing for the influx of patients, an effort that includes everything from making sure there are enough medical supplies on hand to preparing staffers psychologically for what they will see.
"It was a busy winter, but not as busy as it will be this summer," said Air Force Lt. Col. Paul Conner, the hospital administrator, who serves with the 59th Medical Wing at San Antonio's Lackland Air Force Base.
After this summer's fighting season, the number of American troops is scheduled to fall from about 90,000 to 68,000 in advance of a planned departure in 2014.
Meanwhile, the carnage of war exacts a toll on those who care for the wounded.
"I've been doing this for nine years, and I'm still not used to it," said Staff Sgt. DeMorris Byrd, 27, of Houston, a medical technician on his third deployment to Iraq or Afghanistan. "But you have your ways of coping with it. You try not to take it back home with you."
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In the predawn darkness, a hulking C-17 cargo plane sits on the tarmac. Its massive open hull illuminates the night as members of the crew prepare for what many of them consider a sacred calling.
Service members wounded in the field are first airlifted to Bagram, a sprawling air base originally built in the 1950s and expanded by the Soviets after their 1979 invasion of Afghanistan. The evacuation process has grown increasingly efficient over time, officials said. "It can be less than 20 hours from when they are blown up in battle to coming here and ending up in Landstuhl," said Air Force Capt. Douglas Ferrette.
The C-17 flight is one of the medical marvels of the war. In less than an hour, service members can unload tons of cargo and transform the massive plane into a flying ambulance, complete with hospital beds and oxygen lines. The plane flies almost nightly, often carrying more than a dozen gravely wounded troops as well as a medical staff on the seven-hour flight to Germany.
That quick response has been credited with saving many more lives than in past wars. The ratio of service members who survive their wounds compared with those who die has increased dramatically since 2006. Hospital officials said another factor is the deployment of surgical teams near infantry units, which means that more badly wounded soldiers are receiving trauma care within 60 minutes of their injuries, the so-called golden hour considered crucial to surviving major injuries. Technical advances such as better use of tourniquets and blood clotting medications have also contributed to the higher rates.
On this night, 12 patients, including the gunshot victim, a member of the Polish armed forces, are flying to Germany. The previous night, the flight had five soldiers in critical condition, most with gunshot wounds, including to the chest and scrotum.
In a highly choreographed movement, service members carry the wounded from a bus onto the cargo plane, where medical staffers place them on litters, hook them into oxygen lines and adjust IVs. The entire process takes less than 10 minutes.
A number of troops on the air base volunteer to help move the wounded. Among the volunteers on this night is Maj. Denise Taylor, of Marble Falls, Texas, an 18-year veteran of the Air Force, who works in logistics at Bagram Air Base.
"It's easy to forget about what's going on outside the safety of the walls of our base here," she said. "The military is family, and family helps each other out. This is great for putting life into perspective."
Alexandra Kennedy, a 21-year-old Air Force medical technician who was previously stationed in San Antonio, is one of the last people wounded troops talk to before their flight. She helps bundle them onto stretchers, trying to make them as comfortable as she can, an effort that often means finding the words that will calm them in the face of grievous injuries and an uncertain future.
"I think about what I would want," she said. "You have to think about the little things. For me, I try to find out about them, talk to them, what can I do to make the trip that much better for them. I tell them, 'You're going home.' I try to give them that extra little bit of hope."
On this night, that meant bringing a photo of the Polish soldier's wife to him so that he could hold it during the flight. The soldier, who didn't speak English, touched his hand to his heart in thanks.
"It's heartbreaking when they say, 'Thank you,' "she said. "It's like, 'No. Thank you.' I would do this 365 days a year if I could."