War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007

War Surgery in Afghanistan and Iraq, with a foreword by Bob Woodruff, describes the management of nearly 100 cases of acute comat trauma, conducted in the forward austere operative environment of war in the 21st century.  Presented with vivid surgical photos, the cases encompass the spectrum of trauma that characterizes war today, as well as the medical interventions constantly evolving to treat these wounds.

With the most recent cases report from cobat hospitals within months of publication, this book presents emerging medical-surgical practice in real time.  The authors discuss in detail an array of topics including:
*  Damage control surgery
* Aggressive management of compartment syndrome
* New directions in the management of head injuries
* Use of tourniquets,
* Decision analysis in the approach to vascular repairs and
* Soft-tissue coverage of wounds.

War Surgery in Afghanistan and Iraq provides all medical professionals with insight into the extraordinary technical, clinical, and ethical challenges of their deployed colleagues.
 

JAMA, American Medical Association dated November 5, 2008 by Thomas M. Scalea, MD, Shock Trauma Center, University of Maryland School of Medicine, Baltimore

"The organization of the book is unique and easy to comprehend.  The case presentations are quite succinct.  Teaching points as well as clinical implications are highlighted to make them easy to follow and to aid in understanding the important lessons.   . . .

The book becomes almost a tutorial essay of what can and should be done when delivering trauma care on the battlefield.  To my knowledge, no similar book has ever been put together to help educate civilian trauma practitioners.   . . .

I enjoyed the opportunity to review this book and enthusiastically recommend it to all readers interested in injury care."

 

Library Journal 5/15/2009 issue  Special Feature Article by Jim Church "Looking Back, Moving On: 2008 Best Notable Government Documents"

War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007. by Shawn Christian Neesen & others. U.S. Dept. of the Army, Office of the Surgeon General. 2008. 441p. illus. SuDoc # D 104.35:SU 7. GPO Stock # 008-023-00133-2

"The latest volume in the "Textbooks of Military Medicine" series is not for the faint of heart, with its photos illustrating the grim nature of today's military conflicts.  Prepared especially for emergency medical personnel, the book provides the principles and priorities critical to managing the trauma of modern warfare."


American Medical Writers Association --- Winner of the Distinguished 2009 AMWA Medical Book Award
Physicians category

Publication: Medicine, Conflict, and Survival, June 2010 issue

Review Article citation: van Bergen, Leo , de Mare, Heidi and Meijman, Frans J.(2010) 'From Goya to Afghanistan - an essay on the ratio and ethics of medical war pictures', Medicine, Conflict and Survival, 26: 2, 124 - 144

"We performed a multidisciplinary analysis of War Surgery (2008), a book containing harsh, full-colour photographs of mutilated soldiers from the Iraq and Afghanistan wars. Our analysis shows that, within the medical context, this book is a major step forward in medical war communication and documentation. In the military context the book can be conceived as an attempt to put matters right given the enormous sacrifice some individuals have suffered. For the public, the relationship between the 'reality' and 'truth' of such photographs is ambiguous, because only looking at the photographs without reading the medical context is limiting. If the obsdrver is not familiar with medical practice, it is difficult for him to fully assess, signify, and acknowledge the value and relevance of this book."

Shawn Christian Nessen, DO, FACS, LTC, MC, U.S. Army
Dr. Nesen is a graduate of Idaho State University in Pocatello and the College of Osteopathic Medicine at Des Moines University in Des Moines, Iowa.  He did his general surgery residency at William Beaumont Army Medical Center in El Paso, Texas. In year 2003, he served as a staff surgeon with the 10th and 28th Cobat Support Hospitals in Iraq.  As this book went to press, LTC Nesen was completing a 15-month deployment as Commander of the 541st FST (ABN) in Afghanistan.

Dave Edmond Lounsbury, MD, FACP, COL, MC, U.S. Army (Ret.)
Dr. Lounsbury is a graduate of Bates College in Lewiston, Maine and the University of Vermont College of Medicine in Burlington, Vermont.  He did his residency training in medicine and neurology at Letterman Army Medical Center in San Francisco, California.  He was assigned to the 300th Field Hospital (EPW) in the first Gulf War (1991) and served as Brigade Surgeon in the Balkans (UNPREDEP) in the winter of 1995-1996.  In year 2003, Colonel Lounsbury was the Deputy Commander of the 10th Combat Support Hospital in Kuwait.  He retired from the U.S. Army Medical Department in year 2005.  Dr. Lounsbury is presently Developmental/Consulting Editor at the Borden Institute at Walter Reed Army Medical Center in Washington, D.C.

Stephen P. Hetz, MD, FACS, COL, MC,  U.S. Army (Ret.)
Dr. Hetz is a graduate of the U.S. Military Academy at West Point and the Uniformed Services University of the Health Sciences in Bethesda, Maryland.  He did his general surgery residency at Dwight David Eisenhower Army Medical Center in Augusta, Georgia.  In the first Gulf War (1991), he served as a staff surgeon with the 12th U.S. EVAC Hospital.  In year 2004, Dr, Hertz was Commander of the 31st Combat Support Hospital in Balad, Iraq. He retired from the U.S. Army in year 2006.  Dr. Hertz remains on the general surgery teaching staff and is the Director of Medical Education at William Beaumont Army Medical Center in El Paso, Texas.

FOREWORD EXCERPT BY BOB WOODRUFF

foreword

On January 29, 2006, I was riding on top of an Iraqi APC (armored personal

carrier), heading down a road in Taji, Iraq, that was supposed to represent a

success story of the war: a collaboration between US and Iraqi forces against the

insurgents. As the newly named co-anchor of ABC World News Tonight, I was

in Iraq to cover President Bush’s State of the Union address and to report on the

positive stories of the war—the hard work of the military to train and empower

local forces on the ground.

In an instant, an improvised explosive device (IED ) exploded about 20 yards from

the vehicle, and my life was changed forever, as well as that of my cameraman,

Doug Vogt. The force of the blast, a 155-mm shell, shattered my skull over the left

temporal lobe. Hundreds of rocks, packed around the IED , were blasted into the

side of my face. One rock, the size of a child’s marble, sheared my helmet chinstrap

in half and traveled through the left side of my neck, coming to rest on the carotid

artery on the other side of my head.

For the next 36 days, I would remain in a medically induced coma; but the quick

actions and amazing skills of the medics, military doctors, nurses, and assistants

would not only save my life, but also save my brain function following this lifethreatening

injury. Their experiences with such large numbers of those wounded

by IED s, most of whom would not have survived in previous wars, gave them the

confidence to make split-second decisions. In the medical barracks of Balad, the

doctors did not hesitate, giving me the chance for the best possible outcome.

One of the most amazing stories I heard later, which speaks to me of the dedication

of our men and women in uniform, is a story about the MEDE VAC pilots. After

the IED exploded, a gunfight ensued and the helicopter pilots were instructed not

to land. Unaware of who was on the ground and only knowing that someone

needed help, these pilots turned down the radio, ignored the order, and landed. I

was then taken to Baghdad, assessed, and then sent to Balad, where—within the

hour—my skull flap was removed and my brain began swelling. From Balad, I

was sent to Landstuhl Regional Medical Center in Germany, a major way station

for wounded soldiers en route to the United States. Just 60 hours after my family

arrived there, I was ready to be transported again to neurosurgical care at the

National Naval Medical Center (also known as Bethesda Naval Hospital) outside

of Washington, DC.

It was there that I received top-notch medical care from an expert team of dedicated

military specialists. It was their skill, perseverance, team approach, and kindness

that created a platform from which to heal. In writing this foreword, I want to

applaud the efforts, bravery, and dedication of the American military. It is well

known that much of cutting edge medicine in civilian life comes from the valiant

efforts, ingenuity, and pure guts of the battlefield physicians in an effort to save

lives under extreme conditions. I am not a hero. I leave that to the men and women

serving their country in uniform who put their lives on the line every day for our

freedoms. After their wounds, their lives (like mine) are changed forever. What do

we owe these men and women? How do we measure our debt to them and their

families? What will be our legacy of how we treat those with long-term injuries—

such as traumatic brain injury, posttraumatic stress disorder, depression, and other

mental illnesses—that can require years of appropriate therapy as the brain heals

and the body regenerates?

George Washington, our nation’s first Commander in Chief, said, “The willingness

with which our young people are likely to serve in any war, no matter how

justified, shall be directly proportional to how they perceive the Veterans of earlier

wars were treated and appreciated by their nation.” Today, in the face of so many

injured returning from the wars in Iraq and Afghanistan, we are faced with a wave

of wounded, many of them young, all of them returning to a life vastly different

than what they left, and families who must learn to deal with a new reality. Are we

adequately meeting that charge from our founding father?

Once I passed through the acute stage of my injury, the real work began with

my long journey to heal during rehabilitation. Time, energy, commitment, and

dedicated professionals supplied the framework to help my brain heal. The love

and encouragement of family and friends provided my personal motivation to “get

my brain back.”

I hope that this book instructs deployed physicians in aspects of the care of initial

injuries. But may it also serve as a stepping-off point to focus on continuing that