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  LRMC News Conference, Operation Iraqi Freedom Casualties

March 24, 2003

Participants:
COL David Rubenstein, Commander
MAJ (Dr.)Yong Chun, Medical Director for Deployed Medical Center
1st Lt. Christine Gerba, Staff Nurse, Medical Surgical Ward
SrA Christinamarie Loving, Intensive Care Unit

Rubenstein:
Good afternoon to you all. It's a pleasure to have you here this afternoon on the hilltop in Landstuhl, Germany. Before we begin, I'd like to ask us all to remember that soldiers, sailors, airmen and Marines and civilians are in harms way as we meet here in Landstuhl.

Of course our heartfelt condolences go out to the family members and other loved ones of those service members who have given their life on the battle field in and around Iraq and we think about the casualties that have been generated those who have come here and those who have yet to come here from those military operations.

On behalf of an absolutely outstanding medical staff, nursing staff and support staff at Landstuhl, I'd like to let you all know that the quality of care, the readiness to provide quality care to our patients is absolutely the highest order.

We have a staff made up of soldiers, sailors, airmen, of civilians and the Department of Veterans Affairs who are well prepared and are absolutely ready to provide quality health care. They work every day to meet their mission statement. The mission for Landstuhl is to serve as America's beacon of health care for our son's and daughter's abroad - and we take that mission very, very seriously indeed.

On the 19th of October 2001, the first to patients - the first two casualties generated from Operation Enduring Freedom in Afghanistan arrived here at Landstuhl. Since that time a almost 2,000 patients have come here from operations in and around Afghanistan, operations in and around Iraq and the preparation build-up in Kuwait and the area around Kuwait during that time. In all instances the care is absolutely top-notch in this fully-accredited facility and the patients are well cared for, returned to duty or evacuated to home stations in the United States or here in Europe.

We prepare everyday for what we have been doing the last 24 hours, the last year and several months and what we will be doing in the future.

Today 12 patients arrived from Operation Iraqi Freedom. Those 12 patients consisted of eight combat injuries and four non0combat injuries. We had six Marines and two soldiers were counted among the combat-related injuries, and I'll let Dr. Chun and others take care of the specifics there. We are pleased to have you here today, we are pleased to take care of America's finest and those of our allied forces should they come this way as well.

And I will open up to your questions.

Q: Can you tell us anything about the type of environment they were in, what kind of combat they were actually in and what kind of injuries you're actually looking at?

Rubenstein: I don't believe we can - I'll ask Major Chun

Chun: I can answer the type of injuries that we're getting. The type of combat injuries are mostly from blast injuries.

Q: But you cannot give any specifics of if it was in battle or was it a blast that happened.

Chun: I cannot give you that detail.

Rubenstein: We can tell you that eight of those casualties are combat casualties and that they received blast injuries as a result of combat operations. Quite honestly, we're concerned with taking care of the patient and the series of injuries that the patient presents with. If during the course of their here they talk to us about what they were doing at the time, that's a conversation we'll have, but first and foremost these patients have been here for just a few hours we're taking of first.

Q: Can you track their combat injuries for us in terms of levels of care that they have received prior to coming to Landstuhl?

Rubenstein: Sure. When a service member, whether that a soldier, sailor, airman, Marine or more and more often on the battlefield a civilian is injured, they first receive level one care, which is defined as care provided by fellow soldiers or by combat medics. They are then evacuated to what is called a battalion aid station, where you'll find two physicians and about 30 medics. At the battalion aid station they receive initial life saving care. That's level one care. They will then be evacuated to level two care which we categorize as a more intense care - we now have eight physicians and we start including surgeons at the level two facility. From there they would be evacuated to a combat support hospital or a mobile army hospital or a field hospital where we have more definitive care, the specialization of the surgeons is a little bit more acute and their ability to further stabilize the patient is more pronounced. That takes you from level one to level three, and that's what you find on the battle field or immediately behind the battle field. Landstuhl is a level four facility and we would receive the patient, we would treat them, stabilize them and prepare them for evacuation to their next facility or to return them to duty. A level five facility is considered rehabilitation for rehabilitative care.

Q: Can you say how severe are the injuries and how long the patients are going to stay here in Landstuhl?

Chun: We have of those battle injuries two are currently in ICU - intensive care units - and six are in medical surgical wards. Of those six actually only four of them are combat casualties and out of those, two intensive care unit. They are in stable condition and we are fully expecting them to recover. And there is going to have a long rehab process going on, but they'll be stabilized here and we'll transfer them back to the United States as necessary.

Q: Can you comment on - you talked about those different levels of care - how much context is there in that level one, the battlefield, the medic or the (inaudible) that comes into practice? And in what condition did these soldiers come to you in? Was the level of care sufficient enough that when they get to you they're in relatively good.

Rubenstein: I'll answer the first part and I'll ask the staff here who takes care of the patients to answer the second part. About two years ago, Lt. Gen. Jim Peak, who is the Surgeon General of the United States Army instituted - I can only speak about the Army, not the Navy or the Air Force - instituted a program to dramatically increase the quality of training that our medics receive. Our combat-medics are now EMT qualified, national registered, they receive pre-hospital trauma training and additional training. The quality of medic on the battle field is much improved over the previous combat-medics, who were very, very good in their own generations. The patients are well cared for - once casualty on the battle field reaches a combat support hospital their likelihood of surviving is very great. The issue has always been to get them to that combat support hospital or field hospital alive. Our current day combat medic, under what we call the 91-whiskey program - their identifier - the current combat medic is very capable of getting that soldier to a proper combat support hospital alive. As far as the quality, condition of the patients when they get here, I'll defer to the medical and nursing staff.

Gerba: It seems as if the quality of care is very good. I don't have much information or specific information from the patients about the level one care. The patients come to us very much stabilized, very much in good condition and from my experience.

Chun: In certain cases they actually receive definitive care at the down range location or in the area of operations, and when they get here it makes our job easier to take care of them and rehab them. So the quality of medical treatment that they receive in the combat area is superb.

Loving: I basically say the same thing - that the patients received excellent care before they came to us. And we've just basically made them comfortable and were able to let them contact home.

Q: Two questions. First question, this morning at Ramstein we saw one patient who was put in an ambulance (inaudible)

Chun: He is one of the two patients in ICU, and he is on ventilator support and I cannot discuss (inaudible)

Q: Second question was going back to the levels of care. The ship.

Rubenstein: The USNS Comfort.

Q: Thanks - what role does that play in these levels of care?

Rubenstein: The USNS Comfort is a level three facility. They'll receive and stabilize patients and then evacuate them to receiving hospitals - to Landstuhl.

Q: Can you talk about what type of blast injuries, were they grenades.. (inaudible)

Chun: I do not have specific information as to which unit they belong to. I can tell you only Army and Marine and Air Force breakdown. As far as what type of blast injuries, there are so many different blast injuries, but combat injuries we know some are caused by rocket propelled grenade blast injuries but there are various other types. And again I can't really specify.

Q: (inaudible)

Chun: I'll tell you in general terms, we're going to take care of any patient that comes off an aircraft and is delivered to us. Whether that is an American soldier, an allied soldier - part of the coalition - whether it's an Iraqi or American, we're going to provide quality healthcare irrespective of the uniform. I'll let the staff address that too.

Loving: We've been highly trained to for any kind of weapons for mass casualties and any kind of biological, chemical . we know what we're going to be doing. We just hope we don't have to use it.

Gerba: And I couldn't say anything further than what Col. Rubenstein said. Our job is not to judge the patients as they come, our job is to just take care of them. That's what we're going to do.

Q: (inaudible)

Chun: This morning's soldiers, we did not have any female casualties at this time. And as for future casualties, I believe the PA officer already has already announced what we're expecting to receive in the next 24 hours.

Q: Can the staff talk about the mood among these soldiers a bit, how their spirits are? Are they prepared to go back to the field? do they want to go home? Have they expressed they want to talk to their families? Have you allowed them to talk to their families? What is the general mood in the ward?

Loving: Well, the patient I have taken care of, his mood is extremely high. His basic concerns arebeing able to call home and talk to his family. We're in the process of trying to get him in touch with his family, but I believe the lieutenant has been able to talk to some of her patients families.

Gerba: The patient that I cared for today, his first priority was really to reach his parents. And so, that's typically what we'll do. Once we settle the patient in we put a call through to their families, and I was able to post a call to the soldier's parents and connect the call for him. His mood is also very good. The soldiers that I take care of are eager to get back to their units if possible. But the mood is very good.

Q: Have they expressed what kind of environment they've seen. Have they talked about the hostility and all that. For some of them, these are very young soldiers. This is the first time they've been in combat. Do they have any psychological problems as well.

Chun: These patients just arrived just a few hours ago, so we have not had a chance to discuss all those details. But I do want you to know that we do consider and have staff specifically trained to take care of their mental needs or psychological needs, as well as their physical or medical needs.

Q: You have ICU patients. (inaudible) Was this a regular medical evaluation? (inaudible)

Chun: One patient required a CCAT - Critical Care Air Transportation - and the team consists of a doctor, a nurse, a respiratory therapists, and CCAT patients are required when the patient's condition is not stable, or is worrisome, that the transit from the area of operations to Germany, an 8-hour flight, may pose some danger to a patient. The CCAT team is called upon to accompany the patient all the way to Germany and actually transfer the care to the provider here at Landstuhl hospital. And the care they receive in transit is excellent, it's an ICU - very similar to an ICU setting.

Q: Given the fact at the onset of the campaign, President Bush came out and said this may take a little longer, America should be prepared to receive casualties, wounded and killed in action. Did that comment - has anything that's happened so far, the fact that Iraqis are not surrendering as much as many has people had thought - has it caused you to change some logistical situations here, whether it be staffing, or supplies, or anything like that, have you altered things based on . ?

Rubenstein: We really haven't altered anything based on what we see happening and what the president has said. As a receiving hospital, our mission is to receive, treat, stabilize and then evacuate or return to duty. We do that fairly rapidly the objective is to keep the beds available for other casualties who need those beds. We're not a rehabilitation facility, we don't hold the patients for a specifically long time, but rather roll them through and when they're physically able we move them back to the United States, or back to their units.

Q: Is there any indication at this point of the group that we were talking about now, how many may return to duty?

Rubenstein: I suspect they'll all return to duty, but not in the near term. The prognosis for all of the patients is good. Whether they return from here to duty - no. They'll be going back to the United States.

Q: (inaudible)

Chun: A lot of patients do seek or ask for chaplain services and we actually have a couple of chaplains in our audience here. They have a team of excellent chaplains that provide any type of counseling. As far as the patients are concerned, if the patients are listed as seriously ill or very seriously ill - SI or VSI for the military lingo - if they're listed as such then military will actually invite the patient's family members over from the States to Germany to be next to the patient. At this point we are actually working that issue.

Rubenstein: And we do have a very elaborate process in place to take care of families who do come out here, we have activated a family assistance center, we've got two Landstuhl Fischer Houses, which are home away from homes that we put our families into for their care here, and we do expect to receive families while their here.

Q: (inaudible)

Rubenstein: They were not from the same unit - no. They were from different actions, and once again we're really not at the point since they've only been here a few hours, we haven't got to the point of sitting down with them, as the nursing staff will do as they get to know the patients and start to talk to them about what happened, how it happened - things that patients normally want to talk about - but having been here for just a few hours we're still involved in getting them settled in and taking care of their immediate needs.

Chun: Our first and foremost job is to take care of their medical needs, we usually don't discuss specific battle situations.

Q: (inaudible)

Chun: Since October of 2001 this hospital has actually stood up a special team office of deployed medical management center, and what we do is we actually monitor any type of inbounds, combat casualties or injuries soldiers or ill patients who are coming from combat areas. So what we do is, the military has set up a web site where we can actually access and have visibility of these patients about 12 to 24 hours ahead of time that they are due to arrive in Germany. At that point we collect our information and make triage process by patient, where they need to go as to intensive care unit versus medical surgical ward versus outpatient. And once we make a determination we actually assign a physician, a nursing team for each patient that is due to arrive for what we will need in patient care. And once the patient's plane arrives at Ramstein or Rhein Main then those patients are transferred over to Landstuhl Regional Medical Center via Air Force units called Aeromedical Staging Facility to transport the patients to our hospital and we assign these patients to each ward via ICU or medical ward.

Q. Did any of the patients' conditions change from during the flight?

Chun: No actually out of 12 patients who arrived today, the condition of those patients was as expected.

Q. The patients that came in, you talked a lot about the previous levels of care, the more serious ones or any of them, do any of them require any additional procedures, perhaps surgery and if so are any in surgery right now and what type of surgery is being done and what type of procedures are being done.

Chun: Many of these combat patients, combat injury soldiers have received surgeries in downrange locations and here while they are in Germany at Landstuhl hospital will probably provide more surgical procedures, (inaudible) before they get transferred over to the states.

Q. They're more or less follow-up procedures though, there's not any one in such a situation that he has to go through several operations given the nature of his injuries. These are more or less follow-up and secondary procedures.

Chun: That is correct (inaudible)

Rubenstein: It is possible to get a soldier who needs or any casualty who needs several visits or trips to the operating room but by and large we are receiving patients who have already been cared at the earlier levels and we are refining what they have received.

Q. Would you say that's more of a reflection on the nature of their injuries or the level of care that they have received downrange?

Rubenstein: The nature of their injuries. They're receiving quality care. One thing that families and loved ones need to understand is that the care provided on the battlefield, immediate medical, surgical, psychiatric care available on the battlefield is of the highest order. But those soldiers do need to be evacuated and sent back to other care.

Q: The two who arrived yesterday are in the intensive care unit?

A: I do not have that information.

Q: The other question I have is the hospital in Spain near Rota, I hear you have a burn unit specialist and a specialist (inaudible) chemical training. What sort of decision are made to send patients either to Rota or here? Are there any specialties that don't exist here?

A: The decisions are actually made at a unit or organization that are external to us. The decision are made at the theater patient medical center where the planners the decide where patients go based on bed availability and the types of beds that are available.

Q: (inaudible)

A: The plane hasn't left yet, so the numbers can change until the wheels are off the ground. And so it wouldn't be fair to characterize the number or type of casualties just yet.

Q: Will there be an additional press conference on the next incoming flight?

A: I can't speak to what's available at Ramstein - you're always welcome here.

CAPT Jones: We appreciate you coming here today. We will keep you advised of media opportunities as we did today and we appreciate your interest in this story.