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Textbook Details Progress In Wartime Surgery

Aug 9, 2008 (Weekend Edition Saturday)

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U.S. combat deaths in Iraq are at their lowest point since the war started in March 2003. But at least 30,000 soldiers have been wounded in action and the use of IEDs and other explosive devices has changed the nature of war injury.

Yet soldiers are more likely to survive today than in any previous conflict because of improved medical knowledge and technology. And surgeons operating both inside and outside the theater of modern war have a new guide: the textbook War Surgery in Afghanistan and Iraq. The book is an instructional collection of cases taken from 2003-2007 for use among medical professionals.

Co-author Dr. Stephen Hetz tells Scott Simon that while the injuries in Iraq aren't necessarily new, the volume of blasts in Iraq is what causes so many devastating, traumatic injuries.

Hetz, who was deployed to Iraq twice, says the battlefield helps surgeons hone existing medical practices with a finer edge. One procedure that he says improved is called "damage control" — a procedure during which the major focus "is to stop the bleeding and further contamination" — whatever doctors can do to get the patient out of the operating room and to a place where he or she can be resuscitated. The process is faster and more effective, enabling higher survival rates.

The coffee-table sized book is not designed for public use. It features more than 400 pages of detailed case studies presented alongside graphic and often disturbing images. These photographs, informal and gruesome, were often taken on consumer digital cameras belonging to doctors and soldiers serving in Iraq and Afghanistan.

Hetz says based on this widespread availability of images and the sheer number of cases, a textbook for surgeons was a "natural offshoot of the war." He says that when he began assembling the book with two of his colleagues, Shawn Christian Nessen and Dave Edmond Lounsubry, a military edict was released limiting what was termed 'actionable intelligence' — information or photographs about the conflict that could compromise the military's operations in Iraq.

The military expressed concerns about the book and Hetz and his colleagues had to submit the cases they wished to use for approval. The collection was finally published this year.

Hetz says War Surgery in Afghanistan and Iraq is a significant book because many civilian surgeons will not seen the types of blast surgeries that occur in Iraq and Afghanistan, and can learn immensely from what the book has to show.

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