An Army specialist provides security for his fellow soldiers during a patrol in Mosul, Iraq, on February 5, 2006. Department of Defense photo by Tech. Sgt. John M. Foster, U.S. Air Force.

n this issue, ASA NEWSLETTER Editor Douglas R. Bacon, M.D., has been kind enough to offer space to the Uniformed Services Society of Anesthesiologists (USSA), an ASA component society since 2003, to highlight some of the changes in how the U.S. military delivers medical care to injured soldiers, with personal insights from some of those involved in their care. In coordinating the development and submission of these articles, we attempted to provide some perspective on the different treatment locations and advances in treatment that an injured soldier, sailor or airman/woman may be exposed to along the way.

The first article (page 8), by Capt. Bruce C. Baker, M.D., Medical Corps, U.S. Navy, gives a general overview of the capabilities and locations of the different types of medical providers and facilities. Dr. Baker is uniquely qualified in this area, having been instrumental in the development of policy for the anesthesiology component of the Navy’s far-forward surgical units, the forward resuscitative surgical service (FRSS) that support the Marines. In addition he has been on extended deployments with FRSS units both in Afghanistan and Iraq. While level II surgical facilities provide initial damage-control surgery and extensive resuscitation of casualties, they have limited resources to provide prolonged care. Transport between the point of injury and a surgical facility such as the FRSS or the FRSS to a hospital facility with more capabilities is handled by the casualty evacuation system. Lt. Cmdr. Joseph G. O’Brien, Jr., M.D. (page 12), an anesthesiology resident at Portsmouth Naval Medical Center in Virginia and a fully qualified Navy pilot who holds the privilege of being a dual-designated Naval aviator/flight surgeon, provides insight into the aspect of operational Marine and Marine casualty evacuation medical care from his personal experience in Iraq.

Our level III facilities come in many different flavors but have similar capabilities. Col. John H. Chiles, M.D. (page 15), who is finishing a 30-year career with the U.S. Army this year, writes about the role of the 31st Combat Support Hospital and how little more than a handful of doctors provide further stabilization and surgical care for injured soldiers, U.S. civilians and Iraqi nationals in Baghdad.

John F. Capacchione, M.D. (page 17), a former U.S. Navy Lt. Cmdr., and Lt. Cmdr. Ana C. Krakusin, M.D. (page 19), have provided stories of how U.S. Navy level III assets also are used to support those injured in combat operations and as a part of humanitarian missions.

Lines in the Sand An Army combat support hospital in Iraq during Operation Iraqi Freedom. The conditions were oftentimes difficult and the work was frequently demanding, but the rewards for the physicians whose stories follow in these pages were always great.

As the casualty evacuation system is critical to moving casualties from one medical facility to another in the area of conflict, the air evacuation system of the Air Force is responsible for movement of casualties from the operational theater back to the United States. Because of the small footprint of our forward surgical units and our deployable hospitals, the Air Force has adapted to the need to move critically injured soldiers thousands of miles within days of injury. In addition to deploying as a member of a Critical Care Air Transport Team (CCATT), Lt. Col. Todd E. Carter, M.D., is uniquely qualified to discuss the role of CCATT since he was instrumental in the growth development of the concept in the years before 2003 (page 21).

After a CCATT helps with the transport of patients from a hospital in Iraq to Landstuhl, Germany, many need a return trip to the operating room for wound care. Lt. Cmdr. Tammy J. Penhollow, D.O., and Capt. John K. Zaugg, M.D., two residents from the combined Army/Navy anesthesiology residency in the Washington, D.C., area, explain how we have been able to integrate education advances and improve patient care by participating in a regional anesthesiology rotation in Landstuhl, Germany (page 24).

Finally Maj. Scott M. Croll, M.D., and Maj. Sean M. Shockey, M.D., have highlighted the responsiveness and accomplishments of triservice cooperation in the arena of pain management (page 26). While many have worked hard to move those pain initiatives forward, the cooperation was catalyzed by personal relationships fostered in 2003 at the first annual meeting of USSA.

Paul D. Mongan, M.D., Col., Medical Corps, U.S. Army, is Director, National Capital Consortium Anesthesiology Residency Program, and Associate Professor and Chair, Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland.

Darin K. Via, M.D., Cmdr., Medical Corps, U.S. Navy, is Chairman, Department of Anesthesiology, Navy Medical Center Portsmouth, Virginia, and Associate Professor, Uniformed Services University, Bethesda, Maryland.