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Burn Center Restoring Wounded Troops' Lives

By Donna Miles
American Forces Press Service

FORT SAM HOUSTON, Texas, Sept. 2, 2004 – Army Staff Sgt. Michele Mitchell's journey here to the Defense Department's only center committed to treating burn victims began in late April, when she was riding in an up-armored Humvee near Baghdad as part of a five-vehicle convoy dispatched to pick up troops.

Click photo for screen-resolution image
Rumiko Cahill, a physical therapist assistant at the U.S. Army Institute of Surgical Research's Burn Center, helps Army Staff Sgt. Michele Mitchell, left, stretch her fingers to increase their flexibility as she heals from injuries received in Iraq. Photo by Donna Miles

(Click photo for screen-resolution image);high-resolution image available.

The 571st Military Police Company medic, who deployed to Iraq with her unit from Fort Lewis, Wash., recalls sitting in the back seat, directly behind the driver, "scoping" the area for aggressors as the convoy traversed through a series of checkpoints.

What Mitchell's scope didn't detect was a hidden improvised explosive device in the roadway that sent shrapnel blasting through her vehicle and caused it to burst into flames.

The explosion and fire mangled Mitchell's arm and left both legs with extensive burns. "It just ripped me up," said the veteran of 10 years, who said she "knew something was wrong" immediately but never actually saw her injuries until weeks after the incident.

After being airlifted to Logistics Support Area Anaconda, in Balad, Iraq, then to Landstuhl Regional Medical Center in Germany, Mitchell was quickly transferred here, to the U.S. Army Institute of Surgical Research's Burn Center.

The center, which opened in 1947, treats burn patients from every military service, as well as veterans. And as the only burn center in central Texas, it also serves as the regional burn center for civilian burn victims, explained Army Lt. Col. Lee Cancio, a surgeon at the center for the past 10 years.

But of all the center's patients -- typically several hundred a year -- Cancio said none pull at the center staff's heartstrings more than service members injured in the line of duty, particularly in combat.

"We're here because we want to take care our injured combat casualties," he said. "It's difficult work, both physically and emotionally, but the entire staff takes great satisfaction in being able to help these men and women who have served their country."

Since the start of the war on terror, 129 service members have been medically evacuated from Iraq and Afghanistan to be treated for severe burns at the center. Nearly half have been accompanied during their flights to Fort Sam Houston by the burn center's five-person flight team, which ensures the patient is stable and begins lifesaving treatment immediately.

"The war has increased our workload quite a bit," said Cancio.

Initially, many burn victims from Operations Enduring and Iraqi Freedom were injured through preventable accidents, including those involved with burning human waste, he said. Later, after an aggressive education program helped reduce those injuries, Cancio said, rocket-propelled grenades became the No. 1 cause of burns in Southwest Asia.

But today, roadside bombs like the one that Mitchell said left her legs looking "like burned hamburger meat" are the leading cause of severe burns in Iraq.

Regardless of their cause, burns inflict tremendous damage to the body. Infection threatens exposed tissue. Skin can't retain fluids, sometimes threatening to shut down the kidneys. Body temperatures plummet, causing patients to shiver from cold, even when under heat lamps. Lungs often are damaged by fire, smoke and chemicals.

"This is probably the worst kind of injury a person can endure," said Army Staff Sgt. Dave Waymon, a licensed vocational nurse at the center for almost five years. "The treatment is long, extensive and painful for the patient."

And while the pain of the injury can be unbearable, the treatment can sometimes feel worse. Staff members at the center say the hardest part of the job isn't working 12-or-more-hour shifts in wards heated to 85 to 100 degrees. Nor is it not having to scrub up and don a mask, gown, gloves and boots every time they come near a patient. It's not treating patients so deformed that they're unbearable to look at.

It's knowing that everything they do for a patient, however therapeutic, inflicts even more pain. Dressing changes, dead tissue removal, antibiotic cream applications and skin grafts -- all necessary to fight infection and speed up healing -- can be unbearable. Spray from a shower nozzle can feel like bullets against charred flesh. Physical therapy exercises, critical to keeping a patient's muscles from tightening as they heal, can be tortuous.

When a new patient is admitted to the center, one of the first steps is to remove any dead skin or hair from the wound that can harbor bacteria and lead to infection, Waymon explained. That requires a thorough scrub-down that some burn patients, like Mitchell, say they're so medicated they don't remember -- and that those who do remember wish they could forget.

"The whole time they're here, that initial bath or shower is the most painful," Waymon said. "I explain to (the patients) what I'm going to do and why I have to do it, and tell them that I will give them pain medicine and do my best to minimize the pain."

Treatment for burn victims generally takes far longer than for other trauma patients -- typically one to two days for every 1 percent of the body burned, according to Maj. Louis Stout, head nurse at the center. For some patients, hospital stays can last months.

Five months after her injury, Mitchell is well along the path to recovery, but still undergoing treatment at the burn center. "Laughter and a lot of prayer got me through" the most difficult days, she said. "You learn just how strong you can be, and your patience increases because healing doesn't happen overnight."

Recovering from severe burns, she said, "is like going through a tunnel. If you realize you're simply going through it and that it's not a permanent stay, you'll make it."

Army Sgt. Joshua Forbess, one of just five soldiers who survived a fiery Black Hawk helicopter crash last November in Mosul, Iraq, credits the staff at the burn center with pushing him to recover from his serious burns. "The staff here is amazing. They really motivated me," he said. "And they impressed on me that you have to push yourself, too."

Despite the physical and emotional demands of the duty, Cancio said duty in the burn center has a lot to offer military medical professionals.

"Some people are reluctant to come to work in the burn center because they know it's extremely hard work in very difficult circumstances," he said. "But the folks here are delivering top-notch care in a state-of-the-art facility. If you want a place to learn cutting-edge combat-casualty care, this is the place to do it."

The center staff say the job brings tremendous personal gratification as well. "One of the satisfactions is telling a patient, 'You're fine. Go back to your unit and have a good life,'" Cancio said.

Of the 129 servicemembers admitted to the unit with burns received in Iraq and Afghanistan, all but 15 are back on active duty, although some are still on convalescent leave or have duty restrictions. Cancio said a new outpatient burn clinic at Brooke Army Medical Center here opened in May and provides long-term follow-up care for patients.

"It's probably the best feeling you can get, seeing the success stories," said Stout. "It's great seeing patients come back to visit, like one guy who had 70 percent of his body burned and was here for seven months. It's successes like that that keep you coming back every day."

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U.S. Army Institute of Surgical Research Burn Center

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