THE NATION’S NEWSPAPER
Collegiate
Case
Study
www.usatodaycollege.com
Bone condition hampers
soldiers’ recovery
Medical innovations emerge from war
By Liz Szabo
Most news about the war in Iraq focuses on political or strategic developments. Less
well known, but equally important, is the development of new medical technologies
used to treat soldiers. With more than 300 amputees among the wounded, medical
suppliers have been challenged to develop improved prosthetics and other devices.
Advances in medical transportation and wound treatment have enabled soldiers to
receive far more sophisticated and effective care than in previous wars. This case
study focuses on the medical advancements and innovations that are a necessary
byproduct of warfare.
....................................................................................6
War vets ready for new battle:
Politics
By Andrea Stone
.................................................................................7-9
Military to fund prosthetics
research
By Dave Moniz
..................................................................................10
Arm amputees rely on old
devices
By Laura Parker
.............................................................................11-12
Critical inquiry
...................................................................................13
USA TODAY Snapshots®
Active-duty U.S military personnel:
3.4 million
1.4 million
174,000
1967
Military doctors refine,
and invent, techniques
By Greg Zoroya
USA TODAY
AD DULUIYAH, Iraq — Even with 10
milligrams of morphine, Army Sgt.
Rober t Mundo lay in agony after a
sniper's bullet pierced his thigh and
blasted through his groin.
Mundo gripped the hand of another GI
as medic Bridgett Joseph surveyed the
bloody damage. Then Joseph reached
into her bag for a bandage no other war
has seen.
Military’s march through time
1915
Lifesaving knowledge, innovation
emerge from war’s deadly violence
2006
Source: Census Bureau
Made with an extract from shrimp
cells, the HemCon bandage created a
tight bond that stopped the bleeding
almost instantly. Seconds later, Mundo,
24 — a widower from Colorado Springs
and the father of two young girls — was
airlifted to the Air Force Theater Hospital
in Balad, 10 miles away. He got there in
five minutes.
Photos by David P. Gilkey, USA
TODAY/Detroit Free Press
Flying hospital: An Air Force C-17 transport carries wounded and sick servicemembers from the
hospital in Balad, Iraq, to Landstuhl in Germany.
New ways of healing are as much a
product of war as are new ways of killing.
To save lives on the battlefield, medical
innovations are born in days rather than
in years, military and civilian doctors say.
And as with wars past, the new ways of
treating the injured and sick in Iraq and
Afghanistan — soldiers such as Mundo —
could have benefits beyond the
battlefield.
Civilian emergency care experts such
as Thomas Judge say medical technicians
in the USA are beginning to use the
HemCon bandage and new battlefield
By David Stuckey and Marcy E. Mullins, USA TODAY
© Copyright 2006 USA TODAY, a division of Gannett Co., Inc. All rights reser ved.
AS SEEN IN USA TODAY’S NEWS SECTION, MARCH 27, 2006
tourniquets to treat trauma patients. A
portable heart-lung machine developed
in Germany and not yet approved for use
by U.S. doctors is helping wounded
soldiers breathe. It is small — not much
larger than a laptop computer — and
connects to blood vessels in the groin to
filter out poisonous carbon dioxide while
filtering in oxygen. Military doctors in
Balad also are using an expensive clotting
drug, licensed for use on hemophiliacs, to
help stem massive hemorrhaging in
troops torn apart by roadside bombs.
As patients arrive, doctors and nurses
poke, prod and inspect; they cut away
clothing, shout out blood pressure
readings, insert oxygen tubes and wheel
up portable X-ray machines. Helicopter
medics, helmets under their arms,
squeeze into the scrum to recite how
each soldier fell on the battlefield.
Bloody linens and body fluids collect
on the floor. The clatter of arriving or
departing helicopters, beating against the
hospital tents, muffles conversation.
"You got kids?" Air Force Lt. Col. Jay
Not all advances come easily. Civilian
doctors complain that the militar y
sometimes fails to share information on
the success of a new drug or technology.
Militar y doctors disagree over the
effectiveness of some new products. The
Army, for instance, favors the HemCon
bandage even though Navy and Marine
doctors question whether it works as
well as a cheaper bandage developed by
the Navy.
Some innovations, such as the
HemCon, result from governmentsponsored research. Others come from
the ingenuity of battlefield doctors who
seek new ways to use existing medicines,
or try untested technology when all else
fails.
"The military has to try things that
nobody has tried before," said Judge,
immediate past president of the
Association of Air Medical Services, an
air ambulance trade group. "Some of the
greatest advancements of medicine only
come about from war."
Controlled chaos
When Mundo arrived at Balad at 11:45
a.m. on March 5, a rickshaw-like gurney
carried him from the helipad into the
controlled chaos of the Air Force Theater
Hospital emergency room. Nurses,
medical technicians and doctors — some
of them with 9mm pistols slung from
shoulder holsters — swarmed over each
patient wheeled inside. (They're under
orders to carry weapons, even during
surgery.)
N
0
175
Miles
Tikrit
Syria
Ad
Duluiyah
Balad
Fallujah
Baghdad
Iraq
Iran
Saudi
Arabia
Kuwait
By Adrienne Lewis, USA TODAY
Bishoff, a urologist, asked Mundo. "I have
kids," Mundo answered apprehensively.
"But if I get home, I may want more."
"Well," Bishoff replied, "you'll be able to
have a lot more."
About 20 minutes after entering the
ER, Mundo was wheeled into one of
three operating rooms. There, Bishoff
began knitting the soldier back together.
"We'll rebuild everything," Bishoff said
through his surgical mask. "We're going
to reconstruct it. Save it."
Simple, effective design
The Air Force hospital in Balad is one of
the two largest military hospitals in Iraq.
The other is an Army facility in Baghdad.
The 300 staff members at Balad treat
about 9,000 patients a year: Americans,
coalition troops, Iraqis, even captured
insurgents. The caseload rivals any major
trauma center in the USA, said Air Force
Col. Tyler Putnam, chief of intensive care.
Its 37,000 square feet lie under a series
of tents, and surgeons here are
par ticularly proud of the hospital's
simple design. Combat casualties pass
from emergency room to CT scan and
into surgery.
"It's this 100 yards from the ER doors
to the operating room. It's just a straight
shot. There are no corners, no turns —
you just go straight down the hallway,"
said Air Force Lt. Col. Jeffrey Bailey, 49, of
St. Louis, the chief of trauma here.
Because a major airbase sits within the
Balad installation, almost all sick and
wounded Americans from across Iraq
flow through the hospital on their way
home.
American casualties here fall into two
categories. Those with mild ailments —
kidney stones, for example — are treated
and recuperate here, then return to their
units.
The severely wounded undergo
surgery, then are quickly placed aboard
aircraft for flights to the Army's
Landstuhl Regional Medical Center in
Germany. Mundo would join this river of
casualties soon.
After Mundo underwent almost two
hours of surger y, his battalion and
company commanders and other
soldiers visited to wish him well. They
joked about his bravely "taking one for
the team." A Purple Heart and a Combat
Infantryman Badge were pinned to his
pillow.
Bishoff, 44, of San Antonio, said it was
the 16th groin injury he has repaired
since arriving in Iraq more than a month
ago.
"Every time I do it, I get better, I get
faster, I learn more," he said. "In prior
wars, he would have likely lost both of
his testicles."
Reprinted with permission. All rights reser ved.
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AS SEEN IN USA TODAY’S NEWS SECTION, MARCH 27, 2006
Innovations
Driven by the need to save lives, the U.S. military has
broadened medical knowledge and ability in wartime:
u Revolutionary War: Gen. George Washington orders first
mass inoculation against smallpox for his army at Valley
Forge.
u Civil War: Carriages are used systematically to move
wounded from battlefield to military hospitals. This leads to
postwar ambulance service in New York City.
Photos by David P. Gilkey, USA TODAY/Detroit Free Press
Precious minutes: Medics Robert Munson, center, and Bridgett Joseph work
to stabilize Army Sgt. Robert Mundo after he was wounded in Ad Duluiyah.
They used one of the new HemCon bandages to stop the bleeding.
Doctors have learned about the extent of damage caused by
high-velocity bullets and bomb blasts. They have taught
themselves how to better identify dead tissue and reconnect
what can be saved.
Applying the lessons
The lessons from treating complex battle wounds can form
the basis for seminars and published papers to educate doctors
at home.
Almost every war has given rise to medical achievements.
After yellow fever killed soldiers during the Spanish-American
War, military doctors were the first to prove that mosquitoes
carried the disease. Among those doctors: Maj. Walter Reed,
namesake of the famous Army hospital in Washington, D.C.
Large-scale blood transfusions began during World War I.
And medical evacuations by helicopter originated during the
Korean War and became common in Vietnam.
u Spanish-American War: Military doctors investigate
causes of yellow fever. Their work is a precursor for today's
Centers for Disease Control and Prevention.
u World War I: Blood transfusions get their first widespread
use.
u World War II: Coordinated effort brings together military
and civilian researchers to develop cheap, mass-produced
penicillin.
u Korean, Vietnam wars: Korea sees the first medical
evacuations by helicopter. System expands in Vietnam.
Widespread civilian use of air ambulance service follows.
Source: Dale Smith, professor of medical history, Uniformed
Services University of Health Sciences in Bethesda, Md.
civilian medicine, are being pushed even further in Iraq and
Afghanistan.
"Things come from civilian medicine, and then we take it into
the cauldron of the war and focus it, test it and evaluate it, and
then use it many, many, many more times than the civilians
Today, the Pentagon is asking civilian researchers to develop
dehydrated blood products that can be stored up to two years;
a portable battlefield device that stops internal bleeding with
ultrasound; a non-addictive painkiller as powerful as morphine,
and prosthetics that respond to brain waves.
"Many, if not all, of these will have civilian uses," said Brett
Giroir, a deputy director at the Defense Advanced Research
Projects Agency, which does research and development for the
Pentagon.
Even more important, doctors say, are further advances in
trauma care, the long-term process of saving, healing and
rehabilitating the wounded and injured. Traumatic injuries
remain the No. 1 killer of Americans under age 45. The speed
and efficiency of trauma care, improved upon recently by
Awaiting the next stage: Sgt. Maj. Daniel Daily and others stop in to see
Mundo at the Balad hospital as the wounded soldier recovers from emergency surgery before being evacuated to Germany and then to the USA.
Reprinted with permission. All rights reser ved.
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AS SEEN IN USA TODAY’S NEWS SECTION, MARCH 27, 2006
Trauma center: Operating room personnel tend to an Iraqi man at the Air
Force Theater Hospital in Balad. The man’s head had been shaved in preparation for surgery.
have. And then whatever spits out in the
end is better," said Army Col. John
Holcomb, commander of the U.S. Army
Institute of Surgical Research.
At the Balad hospital, Air Force Maj.
Paul "Chip" Gleason, 35, of Springboro,
Ohio, heads or thopedic surger y.
Advances in body armor protect the
abdomen and upper chest of soldiers. But
the legs, arms, faces and lower
abdomens remain vulnerable to bullets
and explosions. Orthopedic surgeons
stay busy. In surgery, Gleason uses a small
digital camera to record images for future
lessons. A key task is recognizing and
removing dying tissue eviscerated by
bullets or shrapnel. Dead tissue can cause
infection.
Because of endless opportunities to
examine torn flesh, "I've noticed a steady
progression in my ability to judge what's
viable, what's living and what's been too
damaged," Gleason said.
Back in the USA, exper ts such as
Andrew Pollak, an associate professor of
or thopedics at the University of
Maryland School of Medicine, said the
knowledge gained in Iraq will prove
priceless.
"If you see these injuries in numbers of
one and two, you never gain any
Scrubbing up: Maj. Paul “Chip” Gleason, head of orthopedic surgery, prepares for a procedure. He says seeing so many trauma patients has
sharpened his ability to judge what tissue can be saved and what tissue
is too damaged.
experience," Pollak said. "When you do a
high volume … you can teach people
what works and what didn't work."
Air Force Lt. Col. David Powers, 42, of
Louisville, is a facial surgeon at Balad. He
already has helped publish a guide based
on his experience treating the wounded.
One lesson: Hold off on surgery until
three-dimensional models of the face
can help guide doctors on what lies
beneath the damage.
A medical journey
From the moment the sniper shot
Mundo in a market in Ad Duluiyah, his
world changed rapidly. After the fiveminute helicopter ride to Balad and
almost two hours in surgery, he was
recuperating.
By 5 a.m. the next day, he was strapped
to a litter and loaded onto a C-17 aircraft
headed for Germany.
The Air Force's system of using
specially configured aircraft to move
thousands of casualties from war zones
almost daily is another crucial
innovation. The technology didn't exist
during Vietnam, the last war in which
large numbers of casualties were
routinely evacuated to the USA. In those
days, doctors typically waited up to six
weeks for patients to become stable
enough to complete the trip home, said
Dale Smith, a professor of medical
histor y at the Uniformed Ser vices
University of the Health Sciences in
Bethesda, Md.
Now, because of new treatment
methods and technology on the aircraft,
the most critically injured patients can
make the trip in a few days. "They've
really thought about this very carefully,
no wasted moments, no wasted
movements," Judge said of the military.
"It's very, very focused."
He and others say the long-distance air
evacuation process — with its speed and
flying care centers — would prove
invaluable should a terrorist attack or
natural disaster overwhelm local medical
facilities, as happened with Hurricane
Katrina last year. After Katrina, hundreds
of patients from flooded hospitals were
moved to other cities by Air Force
medical crews. The White House
investigation into the hurricane
recommended that disaster response
plans better integrate militar y air
evacuations.
Rather than try to re-create in Iraq or
Afghanistan sophisticated hospitals such
as L andstuhl, the militar y has built
smaller field hospitals where patients are
treated and stabilized. Doctors in Iraq
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AS SEEN IN USA TODAY’S NEWS SECTION, MARCH 27, 2006
circulated throughout the plane, offering
water, oxygen and medication to relieve
the pain. They also kept a close eye on
monitors.
"The civilians are always amazed at
how we do this," said Air Force Reserve
Maj. Ken Winslow, 49, a flight nurse from
Issaquah, Wash.
About 65 hours after he was shot —
and after a stop in Germany — Mundo
arrived at Andrews Air Force Base near
Washington. From there, he headed to
Walter Reed.
"It was great because I didn't really feel
like I needed to be that far away from
home. I wanted to get here to Walter
Reed and start doing my rehab," he said.
Medical decisions: Military doctors at the Balad hospital look over the X-ray of a patient who had suffered a gunshot wound to the head. Examining the images are, from left to right, Eugene Ross, Hans
Bakken and Brett Schlifka.
now leave many wounds open and
vacuum-sealed with plastic. That also
was not possible in Vietnam. "Now the
sickest of sick patients can get on that
airplane," said Air Force Maj. Timothy
Woods, a general surgeon at Landstuhl.
A hospital in the sky
On a recent C-17 medical evacuation
flight from Balad to L andstuhl, 32
patients rested comfortably, many of
them in litters stacked three high on
aluminum racks. Among them: burn
patients; an amputee; soldiers with
broken bones, a shoulder sprain and back
injuries; one with a blood disorder; two
psychiatric cases; and a servicemember
stricken with lung cancer. Two in critical
condition were hooked to ventilators.
Like flight attendants, the nurses,
medical technicians and doctors
Within eight days of his return, Mundo
had been reunited with his daughters,
JoLyne, 3, and Shania, 1, and flew home
to Colorado. The two girls had lost their
mother, Rachel, to lupus in November,
just days before their father shipped out
for Iraq. In his absence, Mundo's sister-inlaw, Jessie Mundo, cared for them.
The children were thrilled to see him
and curious about his wound.
"I didn't want to tell them about the
sniper or anything," Mundo said. "As far
as they know, it was just a nice little
doctor's shot."
Contributing: Paul Overberg, Robert
Davis, Liz Szabo in McLean, Va.
On the tarmac: An Air Force C-17 medical transport waits at Balad as ambulances and buses pull
up to deliver patients. Wounded and sick servicemembers will be flown to the U.S. military hospital at Landstuhl, Germany.
Reprinted with permission. All rights reser ved.
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AS SEEN IN USA TODAY’S LIFE SECTION, FEBRUARY 13, 2006
Bone condition hampers soldiers’ recovery
Abnormal growth in
blast-injury amputees
Because the complication is so rare,
surgeons need to do more research to
discover the best way to prevent it or fix
it, Potter says.
By Liz Szabo
USA TODAY
Exposing the amputation site to
radiation appears to prevent H.O. if the
treatment is given within two or three
days of the injury. But few field hospitals
have access to radiation treatment. And
radiation also can impair the healing of
fractures, Potter says. Non-steroidal antiinflammatory drugs, such as ibuprofen,
also reduce the risk of H.O. But these
drugs may cause unwanted side effects,
such as stomach bleeding.
Many soldiers who lose limbs in Iraq or
Afghanistan are developing bone
problems that have been seldom seen in
previous wars or civilian life and that can
complicate their recoveries, military
doctors say.
Nearly 60% of the 318 amputees
treated at Washington's Walter Reed
Army Medical Center develop
heterotopic ossification, or H.O., a
condition in which bone grows where it
doesn't belong, says Army Capt. Kyle
Potter, a senior or thopedic surger y
resident and researcher. Nearly 70
patients from across the military have
been treated for H.O. at Brooke Army
Medical Center in Texas, says Jaime
Cavazos, spokesman for the Army
Medical Command.
Although the problem rarely occurs in
civilian amputees, it is more common
among the victims of blast injuries. Highintensity blasts, which can shred
muscles, tendons and bone, appear to
stimulate adult stem cells to heal the
damage, says Vincent Pellegrini Jr., a
professor and chairman of the
or thopedics depar tment at the
University of Mar yland School of
Medicine. If repair signals go awry, new
bone may stretch into long icicles or
feather y webs under the skin of
shortened limbs.
Rarely seen in wars of the past: In heterotopic
ossification, or H.O., among amputees, new
bone grows where it is not supposed to.
Doctors know relatively little about the
condition among amputees. Potter
searched 70 years of medical journals
and found only a handful of mentions of
the problem.
Potter says the complication is more
common now than in past wars largely
because of two advances. Blast-injury
victims today are more likely to survive,
thanks to body armor, modern helmets
and rapid medical intervention. Doctors
today also can preserve more damaged
tissue, which allows patients to keep
more of their limbs. But this salvaged
tissue is sometimes badly mangled;
injured flesh appears more likely to lead
to H.O., he says.
Although some H.O. patients feel no
pain, the abnormal growths can cause
skin ulcers or interfere with skin grafts,
Potter says. The growths can make it
more painful to walk. Left untreated, the
spreading bone can fuse joints together,
making it impossible for patients to bend
their legs.
Army doctors intervene before H.O.
becomes that severe, however. Up to 20%
of patients require surgery, says Army
Maj. Donald Gajewski, director of
orthopedic care for the Armed Forces
Amputee Patient Care Program at Walter
Reed. Doctors there have operated on 18
patients with H.O.
Combining surgery with radiation and
a drug such as ibuprofen appears to keep
the bone from growing back. But
amputees, who endure a batter y of
operations, might not welcome the
prospect of additional surgeries, Potter
says. In less serious H.O. cases, prosthetic
experts can relieve pain or help patients
avoid surgery by adjusting the artificial
limbs.
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AS SEEN IN USA TODAY’S NEWS SECTION, JANUARY 23, 2006
War vets ready for new political battle
Illinois amputee among 10
post-9/11 veterans making
runs for Congress
By Andrea Stone
USA TODAY
ELK GROVE VILLAGE, Ill. — The lunchtime crowd is thinning
at Portillo's Hot Dogs near O'Hare Airport when the candidate
arrives. Leaning on a cane, she moves slowly on her $120,000
bionic legs with a stooped and halting stride. "Hi! I'm Tammy
Duckworth, the Iraq war veteran running for Congress. You
might have heard of me?" she says, extending her mangled
right arm to shake hands.
Indeed, many here in Chicago's western suburbs have already
heard of the Illinois National Guard helicopter pilot who lost
both legs and full use of her right arm when a rocket-propelled
grenade hit her Blackhawk in a 2004 attack in Iraq.
Maj. Ladda "Tammy" Duckworth, 37, spent nearly a year at
Washington's Walter Reed Army Medical Center, and her
rehabilitation has been chronicled in national media, including
USA TODAY.
Duckworth is the only seriously wounded combat veteran
running this year for Congress, whose ranks of members with
military experience are at their lowest since World War II,
according to Congressional Quarterly.
But at least nine other veterans who served in the post-Sept.
11 militar y have announced House bids. All but one —
Republican Van Taylor in Texas — are Democrats who have
criticized the Bush administration's conduct of the war. They
join dozens of older veterans from both parties touting military
credentials as U.S. troops head into a fourth year in Iraq.
By Tim Dillon, USA TODAY
In Chicago: Congressional candidate Tammy Duckworth, wounded in Iraq,
greets rail commuters Jan. 10.
is competing on another field of battle: politics. She hopes to
succeed retiring Rep. Henry Hyde, a Republican who has held a
House seat for more than 30 years. Duckworth must first beat
two other Democrats in a primary and then take on Peter
Roskam, a Republican state senator in the GOP-leaning district.
Duckworth says politics doesn't compare to what she's
already overcome. She recalled the "nightmare" of Nov. 12,
2004, when crewmates struggled to carry her maimed body to
safety, dropping her because her gushing blood made her too
slippery.
"They gave me a second chance at life," she said, choking
back tears, during an interview. "I've just got to do something —
just to be more."
Veterans have long returned from battle to continue their
public service in politics, but the current field of candidates
with military experience may be the largest since World War II.
John Szeliga, 29, a salesman here, is the kind of voter
Duckworth and her fellow veterans-turned-candidates hope to
attract. "Her story is pretty cool," he said. "Being a veteran,
crashing a helicopter, now running for Congress. Not too many
people do that."
The new candidates reflect their times. Support for the war,
and the Republican administration behind it, is at its lowest:
61% disapprove of President Bush's handling of Iraq, according
to a mid-December USA TODAY/CNN/Gallup Poll.
At least not lately. One in four House members and fewer
than one in three senators have served in the militar y,
Congressional Quarterly says. In the USA, 12% are veterans, the
Census Bureau says.
Duckworth says it was "a bad decision" to invade Iraq. So she
After World War II, future presidents John Kennedy and
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AS SEEN IN USA TODAY’S NEWS SECTION, JANUARY 23, 2006
"A strategy based merely on recruiting veterans, even Iraq
war veterans, overemphasizes a single credential," Rothenberg
says.
Carl For ti, a spokesman for the National Republican
Congressional Committee, agrees. "You also have to be a good
candidate," he says.
Still, some Democrats took heart from a special House
election in August, when Iraq combat veteran Paul Hackett lost
by fewer than 4,000 votes in an Ohio district that went 64% for
Bush in 2004.
Determined to give back: Tammy Duckworth works out on the living room
floor at her home. Her crewmates "gave me a second chance at life," the 37year-old veteran says. "I've just got to do something" with that.
The Republican who beat him, Jean Schmidt, helped rally
Democrats in November during a heated House floor speech.
She said a constituent asked her to tell Rep. Jack Murtha, D-Pa.,
a decorated veteran who has called for troop withdrawals in
Iraq, that "cowards cut and run, Marines never do."
Richard Nixon were among veterans who ran for Congress
almost as soon as they got home. It took more than a decade
for Vietnam veterans, many of whom were reviled for their role
in the unpopular war, to get into national politics. Today, their
ranks include Sens. John McCain, R-Ariz., and John Kerry, DMass.
"When Schmidt called Jack Murtha a coward, she called each
and every one of us a coward," says Eric Massa, a former
military aide to Gen. Wesley Clark, who is challenging Rep.
Randy Kuhl, R-N.Y.
By Tim Dillon, USA TODAY
Republicans tried in 1992 to recruit Persian Gulf War veterans
to challenge Democrats who opposed ousting Saddam Hussein
from Kuwait. Few answered the call.
Today, Democrats lead the recruiting drive, focusing on GOPmajority districts where being strong on defense plays well.
Most troops lean Republican
The numbers of veterans running as Democrats are all the
more remarkable given a Military Times Poll late last year that
found 56% of active-duty troops consider themselves
Republicans and 13% are Democrats.
Massa and Duckworth are among the "Fighting Democrats"
party leaders hope will help recapture the House after 12 years
of GOP rule. Some have formed a political action committee
(www.bandofbrothers2006.org) to support veteran-candidates
and fight back against conservative campaigns like the ones
that targeted Sen. Max Cleland. The Georgia Democrat, who
lost three limbs in Vietnam, was defeated in 2002 by
Republican Saxby Chambliss, who ran ads picturing Cleland
with Osama bin Laden.
Cleland says there is "a disquiet in the gut" of returning
veterans. "They want to come back and tell the truth about
Iraq," he says.
"Since Vietnam, the Democratic Party has been viewed as
the weaker on national security issues," University of Virginia
political scientist Larry Sabato says. "Who better to make the
case than veterans of the war? It's hard to accuse them of a lack
of patriotism."
The Democratic veterans differ on domestic issues but
contend the Bush administration failed to provide enough
troops, armor and planning in Iraq and has no strategy to get
out. Some, such as Duckwor th, say troops should be
withdrawn gradually. Others, such as Patrick Murphy, a military
lawyer who served in Baghdad and is challenging Rep. Michael
Fitzpatrick, R-Pa., favor a timeline for withdrawal.
Democrats thought they inoculated themselves when they
nominated Kerry, a Vietnam combat veteran, for president in
2004, only to see his military record picked apart over his later
anti-war activities.
"They can't give us a snow job," says Murphy, 32. "We've seen
with our own eyes."
Being a veteran isn't enough, says Stuart Rothenberg, editor
of the independent Rothenberg Political Report. He says some
Democrats have rallied around political novices with military
experience after they couldn't attract more experienced
candidates.
The candidates insist they are not one-issue politicians. Chris
Carney, a Naval reservist who served as a special adviser at the
Pentagon two years ago, says he decided to run against Rep.
Don Sherwood, R-Pa., last March at the height of the right-todie controversy over Terri Schiavo.
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"I didn't think it was Congress' business" to get involved with
the brain-damaged woman's fate, he says. "That was the final
straw of politics at the extreme."
It was no accident, either, that Duckworth's first campaign
speech was on a subject of great interest in her upper-middleclass district: taxes targeting the affluent. "If I suck you in here
because of my legs, that's great," she said. "Now let's talk about
the really important stuff to people in my district."
Rothenberg calls Duckworth "one of the stronger" veterans
running. Her story and charismatic personality first caught
Democrats' attention soon after she arrived at the Army rehab
hospital in Washington. It was there that Sen. Dick Durbin of
Illinois, the Democrats' No. 2 leader, first met her and invited
her to attend last year's State of the Union address.
"Seeing the pageantry of what I had just given up my legs for
was very emotional," she recalls. Duckworth returned to
Capitol Hill in March to testify about veterans' care and was
struck by "the need to have more people serving in Congress
who've been there."
When Durbin asked her to run last summer, she thought, "It's
my generation's turn to step forward."
Initially, little enthusiasm
The national party's enthusiasm for Duckworth wasn't
matched, at least initially, among local Democrats, who noted
she lives 3 miles outside the district. The Constitution requires
only that representatives live in the state, and Duckworth says
Vets seeking office
A look at some of the Iraq veterans running for Congress:
u Chris Carney, 46, is a lieutenant commander in the Naval
Reserve and was called up in late 2003 to serve as a special
Pentagon adviser on intelligence and terrorism. The
Democrat is running unopposed for his party's nomination
in a northeast Pennsylvania district. He will face Republican
Rep. Don Sherwood, whose recent settlement of a lawsuit
by his mistress could prove a factor in the race.
she is "emotionally attached" to her house, which was
modified for her wheelchair.
Before Duckworth got in the race, local Democrats had
backed Christine Cegelis, a computer consultant who won 44%
of the vote against Hyde in 2004. But Cegelis has raised little
money and lacks Duckworth's "star power," University of
Illinois-Springfield political scientist Kent Redfield says.
Wheaton College professor Lindy Scott is also running in the
primary.
Roskam says that after "knocking on 3,500 doors," he
believes Iraq isn't a "resonant theme" for voters.
But at a recent meeting in Schaumburg, Democratic activists
sat raptly as Duckworth rattled off stories about Iraq, including
how U.S. forces gave body armor to Iraqi troops just before
missions so they wouldn't sell it to insurgents.
The next day, even Cegelis admitted Duckworth's war stories
were "extremely compelling," noting they opened her eyes to
what is happening in Iraq. Still, she says the move to field
veterans instead of more liberal candidates who she believes
would appeal to the party's base is "about symbols, and that's
very disappointing."
Democratic committeeman Rocco Terranova says that
although many "were a little disenchanted" when Duckworth
was drafted into the race, they've adjusted.
"She's a war hero," he says, "and the war's on everybody's
mind."
to the Iraqi Special Tribunal trying Saddam Hussein. If the
Democrat wins a party primary, he would face GOP Rep.
Robin Hayes in a North Carolina district with a strong military presence that leans Republican.
u Patrick Murphy, 32, is a former West Point professor who
deployed to Iraq as an Army lawyer in 2003. If he wins a
Democratic primary in suburban Philadelphia, Murphy
would face GOP freshman Mike Fitzpatrick in the fall. The
district backed Democrat John Kerry for president in 2004.
u Andrew Duck, 43, is a former Army intelligence officer in
Iraq who currently works as a Pentagon contractor. The
Democrat is running in rural Maryland for the seat held by
Republican Rep. Roscoe Bartlett, a House Armed Services
Committee member. The district voted 65% for President
Bush in 2004.
u Van Taylor, 33, is a former Marine Corps captain who
worked with special operations forces in Iraq to locate and
help plan the rescue of American prisoner of war Jessica
Lynch. The Republican faces a primary. If Taylor wins, he
would face Democratic Rep. Chet Edwards in a heavily
Republican district that includes President Bush's Texas
ranch.
u Tim Dunn, 45, is a lieutenant colonel in the Marine
Reserves who served in Baghdad in 2004 as a legal adviser
Sources: Candidate websites, USA TODAY research
Reprinted with permission. All rights reser ved.
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AS SEEN IN USA TODAY’S NEWS SECTION, OCTOBER 6, 2005
Military to fund prosthetics research
$35M to
develop better
arms, hands
By Dave Moniz
USA TODAY
Lost limbs
Most amputees lose a foot or a leg,
but amputations of hands or arms
have increased among U.S. servicemembers in Iraq. Percentage of amputees who lost a hand or arm
among:
VA amputee patients
WASHINGTON — The Defense
Department is embarking on a
multimillion-dollar research program to
revolutionize upper-body prosthetics after
a surge in troops who have lost hands and
arms in the Iraq and Afghanistan wars.
The technology for artificial hands and
arms hasn't improved much since World
War II. During the next four years, the
Pentagon will spend almost $35 million to
develop improved artificial arms, aiming for
one a Defense Department report says will
"feel, look and perform" like a real arm
guided by the central nervous system.
The commitment is the largest pool of
funding for prosthetics in at least a decade,
says Jan Walker, a spokeswoman for the
Defense Advanced Research Projects
Agency, which will award the contracts.
Improved body armor has led to the
increased injuries to arms and hands, says
5%
Civilian amputees
10%
U.S. amputees from Iraq, Afghanistan
28%
Sources: Defense and Veterans Affairs
departments, Rehabilitation Institute of Chicago
By Frank Pompa, USA TODAY
Lt. Col. Paul Pasquina, medical director of
the amputee program at Walter Reed Army
Medical Center. The armor protects the
upper torso but not the limbs and in some
cases saves troops who would have died in
previous wars. Also, Pasquina says,
insurgents' use of rocket-propelled
grenades and roadside bombs causes
devastating injuries that lead to
amputations.
Reprinted with permission. All rights reser ved.
A total of 337 U.S. troops have lost at least
one limb in Iraq or Afghanistan and have
been treated at Army military hospitals. Of
those, 93, or more than a quarter, are hand
or arm amputees.
Overall, hand and arm amputees make
up only about 5% of all Department of
Veterans Affairs patients who have lost a
limb from wartime injuries, accidents or
disease, department spokesman Terry
Jemison says.
Artificial legs are more sophisticated than
upper-body prosthetics, because there's a
larger market for them, says Todd Kuiken,
director of the amputee program at the
Rehabilitation Institute of Chicago. It's
difficult, he says, to design artificial arms
and hands light enough to be practical and
to replicate the hand's fine motor skills.
Amputees control artificial hands and
arms by moving muscles attached to the
prosthetic devices. Some artificial legs run
on computer chips and can closely replicate
human movements.
An estimated 1.2 million Americans are
missing at least one limb, according to the
Amputee Coalition of America, a non-profit
group in Knoxville, Tenn.
"Investment into artificial limb research
tends to follow wars. This war has
encouraged more research," Kuiken says.
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AS SEEN IN USA TODAY’S NEWS SECTION, OCTOBER 6, 2005
Arm amputees rely on old devices
Technology falls behind
as market focuses on
lower-body prosthetics
By Dave Moniz
USA TODAY
QUANTICO, Va. — Sgt. James "Eddie" Wright can drive a car,
shoot a rifle and handle a bayonet.
That seems unremarkable unless you know this: Wright has no
hands.
They were blown off in a fierce battle near Fallujah, Iraq, in April
2004, when his unit was ambushed by about 40 insurgents. This
summer, after intense rehabilitation, Wright returned to active
duty in the Marine Corps as a martial arts instructor.
It is perhaps telling that he uses traditional metal hook
prosthetics as his new hands. The only double-arm amputee from
the Iraq war to return to military service, Wright chose the World
War II-era technology instead of several newer, battery-powered
prosthetic hands now on the market.
"I remember when I first came back for rehabilitation, they were
touting the myoelectric (battery-powered) hands as the greatest
innovation. I was so disappointed," Wright said, describing how the
hooks are much easier because they don't fall off his arm, are
supple enough to "pick up a paper clip" and are much more
reliable than battery-powered limbs.
Recognizing that the technology for hands and arms hasn't
improved significantly in the past six decades, the Defense
Department is embarking on a multimillion-dollar research
program to revolutionize upper-body prosthetics. Over the next
four years, the Pentagon will fund development of what it hopes
will be vastly improved artificial hands and arms that can be
controlled by the central nervous system.
Richard Weir, a Department of Veterans Affairs scientist in
Chicago, says the Pentagon probably won't be able to achieve
every goal right away. But Weir said he believes the research will
spin off better technologies for long-suffering arm amputees.
"I imagine we'll see a big advance in the next couple of years,"
said Fred Downs, a Vietnam War amputee who is the VA's chief
By Alan Lessig, Marine Corps Times
Martial arts training: Sgt. James "Eddie" Wright, using a wooden knife,
practices on Master Gunnery Sgt. Shane Franklin.
consultant for prosthetics.
A variety of artificial arms are available for military personnel
and civilians. They range from flesh-colored artificial hands that
are solely cosmetic to cable-controlled hooks, such as Wright's, to
battery-powered arms with motors that control elbows and
hands.
Only about half of all arm amputees who are fitted with
prosthetics even use them, said Joe Miller, who oversees
prosthetics at Walter Reed Army Medical Center in Washington,
D.C. Many are heavy, hard to use and prone to break.
The vast majority of Americans who use prosthetic devices are
leg amputees, according to the Amputee Coalition of America, a
non-profit advocacy group in Knoxville, Tenn. Of the 199,000
Americans using artificial limbs in the mid-1990s, the latest figure
available, about 87% were missing feet or legs.
"There is no commercial market for upper-extremity devices,
and this is something we have argued to the Pentagon," said Lt. Col.
Paul Pasquina, medical director of the amputee program at Walter
Reed.
Pasquina said the limitations are widely known and a source of
frustration to doctors and patients alike.
Artificial arms are much more difficult to design than artificial
legs and have proved a harder sell to skeptical patients. Leg
Reprinted with permission. All rights reser ved.
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AS SEEN IN USA TODAY’S NEWS SECTION, OCTOBER 6, 2005
amputees typically need a prosthetic
device to move around and are therefore
more likely to use one. A single-arm
amputee can often get along without a
prosthetic. Adding motors and other
materials needed for an easy-to-use
artificial arm has been a huge challenge,
said Weir, a researcher and artificial-hand
designer at Northwestern University.
Perhaps the most difficult hurdle for
those who use artificial arms and hands is a
lack of natural control. Devices known as
"body-powered" arms, which have hooks
that are manipulated by cables and
harnesses, are controlled by gross
movements of the shoulder, arm and chest.
Another type of artificial arm, known as
myoelectric, is battery powered and is
controlled by the movement of remaining
arm and chest muscles. These devices
amplify electrical signals from muscle
twitches to power the artificial arm.
A typical adult human arm, Weir said,
weighs about 5.5% of a person's total body
weight. So someone who weighs 170
pounds has arms that weigh more than 9
pounds each. But even a 6-pound artificial
arm, he said, is too heavy for most to wear
very long because it doesn't have the
support that a natural arm has.
Many arm amputees, including Wright,
choose to use the traditional metal hook or
nothing at all.
Weir said there is a challenge in
duplicating the functions of a hand, which
can move in dozens of ways.
"The artificial hand is a very poor gripper
if you can only keep it in one shape," he
said, noting that no artificial hands on the
market can simulate the hand muscle
movements necessary for daily living.
By Alan Lessig, Marine Corps Times
G e t t i n g s u p p o r t : Wright hugs his girlfriend,
Donette Mathison, after therapy at Walter Reed
Army Medical Center.
Reprinted with permission. All rights reser ved.
Miller, the Walter Reed prosthetics
manager, said he believes that within four
years, the new research will yield hands
and arms that are lighter, easier to control
and more flexible. "We hope to have a
prosthetic that looks and functions
normally," he said.
Page 12
CRITICAL INQUIRY
1. Besides the reference to the use of evacuation procedures for Katrina victims, what other applications can
you see for the innovations emerging in response to combat injuries?
2. Do you think that advancements in prosthetic devices and technology will have an affect on the morale of
military personnel? Why or why not?
3. Based on the combat circumstances reported in the articles, what other medical conditions (besides the
need prosthetic devices) may arise that will require government attention?
4. How has the deployment of body armor altered the conditions under which soldiers operate and the types
of injuries? Do you think that it will be used in all future combat situations? Why or why not?
1. What other innovations from U.S. activity in Iraq and
Afghanistan may eventually impact civilian life?
Explain.
FUTURE IMPLICATIONS
2. How have medical advances affected the ability of the U.S. to fight and win ground wars?
3. Do you think that these advances will affect U.S. engagement in future conflicts? Why or why not?
4. What are your predictions for the future aims of war-related medical research?
5. Consider the basic goals of any war. What benefits (e.g., technological, medical, social, etc.) has humankind
reaped as a result of warfare? Are the paybacks worth the conflict and casualties?
ADDITIONAL RESOURCES
v Wounded Warrior Project
www.woundedwarriorproject.org
v Disabled Sports USA
www.dsusa.org
v Disabled American Veterans
www.dav.org
v National Amputation Foundation
www.nationalamputation.org
For more information, log on to www.usatodaycollege.com
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