I kind of hate to ask this question but it is really on my mind so here goes. My twin brother just returned from his third tour of duty over in Afghanistan. This time he came back with a blast injury to the spine and some serious damage. They brought him home in a “flying hospital” and tell us he got the best of care. I still can’t help but wonder if all the problems he developed (infections, blood clots, nerve damage) wouldn’t have happened if this type of injury was treated stateside. Is there any way to even compare this or figure it out?

Your concern is very understandable and having some answers might help reassure you. Our military medical personnel are functioning in a very challenging arena. The environment in which they are working (desert conditions with extreme weather patterns) and the complications of evacuation are beyond anything we can fully appreciate.

They do indeed have flying intensive care units (ICUs). Surgeons and nurses treat the soldiers while in the air evacuating from the field of battle to military hospitals. But there are many challenges as you can imagine. They have limited equipment to make a complete diagnosis. The evacuation process is complex and can delay treatment. And there’s really only so much that can be done to treat serious injuries even in a flying ICU.

Even so, every effort is made to provide rapid response to any injury with complete medical care — either at the theater of operations, in the air, or at the nearest hospital setting. Sometimes that is a mobile hospital like the kind featured in the long-time TV series MASH. In other situations, it is a med-evac to a hospital in Europe. Once the wounded soldier is stable, evacuation to the United States takes place.

It may help you to know that a recent study of military spine injuries was published. In that report, they noted that the specific types of complications experienced in our wounded warriors aren’t that different from what happens among civilian patients with similar injuries.

Infections, blood clots, urinary tract infections, cerebrospinal leak after surgery, and pneumonia are typical minor complications. Likewise, more serious problems such as failure of the wound to heal, injury to blood vessels or nerves during surgery, spinal cord injury, injury to the gastrointestinal tract, and even death were the same for U.S. military solders as are reported in civilian studies following surgery for spine injuries.

Protection of our troops is an important goal — whether on the ground, in armored vehicles, during transport following injury, or during and after surgery. Examining the type and number of complications associated with military spine injuries will help with decision-making in the Theater of Battle. The fact that our military medical staff are paying attention to these kinds of problems and studying them closely is very reassuring.