Roadside bombs are a terrifying hallmark of the war in Iraq, and the serious head wounds they cause occur at nearly double the rate of past wars. The injuries suffered by "World News Tonight" co-anchor Bob Woodruff and ABC News' cameraman Doug Vogt happen on a regular basis to the men and women who serve in Iraq.
The two ABC News' journalists are in serious but stable condition, which means "that the vital functions, the heart, the breathing, have been controlled so that life is not in serious threat," said ABC News' medical editor Dr. Tim Johnson. They are now being treated in Germany and have been joined by their wives and Woodruff's brother David.
Compared to the Vietnam War, when about 12 percent of all wounded soldiers sustained a brain injury, in Iraq, 22 percent of the wounded have serious head wounds.
But the wounded in Iraq also have a much greater chance of surviving. In World War II, 30 percent of all injured troops died; 24 percent died in Vietnam. In Iraq, just 9 percent of the injured lose their lives. Improved body armor and advances in battlefield medicine have saved countless lives.
So far, more than 16,500 U.S. soldiers and Marines have been injured in Iraq.
Researchers who examined records at Walter Reed Medical Center in Washington, D.C., found that every patient who was exposed to a blast was evaluated for traumatic brain injury. They found that 59 percent of those evaluated sustained a traumatic brain injury and that 56 percent of those cases were considered moderate or severe. Usually, the Army finds that 20 percent of those evaluated actually sustain traumatic brain injuries, according to the Army's public affairs office.
The reasons for the increase are somewhat complicated. Improved body armor and helmets are effective in shielding the wearer from bullets and shrapnel; that improves overall survival rates. But the helmets cannot completely protect the head, neck and face. They have, however, reduced penetrating injuries, in which shrapnel pierces the skull. Yet helmets are much less effective against closed brain injuries, which result from the enormous concussive force from an IED explosion. The explosion can damage the brain all by itself or can damage the victim's brain by slamming him to the ground or into a vehicle. According to the New England Journal of Medicine, "approximately 8 [percent] to 25 percent of people with blast-related injuries die."
"Even if the explosion does not cause any direct damage to the brain, the explosive force in the air … can cause a contusion, which can lead to brain swelling," Johnson said. "The big enemy in head-injury cases is brain swelling."
He said that doctors would try to reduce the effects of the swelling with surgery. When the journalists are back in the United States, they will undergo rehab to focus on the long-term effects of the brain swelling.
"We don't know what the outcome will be," Johnson said. "It will be weeks or months of an assessment of functional activity, and that's what really counts."
Swelling, Johnson said, should start to significantly reduce within weeks. It becomes the doctors' top treatment priority after they make sure that the injuries to the heart and other vital organs are tended to.
Today, doctors can do operations in field hospitals that were unthinkable a few years ago, such as micro vascular surgery, which allows doctors to reconnect tiny severed blood vessels and nerves. At the hospital in Balad, Iraq, where Woodruff and Vogt were treated, doctors could perform every kind of operation except organ transplants.
"Ten or 20 years ago, this would have been an automatic death sentence," Johnson said.
Additionally, soldiers or injured civilians in Iraq can be transferred to the United States for medical treatment in less than 36 hours. In Vietnam, the average time for such transport was 45 days.
After the Gulf War, military doctors decided that field hospitals were too far from the battlefield and needed to be closer, dramatically cutting transit time, which drastically increases chances of survival. In fact, if a wounded person arrives alive at Balad, his or her chances of surviving are 97 percent. Woodruff and Vogt arrived at the Balad hospital 37 minutes after the explosion.
Woodruff and Vogt are recovering in the U.S. military hospital in Landstuhl, Germany, where doctors have treated more than 5,000 combat wounded. It is the largest American hospital outside the United States.