Landstuhl’s high-profile military hospital going strong with 50 years of service
Stars and Stripes June 15, 2003
For millions of Americans watching around-the-clock news coverage of Operation Iraqi Freedom, Landstuhl Regional Medical Center became known as “the Army hospital in Germany” — the hospital where Marines and soldiers injured by traumatic amputations, blast and shrapnel injuries and gunshot wounds suffered in the war were taken for medical treatment.
Press conferences with injured servicemembers and their physicians and nurses were broadcast from Landstuhl via CNN, Fox News, ABC and other media into the homes in the United States on a regular basis. And when injured patients were high-profile cases, such as former prisoner of war Pfc. Jessica Lynch, Landstuhl became the focus of international media attention.
How fitting, then, that during the weeks leading up to Landstuhl’s 50th anniversary on April 5, the hospital met its greatest challenge ever — receiving and treating 606 patients evacuated out of the theater of operations in 28 days. Of those 606 patients, 241 — or about 40 percent — had battle-related injuries, said Landstuhl’s commander, Col. David Rubenstein.
People associated with the hospital past and present “were bursting with pride over the high profile given to Landstuhl,” said Dr. (Gen.) Eric Schoomaker, former deputy commander for clinical services at Landstuhl and now commander of the Dwight D. Eisenhower Army Medical Center in Fort Gordon, Ga.
During the war in Iraq, the physicians, nurses and medics at Landstuhl provided an unprecedented level of medical care to the largest number of American men and women servicemembers wounded in combat since the 1991 Persian Gulf War. Wounded were first treated by battalion aid stations, forward surgical teams or forward resuscitative surgery teams closer to the battlefield than in any previous war.
Patients were evacuated to Landstuhl — about a seven- to eight-hour flight — when their injuries required treatment beyond the level of care that could be provided in theater. Injured servicemembers were also sent to the Navy’s hospital ship, the USNS Comfort, which was stationed in the Persian Gulf, as well as to the naval hospital in Rota, Spain.
However, Landstuhl remained the primary receiving hospital, and received most of the casualties coming out of Iraq, Rubenstein said.
While Lynch’s story of rescue from an Iraqi hospital by Special Operations Forces might be the most celebrated tale to come out of the war, each of the 606 patients and more who arrived at Landstuhl has a story to tell, some more heart-wrenching than Lynch’s. Out of earshot of the media, these stories are told to the nursing and medical staffs as patients come to grips with the events that brought them to the hospital.
“There are some tremendous stories here,” said Col. Roy Harris, Landstuhl’s deputy commander for nursing and chief nurse of the Europe Regional Medical Command.
Nurses close to the ages of their young patients, and older nurses who could have been their patients’ mothers, were all affected by what they saw and heard, Harris said. The nursing and medical staffs were especially touched by a Marine and a sailor bound by misfortune.
Rubenstein tells the story this way:
While in Iraq, the Marine was getting out of his vehicle when he stepped on a land mine. One of his legs was blown off. A Navy corpsman who was nearby went to assist him. But the corpsman stepped on a land mine as well, losing both legs. The men were evacuated to Landstuhl and put in the intensive care unit in adjacent rooms.
Gen. B.B. Bell, U.S. Army Europe commander, and his wife went to Landstuhl to visit some of the wounded servicemembers. While they visited the Marine, a nurse asked the corpsman if he would like to see the general, as well.
He said, “Of course, but you’ve got to help me.”
The nurse said, “What’s wrong?” and the sailor replied, “I need some pillows.”
Thinking he was uncomfortable, the nurse asked, “What do you need these pillows for?”
The corpsman answered, “I need to put them behind my back so I can sit at attention.”
Rubenstein tells the story of another injured servicemember who received a get-well card from a boy named Bobby. Inside the card was an American flag made of cloth. Bobby’s father had given him the flag before leaving for Iraq. But the child wrote, “I thought you needed it more than me.”
The story doesn’t end there.
The servicemember who received the flag from Bobby was transferred to Walter Reed Army Medical Center in Washington, D.C. A Landstuhl psychologist, Col. Sally Harvey, visited the patient during a trip to the States. The servicemember gave the flag to Harvey, who was able to track down Bobby’s dad. The father himself was headed back to the United States. Harvey returned the flag to the boy’s dad.
On his arrival at Landstuhl two years ago this August, Dr. (Maj.) Yong Chun didn’t anticipate coordinating the care of the largest number of U.S. combat casualties since the ’91 Gulf War. But when Operation Enduring Freedom started, Chun was Landstuhl’s lead triage physician for the war.
“It was a challenge and a great opportunity for me,” he said. “The attitudes of the soldiers, Marines and sailors who have come through here have been surprisingly high, and it has made me proud to serve them.”
Largest outside States
Landstuhl is small compared to civilian facilities in Europe and the United States. But it is the largest military hospital outside of the States and is the medical referral center for the European Command as well as Central Command.
Its official mission is “to serve as America’s beacon of health care for its sons and daughters abroad.”
Until the early 1970s it even had a fleet of medical trains to help it accomplish its mission, said Bill Addison, the contract historian of the Office of Medical History, Office of the Surgeon General. The trains were staffed by medical personnel who provided patients with minor, en route care by rail to Landstuhl, Addison said.
The hospital also once served as training grounds for U.S. military medical students and German civilian interns and residents, he said. For the Germans, the training provided hands-on experience that their book-oriented education was lacking, Addison said.
Today, servicemembers and their families sometimes travel from as far as Africa to be treated at Landstuhl.
The medical center’s resources have been stretched in caring for servicemembers evacuated from Operation Enduring Freedom and Operation Iraqi Freedom during the past year and a half. But Landstuhl also continues its peacetime mission of treating the approximately 300,000 members of the military community in Europe who develop routine and emergency health conditions, Rubenstein said.
Landstuhl didn’t always have such a high media profile. Before the early 1990s, a friendly competition for patients existed among the military’s top three hospitals in Europe — Landstuhl, the Army’s 97th General Hospital in Frankfurt and the Air Force’s Wiesbaden Medical Center, both also in Germany.
During the 1980s, Wiesbaden became well-known for its television shots of “celebrity” patients waving from the hospital’s balconies. The best-known patients were the former hostages in Lebanon who were released sporadically during the late 1980s.
“Wiesbaden would get all the press when the patients arrived, but we would end up taking care of them,” said Dr. (Gen.) Elder Granger, commander, Europe Regional Medical Command Surgeon, USAREUR and 7th Army Training Center, and Tricare lead agent.
With a rise in worldwide terrorist acts against Americans, Landstuhl began caring for servicemembers injured in attacks such as the bombing of the Marine Corps barracks in Beirut, Lebanon, in 1983 and the LaBelle disco bombing in Berlin in 1986.
A test for Landstuhl
But the first tests of how well Landstuhl could cope with mass casualties occurred in 1988, when Italian jets performing in an air show at Ramstein Air Base, Germany, collided, sending scorching pieces of metal into the crowd of Germans and Americans. More than 60 people died, most from serious burns. Landstuhl treated 500 casualties.
The air show disaster was the first real test of the hospital’s ability to manage large numbers of casualties, Schoomaker said.
“It did a remarkable job of responding to the challenge,” he said.
At that time, Landstuhl was prepared to care for casualties coming from land and air battles in Europe.
“I don’t think anyone thought we would receive casualties from outside the European theater,” Schoomaker said.
The ’91 Gulf War changed traditional thinking about war. Military hospitals in Landstuhl, Wiesbaden, Nürnberg and Frankfurt all received casualties from Operations Desert Storm/Desert Shield. But Landstuhl received the most patients — because of the depth of medical care it could provide and because of its proximity to Ramstein, Schoomaker said.
Following the drawdown of the U.S. military in Europe after the Persian Gulf War, the Frankfurt, Wiesbaden and Nürnberg hospitals were shuttered, leaving Landstuhl as the largest military medical facility outside the United States.
Landstuhl continued to care for servicemembers injured in terrorist acts through the 1990s. To better cope with these contingencies, Landstuhl established an emergency operations center. Granger, who spent seven years at Landstuhl, including a stint as its commander from 1999 to 2001, helped establish the center and was there during its first real disaster when the USS Cole was hit by suicide bombers in a boat in Yemen in October 2000.
The hospital had just completed a disaster exercise, and personnel were preparing to shut the center down when they received news of the Cole’s bombing.
“We left the center open and got it operational,” Granger said.
The center allows decision- makers to gather in one place to collect information and make decisions about security, patient administration and logistics.
“It helped us to stay aware of the situation,” Granger said.
The emergency operations center, in addition to newer emergency response strategies developed since then, enables the hospital to more efficiently care for casualties coming from long distances, a pattern that shows no signs of stopping.
“Prior to Operation Enduring Freedom, Landstuhl was the center of some important missions, but they were focused and short-term,” Rubenstein said. “For almost two years now, there has been a sustained effort to care for large numbers of casualties. We are still receiving patients from Afghanistan.”
As of May 29, the hospital has treated 1,568 casualties from Operation Enduring Freedom, and 1,721 casualties from Operation Iraqi Freedom.
New ideas that help Landstuhl better care for these patients include TRAC2ES, which stands for the TRANSCOM Regulating and Command and Control Evacuation System. Developed after Desert Storm, the system contains information, such as the medications a patient is taking, treatments provided to patients for their illnesses and/or injuries, and any other special medical instructions needed by physicians.
“It allows us to track patients at each leg of their air evacuation journey to LRMC,” Chun said. “Since the information is constantly updated, we can also make initial medical triage decisions according to the information contained in TRAC2ES.”
The second system is the Deployed Warrior Medical Care Center, which was developed at Landstuhl to ensure that the hospital’s resources would not be overwhelmed by the arrival of large numbers of casualties from Operation Enduring Freedom. The warrior care center consists of a team of medical and administrative personnel. Chun’s role as the medical director of the warrior center is to monitor the flow of patients through Landstuhl and to ensure they receive appropriate care.
Landstuhl continues to upgrade and expand its facilities and purchase new medical equipment to keep up with rapidly changing technology. For instance, it is currently building a new eye center. It is also one of the few military hospitals that integrates Army and Air Force (86th Medical Squadron) medical units. The hospital comprises 76 percent Army and 24 percent Air Force personnel, along with a contingent of German civilian employees.
Just as Landstuhl has refined its procedures to care for large numbers of casualties, its staff has also learned how to cope with swarms of U.S. and international journalists who camp outside the hospital’s gates during high-profile cases.
“The media covers the same stories here but in different ways,” said Marie Shaw, who has served 25 years as Landstuhl’s public affairs officer. “Everybody [television, radio, print] has a different angle. I need to know their needs and be flexible while responding to them.”
The opening of a dedicated press center enables Shaw to juggle those needs. The hospital can hold video press conferences with patients who cannot leave their rooms while reporters question them from the press center.
For the war in Iraq, Landstuhl also set up a joint information bureau in the education building and brought in public affairs support staff. The hospital accredited 364 members of the media in a three-week period during the war.
“Working with the media and all its forms is so important,” Rubinstein said, “because it tells people back home that there is an excellent health care system from the point of a servicemember’s injury, to his evacuation to Landstuhl, to his arrival back home.”
Shaw has worked with nine commanders and is one of the few constants in a military community where personnel routinely come and go. Shaw says she decided to remain at Landstuhl after witnessing one event in particular after the bombing of the Marine barracks in Beirut in 1983.
The attack occurred around the same time as the Marine Corps’ birthday. A Marine commandant arrived at Landstuhl to help celebrate. Wounded Marines gathered in a big bay, some in beds, others in wheelchairs. One of the Marines treated at Landstuhl suffered injuries that left him a quadriplegic.
The commandant walked in while other Marines carried flags and pushed a large birthday cake. The commandant went to the bed of the Marine who had lost the use of his limbs. He put the ceremonial sword in his hands and helped him cut the cake.
“As the cake was cut, all the Marines said ‘Semper fi’ in one voice,” Shaw said. “There was not a movement in the room. Everybody was crying. I think that moment was the deciding factor for me; to see the respect and pride of the members of the armed forces caring for their own.”
No end in sight for center
What does the future hold for Landstuhl Regional Medical Center?
For now, the center continues to receive large numbers of patients from the Middle East theater. The 600 reservists and augmentees who were sent to help the hospital handle the influx of casualties before the war started will remain in Germany indefinitely.
Although combat has ended in Iraq, that doesn’t mean “we are not getting our fair share of work,” Col. David Rubenstein said. “It remains very busy. Our immediate future is to maintain our focus.”
In fact, Iraq remains a deadly place for American soldiers, and the military is launching a new offensive to rout out pockets of Iraqi resistance. In a three-day period from May 25 through 27, eight soldiers were killed and about 24 injured in direct attacks by Iraqis. There are also the more numerous nonbattle-related injuries and deaths from motor vehicle accidents, work-related accidents and unexploded pieces of ordnance unknowingly picked up by servicemembers.
So the hospital continues to work in a state of readiness, prepared to treat casualties from any emergency or disaster near or far.
“There’s a new state of normalcy here, a heightened sense of awareness that we can be impacted by international events,” Col. Roy Harris says.
The medical center’s ultimate future will be decided by military planners in the Pentagon as they determine the role of U.S. forces in Europe and other parts of the world.
In the meantime, Landstuhl will belatedly celebrate its 50th birthday with an open house, picnic and other fests attended by military, civilian, American and German friends, past and present, June 21. The celebration was delayed because of the war in Iraq.
— Janet Boivin