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LANDSTUHL, Germany — When Col. Barbara Holcomb took command of Landstuhl Regional Medical Center last May, the hospital was already a distinguished institution renowned for its treatment of American casualties from two bloody wars in Iraq and Afghanistan.

But with one of those wars over and the other drawing down, Holcomb’s legacy here is likely to be her leading the hospital’s preparations for the postwar era and overcoming its budgetary shortfalls.

Holcomb relinquishes command of the hospital Wednesday, long before many of the changes she initiated shift much of Landstuhl’s focus from the traumas of war to the ailments of Americans in Europe.

When she took command, “Everything was going along smoothly,” she said. But with the end of the war in Afghanistan looming, she prodded her staff to think, “What happens when the war ends?”

That, she said, has been the “underlying theme” of her tenure — “getting us downsized to where we can still have the capability to meet the mission, but within our means.”

Though she counts laying the groundwork for this transition — set to be completed by the end of next year — among her major accomplishments, she’s concerned about how the hospital will weather the change.

“I think Landstuhl, a lot of the staff is going to have an identity crisis,” she said.

Many of the staff “feel like they’re contributing to the war effort because they get direct interaction or contact with those patients” injured in Afghanistan.

“My concern is that when that stops, are they still going to find the same satisfaction in taking care of the patients that are here that they feel currently?”

At least some personnel may have other concerns: finding a new job.

The hospital’s future staffing is still under review, but Landstuhl is expected to lose about 440 positions in the drawdown, Holcomb said. Those cuts are across the command’s footprint, which includes Army clinics around Europe. But it’s Landstuhl that will take the brunt of the losses, Holcomb said.

Over the past decade, Landstuhl added hundreds of personnel to its staff to handle the crush of casualties flying in daily from Iraq and Afghanistan. Three years ago, all of those personnel were needed, Holcomb said.

But the volume of ill and injured patients evacuated from the war zone has been trending down dramatically.

“As the war ends and as casualty rates come down, we don’t need as many people any longer,” Holcomb said.

But despite major reductions in the number of U.S. personnel in Europe and the end of the wars that thrust Landstuhl to fame, the hospital will continue to be relevant and needed, she said.

Before Landstuhl was a household name, it treated the casualties from the bombing of the USS Cole in Yemen in 2001 and from the bombing of Khobar Towers in Saudi Arabia in 1996.

More recently, it tended to personnel wounded in the terrorist attack on the diplomatic compound in Benghazi, Libya, last September, and was on call to accept casualties from the terrorist takeover of an oil facility in Algeria in January.

“So, regardless of the size of the beneficiary population surrounding Landstuhl, it’s a strategic platform for everything else going on in” Africa, the Middle East and surrounding regions, Holcomb said.

But it will exercise that role with less money than it’s had for much of the last decade.

In the current fiscal year, Landstuhl has scrambled to overcome a $26 million funding gap caused by defense budget cuts and sequestration.

“And that required every staff member to participate and look at their work to figure out how they could help us save money,” Holcomb said.

Some of those savings came from canceling a contract for lab tests and pulling the work in-house; consolidating personnel in dwindling communities to cut housekeeping expenses; centralizing purchasing and reducing stocks of medical supplies.

All of this, she said, has led to uncertainty, particularly for Landstuhl’s civilian staff.

Sequestration triggered a hiring freeze and the potential of furloughs, which are expected to strip 11 days of work and pay from most Defense Department civilian employees by the end of September. And more than a dozen civilians under her command were recently notified they were erroneously receiving allowances to cover their housing expenses.

“It seems like one thing after another, and it seems like our civilian staff has taken the hardest hit,” Holcomb said.

Despite all that, she described her departure from Landstuhl as “bittersweet.” She’s been selected for promotion to brigadier general and will move on to assume the post of command surgeon for U.S. Forces Command at Fort Bragg, N.C.

The toughest moment of her time commanding Landstuhl, she said, “will probably be … when I have to pass the flag.”

“Mentally I’m having difficulty being ready to go, because I have not seen through the plan that we laid out.” Twitter: @mattmillham

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