LANDSTUHL, Germany — On a drizzly, frigid morning, about 20 injured servicemembers were unloaded from buses at Landstuhl Regional Medical Center.

Some walked off. Others lay on gurneys covered in green blankets that had kept them warm on the long flight from Afghanistan. As the hospital staff eased the wounded off the buses, the mood grew solemn, as it often has lately.

“Hey ‘Devil Dog,’ how you doing?” asked a staff member as he pushed a sandy-haired Marine through the hospital’s front doors.

The number of combat-wounded troops from Afghanistan treated at the hospital has spiked during the past three months. Doctors from Landstuhl — the first stop for the wounded from the war zone — saw 163 troops with battle injuries during August, 152 in September and 109 in October.

The uptick coincides with some of the deadliest months for coalition and NATO troops fighting there. A record 72 were killed in August, 61 in September, and then 62 in October, according to independent Web site icasualties.org.

“It has definitely been busier the last few months than it had been six or nine months ago,” said Air Force Lt. Col. (Dr.) Raymond Fang, Landstuhl’s trauma director.

The number of combat-wounded from Afghanistan in August was the highest of any month since the war began in 2001, statistics show. Still, the hospital staff is not as busy as it was when fighting in Iraq was at its most intense, such as the “surge” and Fallujah’s battles, Fang said. During the surge in May 2007, there were 326 war-related inpatients at the hospital, and during the first attack on Fallujah in 2004, there were spikes in April with more than 400 war-related inpatients and in November with about 500.

Taking a tactic from the Iraqi insurgents, the Taliban are using crude but powerful improvised explosives. As a result, the number of troops in Afghanistan injured by roadside bombs has swelled, Fang said.

“The [bombs] cause polytrauma, which include blast injuries, burn injuries, and penetrating injuries from fragments,” he said.

The general surgery team is shouldering the brunt of the work as a result, Fang said. These surgeons, who have backgrounds in trauma care, are able to treat several different injuries and coordinate care with specialists. The time surgeons spent in the operating rooms has also climbed these past months, but Fang and his team were ready, with systems already in place to handle the influx of wounded troops.

Sitting in a hospital bed, Capt. Chad Marzec was recovering after surgery on his left ankle, to clean and repair injuries from a bullet wound. The Kiowa Warrior helicopter pilot was providing air support for 2nd Battalion, 12th Infantry Regiment soldiers on patrol in the Pech Valley of Afghanistan’s Kunar Province in early November.

Having finished a meeting with village elders, nearly two dozen soldiers were walking across the valley’s center when they were ambushed. The soldiers returned fire, ducking behind a nearby stone wall, and called on the helicopter’s guns, as well as mortars from a nearby base, for help.

“When they’re being shot at, there’s a certain distress in their voice even though they are trying to stay calm,” Marzec said. “You hear gunfire in the background.”

The helicopter swooped down to provide suppressive fire, but during one of its subsequent runs, a bullet pierced the cockpit, went past the pilot and struck the back of Marzec’s left ankle. He was several days away from returning home from Afghanistan.

The soldiers were able to fight their way out of the skirmish.

“You could say I was unlucky. But I was lucky where it hit me,” said Marzec, who should recover completely.

Marzec said he hasn’t noticed a recent uptick in patrols. He was flying about four support missions a week.

But he knew that this one in the rugged terrain of eastern Afghanistan, with many caves and peaks for enemy fighters to hide in, would be dangerous.

“There are more dangerous places than others,” he said, “and this was a particularly hostile place.”

Migrated