On a recent hot summer night, two soldiers are transported to the burn unit at Brooke Army Medical Center in San Antonio. The men are in critical condition. Most of their bodies are covered by full thickness -â€“ or third-degree â€“- burns.
Brooke Army Medical Center is the Defense Department's only burn center. It is able to save people like never before because burn victims get there quickly -â€“ as fast as 36 hours from injury in Iraq to the U.S. military hospital in Landstuhl, Germany, and then to Texas. Doctors there have treated more than 450 patients with severe burn injuries from the wars in Iraq and Afghanistan.
When burn victims arrive, they are cleaned in a process called a debridement to remove any blisters or dead skin. Once the patient is in stable condition, they head to the operating room where doctors cut away dead tissue to prevent infection. Then, exposed areas are covered with skin grafts.
Without skin, burn patients cannot maintain their core body temperatures, so patients' rooms and the operating room are kept between 90 and 100 degrees. The center uses two freezers as a tissue bank. Grafts are taken from the patient â€“- if there is enough unburned tissue. If not, they use synthetic skin, pig skin or skin from cadavers. Sometimes, epicells are grown in the lab from biopsies of the patient's skin.
Doctors also must control the patient's pain. Dr. Ian Black, chief of anesthesia, says patients endure excruciating pain from burns, trauma and often amputation.
When patients die, the medical staff also has to find ways to deal with the losses. One nurse has a spot at the side of the road where he'll go to cry, pray or meditate so he won't take the emotion home. One doctor says that after a death, some of the staff kick the file cabinet; some of them hug the family, and some of them cast their eyes toward the ground to avoid the family that they feel they failed.
Produced by NPR's Andrea Hsu.