Ghazi Balkiz / NBC News
A US Air Force Boeing C-17 getting prepared for a medical evacuation flight from Bagram Airfield, Afghanistan to Landstuhl, Germany on November 29th 2013.
LANDSTUHL, Germany — When a rocket blast struck him in southern Afghanistan nearly two weeks ago, cleaving a nine-inch gash in the back of his neck, Marine Corporal Michael Hall began a journey that has become a signature route home for thousands of American service-members.
Hall’s first stop after leaving Afghanistan was the American medical facility at Landstuhl Regional Medical Center, in Germany.
More than 19,500 Americans have been wounded in the war in Afghanistan, according to the Department of Defense. Of those wounded, nearly 6,500 American service members have been treated for battle injuries at Landstuhl, the largest American military hospital outside the United States.
There, doctors specializing in trauma care stabilize the war-wounded before patients are moved to American hospitals, including Walter Reed, in Bethesda, Maryland, and Brooke Army Medical Center, in Houston, Texas. The system, refined over twelve years of war, boasts remarkable results: Landstuhl’s survival rate is 99.5 percent.
Ghazi Balkiz / NBC News
Members of the Expeditionary Medical Operations Squadron transport a patient to a US Air Force Medical Evacuation plane at Bagram Airfield, Afghanistan on November 29th 2013.
The key, doctors say, is to move patients quickly. The average inpatient period at Landstuhl is three days. Service members are then delivered back to the US at a critical time when a morale boost from family and friends matters most.
In order to achieve that objective, the US military has been pushing care closer and closer to the front lines. "What we've been able to do in this conflict is really revolutionize patient movement," says Dr. Jerry Fortuna, the chief of general surgery at Landstuhl and a US Air Force Lieutenant Colonel. "We're continuing treatment from point of injury all the way until you get back to Walter Reed."
Trauma care now begins on the battlefield itself, military doctors tell NBC News. Groups of doctors and nurses deliver immediate aid aboard the very helicopters that extract the wounded from battle. The wounded are whisked to forward operating bases, where awaiting surgeons go right to work. From there, the wounded are moved to the sprawling Bagram Airfield, north of Kabul, and loaded daily onto C-17 flights to Germany.
Along the way, the wounded are cared for by flight nurses and other military personnel who, without fanfare, ensure safe passage
“You see the younger people that are getting injured, and to me they’re like babies,” says Lieutenant Michelle O’Connor, a US Air Force flight nurse. “They’re like my little brothers or my little sisters.”
O’Connor, who has served in the Air Force for 14 years, has shuttled troops from both Iraq and Afghanistan.
“It brings tears to my eyes sometimes, because they’ve sacrificed a lot, and I just hope everybody realizes that,” she says. “I’ll take it with me for the rest of my life, the things that I’ve seen.”
Less fighting, fewer injuries
As the US military prepares to draw down in Afghanistan after 2014, the mission in that country is quietly changing.
The new watchwords are “advise and assist.” Fewer American troops are leaving their bases. Missions have increasingly been handed over to the Afghan National Army, which relies on funding and equipment from the Americans.
For the doctors at Landstuhl, this has come as some relief. They say amputations are down 20 to 30 percent since last year.
Ghazi Balkiz / NBC News
Marine Corporal Michael Hall onboard a medical evacuation flight at Bagram Airfield, Afghanistan on November 29th 2013.
"We haven't seen a triple amputation in nine, ten months," Jerry Fortuna, the Air Force surgeon, says.
Still, there is violence, and single amputations remain common – the result of the roadside bombs and land mines that have become a regular feature of the post-9/11 wars.
Last week, Fortuna removed the leg of a young marine who stepped on a land mine in Afghanistan three days before Thanksgiving.
Fortuna, who has deployed twice as a trauma surgeon to Afghanistan and once to Iraq, estimates he has performed some one thousand operations on American service members.
“It really is an honor and a privilege to take care of these guys. I can’t think of a job I’d rather be doing now,” Fortuna said. “And you know, it’s been difficult. You get a little numb to this.”
Corporal Michael Hall, the wounded marine, is lucky to be alive. Doctors say the shrapnel severed an artery, and nearly paralyzed him.
But Hall may have saved a life, too. At the moment of the blast, he made a split decision to lunge at another marine who had not taken cover. He hardly knew the man he decided to tackle.
“If something had happened to him, even though I’d only known him a week, I’d have blamed myself,” Hall says.
But Hall is in some ways an unlikely hero. He joined the Marines two years ago, after he couldn’t find work as a math teacher. Now, at 24, he knows his life has changed. He’d like to get into politics, he says. He plans to run for office after serving a stateside tour as a Marine recruiter in Florida, where he’s buying a house with his wife Victoria.
Meanwhile, the marine Hall tackled was also taken to Landstuhl, where he was treated for shrapnel injuries to his leg.
He's already home in California. Hall's waiting.
NBC News' Ghazi Balkiz and Chloe Nouvelle contributed to this report.