Angels of the battlefield; War-zone nurses put their skills on the front line.

Byline: Andi Esposito

Severely injured with a tunneling wound through his liver, the Marine lay sedated, clinging to life, in the intensive care unit at the 399th Combat Support Hospital in Al Asad, Iraq, under the care of U.S. Army Reserve Lt. Melinda A. Nekervis of Sterling.

"He ended up getting well over 100 different blood products," said Lt. Nekervis, a soft-spoken Army ICU and flight nurse who returned in October from Mosul and Al Asad, Iraq. When everything but whole blood was exhausted, Lt. Nekervis asked if the Marines keeping vigil would donate their own.

"They were more than willing to do that," she said. "We transfused the buddies' blood into the patient. It was quite a moving experience. We were very lucky not to lose him. He was pretty sick. They had to do surgery right at the bedside, and he survived."

Stabilized, the Marine was later sent to Germany aboard an Air Force medical evacuation flight.

"I know that the doctors, from the extent of his injuries, didn't know if he would make it and what his deficits would be," said Lt. Nekervis, 32, who in civilian life is a registered nurse working in intensive care at UMass Memorial Medical Center - University Campus.

"I had him for four long days," she said. "I will never forget him, but he will never remember me."

Military nurses in Iraq and Afghanistan are a critical link in a chain of medical care that has enabled more soldiers to survive injury than ever before in the nation's history of warfare. In World War II, about 30 percent of soldiers died from wounds, a rate that fell to 24 percent in the Vietnam War. Since the start of combat seven years ago in Afghanistan, and since 2003 in Iraq, more than 32,000 service members have been wounded in action. Statistics recently released by the Department of Defense show that 4,579 have been killed in action or died under non-hostile conditions during Operation Iraqi Freedom and Operation Enduring Freedom.

But the survivability rate - the portion of people dying from wounds on these fronts - has fallen to about 10 percent.

"We are doing such a good job saving soldiers that there is a much higher rate of survival," said Col. Andrea J. Wallen, chairperson of the Department of Nursing at Worcester State College and chief nurse with the 804th Medical Brigade at Devens, which oversees the 399th and 12 other medical units.

Nurses and military medical experts say the survival rate is higher because soldiers wear more and better equipment, and because medical help has been pushed closer to the battlefront and dispersed into smaller teams reaching more locations. More people are being trained in lifesaving procedures, specifically in response to trauma; surgery is done earlier; and better communication has allowed medical equipment and supplies to be quickly sent where needed.

But most important is the speed at which the wounded are attended.

People are moved in record time by helicopters, aircraft and specially fitted flying hospitals - in C-17s and KC-135s - to higher-level or more specialized care in Germany and the United States, including Brooke Army Medical Center in San Antonio, known for its burn center.

"The goal was to get the critically injured to Landstuhl (Regional Medical Center) in Germany within 72 hours," said Lt. Nekervis, who also logged 50 hours of retrieving and nursing the wounded aboard a Blackhawk helicopter medevac air ambulance and earned a Bronze Star Medal for her service.

Much as Civil War soldiers called Oxford's Clara Barton, founder of the American Red Cross, "angel of the battlefield" for care she gave the injured in makeshift hospitals close to the battlefront, military nurses, often working under fire, help make the difference between life and death. Most are in the National Guard or Reserve on deployment from hospital and health care jobs. These weapons-carrying nurses, wearing Kevlar body armor, helmets and dressed in desert fatigues, are combat-ready professionals who, faced with the terrible consequences to flesh and bone of roadside bombs, guns and rockets, save lives under challenging conditions and at risk to their own safety.

Many have been deployed several times; most would go again in a moment.

"Battlefield nursing is about service, and if you can serve your country, make a difference and be a powerful force on the battlefield helping people, that is life-changing," said Col. Bruce A. Schoneboom, a nurse anesthetist and acting dean of the Graduate School of Nursing of the Uniformed Services University of the Health Sciences, Bethesda, Md. The school specializes in military and public health medicine and trains people for battlefield medicine in Iraq and Afghanistan.

Within days of her arrival as chief wardmaster for the 399th's Combat Support Hospital in Mosul, Iraq, U.S. Army Reserve Master Sgt. Kimberly L. Luce, 42, of Shrewsbury, a licensed practical nurse, said the 36-bed hospital was hit by mortars. She remembers the sounds of war - alarms, the "earth-moving" rumble of U.S. Stryker armored vehicles on patrol outside the hospital walls and the 60 mm rocket she didn't hear on the way to chow.

"Thank God it hit a tree. There were six of us on the road that day," said Master Sgt. Luce.

But more than sound, the scenes that arrived with the day's casualties are stuck in her mind.

"The challenge for me, being a nurse, is to get over the shock of what you see. You don't have war every day," said Master Sgt. Luce, who in civilian life works for Verizon with customers who have disabilities. "It doesn't change how you nurse or the quality of the care you provide, but it is shocking to see a human being so severely injured, and whether you can save his life. What you feel for that human being will affect you in one way or another."

Responsible for 125 enlisted service members, including medics, LPNs, operating room, X-ray and lab technicians, Master Sgt. Luce worked muscle and mind. Among chores, she moved concrete T walls that protected against bomb blasts, laid sidewalks and constantly assessed the mental health of her troops.

She speaks in blunt, precise and descriptive words about her experiences.

"It was very stressful in Mosul, especially for younger troops. They had never seen a body dead or with limbs missing. They had never been exposed to it. Some of these people are landscapers, mechanics, full-time students. They were being exposed to the remnants of war."

Master Sgt. Luce remembers the Marine in Lt. Nekervis' care as the most critical and complicated of cases handled at Al Asad, where she also served.

"Mindy did remarkable things for him. He ended up surviving. He was at death's door," she said.

"Going to Iraq was scary, overwhelming and exciting. But you learn to adjust and do your job. It was real. I can say I went to war. Now I truly feel like a veteran. I served overseas in a combat zone and was fired upon. And I would do it again in a heartbeat."

If one end of the medical care spectrum begins on the battlefield, the other arrives by air.

U.S. Air Force Reserve Capt. Susan E. Hodges, 32, of Paxton, spent six months as a flight nurse on medical evacuation flights carrying the ill and most severely wounded from Balad Air Field in Iraq and Kandahar, Afghanistan, to Ramstein Air Base in Germany, where she was stationed.

Before departure, the seven-member flight teams would be told of the injuries they could expect and equipment they would need.

"But in the eight hours it takes to fly down, anything can happen," said Capt. Hodges, a registered nurse. Casualties may have been evacuated on another flight; medical conditions change. "So you improvise fast. You have to; you will sink if you don't," she said.

Adaptation and improvisation - nursing skills also considered critical by Lt. Nekervis and Master Sgt. Luce - serve Capt. Hodges well in civilian life as an operating room nurse at St. Vincent Hospital in Worcester. "Being adaptable to the changing situation in surgery is the biggest skill I have pulled from the Air Force," she said.

Carrying cargo from Germany, the C-17 and KC-135 planes had to be emptied and transformed into flying hospitals within hours of their arrival, with patient litters secured and defibrillators, oxygen, electrical lines and other medical equipment and supplies set up.

Capt. Hodges most frequently handled the effects of trauma from mortars and IEDs, and illness. Some were not physically injured, she said, "but their minds, the things they had seen. How do you turn off that feeling? They may not be that hurt, but they've got a lot more going on than a broken arm."

Like family pictures on a mantelpiece, the memory of certain patients stays with her.

"I had 10 in my head that I will think about for the rest of my life, and I will never know how they are doing," she said. "You wonder and hope that they made it through and are healthy. I hope to God I don't forget about them. I don't want to."

Contact Andi Esposito by e-mail at [e-mail].

ART: PHOTOS; MAP; CHART

CUTLINE: (1) Above, U.S. Army Reserve Lt. Melinda A. Nekervis, of Sterling, working in the intensive care unit of the 399th Combat Support Hospital in Al Asad, Iraq, prepares a Marine for airlift to Germany. (2) At right, U.S. Army Reserve Master Sgt. Kimberly L. Luce, LPN, of Shrewsbury, comforts Naba, an injured girl, in Al Asad, Iraq. (3) Below, U.S. Air Force Reserve Capt. Susan E. Hodges, of Paxton, in the operating room at St. Vincent Hospital in Worcester, served as a flight nurse. (4) U.S. Army Reserve Lt. Melinda A. Nekervis, left, is shown with Col. Andrea J. Wallen, chairperson of the Department of Nursing at Worcester State College and chief nurse with the 804th Medical Brigade at Devens, which oversees the 399th Combat Support Hospital and 12 other medical units. They are in the college's physical assessment lab, which is used by nursing students. (5) U.S. Army Reserve Master Sgt. Kimberly L. Luce of Shrewsbury comforts an injured boy in Al Asad, Iraq. She served as chief wardmaster for the 399th Combat Support Hospital in Mosul and Al Asad. (6) U.S. Air Force Reserve Capt. Susan E. Hodges, of Paxton, is shown relaxing against some sandbags during her recent tour of duty. (MAP) IRAQ (CHART) Battlefield nursing's ties to Worcester County 

PHOTOG: (1) Photo courtesy of MELINDA A. NEKERVIS (2, 5) Photo courtesy of KIMBERLY L. LUCE (3) T&G Staff/DAN GOULD (4) T&G Staff/PAUL KAPTEYN (6) Photo courtesy of SUSAN E. HODGES