In the small hours of every Thursday, while most of North Carolina still sleeps, a group of doctors at Womack Army Medical Center in Fayetteville begin medical rounds that will take them to the other side of the world.

With a few clicks and webcam switches, the doctors are plugged into Bagram Air Field in Western Afghanistan, where dozens of the most critically injured U.S. soldiers arrive daily, according to The Washington Post.

The doctors are joined by medical colleagues — fellow doctors, nurses and medics — at other combat hospitals in Afghanistan, military hospitals in Europe, and other hospitals across the United States. They pore over medical charts that catalogue the brutality of war: traumatic brain injuries, limbs ripped apart by Improvised Explosive Devices (IEDs), flesh burned to the bone.

This is not Moses Cone’s emergency room on a Saturday night. At Bagram, injured soldiers often suffer from a dozen injuries or more. Womack doctors and the rest of the medical team diagnose soldiers before treating and transporting them from the battlefield, prior to sending them to various hospitals across Europe or the United States.

Medicine during wartime shed its M*A*S*H image long ago. Critically injured soldiers are no longer rushed from the battlefield to a combat hospital, where one or two doctors try to fix what they can. The Washington Post reports that these days, injured soldiers are examined in person or by far-removed doctors in, say, North Carolina, before being sent to specialized hospitals.

Years of battlefield experience — in Iraq and now Afghanistan — have shown that progressive, step-by-step surgery has reduced the battlefield mortality rate. According to The Washington Post, the system is based on an approach called “damage control surgery,” borrowed from civilian medicine.

“Twenty years ago, if you left the operating room without fixing everything, you weren’t a good surgeon,” Rodd Benfield, a 39-year-old Navy surgeon, told the Washington Post. “We don’t believe that anymore.”  

This is not cookie-cutter medicine. The soldiers receive plenty of attention from doctors and nurses. But for a majority of them, the weekly teleconferences are short-lived before they are flown out of Afghanistan.

Wounds are tended to in stages, according to The Washington Post. Surgery is limited so as not to stress an already-traumatized body. Most soldiers with critical injuries get two operations in two hospitals in the first 24 hours.

The teleconference is part of the military’s Joint Theater Trauma System (JTTS), which organizes trauma care in both Iraq and Afghanistan, reports The Washington Post.

Established in March 2005, the JTTS comprises a joint team of medical professionals whose many missions include improving patient tracking, communications, and development of a theater trauma registry to assess the care of soldiers and establish a direct cause and effect of the outcome of procedures performed along the way.

Before the system was created, soldiers were routinely sent to the wrong locations — such as landing at a forward surgical team instead of going to a combat support hospital. Staffing and surgical placement were concerns. Medical records were not delivered reliably with the casualty.

At a recent teleconference, surgeon Jay Johannigman remarked about the efficiency of the new system.

“None of these kids would have survived in the civilian world,” he said according to The Washington Post. “And we never would have saved them five years ago.”