July 28, 2021

In 2008, an American military contractor working in the Iraqi city of Fallujah came to a trauma unit operated by U.S. Marines complaining of headaches. A few days earlier, the vehicle the contractor was traveling in had hit a bump, knocking his head against the roof. He was seen by Luis Becerra, MD, a neurologist and U.S. Naval Officer with the U.S. Marines deployed during the Iraq War troop surge. The patient appeared normal during his exam and had no other outward symptoms, but Becerra decided to observe him for 24 hours, during which time the man’s condition declined. Becerra believed he was suffering from a potentially lethal brain bleed.

In prior deployments, the doctor would have had to rely solely on his observation of clinical symptoms, such as slurred speech and disorientation, to determine if a patient should be transported to one of the two medical centers in Iraq equipped with a computed tomography (CT or CAT) scan machine that could confirm a head injury. The stakes are high: An expensive helicopter evacuation for a patient who turns out healthy is a waste of precious resources; conversely, waiting too long to treat a head injury could be fatal. On that particular day, a dangerous sandstorm raging across the region also weighed on his decision...

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