HABBANIYAH, Iraq, July 23 — Hospitalman 3rd Class Jeffrey Ramirez is starting an IV on a wounded Marine, scrambling to coordinate lab work and X-rays while trying to reflect on his almost six years as a corpsman—the Navy equivalent (who also accompanies Marines) of an Army medic. Much has changed in the scope of battle across Iraq since his first deployment straight out of Field Medical Service School, in the lead-up to the American invasion in 2003, affecting how patients get to him and how he treats them.

Back then, Ramirez remembers, most of the American military casualties came from bullets, as he and his Marine battalion “got shot at a lot daily” while patrolling Baghdad. Today, as he and 100 medical and administrative staff stabilize combat casualties at the TQ Surgical unit inside massive Al Taqaddum Air Base, it’s blast injuries coming through the hospital doors—the results of RPGs and IEDs.

And while TQ Surgical sees many fewer casualties than its previous high of 10 to 20 a day, now that Marines have tried to pacify this dangerous province, there remains the tense sense of being unprepared. Hospitalman 3rd Class William Harris Smith, for example, who has been a corpsman for three years, was excited about deploying here to TQ. He knew the basics of emergency care, but had little experience treating anything as advanced as gunshot wounds and amputations. Here, he says, still admitting shock at some of the injuries that come in from the desert, “You get to give more care to patients and see them through their hardest times.” —Leslie Sabbagh