And Duckworth, who was plucked from her crippled Blackhawk helicopter after a rocket-propelled grenade tore through the cockpit as she flew across Iraq, wouldn't understand until the haze of medication lifted that she was one of the lucky ones.

Maj. Ladda "Tammy" Duckworth and others will testify before the Senate Veterans Affairs Committee today about military personnel who have been injured in the war and others without apparent injuries who may later seek health services from the Department of Veterans Affairs.

Sen. Larry Craig, R-Idaho, the committee chairman, said about one in four service members died from their wounds in Korea, Vietnam and the 1991 Gulf War, but today the rate of fatal battlefield injuries has been cut in half.

"But many are coming back with very severe disabilities, including missing limbs," Craig said. "I want to ensure that for Tammy and others, there is a seamless transition from military service to civilian life."

Duckworth is the daughter of Frank Duckworth, who died this year, and Lami Duckworth of Pearl City.

"Major Duckworth's firsthand experience in Iraq and her evacuation to Walter Reed will help us as we grapple with how best to ensure that our service members ... are provided with the care they need," said Hawai'i Sen. Daniel K. Akaka, the top Democrat on the committee.

Duckworth said she gets through her vigorous physical therapy by focusing on her dream to fly again, either for the military or as a private pilot.

If her injuries had happened during World War II, Vietnam or even the Gulf War, doctors believe Duckworth, who lost nearly half of her blood in the assault, would have died. But a revamped emergency medical system rushed her to battlefield surgeons, saving her life.

Why more survive

Maj. Tammy Duckworth, a National Guard helicopter pilot — and McKinley High and University of Hawai'i graduate — rehabilitates at Walter Reed Army Medical Center. Michael Chow • Arizona Republic

Military leaders point to three changes behind a higher survival rate: They gave troops better body armor, put surgeons in field hospitals closer to combat and created an air evacuation plan to get the wounded to surgical care within an hour.

Another factor is advances in first aid carried by medics traveling with the troops. One such advance is QuikClot, a mineral powder that adheres to exposed tissue and helps blood clot. Bleeding is a primary reason so many wounded die.

The goals are to keep the patient alive and with as many body parts as possible, and to whisk him or her out of Iraq to the Landstuhl Regional Medical Center in Germany, the largest U.S. hospital in Europe.

Helping get them to Landstuhl is the newest, and what some call the most important, leg of the medical journey: a ride on a Critical Care Air Transport helicopter. These "flying ICUs" are the workstations for doctors and nurses who tend to patients during the eight-hour flight.

The physical therapy room at Walter Reed Army Medical Center in Washington, D.C., is full of soldiers who lost limbs in Iraq. Advances in care have cut battlefield fatalities dramatically since the Vietnam War. Michael Chow • Arizona Republic

The 'golden hour'

Nearly 6,000 wounded troops have gone in and out of Landstuhl since the start of Operation Iraqi Freedom. But more than 1,500 troops have died, most before getting to Landstuhl. In Vietnam, most of the 58,000 deaths happened before the wounded could ever reach a surgeon, a wait of several hours or more. During the Gulf War, field hospitals were closer to the action, but it still could take several hours to get the wounded there.

For the war in Iraq, military officials knew they would need more mobile medical teams that were closer to combat and could get to the wounded by air or land within the "golden hour," that daunting 60-minute window before a battered body begins to shut down.

Suicide car bombs, improvised explosive devices and RPGs have ripped into bodies with such trauma that immediate treatment is necessary to prevent shock or death from loss of blood.

The RPG that struck Duckworth shredded one leg, crushed the other and badly damaged her right forearm, breaking it in three places. She had seen a fireball hit below her feet and thought the helicopter engine had been taken out. Communications inside the aircraft were gone, so Duckworth couldn't speak to the pilot, Chief Warrant Officer Dan Milberg, who was observing her flying that day. They both tried to land the chopper as Duckworth was fading in and out. The last thing she saw before she blacked out and fell forward was grass coming through the floor bubble. Milberg had managed to set the chopper down in a date grove.

It was then that he turned to Duckworth and could see her massive injuries. He thought she was dead.

Flying behind them, another pilot had already radioed for a medical evacuation helicopter, and troops on the ground rushed to do what they could, giving "Buddy Care," the basic first-aid training all troops are taught before they're deployed.

Stop the bleeding

Maj. Tammy Duckworth exercises her damaged right arm. Duckworth, 36, lost both of her legs when her helicopter was attacked in Iraq. Michael Chow • Arizona Republic

Duckworth's femoral artery was severed when her right leg was torn off. She could bleed out within five minutes. The wound was so jagged and so near her hip that getting a tourniquet on was nearly impossible. Medics couldn't stop the blood flow, but they pressed on the wound and slowed it down.

A helicopter flew Duckworth to Baghdad where surgeons amputated her right leg a few inches below her hip bone and cut off her left leg just below the knee. They reset the bones in her arm and stitched the cuts.

She was carried on a stretcher to a Critical Care Air Transport helicopter, and Duckworth was bound for the 350-bed Landstuhl hospital. She was in and out within hours, finally arriving at 10 p.m. Nov. 14 at Walter Reed. Not even 60 hours had passed since the RPG exploded into her legs.

During Vietnam, if the soldier had lived, it could have taken a month to 45 days to get to a stateside military hospital.

When Duckworth woke up that November day at Walter Reed, she was in pain. Her legs ached. Her husband, Capt. Bryan Bowlsbey, was at her side. He knew he had to break the news that what she was feeling was just phantom pain. So he told her what he had to say: Her right leg was gone, and there was nothing below her left knee.

He kept talking, and she quietly took it all in: that she wasn't the only one having to go through this and, like the other amputees in the ward, she would get better.

She didn't cry and didn't ask why it had happened to her. Instead, she said she wanted to get on with it and do whatever was necessary. She told her husband that she loved him but that, hey, after six days by her side, he really needed a shower.

He was relieved. Her can-do spirit and humor were still very much intact.

But it was hardly easygoing the next few weeks.

Duckworth's right arm was in jeopardy and needed repair. For stretches during November and December, she was having surgery every other day to improve the blood flow and to fight a stubborn infection.

After the surgeries

For Duckworth and other patients, it is a frustrating time, waiting for the body to heal enough so they can begin rehabilitation. There is little within the patient's control. Limbs swell. Shrapnel no one ever knew was there suddenly breaks through skin and must be removed. Patients have to decipher what doctors are telling them. Every day can mean visits by new teams of doctors. The Physical Medicine and Rehabilitation Service team. The Infectious Disease team.

Finally, the day comes when, barring the unforeseen, the surgeries are over and the OK is given for physical therapy. It's a chance for dormant muscles to awaken and the patients to regain a little control over their bodies, to see what works and what doesn't. It's time to rebuild.

On a cold morning in late January, bright light flooded the physical therapy room on the third floor of Walter Reed. Duckworth stretched her muscles on a padded table. She watched a soldier try the parallel bars as he tried out the two prostheses attached to his legs.

Most of the people in the physical therapy room have lost a limb. Since the war started, at least 283 people have lost one arm or leg. Duckworth is among the 34 to have lost all or part of two limbs. Four have lost three. If there is someone who has lost both arms and both legs, Chuck Scoville, who manages the Walter Reed amputee patient care program and tracks such statistics, hasn't heard.

Going vertical

Here, at Walter Reed and other surgical and rehab hospitals, progress is made by the slightest of measures.

The patients look forward to the day when someone will make casts of their limbs for prostheses. Before Duckworth can be fitted for her prostheses, she has to continue to work at being completely upright. After weeks in bed or in a wheelchair, a vertical position makes her light-headed.

Therapists move her onto a table and place straps across her body. They then levitate the table to a full standing position while her right leg rests on padding and her left inside a temporary prosthesis.

Duckworth's husband is there to cheer her on. "You aren't turning all white this time," Bowlsbey jokes.

Duckworth grins and nods.

She feels she is lucky in that, at 36, she had a lot of years to enjoy her two legs. The 20-year-olds she sees in the room who are barely beyond their high school football days got a much worse deal, she says.

She gets through the physical therapy by focusing on her dream to fly again.

And she thinks about that day when the RPG hit and how she could have died. She calls the pilot her hero as she talks about those last seconds before the helicopter set down.

During those particularly hard days in therapy, she clings to her memory that she, too, was trying to get the helicopter down.

It speaks to who she is and how she will tackle the challenges ahead.