They started pouring in late last week, at more than double the usual daily rate. By Sunday afternoon, the US military hospital in Landstuhl reported that it had treated 419 US service members since the siege of Fallujah began Nov. 8.
Most of the new patients were involved in the Fallujah operation, hospital officials said. Just over half of those admitted were wounded in combat.
The hospital in Landstuhl, the first destination for most troops wounded in Iraq, has added beds, expanded its intensive care unit, brought in extra nurses and doubled up doctors on shifts to cope with the crush.
But there is no sense of panic or even unusual strain on the part of the hospital's staff. After 20 months of treating the wounded from Iraq, they have become used to these sudden spikes in casualties.
"You learn how to do things better, and the less efficient things fall by the wayside," Colonel Todd Hess, deputy commander of clinical services at Landstuhl Regional Medical Center, said at a briefing on Sunday.
The hospital normally serves US military personnel and their families who are stationed in Europe. In the past week, however, it transformed itself into a combat hospital in the incongruously tranquil forests of southwestern Germany.
The commander of the hospital, Colonel Rhonda Cornum, said routine medical care had been deferred "until this surge of activity is over." In some cases, it has referred patients to local German hospitals.
Cornum said the wounded soldiers, who are shuttled to the hospital from the nearby Ramstein Air Base at a rate of 70 a day, were arriving with a fairly typical array of combat injuries.
"There's gunshot wounds, there's blast wounds, there's burns," said Cornum, who was seriously wounded in 1991, when a helicopter she was riding in was shot down during the 1991 Gulf War.
As is customary at the hospital, officials offered few specifics about the wounds of the soldiers, or how they were sustained.
But they did note that bullet wounds were no more prevalent than in previous clashes in Iraq, despite the fierce house-to-house combat between the Americans and Iraqi insurgents in Fallujah.
Of the 419 soldiers admitted since Nov. 8, almost half have already been transferred to hospitals in the US, but none of the soldiers has returned to Iraq. The hospital prides itself on sending slightly more than a quarter of its patients back into combat.
Cornum said it was too soon to draw any conclusions about the readiness of the hospitalized soldiers to fight again, because it typically takes two weeks for a patient to be healthy enough for combat duty.
Major Kendra Whyatt, the chief nurse, said the soldiers she spoke with were eager to return to Iraq.
"Their ultimate goal is to get back to Fallujah and fight with their brothers and sisters at arms," she said.
A year ago, when the crash of a Chinook helicopter in Iraq brought a sudden influx of wounded soldiers, Cornum expressed frustration that doctors and nurses were working 60-hour weeks. Now, she says, the staff has adjusted.
"We learned that people want to help, and you should let them," she said.
For the hospital, this has been the busiest stretch since the last assault on Fallujah, in April.
But the total number of wounded is higher this time, Cornum said, because the operation has lasted longer.
With US commanders in Fallujah saying their forces have occupied the entire city, the hospital here may soon get a respite. But Cornum said she was not expecting a sudden drop in patients.