"Will I be able to walk?" he mumbled to a doctor at his bedside.

Leonard was lying in a hospital bed far from the spot where a powerful bomb tore into the Bradley Fighting Vehicle he was driving on the southern outskirts of Baghdad the previous night.

Medics at a Baghdad base had amputated his mangled foot, then called for a helicopter to whisk him 55 miles north to Balad just after midnight, one of about 1,100 patients that the facility treats every month.

They took him to Ward 4 at the Air Force Theater Hospital, which the U.S. military calls the most sophisticated combat hospital ever built. Commanders say 96 percent of patients who reach it survive.

Doctors quickly operated to clean Leonard's wounds, one of about 375 surgeries performed in the hospital each month by a team of 45 doctors and 20 surgeons.

In a war where increasingly sophisticated and powerful bombs maim and kill dozens each week, the military has responded by constructing first-rate hospitals and deploying surgeons and advanced equipment farther into the battlefield than ever before. Doctors can now operate on serious wounds near conflict zones, including brain and eye surgery previously unheard of.

"Iraq is 50 yards outside this tent," said Col. Elisha Powell, an orthopedic surgeon who commands the Balad hospital, pointing to the perimeter fence. "We've never put highly skilled, sub-specialized surgeons this close to the battlefield."

The war sometimes comes even closer. The previously quiet city of Balad erupted in violence during the fall. Three suicide car bombers in the mainly Shiite Muslim town killed more than 100 people Sept. 29.

When the wounded arrive, doctors race about inside claustrophobic tents, occasionally simultaneously treating dozens of men - some in their teens and most in their early 20s. Their mission is stabilization. Most patients are evacuated in 12 to 36 hours for final treatment outside Iraq.

"We have to keep churning," Powell said.

Just 48 hours after landing in Balad, Leonard and about 30 other seriously wounded patients on stretchers were loaded onto a cargo plane for a flight to the Landstuhl Regional Medical Center in Germany. CDs with medical records accompanied them.

"A lot of the guys are really young. I'm trying to help them through that, both emotionally and physically," said Staff Sgt. Melissa Boos, an Air Force medical technician from Puyallup, Wash.

Boos treated the patients throughout the dark, droning flight to the Landstuhl hospital, which has treated 27,000 patients from the wars in Iraq and Afghanistan the past four years.

Just two days before, Leonard and seven other survivors had crawled from their smoking 33-ton Bradley after it was rocked by the explosion. He said thoughts raced to his 9-month-old daughter, who was born after he deployed. He wondered if he would get a chance to see her again after the moments he spent with her during a short leave from Iraq.

"Miracles really do happen here," said Powell, who oversees a staff of 350 at the combat hospital with its three operating rooms and 20 beds in an intensive care unit. "It's not about the tents, it's what we do inside the tents."

In addition to his amputated foot, Leonard suffered a deep shrapnel wound in his left leg and had shrapnel in his left eye.

"Our combat medic didn't have morphine. I was riding for nine kilometers in the back of a Bradley," said Leonard, a native of Roswell, N.M. "That was the worst pain of my life."

Nurses wouldn't allow Leonard, lying in a custom-designed tent, to eat or drink water before his surgery. Instead, he chewed on a clump of wet gauze and cautioned bystanders to step back as waves of nausea rolled through his body.

Huge bombs like the one that injured Leonard add to the list of challenges for doctors treating the casualties of war.

Two years ago soldiers riding in Bradleys felt untouchable. Now mammoth car and roadside bombs penetrate the armor, sending more casualties with torn limbs and embedded shrapnel to Balad. Such bombs accounted for 48 percent of U.S. combat deaths in November alone, according to the Brookings Institution.

But doctors are adapting to the changing combat. A weekly conference call between military physicians in Balad, Baghdad, Landstuhl and the United States address new injuries and treatment methods.

Medical specialists also try to get treatment advances to the battlefield, distributing new tourniquets to stop serious bleeds, considered the leading cause of preventable deaths in Iraq.

"Most surgeons will see and do more here in four months than they will in the rest of their career," Powell said. "A lot of advances in medicine can come out of wars."

The addition of specialized doctors has helped save dozens of lives.

Balad has two neurosurgeons for the serious head wounds that often result from roadside bombs, a critical new asset in the field for injured who previously would have died or suffered serious brain damage. CT scans can also be quickly taken and e-mailed ahead to doctors at Balad and in Germany who have not even met their patient yet.

"We can do immediate neurosurgical head trauma," Powell said. "If your brain is swelling from bleeding, you don't have a whole lot of time. You cannot wait to go to Germany."

Doctors also attribute higher survival rates to better body armor, but stress the importance of quick evacuations during the "Golden Hour," the critical time immediately after a wound that requires treatment at a trauma center.

In previous wars, wounded soldiers could not use satellite positioning systems to radio their exact location ahead to helicopters. Today, most wounded soldiers are delivered to medical care within an hour of their initial injury.

Speed is a valued trait at Balad. Doctors still talk of the 18-minute record for a soldier who was treated in the emergency room, received a CT scan and was ushered into the operating room.

"A lot of our patients are on the edge of life and death," Powell said. "We don't have the time to go through protocols."

For the 22-year-old Leonard, who was one month away from returning home to the United States with the 19th Cavalry Squadron, a long recovery awaited. Final "shaping" of his injured leg was left for prosthetic limb experts at the Walter Reed Army Medical Center in Washington.

"The main reason I need to get a new leg is to do some snow boarding," joked Leonard, who used a $200 check from the Army Emergency Relief Fund to buy himself clothes in Germany and a stuffed animal for his daughter.