I have not had anything too exciting recently, but I as looking back and realized I never posted anything about my time in Afghanistan. It's not like I was a "fobbit". For those non military people, a fobbit is someone who never goes out on mission. They basically never leave the FOB or forward operating base. At any rate, this particular story is dedicated to a friend of mine who is currently deployed to a less than desirable location and dealing with some of the worst trauma in the world. This one's for you. And now insert flash back visual affect. Yes, there are other ones besides "star wipe"!
It was late May or even early June in Paktika Province of Afghanistan. It was actually pretty nice day out and we were gearing up for a humanitarian aid drop to the local orphanage when our Ops officer comes outside and asks where our PA is, a convoy hit an IED and there is an unknown number of casualties at this point. I tell him I'm not sure, but I am going. He says he would rather have the PA go as well. No offense to my friend the PA, but this is what I do. That was stated in a much more aggressive and verbose manner, but he wasn't relenting. Either way, I was going on this call. Especially since I was already completely geared up. So I double timed it over to the waiting convoy for a ride to the scene. I pass the PA and give him the heads up that we will be leaving in 10 mikes.
As we close the doors to our Cougars and do a last radio and weapons check we get some traffic over the radio stating that we currently will be having approx. 8 patients in various levels of distress and they will be rendezvousing with us at a predetermined location.
The ride out to the rendezvous point was bumpy to say the least. The funny thing is that in the several months I have spent over there, I have only been a passenger in one of these armored beasts two or three times. Apparently I wasn't missing a whole lot. Well, paved roads are a bit of a luxury over there and once we left the city, it was all dirt and country roads.
Upon our arrival to the rally point, a perimeter was set up and the patients are brought into the center for care. Most of them are walking wounded. All of the wounded were Afghan National Army, or ANA. That makes my job much easier. However there were two that required a bit more attention. The first one, was possible closed head injury with epistaxis and altered mental status. One of the Navy corpsman assigned with the unit took care of that soldier. The patient I end up taking care of was also an ANA soldier. He was the TC or truck commander for an armored vehicle that had hit an IED. This poor gentleman's hips and lower extremities were covered in blood. Thankfully one of the ANA medics did a very good job of bandaging and even started an 18g IV on the guy. However, he was not out of the woods yet. Unfortunately over my many moons in that country I have had to undo a lot of bandaging that the ANA did to see exactly what I was dealing with and medivacing out. We quickly undid the bandages and got a quick look to find a tourniquet and an open tib/fib fracture. I have someone replace the bandages and spike an IV bag of NACL. I grab a quick set of vital signs and wouldn't you know it, the guy is a bit shocky. Who would have thought. He was tachcardic, hypotensive, and screaming in pain. Don't worry, brother. We will take good care of you and help you with you your pain. This is then spit back out through an interpreter.
Now one thing that was not done prior to our arrival was a complete head to toe assessment. Mainly just an upper body and obvious injury assessment. So our pt's other leg is dowsed with blood so we cut off the clothing to find that his other leg also has an open tib/fib fracture which is bleeding profusely. Now I know in the US tourniquet use is almost taboo, however in combat situations they are the first line of treatment. This is because they are fast, effective, and recent data shows that they can be on for up to 6 hours before any permanent damage is done. Any way, I digress...
This ANA soldier gets another tourniquet and bandage/splint job and a 16g IV with a 500 cc bolus of NACL right away. Supplies are limited and carrying liter bags of NACL is a bit much. The fluid challenge didn't do a whole lot for his vitals, so we hang a bag of Hextend. It is a wonderful plasma volume expander that helps treat hypotension second to exsanguinating injury very quickly. Blood is always the preferred resuscitative fluid, but it's very impractical in the field. However, after a 500 bolus he pinks up and his vitals are now with in a range I can treat his pain. This patient is what is referred to as an "urgent surgical" pt and requires immediate treatment at the receiving facility. Due to our location and current operational presence, the closest trauma center is Bagram. So we are waiting for "Dust off" to arrive on scene to transport our two critical patients.
In the distance we can hear the rotor blades cutting through the air as our air ambulances approach and circle the scene for a safe landing zone. I give my patient a quick reassessment and some more pain meds. I also document what was done on the official war zone medical form, 2 inch tape. I place a 8 inch piece of tape across his chest and write what was done, what time the tourniquets were placed, what injuries were found, and what meds were given.
As the flight team lands and clears us to approach we carry our pts over and give a very quick report to the flight medics. They probably didn't hear a word that was said between the rotor wash and their helmets. However, they get the patients loaded and take off for the worlds busiest trauma center, in Bagram.
As the dust clears, and our hear returns, there is an eerie quiet that falls over the scene. It's amazing to think that with all that chaos of radio traffic, rotor wash, people shouting for extra hands to help, and the screams of the patients, that it was all over in 25 minutes. That was from the time we got on scene to the time the patients were in the air. That is one way to start the day. That is something coffee can never do.
A few days later, I hear that our pt not only survived the trip, but is also complaining about the food at the hospital. Sounds like he is going to be just fine. The say with some effort on his part, he will also be able to walk again. It's nice to be able to be apart of something positive in such a chaotic and dangerous situation.
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