[ The Real McCoy Online Home ]                                                                                                                         June 27, 2008

Combat support hospitals make 
difference for Soldiers

Spc. Jon Soles, The Real McCoy Contributor

      All Soldiers know their weapon is their lifeline in a war zone. But it's a combat support hospital (CSH) that can make the difference between life and death when the enemy's weapons find a Soldier, whether it's small-arms fire or improvised explosive devices (IEDs).

Photo: Personnel from the Army, Navy and Marines run a triage during Global Medic training. (Photo by Bill Kern)
Personnel from the Army, Navy and Marines run a triage during Global Medic training. (Photo by Bill Kern)

      The 322nd Combat Support Hospital helped military medical personnel train to save lives using a wide variety of simulated casualties during Global Medic 2008, which was held in June at Fort McCoy.

      In a combat zone, ambulances or helicopters deliver wounded warriors from the front lines to the CSH. Patients are hauled in the back of an ambulance to the triage area, which is a tent set up outside the CSH.

      Two Soldier patients coming in the late afternoon were rushed into the emergency room atop wheeled stretchers. Col. Richard Baldwin, the physician in charge, is waiting in the emergency room of the CSH, which is a complex of tents.

      One of the "Soldiers" has a serious wound to his upper right arm and an abdominal wound. The victims are mannequins, prepared by moulage artists who have expertly simulated wounds with red paint and gel. But the Soldiers treating the mannequins' wounds talked to the mannequins as if they are alive.

      "He likely has an open fracture," says 1st Lt. Doug Olson, a nurse with the 322nd Medical Company (MEDCOM), from Southfield, Mich. "If he has an open fracture, he has to go to the ER (Emergency Room)."

      Olson said in addition to causing blood loss, an open fracture is a serious risk for life-threatening infection and must be treated quickly. The wounds were probably caused by a gunshot.

      The two most important lifesaving actions in the emergency room are clearing the airway and stopping catastrophic bleeding, said 1st Lt. Jannie Morgan, an ER nurse with the 322nd MEDCOM. Once a patient is in the ER, nurses and a doctor evaluate them to decide if the patient will go to the operating room or intensive care.

      "We have to figure out what's wrong and we have to stabilize them," Morgan said. "We start treating a person from head to toe."

"We have to figure out what's wrong and we have to stabilize them. We start treating a person from head to toe."

1st Lt. Jannie Morgan,
Emergency Room Nurse
322nd MEDCOM

      The second patient is the victim of an IED. His lower right leg is covered in blood, with a tourniquet wrapped just under the knee. The patient's tibia had been shattered. "Can you hear me?" a  nurse asks.

      Baldwin examines the Soldier and issues orders. The condition of the Soldier's leg and the tourniquet draw his attention.

      "Worry about the leg," Bald-win said. "I need an X-ray of the patient, I need two units of blood and get him some oxygen." He orders the nurses to get the Soldier ready for the operating room and a probable amputation of what is left of the Soldier's leg.

      Capt. David Miller, a physician's assistant with the 7203rd Medical Detachment from Hobart, Ind., said the patient flow went well. The Medical Communications for Combat Casualty Care system is designed to more accurately and efficiently track patient movement.

      "Being fluent with the computer software is essential," Miller said.

      In the operating room and pre-operating room, a team of surgeons and nurses stayed  busy with the flow of patients. Three are up for surgery, including a new patient -- a Soldier with a gunshot wound to his neck.

      Col. Margaret Eiden, a registered nurse anesthetist with the 6250th U.S. Army Hospital from Fort Lewis, Wash., said the Soldier, a gunshot victim, is conscious and alert.

      She said the bullet apparently missed his carotid artery. If it hadn't, he would have probably bled to death before he even arrived at the CSH, and he also can't be conscious during the surgery to repair his neck wound, which also will reveal the extent of the injury. The nurse anesthetist must administer a combination of drugs to temporarily paralyze the patient and render him unconscious for surgery.

      Radiology specialist Ursula Hernandez, with the 322nd, administers X-rays with a portable, highly-sophisticated X-ray machine on wheels. The X-rays showed whether the Soldier's spine was hit by a bullet or not. The blood loss caused a dangerous combination for the patient -- an increase in heart rate and a drop in blood pressure.

      "They will repair whatever they can. There are a lot of things in the neck. It's a long case," Eiden said.

      Afterward, the colonel steps back into the pre-operating room for a few minutes to reflect on the patient. It's only after treating the patient that she said she had time to think about what had happened. Treating a patient with a traumatic wound leaves no time for emotion -- only lifesaving action. "I didn't think, I just did what I just did," Eiden said.

      It brings her back to memories of Landstuhl Regional Medical Center in Germany, where she has deployed to twice.

      "I never thought it would bother me," she said. "I remember seeing them come to Landstuhl. This brought back more memories than I thought it would."

      After having seen the war firsthand, and being wounded in Iraq and Afghanistan, Eiden said she has a different perspective on Global Medic, "especially for the younger people who have not seen war yet, because it has to be a lot faster and a lot more intense."

      The next patient is a live casualty, played by Navy Chief Petty Officer Darren Schauf of Operational Support Health Unit Great Lakes. He's been gravely wounded by an IED. The blast has pierced his chest and he is suspected to have massive internal bleeding.

      "It's just up to the surgeon to find out what's in his belly. In the meantime, my job is to keep him comfortable and his vital signs stable," said Capt. Steven Skeltis of the 322nd MEDCOM.

      Soldiers do not stay in the CSH long -- not longer than 72 hours. After treatment, they are either returned to the front lines or transported by a medical evacuation (MEDEVAC) flight to the rear echelon.

      But not every patient in the CSH is the victim of an enemy attack.

      The planners of Global Medic thought of many scenarios for the exercise. In the Intensive Care Unit (ICU) room is a female Soldier who was not attacked by the enemy, but by her own fellow Soldiers. She was raped at a latrine before dawn and now is being treated for bruises and emotional trauma, according to 1st Lt. Shannon Goffardo, also with the 322nd.

      "The combat stress team is seeing her and she is to be observed for the next 24 hours," Goffardo said. "Her orders were not to go to the latrine by herself and she did."

      Another victim in the hospital is a dog, used by an explosive ordnance disposal team to detect IEDs. A stuffed animal dog on a cot in the ICU is "Sgt. Lew-Lew," who was apparently hit by a car.

      "We think he was hit by a car, maybe he was sniffing somewhere and got away from his handler," said 2nd Lt. Jack Garcia.

      The dog's front, right leg is in a splint, and he has bandages around his waist. The animal has a probable broken paw and spinal injuries, but seems to be in good spirits.

      Garcia said, "Right now, he's barking and wagging his tail."

      The dog will be evacuated to the rear, just like human patients, on a MEDEVAC flight.

(Soles is a member of the 210th Mobile Public Affairs Detachment.)


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