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).
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
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
Lt. Jannie Morgan,
Emergency Room Nurse
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
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
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
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
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
But not every patient in the CSH is the victim of an enemy
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
"We think he was hit by a car, maybe he was sniffing
somewhere and got away from his handler," said 2nd Lt. Jack
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
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.)