Another Busy Saturday
By LTC Jerold B. Campbell, CRNA, AN, USAR
Chief, Department of Anesthesia
"Rocket City," Afghanistan
Saturdays are beginning to be routinely busy. Fridays are always quiet as, I am told, that is the local day of prayer. I am guessing that Saturdays are the bad guys' "make-up" days for the quiet Fridays. Or perhaps the Imams are inciting them during Friday's prayers. At any rate, Saturdays are always busy.
We had morning rounds at 0700 then showdown formation at 0730. Showdown formation is where you bring all your "sensitive" items for accountability. That includes your weapon, ammunition, gas mask, chemical suit and auto injectors. The injectors are the antidote you are supposed to inject yourself with if you are exposed to chemical agents. We then had a 100 percent accountability check of all the equipment in our department. Every piece of equipment had to be accounted for and documented. Each department chief signs a hand receipt when they take over which states you are responsible for all the equipment in your department and that you have verified that it exists. If you lose any equipment you have to pay for it. After almost four weeks I still had all of mine. Whew.
By this time it is mid-morning. So Major "Scott" (my other nurse anesthetist) and one of the general surgeons, Major "Matt," decided we would walk down to the local Afghan bazaar. We had not gotten 100 yards when we saw all the flight medics come running toward us heading down the street to the flight line. Not jogging. Running.
Two Blackhawk medical evacuation (medevac) "birds" spooled up very fast and were gone. An urgent medevac call had come in. Scratch the bazaar.
This time we beat the "big voice" to the punch and made it back to the ER before the call. "Attention on [base], attention on [base], dragon blue, dragon blue." The unit from New York that was staffing the hospital is officially on their way home after a year of very hard work. The unit from California that took over changed the call sign from "liberty" to "dragon." So we are now the "Dragon Medics" instead of the "Liberty Medics." So a "dragon blue" is now the call sign for three critically injured coming to the hospital.
We get to work making sure everything in the ER is ready to go. There are at least 25 doctors, medics, nurses, CRNAs, X-ray techs, lab techs, etc. All waiting for our patients to arrive. The adrenaline is pumping, you are going through your check lists, I'm quizzing my medics on their priorities and checking all the equipment to make sure it is functioning properly. We are primed. Locked and loaded. Just get them to us with a pulse and they will make it. We can do it. Not this time. Within 10 minutes we hear the call over the radio "cancel dragon blue, cancel dragon blue." This is the first time this has happened. We get word that there was an improvised explosive device (IED) blast and no one survived. The Blackhawks turned around before they even got there. We were stunned. No one knew what to do for a moment. We were frozen. The emotions are hard to describe. Our job is to save lives. Just give us a chance. Just give us a chance.
A short time later we get our chance. Within an hour the radio chirped "attention on [base], attention on [base], dragon white, dragon white." Two casualties. Here we go. Two American soldiers, we hear over the radio. Gunshot wounds. This time we will not be denied. I'm first call today, so I take the red bed and Scott takes the white. My guy arrives. Two gunshot wounds. Left arm and left leg. Tourniquets are on. He is conscious. He is in pain. I tell him my name is LTC Campbell and that I'm going to take care of him. What's your name son? He answers. Pause. My son's name. Not a nickname, but the full name, same as my son. Same age also. Stick to the routine. Don't get distracted. Oxygen, monitors, assess, breath sounds, eyes, ears, get our lines. 18 gauge IV, right arm. A large IV catheter in the right femoral vein. Fluids running. Blood to the lab. Make them naked. Roll them side to side. Look over every inch. Chest x-ray. Secondary assessment. Vital signs are okay. Now I can start giving him some pain medicine. We've got you son. Medical history, allergies, medications and illnesses. He asks if he is going to make it. "Yes," I tell him. "We are going to surgery, but you are going to make it."
The OR crew was fast and we had him asleep, prepped and draped in a matter of minutes. The bullet entered the back of my soldier's upper left thigh and exited the front near his knee, shattering his femur. The fracture was displaced but his pulses were good. It missed the femoral artery and sciatic nerve. The orthopedic surgeon, Colonel "Kimberly," applied an external fixator and realigned the femur. Bleeding was controlled and the wound irrigated and dressed. The femur bleeds a lot. One of our general surgeons, Major "Mark," worked on his left arm. The bullet passed through, just nicking the humerus. Bleeding was not excessive but the hole was impressive. There appeared to be no major arterial or nerve damage. The bleeding was controlled and the wound irrigated, dressed and splinted. During this time I had given two units of blood and two units of fresh frozen plasma (FFP), plus 2000cc of normal saline. Estimated blood loss: 1000cc. OR time was an hour. Awake and extubated with fentanyl and morphine on board, my guy was looking good in the ICU. A lucky young man. He was going to be fine. Evacuation to Bagram AFB and then on to Landstuhl, Germany.
Scott's patient was also very lucky. One AK 47 round passed through his left shoulder. As we were finishing up on my soldier, the OR crew was opening the supplies and getting the adjacent OR bed ready. Fortunately no major arteries or nerves were damaged and after washing out the wound and applying a dressing, they too were in the ICU. Both soldiers were side by side and awake. They were talking and giving encouragement to each other. The relief that they were okay resulted in excited bantering back and forth. The entire hospital staff also was relieved. We had done our job and had a good outcome.
We later learned what had happened. An American patrol had dismounted and were checking construction at a check point. As they were walking back to their vehicles, a pickup truck drove past and started firing. An Afghan soldier was killed and our two guys were wounded. They returned fire and were able to kill or capture all those in the truck. At least some of the bad guys had a bad day.
We ended the day with the ritual incoming rocket fire. Fortunately they landed wide and we had no injuries.
Just another Saturday at Rocket City.