Bagram Air Field Mass Casualty Simulation

This post is not for the faint of heart   

 The base photographer posted better pictures of the mass casualty exercise we did the other day and I though I would post some because it gives you a good idea of what our world is like here.  It is not nearly this crazy on a daily basis but it is what we are trained to do and on a smaller scale we see this type of thing a lot.  All of the actors went to our conference room to get their makeup done.  Most things are pretty realistic in their appearance.

The old severed arm gag, it'll get you every time!

Looks like a zombie apocalypse doesn't it.  Some patients actually walked themselves to the emergency room while others were transported by helicopter or ambulance or whatever vehicle was close. 

Once in the emergency room each patient was evaluated and the extent of their injuries assessed.

When indicated we would run them to the OR for emergency surgery.

Here I am, a man on a mission.

The trauma room is buzzing with activity and people everywhere.

As I mentioned in my earlier email, they did the thing up right, helicopters and all.

Some patients really got in to character.

Others, not so much.

A burnt airway is an anesthesia providers worst nightmare.  I had to get this guy 'intubated' quickly.

Doubling up in the OR.

In these types of situations you do what needs to be done to save lives.  Things like changing into scrubs and wearing masks sometimes have to take a back seat.

It is not abnormal to see shrapnel wounds just like this.

The guy with the carotid artery injury in the truck looks calm as a cucumber.

Helicopters can bring you lots of patients at once so it can get pretty hairy fast.

I just thought this was a cool picture.

Warrior's Way.  Injured soldiers come through here on the way into the hospital.  There is a huge flag on the ceiling so they can see it as they are laying on the stretcher.

Often as anesthesia providers we are standing in the background until there is a need for an airway expert.  Here I am trying to look busy and failing miserably.  

At the end of it all you have to keep track of who you saw and where they ended up so that you know how your resources are being used.  This was a very good simulation and a pretty good experience.

Christmas at Ground Zero

My Christmas experience in Bagram was amazing.  There was none of what you expect from a Christmas celebration in the states.  There were no elaborate decorations or feast of roast beast.  But we had much of the feelings that make the holidays so wonderful.  As an anesthesia department we drew names and got the person a small gift to remember their Afghanistan experience by.  We also went out and bought a white elephant type gift.  On Christmas night we got together as a department and ate food and drew numbers for the white elephant gifts and opened them in numerical order.  It was really fun.  We then exchanged gifts and there was a great feeling of comradery and mutual respect.

This is the cardboard Christmas tree we made during night shift to have some place to put the presents we got for each other.

My Facebook Christmas card.

This is the anesthesia crew in our tiny office.  It gets pretty warm in here with all the bodies.

Stacy with her white elephant belly-dancing costume.  This was highly sought after.

Teresa picked the scorpion preserved in carbonite that I bought for my white elephant.

The anesthesia team sporting their treasures.  I got a cool marble chess set and a genie lamp.

Me sporting my Christmas scarf from Jean and Marie Francoise.

  I had opened all of my presents when they came in the mail, despite the instructions to the contrary (sorry Mom) because I really wanted to experience Christmas for what it really was.  I think partly because I had prepared the talk on the life of Christ and partly because I am so close to where His birth took place (relatively speaking) I had a profound feeling of love for the Savior of the world sweep over me.  There was no room for homesickness or self pity.  I went outside at one point during the night and saw a huge bright star in the sky.  Tears filled my eyes as the spirit manifested to my heart that the King of Kings was born to save all men.  It didn’t matter that the only special thing they had for midnight chow was bananas because I had already been filled with the spirit of the season and like the Grinch had felt my heart swell within me so nothing else mattered.

I was able to Facetime with Cami and the kids and watch them open their presents.  Technology is a wonderful blessing.  

Connor rejoicing at receiving the new Michael Vey book from Grandma and Grandpa Rush

Makenna showing off her marvelous body pillow

McKay tearing into another present

Talking to my family back in Utah

My wonderful in-laws were at my house which was also an incredible comfort to me and to my family.  My mother-in-law made us a quilt hanging that read:

“Oh beautiful for heroes proved in liberating strife.  Who more than self their country loved and mercy more than life.”

The picture speaks for itself

These words from ‘America the Beautiful’ have never hit me like they did then.  I couldn’t talk.  I couldn’t adequately express the feelings that I felt then and continue to feel now when I think about it.  I do not consider myself anything like a hero but this experience has served to solidify my great love for this land of liberty that is our home.  There is a group that makes quilts for the Wounded Warriors, they are called patriot quilts.  Those young boys that come in to the hospital battle worn and weary with their bodies bruised and broken wrapped in these quilts is what I think of when I imagine heroes. 

This is one of the patriot quilts that somehow got put as the cover to our linen cart.  I am trying to talk my conscience into letting me confiscate it.

        

In keeping with local tradition, the extremists in the area launched a volley of six rockets at us Christmas night.  Almost to prove that the Savior came to bring Peace on Earth all six rockets went completely over the entire base and blew up outside the wire.  No one was seriously injured (one soldier saw the rockets and while running tripped and hit his head on one of the concrete T-walls, just a bump on the head).

"Don we now our protective apparel"  Major Stacy Carr, a friend from San Antonio, in our IBA after the Christmas rocket attack.

Brian Landreth keeping the festive mood by sporting some holiday eye protection.

This is me in the trauma room waiting for a Christmas patient.  The guy looking at me is Rafael Cota one of my friends from Commissioned Officer Training

Since Christmas we are back to business as usual.  Yesterday morning there was a 5K ‘Ho Ho’ run on base organized by the USO.  Some of the OR crew talked me into doing it with them even though it was about 25 degrees.  We were all given Santa hats to wear while we ran.  They explained at the beginning of the race that it was called the Ho Ho run because at each turn around point you had to eat a Ho Ho.  It was pretty fun but I do have to admit that I only ate one of the Ho Hos. 

The OR crew that talked me into running.  Left to right Capt Gabucan, OR nurse, Dr Sexton, Vascular Surgeon, SrA Ally, scrub tech

More surgeons joined our group.  This is Dr Gifford in the middle, ENT surgeon.  Dr Hood has the brown hat on and is our neurosurgeon.  I don't know the guy on the end.

After the race with our t shirts and Ho Hos not cigars.

After the race I had just changed my clothes when I got a page that there was a mass casualty exercise in effect and that we were all to report to our duty stations.  I was the anesthesia representative in the trauma room as the patients came rolling in, for those who don’t know about these exercises let me paint you the picture.  A mass casualty is where you get more patients than you can handle at your facility.  It is meant to force you to maximize the use of your resources and think about the most efficient way to triage and treat the injured.  An example of this would be the military hospital at Pearl Harbor that was suddenly receiving truck loads of wounded and dying men.  These simulations are actually pretty useful and the military loves to do them up right.  Everything is run just like it would in real life.  If someone sees you messing around they chew you out and usually give you something hard to do.  In our scenario there was a simulated missile attack.  Unbeknownst to us they had taken thirty-two soldiers and given them all kinds of fake injuries,  stuff like severed limbs, burns, shrapnel wounds, open abdomens, conscious and unconscious, stuff stinking out of their faces or heads.  They have people whose job it is to make the wounds look as realistic as possible, they call it moollage.  The patients show up in waves.  The walking wounded are usually separated from those that are more critical.  The ER docs decide who is too injured to be saved and they are labeled as expectant.  Those who need surgery right away are sent into the OR and others are sent off to various inpatient locations for monitoring.  There are only so many ventilators, nurses, surgeons and anesthesia providers so you have to judiciously allocate your resources.  If your neurosurgeon is in surgery you can’t have him come out and do something else.  So they would take a patient into the actual OR and make the surgeon, nurse and anesthesia provider stay with the patient for at least thirty minutes.  Surgery during a mass casualty is not meant to fix the problem but essentially for damage control to stop the bleeding.  Each of our three rooms has the capability to hold two patients at a time so in a situation like this you could potentially have two surgeries going on simultaneously in the same room.  During the exercise we were forced to double up to get all of the patients fixed.  It was a really good exercise and was generally pretty realistic.  They even had the helicopters drop patients off and the crews come in and report off on them.  I took some pictures but because I didn’t want to look like I was ‘goofing around’ they are pretty blurry.

This was our first expectant patient with fake third degree burns over his whole body.  He seemed to take the news alright seeing as though he could go eat after he died.

A bowel evisceration patient in the OR.  Her fake guts are covered up. 

Reporting off to the anesthesiologist getting a patient

An amputated right arm coming to the OR, fake not real.

Well in a nutshell that is my week.  I anticipate some more excitement with New Years so I will fill you in next week.  In the meantime remember that is our people that make our country great, be the change you expect to see.  I love you all.  Happy 2014! 

The guy on the right is my buddy Phil from San Antonio.  He was at a tiny base in the southern portion of Afghanistan.  He got to go home a couple of months early after they closed his FOB.  The girl in the middle is another CRNA that was going home.

They stopped in Bagram on their way home and I was able to see them before they shipped out.

I gave them the grand tour.  They had both been in tents and couldn't believe how good we had it.

Once a month we are required to clean our guns.  You have to clear your gun in a clearing barrel to make sure you don't have a bullet in the chamber.

Stacy cleaning her gun

I am getting pretty good at taking my gun apart and putting it together again.

The Week in Review

This week has been fairly uneventful.  We have just been doing surgery and trying to stay healthy.  This week we did do a case on a man with a condition similar to Elephantitis.  He had huge bony outgrowths all over his face causing it to be hugely misshapen.  They were able to scrape the excess bone off and make him pretty normal looking.  These are the kind of cases you only read about in textbooks.  Sometimes you even need a textbook to help you on your way.

This is the typical view from the anesthesia side of things.

We had an IDF attack during the week.  Everyone has to report in their gear.  We were told that there had been one person injured and we reported to the ER to await the patient.  These are the windows outside the trauma bay.  The crowds of people inside each have a specific job to do so that things get done very quickly and nothing is overlooked.  We did not actually get a patient from the rocket attack.  It turned out to be someone that hurt themselves running around after the rocket hit and injuries were minimal.

When we get American soldiers that have been wounded they are brought from the small hospitals all over the country to us after they have been initially stabilized.  We evaluate them and take them back to surgery if indicated and then get them ready to ship out to Germany.  These are the cots for the wounded warriors that are to be transported today.  They get loaded on to buses and then put on huge med-evac planes.  

This is an injury I sustained during a wild throw in Ninja Wars.  No Purple Heart for me though.

We got a package from a pre-school and they sent a picture along with it.  I thought it was so awesome I took a picture of it and am passing it along.  I couldn't get it to turn so you'll have to turn your monitor or your head.  I have received several packages from good souls at home that were meant for those that wouldn't get anything for Christmas.  I just wanted to let those people know how appreciated these items have been to those wounded warriors that have received them.  

Lastly,  The weather has gotten cold and everyone is coming down with a cold/flu bug.  So far I have dodged the bullet but it is likely a matter of time considering how closely we all work.  As they say what doesn't kill you makes you stronger.  Have a great week.  I promise to let you know what Christmas in Afghanistan is like.