View Full Version : A day in the life of a combat ER.

11-16-07, 08:14 AM
On the Front Lines
A day in the life of a combat ER.
By Leslie Sabbagh
From Reader's Digest
December 2007

Tough Decisions

The temperature is near 130 degrees on a July day at TQ Surgical. Staffed by Navy physicians, nurses, techs and corpsmen, this trauma center at Al Taqaddum Air Base is between Fallujah and Ramadi, west of Baghdad. The Marines arriving here with combat injuries have been fighting insurgents in Al Anbar province, a desert expanse the size of North Carolina. The crew at TQ Surgical cares for these patients, binding their wounds and sending them back to their units or on to other hospitals. And all too often they line the halls, “manning the rails,” to honor those who have fallen.
Waiting for the wounded to arrive is nerve-racking, relieved by some easygoing banter. Then, with a mix of dread and relief, they hear the beat of helicopter blades.

As soon as the bird lands, the Navy corpsmen race to the flight line in a Gator to transport the wounded. “These are kids. Some survive because they’re young and strong. If you can turn them around, the successes can be miraculous,” says Comdr. John Deordio, director of Medical Services and the Shock Trauma Platoon. The flight medic updates the physician on the condition of the two men while the patients are cleared of ordnance: bullets, weapons, grenades. Both have lower-leg injuries. One, Staff Sgt. Garth Lindelef, smiles in relief and flashes the victory sign. His injuries are not life-threatening. But his buddy has suffered grievous wounds and is crying out, “Please, can I have something for the pain? This is awful!” Amid a barrage of voices, talking over vital signs and orders, the wounded are settled as gently as babies on the beds.

“Labs! I want blood right now!” yells Deordio. The Marine has lost a lot of blood. The X-rays show a right leg with badly broken bones. Worse, the knee is shattered, there’s no pulse in the major artery, and the sciatic nerve is damaged.

Before taking him to the OR, Lt. Comdr. Harlan Taliaferro tells the Marine there’s a chance he’ll lose the leg. “You never want to have a guy wake up and discover he doesn’t have a leg,” Taliaferro says. In the OR, he performs the amputation above the right knee. “It’s not easy, but this was the right decision.”

The day gets worse fast. A Marine has taken a sniper round to the belly. He’s getting CPR on the bird, never a good sign. Minutes later, the helo’s blades beat the air. The physicians stand at the door, and within seconds the Marine is swept into a bay prepared for thoracic surgery.

Moving On

Twelve corpsmen, nurses and physicians swarm the Marine. Bad news—he’s lost so much blood, there’s no blood pressure. “We’ve got a real slow heartbeat,” calls Comdr. Erin Moore. He’s one of the three surgeons who will be operating on the Marine. Within four minutes, they’ve cracked his chest and cross-clamped his aorta to control abdominal bleeding and keep blood in his heart and brain.

“He has a young, strong heart,” Moore calls to the 30 or so medical staff who’ve been drawn to the ER and are quietly watching. With one hand massaging the Marine’s heart and one hand on the clamp, Moore and his team move to the OR. He continues cardiac massage while Lt. Comdr. Christopher Carr and Comdr. John Raheb try to control the bleeding.

Now comes the most difficult of decisions. Before the walking blood bank is activated, the patient must be stable enough to fly to a Level 3 hospital. Moore announces he’s about to release the clamp. The Marine must be able to sustain blood pressure without it. But his horrific wound proves lethal. His blood pressure plummets, and then his heart stops.

It’s as if the air goes out of the OR. Frustration, anger, helplessness and, most of all, a deep, deep sense of loss. Moore calls the time of death. “It was hard to even call it. I’m tired of putting kids in bags.” Even worse is knowing that “within a few short hours, someone will get a call back home.”

Raheb says the team never gives up on a patient until every effort is exhausted: “Before that Marine got here, he received a lot of help from his comrades, who put themselves at risk to save him. They gave him to us to save his life. To turn around and say there’s no hope—what you’ve done is wasted—is just not right.”

It’s tough on the staff to see so many casualties. Still, Deordio says, he’s seen a hundred staffers come in during busy times. “We haven’t called them; they just show up.” Many are just a few years older than their patients.

Comdr. Chris Haughton, senior OR nurse, tears up as she remembers another difficult day. “Several patients came in, and every other Marine had a ring on his left hand.” She thinks of their calls home, what they would say: “I’m okay, honey.” It’s remarkable, she says, how the staff comes together again and again to talk to the patients, to reassure them, to grieve for them when they’re gone.

Still, finding the motivation to continue is not difficult. “This is not a hard job compared to what these guys are doing out of small forward operating bases, patrolling in tight quarters in 120-degree heat,” Taliaferro says. “If I can do more to take care of the Marines, these young guys, well, our group is good about that. I think we’ve maintained focus. That’s why we’re here. It’s a noble cause.”

A few hours later, Lindelef is lying on a gurney, waiting for his flight to the next level. He’s fared better than his buddy, with a through-and-through wound in the calf of his right leg, and an M&M-size wound in his lower back, next to his spine. His friend, still sedated from his amputation, is scheduled to fly out on the same helo.

Lindelef talks about the progress his unit has made. “It’s been a good tour, and these are great guys. Hell, we’ve been together for three years.” He stops talking and raises his head a little to look over at his buddy. A shadow crosses his face. His heart’s with the Marines who aren’t so fortunate.

He looks up, shakes off the sadness. The physicians, nurses and flight crews in the hall notice, and their faces lighten. His grin makes everyone smile back. Lindelef’s courage heartens them; his irrepressible spirit heals some of their pain. He’s given them what they need to go on.

Last Updated: 2007-10-24

Photos from the War Zone: Emergency Rescue Missions and Military Medicine In Iraq


06-05-08, 02:31 PM
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