Since it’s Veteran’s Day, I thought it would be a good time to share one of my more memorable days in the Air Force Medical Corps. While this story does not deal with battlefield medicine, it does highlight some of the differences between civilian and military medicine.
It was the first Sunday in March. I was deployed to a small air base in the Middle East with the 820th RED HORSE, a group of construction engineers. We were halfway through a six-month deployment designed to improve the local infrastructure and air fields. I was the only physician assigned to RED HORSE (though there was another doc who took care of the rest of the base). I had two excellent medics working under me, and we had been able to keep the injuries and sicknesses to a minimum despite the construction crews working round the clock, seven days a week.
It had been a quiet Sunday morning in the medical tent so far. I was finishing the medical portion of our weekly situation report and thinking about that night’s midnight meal. Sunday was the one night a week the mess hall made waffles. This far from home, good food was always welcome and the waffles they made were unbelievably good. A sudden call over the radio broke my reverie.
“Man down at the checkpoint!” the radio blared. “Trapped under a concrete-”
I grabbed my kit and was out the door before the sentence had finished. The checkpoint was about ¾ of a mile away over desert terrain and I was running full tilt. Out of the corner of my eye, I saw a pickup crossing the sand in the same direction. Our vice-commander was driving and heading the same place I was. He slowed down and I jumped in the cab and we sped off to the checkpoint.
Once we got there, the source of the call was clear. A concrete road barrier had fallen over, trapping the entire right leg of John, one of our younger troops. As we arrived, a group of soldiers had managed to lift off the heavy block. A quick exam showed that his leg looked intact though the ankle was clearly pointing in the wrong direction. About this time the ambulance pulled up and Jesse, my senior medic, hopped out. After a second quick exam, we got John splinted, strapped onto a stretcher and loaded in the back of the ambulance. Jesse and I climbed in back with him while the driver got in front and we raced off.
Like many Arab nations, the country where we were stationed had several vastly different levels of hospitals. There were the lower quality hospitals that anyone, national or foreign-national, could visit. Next, there were the military hospitals. They had a much higher quality of care and that’s where we were headed. Finally, there were the elite hospitals only open to the aristocracy. We weren’t allowed to use these except in the direst emergencies, and even then we had to get permission.
The ambulance driver was relatively new at the job, so hadn’t yet realized that pure speed is not always the best choice. As Jesse, John, and I were tossed around the back of the ambulance, I wished that I had had the foresight to bring along some pain medicine for John.
We arrived at the hospital and John was whisked inside. I followed along while Jesse went back to update our commander. John was placed on an exam table and the Emergency Room doctor examined him. He called for x-rays. John was clearly in a great deal of pain, but refused to admit it. It took several doses of morphine before he was able to relax enough to get a good series of x-rays. The films showed quite a bit of damage: a tri-malleolar fracture, comminuted tib/fib fractures and a pelvic fracture. Remarkably, the femur was intact and the pelvis only had the single fracture — which is somewhat unusual.
The Emergency Department care at the local military hospital was good, but not up to American standards. The exam had focused only on the clearly injured parts of John’s right leg. Cautiously, I suggested that we perform a thorough inspection and we soon found several areas of skin severely damaged by the crushing concrete block. Because of the crush injury, there were concerns about a possible compartment syndrome and an IV was placed and run wide open.
An hour or so later, the local orthopedic resident came down and looked over John. He was clearly excited about the chance to operate and called his attending physician. The attending said that he’d come down and look at John, but it would take a few hours. The resident sauntered off and I settled down with John to wait. Frankly, I hadn’t been too impressed with the resident. His bedside manner was poor and his exam skills abysmal. I had concerns over a possible compartment syndrome, but the resident brushed them aside pointing out that John still had good capillary refill. While it’s true that capillary refill is compromised in compartment syndrome, it is one of the last signs to appear, and by the time it does appear the damage may be too severe to repair.
John and I had several long talks over the next few hours. He was in good spirits but was upset that he wouldn’t be able to finish his assigned mission. I did my best to cheer him up. More importantly, I made sure that he was properly taken care of. The Emergency Room staff seemed to forget he was there, so I made it my job to be the “squeaky wheel” and get him his IV fluids and pain medicine.
Finally the orthopedic attending arrived and decided that this hospital was not equipped to deal with such a severe set of fractures. The best hospital was a two hour drive away. I had serious reservations about transporting John for two hours in the back of a bumpy ambulance to the hospital I knew nothing about. I called the other physician on base and we decided our best option was to call for a Med Evac to take John to the US Army hospital in Landstuhl, Germany. I was concerned about his pelvic fracture as well as the poor local quality of medical care. An unstable pelvic fracture can cause a significant amount of bleeding, and while this one appeared stable, I wasn’t entirely convinced it would remain that way. I felt that US military medicine was John’s best option. I called the base and alerted our commander. He agreed.
After nearly ten hours cooped up in the local hospital, I was overjoyed to see our Air Force ambulance pull up. As we loaded John in the back, Jesse handed me a bag he had picked up from the only McDonald’s in the nation. It was a cold hamburger and fries, but at this point I was glad for any kind of food.
I had already updated Jesse on the plans by phone earlier and he had done a good job organizing the Med Evac. The plane was supposed to arrive at our airstrip at midnight. As we pulled onto base and were being searched at the vehicle search area, my phone rang. It was Doug, my other medic.
“James just tried to commit suicide,” he said.
James was one of our electricians who had come to me about two weeks into the deployment and told me that he may have made a mistake when he stopped taking his Prozac. He was a fairly depressed and anxious person who had been put on the anti-depressant while back in the US. It worked well enough that he decided he was “all better” so decided not to bring it along on deployment. I ordered some more from home for him, but that was a six-week shipment, and then it takes Prozac about four weeks to kick in. All the medics and I had done our best to help him, and I thought he had been doing much better. Apparently he had received some bad news from home and that pushed him over the edge. He ran into the command tent (where Doug was working on the computer), ripped off his wedding ring, threw it on the ground and stated that he was going to go kill himself by grabbing hold of some live wires. Knowing he was an electrician, Doug figured he meant business. Doug and the vice-commander tackled him and took him to our medical tent.
After Doug updated me on James, I called our commander back. I updated him on the latest situation and told him that we needed to ship James out as well. We simply didn’t have the manpower required to have someone watch over James at all times and there were no mental health facilities in the area. The Colonel listened to what I said and ultimately agreed. When the Med Evac came, it would take James as well as John to Germany.
It was now 2200. The medical tent was crowded. On one cot lay James under suicide precautions. That meant no shoelaces, no belt and one of the senior electricians was at his bedside watching over him. About ever half hour, we’d give him another injection of a milligram or two of Valium to keep him calmed down. On the other side of the tent strapped to the other cot was John. About every half hour, we’d give him another injection of a milligram or two of morphine to take care of his pain. It took us most of the next ninety minutes to fill out the proper paperwork and get all the minor details of the evacuation arranged.
When it was nearly midnight, we loaded them both in the back of the ambulance and headed out to the airstrip. Shortly after we arrived, a Med Evac C-130 landed. We pulled up to where it had finished taxiing. We handed the patients over and watched as the crew securely tucked them in. In a few minutes, the C-130 had taken off again. We jumped back in the ambulance and headed back to our tent. We cleaned everything up, inventoried the controlled substances, and then headed off to the mess hall. Sadly, we were too late. They had served the last waffle ten minutes before.
Courtesy: Scott
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