LWW/AENJ LWWJ351-10 August 8, 2007 0:50 Char Count= 0 Advanced Emergency Nursing Journal Vol. 29, No. 3, pp. 265–283 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal Stories and Lessons Learned in a Combat Support Hospital in Baghdad LTC John Groves, RN, BSN, MSN, CEN Editor’s Note: The selections that follow are a col- constant concern about what we would face lection of impressions and memories from Army in terms of traumatic injuries. The Ibn Sina nurses, physicians, and medics deployed to Iraq in hospital, formerly the Bathist hospital, was 2005–2006. Many were written while the contrib- well known not only through the Army Med- utors were still deployed in Baghdad and, as such, ical Department, but throughout the world, represent very personal and real-time reflections as one of the busiest trauma centers in the on war-time trauma care, the intensity of which most of us will never experience. These are touch- world. A veteran of Baghdad told me, “It will ing and, in some cases, difficult stories to read; all be the best and worst time of your life.” She the more reason we need to read them. was right. The following is a compilation of —J.A.P. reflections on the professional challenges and personal stories of our experience and the im- The following manuscripts are a compila- pressions it left on each of us. The views con- tion of several of the 10th Combat Support tained herein are those of the authors and do Hospital (CSH) staff’s experiences in the com- not represent the opinions of the U.S. Army. bat zone for a year-long tour from October 2005 until our return in October of 2006. We —LTC John Groves had the youngest group of nurses and medics deployed in the 4 years since the start of Oper- REFERENCE ation Iraqi Freedom. We learned many lessons during the development of this team while in Bowe, M. (2007). The evolution of trauma resuscitation in a combat support hospital. Journal of Emergency treating some of the worst injuries any of us Nursing, 33, 83–86. had ever seen. Our 94% survival rate for the care of over 7,000 casualties has been well documented in several publications (Bowe, Taking Young People to War 2007). It is our hope that the insight shared LTC John T. Groves, Jr., RN, BSN, MSN, CEN by these personal first-hand accounts will be Formerly Emergency Medical Treatment (EMT) Head of help to our colleagues. Nurse, 10th CSH, Baghdad, Iraq When I received orders for deployment with the 10th Combat Support Hospital in Emergency departments are usually re- support of Operation Iraqi Freedom, I had served for the eyes of crusty old veterans in high expectations for the young nurses and the nursing and medical profession. Not so in medics. They exceeded my expectations. the Army. While maintaining a level of care During our 6-week training period and up to unprecedented in any previous conflict (less our nighttime entry into Baghdad, there was than 10% casualty rate) what may have gone 265 LWW/AENJ LWWJ351-10 August 8, 2007 0:50 Char Count= 0 266 Advanced Emergency Nursing Journal Figure 1. Members of the 10th CSH EMT in Baghdad, Iraq, holding a flag sent from a civilian ED stateside. unnoticed is not only how we train but who years of experience, it has become the pin- we train to go to war. Surgeon General Kevin nacle of my career to serve with such special Kiley stated, “other armies have brave peo- young people (Figure 1). ple, they have smart people but the differ- It is often said of our “greatest generation” ence between how we fight and how other that they were unique young people who an- countries fight is how we train.” Even hav- swered the call during World War II. Hearing ing had some unique teaching assignments those veterans speak, they have no doubt that ranging from Special Forces medicine to the our current generation will rise to the same Army Trauma Training Center in Miami, I am level if needed. I can certainly attest to that still surprised. We are currently deployed in without hesitation. Our Generation-Xer’s and Iraq with a staff so inexperienced that most younger men and women are more than up to hospitals would not consider hiring them for the task. their least challenging areas without special In just 4 months here in Iraq, examples training, let alone their emergency and critical of their heroics in saving lives are countless. care units. We train and take medical special- Three days after arrival in country, this young ists of all ages, but most are very young. Just team received four U.S. fatalities simultane- like the 18-year-old rifleman, the Army Medi- ously, a larger group of fatalities than the pre- cal Department takes 18-year-old medics and viously deployed Combat Support Hospital 22-year-old nurses fresh out of school and puts received during their entire tour. It was un- them in some of the bloodiest emergency de- nerving, shocking, sad, and heartbreaking. partments in Iraq. As a senior officer with 19 And, it all happened within a matter of LWW/AENJ LWWJ351-10 August 8, 2007 0:50 Char Count= 0 r July–September 2007 Vol. 29, No. 3 Personal Stories and Lessons Learned in a Combat Support Hospital 267 minutes. Watching inexperienced nurses and I now understand why we are here. It is medics challenged with the horror of death of for the combat soldier. But also it is for these young Americans their own age is something young heroes. They will carry the torch and that touches even the most seasoned profes- caduceus for all of those who have come be- sionals. One of the most memorable moments fore and all of those who will come after. of this tragedy came after lifesaving efforts were ceased on one young soldier. A colonel from the 2nd Brigade, 502nd Infantry Reg- “Oh by the Way, Flight Nursing iment, stepped up to the desk to offer his Is Part of Your Job.” comfort to one of our youngest nurses. His words were extremely touching, “Thank you LTC John T. Groves, Jr., RN, BSN, MSN, CEN for what you do and all your efforts; he was a Formerly EMT Head Nurse, 10th CSH, Baghdad, Iraq good man and is deserving of your tears.”Wit- nessing a colonel personally thanking a young Flight nursing is a specialty all to itself in lieutenant was something very special. the civilian community. For a nurse assigned Now fast-forward to 4 months later and you to the emergency department of the 10th CSH couldn’t pick out the two seasoned nurses in Baghdad, it’s considered an additional duty and three seasoned medics who were de- akin to courtesy patrol or pulling guard duty. ployed among the 31 rookies. Events oc- When we arrived in Iraq, the average ED curred daily that hardened the young soldiers. experience of our team was only 4 months. More important, skills have been forged at This remarkably young team quickly learned breakneck pace. Not only do these young to manage some of the most traumatic injures heroes resuscitate patients, but they also risk seen in the world from high-energy explo- their lives by jumping into helicopters with sions. However, our greatest clinical challenge patients who have severe brain injuries and was still ahead of us. We were informed in must be flown to another hospital. Treating early December 2005 that the neurosurgery an unstable, severely injured patient in-flight team would be leaving us on the 15th of De- is a task reserved for the most seasoned of cember. We had 2 weeks to train, equip, and nurses and medics in the civilian community. identify nurses and medics from our current Out of necessity, this is not always possible in staff to configure a flight program to trans- Iraq. port multiple trauma patients whose injuries Even with events from home overwhelm- included devastating trauma to the brain and ing them, they hunker down and drive on, the nervous system. not wanting to let their teammates down. One Make no mistake; our young medics who nurse and medic had to be evacuated due serve aboard MEDEVAC flights are some of to personal injuries, yet both pleaded to be the bravest soldiers in our Army. They pro- brought back. This is the value of selfless ser- vide one of the most essential missions and vice. It reflects one of our main Army val- contribute to the historically high survival ues: placing the needs of others ahead of your rate we have achieved in this conflict. How- own. ever, they do not have the critical care train- Here are some special moments from our ing needed to fly intubated, brain-injured pa- time here: friendly competition to get the tients who may be fresh off the operating most helicopter flights in, a successful thora- room (OR) table and commonly are receiving cotomy by a young physician who had only paralytic and sedative medications. With the trained on animals prior to deploying, and, high incidence of neurologic trauma we re- after saving a pulseless soldier, a young lieu- ceived at the 10th CSH, we immediately re- tenant remarked, “I learned today that when alized this would create a challenge. As the you do CPR that doesn’t always mean they Head Nurse of the ED, I immediately began to die.” brainstorm how we would be able to urgently LWW/AENJ LWWJ351-10 August 8, 2007 0:50 Char Count= 0 268 Advanced Emergency Nursing Journal Figure 2.