This one time in Afghanistan...

It's been a while since I had any cool war stories to share. I had a trying mission the other day that I'll relate, and give my readers some insight into the exicting side of my deployment. These exciting moments don't come along everyday. Or even once a week. And sometimes in a month. But I did have a really cool one come along a few days ago.

I was on the second-up crew and through a series of unexpected events we had to take a mission for three urgent patients without the assistance of a flight doc. It's standard practice to bring one with us in case the patient needs care that exceeds the medics ability, training or if there is just too many things going on at once. We don't always bring one if the patients have some really lame ailment. But this wasn't one of those times. The only info we had was that all three patients required immediate surgery, and they were all already on ventilators. No info about specific injuries, treatment they have already received or anything.

While I was loading up the aircraft with all the extra monitors and breathing machines I thought I might need, someone else was trying to get a doc to us. In the end we decided to go without. I was a little nervous on the way down. When we got to Jalalabad and I saw my patients I was able to relax a bit. They were in a truck that was hit by a bomb, caught fire and crashed. Two were US soldiers and one was a local interpreter. They all had burns to their upper bodies and airways, and some broken bones, but they were all stable and drugged out. Our people in flight operations had called the Jbad aid station while we were in flight and told them we were without a flight doc, and they had a surgeon there for us. He didn't have any medevac experience but it was better than nothing so I brought him along. None of the patients looked like they would be any trouble and I didn't think I would need him anyway.

Normally if we only have one patient the doc doesn't have to do anything. If the patient is really messed up the doc and I will split up the work- ei one of us works on the airway and the other hooks up monitors and get the fluids and drugs pumping. And if we have multiple patients I'll work on the one worst guy and the doc will keep an eye on the less severe ones, and be a ready resource if I run into anything I haven't seen before.

On this flight the doc had no way of knowing what he should be doing, and wasn't up on our internal communication system. So to get his help with anything I used the highly inefficient point and scream method. Like so.

Me: (points to doc and screams) "YOU", (points to my eyes, then points to patient closest to doc and screams) "HIM".
Doc: (blank stare)
Me: (same thing but louder)
Doc: (nods, but doesn't do anything)

I wasn't his fault though. We normally train our docs on what we expect them to do. And doc aren't used to working in an environment that they didn't personally set up.
It all worked out in the end. It was extremely crowded and cramped in the back of our bird but eventually I got everyones O2 adjusted, IV bags hung and flushed, monitors monitoring and wounds looked at. Once that is done the rest of the flight usually goes real smooth but with these three there was always one or two things that needed to be done. A piece of equipment would fault and need to be troubleshot and fixed, a different patient would need suction, the middle guy needs more oxygen. And since the doc didnt know where anything was, I spent the ride crawling over the litters from one patient to the next constantly trying to fix something. The worst was in the last 5 mintutes of the flight.

I was doing something with dude-in-the-middle when I faintly heard the doc screaming something at me and pointing to the monitor on dude-on-the-left. His oxygen saturation display is showing a rapid drop. After checking the equipment to make sure the sensor is working right, I disconnected the ventilator and hooked the O2 to a bag and started breathing for him manually, and asked the pilots to please fly faster because all of the oxygen tanks are about to run out. I happily those O2 sat numbers climbing back into the pink. That's when I looked at dude-on-the-right and saw his pulse had doubled and his hands where clenched and shaking. Apparently while I wasn't watching his drugs were wearing off and he had noticed a big fat tube was shoved down his throat. So the doc took over bagging and I crawled/swung over the patients so I could get to my drug bag and send dude-on-the-right back to lala-land. Once that was done I looked to see how the doc was doing, and it lookded like his guy was tanking again. Thankfully we landed right then. Whatever was wrong with the patient at that very moment could wait the 60 seconds it takes to get to the emergency room.

We got everyone off nicely and wheeled into the ER, I gave my report to the doc there, thanked the guy that flew in the back with me, and went back to my bird. The cargo area looked like a bomb had gone off. Wires and tubes strewn everwhere, wrappers and syringes and trash getting blown around, a couple little puddles of bodily fluids, the hiss of leaking oxygen canisters, and alarms beeping angrily from two or three various machines. Accompanied my all this was a deep feeling of peace and accomplishment. I managed all three patients without panicing or forgetting everthing I ever learned about medicine, and everyone got to the hospital safely. After 9 months in this country I felt like I had been thrown into the fire and finally come back out unsinged. It was a great feeling, and since that mission I haven't had the usual pre-mission butterflies and doubts. I have arrived!