Message from the Medical Front

More news from our modern day Florence Nightingale. I was having a lousy day at work today; lousy as in when people just don't do their jobs so I can do mine. My reality and this message from the front reset my definition of lousy. Nothing is "hard" about my days compared to one day in a Baghdad hospital.

This one was hard for me to read, so be warned.

So there goes another week. I have been sick now for the last few days, so I have been really bad about getting back to people. I'm sorry. It has been both busy on the floor and I have been too tired to do much of anything else, but get through the work night.

I had a pretty interesting week. We continue to be busy. Our turn around for patients is like no other that I have seen. We keep US soldiers for 12 hours or less before air evacuating them to the next level of care and back to the states. The Iraqi injured are kept a bit longer, but usually they are shipped out to "Medical City" within 24-72 hours. I'm not sure that the Iraqi injured will get the best of care in their medical facilities, but at least they are trying to take care of their own once they have been stabilized here.

Two nights ago we had a difficult night ahead of us. A Unit was hit really badly on a convoy and brought in many casualties through our EMT section. We received 4 of their soldiers. The ICU's were packed along with the wards. We had secondary plans to turn our stepdown unit and PACU into ICU's in order to cope with the influx of wounded. Luckily we didn't have to, but nonetheless it was a crazy night. I was actually working in the PACU that night, but came over to the unit to help out because we essentially turned over half our ICU with new patients in about 10 minutes or so. These guys came in intubated, bleeding, and unstable. We gave more units of blood than I could count and dumped it in as fast as we could. I ran up and down the stairs a bunch of times to go to the lab, the pharmacy. I was picking up medications and blood and requesting more with each pass. Our doc was running between all the patients and giving out orders left and right for each one. I was just helping whomever I could with whatever they needed.

We extubated 3 of the soldiers and they did pretty well once that happened. We then were told that they would all be flying out that night. One of them had to remain intubated because he was not stable enough to breathe on his own.

When we fly these soldiers out we have to complete air evac paperwork. It is a tedious job. Requests for transport get put in by the docs and then it is reviewed by our patient administration people. There is much coordination in the scheduling and transport of these flights and soldiers. As nurses we get the soldiers ready to go which includes copying their chart and any other paperwork that has been filled out for them. We pick up meds they may need, get a litter ready and all equipment essential for them to fly. For example, our intubated pt required a litter on a rickshaw with plenty of sheets/blankets for warmth, a portable, fully charged, and flight approved ventilator, propaq monitor for blood pressure, heart rate, and pulse ox monitoring, and an IV pump. Plus they need a nurse to fly with them too in case they should crash (physiologically) and need CPR/resuscitation or medications.

Basically what happens is you wrap your, hopefully as stable as you can get them, patient on a litter like a burrito/taco with the sheets and blankets trying to make the litter as comfy as possible with an eggcrate type mattress under them. Then you place all their needed equipment on them or on this device that holds it just above them. Keep in mind you don't have too much clearance because you have to fit them on the blackhawk helicopter and the litters are stacked. The helicopter fits 4 litter patients. You have to account for everything: fully charged, flight approved equipment, an oxygen tank that will get you to your destination, an ambu bag in case you have to breath for your pt and their vent stops working, any and all medications that you may need to give them in order to save/sustain their life until you reach your destination. It is a complete nerve racking event. We are trained to know this stuff and often it comes as second nature to you, but it is hard planning for the unknown. Many of the patients you fly with are not stable, but in a sense stable enough to fly out and get back to the states. Plus things can change at any moment. It is up to you to ensure they make it to the next stop in the series of stops they make on their way home. After all they survived the trauma of what happened to them at the point of injury, but trying to keep them surviving is the hard part. You strive to keep them alive so that they can thrive once they get back home.

Many of the patients you fly with are not stable, but in a sense stable enough to fly out and get back to the states. Plus things can change at any moment. It is up to you to ensure they make it to the next stop in the series of stops they make on their way home. After all they survived the trauma of what happened to them at the point of injury, but trying to keep them surviving is the hard part. You strive to keep them alive so that they can thrive once they get back home.

So to make a long story short I got to fly with 2 of our soldiers on the helicopter to Balad. Balad is one of their stops before reaching Germany and then the states. It is approximately a 20 minute flight from here in Baghdad. I was nervous and excited. I haven't gone on any flights where I actually had to take care of patients. It's dark and cramped and I had 2 lives in the palm of my hands. Things could go bad at any time. I put on all my gear on and loaded up my pockets with medications and stuff I may need. We loaded the guys on the bird and we were off. Six soldiers flew out that night.

You work by the light if a blue lens mini maglite flashlite. The glare of the monitors blinking at you as you check over your patients vital signs. "Ok, heart rate- good; Blood pressure- ok; pulse ox (oxygen saturation)- not so good." Your checking your pt to make sure the sensor is on them and that they are breathing ok. You use hand and arm signals and hope they understand you as you try to communicate what you want them to do. The litters are stacked so the first litter is at about chin level and the other about ankle level. I used my hands to check for breathing and pulses. I had the head set on so I could hear the pilots and medics communicating and it was my lifeline, so to speak, in case something went wrong in the back where I was. The flight to Balad seemed long, because you are hoping the whole time that nothing happens to your patients or the aircraft.

We arrived safely and off loaded the patients. They are taken to the EMT section in Balad where the Airforce has a hospital set up there. They are reassessed and I gave report to the accepting nurses and docs. I had to fill out some paperwork explaining what was done for them at our hospital and what kind of injuries they sustained. You have to do this quickly or the helicopter will leave you as they have many other flights and stuff to do. One of our nurses got left behind and stayed overnight in Balad and did not return until the next afternoon when he could catch a flight back during one of first flights out when we arrived here.

We grabbed all our equipment and headed back to the bird. Luckily they had to refuel and the pilots left their flight medics with us so we were guaranteed a ride home. We loaded up and headed back relieved that all 6 of our soldiers made it there. One step closer. The flight was a good experience. Certainly an adrenaline rush, but worth it. I hope to go out on more flights in the future if need be. I was lucky this time with my patients remaining stable while in flight; I hope that I will be next time.