PAKTIKA PROVINCE, AFGHANISTAN
PAKTIKA PROVINCE, Afghanistan -- “In the medical field, especially in trauma situations, you have a goal of what’s called the ‘golden hour’ from the time of injury to the time you get to see a doctor,” said U.S. Army Staff Sgt. Kyle Jennings, 934th Forward Surgical Team member and a licensed practical nurse from Deweyville, Utah. “Patients who arrive within that one-hour window have a much greater chance of recovery.
Without an FST in place, a soldier could go a long time before they see a surgeon or an operating room, and it’d be a lot harder for that person to meet that critical golden hour goal.”
The Emergency Operations Center of the 934th Forward Surgical Team, located on Forward Operating Base Sharana, is where the action begins.
“We are the eyes and ears of the battle space, always on the lookout for medical calls coming in” said U.S. Army Staff Sgt. George McGraw, a native of Clarksville, Tenn.
At the EOC, soldiers man the phones, radios and computers, waiting for alerts to potential medical casualty evacuations that could be coming their way.
Once a patient is confirmed to be arriving, the EOC has to act quickly because it can take just a matter of minutes for a helicopter to leave their station, pick up a patient and drop them off at the FST.
Members of the EOC instantly begin to spread the word around the facility, and information snowballs to the rest of the unit.
Paul Revere-style runners, perhaps shouting, “The whirly-birds are coming, the whirly-birds are coming,” are dispatched to locate medical personnel, helped in their task by large white boards throughout the unit with up-to-date locations for unit personnel.
“There’re not that many places to go on this base, so finding people is usually pretty easy,” said U.S. Army 1st Lt. Austin Adamson, the 934th FST executive officer from Preston, Idaho. “It’s not like someone can go off and really hide someplace for very long, so tracking people down to get them in here quickly is usually pretty simple.”
The first qualified responders to the unit jump into the prepositioned field litter ambulance and rush to receive the patient.
“Being the medic in the back of the ambulance is really exciting,” said U.S. Army Staff Sgt. Benjamin Chou, an Army paramedic from Salt Lake City who is also the noncommissioned officer in charge of the Advance Trauma Life Support section of the FST. “When you’re in the back of the ambulance, it’s just you and the patient. You’re responsible for them until they get up to the unit. That’s what we’re trained to do, so I feel a little more comfortable in the back of the ambulance. Even though it’s a short transport, we still get people who are in a great need of care so sometimes you have to do a lot of stuff just to get them to a provider.”
Those awaiting the return of the ambulance prepare gurneys and equipment for the patient’s arrival, as well as ensure each member understands his role with the patient.
“If you’re not on the ambulance, you’re back at the unit preparing for whatever might be coming,” said Chou. “We make sure that prior to arrival, all team members know what they’re responsible for, that way there’s no confusion when it’s time to perform.”
When the patient arrives to the clinic, things occur in rapid succession.
“We have five people assigned to each bed. Trauma is already a pretty chaotic event so we try to maintain as much order as possible,” said Chou. “Every person surrounding the patient has a specific job to do when that patient arrives, and all do it well.”
The five members of the team include a team leader; usually a physician who quickly assesses the patient and supervises patient care to ensure no detail, no matter how small, is overlooked.
Additional team members include a certified registered nurse anesthetist who looks after the patient’s airway and performs neurological assessments, a nurse who monitors the patient’s vital signs, and up to three paramedics who help prepare the patient for surgery by inserting intravenous and other access lines, as well as help check for injuries that may have been previously missed.
“Even though there is just one team leader, there are always four additional sets of eyes on the patient; so everyone is helping to see if there is anything else critical going on with the patient that may have been missed,” said Chou.
For some of the personnel in the unit, the types of patients treated by the FST are different than what they usually see in their daily careers.
“Back home, where I’m stationed, we don’t do trauma,” said U.S. Air Force Capt. Elizabeth Norris, of New Madrid, Mo., the officer in charge of the ATLS section. “Here, all we do is trauma. I’m an emergency room nurse by training, so it’s not that much different for me, thankfully. We perform well by working together. The team concept we do here works really well in helping a patient survive.”
The entire ATLS process takes as little as ten minutes.
In the best circumstances, the patient only requires small-scale medical procedures, such as suturing wounds or a brace for an extremity, in which case the ATLS section is the first and only stop for the patient, said Chou.
Sometimes, however, the patient requires more invasive care, at which point the patient is prepared for the operating room.
In the operating room, patients are watched closely by at least one surgeon, a certified registered nurse anesthetist, a nurse and a surgical technician.
“Penetrating wounds, usually from shrapnel or gunshots, are the most common injury seen in our operating room,” said U.S. Army Staff Sgt. Nathan Carrico, of Logan, Utah, the noncommissioned officer in charge of the operating room.
The energy inside the operating room is usually far more subdued than that of the ATLS department, and for a good reason, said Carrico.
“In the OR, we try to keep the atmosphere toned down a little more, in order for the physicians to be able to focus on the task at hand,” said Carrico. “Unless you know what you’re doing, it’s difficult to be able to lend a hand, so that cuts down on the amount of people surrounding the patient.”
Though all team members have experience working in surgery, the types of patients they encounter in the operating room here can be far different from what they’re accustomed.
“Back home, I work a lot with elective-type surgeries, whereas here, if we’re in the OR, it’s a serious injury,” said Carrico, a civilian surgical technician when not actively engaged with the FST. “There is no such thing as a ‘typical’ surgery, ever. Every patient responds differently to their injuries and to the medication they’re given. Also, sometimes, once we open up the patient, we’ll discover a lot more work needs to be done than we originally thought, so doing this job definitely keeps things interesting.”
Each person in the operating room has his own role, but all are dedicated to ensuring the procedure being performed is done efficiently, safely and without delay.
“To me, success in the OR is completing the procedure and having the patient survive the surgery,” said Carrico. “If you do everything you can for the patient every time while they’re in your care, there’s never remorse should something unfortunate happen to the patient.”
Following surgery, the patient is brought to the intensive care unit, where another team of medical professionals monitors their recovery.
“Primarily, we help recover patients after surgery and prepare them for evacuation to a higher echelon of care,” said Jennings. “We also help out in the trauma bay to augment the five-person team when needed.”
Depending on the procedure, a patient may be in the intensive care unit as little as 30 minutes following surgery, said U.S. Air Force Maj. Virginia Dunn, a native of Indianapolis, who is the officer in charge of the ICU unit.
Sometimes, they are forced to hold the patient longer.
“Our goal is to get them to the next level of care,” said Dunn, deployed from Peterson Air Force Base, Colo. “A patient only stays overnight if we have bad weather and can’t fly. We’ve had situations where patients have stayed 24, 48 hours, but it doesn’t happen very often.”
As soon as possible, patients are moved to more permanent hospital arrangements. If that individual needs to be flown to a neighboring hospital, they are prepared for evacuation and their care is handed over to in-flight critical care nurses, such as U.S. Army Capt. Jason Montgomery of Fort Hood, Texas.
“During a medical evacuation, you need someone on the aircraft who can monitor the patient for changes to their condition as well as provide continual care until they reach their next destination,” said Montgomery. “Also, the FST only has a certain amount of beds, so we need to move patients as quickly as possible to make sure the FST can continue to receive patients.
Montgomery is one of a handful of critical care nurses added to the FST to ensure a qualified nurse is available to fly with the patient at all times.
“I’m really lucky to be a part of something like this,” said Montgomery. “We honestly could be making history here with our efforts each day. They’ve never embedded critical care nurses with an FST, so we’ll see how it goes, but it definitely has merit. Though we’re just a piece of a larger team medical approach, we’re lucky to be here.”
So, regardless of where you or your injury may originate from, the 934th FST is prepared to assist you, every step of the way.
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This work, 934th FST: Anatomy of the life-saving process, by Capt. Mark Lazane, identified by DVIDS, is free of known copyright restrictions under U.S. copyright law.