By Master Sgt. Michael Voss
BAGRAM AIR FIELD, Afghanistan--Imagine starting your shift deployed here as a vehicle gunner. Your team charged with conducting routine security patrols around the perimeter of the base, and in an instant everything goes terribly wrong, all you see is sand flying up like a wall above the truck. As you flash in and out of consciousness, you hear your fellow airmen yelling about a lot of blood. A few days later you wake up in a strange room. Still groggy, you can tell from the beeping equipment you are in a hospital. You see nurses scurrying back and forth, checking charts and resetting the annoying machine that keeps beeping to your side. You begin to ask questions…where am I? Where is my team? What happened?
This scenario isn't much different than what some survivors of improvised or mine explosion describe, and many of them will recount this moment for the rest of their lives. Most injured in Afghanistan, often clinging on to life by threads, find their way inside the walls of the Craig Joint Theater Hospital, here.
The hospital named in honor of U.S. Army medic Staff Sgt. Heathe N. Craig, who lost his life attempting to rescue a patient in the mountains of Afghanistan opened its doors March 4, 2007.
Each day young Americans and Afghans enter into the facility's double-doors and begin what will be the toughest period of their lives.
After arriving at the hospital patients are nearly always rushed into surgery. While they pass in and out of the consciousness surgeons and medical technicians work countless hours trying to save life and limb.
Although only deployed six months, surgeons from the orthopedic clinic in the facility often average more than 1,000 surgeries. Doctors and nurses within the hospital work tirelessly trying to save what they can, installing metal pins that extend from the hip to the knee or plates that function in place of ankles.
"Depending on the study between 57 and 63 percent of all of the injuries here are to the extremities, which puts a pretty significant load on the orthopedic surgeons," said Lt. Col. Wade Gordon, 455th Expeditionary Medical Group orthopedic surgeon.
Doctor Gordon who normally works at Walter Reed Army Medical Center in Washington D.C. went on to explain, from July 2009 to July 2010, he completed more surgeries at Walter Reed than any other surgeon in the military, 589. Yet in six months at the CJTH he has completed 450 surgeries. In total, Gordon's team of three surgeons completed more than 1,000 surgeries during their rotation.
Most of these injuries were the result of a scenario similar to the fictional one above, but IEDs are a real problem and the cost to human life can be unimaginable.
A Congressional Report dated 2006 stated "since October 2001, IEDs, or roadside bombs have been responsible for many of the more than 2,000 combat deaths in Iraq, and 178 combat deaths in Afghanistan. In Afghanistan, more than 40 suicide bomb incidents have been reported in 2006. Observers have indicated that the Taliban forces in Afghanistan appear to have learned some IED techniques from the Iraqi insurgents."
"As the surge in Iraq was ending we were seeing a very different injury pattern there then here. In Iraq the injuries were almost exclusively blast injuries as opposed to here with the small arms fire injuries. Most of the injuries there were what we call mounted, which means guys in vehicles," said Gordon. "There wasn't nearly as much of what we call dismounted which means they stepped on an explosive device, which is pretty devastating."
Medical staff here who have been deployed to Iraq often talk about the difference between the wounds they treated there versus what they see today.
"Here we have seen a lot more gun shots, since we have shifted the bulk of the operations from Iraq to here and that is an entirely a different kind of thing. There are more nerve and vascular injuries from gunshots. You don't get a whole limb blown off but you do get some pretty significant injuries from that. It is not like the movies where you just get shot and keep going; it just doesn't work that way," explained the 2004 Air Force Academy and Columbia Medical School graduate.
In addition to dealing with the blows of seeing the carnage that battle brings to warfighters, medics at the Role 3 hospital also must prepare themselves daily for the sites of innocents brought in with injuries caused from landmines and improvised explosives.
Even as advanced as the state of the art field-hospital is being in Afghanistan causes major difficulties.
"Usually when these guys come [into the hospital] they are injured with open wounds and a lot of damaged tissue so you have to keep going back to the operating room about every other day for several from three, five or ten operations just to clean up the tissue. If you just close up the skin they will get infected," said Gordon. "In medical terms it is called limb salvage. Most of the people we operate on have metal splits placed into their bodies which can cause infections, especially if not nice and clean before you close the wound."
Even for hardened warriors, it can be a heartbreaking experience seeing someone's son, daughter, husband or wife suffer with understanding where their life will go from here. A patient is a patient no matter child, U.S. service member or Taliban. Just a month ago they may have enjoyed playing basketball with their friends now they may face the possibility of learning how to walk again.
"It is kind of different here, I don't see this kind of trauma in my everyday life, explained Capt. Cheryl Barnes, 455th EMDG operating room nurse."It's hard to see people, some quadruple amputees, but I think of them. They are the true heroes and I am trying to help them get home."
Of the 232 OR nurses the Air Force employs there are 25 of them deployed at any given time around the world and with the majority of the efforts in Afghanistan it is safe to bet they will end up at some point in the CJTH.
"There is really no preparation for being here," said 455th EMDG operating room nurse and flight commander, Lt. Col. Kimberly Merritt.
Often the kinds of injuries seen within the walls of the hospital cause a lot of anxiety and emotional distress, not only with the patient but with the medics themselves as well. Doctors and medics often feel a strong connection to their patients and the harsh reality of war and truth of life is some patients die.
To assist those coping with injuries and the devastation of losing a comrade the hospital relies on a small team of chaplains and chaplain assistances. Each day military men and women come into the hospital chaplain office, often to discuss some of the worst moments of their lives and find reasons and ways to move forward.
"We work to comfort patients and doctors, even sometimes in the surgical room," said 455th EMDG Chaplain, Capt. David Bowmen. "There is of course a good deal of anxiety, fear and anger the injured are dealing with, and they need a safe place to talk about those feelings. We also counsel the doctors and nurses who from time to time need to vent. Sometimes they need someone to put a hand on their shoulder in a non-judgmental way and say it is going to be alright."
Thankfully courses like combat life saver and care under fire the survivability rate for a patient that makes it to the Bagram hospital is 99 percent.
"With some of the injuries that we see that is remarkable. That is better than someone would get in a lot of trauma centers back home, and that goes to the efforts of the aerovac guys the first responders who are stopping bleeding in some of the most austere locations in the country," said Gordon.
After being stabilized many of the patients are loaded onto a C-17 Globemaster destined for Germany en-route to Walter Reed where they will face in some cases years of therapy. Those fortunate enough to return to duty without the need of additional procedures, tend to progress quickly through physical therapy wanting to rejoin their units.
"We provide acute care and treatment to our Soldiers in the AOR. We rehab knee, shoulder and back injuries providing treatments like Estim, Ultrasound and traction," explained 455th EMDG Physical Therapy non-commissioned officer in charge, Tech. Sgt. Jessica Rivera.
In addition, the physical therapy department also helps on the ward with patient transfers, wound care, fitting patients with crutches and outpatient clinic with braces.
But perhaps the most important thing the entire medical staff at the CJTH does other than save lives and limbs is help patients get past that moment when the sand flew over their vehicle, past the annoying beeping and get back to the where they are needed, supporting the war in Afghanistan one day at a time.
"The best part of my job is when a patient is eager to get back to their unit and does what it takes to get better. The faster we can get them better the sooner they can get back in the fight," Rivera said.