- I'm a 68-Whiskey-Fox-3 Flight Medic for the US Army.
- [Interviewer] And, you were deployed,
can you talk about your deployment and
the pre-deployment training that you...
- We deployed to Fort Hood, Texas,
I'm sorry, mobilized to Fort Hood, Texas,
prior to our deployment in Afghanistan.
We mobilized in August of 2015, Fort Hood
for approximately 40 days.
Train-up prior to that had been
a global medic exercise that we had done.
It was our unit annual training event that we had.
And, as far as medical training while at Fort Hood,
we'd done specific training within the
platoon itself, the forward support medical platoon
that we deployed with, to within,
the medics internally, and then we had the
BCT3 training at Fort Sam, while we were there at Fort Hood.
Then, the Hood MO Brigade did a MASSCAL exercise
as our validation exercise, while we were there.
- [Interviewer] Okay, now can you talk a little bit
about your, what is your medical background?
When you became a medic, what your prior
medical experience is?
- So, I became a medic in 2011.
I went to a 68-Whisky transition program
at Camp Shelby, Mississippi.
Prior to that, I was an 11-Bravo,
and prior medical experience from that
was a registered nurse, graduated from
Spencerian College of Nursing in 2009.
Worked Med-Surg for a couple of years,
and then transitioned into Emergency Room Care, as an RN.
And, army-wise, I've had the Army's Flight Medic program,
and the JECC program,
as well as the 2CF7 course,
which is the MEDEVAC Doctrine Course.
- [Interviewer] So, when you deployed to Afghanistan,
where you were at and how long were you in country
before this event happened?
- We deployed to Afghanistan in September,
the middle of September 2015.
We had been there for approximately 3 1/2 months,
before this event happened.
- [Interviewer] Okay, can you talk about some of the
days events leading up to this actual event?
- The days leading up where just normal days for us.
We run 24-hour MEDEVAC operations.
We'd had a couple calls prior to that,
over the months before.
They weren't regular calls,
so we weren't getting calls every day.
We weren't getting calls every week.
Sometimes we may get two calls a week,
and then go a couple weeks without another call
to go evacuate someone.
The days prior to this were just kinda
normal events that we would typically do.
We would usually get some sort of a mission briefing
that would tell us that the ground forces were going out,
so we were able to prepare and get ready,
and be on, essentially, a higher alert
than we normally were, when we knew that
ground forces were actually outside and,
the possibility to be injured or engaged in combat existed.
- [Interviewer] Prior to this, what was the
longest period of time that you've taken care of a patient?
- Approximately 20 minutes.
Not very long at all, as far as
patient care in the back of the helicopter prior to that.
Are you wanting an experience, like
maybe in the Emergency Room as well,
or just the army side?
- [Interviewer] Yeah, the Emergency Room as well.
- So, in the Emergency Room, we can have patients
that vary from an hour, that we'll have as part of our care,
up to 10, 12 hours, an entire shift, depending on
how busy the hospital is.
So, we could have to manage a critical patient
in the Emergency Room for our entire shift,
if we can't find an ICU room or some other room
to get the patient transferred to.
- [Interviewer] So, can you kinda compare and contrast
what you do in the Emergency Room as a nurse,
to what you do as a flight medic?
- The type of Emergency Room that I work in
doesn't necessarily deal with a lot of trauma.
We do more...
We're a chest pain, an accredited chest pain
and accredited stroke center,
and we see a wide variety of patients,
abdominal pain, all the way down to like,
"I stubbed my toe on,
"on something on the floor."
All the way up to someone who is in a full cardiac arrest
and we're having to work up.
The occasional trauma does come through the door,
not by EMS, because there's a local trauma center,
but we do get personnel who get dropped off at the
Emergency Room that do have trauma.
- [Interviewer] Is there a big difference
in the team environment of the ER, compared to
what you experience in the back of a helicopter?
- Yes, the team environment in the Emergency Room
when a critical patient, we work off of the
Emergency Severity Index in the Emergency Room,
so we have category one through five,
one being the most critical,
five being the lowest priority patient
that would come through.
I'd discuss the stubbed toe,
so that would be a level five,
and a level one would be someone who's in active STEMI,
heart attack, who's having an acute stroke,
or someone who's in active cardiac arrest.
And the team environment there
would be pretty much, all-hands-on-deck.
Doctor comes in the room, every available nurse
comes in the room, all the techs that are available,
and everyone works as a team, to knock that patient out,
and get everything taken care of.
So it's one big team effort, and
it's still chaos, but it's a little bit of controlled chaos.
Versus, my experience in the Army so far is,
you have a medic and a crew chief in the back of
the helicopter, and your crew chief can essentially help you
with what you've trained them to do.
So, their ability to help you in the back of the helicopter
comes out to what you've trained them to do.
- [Interviewer] Can you compare the
environment of the Emergency Room,
compared to what you experience in
back of the helicopter in Afghanistan?
- The environment of an Emergency Room
is everything is well-lit, everything is
placed in the same spot, and there's a supply chain,
so it's easier to get things.
So if you run out of something, you can make a phonecall
and you can potentially get that kind of quickly.
Versus, in the back of a helicopter,
many times it's cramped, it's hard to move around,
especially if you have multiple patients.
We do keep all of our gear,
that our platoon had in the back of our helicopter,
stocked a certain way to where every medic knows
where everything is in a helicopter at that point.
If one medic were to come off a helicopter
because he was sick or he earthed out on hours or something,
then another medic could jump on the back of the helicopter
and know exactly where everything is in that helicopter,
and not have to be told what to do or where to go.
He would know where everything is.
The other downside to in the back of the helicopter
is, noise and light, well, not necessarily noise discipline
but light discipline in the back of a helicopter.
If it's the middle of the night, and you're going into
a potentially hot HLZ, you don't wanna be,
have the cabin or the cockpit of the aircraft lit up.
You wanna go in dark, pick up your patients,
and then you're treating your patients with maybe
a small light in the back of the aircraft,
so you don't have that
that very well lit area that you can see
the potential injuries on your patient,
and you only have your set of eyes, and
maybe the crew chief's eyes
to see any potential injuries that may be on the patients.
Unlike in the Emergency Room, where you have
a lot of eyes, who are looking at the patients,
so they can potentially catch more injuries.
- [Interviewer] So, go into the events of that day,
5 January? - Correct.
- [Interviewer] Can you kind of describe that day
and start to go through the sequence of what happened,
what led you to the casualty?
- Yes, Sir.
So that morning, I had been awakened by our
15-Papa, which is our operations personnel.
They were told to wake myself and the commander up;
I was the platoon sergeant that day, or not that day,
just in general for the deployment.
One of the CCRs for troops-in-contact
was to wake myself and the platoon leader up.
So, they were just following procedures.
He came in and knocked on the door.
We worked a general night shift, so
this was around 9:00 a.m. in the morning, I believe,
that he knocked on the door, woke me up,
and let me know that there was a troops-in-contact.
I immediately left my room; I went and tried to
check out the situation to see what was going on,
to see if we needed to get ready for anything.
At that point, it was just a troops-in-contact,
so we checked that, confirmed that there was
troops-in-contact, and then
a few minutes later we saw that an American service member
had been wounded and they were gonna call up a Nine Line,
so we knew that this was in our area,
and we were gonna get the call.
We went ahead and woke everyone up,
who was on the crew that day, and had them get ready,
and wait for the Nine Line to come down.
So we were essentially already at fly,
in the helicopters, ready to go,
prior to even getting the Nine Line that day,
that came down through the transfers
like they would normally do.
- [Interviewer] How far away was it, time of flight?
- Time of flight was approximately
15 minutes from our location.
The injury sustained that day was in the
city of Marjah, in the Helmand Province of Afghanistan.
The weather that day was, not questionable,
but the clouds were kinda low-lying.
We flew in, identified the compound by the smoke
that they had thrown, did our circle and made our approach
into the compound that day.
- [Interviewer] Can you describe what you saw
from the air as you were coming into the compound?
- As we were coming into the compound,
you could see a lot of movement inside the compound.
My job as a medic is to fly on the left side of the aircraft
and clear the aircraft on the left side,
to make sure that we don't have any obstacles,
or there aren't any enemy or anything that are engaging us,
so we can break away or move away
to do the appropriate actions.
Coming into the compound, I could see there was
a lot of movement comin' around.
As we were coming in...
(chimes)
It's okay.
As we were coming into the compound that day,
I could see that there was a lot of movement,
goin' on inside of the compound, and
as we were coming in, like I said, my job was
to clear the aircraft, so I looked back as we were
coming inside the compound, cleared the tail down,
on the left side, 'cause our tail was inside.
As I swept back forward to
clear the blades on the left side,
I noticed that there was a US service member
with what appeared to be a 240-type machine gun,
who was firing outside of the compound,
and announced that over the radio to the crew members,
and then cleared the blades down
on the left side of the aircraft.
Once the aircraft landed,
I released my seatbelt,
turned to move toward the door,
to get permission to move out of the aircraft,
and started feeling a sudden vibration,
like a very rough vibration.
Looked back to my side, wasn't sure if we had taken
an RPG, or something, just was very odd.
My left side of the aircraft was clear;
I looked back to the right side, and that's when I noticed,
that the blades were striking the side of the building.
I immediately announced that the blades were striking
the right side of the building and the pilots performed
an emergency engine shutdown.
Once that was done, the blades had stopped,
everyone exited the aircraft.
Once we were outside the aircraft,
I did a real quick sweep of everyone
that was a member of the crew,
just to make sure there were no obvious injuries,
asked everyone if they were okay.
They said, "Yes," and I made my way to find the 18-Delta,
to get my report on the patient, to see if they needed
my help at that point, so...
- [Interviewer] Did anybody from the compound
come out to guide you in, or?
- We were inside the compound.
They were still moving toward the helicopter
when the blades were turning and all the debris
was being knocked off the building.
Our crew chief quickly put his hand out
to stop them, and then once we got the aircraft shut down,
we explained to them that we had
struck the side of the building,
and that we weren't going to be flying
the helicopter out of there that day.
At that point, I assumed care.
I spoke to the 18-Delta and I assumed care for the patient.
We were in a pretty heavy and intense fire fight.
They were, from my understanding, surrounding the compound
at that point, as well, and
I felt that the 18-Delta had better suited
fighting and keeping the enemy away from us,
and I could control the patient at that point.
- [Interviewer] So, your helicopter actually landed
in the compound?
- We did, that's correct.
- [Interviewer] And I assume the patient was
in one of the rooms within the compound?
- He was, that's correct.
- [Interviewer] So, what patient report did the 18-Delta
give you with the hand-off?
- The 18-Delta told me that the patient
had sustained a gunshot wound.
Initially, he had said,
"Through and through, on the right thigh."
The tourniquet was in place; they had a
dressing on it,
and he'd given him Ketamine,
TXA, he'd started the first round of TXA,
and he had given him Ketamine.
- [Interviewer] Did he indicate how long ago
the patient was wounded?
- I don't remember in that conversation,
but I know that we landed around,
a little after 10:00 in the morning,
so I think at this point it was around 30,
between 30 and 45 minutes
that the patient had been injured, and
there wasn't a whole lot of conversation about
amount of blood loss, at that point, so,
he'd just informed me that the tourniquet was in place,
the bleeding was controlled, they had a dressing on it.
He'd given TXA and Ketamine to the patient.
- [Interviewer] What kind of IV access
did the patient have at that point?
- He had an 18-gauge in the left AC.
- [Interviewer] So, once you came upon the patient,
what did you see?
- What I saw when I immediately saw the patient,
was a patient who was trying to climb off the litter,
was a little bit confused, askin' a lot of questions,
and there were some people next to him who were
trying to just kinda calm him down,
and console him a little bit, and tell him
that everything was gonna be okay.
- [Interviewer] Was he the only casualty at that point?
- He was the only casualty at that point, yes.
- [Interviewer] As you start assessing your patient,
what did you find?
- So, very quickly, I dropped down to his right side,
just took a real quick look at him.
He was talking, so that let me know his airway was okay.
It looked like he had good chest rise and fall.
I went to feel, to check see if he had a radial pulse.
I could not find a radial pulse initially.
And that's as far as I made it on the initial assessment.
They told us that we were gonna be moving,
that the second helicopter that was our chase bird that day
was gonna try and land, and evac us out
of the situation as well.
So, we immediately picked him up,
moved to an opening in the compound, and
set the patient back down there in the opening.
I immediately started working on the patient again,
again, just reassess the interventions,
make sure the tourniquet was still working,
the tourniquet was good at that point, it wasn't bleeding.
There was no issues; it was in place.
Just looked at, again, there again he seemed confused.
He was very cold to the touch, he was pale,
somewhat diaphoretic, and
still could not find a radial pulse on him.
And at that point I made the determination
that I would go ahead and try and start some blood on him.
In the meantime, while I was getting everything ready,
to get the blood ready to give to him,
I thought that maybe he was having
a bad trip from the Ketamine,
that the 18-Delta had given him.
So, I though I would maybe give him a touch of Versed,
to try and just kinda calm him down, in case he was
having a bad reaction to the Ketamine.
That did absolutely nothing for him.
So, in hindsight, like he was in shock,
so, I gave him the blood.
We had trained our crew chiefs to help us spike the blood,
so while I was working to give him the Versed,
my crew chief was spiking the blood, priming the tubing
and everything for me to go ahead and give.
Setting up the blood fluid warmer, the enFlows that we use
to warm the fluid as we give it to them.
- [Interviewer] So, as part of the blood program
that you guys have on the aircraft,
what do you normally carry?
- We carry either two units of O positive
or O negative blood.
- [Interviewer] Any fresh frozen plasma or thawed plasma,
anything like that?
- We do not.
- [Interviewer] And you said you use enFlow IV warmers,
fluid line warmers? - Correct.
Correct, we carry two of those and
two batteries on our aircraft.
That's just our unit-specific, that's not army-wide.
- [Interviewer] What's used on most
Air MEDEVAC aircraft, in the Army?
- Uh, it's split right now,
between the enFlow Fluid Warmer, or the,
not the Bearhugger, the Thermal Angel warmers.
So, I know the National Guard that came into Khandahar
were using Thermal Angels; they didn't have the
enFlow Fluid Warmers.
- [Interviewer] Okay, so you were
giving the first unit of blood,
waiting on the second aircraft to land?
- Correct.
- [Interviewer] What happened then?
- So, we were there, I can't tell you,
I don't know exactly how much time we were there,
but we were there, waiting on the second aircraft to land.
The SF guys around us were talking about how they were
low on ammo, they were low on smoke.
I gave them, I carry smoke in my vest,
just in case I'm ever on the ground,
and need to mark for the aircraft to
come back in and get me.
So, I gave them the current smoke that I had,
so they could throw for the other aircraft.
And then gave them all of my magazines,
except for the one that I had in my weapon,
and the one that I had in my M4, and then,
of course, the one I had in my M9, to help them out.
The rest of the aircrew did the same.
I continued giving the blood to the patient,
and trying to reassess the patient, see how he was doin',
at the same time, trying to do a quick
head-to-toe assessment on the patient,
to make sure there was no other injuries
or anything that I noted on him at that point.
Like I said, we were in the opening of the compound, and
started noticing some debris and stuff flying off the wall
beside us; it was kinda hitting me on the back of the neck.
Turned around, hearing the crack and pop
of the bullets and stuff, as they're closely coming by,
and kinda turn around,
there's a tracer round burning out at my feet.
That's the conversation that we had earlier,
where I was like, it's time for me to get...
Time for me to get as small as I can.
We were still inside the safety of the compound, but
just barely, at that point.
They were still trying to land the other helicopter.
I had my
embedded radio hooked up,
and I was trying to announce to the other aircraft that,
I had initiated vampire protocols, and that
I needed them to call that up, to let them know that
the patient was critical, at this point.
I was unable to communicate with them,
but I could hear them talking, and
they were sustaining rounds every attempt they took
to land to pick us up.
Then I heard them call, "Return to base."
They had sustained too much damage to land the aircraft
and they were gonna have to return to base.
So, at that point, we made the decision to
move back inside the compound, and back inside the building.
We moved back inside the building; I was giving,
but this time I was on the second unit of blood.
After the first unit I still didn't note a radial pulse.
He was still cool, pale, somewhat confused.
We moved back inside the compound,
realized that I had some resources in the aircraft
that I could use, still had the Propak and the Zoll,
and asked my crew chief to go retrieve the Propak for me.
He went outside the little building we were in,
to go retrieve the Propak, immediately came back inside
after a loud explosion.
They had landed a mortar round inside the compound,
that had went through the stabilator of the aircraft,
that was parked right next to the building.
He then, jumped right back up, and ran back out,
after that was done, and grabbed the Propak
and brought it back in, so we could get a better assessment
on the vital signs that we had on the patient at that point.
So, I finished the second unit of blood.
After the second unit of blood,
the patient started to pink up some,
started to become a little more alert and oriented,
was able to answer more questions,
and not act as confused as he was prior to.
When I'd received the patient, he was also wrapped in
the...
Damn, drawin' a blank now.
- [Interviewer] HPMK?
- HPMK, yeah, he was wrapped in an HPMK
when I received the patient, so,
I just made sure that he was secure and warm.
Just trying to get him warmed back up,
and trying to reverse the effects
of shock that I was seeing.
After that was kinda done,
he started complaining of a lot of pain, so
I started treating his pain with Fentanyl, at that point,
and just tried to, you know,
keep him somewhat alert and oriented,
and at the same time, decrease his pain so
I could just keep a good assessment on his mental status.
- [Interviewer] How much time do you think
had elapsed at this point?
How long had you been on the ground?
- We had probably been on the ground
close to an hour, at this point.
I'd given the blood pretty quickly, I'd
squeezed it in, the method of putting it
between the hands and pressing, and trying to
get the blood to come through, fairly quickly.
Once the second unit of blood was done,
I put him on some fluids,
and just kinda KVO'd,
keep him hydrated and those kinda things,
throughout the day, so, at this point,
they were gonna try to make a second attempt to
bring another MEDEVAC where (video cuts out).
To try and come evac us, so at this point,
it was just a waiting game for them to show up,
so I tried to just
assess him, make sure that his ABCs were good,
and then make sure he was just
comfortable, but not unconscious.
- [Interviewer] Were there any other
casualties at this point?
- At this point, there were no, well...
Potentially, another casualty, the one that I didn't see.
I heard the SF guys rumbling about an Afghan soldier,
commando, who had potentially been shot in the foot,
at that point, but, they were treating him.
- [Interviewer] Kinda describe the environment
that you were treating, within this mud hut.
- So, inside the mud hut, we had him
laying on a Talon litter system, and
we were just right in front of the door.
That way there was easy access just to get him in and out.
There was some little weird pot stove,
or something, that was in the center,
that the family that lived there used, I guess for heat.
The room was maybe
10 feet wide by 15 feet long,
and so there were different personnel
in and out of that room throughout the day.
- [Interviewer] Was there good light?
- There was no light. (chuckles)
Except for what came from the
small little window that was there,
during the day, and then the door,
that was in the opening, when you could
leave the door cracked a little bit from the opening there,
and get some light in and out of that,
so the visibility was not terrific,
but it was usable enough.
- [Interviewer] What about the noise level, temperatures?
- Inside the room, so, in Helmand,
it stays pretty warm, year-round.
I doubt, I think the temperature got
up into the 70s that day, so when midday came around,
it wasn't bad outside.
It was in the low 70s, I believe.
So the temperature wasn't bad.
We were inside the room, so we were cut off from wind
or anything like that.
So the temperature was comfortable inside the room.
I remember being very hot, but of course,
I was still in my flight vest, and body armor,
and wearing my flight helmet at this point.
So I just remember myself being hot,
and I remember the patient, after a couple units of blood,
and being wrapped up, and kinda turning him around after
a little bit of fluids, complaining about being hot as well.
- [Interviewer] Right, so the further attempts at
bringing in helicopters didn't work out?
- It did not.
We were told that the second helicopter
was making an approach to come in,
and they were engaged immediately,
and that one of the crew members on the aircraft
had sustained some injuries and so,
they were returning to base as well.
So, that was around the same time that the
second American had been injured.
I was working inside the room
with the current patient that I had,
and taking care of him, Patient number one.
We were taking care of him.
Just kind of making sure he was doing okay.
Making sure the interventions were in place,
and he still had a good strong radial pulse.
I did have the vital signs machine at that point,
but the battery was dying on the Propak, because
I'd used it to get him through the
most critical time that day, and
still had the Zoll available, if I needed it, but
I was just kinda monitoring him.
One of the other aircrew members came in and said,
"Hey, Matt, we need you outside right now."
So, my patient was fairly stable at that point.
There was no bleeding, so I asked someone to
keep an eye on him, I walked outside
and that's when I saw the other
soldier who had sustained injuries.
I ran over to him quickly, realized that he had sustained a
gunshot wound injury to the head.
The 18-Delta had criked him already,
and they were asking if they could borrow my ventilator.
I instructed them that,
that the ventilator probably
wasn't the best idea at this point, we could bag him.
They were wanting some oxygen as well.
I had four D cylinders that we carry on the aircraft.
We always like to make sure that we have at least
an hour's worth of oxygen for one patient on the aircraft.
So I had four D cylinders on the aircraft.
I told him we could give him one,
but we were better off just bagging him, at this point.
There was still a pretty intense
fire fight going on around us.
The Air Force had been dropping some 500 pound bombs,
as well as the 105 rounds from their AC130s,
and there was still a lot of
firing coming into the compound,
a lot of firing going out, lots of confusion that day.
They were bringing mortar rounds in,
walking them into our location.
We had already had one inside the compound.
Someone had mentioned something at the same time
that a couple of Afghans had taken some shrapnel,
and that the 18 Deltas were treating those.
So I started thinking about
the day potentially turning into a MASSCAL,
and started needing to
hang onto the resources that we had.
He was still breathing, but very erratically.
He showed very much signs of Cushing's
Syndrome at this part.
I'm sorry, Cushing's Triad at this point,
and he had a very
faint radial pulse, but he
did have a radial pulse at that point.
Like I said, his respirations were erratic.
I don't know what his blood pressure was.
But he was cold and in wet clothing,
so I instructed everyone that we needed to
get the wet clothes off of him immediately,
so we cut the wet clothes off immediately,
put him into an HPMK, wrapped him up.
I did an IO on his right humeral head,
and started some fluids on him at that point,
and we took one D cylinder and hooked it up,
and gave him a coupla liters through the D cylinder,
as they were bagging him,
through the crike that the 18 Delta had done.
- [Interviewer] Were there any signs of
impending herniation or...?
- (sighs) His pupils were fixed, and dilated,
there was no response at all,
on his pupils when I tried to check them.
And other than that, his heart rate was
very low, very faint.
I remember counting in the 40s, was his heart rate.
I kinda was thinking, in the back of my mind, that
he had possibly already started to herniate at that point.
I suggested that maybe we could hyperventilate him
a little bit, but, you know, it's kinda hard to explain
to some guys who are really trying to work really hard,
trying to save their friend, who had just
sustained injuries, that we need to kinda keep an eye
on resources and not use a whole lot,
'cause the day could potentially create more casualties,
and we would need to be able to treat them as well.
- [Interviewer] How long did the 18 Deltas
work on that casualty?
- So, I wanna say he lived approximately four hours, or so,
after sustaining those injuries,
and I asked if they would like to bring him
into the room with me, and I could keep an eye on him
as well as keep an eye on my patient.
They said no, they wanted to keep the two separate.
I think the two were friends, very close friends.
My casualty was an Air Force JTAG and then
he, of course, was a JTAG for the SF.
So, I think they were close friends,
and they said, no they wanted to keep them separated.
And so they would occasionally, I think,
I'm not sure what they did as far as providing care
but I know that one of our pilots ended up,
doing most of the bagging for him,
and then, after a couple of hours,
they called on me again, to come in and
see if I could find a pulse,
and I could not find a pulse on him at all.
They said they couldn't either but they just wanted
to kind of have someone else back them up on it,
to make sure that, you know,
someone else couldn't find a pulse on him.
When he sustained the injury, we were somewhere around
four hours into the event at this point,
and then we were told that they weren't gonna be
getting us out of there,
that they were probably gonna have to wait 'til dark
to be able to come and get us out of the compound that day.
At that point,
he had had the tourniquet on his leg
for around four hours and I made the determination,
or the decision, rather, to convert the tourniquet,
to try and save his leg,
and see if we could convert the tourniquet at that point.
Grabbed one of the 18 Deltas,
brought him into the room with me,
talked him through my plan, told him that my plan was
to give him a fluid bolus, to try and
help him out a little bit,
to dilute any pollutants that may come through
when we release the tourniquet.
So, started a little fluid bolus,
knew it would be very painful, so I gave him
some Fentanyl and some Versed, at that point,
to try and take him out of the situation,
so he wouldn't remember that,
because I knew it was gonna be very painful.
I gave him the medication, waited
I think, almost, well, somewhere between
five and 10 minutes, is what I waited,
and then started to pack the wound.
Exposed the wound, kinda looked at it,
started to pack the wound with combat gauze, and
applied pressure to the combat gauze.
I remember just thinking in my head,
"They always say three to five minutes,
"but I'm gonna be really safe.
"I'm gonna go ahead and sit here
"and hold pressure for five minutes."
So, packed it, held pressure for five minutes,
and then wrapped one good, strong, tight wrap of
ACE wrap around that, and slowly started to
back off the tourniquet and just watched for bleeding.
At first, it looked like it was working,
and the bleeding was controlled, but after
a little while, I started to see a little blood come up,
and so I just marked it, and the blood just continued to
to grow and so I made the determination to just go ahead
and reapply the tourniquet at that point.
While the tourniquet was off, I did check for
the CSM, or PMS,
whatever the Army calls it these days.
I don't know, I don't think I can call it
PMS anymore, I'm sorry.
But I did check for some motor issue,
make sure the motor was there,
make sure sensory stuff was there,
make sure he could wiggle his toes,
do pedal pushes, pedal pulls, those sorts of things.
It was off and he was able to perform all that as well.
He could tell me which toe I was touching, and
everything looked good at that point.
But the bleeding was still not controlled,
so I made the determination to
put the tourniquet back on at that point.
- [Interviewer] Did you use the same tourniquet
or a new one?
- I did, I used the same tourniquet that was there
at this point, I just reapplied the tourniquet.
And, you know, just continued to monitor the patient.
Treat his pain throughout the day here.
- [Interviewer] What kind of tourniquet was it?
It was a C-A-T.
- [Interviewer] And you didn't have any problems with it
bending, or the windlass bending or anything like that?
- I did not, it was one of the red tip C-A-Ts that they had
with the upgraded windlass on it,
so it worked well at that point.
- [Interviewer] Right.
How far away from the wound was the tourniquet?
- The tourniquet was about three inches above the wound.
- [Interviewer] Right, so the first tourniquet conversion
attempt didn't work.
How was his pain when you were packing the wound?
- Very, very intense.
He was screaming, he was not comfortable, at all,
and very upset about the situation,
but at the same time, was very adamant about
keeping his leg, so, he understood the
pain was gonna come with it, but was
definitely willing to undergo the pain
to try and convert the tourniquet to try and save his leg.
- [Interviewer] Would you say that the
tourniquet easily controlled the bleeding?
- Yes, the tourniquet did easily control the bleeding.
- [Interviewer] Right, so, what happened after that?
- So, after that, we just monitored the patient.
Didn't mention earlier, but while I was
slowly releasing the tourniquet on him,
I was monitoring his vital signs,
checking blood pressures frequently,
checking the heart rate frequently,
checking his SPO2, to make sure that he didn't
go hypotensive or have any issues,
from that immediate release of
the blood that had been contained inside the leg that day.
So, just for another couple hours, I think it was
around two hours, I just kept an eye on him,
tried to treat his pain, if he had any,
just keep him stable like he was before,
and throughout all of this, there still was a
fire fight that was going on outside.
There was talk of, when we were gonna get out of there,
when we were gonna get resupplied, and
we had no idea on any of those.
There were ideas that they were throwin' around,
"They're coming to get us now."
"That's changed; that plan's not gonna work anymore."
There was a lot of, there was...
The SF guys were giving us the communication on
what they knew, as far as the plan to come get us
out of there, and they were keeping us up-to-date,
but the problem was, the plan was changing so much
above our head, that it was really hard to kinda keep up
with what was happening, so I just kinda hunkered down
for the long haul.
I didn't know when we were gonna get out of there,
but you know, just do my best to treat the patient.
I also, at this point, had already started the second round
of TXA on him, and was letting the TXA go in, as well.
I'd given him antibiotics, Invanz,
to try and treat any infection.
I had heard that
there was a pretty nasty bug
that you would sometimes get from the soil in Helmand,
that a lot of soldiers were really fighting,
some sepsis and stuff with.
And so I wanted to go ahead and get on top of that,
and get some antibiotics in his system,
and hopefully we could combat that,
right away, so...
- [Interviewer] So at this point I guess you're
probably eight hours into it?
- Well, not quite at this point,
'cause I think I made another attempt
at around six or seven hours, to
back the tourniquet off again,
and see if I could get some,
see if the bleeding would have been
controlled, at that point.
This time, the second time that I tried to
convert the tourniquet, I backed it off,
monitored for bleeding, and went ahead and
removed more of the clothing around,
that was around that area, and
switched out the tourniquet, at this point, to
a SOFTT-Wide,
and just monitored and
realized that, one of the things that I
didn't mention to tell you at the beginning,
is that one of the...
When he initially thought that it was
a through-and-through at the beginning,
there was a hard mass that was on the bottom side
of the tourniquet, and didn't know if that was a hematoma,
or what was going on with it.
But the tourniquet was wrapped around it,
it was applied and bleeding was controlled.
We found out, on discovery, that once we'd cut everything
and tore everything away, that that hard mass was
a 5-hour ENERGY bottle, that was on the back side of that.
So we removed all that, cut it away,
and reapplied the SOFTT, and the tourniquet was
significantly more comfortable for him. (chuckles)
It still wasn't comfortable,
but it was a little more comfortable for him,
once that was removed out of the way.
Looking back on it, there are a lot of things that,
when it comes to an assessment of a patient,
I didn't really wanna mess with the tourniquet,
that was doing its job, to try and yank a patient around
for a really good assessment.
My assessment really was more feeling, opening things up
and looking, than it was yanking the patient back and forth,
and I didn't wanna take a chance on
tearing that tourniquet away,
and if it was a severe arterial bleed,
that you know, take a chance at losing life
or losing more blood, because of a silly mistake.
My initial assessment of the patient was
that there was no other bleeding in the current area,
was that the bleeding was controlled.
So, going back and actually cutting clothes away,
and finding the 5-hour ENERGY bottle that was wrapped
up in a ball underneath the tourniquet.
I guess that would be something that you could
look back on later and, you know, think,
how can you get around that?
But the tourniquet was on and it was working,
and I didn't wanna mess with that.
- [Interviewer] Did your second
tourniquet conversion succeed?
- It did not.
Watched it for a while, and it continued to bleed.
And then for the rest of the day,
it was just a, every two hours or so,
it was just the same thing, give a small fluid bolus,
to the patient, and try and monitor the patient
to see if we had bleeding that was controlled,
to see if there were any signs and symptoms
of kidney involvement, from releasing the tourniquet,
releasing the toxins into the kidney.
And that's the approach that I went.
When I went to convert it,
I kinda thought about crush principle injuries,
and how, if you're gonna treat someone
who's got a crush injury, what you wanna do.
You give them fluids, and try and dilute
any toxins that may be in there, and
monitor for blood pressure issues, those kind of things.
Check for, you know, urine output on the patient.
He was able to urinate earlier in the day, with no issues,
we used a water bottle, cut the top off a water bottle,
and he was able to go into the water bottle.
He was able to sit up just a little bit.
I didn't want to move him around too much,
didn't wanna create, like I said,
an issue with the tourniquet.
But he was able to urinate in the water bottle,
once during the day, but then after that,
his kidneys still continued to make urine,
but he was unable to urinate, and just
had a lot of pressure built up, throughout the day.
But, I knew that at least his kidneys were working;
they were functioning, so, that was good
for me to know at that point.
- [Interviewer] Did any of the
tourniquet conversions succeed?
- Yes, the last one, wanna say it was around midnight,
finally worked.
I released the tourniquet, and it actually was
the bleeding was controlled at that point.
So, I left the tourniquet in place, but loosened,
to where I could quickly tighten it again
if I had any involvement, or any bleeding,
beyond that point, so...
At that point it did work,
and we tried to keep
movements to a minimum to not create any issues
to where it would ruin the clot
that we had created at that point.
Every tourniquet conversion that I did throughout the day,
I did checks to see if he had strong pulses,
and he had pedal pulses, he was able to pedal pushes, pulls,
identify toes that I was touching, wiggle his feet,
move 'em around, do what he needed to do, so,
we were able to maintain good circulation,
when the tourniquet was released.
- [Interviewer] So, when we talk about prolonged field care,
one of the things we talk a lot about is nursing care.
Were there examples of things that you did with your
background as a nurse that medics wouldn't normally do
or think about?
- Um, I felt very comfortable using
drugs other than morphine, to treat his pain.
I initially used Fentanyl, to treat his pain.
I used 650 micrograms of Fentanyl throughout the day
to treat his pain, and eventually used every bit of it
that I had, tried to transition to morphine,
and morphine would not do anything
for his pain at all, at that point.
So one of the things that I had used
in the hospital setting before is Ketamine,
and I felt very comfortable using Ketamine
so at that point I created a drip of Ketamine
to use on him, and so, that,
I was very comfortable doing that.
I knew that Ketamine was a good drug,
and looking back on it now, I wish that
I had used the Ketamine drip the entire day.
I carried 1000 milligrams of Ketamine with me,
and plus the 18 Deltas had some Ketamine
that I could have used as well.
It controlled his pain, better than the Fentanyl did.
It took his level, pain level, most of the day he
averaged an eight, nine, sometimes a 10 on his pain.
With the Ketamine, it would take his pain
down to as much as four, five or six.
He was very lucid, in and out of sleep,
and so it seemed to work very well for him.
His mental status, for me, with the Ketamine, was okay.
I knew there was gonna be a little bit of
an amnesia sort of factor, with that,
where he may wake up, ask me a question,
doze back off, wake up, ask me that question again,
but at least I had a good feeling of
his mental status at that point,
and it just maintained good, strong vital signs
throughout the day.
- [Interviewer] Can you describe how you made the drip?
- So, yeah, I took a, I carried 100 milliliter bags of
normal saline in my kit,
so I would just mix 100 of
normal saline with 100 of Ketamine.
- [Interviewer] And you just titrated that to his effect?
- I did, mm-hmm.
- [Interviewer] What did you base the effect off of?
- The pain control and the in and out of sleep, for me.
He was, didn't seem to be uncomfortable,
other than the fact that he had to urinate.
He seemed to be comfortable, relaxed, he
didn't show any anxiety about the situation,
he just seemed kind of comfortable, and so
I kept him there.
If he started to get a little bit
get a little bit uncomfortable, bit antsy, wanna move,
I would turn the drip up slightly on him.
And if he started to get a little sleepier
than I wanted him to be, I would back the drip off some.
- [Interviewer] Was he on the litter the entire time?
- He was.
- [Interviewer] Any efforts to pad the litter
or anything like that?
- We had some stuff that we just kinda
put some under his lower back, and that kinda stuff,
and then every now and then, we'd just kinda
just move him around a little bit, to not create hotspots.
Not large movements, but just enough
to get off of that spot, to just move him
just a little bit on his left side,
or just a little bit on his right side.
- [Interviewer] Did he ever get thirsty or hungry?
- He did; he never mentioned anything
about wanting to eat.
He did mention about thirst a couple times,
so we'd just give him small, little...
Didn't wanna give him a lot to drink.
Kept reminding him about surgery, and
he wanted to smoke a cigarette, but
I wouldn't let him smoke a cigarette.
But I would give him small capfuls of water,
just to kinda wet his mouth, and those kind of things,
for the dry mouth issues he was having,
just to kinda try and keep him comfortable.
- [Interviewer] What about yourself and your crew mates?
How did you guys deal with the long term that you took
care of the patient, the fatigue?
- (sighs) I don't remember getting tired until
very early in the morning, I think it was probably around
1:00 or 2:00, when a lot of people would
come inside the compound.
Not in the compound, but inside the building,
and were napping, when they weren't pulling security.
Crew members took small, little cat naps throughout the day.
I didn't nap at all, just the adrenaline and my focus
on the patient really kept me awake.
But, when everyone came inside and everyone was
laying back and it was quiet, and it was dark outside,
we had a little light, that, I guess, the family
that lived there would use, they would
hook it up to a battery, and it was a little LED light.
It provided me with enough light to look at his leg
to make sure it wasn't bleeding, and to see his face
and chest rise and fall, and that kind of stuff,
so it worked out well for me.
But, I started to get a little tired at that point.
Not necessarily sleepy, but just tired and
kinda reflect on, you know,
holy cow, what kinda day had just happened and transpired,
and all the events.
We had a couple bottles of water, or not bottles,
couple packs of water that we keep on the aircraft, and the
SF guys that were on the ground that day were
very thirsty throughout the day, and,
of course, we don't think we're gonna be there
very long, so we pull all of our water off, and
we're like, "Hey, guys, take the water.
"Take this water, you guys need to hydrate,
"you need to drink."
So we gave them our water and we ended up being there
a really long time, and there was an attempt to resupply us.
The C130s flew over, they parachuted a couple pallets
or triwalls that they were gonna try and land
inside the compound, of food and medical supplies,
and ammo, and those kinda things.
Initially, it was thought it was gonna land
inside the compound, but the wind caught that
and took it outside the compound.
This was still during the day,
so there was no way, without other injuries being sustained,
that anyone could get outside the compound to get that.
It wasn't until later that evening,
that we, I thought, as we were sitting around
and people were talking about being hungry,
and being thirsty, and those kinda things,
that we have scram-kits on our aircraft.
We have four scram-kits on the aircraft,
which contain some food, some water, and those sorta things
that we were able to break out at that point, and so
it was not fun, but it was almost kinda fun,
'cause we'd never really, you know,
we'd talked about what was inside of 'em,
but we've never tried the food that was inside of 'em.
So we had water in a pouch, and like a rubber pouch,
plastic pouch, drinking that, and so
we were able to feed the SF guys that night too,
as far as giving them little snack bars, and there was
water and stuff inside the scram-kits.
Everyone got a little bit to drink
toward the end of the night.
- [Interviewer] So, the total time that you had the
casualty on the ground was?
- 17 hours.
- [Interviewer] And when you guys finally
did get out of there, how did that come about?
- So they brought Chinooks in, to get us out.
that night; four Chinooks landed.
Prior to them getting there, we all talked about
there were gonna be different teams.
There was a Red team, a Blue team,
a Green team, and those would be on the different aircraft,
and of course, they assigned us with
someone that we had seen, one of the SF guys
that had been with us, the majority of the day,
so they assigned us with him, and they were like,
"Just make sure you stay with him, follow him,
'you're gonna go to this aircraft."
And the took the hero at that point,
and they went to a separate aircraft;
they had kept those two separated throughout the day.
We got in our little chalks, moved outside
into an open field that was just south of the compound,
and the entire time, I was continually reassessing
that patient, the patient's leg, because the tourniquet was
not in place at this point.
The bleeding was controlled and I was just continually
monitoring that leg to make sure
the bleeding had stayed controlled.
At the same time, I was using,
I had saved one of the blood fluid warmer batteries,
because I thought the helicopter ride was gonna be cold.
Hypothermia may be an issue again, with this patient.
I knew that his hydration status was
better than it was when I got him, and
we had worked though the shock time-frame that he was in,
but I didn't want to create another issue again,
so I saved a blood fluid warmer,
and I still had him on the Ketamine drip at this point.
In the beginning of the day, I had started
an 18-gauge in his right AC, when I started the blood,
initially, so I had two lines of access,
and they both worked great, so,
I was giving him warm fluids,
prior to getting on the aircraft,
and we got on the aircraft and
turns out that Chinooks have the
heaters underneath their seats in the back
that come out through the floor,
so that was an added bonus, as far as
keeping the patient warm on the transport back.
- [Interviewer] So you floor-loaded the casualty
on the CH47, and you had to take care of him,
because you were the only medic on board?
- Correct.
- [Interviewer] Had you ever taken care of a
patient in a 47 before?
- I had not taken care of a patient in a 47 before.
We had, at flight medic school, we had
messed around with starting IVs on each other
in the back of a CH47, the same in the JECC course,
but not actually taking care of a patient.
I said that I was the only medic on that day.
There was another one of our flight medics,
that was on that aircraft, but he was up in the front.
They had put a flight medic on each Chinook,
to send out, in case there were other casualties,
or anybody else needed to be treated,
but that medic didn't realize that we were on the
back of that aircraft with a patient.
He made his way down the hallway and
realized that we were back there.
But, I provided the care for him all the way back.
There was an 18 Delta, that sat to my left,
but at that time, he was just relaxing.
There was really nothing to do, at this point,
other than to monitor his bleeding, his ABCs,
and to make sure that he was comfortable.
- [Interviewer] What happened at the Forward Surgical Team?
- So, I jumped off the helicopter, ran inside,
gave the report to the nurse anesthetist,
that was working there.
And of course, the only complaint he had, at this point,
was he really had to pee.
So they put a Foley in him at this point,
and took out around 1200ccs at that point.
But he had been complaining of having to urinate
for a while that day, so, looking back on that,
I felt kinda bad, and that's where
we've had the conversation of,
items that I wished I would have thought about,
'cause I thought about it shortly after,
which would have been to use a soft tip suction catheter
and we had some lubrication that we coulda used,
to relieve his bladder that way.
Just something to think back on.
I guess there's probably more things that could bother me
about that day, but that's one that sticks in my head,
that I wish I'da thought about that while we were out there.
Just kinda help take care of that.
- [Interviewer] Have you ever heard of any medic
taking care of a patient as long as you did?
- No. - Did you ever expect
anything like this to happen?
- I did not.
- [Interviewer] What do you think, in the future,
could help prepare medics for something like this?
- Never say never. (chuckles)
That's one of the things that we
kinda always talked about was
"That's not gonna happen."
You know, like, "Why do we have all these things on here?
"It's never gonna happen to us."
And a lot of things that I said probably wouldn't happen,
happened that day, and so,
that was a very uncomfortable situation.
To look back on the things that would help out would be,
better training in a clinical environment,
to understand the body better, how the body works.
The 68 Whiskey program teaches you trauma.
They teach you a little bit of aid station stuff,
but it's nothing elaborate and it doesn't help you,
and the EMT portion doesn't help you understand
how the body works, and why you need to do certain things,
when the body starts to work against you.
And so I think a better
educational program for medics to help understand
body processes and why they work that way,
and why you need to do the things.
Instead of just telling a medic,
"You need to do it this way," I think,
explaining to the medic why you need to do it that way,
"because the body works this way,"
would definitely help them out.
Because, you never know what's gonna happen,
and if you get stuck there and
you don't know what's goin' on,
or truly understand how it's working,
it could potentially be dangerous for yourself
and for the patient.
- [Interviewer] So, how did the casualty do overall,
for a recovery?
- So, what I've been told, is that there was
very little to minor involvement with an artery.
That's what I was told from the surgeon
that I spoke to that morning.
He said there was just very little,
so I'm not sure why we had such a problem
controlling the bleeding.
But, he went on to Germany,
then they'd sent him to Walter Reed,
and they had agreed to send him home.
I believe it was within probably two weeks,
I saw that he was up walking, with a cane.
And the last I've heard, the update that I heard
from the JTTS conference is that he was able to
run two miles in around 17 minutes,
and that his leg was doing great,
and he's expected to make a good recovery
and be back on jump status,
and back to doing what he loves.
His big request to me that day was,
"Don't let them take my leg," and so,
I'm glad I could oblige that for him.