(This is the 8th dispatch from my friend Andy, an American doctor serving in Iraq with the Air Force Reserves)
Hello. Today we had training with the Army, but I hope I'll be leaving before I have to use what I've learned. It is called "extraction training" used when a patient has to be extracted from a "hot" (under fire) LZ (landing zone). The training took place in our customary 120-130 degree heat - while wearing full battle regalia.
As the team medic, I had to be comfortable (or more comfortable) functioning in this enviroment. First we were given a 30 minute lecture explaining the differences between trauma response in the military vs. the civilian side. The first point reieterted over and over was to supress enemy fire before caring for the patient.They showed footage from early in the Iraq campaign of a well meaning medic going out to help a fallen comrade and subsequently being shot. The main emphasis was to stop the bleeding using either local pressure or a tournequiet, starting an IV quickly if pulses were decreased (signalling decreased BP) and attending to the airway last as, reportedly, hemorrhage is the cause of 90% of battle deaths.
After the lecture they brought us outside and had our team of 4 leave the helicopter..go to a hot landing zone..supress enemy fire and care for our patient. We had to make sure not to be so focused on the patient that we forgot about what was going on around us. Also if we were attacked, and the patient could not move on his own, we were to (against our better instincts as physicians) leave the patient until the enemy was "supressed" or, at least, out of the area.
I felt like a poorly prepared extra in a war movie while I was stalking through the LZ with my M-16 Rifle..which I had only touched once on a deployment with the Marines, while in the nation of Chad. But the army guys were taking this very seriously and having us walk in staggered formation with 360 degree coverage.
When we identified the patient we first had to win the firefight (they were firing blanks from rifles and, frankly, I HAD NO CLEAR SENSE OF WHERE THE FIRING WAS COMING FROM) and then manuuver the team to the patient.
With the heat, the army guys (who have fought in two wars) instructing us, and sporadic blanks in the distance, it was as close a sensation to a real firefight as I ever want to have. The patient had a right leg amputation for which we applied a tournequit, he than lost his pulse - for which I started an IV (a real IV-these guys are tough). And, after abandoning the patient while under attack (as instrcuted) we dragged him to the waiting chopper.
I frankly felt hapless as a soldier but the army guys were very charitable in saying that I hit the ground quick under fire and abandoned my patinet as required. They kindly said I should probably shoot my weapon every now and again "just to help the team and keep the enemy honest". They were very impressed with my effeciency in starting an IV in the field quickly on the first try. After that we had an opportunity to teach the army folks some basic theory about drugs, management of low blood pressure and respiatory failure.
These guys absolutely love their job. They also speak glowingly of their wives and little kids but are away from them way too long. While some of those serving here in the Army have serious mental health issues (as noted before..which I will address), the vast majority of troops I have met absolutely LOVE their jobs..despite the sacrifice.
It was somewhat touching that these hardened warriors were spending so much time (and taking seriously) teaching me how to function in their environment - and, in a very respectful fashion. They were great teachers. Its yet another experience I will simply never forget.