Care to spare on the battlefield

          AF medics pick up slack for a strained Army

Bringing pharmacy needs to the bustling Emergency Room at Balad Air Base, Iraq are pharmacy apprentice Staff Sgt. Jared Hargrave (left) and pharmacist Lt. Col. Larry Gudgel, both deployed from the 59th Medical Wing.   (U.S. Air Force photo by Dewey Mitchell)

By Gordon Trowbridge
Air Force Times staff writer

BALAD AIR BASE, Iraq -- Capt. Kimberly Green remembers the last words of the recruiter who brought her into the Air Force a year and a half ago: “Don’t worry,” he told her. “You’re never going to deploy.”

She tells the story just outside the operating rooms of the hospital at Balad Air Base, dubbed “Mortaritaville” by the Army troops who have guarded the gigantic logistics hub for more than a year.

Green, an operating room nurse, isn’t the only one in unexpected territory. The Air Force Theater Hospital at Balad has been an exercise in the unanticipated, forcing planners back home and medical staff here to adapt the service’s deployed medical capabilities far beyond their normal scope, providing care on a scale perhaps unmatched in the decades since Vietnam.

“Have we ever practiced or drilled deploying a Level 3 trauma center? No,” said Air Force Lt. Col. Jim Hill, an internal medicine specialist from Wilford Hall Medical Center in San Antonio, where the bulk of the hospital’s 300 staffers are based. The Balad staff is nearly three times as large as the prepackaged Expeditionary Medical Support teams developed in the late 1990s as the standard deployed medical center in the Air Force arsenal.

But the length and violence of the campaign in Iraq have strained the Army’s medical capabilities enough that other services have had to fill the gap, said Col. Greg Wickern, commander of the hospital and of Balad’s 332nd Expeditionary Medical Group. Wickern said medical planners from all the services met in March to develop plans for tapping the military’s medical capacity, and Air Force officials proposed reviving the concept of an Air Force theater hospital.

Balad’s facilities include a wide scope - trauma and orthopedic surgeons, specialists in brain, spinal, ear and eye injuries, three intensive care wards, mental health and physical therapy specialists - all in an Hshaped warren of air-conditioned tents pitched on a concrete pad.

A wounded service member may first be treated at one of dozens of aid stations in the country, providing what military health care specialists call Level 1 care - basic, lifesaving first aid. The injured person might then be transferred to a Level 2 facility, which has field surgeons who can repair serious internal injuries until the patient can be transferred to a Level 3 hospital, such as Balad, with its broad range of specialists and medical technology.

Balad is one of three such facilities in Iraq - from them, patients move to even more advanced facilities in Germany or the United States, usually within 48 hours.

Wickern, a pediatrician at Wilford Hall, got his assignment in May, just before Mother’s Day. He traveled in July with Lt. Col. Don Jenkins, head surgeon at Wilford Hall’s trauma center and the Balad hospital’s chief of surgery, to assess the 31st Casualty Assistance Hospital, which the Air Force hospital would replace.

When he returned, he briefed most of those who would deploy to Balad, giving them a sense of the threat from Iraqi insurgents they would face when they arrived in September.

After a few days on the ground, Wickern’s apprehension began turning to relief. He began to hear from staffers that the danger wasn’t as great as they had feared. But that confidence was soon shaken.

“After three days here, we had a rocket land in the Air Force tent city,” Wickern said.    Several of the newly arrived hospital staffers were first responders to the attack, which wounded an airman so badly, he eventually lost both legs and part of one arm.

Air Force Lt. Col. Jim Quinn, chief of staff, called it “the gut check. People realized this was real, with real lives and real people.”

Jenkins said those emotional challenges are compounded by the fact that the Air Force’s Expeditionary Medical Support packages are designed to handle the industrial accidents that can occur in the workshops and on the flight lines of an air base, not the multiple and serious wounds of wartime.

While Wilford Hall’s trauma center sees more than 1,000 patients a year, few are as serious as the damage done by roadside bombs, suicide bombers or mortar bombardment.  Still, for medical experts, Jenkins said, the work is immensely rewarding.

“This is what we all spend our careers preparing for,” he said. “God forbid it was ever needed, we want to be the ones who are there and save that life, save that limb, give that guy a second chance.”

The medical challenges don’t end with traumatic injuries and worries about incoming fire. Public enemy No. 1 is infection. Combat wounds, Jenkins said, are more prone to infection, in part because explosions or gunfire can force contaminated material into the body. Bacteria-carrying dust is blown into the tents and carried in as people enter the facility, especially when winds pick up.

The staff has come up with 17 proposals to reduce infections, from the simple and easy - installing plastic flaps in doorways to block dust and flies - to the expensive and complicated - sophisticated air filtering systems that are now on their way.  

Jenkins also said the staff hopes to add a pathology lab that would give doctors a better chance of identifying the source of infections.

Even without the lab, Jenkins said, the hospital’s tracking of Iraqi patients, who make up nearly half of the hospital’s patients, indicates success in cutting the infection rate. (Reprinted by permission of the “Air Force Times”)