High-tech mobile hospital trains to save lives in combat
March 3, 2009
FORT BRAGG, N.C. - "Mascal! Mascal! Mascal!" someone shouted as Soldiers ran out of tents towards a 15-passenger van, horn beeping loudly. Medical personnel whistled loudly to get everyone's attention focused on the latest casualties coming into the area Feb. 12.
A doctor ran to the van and started assessing which wounded personnel were the most critical as medics stood at the ready with wheeled stretchers and all-terrain vehicles to take the patients into the emergency medical treatment area.
"This looks like chaos but it's truly not," said Lt. Col. Carlotta Head, 28th Combat Support Hospital. The mass casualty exercise is one of the many exercises planned to train the doctors, nurses, technicians and medics of the 28th CSH. "Controlled chaos," added Col. Bruce McVeigh, 28th CSH commander.
The hospital conducted a 20-day exercise near Normandy Drop Zone. The Soldiers of the 28th CSH constructed a 44-bed hospital complete with dining facility, EMT, operating room, laboratory, radiology, chapel, motor pool and laundry as well as living facilities for the staff.
"The main reason we came up with this exercise was to get set up, to put the hospital through stressors and (as) realistic functions as we could," said McVeigh.
Some of the activities planned were live surgeries, mannequin training, medical evacuations and field hospital setup. After setup, the CSH was validated by Womack Army Medicine Center, according to McVeigh.
Medics set up an area in front of the EMT to fill in-patient information and assign them to medical teams as fast as they could.
In the EMT, mock patients writhe in various degrees of pain on tables as a staff comprised of a doctor, a nurse and two medics quickly cut clothes off to see the nature of their patient's injuries. "Those people who need immediate care will be brought in first," said Head.
"They do a secondary triage once they get inside. They get clothes off, they get a better look so even if this doc says 'This is a delay, it can wait,' this doc gets a better look and can elevate that person."
Capt. Lindsay Colburn, one of the "patients" lies on a table while a medical team works on her "injury." She volunteered to help train the medical staff at the hospital. "It helps us to prepare for real world mass casualties," she said.
At another table, a medic cut the clothes off a patient. "Don't let me leave," he screamed out.
"I'm right here," said one of the chaplains at the hospital.
"Chaplains generally respond when the hospital gets patients in the EMT to offer whatever support they can give to patients," said Col. Ruth Lee, 28th CSH chief nurse. "Sometimes if it's a mascal, they even help cut clothes, whatever they can do to offer assistance to us."
Chaplains who deploy are also taught Muslim rites for host nation casualties. The commander finds having two chaplains assigned to the hospital very helpful.
"They need someone to talk to after seeing carnage or trauma," said McVeigh.
When the hospital's staff is overburdened by casualties, the rest of the team is ready.
"We pull nurses from the intensive care units and have them assume command of the beds. They follow the patients to other areas of the hospital," said Lee. "We try to cross-train our nurses so they can work at more than one area of the hospital in the event that we do get overwhelmed. When we're overseas, we don't have a nursing pool to call in and say, 'Hey, we need more nurses today.' We make do with what we have."
Once patients are stabilized, they can go to ICUs or straight to surgery. The 28th CSH has two ICUs with a staff made up of medics and nurses; both registered and licensed practical.
"We take care of patients that are coalition forces, contractors, host nation civilians, enemy combatants, we take care of everything," said Maj. Crystal House, 28th CSH nurse.
One of the tools military medical personnel use from the EMT to ICU to other parts of the hospital is the Medical Combat Casualty Care System. MC4, a computer system, is used in Iraq, Afghanistan and stateside.
"It's a wonderful tool that we can utilize to document patient care and be able to utilize that system to send the information to other folks. They can actually sit in remote areas so they can re-transfer a patient to the next level of care. They have the ability to go in and see what we've been doing at our level and get a background history on that patient so it is an invaluable asset for us to be able to track and maintain patients and provide quality medical care," said House.
Another wealth of knowledge the hospital can use is the professional fillers system deployment system. Run by the Army Medical Department, the system identifies medical personnel with certain skills to be able to deploy wherever they're needed.
"We brought in 30 of what we call professional fillers from 10 different (hospitals) from as far as Hawaii and as close as Womack," said McVeigh. "When we go to war, we'll have about 200 or so professional fillers go with us. What they bring is expertise. They are our docs, our surgeons, our anesthesiologists, more nurses and more technicians. We couldn't have done what we did in this exercise and where we're going without those folks coming around with us. They've been critical to success for us."
Capt. Angela Rosario, a nurse in the ICU is a PROFIS flight nurse, from Hawaii. If a patient has a head injury, or needs further help, flight nurses, along with a flight medic, travel by helicopter to a larger medical center.
"When we transfer patients on flights, the nurses are very responsible for the patients," said Rosario. "We take care of everything. We have all the life support measures that we need. We monitor them and give them drugs that they would need in order for them to survive."
The hospital also has an operating room with two operating tables. The patient first comes to preoperative area. Beyond the red line, everyone must wear headgear, masks and gloves to keep a sterile environment according to Capt. John Avery. After the surgery, the team walks to the decontamination area to sterilize equipment for the next surgery.
The OR at the CSH can accommodate surgeries from appendectomies to life-saving surgeries according to Lee. "Any type of surgery that saves a Soldier's life," she said. Once a patient is stabilized but needs more intensive surgeries, the 28th CSH sends them out of theater, said Lee.
While patients are being treated from the EMT to the OR, lab and X-ray technicians are busy with patients' tests and images.
Technicians in the lab can receive blood, urine and body fluids to test for a myriad of conditions. With most casualties coming in needing pints of blood, they receive O negative, the universal donor blood type in the EMT. Once a patient is stabilized, the lab techs can type their blood so they give them the right type and also save the O negative for other trauma patients. The lab is also a storage area for blood products.
The X-ray department has both a stationary and mobile X-ray machine for immobile patients as well as a computerized tomography scanner. Like every other department in the CSH, they also use the MC4.
"We can send images to anywhere. So if something happens in Iraq, we can X-ray the patient and the images will be there before they arrive," said Cpl. Mark Gichuru, X-ray tech.
The hospital also has a pharmacy stocked with supplies. The pharmacists can print a prescription label straight from the MC4 system and have the medicine ready for pickup.
Once a patient is resting at the hospital, they can look forward to three hot meals cooked by a health care nutritionist specialist according to Lee.
Last but not least is laundry. In one of four self-contained mobile systems in the world, laundry specialists give hospital linens and clothe a very thorough cleaning.
The water gets filtered three different times through three different filters, which take out any biotoxins left behind. The water goes through the boiler at 140 degrees Fahrenheit and comes back into the tank then goes into the next cycle according to Spc. Jason Sprague, 28th CSH. Clothes and linens are dried and folded for pickup.
McVeigh said he and his staff wanted to make sure the field hospital exercise was as real as possible so they would be ready for a deployment in the fall.
"The focus is every one of these kids being ready to give the best care they can to America's sons and daughters because that's what we're going to ask them to do. In some form or fashion to include the host nation we're supporting," he said.
Lee's reason is more personal.
"I entered the Air Force during the end of the Vietnam era. I heard about the war but didn't really live in it. But now having done it a few times, at least my attitude has changed," said Lee.
The 36-year veteran paused to steel her emotions.
"My intensity has changed because I feel like we really have to get them ready to be over there. Because even one medic who doesn't know his job can really impact saving someone's life."