Sunday, February 28, 2010

Days and Nights in Baghdad

I left for Iraq in July of 2008 and working as a PA for the Baghdad Embassy Security Force was unlike any of my other jobs. Sure, we had regular “sick call” clinic hours and often had to be called to the clinic after hours for urgent or emergent problems, but our responsibilities didn’t end at the door to the clinic. I guess it was about 0630 or so when I got the call on my Asia-Cell phone. Our eastern checkpoint for the road in front of the embassy had received rocket fire and we had at least two security force casualties. I donned my body armor and met one of the paramedics at the ambulance in front of the clinic. Together, we responded to the scene of the attack.

When we arrived, one guard was down in the street. The other was sitting nearby, and a third civilian casualty was also sitting nearby. The fire department had just arrived on the scene, and the EMTs were covering the more seriously injured guard with a blanket. I went to this guard first. He was conscious and talking, but had a penetrating shrapnel wound to the upper mid-abdomen. Fortunately, he could move all extremities. There was no exit wound. I asked the EMTs to package him for transport and place him in our ambulance, leaving my paramedic to supervise. The second guard seemed OK, he had sustained a head wound from shrapnel. He was also conscious and talking, if a bit dazed, but he seemed to have escaped more serious injury. I had another member of the guard staff escort him to our ambulance. I then went to the civilian, a female, who had sustained a wound to the left chest. She seemed to be in only minimal discomfort, with no respiratory difficulty. When I palpated the chest wall, I could feel a large fragment in the soft tissues superficial to the ribs. Her abdomen was fine. I directed that she be transported by a civilian ambulance arriving on the scene at that moment. With the first two patients already loaded in my unit and my paramedic yelling that we needed to “get off the X,” I left the civilian in the care of the EMTs and we began transport to the nearby Combat Support Hospital.

The first guard seemed to be doing poorly. He was getting restless. Though there was minimal external bleeding, I was sure that he was hemorrhaging in the abdomen, in addition to having any number of other injuries. I adjusted his oxygen, started a large bore IV and administered 10mg of Nubain for pain. The second guard was doing fine, less dazed now, so I stayed focused on the first guard until we reached the hospital.

At the ER, the patients were evaluated expeditiously. As I suspected, the shrapnel had penetrated deeply into the posterior upper abdomen. This likely injured large and small bowel, stomach, pancreas, as well as any number of vascular structures. Fortunately, the chest looked OK and he was holding his own with IV fluid at this point. Soon, he was whisked off to the OR. He did well and was eventually evacuated back home. The second guard and the civilian were luckier, with only superficial shrapnel wounds and a mild concussion for the guard. He returned to duty after a few days. A little while later, we responded to a second attack nearby to the hospital. Fortunately, there were no injuries.

I get a lot of questions about what I did in Iraq. Sure, I provided clinic care, and also urgent care for sprains, strains, wounds, etc. I also dealt with the same emergencies that I would see in the ED, appendicitis, asthma/COPD, diverticulitis, kidney stones, MI, seizures. I would also respond into the field, triage patients and provide care on the scene and en-route to the hospital. Seems I did a little bit everything medical and I did it all in a very interesting and diverse environment. I made a lot of new friends in the process and wouldn’t trade this experience for any other that I have had. I left the desert for good in September 2009, but I think that a little part of me will always be back there.

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