Bagram’s mass casualty exercise streamlines care
A medical response team triages a patient in “Warrior’s Way” at the Craig Joint Theater Hospital, Bagram Airfield, Afghanistan, during a mass casualty exercise. More than a dozen patients were treated at the hospital after a simulated improvised explosive device attack. (U.S. Air Force photo by Staff Sgt. Katherine Spessa)
BAGRAM AIRFIELD, Afghanistan — The steady thrum, thrum, thrum of rotors beat overhead, kicking up wind and dust into the faces of the waiting medical response team. With a wave of his hand, the helicopter’s crew chief ushers the team forward to receive the patient.
Head wrapped in gauze, the patient’s face, arms and hands are covered in burns – typical injuries seen after an improvised explosive device attack. He is one of thirteen patients to arrive in a matter of minutes at the Craig Joint Theater Hospital, here, as part of a mass casualty exercise.
The drill was used to streamline medical response beginning with patients’ medical evacuation through to their treatment.
From the outside looking in, the process seems chaotic. With more than a dozen patients and an all-hands-on-deck response from the 455th Expeditionary Medical Group and their Army partners, there are people everywhere.
“We call it a dance and it truly is,” said Air Force Tech. Sgt. Mandy Mueller, a paramedic at the CJTH. “You have to move around each other, you have to speak clearly, because you have a mask on, the patient may or may not know English, so you have to add talking through an interpreter on top of that… All of us have to do each and every step well and smoothly.”
The emergency room is kept at a toasty 85 degrees for the comfort of the patients and to aid in blood coagulation. The simulated patients are covered in gruesome moulage, makeup made to look like realistic injuries. Doctors and medics masked and garbed in identical multi-cam patterned scrubs and bright yellow paper gowns work feverishly over the casualties.
The exercise comes at the beginning of a new rotation of deployed medics. While each of them has been through training, the new group is a mixture of seasoned veterans and brand new Airmen on their first deployment. The purpose of the drill was to create a realistic scenario of an incident that may happen on their tour and run through how each team would handle their roles.
“We have various teams that are working together simultaneously,” said Air Force Maj. Tricia Cain, 455th Expeditionary Medical Support Flight commander and exercise organizer. “They each know what’s going on within their team and within the other teams.”
One of the seasoned medics taking part in the exercise, Mueller, was first deployed to a small tent hospital in Kirkuk, Iraq, in 2005, said she has seen situations like this many times before.
“I don’t need any of this equipment,” Mueller said. “I don’t need a ton of people. I need a small group of people that I work together well with, where we can learn from each other and take care of our patients. As soon as that happens, no matter how sick someone is, you start to figure out what to do and how to do it best and the quickest for your patient.”
Volunteer patients applied moulage at the embassy in Kabul and medevacked to the hospital here at Bagram. From the minute their transport helicopters touched down, the personnel at the Craig Joint Theater Hospital, which includes the U.S. Air Force’s 455th Expeditionary Medical Group and the U.S. Army’s 710th Area Support Medical Company, worked together to assess and treat the patients.
Patients are first carried by litter from the helicopter and brought to a security checkpoint, where they are searched for weapons and explosives. They are then triaged to determine their status and where they should be brought for treatment in the hospital. From there they are taken to the appropriate team to give them care – whether it’s the emergency room, operating room or intensive care units.
The training enables personnel to develop what Mueller and Cain call the “muscle memory” of treating a patient, so that when a real world situation occurs, their training takes over regardless of adrenaline or emotional factors.
“My job as a paramedic is always chaotic,” Mueller said. “I never get to see people when they are a little bit sick, my job is always to see people at their very worst, on the very worst day of their whole life. I think today and every time we do training, [it’s important] to treat it like its real and to learn every single time, because you don’t get to learn in real life here.”
While this was a test of the new rotation’s capabilities and invaluable training, Cain said this is something they do each and every day. Mere hours before beginning the exercise, a real-world patient was flown in with injuries to be treated at the hospital.
“I hope that everyone who went through here got some understanding of how to do it calmly and efficiently,” Mueller said. “I hope that people understand that just because our patients today stood up and walked away at the end, that doesn’t mean they always do.”
Still begrimed with fake blood, smoke and exposed bone, each volunteer patient sat in the hospital’s dining facility discussing the experience and preparing to go about their lives back at the embassy. The exercise gave the care providers a vital training opportunity to prepare them for those with injuries that can’t be washed away.
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