Observations from an ER Doctor in Afghanistan:
MAJ hevë Becktmih, 4 graduate of the U.S.' Military Academy, is an emergency physician at Fort Hood, Texas, In January, he returned from a six-month deployment to Afghanistan during which he spent three months working in the 31st Combat Support Hospital (CSH) at Camp Dwyer, a large Marine Corps base in Helmand Province in southern Afghanistan, and three months working at a small Italian base in Bala Morghab, in the northwestern part of the country. This was his second deployment; in 2007-08, MAJ Beckwith deployed for 15 months to southern Iraq.
ARMY; Lef s start with a background description of the areas in which you served in Afghanistan - how big were the bases, the hospitals and the medical teams, and what kind of patients and injuries did you treat?
MAJ Beckwith: At Camp Dwyer, we had a fairly extensive medical facility. There were multiple operating rooms [ORl, an ICU [intensive care unit], an emergency room [ER] and multiple ward bays. We were well staffed and had a fairly broad complement of medical specialists. In spite of the remote location, we could really bring a huge number of medical assets to bear for any given patient. The hospital was primarily designed to provide trauma care, and that accounted for the majority of our patients. The injuries were mostly IED [improvised explosive device] and gunshot related, though we would see a smattering of nontrauma cases as well.
By comparison, the facility at Bala Morghab was much smaller, really just two tents. The Italians had a small medical staff on the base, so we worked closely with their team to pool our resources. Most of the patients in that area were local Afghans who had presented to the gate. Many had never seen a physician, so the spectrum of pathology was incredible.
What was your normal day like in Helmand?
In Helmand, we were living in tents right next to the hospital. On this large Marine Corps base, we had sort of a medical compound. ... The tents were not super comfortable; we had about 20 guys in a tent - not a lot of personal space. Guys would set up little barriers with sheets and ponchos, but for the most part it's pretty tight in there. Some of the guys had beds. I was on a cot for a while. As time wore on and you had more tenure, you might be able to move up from a cot to a bed.
We'd get up in the morning, pretty early. My shift would start around 7 a.m. The first thing we'd do is basically have a team meeting with the whole hospital - the doctors, nurses, lab, and pharmacy would all get together and run through the prior day. We would discuss patients, put out information and get the daily security brief. I always found it interesting to hear what the marines were doing in the area. It definitely made you feel more connected to the guys. They'd tell us basically, "Hey, the marines are going over here to patrol this village, so we may expect some contact." They would also give us an idea of where the prior day's casualties had come from.
Once the staff was on the same page, I'd go back to the ER and start seeing patients, if we didn't have any patients corning in, we'd do some drills and training for the medics. One of the nice things about that setting was that we would have a little bit of downtime throughout the day to work on team building with the trauma crew.
When casualties arrived, they tended to come in bunches. Most patients arrived by air, so our medics would go out to the helipad, put them on stretchers and then get them into the ER. The way we had it set up there, we had six bays, so we'd put patients starting in Bed One all the way down to Bed Six. We had one bed that was set up specifically for pediatric trauma, with size-specific equipment and medications.
On each team, we tried to have about six people total: two doctors, two nurses and two medics. We would also have our pharmacy, lab and X-ray …