Fast CSH Traditional Cache

    I arrived at Tallil airfield inside Iraq on the 25th of March, 2003. It was shortly after 1AM when we pulled onto the runway, just cleared but not yet secured by the Third Infantry Division. As the Officer-in-charge and head Nurse of a 10 person Advanced Trauma Life Support (ATLS) section, it was my task to become the first operational section of the hospital. We dropped the tailgate on the truck and grabbed jump packs to do “Tailgate Medicine” since the area off of the runway was suspected to be mined. No business that evening, but plenty the next day. However, it’s the 27th of March that will always remain engrained in my mind.
    It began with a bus pulling up. Thirteen casualties, all local nationals, some enemy combatants, some were civilians. It was not for me to decided who was and wasn’t an enemy combatant. My responsibility was to decide who was the most severely injured and who needed treatment first. The medic that had accompanied the patients said that the 6 year old with the gun shot wound to the head had been showing signs of improvement. I know she was not an enemy combatant. She came off and went inside first. Triage states that the most injured that could be saved is treated first; she should have been last, but I’m human. It wound up the rest of the bus was relatively stable.
    I triaged on the bus, military police men standing over the Enemy Prisoners of War (EPW). I triaged them Immediate, Delayed, Minimal, or Expectant with colored tag. Then a team of two would carry them off of the bus to the appropriate staging area in front of the hospital. Gunshots to arms and legs, shrapnel to the head and torso, most of them delayed injuries. Slowly the bus emptied out. It was about that time that things got worse.
    We heard them first, the WHOOP-WHOOP of two large Navy CH-46 Sea Knights landing a quarter-mile away. My handheld radio crackled to life, “There’s casualties on those birds.” With a fist full of triage tags and two jump bags, Doctor B (my ER doc), SFC B, my NCOIC (sergeant in charge), and I sped off to the landing zone on a 4x6 ATV type vehicle called a gator. We arrived to find about 60 patients, thrown on the chopper on ponchos, on the floor, on webbing seats. Civilians and soldiers, US and enemy, were strewn about. I shouted for 20 to 30 personnel above the whine of the helicopters along with all the litters not in use and about a dozen vehicles.
    Soldiers began to run to the landing zone, carrying litters. When they arrived, I had them drop the litters in a central location and then would wait till I had two capable bodies. Then they’d grab a littler and move to alternating choppers to off load a patient. Some injured walked off and after a quick look over, most were triaged as minimal. As others were carried off, I began to separate piles and told litter teams where to drop patients. We even utilized some of the injured to carry other wounded.
Around this time, the vehicles began to arrive to transport injured to the hospital. We loaded flat bed trucks with 6 to 8 litter casualties and uncounted ambulatory casualties. Field ambulances carried 4 litter or 8 ambulatory patients. Immediate were transported to the hospital without delay on the gator, along with any walking wounded that could fit. I put a sergeant in charge of each triage area, Immediate, Delayed, Minimal, and Expectant, and tasked them to load patients to their assigned vehicles.
    We were busy. SFC B would search all the locals who had arrived and before they were put in triage categories. Doc B did the majority of triage, with me assisting when freed from other duties. With the rotors still turning it was impossible to talk when the person was next to you, let alone 20 to 30 feet away. I would look at Doctor B, he’d look at me, and we impromptu a sign language. I’d tap on a body area to show where the injury was, make a breaking motion or a cutting motion, and make a explosion or shooting sign to indicate the mechanism of injury. I could check my own pulse and give a thumbs-up to indicate good pulses distal to a fracture on the patient. After awhile, Doc B, SFC B and I would just LOOK at each other, know what was going on with the patient, and how severely wounded he or she was. It was at this point two UH-60 Blackhawk helicopters landed on the roadway.
    The Blackhawk can only hold 6 litter or 7 ambulatory patients, so we knew at most, there was only 14 more casualties. I sent 6 personnel with a senior medic in each group to go check out the bird. They moved all the casualties to our area, 50 meters from the roadway where they were triaged and put with others. Trucks would drop off their wounded and return. The choppers took off leaving us covered in fine sand and with…silence? No. That was just my ears ringing. Then I heard the women and children crying out in an unknown language, the grown men shouting “ALLAM!” (pain in Arabic). And I instantly wished for the sound of choppers to come back and drown it all out.
    When it settled down, Doctor B returned to the hospital where he was most needed. Those whom had not already been transported to the hospital began to receive treatment from SFC B and others. I rode one of the last transports back to the hospital and was amazed by what I saw. So was one of our imbedded reporters as evidenced by the tears in his eyes. There were well over 100 additional people who had come out to help. They were cooks, chemical specialists, and military intelligence officers. People with no medical training were wetting lips, carrying litters and holding hands with soldiers and civilians. When I asked for a litter team of four, I had ten volunteers. It was the strongest display of humanity I had ever been a part of, and suspect that I will never be a part of again.
    Two of the six medics I worked with in the ATLS area are a year out of high school and are so young they can’t even get into clubs, let alone drink. The other three, besides my NCOIC, were under 24. They had been taught how to care for wounded, but had never experienced something as traumatic as loosing a six year old girl. They had never seen 81 battle-injured patients in 60 minutes. Their strength and performance is something that goes beyond words and something that I feel honored to have been a part of that day.