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This is an excerpt of the time I was at a forward operating base in Afghanistan embedded with the Afghanistan Army and we had a medevac of little Afghanistan girl come in our Helicopters. Typically, the Afghanistan Army would handle "local" cases, but they were not around their Medical Clinic. We took her into our Army ambulance I was worked on here in the back till we got her to the hospital.. Excerpt from my book: My Journey as a Combat Medic: From Desert Storm to Operation Enduring FreedomSep 1, '11 by patrick1rnI was in Operation Enduring Freedom working out of a small forward operating base right outside the town of Herat, Afghanistan. It was early February, 2005. We received notification that a Blackhawk helicopter was bringing us a four year old girl from one of the other bases south of us. Out military was embedded with the Afghanistan Army during both tactical and garrison activities. We were teaching them how to become an Army. The idea was to let the Afghanistan Army handle local national wounded.
The little girl had ingested insecticide. She drank liquid that was used to kill flies and other insects. Insecticide is the same thing as nerve agents are, but on a smaller level. The helicopters were about fifteen minutes out; we drove with our Infantry forces to the landing zone. The Infantry guys formed a perimeter around the landing zone as the helicopters touched down. The patient was cared for on the helicopter by one of the doctors from that base. He gave me a report on her status and what they did for her. I had managed this condition back in the States working as a registered nurse, just not with a small child. The helicopters left and this child was now in our hands. Her father was with her on the journey.
We went to the Afghanistan medic aid station and no one was home, the door was locked. They did not understand that operations occur twenty four hours a day, especially medical emergencies. Typically, the Afghanistan medics take care of their own sick or injured, but now she was my responsibility. I was not a pediatrician. We notified the commander that we had to take this child to the hospital in Herat because none of the Afghanistan medics were around.
Our security forces were already out from the landing of the helicopter, so basically all we had to do was convoy to the hospital in the city. I knew that the drive would take about thirty minutes with good traffic conditions. The father and one of our interpreters were in the back of the ambulance with me, while the other two medics drove up front. I never liked the idea of taking the ambulance out on convoys like this. It had really minimal shielding from a blast. The back of the ambulance had some Kevlar protection. Well, we went to war with the equipment that we had. One improvised explosive device and it would have been lights out for all of us.
I had basic pediatric training from nursing school, but I was used to treating adults, I remembered that in children everything is normally faster, the heart rate is faster, they breathe faster and their metabolism is faster. I had never really cared for a child working as a registered nurse. Other than that, I just wanted this little girl to stay alive when she was in my care.
The little girl was in the back of the ambulance resting on a litter. It was different seeing someone so small on those litters. She had a bag of normal saline infusing at a slow rate with atropine. Atropine was the medication used to treat the insecticide poisoning. In fact, the military uses atropine, because it is the antidote for nerve agent poisoning. I was comfortable with what I was doing; I just didnít want this little girl to die in the back of the ambulance while she was under my care. Her father and the interpreter were watching my every move.
I had a pulse oximetry monitor that I put on her thumb to tell me how fast her heart was beating and it could measure the amount of oxygen levels in her blood. If her heart rate went down too much, I could see it on the monitor right away. It was hard trying to listen to her heart with my stethoscope in the back of the ambulance, but I could feel her pulses with my fingers.
I wanted to keep her heart rate fast, I listened to her lungs and to her abdomen and then I felt her belly. I was worried about her vomiting and then aspirating what she vomited. We had a portable suction canister; typically it is one of those pieces of equipment that gets in the way, except when we needed it.
I had the suction ready if needed. I placed her on a facemask. The most I could do if I had to protect her airway was to insert a small tube called a J tube that moves the tongue so air can get into the airway. She would have to lose consciousness in order to do that. I preferred that she stayed awake. We did not have any airway tubes to insert into the nose to help protect the airway because we typically did not stock those for pediatric cases. She started to vomit. I quickly turned on the portable suction canister and cleared the contents out of her mouth. I sure as hell was not going to allow this little one to aspirate and die over something so simple. I suctioned out the gastric contents. Her oxygen levels were more stable. I was satisfied with her levels after the vomiting.
She closed her eyes and dozed off; her heart rate was below ninety. That was not good; I increased the infusion rate of the atropine and rubbed on her chest. The poor girl started to cry. We didnít have the atropine on a pump like in a hospital or an ambulance back in the United States, I had to eyeball this. I infused enough atropine so her heart rate would go back above one hundred and ten. I asked my interpreter to tell the father to talk to his daughter and tell her to keep her eyes open. I explained to the father that I did not want her to fall asleep in the back of the ambulance. The interpreter translated this for me and the father nodded yes in understanding.
We arrived at the hospital in Herat. The executive officer, a large Army Lieutenant Colonel, took hold of the little girl as we opened the ambulance doors. He carried her in to the emergency room and placed her on an Army litter that was held up by old-fashioned litter stands. I gave a quick report about what happened to the girl to doctor. He was busy as I could see. There were people on litters with amputated legs moaning and blood pooling on the floor. The father could explain the rest to the doctor.
I took a walk around the hospital. It was barely a hospital. There were minimal supplies and lighting. The floor was concrete and to light the place, they used a portable light set and strung lights in different working locations. I almost felt guilty dropping her off here. The rooms, if you could even call them that, were sectioned off by rope and to have some privacy, old green Army blankets were used. We had done the best we could for the little girl. I just didnít want her to die in the back of my ambulance on the way here. I didnít want her to die at the so called hospital either. I heard through the interpreter that the child was released a few days later. That put a big smile on my face!Last edit by Joe V on Sep 3, '11
I am a Family Nurse Practioner and a retired Army Combat Medic, I served with the 160th Special Operations Aviation Regiment in Desert Storm and I served with the 76th Infantry Brigade in Afghanistan in 2004-2005. My website is www.armycombatmedic.com
patrick1rn has been a member since Feb '06 - from 'Indianapolis, IN'. Posts: 437 Likes: 287 You can find patrick1rn on Website
5,086 ViewsSep 3, '11 by emtmom66Thank you for what you did.Sep 3, '11 by patrick1rnThanks...Sep 4, '11 by ElvishAs a mother, thanks for saving another mother's daughter.Sep 5, '11 by patrick1rnI decided to go the FNP route instead of just the ANP because of this experience. I enjoy helping kids..Sep 5, '11 by emtmom66Good for you. After a bad experience as an EMT, I was totally terrified when I started my peds course and clinical rotation. I actually loved it. Even spent 2 rotations in the ED & 1 in PICU. I liked that babies most of all. Can't wait til graduation in December!Sep 5, '11 by cherryames1949Thank you for your story and your service.Sep 5, '11 by patrick1rnThanks Cherryames1949
This is my first time at writing a memoir. I felt that I had to record on "paper" what I did during the war. I took plenty of pictures and some video. Some of the lesser events are starting to fade. Its been over 5 yrs since I have been home from the war and I try to adjust back to life here in USA. Writing is one way to help me deal with things. I discovered that I like to type alot of blogs and replys and on facebook.. So why not tell my story. I felt that I should share one of my stories with fellow nurses..Sep 6, '11 by kcmylornI am currently a civilian nurse on a USA military base- I was given the priviledge of caring for your families while you soldiers are off to the war, to temporarily stand in here in the US for my military collegues while they were deployed. I have heard some of the remarkable stories of the depth and talent of my military counter parts. It is so amazing to take a med surg RN and train them for 1 month and turn them into a highly skilled trauma nurse. This has been the most wonderful nursing position I could have asked for. I have met and worked with some remarkable nursing leaders. The nursing leadership in the military is so far superior to the civilan counterparts.
Thank you for all you do. We are here taking care of your families while you are over there doing what you need to do.Sep 7, '11 by NiteQwillFrom one former Army Combat Medic (a decade) turned Army RN, thank you for your service.
I was in the other theater of operations during your time in Afghanistan and I can empathize with your experience. My experience as a medic helped drive me to be a better, best, sincere nurse. I too am currently in school for my FNP/ACNP because of similar experiences like you.