4th Flight (Or Planes, Trains, and Automobiles...)

Had my 4th flight last night, an Iraqi with a messed up leg and hand from a bomb. Took him to Al-Assad (Army hospital Level III), the first nurse from our group to go to their new facility. Normally the helicopter that takes us to the hospital brings us back, not this time. Due to an oversight in paperwork (that no one knew we had to do anyways), a return trip was not officially requested, so it was not provided (Go Army!!). After 6 hours, 3 military bases, a ride in an ATV, SUV, Pick-up truck, CH-46 and CH-60 helicopter, I made it back to my room at 2AM. Originally they were going to have me stay overnight and fly back the next night, but through cajoling, bullying, and several helpful people, I made it back the same night. Patient was fine, no problems.

A Trip Around the Base

In case you would like to see what I'm seeing around here...

3rd Flight (1st Day Flight)

Had my 1st day flight, took a 12 year old Iraqi boy that was coming out of school and happened to walk into the middle of a firefight between Iraqi Army and Insurgents. He was shot in the left flank. The Surgeons had to remove a kidney and part of his colon, worst part is he was unable to move anything below his waist, paraplegic. Took him to Balad, no problems. No one even shot at us, I'm feeling that the bad guys don't feel I'm a worthy target, rejected by the enemy. ;)

Photo Op with the Helos

Here we are, by a CH-46, flown by the Marines. The group photo is of the 6 nurses here that fly the Enroute Care missions. We will be recieving another 3 ERC nurses this week, as Al-Assad is closing down due to the Army opening up a level 3 facility to replace our level 2 that is there. From left to right, we have me, LT Kurt Giometti, LCDR Robin Cross, LT Lora Martin, LCDR Lew Dyer, and LTjg Mark Laquihon. The Original 6.

Doc and Me

With me is Sean Barbabella, one of our two ER docs. We worked together at Portsmouth a couple years back. Sarah said I need to put more pictures of me on here... As you can see, my hair is getting shorter and shorter with each time I go to the barber.

The Chow Hall and Parking Lot

I'd imagine that thess are not the types of vehicles you normally see in a parking lot. The chow hall is the large building with the double roof, there is a layer of sand bags in there to help protect against incoming mortar rounds. The chow hall has extremely good food, every Wednesday is steak and lobster, frequent stir fry, and an incredible dessert area (I'm avoiding that one until I lose a few more pounds). The majority of the service staff are civilian contractors from other countries, India and the Phillipines are well represented.

2nd Flight (Solo)

I had my 2nd flight early Wednesday (1am), an Iraqi Police that was shot in the chest. The surgeons opened up his chest, tied off the bleeding vessels in his lungs, and gave him to me to take to Balad. The transport was busy, but smooth. With help of our Anesthesia staff, I was prepared to give blood and many medication enroute to keep the patients blood pressure up. Balad is an Air Force level 3 facility, I'm at a level 2. This means they have more logistical support, more staff, and more specialists. From the level 3 they are flown out to Germany (Americans, not Iraqis) if needed. Balad is a tent structure, compared to Baghdad's actual hard structure. Baghdad is an Army facility.

Not Just Humans….

We care for working dogs here, they hold rank, just like the rest of us, and they receive the same care we do. If needed, we will take them into the OR to provide any care we can. This was a particularly tragic situation, as the Marine handler and the dog were both the victim of an IED, the dog was the only one to survive. The blood on the ground is from our furry patient, the bandage over the muzzle is for injuries, not as a muzzle. Canines are used in many roles here, from security to sniffing out IEDs/bombs to keep the rest of the unit safe.

Read About Us in the Media...

www.stripes.com/article.asp?section=104&article=44425
(You will have to cut and paste this into your browser, I'm having difficulties getting an automatic link to work)

Here is a news article in the Stars and Stripes, I'm in one of the pictures. The one in the ER, 3rd one down. I'm on the bed on the right, face to the camera. The online photo is smaller than the one in the actual paper.

No Joy

Yesterday I was primary flight, meaning I'm 1st up for any flights. Not a thing came in. I'm like the anti-black cloud, I bring peace and quiet wherever I go. Good for the people around here, not very exciting for me. I guess I will have to continue to poach the other nurse's flights.

Preparing for the Mass Casualty

Dr. Kane (also of Great Lakes) catches a quiet moment before a group of 10+ injured arrives. We are able to set up and man beds for over 10 casualties at a time, more if needed.

IED Class

We all attended a class on Improvised Explosive Devices, very eye opening. After a short lecture, we were taken as a group through a path in a junk yard, trying to find the IED's along our way. We didn't find many before we 'died'. The wheelbarrow is an actual Haji rocket launcher that was attempted to be used against troops. Rockets were in the tubes on the side. We have missiles that can be launched hundreds of miles away, and fly into a particular window of a particular house, they have wheelbarrows with rockets.

Revenge

Here is a pic of the Cobra Attack helicopter, it provides escort coverage for all of our flights.

The First Video/Slideshow...

This is my first, fledgling, attempt at making a slideshow. It's nothing fancy, but might be worth seeing. I hope to do more with this type of thing in the future, now that I know some of the basics. Click on the Play button.... (for slower connections, click on the play icon, then click the play/pause button in the lower left corner. Walk away for a while and let it load the video before you press the same play/pause button.)

Cherry No More

My 1st Solo Flight!!
Here is my patient, wrapped and ready for transport. We call the package a 'hot pocket'. It is a body bag with a self-warming chemical blanket, foil blanket, and a couple wool blankets, all wrapped around the patient. We cut flaps/hole in different areas of the bag for access to the patient. It has been found that keeping the patient warm is essentail, especially when flying. This method is very effective in keeping them warm. On top of the patient is 2-3 oxygen tanks, a portable ventilator, propack vital signs machine, at least 2 IV's with bags of fluid, and lots and lots of tubing. All taped down to avoid getting caught on something when loading or unloading the helicopter. I'm wearing a cranial (helmet), and a flak vest with SAPI plates, I'm not sure what the official weight is, but I'm guessing around 40 pounds. The little blue thing on my vest is my light, that's all I have to see with in the back of the helo, very dark during the night flights.

Last night (Wednesday), was my first solo flight. A group of Iraqi’s were hit by a mortar round, my guy had a piece that hit his neck, cutting the right carotid artery. The vascular surgeon here took a piece of vein from his leg, patched it into his neck artery, then I flew him in a CH-60 Blackhawk to Baghdad. Seamless flight, no problems. Night flights are the best, safest. Started dealing with this patient around 1800, finished and crawling into bed after midnight. Day started around 0530. Up early the next morning for my duty day. Wednesday we had several groups of injured, largest was 13 patients, of which my guy was one of. Total of 4 flights that day, Lou Dyers (senior nurse) had 2, Kurt had one, and I had one. My flight was actually supposed to be Kurt Giometti’s, but I was antsy to get my first, so I took his 2^nd. No problems, gave my patient plenty of medications to keep him unconscious, Baghdad is a large hospital. I think it had marble floors, the Army were pretty cool, I got three regulators for our oxygen tanks, those things are next to impossible to get, and they gave me some replacements we had left there a couple weeks ago. Hard to believe we have only been here 2 weeks, feels like 2 months. And yet each day passes so quickly. Maybe it’s because so much happens each day, it is hard to remember what started the day. I can only remember around 2 significant events a day, and we seem to hit that by noon.

The next day (Thursday), an Iraqi family was brought in, mom and ~9 year old son injured by a mortar round that was aimed by bad guys at a police station, hit their house instead. The boy had a deep cut to his nose, down through the turbinates, ~1 inch deep straight in. Lots of future plastic surgery to repair needed. Mom had a piece of shrapnel that went through the front of her right shoulder, small hole up front, big hole in back where it blew out. The surgeons (all 5 of them) worked together for ~2 hours to save a life. One of the more impressive things I’ve seen medically. The artery that supplies blood to the right arm was severed, they could not find the artery to tie it off, they 1^st tried to get it by cutting out her right clavicle bone, then they ended up removing her right arm at the shoulder to get to the artery, and because of the initial damage to the artery, that arm was not going to survive with out the blood flow anyways. Life over limb. Successful. Her heart stopped multiple times, her chest was cracked open and internal defibrillations given. 16+ units of blood given, which is almost more than we carry here. The walking blood bank was activated, meaning we call out to the base for donations. They walk in, we get whole blood from them, then give it to the patient. ~15 military people coming to give blood to an Iraqi. Robin Cross was the flight nurse, we loaded the mom and kid into a helo, they took off, then returned 10 minutes later, sandstorm. Helo’s are unable to fly in sandstorms, we had to call in a C-130 plane, which can fly in most any weather. They left around midnight. A huge plane, just for our 2 patients. We try just as hard on every patient, American or Iraqi.

Loading the Bird

Here are 2 of my fellow nurses with help loading their patients onto a CH-46 helo to transport to another hospital. They each have a patient on a vent to monitor, and a couple other patients that are walking wounded that tag along for the ride. The patient is wheeled near the helo, than carried into and locked in place. The nurses will continue to monitor the various equipment, often giving medications to keep the patient unconscious and pain free. Maintaining the equipment in the helo can be a challenge, in the 46 the doors and windows are open, creating a wind tunnel. It is impossible to hear anything, so your patient assessment skills have to evolve to the new environment (no stethescope to check lung sounds). You can see the tail gunner, there are also 2 more door gunners, one on each side. Following each transport is a helicopter gunship known as 'Revenge', since they will eliminate any one that shoots at the transport helicopter. I'll try to get a photo of them soon. We have done a total of 10 transports so far (I'm still at one), several of those transports had 2 patients or more at a time.
Yesterday we transported a family of 5, 2 parents and 3 children that were in an auto accident, 2 of the children required a nurse since they were intubated. We hear all are doing fine a day later.

TQ Surgical

This is where I spend my days (and often nights). It has a large ER, 4 Operating rooms, 8+ bed ICU/PACU, 3 Wards (1 each for American, Iraqi, and Bad Guys), and many other supportive function areas. It is located right next to the flight line (to the left side of the picture). It is not too far from my can (berthing).

My First Flight

Flew last night in a H-60, an army Blackhawk. Took an Iraqi to Balad, didn't see Jake Drueke (Co-worker at Great Lakes), uneventful night time transport. A lot more water around here than you'd think. I was the 2nd nurse on the transport, just an observer. I look sweet in a flight suit with pistol in leg holster.

My Can

Here is my Can, I have the bed in back. They are pretty nice, better than tents anyway. there are large concrete walls around every group of cans, after walking around in them for a while you feel as if there were a block of cheese somewhere, and we were being timed to find it in the maze.

The Flight to TQ

We flew in a C-17 from Kuwait to Iraq. I managed to get the very last seat lining the side, so I had plenty of leg room, but the Army group that got on after us weren't so lucky. You can see them squeezed into the middle. Very uneventful trip, I woke up after we landed.

I'm Here!!

Got here yesterday am (Thursday), spent the day mostly comatose from being up 30+ hours in a row. The place seems OK, much better than the worst it could be. I do have a feeling of (relative) safety here. Going to visit the Hospital today, start the orientation process. I will post photo's of everything soon, I need to get more organized first.
The trip went well, flew in a large military plane. More to come....