K-9 Flight Gear

This K-9 has been outfitted with his very own goggles for flight.

This picture was taken at a base northwest of here.

Hey, I didn't say it...

Clothes Donations

Last weekend we spent over 8 hours organizing all the clothes donations that we have recieved. What you see here is only a fraction of what we have. When patients (military, civilian, adults and children) are brought to us, their clothes are often already destroyed, or cut off by us. This is so we can quickly evaluate what is wrong and where the injury is. With these donations, we are able to outfit the patients with clothes to wear when they leave us. Along with clothes, we have been recieving toys for the children, who are very appreciative.
We have not been seeing as many civilians as we used to, so we plan on giving any extra clothes we have to some of our military members who have contact with the Iraqis, so all clothes will be used.

Baghdad Mosque

The picture is a little fuzzy, it was taken through a dirty helicopter window. This is a HUGE mosque in Baghdad that is under construction, you can see not all the domes are in place. It is hard to see, but just look at the size of the building in comparison to the other buildings around it. Some of them look to be ~5 stories tall, but they are tiny in comparison...

Iraqi Ambulances

The ambulance below reminds me of the one from "Mother, Jugs and Speed", which only EMT's will understand the reference...

Update on Helicopter Safety in Iraq

Here is an article (CLICK ME) in today's USA Today on the spate of Helicopter incidents when we 1st arrived here, and what has been done to make our flights safer.

Stars and Stripes Photo

Here is a picture that was printed in the Stars and Stripes article in the 1st couple weeks we were here (see March 20th).

All of Us

A penny if you can find me...

Ward Meeting

Each morning the Nurses and Ward Corpsmen meet for patient turnover and to hear whatever may need to be passed. There were no patients on the ward, so we met here versus our normal location in the building
Recently our ward census has been very low, I hope this is a reflection of the improvement in the local area as it becomes more and more controlled by those Iraqis interested in developing their country peacefully.

10th Flight

Had a rather unique transport recently. I escorted an Iraqi VIP with significant recent trauma, in both a helicopter and a large airplane, in order to get him to a neighboring country. This was so he could receive a higher level of care in a civilian hospital. I have few pictures I can share, but the country I took him to looks just like Iraq. All Sand.
The flight involved 4 bases, one helicopter, one C-130 plane, and 7 hours. The picture is from the C-130 enroute to our destination.

NASCAR fan

This is a picture of one of the helicopters here, the pilot is obviously a fan of Dale Earnhardt Jr. Normally the Commanding Officer's helicopter is numbered '00', but when you are in charge, you can change things up. Along with the number, the major sponsors for the car are included, and inside there are chrome kickplates. I have never seen chrome on a helicopter before, it was apparent that the flight crew took great pride in this bird.

Touring a Helicopter

Part of our quest to qualify for the Fleet Marine Force Officer Qualification is to get signed of on being introduced to a helicopter, and being taught how to properly egress in event of emergency. Boy, somewhere in my Flight Nurse Training I think this was covered...
Here I am with LT Stuart H in the back of a CH-46.
We started on the same ward at Portsmouth, Virginia 6 years ago. Small Navy.

And it's still May.....

A Bird's-Eye View of Iraq

I think I'm getting a little better making these things...

9th Flight

Had my 9th flight last night. Took an Iraqi Army guy to Al-Assad. He had a gunshot to both lower legs, the surgeons did a great job restoring circulation to his feet, which the initial injury had interrupted. Flight was smooth, no problems.
The heat has really come to the forefront when planning for how we package out patients for transport. When we first arrived here, we needed to take action to keep our patients warm. Now, just being outside will warm our patients, even in a helicopter with the doors open and strong draft. If you would like to simulate riding in a helicopter, I'd suggest sitting in front of 4-5 hair dryers, and turn them on (on low for a night flight, high for a day flight.) After sitting in front of them for ~30 minutes, you have now simulated a flight.

Yellow Air

About 2 weeks ago we had some high winds during the day, which in the desert means a sandstorm. After the winds died down, this is what it looked like outside. Quite unusual, I have never seen yellow air before. It is around 4:30 in the afternoon, several hours before sunset.

Welcome to the Desert.

And it is only May 6th.

The Nurses of TQ

It's a girl!

Huey brings a patient

Here is a picture of the 3rd kind of helicopter that brings us patients. I believe the official designation is UH-1, and has been around since Vietnam. We do not do any Nurse flights on this bird.

TQ Night Life

A group calle Bandshe stopped by to give a concert for the base. MWR (morale welfare recreation) does a pretty good job around here keeping different events available to keep busy. From bringing in the occasional band, having footbal players stop by for autographs, movie nights, sports tournaments, etc.

8th Flight

Had my 8th flight last night. Took an Army Soldier that was hit by an IED, amputated left leg at the knee, and a head injury, to Balad in a Blackhawk. Flight was busy, but smooth.

Trying to Speak the Language

I'm trying to repeat some of the Arabic medical related phrases I have written down in my pocket brain, must of worked because he understood what I was trying to say. That didn't stop everyone from making fun of my (successful)attempt...

Ask for a nurse and this is what you get - Paperwork and Needles

Here is LT Vince Johnson and myself, ready to do what we do best.

TQ Surg In Action

Here is a picture taken during one of our mass casualties. If you look closely (click on the picture to see a larger image), you can see the bottle of milk on the 1st table belonging to the child being treated there. There are only 4 patients at the time of this picture, we have had as many as 16 at one time. It looks a little chaotic, but every person has a job, and everything the patient needs is addressed. Prior to our arrival here, the previous group had a mass casualty of around 60 people at one time, so we try to be prepared for anything.

The Twinkie

Here is a good photo of where we work, Al-Taqaddum Surgical. One of the staff members showed this photo to his son, who then said "Dad, you work in a twinkie". A new name for where we work was born.

7th Flight

It has been a very busy couple days.
Thursday we had a mass casualty of 15 patients after a dump truck exploded at an Iraqi checkpoint. 1 American and 14 Iraqis came through our facility.
Friday we had 9 patients come in at once after another vehicle borne IED. 1 Iraqi and 8 Marines. 8 of the patients were flown out to a higher level after initial stabilization, 6 of those needed to be accompanied by an ERC Nurse due to being intubated and relatively unstable. 2 nurses took 2 patients each, quite an impressive feat when you consider that 1 patient tends to keep you busy for the 25-40 minute flight, and 2 more nurses took one patient each.
I took a Marine with severe trauma to both legs, an arm, abdominal trauma, and facial fractures. Flight went smoothly, I was in an Army Blackhawk, and they flew at a low altitude the entire trip to Baghdad. Lots of maneuvering, one of the best rides (in a rollercoaster type point of view) that I have had yet. It was a day flight, evening specifically, so ground fire is definitely a concern. I do not know if we were actually shot at, but the flares went off several times when we got near Baghdad. Flight crew didn't seem overly concerned, which is a good indication I did not need to be either.

In the News...

Please follow the link for an article about Navy Enroute Care Nursing with quotes from 2 of our nurses here at TQ.

Volunteer Navy Nurses Serve as Skyway Angels

or cut and paste the following address into your browser address bar:

http://www.usmc.mil/marinelink/mcn2000.nsf/main5/92253599E321409A852572C200170567?opendocument


And here is the text version without pictures:


Marine Corps News

Volunteer Navy nurses serve as Skyway Angels

April 19, 2007; Submitted on: 04/19/2007 12:11:27 AM ; Story ID#: 200741901127

By Cpl. Wayne Edmiston, 2nd Marine Logistics Group



AL TAQADDUM, Iraq (April 19, 2007) -- The Merriam-Webster Dictionary defines an angel as an attendant spirit or guardian.
In famous art, artists often depicted angels as human-like beings, with white robes and wings, serving as transporters of messages from other celestial beings.

Many seriously wounded service members in Iraq can testify angels aren’t always dressed in white. Several wear tan flight suits and their wings are merely the rotors of soaring aircraft.

These particular angels remain faithful to the Merriam-Webster definition by serving as attendant spirits, as well as guardians – guardians of life.

These guardians are called en-route care nurses and fly onboard casualty evacuation helicopters to stabilize and monitor patients being transferred to a larger treatment facility.

When Operation Iraqi Freedom first started, patients were often accompanied by a hospital corpsman, or no caretaker at all. Medical professionals in Iraq knew there had to be a change.

Lieutenant Cmdr. Troy L. King, an enroute care nurse with Al Taqaddum Surgical Detachment, 2nd Maintenance Battalion, 2nd Marine Logistics Group (Forward), was one of the ground level participants when nurses began jumping aboard with flight crews.

In 2004, medical personnel realized that in-flight patients were not receiving the same quality of care that they would at established facilities, according to King.

“So they started flying nurses with them,” he said.

The nurses who initially began flying were, and even to this day are, volunteers. They volunteer to fly with patients without the extra flight pay and flight status other aircraft crewmembers receive.

Lieutenant Lora A. Martin, an ERC nurse with the detachment, explained the process the patient and nurse must go through prior to boarding the aircraft.

“The people we transport often are treated in the OR (operating room) because of how serious their injury is,” the North Platte, Neb., native explained. “Being in the OR is critical because that is where we get our most valuable information on our patients.”

During the flight, the nurse is continuously monitoring the patient’s vital signs, adjusting ventilators, giving donated blood to the patient, giving pain medications and keeping them stable.

The possibility of a breathing tube moving out of place or a power failure in the aircraft knocking out vital life-preserving machinery is one of many worries rushing through the heads of the nurses onboard, Martin explained.

This process can be even more difficult when flying over enemy territory where the risk of hostile fire can become a hindering factor, or at night, when the only light the nurses have to work by is the faint blue cabin light.

Once they arrive at advanced care facilities in Al Asad, Balad or Baghdad, they turn the patient over to the local staff and ERC nurses begin the trip back.

The job has obvious satisfaction. Seeing their patient arrive alive is always a plus, but not every story has a successful conclusion for these nurses, and some patients don’t always make it to the next echelon of care.

When the mission is accomplished, the patient often will never remember the nurse who kept them alive during that golden period, but the nurses often remember their patients.

“I have seen some of my patients in the news and there are a couple of patients I remember who I know are still alive,” said King, a Hemphall, Texas, native. “Patient survival is the most rewarding part of my job.”
-30-
The en-route care nurses of Al Taqaddum surgical stand in front of a UH-60 Blackhawk casualty evacuation helicopter here April 15. When Operation Iraqi Freedom first started, patients evacuated were often accompanied by a hospital corpsman, or no caretaker at all. Medical professionals in Iraq knew there had to be a change and began putting nurses on board. Photo by: Cpl. Wayne EdmistonThe en-route care nurses of Al Taqaddum surgical stand in front of a UH-60 Blackhawk casualty evacuation helicopter here April 15. When Operation Iraqi Freedom first started, patients evacuated were often accompanied by a hospital corpsman, or no caretaker at all. Medical professionals in Iraq knew there had to be a change and began putting nurses on board. Photo by: Cpl. Wayne Edmiston
A UH-60 Blackhawk casualty evacuation helicopter sits in front of Al Taqaddum surgical here March 26. When Operation Iraqi Freedom first started, patients evacuated were often accompanied by a hospital corpsman, or no caretaker at all. Medical professionals in Iraq knew there had to be a change and began putting nurses on board. Photo by: Cpl. Wayne EdmistonA UH-60 Blackhawk casualty evacuation helicopter sits in front of Al Taqaddum surgical here March 26. When Operation Iraqi Freedom first started, patients evacuated were often accompanied by a hospital corpsman, or no caretaker at all. Medical professionals in Iraq knew there had to be a change and began putting nurses on board. Photo by: Cpl. Wayne Edmiston

Enroute Care Nursing in Al-Taqaddum, Iraq

Team Nursing

Here are LT Kurt Giometti, LT Lora Martin, LT Patrick Harrison, and myself preparing a patient for flight. What you do not see here is all the Corpsmen that are intricately involved in patient care, without them we could not do what we do. It just so happens that all the nurses pictured above used to be Corpsmen before going over to the Dark Side.

Thinking of Home...

A New Photo of the Enroute Care Nurses

Here is almost all of us. All except LT Kurt Giometti, who couldn't make it for this photo.

6th Flight

Had my 6th flight early this morning, flew an Iraqi army guy that was shot in the chest to Baghdad. No problems. Got to see the sunrise while in the back of an Army Blackhawk, took many pictures that I'll try to put together later. I don't think anyone shot at us, but the flares shot off fairly often for a while (the flares shoot off automatically if the computer percieves a threat). The photos above are not from this particular flight, but from previous flights. Kurt Giometti is helping prep a patient for flight by pushing in some blood, I'm giving a medication to keep the patient paralyzed. The 1st photo is that of a Blackhawk.

Today's Pic

We did an interview for the American Journal of Nursing, many pictures taken. Here is one of them...

Flight #5

Flew my 5th patient last night in an Army Blackhawk, an Iraqi Army that was shot in the chest. I flew him to Baghdad, I have yet to see Baghdad during the day. Other nurses say it is a pretty city, I'll have to wait...
The flight went smooth, from Baghdad, we flew to Tikrit to drop off another stable patient. That was over an hour to there, then back to TQ. Total 3 hours from when I left to when I got back. I got back around 2am, which worked out well that I could call home at a decent hour for Sarah, I'm 9 hours ahead of Central time.

Happy Easter

Hope you all had a happy Easter. We had a fairly slow day up until around 8pm, when 5 Americans and 3 Iraqis came in after an explosion hit a convoy and a building nearby. All that made it to us will be fine, I regret that there may have been some Iraqis in the collapsed building that didn't make it to us.
For the most part, every day here is just like the one before. Hard to tell what day of the week it is without a calender. Kind of like that movie, 'Groundhogs Day'. Who new Easter fell on Ground Hogs day?

Mark Green, one of the nurses in Ramadi, spent the day with us when his ride back was delayed. From Left to right: Lew Dyers, Mark Green, Me.

Follow up

The 12 year old I flew last week returned to us from Balad, he is doing much better. He and his father are very grateful for the care he recieved. He is paralyzed from the waist down from the bullet, but his one kidney he has left is working well. He went home yesterday afternoon. We hear from our Iraqi translators that they are seeing a shift in the attitudes of many of the local population. The translators have been here for a while, and have said that they now see that the local population wants to be seen at our facility if the are sick/injured, whereas before they did not trust us when we first arrived. Some have said that they now see that the bad guys are not doing what they promised to do for the local population.
This is all anecdotal, I have not yet had any personal conversations with the Iraqis about this, but I do see how grateful they are to recieve the care we give them, like the father (who is a teacher) of this 12 year old.

Pics from the 3rd Flight

These are pics from the one day flight I did, the one with the 12 year old. You can see what our patients look like when strapped into the helicopter. We use several different medications to keep them unconscious and paralyzed, mainly to avoid further injury, or re-injury of what the Surgeons just fixed. We are breathing for them, with a small portable ventilator strapped onto the stretcher with everything else. You can see the door gunners in another photo, and what it looks like out the back door, which remains open during the flight. The last photo is during a temporary stop to get fuel on the way back.

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.