I am counting down the last 10 days or so until I go home. I cant wait. Its been a blessing to serve, but this six months has been hard. Just lask week a medic I trained was my patient, and another medic I knew was shot in the head and died. I need some time to reflect and be with my family. Michelle Racicot, Aug. 16, 2009
Army Capt. Michelle A. Racicot, RN, was sent to Afghanistan this past spring, shortly after newly elected President Barack Obama decided to send 21,000 more troops there to quell a resurging Taliban. She was sent to two forward operating bases to set up small, mobile surgical teams referred to in military terminology as an FST (forward surgical team).
An FST is a group of specially trained nurses, doctors, and medics who can operate on wounded soldiers closer to the frontline, stabilize them, and then transfer them to a battlefield hospital for further care.
The FST Racicot set up at FOB Ghazni was part of Secretary of Defense Robert Gates new mandate that there be an FST with medical evacuation capabilities in each province in Afghanistan so that every wounded soldier, Marine, and airman would receive advanced trauma life support within an hour of being injured, as they do in Iraq. Gates said he knew that with an influx of service members, and a tough, tenacious enemy, there would be an increase in deaths and injuries among U.S. and coalition troops.
His prediction was correct. As of Oct. 23, there have been more U.S. military deaths in 2009 253 than in any year since the U.S. went into Afghanistan in 2001, according to www.icasualties.org/OEF/. There were 155 U.S. deaths last year and 117 in 2007. August proved the deadliest month so far with 77 U.S. deaths. There were 70 deaths in September.
I know that we save a lot of lives, Racicot wrote in an e-mail Aug. 23. And our FST is known for our skill so if in flight [medevac team members] have issues with patients crashing on them, they will stop and have us evaluate them in emergencies. I also know that having our FST here enables patients to be seen and do damage-control surgery. We can save lives of soldiers who would die if they had not stopped for care at our FST first.
FOB Ghazni is in eastern Afghanistan, not in the southern part of the country in Helmand Province where the heaviest fighting takes place. But heavy fighting occurs near Ghazni, as well, its just not reported, Racicot said in her e-mails. The violence, she added, increased leading up to the national Afhghan elections this summer.
We had a badly injured soldier the other day. He was in a convoy and his MRAP [mine-resistant, ambush protected] vehicle was hit with so much C4 [plastic explosive] that the force of the explosion caused a degloving of his sacrum and shattered his coccyx, Racicot wrote. He was in severe spinal shock. We had him on Epi and Vasopressin. After we transferred him to BAF [field hospital in Batgram], I went to the showers and cried. I think it is time for me to have a break, but then I feel like I need to stay and care for our soldiers.
Racicot returned to the U.S. on Sept. 6. She is now assigned to Brooke Army Medical Center in San Antonio.
Racicot is only one of the many nurses, physicians, medics, and corpsmen who have accompanied the thousands of additional service members heading to small outposts in Afghanistan. These highly trained medical teams are as important to the fight as the counterinsurgency tactics that soldiers and Marines will use against the Taliban, said Col. Susz Clark, RN, the second in command of the Army Nurse Corps and the former top Army nurse in Iraq.
Combat healthcare is proving to be an important weapon system in its own right, says Clark, deputy chief of the ANC and, from 2007 to 2009, chief, clinical operations/deputy commander for nursing, TF 62 Med, Baghdad.
Although it may seem incongruous to describe medical care as a weapon, Clark explaind that the medical units caring for the wounded in the counterinsurgencies in Iraq and Afghanistan need to be as flexible, agile, quick, and adaptive as combat troops in these unpredictable environments. (For more about Clarks concept for a new, smaller, and more mobile medical unit, see sidebar).
Based on her experiences in Iraq during the 2007 surge when thousands of additional troops were dispersed to small outposts in Iraqi villages, Clark learned medical units needed to be even smaller and more adaptable, she said in a phone interview with Nurse.com.
When Racicot arrived in Afghanistan this past spring, she was asked to set up a fully functioning FST in less than three weeks with minimal supplies, equipment, and personnel. The team had less than half of the 20 personnel that usually comprise an FST.
She also had to integrate, assess, and train a Polish medical team also located at FOB Ghazni. Integrating the Polish team with our team proved to be a work in progress, she wrote. With each trauma and a resulting after-action report, we have improved our trauma process.
Many times the wounded who are transported to a U.S. medical unit are not American or coalition soldiers. Instead they are Afghan men, women, and children, who have been hit by rocket propelled grenades, improvised explosive devices or land mines, as Racicot learned.
I had an interesting moment one day when I was filling out an application for a masters degree program. One question asked, Briefly describe your experience working with cultures other than your own. Before I could type my response, I was asked to fly with the medevac team to evaluate three pediatric patients hit with shrapnel from a rocket propelled grenade. We flew to a remote FOB, and I was greeted by one of the Polish medics who attended my classes.
One of the children had an eviscerated bowel and was having shortness of breath and nausea. While I was covering his wounds and drawing up medication to give him, he would not let me let go of his hand. I later learned that he did not survive. It was a reminder that even with all we can offer with medicine and surgery, sometimes it isnt enough.
Janet Boivin, RN, is a senior staff writer for Nursing Spectrum and NurseWeek magazines.