Chicago, IL. The evidence is mounting that the Allied ground offensive may begin at almost any time. Multiple small skirmishes and probes are being conducted all along the Saudi/Kuwait border. Marine amphibious units are at sea and along the beaches in the Northeastern part of Saudi Arabia, North of Khafji.
Marine General Neil, and Army Gen. Kelley say that the Coalition forces are ready to move as soon as President Bush gives the orders. Gen. "Stormin Norman" Schwartzkoph describes the Iraqi troops as being "demoralized" and "on the verge of collapse". The elite Iraqi "Republican Guard" has been pounded, both day and night, by B-52s and other Allied aircraft. Iraqi soldiers are defecting in droves and surrendering to American, Saudi, and other Coalition forces. Military strategists indicate that it may now be possible to launch the largest military offensive since the D-Day Invasion at Normandy.
Undoubtedly, there will be casualties; there always are in battles of this magnitude. The next question that comes to mind is what kind of medical care will the wounded Coalition forces receive? In order to answer that question and examine the state of emergency medical care in the Persian Gulf, let's follow a typical soldier from the battlefront through the process of care...
After crossing several small berms of sand that SGt. Smith's crew had already reconnoitered, they moved rapidly towards the rising smoke and sand that was evident on the breaking twilight. It was "0-DARK-thirty" when the men had been roused from their listening posts and tents to begin the early morning assault on the dug-in positions of the Iraqi troops.
As they approach the first anti-tank ditch, they note the digging that has been done by the combat engineer battalions and follow the track provided. It is marked with tape that is visible with their night-vision "Starlight Scopes". They also note that it appears that several mines have been exploded in the vicinity of their trail. As they rumbled forward, SGT Smith's Bradley begins to receive small arms fire from an emplaced position on his left flank.
The radio crackles, "Bulldog 6 to Redeye flight...Bulldog 6 to Redeye flight.....fire mission on an enemy bunker....what have you got??". SGT. Smith hears his Company Commander call the FAC (Forward Air Controller) and request an airstrike on the bunker complex to the company's left flank. The FAC acknowledges Capt. Lewis's request and advises him that two A-10As are immediately in the area. The famous "Warthogs" have a particularly lethal weapon's load. SGT Smith has seen the A-10 30mm cannon, which fires 2,100 rounds a minute, completely "chew-up and spit out" a Soviet BMP in practice AirLand battle training. Shortly, the two squat, ugly, sand colored jets streak in from the west and strafed and bombed the bunker complex. Firing from that direction ceases.
The Bradley is continually engaging small "spider-hole" size emplacements of troops who are using AK-47 Kalashnikov assault rifles. SGT. Smith's troopers engage the Iraqi troops through the firing ports on the Bradley. The gunner continually fires the 25mm auto-cannon at larger or more hardened targets. He hits a Soviet BMP fighting vehicle that becomes visable after rounding a small wadi (ravine). The radio crackles again, "BullDog 6 to Bulldog 3....Bulldog 6 to Bulldog 3...". "Bulldog 3" was SGT Smith's call-sign on the company radio net. SGT Smith picked up the mike and shouted over the roar of the Bradley's strained engine, "BullDog 3 to BullDog 6...Go!!". "BullDog 6 to BullDog 3...Dismount and engage that emplaced artillery battery at 45 degrees true" SGT Smith answered, "Roger..BullDog 6...Wilco...BullDog 3 out".
SGT Smith and his squad dismounted at a run. They were heavily armed to engage the enemy infantry that was protecting the artillery and missile launchers. The Squad carried an M-60 Machine Gun, two M248 Squad Automatic Weapons (SAW), and modified M-16A2 rifles which included the 40mm Grenade launcher in the M203 configuration. Rifle rounds and mortar fire were striking the sand near the squad. As SGT Smith and PFC Andrews crawled towards the safety of a nearby wadi, the now familiar sound of AK-47s increased in intensity. Suddenly, PFC Andrews was thrown up in the air as a mortar round impacted near his position. SGT Smith screamed for the squad medic! "Medic...Medic...Medic to the front!!!"
As Spec.4 Brown crawled towards them, SGT Smith withdrew the trauma dressing from PFC Andrews web-gear. He placed it on an angry wound in the young PFC's chest. After noticing that it was "sucking" air, SGT Smith removed the plastic wrapping from the battle dressing and placed it on the wound first, before securing the `tails' of the dressing. SGT Smith knew that this would stop air from entering the chest wall and keep the lung from collapsing. As Spec.4 Brown scrambled into the wadi, he noticed the proficient method that SGT Smith had used to sealed the chest wound.
Spec.4 Brown had recently completed the new U.S. Army Emergency Medical Technician (EMT) program at Ft. Sam Houston, Texas. It was similar to that taught to civilian ambulance attendants in urban America, but focused on those skills needed to treat the traumatically injuried victim. In that program he had learned to assess and stabilize battlefield casualties prior to them being transported to field hospitals or hospital ships. SGT Smith yelled to Spec.4 Rodriguez, who was carrying the squad radio, "Hey Sammy...get on the horn and get us a `Dust-off' for Andrews!" Specialist Rodriguez knew that SGT Smith was asking for an "BlackHawk" or "Huey UH-1H" aeromedical evacuation helicopter,that had become so familar during the Viet Nam War, more than twenty-years before.
As Specialist Brown checked Andrews vital signs, SGT Smith assisted him in bandaging several lacerations and assessing his level of consciousness. It was extremely likely that PFC Andrews had suffered a concussion and loss of consciousness. With his major shrapnel wound to the chest, Brown knew that Andrews was a priority patient; he needed decompression of his chest and intravenous therapy at the earliest opportunity. Specialist Rodriguez was attempting to call in the "Medivac" helicopter, but was told by the Battalion Radio net that "it is too hot in your AO (Area of Operations)... "we've dispatched a `Medic-Track' to your location for extraction of your U.S. W.I.A. (Wounded in Action)".
Soon an M-1 Tank and a M-2 Bradley with large Red Crosses on the side came into view. PFC Andrews was placed on a stretcher and lifted into the mounting brackets inside the specially designed and equipped tracked vehicle. The Bradley reversed his course and moved back towards Saudi Arabia. SGT Smith and his men watched as a flight of F-15E "strike Eagles" strafed the artillery detachment and destroyed a large cache of ammunition. SGT Smith and his men returned to the battle. PFC Andrews had entered the U.S. Army Emergency Medical System.
While travelling at 35 m.p.h., the Bradley medic checked the battle dressings that had been placed on PFC Andrews. He re- calibrated an Intravenous-line of Lactated Ringers in Andrew's arm and repositioned a burn dressing on his leg. He also administered an ampule of morphine to the now moaning Private First Class. Soon, the Bradley arrived at a marked flat area that was approximately 10 kilometers from the actual fighting. Several UH-60 "Blackhawk" aeromedical evacuation helicopters were arriving and departing the improvised "chopper pad". Several men were standing nearby and talking on UHF and VHF radios, coordinating the destinations of patients that were being collected here from several points on the battlefield. A large security contingent of Saudi and British Infantry Fighting vehicles were guarding the perimeter.
PFC Andrews was quickly assessed by a "triage team" of a doctor and two nurses. The Physician inserted a " one-way dart" into the intercostal space above Andrew's lung injury in order to insure that the lung would not collapse. An additonal I.V. was inserted into his other arm and oxygen was given to Andrews. After initial triage, Andrews was found to be losing consciousness from an internal loss of blood and shock. The Doctor inserted an airway, put on an anti-shock garment and directed the badly injuried PFC toward the next "out-bound chopper". As the Aircraft Commander gathered the collective and kicked the high performance "Blackhawk" into a hard right bank, the co-pilot was clicking in the appropriate radio frequency for the 85th Medical Clearing Hospital (Commonly known as Med-Base America).
After establishing the radio link, the co-pilot turned the radio traffic over to the flight medic who was attending three patients in the rear of the helicopter. "Go ahead Doc..give them a progress report", the chief warrant officer intoned into the on-board intercom. The flight medic acknowledged, "Roger that Mr. Goff...Dustoff niner-seven-five to Med-Base America...we are inbound to your location with three W.I.A.s, two of which are flesh wounds and lacerations...I also have a sucking chest wound with a loss of consciousness..he is rousable by pain..has two I.V.s and M.A.S.T. suit, his chest was decompressed by a doc at the forward clearing station....Do you copy Med-Base??". The radio squaked, " Roger.. Dustoff niner-seven-five...what's your ETA (Estimated time of arrival)?". The medic responded, "Med-Base...we are approximately 1-Zero minutes from your location". "Roger...niner-seven-five...we have a bed for you...Out!".
As the powerful twin turbine engines pushed the rotors that beat the hot desert air, the flight medic rechecked each of his patients, with particular attention for PFC Andrews. Just as he was completing his reassessment, the intercom crackled, "Doc..we're zero-two minutes from touchdown...anything else?". "Negative, Chief....we got it", he said as he and the crew chief began to prepare to unload the the stretchers. The helicopter settled gently to the ground. A knot of doctors, nurses, and medics gathered at the door to help unload the patients. They are quickly moved into inflatable and tent triage centers. Doctors and nurses move quickly around them and reassess the status of the patients and decide in what order they need to be taken to surgery.
PFC Andrews is getting hypotensive, but is essentially stable. He is chosen for immediate surgery, stripped, washed and prepped for surgical intervention. A suction device is attached to a chest tube, which will be then be inserted into Andrews chest. Exploratory surgery of his abdomen and chest will insure that he doesn't have any internal bleeders that might threaten his recovery. An experienced trauma surgeon and medical team will monitor his vitals and the extent of his brain injury. He will then be closed and given antibiotics to prevent infections. If his burns require immediate grafting, they will be given preliminary debridement and enmeshed in a protective covering.
PFC Andrews will be continually monitored until he is stable enough to be transported to Riyadh or another major airbase for a U.S. Air Force MAC (Military Airlift Command) flight out of the theatre. It is likely that he will then be taken to Italy, Germany, or another Coalition country for more extensive care and rehabilitation. It is possible that he will be transported directly to the United States, if his medical condition permits. Once there, he will enter the AU.S. Military hospital system, the Veterans Administration Hospital system or the National Disaster Medical System and be placed in a civilian hospital bed that is contracted for by the U.S. Government.
PFC Andrews was extremely lucky and was provided with a system of military medicine that has learned a great deal from the civilian practice of trauma surgery. The concepts and experience learned on the "mean streets" of New York, Washington, Chicago, Los Angeles, and other urban areas may have helped the wounded soldiers of "Desert Storm". Many physicans who practice in civilian trauma centers have been recalled into the reserves for the duration of the conflict and practice those skills that have been "honed" by treating high-velocity gunshot wounds caused by "drug-wars" and other domestic violence. These skills would seem to have been life-saving for PFC Andrews and other "Desert Storm" participants.
(c) EMERGENCY RESPONSE & RESEARCH INSTITUTE
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ABOUT THE AUTHOR:
Clark Staten is a U.S. Army veteran and former member of the 407th
Medical Company (Air Ambulance), former policeman, and
the author of "Emergency Response Guide To Terrorism". Mr.
Staten is an EMS District Commander for the Chicago Fire
Department and a Frequent lecturer on the history, tactics,
weapons, and political implications of world-wide Terrorim.
He has taught the U.S. Army, U.S. Air Force, law enforcement
agencies, and other emergency responders from throughout the United States.