Short stories, Travel and Health Information
The unexpected shell scored a direct hit on the Resuscitation Bay.
One moment the team was hard at work, resuscitating the wounded soldier on the stretcher table – and the next there was just dust and smoke and the smell of burning.
“Sergeant David!” the Medical Officer called out from where he was lying “Davo!”
They had been expertly working on the injured soldier who had been brought in, several minutes ago, by the stretcher bearers. Just as the manual described – with the nursing officer Liuetenant Libby White at the head of the bed squeezing the ventilator bag that pumped oxygen through the plastic tube that went through the patient’s throat into his lungs, the two medics Bernie and Stuart on either side of the patient deftly inserting needles into the patient’s forearm veins to inject drugs and run in intravenous fluid, Sergeant David doing the task of scribe by acknowledging and writing down on the white board each new drug or procedure and Major Reid the medical officer standing at the foot and slightly to the left of the bed directing proceedings.
It did not always happen as the manual prescribed. More often than not the Major Reid was in there getting his hands dirty – taking over a difficult situation, doing a cut down to get a drip into a shocked and collapsed soldier, putting an intercostal tube to drain a damaged chest of blood and trapped air. But his team – the group that he had encouraged and nurtured from the time he had first been appointed as their “Doc” – was well trained, having rehearsed these scenarios over and over “by day and by night and by wet and by dry” so that they could successfully do it in sun, rain, dusk or dark whether in peacetime and in wartime.
And he had made sure that everyone of them could at a pinch undertake everyone else’s task, so that instead of boringly functioning as assembly line workers they could take responsibility for becoming good at tasks over and above their own. Which other Health Support Company could boast of a sergeant who could close skin wounds with such neat subcuticular stitches that would be he envy of any cosmetic surgeon – or a corporal who could confidently intubate a baby?
“I’m over here Sir” he heard Sergeant David’s voice, in that strong Scottish accent that nineteen years in Australia had not been able to change.
Sergeant David and Major Reid went back a long way. When he had started his career in the Army as a young Regimental Medical Officer or RMO, not long after finishing medical school and the specialist service officer training course at the Royal Military Academy in Duntroon, it had been Corporal David who had been his first ‘RAP Medic’ – the experienced soldier who, trained as an Army Medical Technician, had managed his Regimental Aid Post with unflappable efficiency. Not only efficiency but also tact – David had mastered the technique of telling highly qualified but quite inexperienced Captains under whom he was tasked to work as a subordinate what to do without making them feel that he was telling them what to do.
It would be true to acknowledge that young Captain Reid had leaned most of what he knew about Army medicine from Corporal David.
At the end of their two years working in that RAP they had both been posted to other units – but five years after that, both one step up the ladder of promotion, they had come together once more at the Health Support Company. Here they became part of the same team– comprising of one doctor, one nurse, one sergeant medic and two younger medics – tasked with manning a Resuscitation Team. In forward parts of the battle area, such Resus Teams would be situated near the front line to provide what is termed Level 2 medical support with the capability of receiving soldiers injured in battle, resuscitating them and transferring them on to better staffed and better equipped (Level 3) facilities where initial wound surgery could be undertaken.
Manning a Resus facility was a tough job. The supplies of drugs, intravenous fluids etc. would be brought in by vehicle or helicopter in large green boxes, two boxes at a time. With enough equipment to undertake 12 resuscitations until re-supplied, the Resus Team’s task was to get those casualties who still had life in them tubed, perfused and patched up so they could be safely transported back to facilities where they could undergo definitive surgery.
It was also a dangerous job. A Resus facility was about the closest to the scene of actual warfighting that medical personnel would get to – and on the infrequent occasions that the Medical Corps or Nursing Corps suffered battle casualties, it was almost always in a Resus facility.
As had happened in this instance.
Lieutenant White the nursing officer was already dead as were the two young medics. Being at the head end of the resuscitation table they had taken the full force of the explosion. The blast however had thrown the medical officer and the sergeant who had been at the foot of the table backwards and out of the now destroyed Resuscitation bay. Having been where they were when the rogue shell had exploded had saved their lives – but for how long?
“You okay, Doc?” Sergeant David called out groggily.
“I’m okay, Davo” he replied “Just a flesh wound. How about you?”
“Ah, I’m surviving! A bit o’ blood, but I’m just putting my field dressing on it.” A moment later “Can’t hear a peep from Libby and the boys though, sir”
“We’ll check on each other and then see how they are, Sarge – but I guess it’s just the two of us left now.”
The smoke and dust were beginning to clear. It was time to take stock of the situation.
Crawling over to where his colleague lay wasn’t easy but he managed to make it across with difficulty.
“Jesus! That’s a big bleeder,Doc. Hang on.” He pulled a CAT – the new Combat Action Tourniquet – out of the injured man’s upper arm pocket and, quickly slipping it over the injured leg and knee he tightened he it around the thigh. The spurting artery squeezed shut.
“You’d have lost a lot of blood from that.” He felt for the carotid artery and checked the pulse – 180 per minute, thready volume. “I’ll try to set up a drip.” Luckily the re-supply boxes on the far side were undamaged so he cautiously stood up, made his way there and rummaged until he found what he was looking for – and returned with a bag of saline, a tourniquet and a giving set. Years of practice had given him confidence, and soon, venepuncture accomplished at his first attempt, he had the resuscitating fluid running in rapidly through a large bore cannula into a forearm vein.
Miraculously he discovered that one of the tent struts had been opportunistically twisted and was close enough for him to hang the bag of saline from. He carefully made his way back to the re-supply box and brought back two more bags – one of Hartmann’s solution and the other of Haemaccel.
In the distance they could hear the faint hum of a vehicle.
“I hope that’s our Evac Team returning, Doc.”
The saline was running in relatively fast and the litre bag was almost finished – but the patient still remained pale and poorly perfused. He squeezed the last of the saline from the bag into the drip tube, disconnected it and connected a bag of Haemaccel in its pace.
Same volume, same drip rate.
The sound of the vehicle was getting louder. Sgt. David could make out that it was in fact their ambulance, returning to collect the resuscitated casualties from the Resus bay for the trip back to the field hospital where the surgical team would be waiting for them. Little would the Evac Team have imagined when they set out from the hospital that the Resus bay would be destroyed and that their next two patients would be the Doc and the Sarge, with the rest of the medical staff as well as the poor soldier they were attempting to resuscitate all dead!
The ambulance screeched to a halt. Two soldiers jumped out, consternation on their faces.
“There’s no danger now, just check inside the tent to see if the other three are still alive” he ordered them “I’ll stay here.”
He felt for the carotid pulse again – still weak, 190 per minute. Despite the intravenous fluid rapidly flowing in, the patient was still in shock and did not seem to be improving.
“Go back to the basics” he murmured to himself “A.B.C.”
Airway – OK, the patient could talk. No problem there.
Breathing – no air hunger, the breathing was alright, he wasn’t using his accessory muscles of respiration to breathe. No problem there either.
Circulation – popliteal artery bleeding, tourniquet applied, bleeding stopped. There must be another site of blood loss……
He ripped off the buttons and exposed the officer’s abdomen.
It was obviously distended. As if mocking him, in the middle of the right upper part just below the edge of the rib cage was a small wound through which he could see the tip of a sharp spike of metal sticking out. It must have entered from behind, torn through the liver and perforated a large blood vessel before poking out through the front of the abdomen.
“You OK, Sarge?” it was the voice of the ambulance driver who had gone in to check the damage in the destroyed Resus bay. “Libby and the boys had no chance – the direct hit would have killed them instantly.”
Major Reid weakly opened his eyes. “Not your fault, mate.” The faintest of smiles played on his lips. “It must have lacerated my liver.”
From where he was lying – cold, clammy and with his liver slowly but steadily haemorrhaging uncontrollably into his abdominal cavity – he looked up at his old friend Sergeant David.