Sunday, October 4, 2020

Do not let our wounded walk their journey alone!

This story drops back to the early days of the Iraq War, roughly 2003-2005. The focus is on those who were wounded. Recall the US invasion of Iraq was quick and decisive. The invasion stepped off the Line of Departure on March 30, 2003. Baghdad fell on April 9, 2003. But the war continued on.

One writer has described our “wounded” as the “dark underbelly” of war. There is merit in that description, but it leaves one cold. What constructive can be done with a statement like that? Feel bad? Be depressed? 

Bill Congleton of Winston, Oregon, cautioned:

"Being depressed doesn't help, it just leads to longer days."

 The News-Review of Roseberg, Oregon, said something similar after interviewing several wounded soldiers from the local area:

 “…The humility and sheer guts of these young (wounded) men and women deserve applause and honor. They didn't know when they signed up they'd come home like this, having to deal with crushed limbs and battered bodies. War is like that. Look at the picture of these hurt but strong men. See their faces. They are our sons and brothers, fathers and friends. They are heroes, and we won't forget that." 

A mother of a soldier wounded in Iraq said this:

“To all our Wounded Warriors: Know that through the support and prayers of family and friends, we won't let you walk this journey alone! God Bless.”

That is constructive. It tells us to act and support the wounded military on the path to the best recovery that can be obtained.

How often have you heard a report that a roadside bomb exploded near an American convoy, with one soldier wounded. Thank God, you think, no one killed. But wait, there was one wounded. Next time you hear such a report, stop for a moment to ponder what that word, "wounded," might mean.

Are we talking about a few minor cuts from flying debris, or are we talking about limbs blown away and shrapnel lodged in a soldier's head? But there is far more, even than that. When an American soldier is wounded, there is a massive apparatus from the scene of the explosion all the way to hospitals in the US prepared to kick into action. And, there often is a long, extraordinarily tough, struggle-filled journey this soldier will travel.

Thomas Yarber, in 2004 an Army lieutenant colonel, registered nurse, and the deputy commander of the Army's 31st Combat Support Hospital (CSH), in Iraq. He was asked what he would like Americans to know about the work his nurses were doing at the hospital's facility in Baghdad. He responded this way:

“In the news, you hear about the number of soldiers killed, but you don't hear about the number wounded. We take care of these wounded soldiers so they can go home and be with their families. I want Americans to know that our nurses are here with those soldiers, that our nurses are with them if they die. My nurses are here, holding their hands.” 

There is much to think about when thinking about the wounded. Two of these will be addressed in this report.

A first place to start is to get a glimpse of the sequence of events in the medevac business in the early days of Iraq, roughly 2003-2005.

At the time, the Secretary of the Air Force, Michael W. Wynne, while testifying before the Senate Defense Appropriations Subcommittee on March 29, 2006 said:

“The miracle of Iraq is actually in Medevac.”

David P. Gilkey, a Detroit Free Press photographer and USA Today reporter Gregg Zoroya worked with the Air Force's 332nd Air Expeditionary Wing and Army's 57th Medical Company, Air Ambulance (AA), to produce a video report on Iraq medical evacuation (medevac). The following are some clips to take you through the process, from the moment a trooper is down to loading him-her up for the flight to Germany.

The history of the medevac crews, known as the “Dustoffs,” established a motto early on when first officially formed:

“No compromise. No rationalization. No Hesitation. Fly the mission.”

The klaxon has sounded, a Dustoff crew dons its survival gear on the run to its helicopter. This crew is from the Army's 57th Medical Company.

The crews fire up their UH-60 "Blackhawks" and get them airborne and to the scene, about a five minute ride by air. A soldier has been hit in the belly by an enemy sniper.

The Dustoff is on the scene, it has dropped off its medics, they are patching the wounded soldier, who is in great pain and bleeding badly. The Blackhawk stands nearby, engines running, and a group of his fellow soldiers has set up a security cordon around them, firing at any suspected enemy nearby while the medics work. The wounded soldier is Sgt. Robert Mundo, 24, 4th Infantry Division, 3rd Battalion Combat Team.
Using some of the most sophisticated bandages made for this kind of wound that stops the bleeding almost on contact, the medics have patched their patient, moved him onto a stretcher, and must now run to the waiting Blackhawk Air Ambulance to get him to the hospital. Their security cordon remains their protection force.

This is one of the crew at the scene carrying the patient on the run to the helicopter. The look on his face says it all --- hurry up, we gotta get this guy loaded and to the hospital, mega-pronto.

The Blackhawk, within a matter of minutes, arrives at the US Air Force Hospital helipad, Balad Air Force Base (AFB), Iraq. 

The Dustoff and hospital medics offload the patient. Note the crewman standing in front of the Blackhawk --- he keeps the skipper informed of the progress so there are no inadvertent accidents between medics and machine on the pad.

 In this photo, Mundo has already been in the surgery room.
 Sgt. Major Daniel Daily, with the Army's 4th Infantry Division, reassures Mundo: "You're safe now, you're in the hospital."

Sgt. Mundo has been repaired by doctors at Balad, he has received the Purple Heart from his fellow soldiers for his combat action, he has been stabilized, and now awaits transport home for further care. As an aside, a wounded soldier is not recommended for this award. He or she is entitled to it.

This all happened in one day, actually the same afternoon.

In the mean time, the war goes on and medical techs prepare a patient for surgery. This hospital is probably among the busiest American hospitals in the world, treating US and Iraqi forces and Iraqi civilians caught in the cross-fire.


The doctors review the medical images.

The doctors go to work. The patients are "put back together again as fast as possible."


The stresses on everyone involved are enormous, but they have to keep on going. After work, besides sleep, if they have time, physical exercise is what keeps most of them afloat. Some work out right in the emergency room during a lull.

The patients who are stabilized and ready to fly are carried to a bus and bused to the waiting "Freedom Bird," a USAF C-17 Globemaster, like this one shown here, standing at the ready to fly them to the Landstuhl Regional Medical Center in Germany. The patients are offloaded from the bus...

...and uploaded on the waiting aircraft.

Each patient is placed on a cot and hooked up to requisite equipment and/or IVs, or just made more comfortable and reassured that they are in good, caring, loyal hands.

The on-board medical crew begins monitoring the patients through an elaborate network of computers and monitoring devices. This is akin to an airborne emergency room, ready to handle whatever they have to handle.

The C-17 is configured to carry 48 litter patients and troop seats for 40 ambulatory patients along the walls. The crew can configure the aircraft according to the requirements of the manifest.

 The busses and ambulances prepare to leave, the back of the aircraft will be closed, there will be an engine start and off she'll go to Germany, the Freedom Bird's crew responsible for their charges' health and welfare for the entire trip.

Wounded soldiers will spend about 48 to 72 hours at the Balad hospital, anywhere from a few days to two weeks at Landstuhl, and then back to a medical facility in the US for further treatment. Their port of entry normally is Andrews AFB in Maryland, close to both Walter Reed Army and Bethesda Naval hospitals.

Testifying on March 29, 2006 before the Senate Defense Appropriations Subcommittee hearing, Air Force Chief of Staff, General T. Michael Moseley, said that the C-17 was “worth its weight in gold.” 

Secretary of the Air Force Michael W. Wynne said this:

"The miracle of Iraq is actually in Medevac. And the fact that we can get people from the frontlines into Balad and into Landstuhl and then back to Walter Reed in very short order and that is saving lives in a dramatic way. The C-17 is the workhorse of this engagement without a doubt."

The history of the Dustoffs is incredibly inspirational. MSgt. Stan Hutchson, a Vietnam vet, wrote a poem entitled, simply, "Dustoff," and it opens like this: 

"They come in fast and furious. Sliding in over the top of a tree. A better sight on all this earth. Believe me, you’ll never see." 

Let's now move to a second place to start such thinking about the wounded is to address this question:

“What does the term 'wounded' mean to you?” 

A mother of a wounded soldier has suggested that to understand what that word means, it is essential to understand what has happened to the men and women who are wounded in battle.

Nancy Montgomery removes all the sugar coating right away, writing an article for Stars and Stripes published on May 9, 2004, entitled, “31st Combat Support Hospital in Baghdad:”

“There can be no place worse on Earth, and none better, than the 31st Combat Support Hospital (CSH) in Baghdad. In the intensive care unit, service members lie silent and sedated, their breathing aided by respirators. They were hit by roadside bombs, mortars and, for one, a tank gun barrel that swung around while he was driving past atop his Humvee. The barrel smashed squarely into his face and shattered every single bone. Every day, patients come off the helicopters and through the doors of the CSH (pronounced 'cash') in an unending stream of such terrible injuries that, in former wars, they would surely have died. The hospital staff has worked long hours and saved many young lives. But it has taken a toll. 'The injuries are devastating,' said Capt. Leslie Goodwin, a nurse in the intensive care unit. 'There's no way you can be here and go back home the same.'

“ ‘We're exposed to every bad thing that happens every day in Iraq,' said Lt. Col. Steve Smith, CSH executive officer. 'People in the CSH are just a little overwhelmed. And there's no let-up in sight.'

“ ‘It's the injuries and the number of injuries and the mass casualties,' said Maj. Van McCoy, head nurse on the intermediate care ward. 'Some of the soldiers have nightmares, and it's hard on everyone. I've heard a lot of comments: 'When is it going to stop?'” 

Lt. Col. Tobert Carroll, an eye surgeon from Waynesville, Missouri, is quoted saying:

“We're saving more people than should be saved, probably. We're saving severely injured people. Legs. Eyes. Part of the brain … We can save you. You might not be what you were." 

Lt. Col. Joseph Helminiak, a certified registered nurse anesthetist (CRNA), wrote in an e-mail at the time of the Iraq War:

“I've been an RN for 29 years and a CRNA (Certified Registered Nurse Anesthetists) for 10. I thought I'd seen and done it all. I never, never anticipated how I would feel with the blood of battle from these soldiers on my hands. I pray everyday that I can find the strength and skill to give them the care they so richly deserve. The pace here has approached an insane level, we have had multiple MASCALS [mass casualties alerts]. Very little sleep, every soldier from the lowest ranked enlisted to the highest ranked officers moving as fast as they can to try and save soldiers… It's heart-wrenching to see these young soldiers. A lot of times they just want to know when they can go back to their buddies. It makes me very proud to be doing what I am.” 

The character of war seems to have changed. The enemy is not so much fighting a shooting war to win on the battlefield. Instead, the enemy is fighting an explosion war to maim our soldiers with a view toward severely impacting troop and national morale.

Explosives are nothing new to war. They have done enormous damage to soldiers for centuries. Today, our troops are wearing superb body armor and Kevlar helmets. One result is that it is very hard to take down one of our soldiers through a shot to the head, chest or abdomen, especially for terrorists and militia who do not have good training.

These things called the improvised explosive device (IED), car bomb, and suicide bombers are able to inflict enormous damage to our soldiers, however. These weapons do not have to be pinpoint to do their damage. Explosions create enough overpressure to damage eyes, hearing and the brain, even if not a direct hit.

Additionally, the flying shrapnel and debris; improvised explosive device - IEDs - are often filled with nails, broken glass, and gravel blow off arms and legs, leaving muscles, ligaments and hamstrings dangling. They blow into the face, up through the face into the brain, and, are even finding some space behind the helmets to creep up through the neck and into the back of the skull.

If one survives the explosion, he or she almost surely endures a life altering experience. The road to recovery is extraordinarily hard, involving great personal struggle over long periods of time. Here are a few examples drawn from

Robert Acosta

Allan Jermaine Lewis

Tristan Wyatt

Gary Boggs

In the early stages of the Iraq War, which began in 2003, our medical people did not have enough data to address the recovery rates from the brain injuries that they were repairing. Maj. Rich Gullick is quoted describing it this way:

“Three or four months from now, 50 to 60 percent will be functional doing things. Functional (means) up and around, but with pretty significant disabilities.” 

The remaining 40 to 50 percent have no prospect of regaining consciousness. An objective is to get them to the states alive, so their families can hold their soldier's hand and then decide with the doctors present what to do; that is, whether to remove life support.

As a way to conclude. here are some photos of some of those who took care of our soldiers, out in the field and at hospitals in Iraq, in Germany, and here at home, during the early years of the Iraq War. These men and women were, and remain, ”angels of compassion and healing."

An HH-60 Blackhawk medevac helicopter crew from the 82nd Medical Company (Air Ambulance), 82nd Airborne Division, unload their aircraft to prepare for another mission at a forward deployed location in southern Iraq. The pilot is to the left, the flight medic on the right, and Tanoah Thomas in the center. Thomas, the flight engineer, said:

”As I remember it, we were just landing in Tallil, Iraq, with all of our earthly positions on board, since we (a crew of 4) lived with the helicopter, and received a medevac call of wounded soldiers. We moved with haste to unload our gear so we could respond to the call. There just happened to be a US Air Force photographer documenting the event." 

67th CSH North. That's the hospital, folks. To show you this, we cut out the tent city where the staff lives, off to the right. This ain't "downtown" or Walter Reed-Bethesda, but for the 67th, and the soldiers it cares for, it's "hometown."

Trauma team tending to gunshot wound.

Capt. Rhonda White comforts a U.S. Navy Seabee who was wounded  in a mortar attack and just had his breathing tube removed, 31st CSH, Baghdad.  

The 21st Combat Support Hospital was ready to receive casualties within three days of arriving at Balad airbase, which was captured quickly by the Allied invasion force and the 21st followed in. Here, a state-of-the-art medical city is born from corrugated metal shipping containers and canvas tents.

Dr. Ben Gonzales, 28th CSH, performing surgery, working on a soldier shot multiple times.

Leg surgery, 21st CSH.

Staff at the 31st Combat Support Hospital in Baghdad, the Iraqi capital, move a patient into position for a CT scan.

The patient, Pfc Trista VanAestyn, a 67th CSH member at Mosul, was injured when the hospital's living area took a direct hit by a 107 mm rocket. She was awarded the Purple Heart, and evacuated to Germany where she recuperated. The blonde is Major Flash. Lt. LeValley is the staff member on the far left. 

Army soldiers assigned to the 86th Combat Support Hospital use an All Terrain Vehicle (ATV) to transport a litter patient at an undisclosed location in Iraq. March 30, 2003.

Aboard a Blackhawk helicopter on a medevac mission, Major Kathleen Feeley operates a ventilator to help an injured American soldier breathe.

Soldiers on duty in Tikrit were training local Iraqis on nursing skills. Note the womamn on the left front; she's wearing her "six gun"

Blackhawk Medevac crew serving the 31st CSH, Ibn Sana Hospital, Baghdad. From left to right is Pfc. Jeffrey Patterson (crew chief), Sgt. Edward Kostelnik (medic), Sgt. David Larson (flight instructor/crew chief), Spc. Pham (Public Affairs), 1Lt. Jerry Murphy (pilot), and Cpt. Roderick Stout (pilot-in-command).

Intensive Care Unit Team, 67th CSH Forward, Tikrit. Photo courtesy of the 67thCSH

Members of the 775th EAES (Expeditionary Aeromedical Evacuation Squadron) tend to a patient on a patient support pallet. The new patient transport technology can be used for aeromedical evacuation on KC-135, KC-10 and C-17 airframes.

SFC Sergio Barrera, Major Jacqueline Sheehan and Dr. (Cpt) Braunlich administer care 67th CSH, Tikrit.

Army soldiers assigned to the 86th Combat Support Hospital receive and process injured USA soldiers inside the hospitals trauma room at an undisclosed location in Iraq. March 30, 2003.

Lt. Col. Greer E. Noonburg, MD, (front row, 2nd from right) and several members of the 240th Forward Surgical Team pose with actor Bruce Willis (top row, 4th from left) who visited the troops in Kirkush—a remote, desolate area 60 miles northeast of Baghdad.

Staff Sgt. James Sablan, seated, talks to Lt. Nathaniel Sann during a break at the burn unit on the Tallil Air Base in Iraq. Sablan said, "I can go out there and tell every American what it's like to defend this country." 

Capt. Jeff Schrader and his colleagues from the Nebraska Army National Guard construct their first hospital, we believe, in Tikrit. 

Well, everyone needs some rest. Sweet dreams to our terrific military medical people, up and the down the line

This is 1st Lt. Sarah Grivicic of Louisville, Kentucky. She was assigned to the 28th Combat Support Hospital (CSH), one of several such hospital units to accompany the American-led invasion of Iraq. She worked in the intensive care unit, and said this:

“What is the hardest part of my job? The hardest part of my job is also the best part of my job --- being with a dying soldier. I never understood what 'An angel with a face' meant until my arrival in Baghdad. We are the last ones that they see and the last voice they hear. It is our privilege to ensure that they are pain free in their last hours, that they are not alone and are never forgotten.”

Lt. Grivicic's remarks reflect a spirituality of her noble calling, a kind of humanity so commonly found among those who care for our wounded and dying soldiers in battle.

This kind of compassion is immensely important to our soldiers.

Edward W. Wood, Jr., of Denver, a veteran of D-Day still walking with a piece of shrapnel in his pelvic area, commented on Veteran's Day 2003 for the Denver Post this way:

“The impact of a wound received in combat lasts for life: it never leaves. Our wounds, they changed our lives in so many ways that we never became the men we might have been. 

“The howls of pain from our wounded soldiers in Iraq fills us with rage and tears, young men and women maimed for life as we were, the real consequences of a Purple Heart. Our rage is over American insensitivity to what goes on each day and night in vicious firefights in Iraq, where our soldiers are killed and wounded, while we sit back to our coffees at Starbucks, our martinis, our bottles of wine, our tax cuts. Our tears are for the suffering that those young men and women will inevitably know for the rest of their lives.”